£33570 Be é ay STATE OF FLORIDA iL fs AGENCY FOR HEALTH CARE ADMINISTRATLSN Ske “ap / AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2001041101 AMERICA SENIOR LIVING OF FORT WALTON BEACH d/b/a WESTWOOD HEALTH CARE, The Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against the Respondent, AMERICA SENIOR LIVING OF FORT WALTON BEACH d/b/a WESTWOOD HEALTH CARE, pursuant to Section 120.569, and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTION - 1. This is an action to impose an administrative fine in the amount of $2,500 against AMERICA SENIOR LIVING OF FORT WALTON BEACH @/b/a WESTWOOD HEALTH CARE, pursuant to Section 400.102, Florida Statutes. JURISDICTION AND VENUE 2. This tribunal has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. Venue shall be determined pursuant to Rule 28- 106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987,Title IV, Subtitle c (as amended); Chapter 400, Part II, Florida Statutes, and; Chapter 59A-4 Fla. Admin. Code, respectively. S. WESTWOOD HEALTH CARE is a_ skilled nursing facility in the State of Florida, whose 60 bed nursing home is located at 1001 Mar Walt Drive, Fort Walton Beach, Florida 32548. WESTWOOD HEALTH CARE is licensed as a skilled nursing facility license #SNF1602096; certificate number 8818 effective March 6, 2002. WESTWOOD HEALTH CARE was at all times material hereto, a licensed facility under the licensing authority of AHCA, and was required to comply with all applicable regulations, statutes and rules. COUNT I THE FACILITY FAILED TO ENSURE THAT EACH RESIDENT RECEIVES ADEQUATE SUPERVISION AND ASSISTANCE DEVICES TO PREVENT ACCIDENTS. 42 CFR 483.25 (nH) (2); SEcTION 400.23(8) (B), FLA. STAT., AND; RULE 59A-4.1288, FLA. ApMIN. CODE. 6. AHCA re-alleges and incorporates by reference paragraphs (1) through (5) as if fully set forth herein. 7. AHCA surveyors conducted a survey of Respondent’s facility on June 25-27, 2001. Staff interview, record review and surveyor observation brought to light the following: a. Record review for Resident #2 revealed the resident had previously fallen in June of 2000 and sustained a hip fracture. The admission assessment completed on 11/20/00 failed to indicate the occurrence of this fracture. A Fall Risk Assessment completed on 11/10/00 identified the resident as being at high risk for falls, however, the resident’s plan of care did not identify him/her as having problems with falls until 4/20/01. Record review revealed the resident sustained falls on 4/30/01, 5/3/01, 6/2/01, 6/13/01, and 6/23/01. Facility documentation showed the cause of the fall to be due to new shoes being worn by the resident. There was no other documentation as to the cause of the falls. An interview with facility staff showed that the resident’s condition had been discussed at a previous meeting and therapy was 3 asked to see the resident. There was no documentation to confirm the referral. Further conversations with the administrator on 6/27/01, indicated that therapy staff had failed to assess the resident in order to develop interventions to prevent further accidents. 8. Respondent’s failure to ensure each resident receives adequate supervision and assistance devices to prevent accidents is a violation of 42 CFR 483.25 (H) (2). 9. Respondent’s failure to ensure each resident receives adequate supervision and assistance devices to prevent accidents is a violation of Rule S59A-4.1288, Fla. Admin. Code. 10. Respondent’s failure to ensure each resident receives adequate supervision and assistance devices to prevent accidents is a class II deficiency as defined in section 400.23(8) (b), Fla. Stat. - CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1). Factual and legal findings in favor of the Agency on Count I; 2). Imposition of a $2,500 administrative fine. Respondent 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 the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida, 32308; Christine Tt. Messana, Senior Attorney. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted. Dated this Cth day otha ¢! cf 2002. NS Lh Christine T? “um Fla. Bar. No. 0153818 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, FL 32308 (850) 922-5873 (office) (850) 413-9313 (fax) cc: Elizabeth Dudek CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on this Gur aay of Ass} 2002 to: AMERICAN SENIOR LIVING OF FORT WALTON BEACH a/b/a WESTWOOD HEALTH CARE, 1001 Mar Walt Drive, Fort Walton Beach, Florida 32548, Of ALE. Christine T. Messana

Docket for Case No: 02-003510

Orders for Case No: 02-003510