* FILED STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION MAY ID 92 AGENCY FOR HEALTH CARE AE DAR ee ta ADMINISTRATION, CPPARTMON. CLERK Petitioner, vs. AHCA NO. 2002021061 ‘* a ton \ CAPITAL HEALTH CARE ASSOCIATES, LLC d/b/a CAPITAL HEALTHCARE CENTER, Respondent. a5 / os ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through its undersigned counsel, and files this Administrative Complaint against CAPTIAL HEALTHCARE ASSOCIATES, LLC a/b/a CAPITAL HEALTHCARE CENTER (“Capital Healthcare Center”), pursuant to Section 120.569, and 120.57, Florida Statutes (2001), and alleges: NATURE OF THE ACTION 1. This is an action to assign a conditional license to Capital Healthcare Center pursuant to Section 400.23(7), Florida Statutes (2001), and to assess costs related to the investigation and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2001). The original conditional license is attached hereto as Exhibit “A”. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). 3. AHCA has jurisdiction pursuant to Chapter 400, Part II, Florida Statutes (2001). 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2001). PARTIES 5. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable Florida laws and rules governing skilled nursing facilities pursuant to Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 6. Capital Health Care Associates, LLC, doing business as Capital Healthcare Center, is a Florida limited liability company with a principal address of One Professional Center, One Northeast First Avenue, Suite 302, Ocala, Florida 34470. 7. Capital Healthcare Center is a 156-bed skilled nursing facility located at 3333 Capital Medical Boulevard, Tallahassee, Florida 32308. Capital Healthcare Center is licensed by AHCA as a skilled nursing facility having been issued license number SNF1073096, certificate number 8446, with an effective date of March 1, 2002 and an expiration date of November 30, 2002. 8. Capital Healthcare Center is and was at all times material hereto a licensed skilled nursing facility required to comply with Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I EFFECTIVE MARCH 1, 2002, AHCA ASSIGNED A CONDITIONAL LICENSURE STATUS TO CAPTIAL HEALTHCARE CENTER BASED UPON THE DETERMINATION THAT CAPITAL HEALTHCARE CENTER WAS NOT IN SUBSTANTIAL COMPLIANCE WITH APPLICABLE LAWS AND RULES DUE TO THE PRESENCE OF TWO (2) UNCORRECTED CLASS III DEFICIENCIES AT THE MOST RECENT SURVEY OF MARCH 1, 2002. § 400.23(7), Fla. Stat. (2001) 9. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. FIRST UNCORRECTED CLASS III DEFICIENCY 10. On or about January 22-25, 2002, AHCA conducted a survey at Capital Healthcare Center. A class III deficiency was cited against Capital Healthcare Center based on the findings below. 10.1. On or about January 22-25, 2002, an AHCA surveyor observed medications left at Resident #1's bedside table. Fourteen (14) pills were observed in a soufflé cup. Additionally, a white liquid and a yellow liquid were found in separate soufflé cups. Upon entering the resident’s room, the surveyor observed no staff person in the room. The AHCA surveyor interviewed Capital Healthcare Center’s Director of Nursing about the foregoing. During the interview, the Director of Nursing admitted to the AHCA surveyor that resident #1’s medication should not have been left on the bedside table unless resident #1 self- administered medication. A review of Resident #1’s medical record by the surveyor revealed no physician's order for the self-administration of medication. 10.2. On or about January 22-25, 2002, an AHCA surveyor observed resident #4 with a gastrostomy tube in place. The surveyor further observed a nurse administer Calcium 600 + D, Sinemet, and Zyprexa to resident #4. The surveyor observed the nurse crush the medication and place all of the medication into one soufflé cup. The nurse then administered the medication to resident #4. The nurse did not verify the placement of the gastrostomy tube prior to administering the medication to the resident. A review of Capital Healthcare Center’s current Medication Administration Policy Manual by the AHCA surveyor revealed that all gastrostomy medication must be ground separately, mixed with a small amount of water, and administered separately. A further review of the policy Manual by the surveyor revealed a facility policy of verifying the gastrostomy tube placement prior to the administration of medication. 11. Based on all of the foregoing, Capital Healthcare Center violated: (a) 42 CFR § 483.60(a) via Rule 59A-4.1288, Florida Administrative Code, by failing to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident; (b) Rule 59A-4.112(1), Florida Administrative Code, by failing to adopt procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident; and (c) Rule 59A-4.106(4) (t), Florida Administrative Code, by failing to maintain policies and procedures in the area of pharmacy services. 12. Pursuant to Section 400.23(8)(c), Florida Statutes, the foregoing is a class III deficiency because it resulted in no more than minimal physical, mental, or psychosocial discomfort to the resident or potentially compromised the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 13. AHCA gave Capital Healthcare Center a written mandated correction date of February 23, 2002, in accordance with Section 400.23(8) (c), Florida Statutes. Capital Healthcare Center, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 1, 2002. Based on the foregoing, Capital Healthcare Center was cited for an uncorrected class III deficiency at the survey on or about March 1, 2002. 14. On or about March 1, 2002, AHCA conducted a survey at Capital Healthcare Center. An uncorrected class III deficiency was cited against Capital Healthcare Center based on the findings below. 14.1. On or about March 1, 2002 an AHCA surveyor observed resident #4 lying in her bed. The surveyor further observed on the resident’s dresser a 30-milliliter vial of Heparin flush. The vial had a needleless access system through the rubber top and a resident specific label. 14.2. On or about March 1, 2002 an AHCA surveyor observed resident #17 lying in his bed. The surveyor further observed a 30-milliliter vial of Sodium Chloride on the resident’s bedside table. The vial had a needleless access system through the rubber top and a= resident specific label. 14.3. On or about March 1, 2002 an AHCA surveyor interview Capital Healthcare Center’s Director of Nursing. During the interview, the Director of Nursing stated that, per facility policy, the medication for resident #4 and resident #17, respectively, should have been stored either in the medication cart or in the medication room. 15. Base@ on all of the foregoing, Capital Healthcare Center violated: (a) 42 CFR § 483.60(a) via Rule 59A-4.1288, Florida Administrative Code, by failing to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident; (b) Rule 59A-4.112(1), Florida Administrative Code, by failing to adopt procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident; and (c) Rule 59A-4.106(4)(t), Florida Administrative Code, by failing to maintain policies and procedures in the area of pharmacy services. 16. Pursuant to Section 400.23(8)(c), Florida Statutes, the foregoing is a class III deficiency because it resulted in no more than minimal physical, mental, er psychosocial discomfort to the resident or potentially compromised the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. SECOND UNCORRECTED CLASS III DEFICIENCY 17. On or about January 22-25, 2002, AHCA conducted a survey at Capital Healthcare Center. A class III deficiency was cited against Capital Healthcare Center based on the findings below. 17.1. On or about January 22-25, 2002, an AHCA surveyor inspected resident room #79. The AHCA surveyor observed the nebulizer unit on the counter next to the sink. The aerosol face mask and tubing was covered with a plastic covering dated December 28, 2001. The surveyor interviewed Capital Healthcare Center’s Assistant Director of Nursing regarding the foregoing. During the interview, the Assistant Director of Nursing stated that the tubing in resident room #79 was out of compliance with facility policy, which requires masks and tubings to be changed every three (3) days. 17.2. On or about January 22-25, 2002, an AHCA surveyor observed a nurse administer medication to resident #4 via a gastrostomy tube. The nurse allowed the barrel of the syringe used to flush the gastrostomy tube to touch resident #4’s contaminated bedside table. The table had not been cleaned prior to the feeding. Next, the nurse removed the syringe barrel from the syringe and allowed the syringe to roll around on the contaminated bedside table. Finally, the nurse placed the contaminated syringe barrel into the syringe and "pushed” the medication into the gastrostomy tube. 17.3. On or about January 22-25, 2002, an AHCA surveyor observed a Certified Nursing Assistant (“CNA”) feeding two (2) residents at the same time. The CNA touched residents and food without washing her hands in between. Specifically, the surveyor observed the CNA feeding resident #19 and another resident simultaneously. The CNA picked-up one piece of toast and handed it to a resident. The CNA then picked-up resident #19's milk and held the straw for the resident. The CNA did not wash her hands in between. The CNA had yellowish fingernails that were approximately one-half inches long. 17.4. On or about January 22-25, 2002, an AHCA surveyor interviewed a family member of resident #20. The family member stated that several CNAs had long, dirty fingernails. 18. Based on ali of the foregoing, Capital Healthcare Center violated: (a) 42 CFR § 483.65(a)(1)-(3) via Rule 59:~A- 4.1288, Florida Administrative Code, by failing to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of disease and infection. An infection control program includes, but is not limited to, the following: (i) investigating, controlling and preventing infections in the facility; (ii) deciding what procedures, such as isolation, should be applied to an individual resident; and (iii) maintaining a record of incidents and corrective actions related to infections; and (b) Rule 59A-4.106(4) (1), Florida Administrative Code, by failing to maintain policies and procedures in the area of infection control. 19. Pursuant to Section 400.23(8)(c), Florida Statutes, the foregoing is a class III deficiency because it resulted in no more than minimal physical, mental, er psychosocial discomfort to the resident or potentially compromised the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 20. Capital Healthcare Center was given a mandated correction date of February 23, 2002, in accordance with Section 400.23(8) (c), Florida Statutes. Capital Healthcare Center, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 1, 2002. Based on the foregoing, Capital Healthcare Center was cited for an uncorrected class III deficiency at the survey on or about March 1, 2002. 21. On or about March 1, 2002, AHCA conducted a survey at Capital Healthcare Center. Capital Healthcare Center was cited for an uncorrected class III deficiency based on the findings below. 21.1. On or about March 1, 2002, an AHCA surveyor observed resident #15's room. The surveyor observed an uncovered urinal containing dried residue sitting on top of a portable toilet at the resident's bedside. 21.2. On or about March 1, 2002, an AHCA surveyor observed resident #14's room. The surveyor observed a used adult incontinent brief with no protective barrier discarded in a waste paper basket next to the resident's bed. 21.3. On or about March 1, 2002 an AHCA Surveyor reviewed Capital Healthcare Center’s written policy on "Diapers/Underpads". Under the policy, soiled adult incontinent briefs must be placed in designated hampers. 21.4. On or about March 1, 2002 the AHCA surveyor reviewed Capital Healthcare Center’s written policy on "Disinfection of Bedpans and Urinals". According to the policy, used urinals should be emptied, washed with a disinfectant solution, air-dried, covered, and returned to the resident's bedside cabinet. 12 21.5. On or about March 1, 2002 an AHCA surveyor interviewed Capital Healthcare Center’s Director of Nursing. During the interview, the Director of Nursing admitted to the surveyor that both the urinal in resident #15’s room and the used adult incontinent brief in the waste paper basket in resident #14's room were not in compliance with the facility’s infection control standards. 21.6. On or about March 1, 2002 an AHCA surveyor observed resident #4 in room #49. The surveyor further observed a nebulizer at the resident’s bedside with an uncovered aerosol face mask and tubing attached. Neither the face mask nor the tubing was dated as per facility policy. 21.7. On or about March 1, 2002 an AHCA surveyor observed resident #18 in room #54. The surveyor further observed resident #18 with a nasal cannula on and a nebulizer at the bedside. The tubing attached to the nebulizer was lying on the floor behind the resident's bed. Neither of the tubings was dated as per facility policy. 21.8. On or about March 1, 2002 an AHCA surveyor observed resident #19 in room #59. The surveyor further observed resident #19 with a nasal cannula connected to a portable concentrator. The oxygen tubing was undated and the sterile water container was empty. 21.9. On or about March 1, 2002 an AHCA surveyor observed resident #20 in room #46. The AHCA surveyor further observed a bag on resident #20’s bedside table with an aerosol face mask and tubing inside, both were dated February 18, 2002. 21.10. On or about March 1, 2002 an AHCA surveyor interviewed Capital Healthcare Center’s Director of Nursing. During the interview, the Director of Nursing stated that, per facility policy, tubing for nebulizers and oxygen must be changed every three (3) days. The Director of Nursing further stated that, per facility policy, all tubing must be dated. 22. Based on all of the foregoing, Capital Healthcare Center violated: (a) 42 CFR § 483.65(a)(1)-(3) via Rule 59A- 4.1288, Florida Administrative Code, by failing to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of disease and infection. An infection control program includes, but is not limited to, the following: (i) investigating, controlling and preventing infections in the facility; (ii) deciding what procedures, such as isolation, should be applied to an individual resident; and (iii) maintaining a record of incidents and corrective actions related to infections; and (b) Rule 59A- 4.106(4) (1), Florida Administrative Code, by failing to maintain policies and procedures in the area of infection control. 23. Pursuant to Section 400.23(8)(c), Florida Statutes, the foregoing is a class III deficiency because it resulted in no more than minimal physical, mental, or psychosocial discomfort to the resident or potentially compromised the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 24. Capital Healthcare Center failed to correct the two (2) class III deficiencies found at the January 22-25, 2002, survey by the mandated correction date of February 23, 2002. Therefore, AHCA cited Capital Healthcare Center for two (2) uncorrected class III deficiencies at the survey on or about March 1, 2002. 25. AHCA assigned a conditional licensure status to Capital Healthcare Center based upon the determination that the facility was not in substantial compliance with applicable laws and rules due to the presence of two (2) uncorrected class III deficiencies at the most recent survey on or about March 1, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: 1) Make actual and legal findings in favor of AHCA on Count I; 2) Uphold the issuance of the conditional license attached hereto as Exhibit “A”; 3) Assess costs related to the investigation and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2001); and 4) Grant any other general and equitable relief as deemed necessary in the furtherance of justice. DISPLAY OF LICENSE Pursuant to Section 400.23(7) (e), Florida Statutes, Capital Healthcare Center shall post the license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility. NOTICE Capital Healthcare Center hereby is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Lori @¢. Desnick, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida, 32308. CAPITAL HEALTHCARE CENTER IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE ADMINISTRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY ACHA. Respectfully submitted on this 10th day of May 2002. L Aer C. Ceprwelr Lori C. Desnick Fla. Bar. No. 0129542 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850) 921-0158 (fax) 17 CERTIFICATE OF SERVICE I. HEREBY CERTIFY that the original Administrative Conpiaint and Exhibit “A” has been sent by U.S. Certified Mail Return Receipt Requested (return receipt # 7106 4575 1294 2049 9184) to Paul Kovary, Administrator, Capital Health Care Associates, LLC d/b/a Capital Healthcare Center, 3333 Capital Medical Boulevard, Tallahassee, Florida 32308 and that a true and correct copy of the Administrative Complaint and Exhibit “A” has been sent by U.S. Certified Mail Return Receipt Requested (return receipt # 7106 4575 1294 2049 9191) to Cc. T. Corporation System, Registered Agent for Capital Health Care Associates, LLC d/b/a Capital Healthcare Center, 1200 South Pine Island Road, Plantation, Florida 33324. LORI C. DESNICK, ESQUIRE COPIES TO: Elizabeth Dudek Deputy Secretary Managed Care and Health Quality Assurance Agency for Health Care Administration 2727 Mahan Drive, M.S. #9 Tallahassee, Florida 32308 (via interoffice mail) Exhibit “A” CONDITIONAL LICENSE License # SNF1073096; Certificate #8446 Effective Date: 3/01/02 Expiration Date: 11/30/02 LICENSE #: _SNF1073096 State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION DIVISION OF MANAGED CARE AND HEALTH QUALITY SKILLED NURSING FACILITY CONDITIONAL This is to confirm that CAPITAL HEALTH CARE ASSOCIATES, LLC_has complied with the rules and regulations adopted by the State of Florida, Agency For Health Care Administration, authorized in Chapter 400, Part II, Florida Statutes, and as the licensee is authorized to operate the following: CAPITAL HEALTHCARE CENTER 3333 CAPITAL MEDICAL BLVD. TALLAHASSEE, FL 32308 with 156 beds. Change In Status ACTION EFFECTIVE DATE: 03/01/2002 LICENSE EXPIRATION DATE: _11/30/2002 Deputy Secretary,

Docket for Case No: 02-002771