STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION. .. STATE OF FLORIDA, ADE AGENCY FOR HEALTH CARE ADMINISTRATION, D9 yy aS Petitioner, AHCA NO: 2002032531 vs. SENIOR LIVING CENTERS, INC., d/b/a COLLEGE HARBOR Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against SENIOR LIVING CENTERS, INC., d/b/a COLLEGE HARBOR, (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose a conditional licensure status effective April 3, 2002 through May 14, 2002 pursuant to Sections 400.23(7) (b) and 400.23(8) (b) Florida Statutes. 2. The Respondent was cited for Tag F325 as a Class II deficiency during the annual survey conducted on or about April 3, 2002. JURISDICTION AND VENUE END VENUE 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part Tl, Florida Statutes. 4. Venue lies in Pinellas County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28, Florida Administrative Code. PARTIES 5. AHCA is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 6. Respondent is a nursing home located at 4600 - 54th Avenue South, St. Petersburg, Florida. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. INCORPORATING BY REFERENCE 42 CFR 483.25 (i) (1), AND SECTION 400.022(1) (1), FLORIDA STATUTES. CLASS IT DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein, 8. Based on resident record reviews and interviews, the Respondent failed to provide adequate and appropriate health care and support services to two residents, Resident #1 and Resident #10, by failing to ensure the residents maintained acceptable parameters of nutritional status, such as body weight and protein levels. 9, Resident #10 was admitted to Respondent’s facility on April 25, 2001 with diagnoses of depressive disorder, anxiety state, hypertension, insulin dependent diabetes mellitus, osteoporosis, rheumatoid arthritis, anemia and alcohol abuse. April 2002 physician orders indicated that the Resident was to receive a mechanical soft, no concentrated sweets diet. Based on interviews and record review, it was determined that Resident #10 suffered a severe weight loss totaling 11.6% or 12.2 pounds from February 2, 2002 through April 3, 2002, 10. There were no dietary progress notes for Resident #10 in the month of February. The Registered Dietician, in a note dated March 20, 2002 regarding laboratory results for March 28, 2002, noted a moderate depletion of Resident 10's visceral protein stores. ll. Despite the fact that Resident #10’s nutritional status was not within acceptable parameters for body weight and protein level, the Respondent failed to initiate specific and effective nutritional interventions, including, but not limited to, increasing the Resident’s intake of calories or protein, to address Resident #10's severe weight loss and depleted visceral protein stores, from on or about February 2, 2002 through April 3, 2002. This failure to act compromised the resident’s ability to maintain or reach his/her highest practicable physical, mental and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care and provision of services. 12. Resident #1 was admitted to the facility on February 7, 2002 with diagnoses of dementia, osteoarthritis, cataracts, hip fracture, dysphagia, anemia, and constipation, 13. A review of resident records dated February 12 and February 20, 2002, Resident #1 suffered severe weight loss of approximately 16 pounds since admission. 14. Admission notes for Resident #1 indicated a need of additional calories for weight gain in view of the fact that the Resident had experienced a severe weight loss prior to admission to the Respondent’s facility of 12.3% or 16 pounds. Despite this recommendation, the established weight goal on the Resident’s plan of care dated February 19, 2002 indicated merely a goal “To meet nutritional needs with weight Stability through the NRD (Next Review Date) .” 15. Laboratory results dated March 13, 2002 showed that Resident #1 had a very low blood albumin level of only 2.7 g/db. 16. Despite the fact that Resident #1’s nutritional status was not within acceptable parameters for body weight and protein level, Respondent failed to initiate specific and effective nutritional interventions to address Resident #1’s severe weight loss and low albumin blood level, including, but not limited to, increasing the Resident's intake of calories and protein, to address Resident #1’s severe weight loss. This failure to act compromised the resident’s ability to maintain or reach his/her highest practicable physical, mental and psychosocial well- being, as defined by an accurate and comprehensive resident assessment, plan of care and provision of services. 17. The Agency seeks to impose a Conditional Licensure Status effective April 3, 2002 through May 14, 2002, based on one Class II deficiency as authorized under Sections 400.23(7) (b), 400.23(8) (b) and 400.022(3), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I; B. Recommend that the change of licensure status effective April 3, 2002 through May 14, 2002, from Standard to Conditional be upheld; and Cc. All other general and equitable relief allowed by law. A een nate DISPLAY OF LICENSE Pursuant to Section 400.062(5) and Section 400.23(7) (e), Florida Statutes, Respondent 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. NOTICE 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 Explanation of Rights (two pages) and Election of Rights (one page). All requests for hearing shall be made to the attention of Michael Sasso, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr. N., St. Petersburg, Florida, 33701. 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, Yucchal p heae Michael Sasso, Esquire AHCA - Senior Attorney 525 Mirror Lake Drive North St. Petersburg, Florida 33701 I HEREBY CERTIFY that a copy hereof has been furnished to Beth A. Houghton, 4200-54 avenue S., St. Petersburg, FL 33711, Return Receipt No. 7001 2510 0007 5976 5025 and to Administrator, College Harbor, 4600 - 54‘? Avenue, S., St. Petersburg, FL 33711, Return Receipt No. 7001 2510 0007 5976 3 . Am 5032 by U.S. Certified Mail, on October , 2002. Swclect (hoe Michael Sasso, Esquire Copies furnished to: Beth A. Houghton Registered Agent for College Harbor 4200 ~ 54™® avenue S. St. Petersburg, FL 33711 (U.S. Certified Mail) Administrator College Harbor 4600 - 54" Avenue S. St. Petersburg, FL 33711 (U.S. Certified 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, Bldg #1, MS Code #33 Tallahassee, Florida 32308 (Interoffice Mail) Michael Sasso AHCA - Senior Attorney 525 Mirror Lake Drive Suite 330K St. Petersburg, Fl 33701

Docket for Case No: 02-004419