LB-BV76 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR RHONDA M, MEDOWS, MD, FAAFP, SECRETARY Qs . September 3, 2002 bey %; 2 . ‘> “eh "5 bos ae _. SK ey Ann Luchini ee v Division of Administrative Hearings Wyre o e The DeSoto Building . Co aa Ss 1230 Apalachee Parkway & Tallahassee, Florida 32399-3060 Re: Notice of Agency Action in Mary Jane Dowling, Florida Hospital Orlando, Florida Preferred Care Facilities II, Inc. d/b/a West Gables Health Care Center, and Hebrew Home of North Dade, Inc., d/b/a Hebrew Home for the Aged North Dade Dear Ms. Luchini: Enclosed are the various notices of agency action that should have accompanied the above petitions for hearings. I will be sure in the future that these accompany requests for hearings submitted to DOAH. Please let me know if you need anything more for these cases. Thank you. Lealand L. McCharen, Agency Clerk Visit AHCA online at www.fdhe.state fl.us 2727 Mahan Drive @ Mail Stop #1 Tallahassee, FL 32308 SEP-@3-2082 15:24 AHCA LEGAL DEPARTMENT P.2 02 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No: 2002018101 Petitioner, Return Receipt Requested 7000 1670 0011 4846 3930 7000 1670 0011 4846 3947 vs. 7000 1670 0011 4846 3954 FLORIDA PREFERRED CARE HEALTH FACILITIES II, INC., d/b/a WEST GABLES HEALTH CARE CENTER, Respondent / ET ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through undersigned counsel, and files this Administrative Complaint against Florida Preferred Care Health Facilities II, Inc., d/b/a West Gables Health Care Center, (hereinafter “West Gables”) pursuant to 28-106.111, Florida Administrative Code (2001) (F.A.C.), and Chapter 120, Florida Statutes (hereinafter “Fla. Stat.”), and alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine against West Gables in the amount of two thousand five hundred ($2,500.00) dollars pursuant to Section 400.23 Fla. Stat. SEP-@3-2882 15:24 AHCA LEGAL DEPARTMENT — JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 3. Venue lies in Miami-Dade County, pursuant to 120.57, Pla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4. BRHCA is the enforcing authority with regard to nursing home licensure, pursuant to Chapter 400, Part II, Fla. Stat. and Rule 59A-4 F.A.C. 5. West Gables is a nursing home located at 2525 sw 75% Avenue, Miami, Florida 33155 and is licensed under Chapter 400, Part II, Fla. Stat., and Chapters 59A-4, F.A.C., license number 1592096. COUNT I WEST GABLES FAILED TO ALLOW A RESIDENT TO RETURN TO THE FACILITY IN THE FIRST AVAILABLE BED AFTER TRANSFER/DISCHARGE AND FAILED TO PROPERLY NOTICE THE DISCHARGE. 483.12(B) (3), C.F.R., 59A-4.1288, F.A.C., AND 400.0255(8), Fla. Stat. (PERMITTING RESIDENT TO RETURN TO FACILITY) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Because West Gables Participates in Title XVIII or XIX, it must follow the certification rules and regulations found in 42 C.F.R. 483, as incorporated by 59A-4.12868 F.A.C. SEP-G3-2882 15:24 AHCA LEGAL DEPARTMENT w 8, During the complaint investigation conducted on 7/25/01 and based on observations, clinical record review and interviews with the facility administrator, Director of Nursing, hospital nursing and social service staff, and a sampled resident, the surveyor found that the facility did not allow one resident (resident #3) to return to the facility in the first available bed after the resident’s transfer/discharge and the facility failed to properly notify the resident of the discharge. Findings include the following: 9. During an interview with the surveyor, the facility’s administrator stated that resident #3 "needs a private room and an oversized bed due to his/her weight, has had no coverage since admission, and the additional expense of the oversized bed and private room created a financial burden for the facility." The administrator also stated that there were “no private rooms available at this time.” 10. When the surveyor toured the facility on 07/25/2001, the surveyor found that there was one private room that was not occupied. According to the administrator, " it (the room) was currently being renovated." Based on information obtained from the hospital, resident #3 was cleared for discharge from the hospital on 5/7/01. Review of the facility’s admission records revealed that two (2) residents were admitted to - G4 SEP-O3-2882 15:24 AHCA LEGAL DEPARTMENT , P.O5 ww private rooms after resident #3 was discharged from the hospital. One resident was admitted on 6/6/01 and the other on 7/17/01. 11. Upon review of the hospital notes, the surveyor found that a 5/7/01 entry revealed that the hospital case Manager called the facility and spoke to “Sandra and Yvette” with regard to resident #3's return to the facility upon his/her discharge from the hospital. The Case manager's note documented that the facility's wound care specialist (Yvette), after speaking with the facility administrator, called the case manager and stated that "they (the facility) would be unable to accept the resident because they have had the patient since December without any reimbursement and have been paying for a patient specialized bed." The facility’s notes attached to the Facility's Admission Record cover sheet documented that "Informed Diane SW (hospital case manager) that we will not be taking back pt. (patient). Ref (refer) to other facility." Hospital records further documented that attempts to have the resident placed in 34 separate nursing facilities were unsuccessful. As a result, the resident has had to remain on the hospital's skilled nursing tnit although cleared for discharge. 12. Upon interview on 7/26/01, the resident stated that when he/she was transferred to the hospital on 4/30/01, staff SEP—B3-2882 15:24 AHCA LEGAL DEPARTMENT did not reply to his/her inquiries about returning to the facility, nor did he/she receive anything in writing. When asked by surveyor how he/she has been affected by the current situation, the resident went on to state that she/he felt "hopeless, angry, disappointed, misled and discriminated against because of her/his weight." He/She stated that “they told me that I needed skilled nursing and that I would be staying there. Now they don't want me even though the administrator told my father that they would take me back. I have nowhere to go." Within a couple of days following the resident's transfer to the hospital, the facility requested the resident’s father to remove the resident's possessions. Hospital psych notes dated 7/23/01 noted "pt. (patient) having difficulty coping. Depressed, tearful today, hopeless, fears." The resident stated that not only was he/she concerned about her/his own status, but was also concerned for his/her father, whose health is very fragile. When asked if he/she would consider returning to the facility, the resident stated, "Yes." 13. On 6/12/01, the resident filed a request for hearing to appeal his/her discharge from the facility. On 7/17/01, an Order to Dismiss Without Prejudice was filed by the State of Florida Department of Children and Families Office of Appeal Hearings. The order ruled in favor of the resident because 2682 15:24 AHCA LEGAL DEPARTMENT w the facility “failed to provide the hearing officer with a copy of the written notice of the resident's transfer notice by 7/8/01." In effect, the facility was ordered to readmit the resident. Based upon interview with the hospital social worker and clinical record review, the surveyor found that on 7/25/01 "MSW phone call West Gables, spoke to Mrs. Carmen Telot-Administrator. She stated ‘does not have available bed for our resident. Also she explained that Corporate is planning to appeal court's decision', MSW informed resident that West Gables has no bed as yet." Social service staff also faxed a copy of the Order to Dismiss to the facility administrator, who denied having received a copy of the order. 14. Sampled resident #3 was discharged home on 5/14/01. The required notice of transfer/discharge was not completed by the facility. The facility failed to provide the resident, in writing: the reason for discharge, the effective date of the discharge, the location of discharge, the name, number, and address of the Long Term Care Ombudsman, and the resident's xight to appeal the decision to discharge. 15. West Gables’ failure to readmit the resident to the first available bed and failure to properly notice the resident of his/her discharge compromised the resident’s ability to maintain or reach his/her highest practicable physical, mental, and psychosocial well-being. SEP-G2-2082 15:24 AHCA LEGAL DEPARTMENT 16. Based on the foregoing, West Gables violated 483.12(b) (3), C.F.R., incorporated by 59A-4.1288, F.A.C., and 400.0255 Fla. Stat., herein classified as a Class II violation, which carries, in this case, an assessed fine of $2,500.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration, requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I, B. Assess an administrative fine of $2,500.00 against West Gables for the Class II violation in Count I, in accordance with Section 400.23(8) (b) Fla. Stat., c. Award the Agency for Health Care Administration costs related to the investigation and prosecution of the case in accordance with Section 400.121(1), Fla. Stat., if costs are applicable, and D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and P.@3 SEP-83-2882 15:24 FHCA LEGAL DEPARTMENT 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 NW 53% Street, Miami, Florida 33166; Kathryn F. Fenske. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted. Kathryn F. Fenske Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142632 8355 NW 53° Street Miami, Florida 33166 (305) 499-2165 Copy to: Kathryn F. Fenske, Assistant General Counsel Agency for Health Care Administration Manchester Building 6355 NW 53** Street Miami, Florida 33166 P.69 SEP+O3-28@2 15:25 AHCA LEGAL DEPARTMENT : P.16 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Gloria Collins, Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to the Administrator, West Gables Health Care Center, 2525 SW 75° Avenue, Miami, Florida 33155, Florida Preferred Care Health Facilities II, Inc. 5212 Village Creek Drive, Plano, Texas 75093, and to Corporation Service Company, Registered Agent, 1201 Hays Street, Tallahassee, Florida 32301-2525, on S, 2002. Kathryn F, Fenske TOTAL P.10

Docket for Case No: 02-003476