24 -~BV 00, rN a », . Wp. by STATE OF FLORIDA 79 AGENCY FOR HEALTH CARE ADMINISTRATION ly 2. AGENCY FOR HEALTH CARE ? ADMINISTRATION, 4 Petitioner, vs. Case Nos, 2002030441 2002024461 2002024451 GULF COAST HEALTH CARE, INC., d.b.a. INN AT SARASOTA BAY CLUB Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against the GULF COAST HEALTH CARE, INC., d.b.a. INN AT SARASOTA BAY CLUB (hereinafter Sarasota), pursuant to Section 120.569, and 120.57, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION This is an action to change Sarasota’s licensure status from Standard to Conditional effective March 27, 2002, pursuant to §§ 400.23(7)(b) and 400.102(d) Fla. Stat., and an action to impose administrative fines in the total amount of $21,000.00 against Sarasota, pursuant to §§ 400.23(8) and 400.102, Fla, Stat., and assess costs related to the investigation and prosecution. of this case, Pursuant to § 400.121(10), Fla, Stat. JURISDICTION AND VENUE 1. This court has jurisdiction pursuant to § 120.60, Fla. Stat. 2. Venue lies in this court pursuant to § 120.60 Fla. Stat. 2B FDVd VOHYV Gppieggrze Tt'6@ 2882/GE/20 wo™ “nN PARTIES 3. The Agency is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable federal regulations, state statutes and rules goveming skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended); Chapter 400, Part Il, Florida Statutes, and; Chapter 59A-4 Fla. Admin. Code, respectively. 4, Sarasota operates a 60-bed nursing home located at 1303 N. Tamiami Trail, Sarasota, FL 34236, and is licensed as a skilled nursing facility, license number SNF16370968, certificate number 8569, effective through December 3 1, 2002. 5. Sarasota was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes, COUNT I SARASOTA FAILED TO FOLLOW ITS WRITTEN POLICIES AND PROCEDURES THAT RESULTED IN NEGLECT OF RESIDENTS CAUSING, OR WAS LIKELY TO CAUSE, SERIOUS INJURY, HARM, OR IMPAIRMENT TO THOSE RESIDENTS. 42 CFR. § 483.13 (c)(1)(i); § 400.23 (8) Fla. Stat.; Fla. Admin. Code R. 59A-4.1288 Class I Deficiency 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On March 25-27, 2002, the Agency conducted a licensure and re-certification survey and first revisit of a complaint investigation of Sarasota. 8. During those surveys, based upon observation, interview and record review, the Agency discovered that the facility failed to notify the physician and seck medical intervention for significant changes in a resident's medical condition in 2 of 16 active sampled residents. €@ FoVd VOHY ObbIzcorzz TT:6@ 2862/86/28 oy r™, 9. _ Resident # 12 was admitted to Sarasota on 11/09/01 with multiple diagnoses including, but not limited to, Arteriosclerotic Heart Disease, Hypertension and Coronary Heart Disease. 10. During the period from admission to 3/26/02, Resident # 12 experienced a 17.2% weight gain and 4+ edema of which Sarasota had failed to notify the resident's physician. 1]. Resident # 2 was admitted to Sarasota on 2/13/02 following a hospital stay for urosepsis and hypokalemia. 12. During the period from admission to 3/07/02, Resident # 2 experienced 4+ edema, low urinary output, vaginal discharge and respiratory congestion of which Sarasota failed to notify the resident's physician. 13. Resident # 2 visited the physician on 3/07/02 and was started on an antibiotic for a urinary tract infection. It was noted the resident had a 2-3+ pedal edema. 14. During the Period 3/08/02 to 3/20/02, Resident # 2 experienced a 7.5% weight increase and 4+ edema of which Sarasota failed to notify the resident's physician, 15. Sarasota's Standards of Care (SOC) policies and Procedures express the intent that it will Policies and procedures of its SOC for two residents. 16. Sarasota's failure to notify the resident's Physician prior to the resident's deterioration, as b@ FOV" VYOHY Gprlzssezz TT-6@ 2882/BE/28 or was likely to cause, serious injury, harm, impairment, or death to the residents involved, a Class I isolated deficiency, subject to a civil penalty of $10,000.00, WHEREFORE, the Agency intends to impose an administrative fine in the amount of $10,000 against Sarasota, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8) and 400.102, Fla. Stat., and assess costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. COUNT II SARASOTA FAILED TO IMMEDIATELY CONSULT WITH RESIDENT'S PHYSICIANS WHEN THERE WAS A SIGNIFICANT CHANGE IN THE RESIDENT'S PHYSICAL STATUS THAT COMPROMISED THE RESIDENT'S ABILITY TO MAINTAIN OR REACH THE RESIDENT'S HIGHEST PRACTICABLE PHYSICAL, MENTAL AND PSYCHOSOCIAL WELL BEING. 42 CFR. § 483.10(b)(11); § 400.23 (8) Fla. Stat.; Fla. Admin. Code R. 59A-4.1288 Class HI Deficiency 17. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein, 18. On March 25-27, 2002, the Agency conducted a licensure and re-certification survey and first revisit of a complaint investigation of Sarasota. 19. During those Surveys, based upon observation, interview and record review, the Agency discovered that Sarasota failed to consult the resident's physician following significant changes in a resident's medical condition in 4 of 16 active sampled residents, 20, Resident # 12 was admitted to Sarasota on 11/09/01 with multiple diagnoses including, but not limited to, Arteriosclerotic Heart Disease, Hypertension and Coronary Heart Disease, SB FOVd VOHY ObpTz2ssgzzz TT?6@ 2682/06/20 21. During the period from admission to 3/25/02, Resident # 12 experienced a 33 Ib Progressive weight gain and 4+ edema of which Sarasota had failed to consult with the resident's physician. 22. ‘Resident # 2 was admitted to Sarasota on 2/13/02 following a hospital stay for urosepsis and hypokalemia. 23. During the period from admission to 3/07/02, Resident # 2 experienced 4+ edema, low urinary output, vaginal discharge and respiratory congestion of which Sarasota failed to notify the resident's physician. 24. Resident # 2 visited the physician on 3/07/02 and was started on an antibiotic for a urinary tract infection. It was noted the resident had a 2-3+- pedal edema. 25. During the period 3/08/02 to 3/20/02, Resident # 2 experienced a 7.5% weight increase and 4+ edema of which Sarasota failed to notify the resident's physician. 26. Resident # 16 was admitted on 6/24/01 with multipie diagnoses including, but not limited to, Congestive Heart Failure, Atrial Fib and Pacemaker. 27. On 3/27/02, Resident # 16's Tight hand was observed with 4 + edema, Clinical records from 2/01/02 through 3/27/02 were reviewed that revealed no documentation that the resident's physician had been consulted about the resident's condition, 28. —_ Resident # 6 was admitted on 1/04/02 with multiple diagnoses including, but not limited to Parkinson, Depression Hypothyroidism and Gastric Esophageal Reflux Disease. 29. _ Review of Resident # 6's Medical Administration Records (MAR's) revealed the resident refused medications during the 9:00 am. medication pass on 1/18/02, 1/19/02, 1/21/02 and 1/25/02 and the resident's physician had not been notified of the refusals. 98 39Vd VOHY ObbIZsGe2z TT:68 288Z/0E/20 30. Sarasota's failure to immediately notify the resident's physicians when there was a significant change in the resident's physical status, violates 42 CER. 483.10(b)(1 1). That failure to immediately notify the resident's physician compromised the resident’s ability to attain, or maintain, the highest practicable level of well being; a Class 1 isolated violation subject to a civil penalty of $2,500.00 under § 400.23(8)(b), Fla. Stat. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500.00 against Sarasota, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8) and 400.102, Fla. Stat, and assess costs related to the investigation and Prosecution of this case, pursuant to § 400.121(10), Fla. Stat. COUNT it SARASOTA FAILED TO IMPLEMENT APPROPRIATE PLANS OF ACTION TO CORRECT IDENTIFIED QUALITY DEFICIENCIES FOLLOWING A COMPLAINT RESIDENTS CAUSING, OR WAS LIKELY TO CAUSE, SERIOUS INJURY, HARM, OR IMPAIRMENT TO THOSE RESIDENTS. 42 CER. § 483.75(0)(2)(ii); § 400.23 (8) Fla. Stat.; Fla, Admin. Code R. 59A-4.123(2) Class IT Deficiency 31. The Agency re-alleges and incorporates Paragraphs (1) through (5) as if fully set forth herein. 32. On March 25-27, 2002, the Agency conducted a licensure and re-certification survey and first revisit of a complaint investigation of Sarasota, 33. During those Surveys, based upon observation, interview and record review, the Agency discovered that Sarasota failed to implement quality assurance Measures sufficient to correct quality deficiencies, 28 300d YOHV ObpTescéze IT?6@ 2882 /@E/20 van o 34. On 2/26/02, as a result of a complaint investigation, Sarasota received & citation for failing to notify a physician. At that time, the Citation was at a scope and severity level of D, On the revisit and annual survey, the citation was found to be uncorrected and at a scope and severity level G, as noted in Count IL 35. Sarasota’s plan of correction for the citation of 2/26/02 stated that it would educate the licensed staff in notification of physicians and revise its policy and procedure regarding nursing assessments and documentation and that these actions would be monitored through a quality assurance review, 36. — Sarasota's failure to implement plans of action to correct identified quality deficiencies violates 42 C.F.R. 483.75(0)(2)(ii). That failure to implement those plans of action compromised residents’ ability to attain, or maintain, the highest practicable level of well being: a Class 1 isolated violation subject to a civil penalty of $2,500.00 under § 400.23(8)(b), Fla. Stat. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500.00 against Sarasota, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8) and 400.102, Fla. Stat., and assess costs related to the investigation and Prosecution of this case, pursuant to § 400.121(10), Fla. Stat. COUNT IV SARASOTA HAS BEEN CITED FOR A CLASS I DEFICIENCY STEMMING FROM AN ANNUAL SURVEY TO DETERMINE ITS COMPLIANCE WiTH FLORIDA STATUTES AND RULES PROMULGATED UNDER THE PROVISIONS OF THOSE STATUTES. § 400.19(3) Fla. Stat. 37. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. : 8@ 39Vd VOHY abpizssezz TT:68 2082/06/20 38. On March 25-27, 2002, the Agency conducted a licensure and re-certification survey and first revisit of a complaint investigation of Sarasota. 39. As a result of that survey and compliant investigation, Sarasota was cited for a Class L isolated deficiency of Scope and severity level J, 40. Sarasota's Class I citation violates § 400.19(3) and subjects Sarasota to the six month survey cycle and a civil penalty of $6,000.00. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $6,000.00 against Sarasota, a skilled nursing facility in the State of Florida, pursuant to § 400,19(3), and assess costs related to the investigation and Prosecution of this case, pursuant to § 400.121(10), Fla. Stat. COUNT V § 400.23(7)(b) Fla. Stat. 41. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein, 42. On March 25-27, 2002, the Agency conducted a licensure and re-certification survey and first revisit of a complaint investigation of Sarasota, 43. During that sutvey and complaint investigation, the Agency determined that Sarasota was not in compliance with criteria established under Part II of Florida Statute 400 or the rales adopted by the Agency in that it failed to implement its policies, a Class I deficiency; failed to immediately notify resident's physicians following a significant change in the resident's Status, a 68 35d VOHV GppTtaggez2 TT:6@ Zaez/eE/20 Class IT deficiency, and: failed to implement plans of correction following a citation, a Class IT deficiency, 400.23(7)(b), Fla. Stat. WHEREFORE, the Agency intends to assign a conditional licensure status to Sarasota, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(7) commencing March 27, 2002. Respectfully submitted this QE aay Re ay, Gerald 1. Pickett Fla. Bar. No. 559334 Counsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, 330L St. Petersburg, FL 33701 727.552.1526 (office) 727.552.1440 (fax) DISPLAY OF LICENSE SASS LAY OF LICENSE @T 39vd YOHY GbpTzgsezz TE*68 4 2802/BE/28 to the Agency for Health Care Administration, Sebring Bldg., 330L, 525 Mirror Lake Drive, St. Petersburg, FL 33701; Attention: Gerald L. Pickett, Senior Attorney, CERTIFICATE OF SERVICE MERLE ATE OF SERVICE THEREBY CERTIFY that 4 true and correct copy of the foregoing has been served by certified mail on July 29, 2002 to; Administrator, Gulf Coast Health Care, Inc., d/b/a/ Inn at Sarasota Bay Club, 1303 N. Tamiami Trail, S » Florida 34236, Copies to: Jane Davis, Administrator Inn at Sarasota Bay Club 1303 N. Tamiami Trail Sarasota, FL 34236 (U.S. Certified Mail) Elizabeth W. McArthur, Esq. 106 East College Avenue #1200 Tallahassee, FL 3230] (U.S. Mail) Wendy Adams Agency for Health Care Administration 2727 Mahan Drive, Bldg #3 MS #3 Tallahassee, FL 32308 (Interoffice Mail) Molly McKinstry Long Term Care Agency for Health Care Administration 2727 Mahan Drive, Bidg #1, MS Code #33 Tallahassee, Florida 32308 (Interoffice Mail) 10 TI 390d VOHV Orb tzggez TT:68 2982/@E/20 OC eee x MEN ON PON ANCES, ‘ mise ys ONCE NSE Aten) Drea Bue a8) paserepy Jo worszar ‘hemes Amdog OOCTERT -ALv NOLLVUIdXd FSNAory COOCLEIED “aLva HALLOg4aa NOLLOY SMBS uy oBueyD ‘Spoq “OT Gt StPE “Td ‘VLOSVUYS TIVUL DAVIAVE *N £061 427) AVG VLOSVUYS LY NNI *Buymoyjoy ayp ayerado 0} pezuomne | ALITIOVA DNISHON GaTIDS ALTTVNO HLTWaH GNV RaVO GEOVNVW dO NOISIAIG NOILVULSININGY auVD HILTVdH YOd AONTDW EPH41OLJ JO azejg ) “HOOOLESTANS™ :y ASNAOM CE -¥ aLvouTiNa | 1T:6@ 2aaz/ee/Za- GbPTecceae eT 300d

Docket for Case No: 02-003406