/ FILED STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION MAY [f% 92 AGENCY FOR HEALTH CARE ; Ages” ERK ADMINISTRATION, BIE AR MRC: Petitioner, oo rT vs. AHCA NO. 2002015424: © CAPITAL HEALTH CARE ASSOCIATES, LLC d/b/a CAPITAL HEALTHCARE CENTER, Respondent. / 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 d/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 impose a $3,000 fine against Capital Healthcare Center pursuant to Section 400.102(1) (d) and Section 400.23(8)(c), Florida Statutes (2001), based on two (2) uncorrected class III deficiencies, and to assess costs related to the investigation and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2001). 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 CAPITAL HEALTHCARE CENTER FAILED TO PROVIDE PHARMACEUTICAL SERVICES TO MEET THE NEEDS OF RESIDENT. 42 CFR § 483.60(a) (2001) Rule 59A-4,.1288, Fla. Admin. Code (2001) Rule 59A-4.106(4) (t), Fla. Admin. Code (2001) Rule 59A-4,112(1), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY ISOLATED 9. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 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 involving two (2) residents. 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. The surveyor reviewed Resident #1’s medical record, which 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 involving two (2) residents. 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. The surveyor interviewed Capital Healthcare Center’s Director of Nursing. The Director of Nursing stated that, per facility policy, resident #4’s medication should have been stored either in the medication cart or in the medication room. 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. The surveyor interviewed Capital Healthcare Center’s Director of Nursing. The Director of Nursing stated that, per facility policy, resident #17’s medication should have been stored either in the medication cart or in the medication room. 15. Based on 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, 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. 17. Pursuant to Section 400.23(8), Florida Statutes, the foregoing is an “isolated” class III deficiency because it affected one or a very limited number of residents, involved one or a very limited number of staff, or occurred only occasionally or in a very limited number of locations. 18. Pursuant to Section 400.23(8)(c), Florida Statutes, AHCA may impose a $1,000 fine against Capital Healthcare Center for an isolated uncorrected class III deficiency. COUNT II CAPITAL HEALTHCARE CENTER FAILED TO ESTABLISH AND MAINTAIN AN INFECTION CONTROL PROGRAM DESIGNED TO PROVIDE A SAFE, SANITARY, AND COMFORTABLE ENVIRONMENT AND TO HELP PREVENT THE DEVELOPMENT AND TRANSMISSION OF DISEASE AND INFECTION. 42 CFR § 483.65(a) (1)-(3) (2001) Rule 59A-4.1288, Fla. Admin. Code (2001) Rule 59A-4.106(4) (1), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY PATTERN 19. 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. 19.1. 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. 19.2. 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 out of the syringe and permitted 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. 19.3. 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 was touching 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 approximately one-half inches long. 19.4. 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. 20. Based on all of the foregoing, Capital Healthcare Center violated: (a) 42 CPR § 483.65(a)(1)-(3) via Rule S9A- 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 59:;A- 4.106(4) (1), Florida Administrative Code, by failing to maintain policies and procedures in the area of infection control. 21. Pursuant to Section 400.23(8)(c), Florida Statutes, the foregoing deficiency 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. 22. 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. 23. 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. 23.1. 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. 23.2. 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. 23.3. 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. 23.4. 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. 23.5. 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. 23.6. 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. 23.7. 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. 23.8. 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. 23.9. 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. 23.10. 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. 24, 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; (1i) 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 59~A- 4.106(4) (1), Florida Administrative Code, by failing to maintain policies and procedures in the area of infection control. 25. 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. 26. Pursuant to Section 400.23(8), Florida Statutes, the foregoing is a “pattern” class ITI deficiency because more than a very limited number of residents were affected, more than a very limited number of staff were involved, the situation occurred in several locations, or the same resident or residents were affected by repeated occurrences of the same deficient practice but the effect of the deficient practice was not pervasive throughout the facility. 27. Pursuant to Section 400.23(8)(c), Florida Statutes, AHCA may impose a $2,000 fine against Capital Healthcare Center for a pattern uncorrected class III deficiency. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: 1) Make factual and legal findings in favor of AHCA on Counts I and II; 2) Impose a $3,000 fine against Capital Healthcare Center; 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. 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 C. Desnick, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida, 32308. 16 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. Pow C Derwreh 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) Ge CERTIFICATE OF SERVICE uy Io “ “hy / ay m 5. I HEREBY CERTIFY that a true and correct ‘Gopy of the Administrative Complaint has been sent by U.S. certifiea Mail Return Receipt Requested (return receipt # 7106 4575 1294 2049 9160) to Paul Kovary, Administrator, Capital Health Care Associates, LLC d/b/a Capital Healthcare Center, 3333 Capital Medical Boulevard, Tallahassee, Florida 32308 and by U.S. Certified Mail Return Receipt Requested (return receipt # 7106 4575 1294 2049 9177 to c. T., Corporation System, Registered Agent for Capital Health Care Associates, LLC @/b/a Capital Healthcare Center, 1200 South Pine Island Road, Plantation, Florida 33324. drew C. Deo eh 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)

Docket for Case No: 02-002772