STATE OF FLORIDA F AGENCY FOR HEALTH CARE ADMINISTRATION oper AGENCY FOR HEALTH CARE ADMINISTRATION, () ) YOx petitioner, AHCA No.-: 2002045942 AHCA No.-: 2002045943 Return Receipt Requested: v. 7000 1670 0011 4846 3343 LIVING CENTERS-EAST, INC. d/b/a 7000 1670 oo1it 4846 3350 * BOULEVARD MANOR NURSING CENTER, 7000 1670 Q011 4846 3367 Respondent. f ————————— —a" ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care administration (hereinafter seferred to as “AHCA’), ry and through the undersigned counsel, and files this Administrative Complaint against Living centers-Bast, Inc., d/b/a Boulevard Manor pursing Center (hereinafter “poulevard Manor”). pursuant to «Chapter 40g, Part tL, and Sect.on 120.60, Fla. ¢tat., and alleyes: NATURE OF THE ACTIONS 1. This 23 an action [0 impose al administrative fine of $27,590,090 pursuant cto Section 40.2318), Fla. stat. (2001), for the protection of the public health, safety and weittare. EXHIBIT A Ser PEN TT OE Te nreerier Te Vea oro rT uy zaont ot 2. This ia an action to impose @ Conditional Licensure status to Boulevard Manor, pursuant to Section aod.23(7) (eh) Yla. Stat. 3. This is an action fo dmpose 4 $6,000.00 sucvey fee pursuant to section 400.1943). Fla- Stat. JURISDICTION AND VENUE 4. This court has. jurisdiction pursuant to sactions 120.869 and 120.57, Pla. Stat-, and Chapter 28-106, PAL. 5. venue lies in Palm Beach County, pursuant to Section goo. 121(2) (ere Fla. Stat., and Rule 28-106.207, Florida Administrative code. PARTIES 6. AHCH is the regulatory avthority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, part LI, Fila. stat., (2001). and Chapter S9A-4 Florida Administrative Code. 7. Boulevard Manor operates a 167-bed skilled nursing facility Located at 2439 8. Seacrest Drive, Boynton Reach, Florida 33435-7994. Boulevard Manor is licensed 25 4 skilled nursing facility? License number SNF1058096: certificate yuunber 8996, effective May 30, 2002, through rath FYOTN TTD TETT NEA areetezezts YA 8ecTT YI ao ot at SON March 31, 2002. Boulevard Manor Was at all times material hereto 4 licensed facility under the Licensing autherity of AHCA anc was required to connp ly with all applicable rules and statutes. 8. Because Boulevard Manor participates in Title XVILTI or wim, it must follow the certification rules and regulations found in Title 42 ©.F-R- 483, as jncorperated by Rule 59A-4.1298, F.A.C. COUNT I BOULEVARD MANOR FAILED TO ENSURE THAT THE RESIDENTS’ ENVIRONMENT WAS FREE OF HAZARDS TITLE 42, SECTION 483.25(h) (1), CODE OF FEDERAL REGULATIONS , RULE F9A-4.1288, FLORIDA ADMINISTRATIVE CODE, (QUALITY OF CARE) cLAss I DEFICIENCY 9. RBHCA re-allages and incorporates paragraphs (y) through (8) 45 if fully set forth herein. 10. Turing initial tour of the facility on May 28, 2002, starting at 9:50 A.M., bathrooms or the residents on the West wing were checkad for proper temperature. The hot water in the bathroom sink in room 27 was turned on and the surveyor put his/her hand under the running water. The water temperature felt very hot. The surveyor used 4 thermometer that was calibrated as per protocol prior to TWOUNT 1) TY9SAT N¥dI orsetzezis Y¥ad Bett VI co.aT or the start of the survey: The temperaLure opt ained was ia4 dagrees,- and was witnessed by the unit manayer-. The other cooms on the wing were then rested. The temperatures wale above the recommended quidelines of 108 7 lis F. The surveyor put ris/her hand under the yunning het water, and coulda not lesve his/bex hand under the water for more than rwo seconds without feeling thar his/her hand was getting burned. On a few occasions, the back of the surveyor's hand was ced after taking it ont from the cunning hot water. The unit manager also put his/her hand under the hot running water and stated that it was too hot for the residents. There were forty-four residents on this unit, many uf whom pave drcreased cognitive abilities, and many of whom are ambulatery OF able to get around independantiy using a wheelchair. Tie following are the temperatures taken in the pathroams of residents on the West wing using a calibrated thermometer: Room 27 -1L24 degrees Room 19 - 140 degrees Room 24 - 138 degrees Room 18 - 134 degrees Room 26 7 132 degrees Room 16 - 138 degrees Room 25 7 136 degrees Room 17 7 138 degrees Room 24 - 138 degrees Room 29 - 149 degrees Room 23 - 13% degrees Room 23 - 130 degrees Room 22 - 13€ degrees Room 21 - 136 degrees 4 ones ENE TT TEN IT OVW HEE Terre V¥a RATT VHT rn -areot lL. An interview conducted with the facility administrator concerning the water temperature matter on 05/28/02 revealed that repair work was conducted on the West Wing water heaters on 05/29/02. It was further revealed from the interview that the facility nursing staff and maintenance staff failed to monitor hot water temperature following the repairs fo ensuré that the hot water tamperatures would. net endanger West Wingy residents. * Please pote that once the facility administrator was informea of the imnediate jeopardy matter, the hot water of the 2 water tanks were drained. The tanks wer? refilled and the not water temperatures were monitoted in the rooms of rhe Weat Wing from 05/28/02 and 05/79/02 to ensure a hot water Cemperatute of 105 to 115% degrees F. On 05/29/02 the tanks were once again repaired by an outside contractor and ah qnterview with the contractor revealed that the repair was made. The facility continued to monitor the hot water temperatures following . the repairs and temperature checks conducted by surveyors revealed that hot water temperatures were within the regulatory requirement. 11. Based on the foregoing, Boulevard Manor violated vn Be ct jo oD ih ») Section 483.25(h) (1), Code of Federal Regulations P00 ayATNTTy d¥9 tate yo TYNAT NEAN nresrzeets YA G2: TT VHT mo oT. OT ee TRS as incorporates by Rule 59R-4.123B, Florida Administrative Code, herein classified as 4 Class I deficiency pursuant to Section 400,23(8) (al, Fla. Stat., whieh carries, in this case, an assessed fine of $12, 500,00 This violation also ives vise to 4 conditional licensure status pursuant to Section 400.23(7) (>). COUNT IT BOULEVARD MANOR FAILED TO HAVE THE FACILITY’ S FIRE ALARM TO GIVE EFFECTIVE WARNING TO ALL STAFE AND RESIDENTS Title 42, Section 483.70 C.F.R. and Rules 59A-4.1288 and 59A-4.130(1) (2), F.A.C- (PHYSICAL ENVIRONMENT) cLASS I 12. ARCA re-alleges and incorporates paragraphs (1) through (9) as if fully set forth herein. 43. During the initial tour conducted on 47 3Of02 ancl pased on observation and interview, it was detecmined the fire alarm system in the building did not qive effective warning to ‘all the staff and residents. Tha facility had installed a rew fire alarm system without the approval of the Agency for Health Care administration Office of Plans and Construction to ensure that the new system had all tne approved components and devices and met all the required NFPA-codes ani the State of Florida celated cocles . 14. On the day of the survey 05/30/02, at approximately 2:00 pi. during an observation of a water NEOCOTIOFTO V¥T et Tt out rant At flow test to activate the fire alarm system, if Was discovered that in the East and West wings, Six of nine enunciater bells attached to the fire alarm system did not function as requixed- 15. The bells tocated in the Bast and West wings in the following locations did not work. (a) In the corridor next fo the Beauty Shop. (o) In the cartidor next to the Activities Storage Roo. (c) In the corrider across from the MDS office. (d) In the corridor hy roors 6, 15, and 22. 16. Five of seven smoke compartments in the West and East wing of the nursing home the enunciator bells were not working aS required. 17. The surveyor was in the corridor outside the jaundry area when the water flow test Was conducted. The alarm was not audible in this corridor neither for the laundry personnel or any one in the vorkshop oF poiler . room. When the surveyor entered the door by the Activities Storage room the alarm stili was not audible. When the surveyor approached the MDS office he/she noticed that the gmoKe doors to the corridor had been closed which would indicate thet the fire alarm was activated but the fire alam still could rot be heard. In the West wing for three BoatA HOTS TT TES : VINT DVD TENT NY AW opestsezTg Y¥A B2°TT VHT 4) oT OT of four smoke compartments no bells were audible. In the smoke comparticent near the Reaury Shep ho pells were audible. In tae East smoke compartment between the Nurse station and the Beauty shop smoke compartments, no bells were audible. ln the East wing for two of three smoke compartments, no bells were audible. 18. After the test was complated and the nature of the problem wis known the surveyor inrerviewed the Director of Maintenance about bis knowledge of rhis situation. He stated that the alarm contractor was in the building: on 05/29/02 to tix some items. He stated that he knew two bells were net working. Thereafter, 4 phone call was made to the alarm contramter by the Director of Maintenance. During the phone call the contrackers personnel stated that they had a work order to fix the bells and had the work scheduled soon. 19. During an interview with the Director ot Maintenance it was learned that the facility did not have any interim plan to show the surveyor what they were going to do in cast of an actual fire emergency to notify personnel, visitor, and yesidents in the affected areas. -20. During an interview with the naministratox of the nutaing home he stated that he had no knowledge of the problem with the fire alarm system. g aro TWOTNT TO T¥Y9AT NYAN orestzc21g¢ Yd 82°TT AHI 20 ot at TTA 21. During an interview the Director of Ma1lnrenance o8/320/02, Lt was revealed that located eld fire alarin panels and installed new panels- and manuel pull wings. They South nurse’ s station. 22. Florida states "All contemplated conversions OL alterations be submitted for the review process” to Administration that all the NFPA codes and met. for the fire slarm Adwwinistration Office 23. While on of Maintenance on 05/30/02 between 1:00 p.m. the surveyor They installed stations in installed annunciator panels Administrative approval of office of Plans The facility nevet applied system to tour of the with the Aaministraneor end on the day of the survey the facility had removed the in the East and South wings new corridor smoke the West and Bast at the West and Code, Rule 59A-4.123(2) shall exemption form the plans Agency for Health Care and Construction to ensure Florida Statues and Rules are for approval or exemption the Agency for Health Care of Plans and Construction. facility with the Director 2:00 p. and M-+ observed that the smoke detectors numbered 13, 34, 36, and 41 were within 3 feet of the air conditionsag outlet. For example, by # 13 the air flow from the air conditioning outlet would blow smoke away from the sinoke detectot. In addition, TEST NET TEST NYE by # 34 and 436 the air conditioning nreerzez71¢e Vea oe. th Vat m0 STN outlet bad been turned packward sc a5 nor to plow an the smoke datector, put the air was blowing back into the air conditioning return outlet, which was oply about four Teet away. This was the only means for cooling the corridear and as set up did not allow for enough air movement to cool the coxxidor propecly- 24. An “Ummecliate jeopardy to residents, employees, and the public was created by these defictencies. 25. Based on the foragoing, Boulevard Manor violated Title 42, Section 433.70, Code of Federal Regulations as incorporated by Rule $9A-4.1288, and 59A=+4.130(1) (2), Florida Administrative Cade, herein classified as 4 Class I deficiency pucsuant to Section 400.2318) ia), Filia. State, which carries, in this case, an assessed fine of $12,500.00 This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (hb). counT fil BOULEVARD MANOR FAILED TO ENSURE THAT A RESIDENT WHO ENTERS THE FACILITY WITHOUT PRESSURE SORES DOES NOT DEVELOP PRESSURE SORES UNLESS THE INDIVIDUAL’ S CONDITION DEMONSTRATES THAT THEY WERE UNAVOIDABLE Tile 42, Section 483.25 (a), C-F-R., and 59A-4.1288, FLAC. (QUALITY OF CARE) . cLass I! 26. BHCK re-alleges and incorporates paragraphs (1) chrongh (9) as if fully set forth herein. 10 ARON Ty TENTT VEAW arec ti erte V¥a oe itt qui roa-g tot eT nth 27. During the annual survey conducted between Bf ge 3anyo2 and based on direct. observation, clinical record review, interview with the unit Manager and with the primary care physician, on all three days vf the survey, it was determined that the facility failed to prevent new pressure sores from developing in L(ip #2) of 24 residents in thea sample selection. Findings include the following: (a) On 05/28/02, during the jnitial tour of the south Wing of the facility, Resident Id #2 was observed in bed receiving AM care. The bed sheets were noted to have tlood stains and «a foul oder was present in the. room. The Unit manager, touring with surveyor, Was questioned 45 ro whether or not rhe xesident bad pressure sores, and she stated, "no, he/she does not”. an assessment of the resident's upper body was nade and no pressure sores were visible. The surveyor then requested the resident's socks be removad for inspection of the feet. The right heel was noted to have an approximate 2x3 cm. purple necrotic aréa with a stage If opening in the center, with drainage. The left heel was observed to have an approximate 2x3 em. dark purple blister. When the wnit manager was further questioned as to the pressure sores, she stated," IT did not know they were there, and they were not there about one week ago when I made wound rounds with the physician”. ayOTSTT) TIT NAN nreerinets VY oe: TT HL rio Clinical record review revealed the resident had pressure sores if April. which had healed. A review of the nurses notes yevealed no documentation of the presence of pressure sores. A review of the treatment record for the months of April revealed the pressure sore Was resolved on Oa/N9/02. A review of the treatment gecord for the month of May “U0R revealed docwwrentatrlon of a healed pressure sore and no treatments in progress. A review of the physician progress notes revealed no documentation of the presence of 3 pressure sere. A review of the facility ems Form 802 revealed no dacumentation of a pressure sore. On O5/28/02, interview with the primary care physician revealed that. the "resident did not have any pressure sores wher examined about one to two weeks ago". Further interview with the physician revealed the "resident does not have a diagnosis of PVD (peripheral vascular disease) and has not worn heel protectors since ordered on 02/18/02". A review of the pressure sore resident. assessment protocol revealed the resident has impaired ability to reposition self has a pressure wlear hishery and is at ryisk for developing pressure sores. Further review of the clinical record revealed the resident has contractures of both knees. Further review of the clinical record and a review of the care plan revealed no decumantation oF approaches for the 12 TROINET THOTT NAW orgeTzezr¢ Y¥a Oct HI oo oT-at use of assistive oF positioning devices (heel protectors, heel 1ifts, multipodis boats, air mattress. turning positioning program ta prevent the pressure sores. Further review of the clinical record and interview with che unit manager revealsd no attempts were made for a physical oT occupational cherapy evaluation for recommerclations for the contractures of the both knees. Further review of the clinical recoxd revealed the resident has poor nutritional status, with meal consumption of less than 50%, and consumption of meal supplements of 0 to S08. A review of the weight rerzord revealed a 9-pound weight loss hetween February and March of 2002. Interview with the registered dietitian revealed she was not aware of the poor supplemental intake. Interview with the family mendoe £ revealed the yesiclent does not like the sweet supplemental shakes and wibd not arink them or anything sweet. Observation oy the noon meal on 0§/28/02 and on 05/29/02 revealed the cesident ate less than 25 4. Further review of the clinical record revealed that on 05/23/02, the wound care physician saw the resident on consultation and debrided both heels. A review of the wound care physician's orders revealed an order for a culture and sensitivity of the left heel, bilateral heel dressings, bilateral multipodis type boots and a physical therapy evaluation for 13 ota fh aan tery] Ae Var PTA TENET NEA npeerrer re YW4 Tee Tt We zarnt- ot 9ToR positioning and knee coptractures. AR teview of the wound care physician notes revealed the resident's healing potential is fair if pressure relief can be maintained. 28. Based on the foregoing, Boulevard Manor violated Title 42, Section 463.25(c)- Code of Federal Regulations 45 incorporated vy Rnle S9A-4.12398, Florida Administrative Code, herein rlassified as 4 Class Il deficiency pursuant to Section 40t..23(8) (b),. Fla. stat., which carries, in this case, an assessed fine of $2,500.00 This violation alsy gives ris¢ te a conditional jicensure status pursuant to Section 400.22 (7) (b). COUNT IV ADDITIONAL FINE UNDER SECTION 400.1943), Fla. Stat. 29. This facility had two Class Ts and one Class Ti deficiencies found in the survey completed on 5/30/02. The Aqency, in addition to any administrative fines imposed, may assess a survey fee. The fine for the 2-year period shall be $6,000, one half to be paid at the completion of each survey. DISPLAY OF LICRNSE “pursuant to Section 400.23(1) le), Florida Statutes, Boulevard Maner Nursing Center shali post the Licensé in a prominent place that is in clear and unobstructed public ls AY VINTD TRYST SEA areetze2ts Vea TesTt IE ao ot at LTOwB view at or near the place where residents are being admitted to the tacility-. the Conditional License 3s attached hereto 45 Exhibat “Ae CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency fo. Health Care Adninistration requests the following relief: A. Make factual and legal Findings in favor oft the Agency on Count I through Iv. B. Assess an administrative fine of $27,500.00 against Boulevard Manor on counts T, LL and itt, and assess a $6,000 survey fea pursuant ‘te section 400.19(3), Pla. Srat. oem Count IV. Cc. Assess and assign a4 conditional jicense status to Boulevard Manor im accordance with Section 4Oa.23(7) (eb), Florida Statutes. D. Grant such other relief as this Court deems is just and proper. Respondent i5 notified that if has a xvight to request 4@n administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative actiou are sat ouf in the attached Election € of Rights and explained in the attached Explanation of 1s TYOINE TO TS AT NY dW oresreezi¢s Vea bes tt Kd ao Gt ot gTAMm Rights - All requests for fearing shall be jade to the Agency for Health care Administration. and delivered to the Agency for Health care Administration, Manchester Building, First Floor, 6355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Nelson E. Rodney. RESPONDENT 15 FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WiLL RESULT IN AN BDMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Nelson &. Rodney Assistant General coumsel Agency for Health. Care Administration B2ss N. W. &3 Street Miami, Florida 33106 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Titftany Drive, Suite 100 West Palm Beach, FL 33407 (U.5. Mall) Gloria Collins Finance and Accounting Agency for Hesaith Care Administration 2727) Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoftice Mail) Skilled Nursing Facility Unit Program Agency For Health Care Administration 2727 Mahan Drive Tallabassee, Florida 32308 iInterc#ftice Mail) 16 TYOTINTTY TORT NYA apectzeet¢ Ya test QHL z0-0T- 08 EXHIBIT “A” Conditional License SNFLOS8096: Cartificata Mo. B96 License No. OS-3N=02 Effective date: 03-31-03 Expiration date: Bra WYO tye . eye . “ ENT TY TYOTT NAW orgetacats V¥a aecrt THI zu oot ol ano By CERTIFICATE OF SERVICE { HEREBY CERTIFY chat a true and cerrect COPY of ihe Certified Mail, Return foregoing has peen furnished U.S. Receipt Requested to Richard A. Aldrich, Acdininistvator, 2839 S. Seacreast Drive, Boynton Reach, Florida 43435-7994, Living Centers-Bast, Inc., One Ravinia Drive, Suite 1590, Atlante, GA 530346, and to ©.T. Corporation System, 1200 South Pine Ysiand Road, Plantation, Florida 33324 on ~~? | 2002. {_— 18 PYOTNT 1) 1¥SSE N¥dN opestzezTS yvd te rt Ha carat oT et * Areead) sppeaey uw axe rll TENG POGLSEPEL TS HOVE NOLNA OF TALI LSTUOVES “§ 6r3T BALNAO ONISUNN YONVA Ga¥ATINO SoLMOpoy ay) aiesado oe “epLoLs Jo amis ap Aq pardope suone(ndes pue sory oy] qicm pardaros sey “DNELSVA - SYBLNAD ONLATT 228) eure BW SK ISS . 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Docket for Case No: 02-004408