oot | STATE OF FLORIDA vy AGENCY FOR HEALTH CARE ADMINISTRATION 4 for rare Tara. rene oe AGENCY FOR HEALTH CARE , ADMINISTRATION, o Petitioner, AHCA No.: 2002046832, Vv. 2002046834 Return Receipt Requested: QUALITY CONSULTING, LLC., d/b/a 7000 1670 0011 4846 2964 CROSS POINTE CARE CENTER, 7000 1670 0011 4846 2971 Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or the “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against quality Consulting, LLC., d/b/a Cross Pointe Care Center (hereinafter “Cross Pointe Care Center” or “Cross Pointe”), pursuant to Chapter 400, Part II, and Section 120.60, Florida Statutes (2001) (hereinafter “Fla. Stat.”), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $2,500.00 pursuant to Section 400.23(8), Fla. Stat., for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Cross Pointe Care Center, pursuant to Section 400.23(7) (b), Fla. Stat. JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 4. Venue lies in Broward County, pursuant to Section 400.121(1) (e), Fla. Stat., and Rule 28-106.207, Florida Administrative Code. PARTIES 5. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Fla. Stat. and Chapter 59A-4 Florida Administrative Code. 6. Cross Pointe Care Center operates an 88-bed skilled nursing facility located at 440 Phippen Road, Dania, Florida 33004. Cross Pointe Care Center is licensed as a skilled nursing facility; license number SNF1119096; certificate number 9075, effective June 25, 2002. Cross Pointe Care Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all apolicable rules and statutes. COUNT I CROSS POINTE CARE CENTER FAILED TO IMPLEMENT POLICIES AND PROCEDURES TO PROHIBIT NEGLECT AND/OR MISTREATMENT OF A RESIDENT. TITLE 42, SECTION 483.13(c), CODE OF FEDERAL REGULATIONS , Incorporated by Rule 59A-4.1288, FLORIDA ADMINISTRATIVE CODE, (STAFF TREATMENT OF RESIDENTS) CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. Because Cross Pointe Care Center 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- 4.1288, F.A.C. 9. During the survey conducted from 6/25/02 through 6/27/02 and based on observation, interview and record review, the Agency’s surveyor(s) found that Cross Pointe failed to implement policies and procedures to prohibit neglect and/or mistreatment of a resident. The Agency’s surveyor (s) determined that the facility did not prohibit mistreatment, and/or neglect, an/or abuse for one resident (#10) of 20 sampled residents. 10. During the initial observation tour of the facility on 6/25/02, resident #10 was noted to have a large purple/black bruise above and below the left eye. It was also noted that there was a large scab area on the eyebrow of the left eye. 11. BA review of the clinical record of resident #10 on 6/26/02 and 6/27/02 revealed that the resident was admitted to the facility on 5/18/02 with diagnoses of S/P (R) Below the Knee Amputee (BKA), Diabetes Mellitus, Depression, PVD, HBP, and Altered Mental Status. Further review of the nurse’s notes revealed documentation dated 6/21/02 that the resident was found lying on the floor of room #29 with a laceration to the forehead above the left eye with a moderate amount of bleeding. It was also noted that the dressing had been removed from the recent right BKA site with a large amount of drainage noted. 12. Further review of the nurse’s notes revealed documentation that the attending physician was called on 6/21/02 at 7:15 pm, 9 pm and 10:15 pm, and during the 11 pm to 7 am shift. In each case the attending physician did not return the call to the facility with orders to treat and evaluate resident #10. Further review of the nurse’s notes revealed that no orders to evaluate and treat on 6/2//02, 6/23/02, 6/24/02, and 6/25/02. 13. Further review and interview with the facility Director of Nurses (DON) revealed that once it was established that the attending physician was not responding to the phone calls, that the facility failed to contact the medical director for orders to treat and evaluate the injury to resident #10. 14. Cross Point’s failure to implement policies and procedures to prohibit neglect and/or mistreatment of a resident compromised the resident’s ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well- being. 15. Based on the foregoing, Cross Pointe Care Center violated Title 42, Section 483.13(c), Code of Federal Regulations, as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II deficiency pursuant to Section 400.23(8) (b), Fla. Stat., which carries, in this case, an assessed fine of $2,500.00. This deficiency also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). DISPLAY OF LICENSE Pursuant to Section 400.23(7), Florida Statutes, Cross Pointe Care Center shall post the license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility. The Conditional License is attached hereto as Exhibit “A” CLAIM 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 Cross Pointe Care Center, pursuant to Section 400.23(8) (b), Fla. Stat. Cc. Assess and assign a conditional license status to Cross Pointe, pursuant to Section 400.23(7) (b), Fla. Stat. D. Award the Agency for Health Care Administration costs related to the investigation and prosecution of the case, in accordance with Section 400.121(10), Fla. Stat. BE. 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 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 N. W. 53rd Street, Miami, Florida, 33166; Attn: Kathryn F. Fenske. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILS RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND ENTRY OF A FINAL ORDER BY THE AGENCY. Kathryn F. Fenske Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 N. W. 53 Street Miami, Florida 33166 (305) 499-2165 Copies furnished to: Diane Reiland Field Office Manager 1710 E. Tiffany Drive, Suite 100 West Palm Beach, Florida 33407 (U.S. mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) THE EXHIBIT “A” Conditional License License No. SNF1119096; Certificate No. Effective date: 06-25-02 Expiration date: 12-30-02 9075 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished U.S. Certified Mail, Return Receipt Requested to Laurente Giambalvo, Administrator, Cross Pointe Care Center, 440 Phippen Road, Dania, Florida 33004, Quality Consulting, LLC, 2884 West Orchard Circle, Davie, Florida 33328 on UG, 7 2002. Kathryn F. Fenske ZOOC/OE/ZI ‘ALVA NOILVUldxXe YSNAOIT 7007/S7/90 ‘ALVC HAILOSAATA NOLLOV asueyD smeis “spaq 83 WIM PoOee TH “VINVG GVOU NdddiHd Orr YALNAO AUVO ALNIOd SSOW :SUIMOT[OJ By) aJeIJedo 0] paziloyINe st s9sUadT] BY} SB PUR ‘soIMeIS EPLIOLY ‘TI Wed ‘OOP JardeyD uF pezuoy;NE ‘uoneNsTUUpY Be} WEOH JOG Kouasy “epllopy Jo areig au) Aq paydope suonenar pue soins ayn yaa pordwios sey OTT ‘ONLLTASNOO ALITVNO 1843 VATUOS 0} ST SIGL TVNOILLIGNOD ALITIOVA DNISHMON GA TIEAS ALITVNO HLTVdH GNV SUV GHDYNVW AO NOISIAIG NOLLVULSININGV FaVO HLTVdH YOd AONAOV VPLIOL,] JO 9}B}S S606TTTANS ‘# HSNHOIT SL06 ‘# BLVOMILaAO

Docket for Case No: 02-004411