STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Certified Article Number *« AGENCY FOR HEALTH CARE 7hOb 4575 L254 2049 7b ADMINISTRATION, SENDERS RECORD Petitioner, _f 0a-4¥8N9 vs. Case No. 200200693 20020070 NORTHPORT HEALTH SERVICES OF FLORIDA, L.L.C. d/b/a DAYTONA BEACH HEALTH AND REHABILITATION CENTER, The Respondent. + / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (SAHCA”), by and through the undersigned counsel, and files this Administrative Complaint against the NORTHPORT HEALTH SERVICES OF FLORIDA, L.L.C. d/b/a DAYTONA BEACH HEALTH AND REHABILITATION CENTER hereinafter referred to as Northport or Respondent, pursuant to Section 120.569, and 120.57, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Northport, pursuant to Section 400.102, Florida Statutes, (2001). and assess costs related to the investigation and prosecution of this case, pursuant to Section 400.121(10), Fla. Stat. (2001). JURISDICTION AND VENUE 2. This tribunal has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, (2001). 3. Venue shall be determined pursuant to Rule 28- 106.27, 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 Cc (as amended); Chapter 400, Part II, Florida Statutes, (2001) and; Chapter 59A-4 Fla. Admin. Code, respectively. 5. Northport is a nursing facility whose 180-bed nursing home is located at 1055 Third Street Daytona Beach, Florida. Northport is licensed to operate a nursing facility license #11210961. At all relevant times, 2 licerised facility remiired to comply with all applicable regulations, statutes and rules under the licensing authority of AHCA. counr I Northport failed to develop and implement written policies and procedures that prohibit mistreatment, neglect and abuse of residents. Section 400.022 Fla.Stat. (2001) 42 CFR 483.13 Rule 59A-4.1288, Fla. Admin. Code (2001) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. AHCA conducted survey of Northport on or about June 13, 2001.” Investigation revealed a Class II deficiency. Based upon surveyor observations, interviews with residents and staff members, medical record reviews and review of the facility policies and procedures for the prevention/reporting of incidents of abuse, neglect or exploitation of residents it was determined that for four (4) of four (4) sampled residents from a total census of 148 residents the facility failed to insure that the residents were not subject to incidents of staff to resident abuse and resident to resident abuse or that when an incident occurred it was reported in a timely manner so that an. investigation could be conducted. These incidents included physical hitting/slapping, being dragged in the hallway by force and having the door to a resident’s room held closed causing involuntary seclusion to a resident. The findings include: a) Resident #2 was admitted to the facility on 5/23/01 with Primary Diagnosis of Alzheimer’s Dementia. On June 6, 2001, at approximately 4PM the facility documented an altercation between a licensed practical nurse on duty a resident who was refusing to take his/her oral medication. Various witness accounts indicate that mutual hitting took place between the nurse and the resident and the nurse took the resident by the arm and pulled through the hallway. The nurse then placed the resident in his/her room and held the door closed for several minutes so that the resident could not leave the room. One witness account described the nurse as being verbally abusive to the resident and making loud, obscene comments in the hallway. On date of June 13, 2001, observation of the resident revealed an area of bruising approximately the size of a golf ball on the resident’s right wrist and a hand print sized bruise on the resident’s upper right arm. b) Resident #1 and Resident #2 were involved in an altercation mentioned on an incident/unusual occurrence report mentioning as seen being choked by resident #2 on 5/30/01. Review of the medical record of Resident #1 failed to reveal any documentation or investigation of possible injury to this resident as a result of the incident which occurred on 5/30/01. Review of the facility accident/incident report failed to reveal a report related to the involvement of Resident #1. BY c) Resident #3 on or about June 4, 2001, had been hit across the face and fought with Resident #2. Review of the medical record of Resident #3 and the Incident/Accident logs for the months of may 2001 and June 2001, failed to reveal documentation of incidents referenced herein. Interviews with the Social Services Director and the RN House Supervisor on the 7-3 shifts failed to elicit an explanation as to why these incidents had not been accurately documented, reported or investigated. da) Resident #4 was hit on the head on or about June 2, 2001, by Resident #2. Review of the medical record of Resident #4 and the incident/accident log for the month of June 2001, failed to reveal documentation of an incident on this date. Interviews with the Social Services Director and the RN House Supervisor on the 7-3 shift failed to elicit an explanation ‘as to why these incidents had not been accurately documented, reported or investigated. 8. Pursuant to Section 400.23(8), Florida Statutes, the foregoing is an “isolated” class II deficiency because it affected one or a very limited number of residents, involved one or a very limited number of staff, or occurred only occasionally or in a very limited number of locations. 9. “NORTHPORT failed to develop and implement written policies and procedures that prohibit mistreatment, neglect and abuse of residents and specifically ailed to protect the rights of the residents to be free from verbal, physical abuse, mental abuse, corporal punishment and/or involuntary seclusion and failed to document, thoroughly investigate and/or report in violation of 42 CFR 483. CLAIM FOR RELIEF . WHEREFORE, AHCA requests the following relief: a. Enter actual and legal findings in favor of AHCA b. Impose a $2,500 civil penalty against Northport. c. Assess costs related to the investigation and prosecution of this case pursuant to Section (,400.121(10), Florida Statutes (2001); and d.Grant any other general and equitable relief as deemed appropriate. COUNT IT Northport failed protect the Residents from unnecessary drugs and failed to insure that Resident’s drug regiment was adequately monitored. 42 CFR 483.25(1) (i) (iii) (iv) (v) (vi) Rule 59A-4.1288, Fla. Admin. Code (2001) Section 400.23 Fla.Stat. (2001) Section 400.19 Fla.Stat. (2001) 10. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 11. AHCA conducted survey of Northport on or about December 11, 2001 and this investigation revealed a Class III deficiency. Based upon surveyor investigation and review it was established that Resident #4 received Haldol 2 mg, BID. Review of the Behavior Monitoring Sheet revealed behaviors of outbursts but did not give specific examples of the resident’s behavior, (i.e. physical or verbal, times, length of outbursts). Further, Resident #11 receives Zyprexa for delusions. Resident #8 receives Xanax and Valium and residents #6 and #9 receives Zyprexa and Buspar. All medications require monitoring but did not have behavior monitoring noted on the Medication Administration Record. (MAR). Resident #16 received Risperdal, Valium and Ativan. Review of the MAR revealed one behavior-monitoring tool utilized for all three medications. 12. Pursuant to Section 400.23(8) (c), Florida Statutes, the foregoing deficiency is a pattern class III deficiency because it involved a cituation a very limited number of residents were affected or more than a very limited number of staff were involved or the situation has occurred in several locations or the same resident or residents have been affected by repeated occurrences of the same deficient practice but the effect of the deficient practice is not found to be pervasive throughout the facility. 13. NORTHPORT was given a mandated correction date of December 1, 2001, in accordance with Section 400.23 (8) Florida Statutes. NORTHPORT, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about December 11, 2001. Based on the foregoing, NORTHPORT was cited for an uncorrected class III deficiency. 14. Pursuant to Section 400.23 Fla.Stat.(2001) The fine amount shall be doubled for that deficiency if the facility wac previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. 15. NORTHPORT was cited for a Class II violation on or about June 13, 2001, a date which is subsequent to the annual inspection. 16. regimen monitor the use without for use NORTHPORT failed to insure the residents’ drug was free from unnecessary drugs and to adequately drug use. Northrop further failed to protect from of excessive dosage or for excessive duration or adequate monitoring or without adequate indications or in the presence of adverse consequences or any combination of these delineated reasons in violation of 42 CFR 483. 25 (1) (i) (214) (iv) (v) (vi). CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a. Enter actual and legal findings in favor of AHCA. o Impose a $2000 fine/penalty against Northport, which incorporates the fine/assessment authorized pursuant to Section 400.23(8) Fla.Stat. (2001). a bo Q Q QO Oo a and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2001); and d. Grant any other general and equitable relief as deemed appropriate. COUNT III Northport failed to maintain policies and procedures in the area of medical records. Rule 59A4.106(4) (p) Fla.Admin. Code Rule 59A-4.1288, Fla. Admin. Code Section 400.23(8)Fla.Stat. (2001) Section 400.19 Fla.Stat (2001) 17. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 18. AHCA conducted survey of Northport on or about December 12, 2001 and this investigation revealed a Class III deficiency. Based upon surveyor investigation and review it was established that Northrop did not ensure that medical records were complete and that they were adequately documented. Based upon record review for six of fifteen sampled residents (residents #6, #8, #9, #10, #11 and #16) the facility did not ensure that medical records were complete and accurately documented. Specific examples are delineated as follows: | a. as to Resident #10 said Resident was admitted to the facility on 11/15/2001 and has a physician’s order for Accu-checks BID. There was no facility documentation that the Accu-checks were completed as ordered from 11/15/2001 to 12/01/2001. b. Intake and output records were not 10 documented on Residents #10 and #6 as indicated on the Minimum Data Sets (MDS) and the Care Plans of the residents. c. Behavior monitoring of psychotropic medications was not complete and accurate on Residents #11, 34, #1, #8, #6, #9 and 16 who receives three Psychotropic medications. 19. Pursuant to Section 400.23(8)(c), Florida Statutes, the foregoing deficiency is a pattern class III deficiency because it involved a situation where more than a very limited number of residents were affected or more than a very limited number of staff were involved or the situation has occurred in several locations or the same resident or residents have been affected by repeated occurrences of the same deficient practice but the effect of the deficient practice is not found to be pervasive throughout the facility. a mandated correction dare of December 1, 2001, in accordance with Section 400.23(8) Florida, Statutes. NORTHPORT, however, failed to correct the Class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about December 11, 2001. Based on the foregoing, NORTHPORT was cited for an uncorrected class III deficiency 11 at the survey on or about March 1, 2002. 21. Pursuant to Section 400.23 Fla.Stat. (2001) the fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. 22. NORTHPORT was cited for a Class II violation on or about June 13, 2001, a date which is subsequent to the annual inspection. 23. NORTHPORT failure to ensure that medical records were complete and accurately documented constitutes a violation of 42 CFR 483.75 (1)(1)(b) and is in contravention of Rule 59A4.106(4) (p) Fla. Admin. Code (2001). CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a.Enter actual and legal findings in favor of AHCA b. Impose a $2000 penalty against Northport which incornorates authorized fine/assessment of $1000, pursuant to Section 400.23 Fla.Stat. (2001). c. Assess costs related to the investigation and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2001); and d, Grant any other general and equitable relief as deemed appropriate. Dated MAY 3 Lar Agency for Health Care Administration Richar oseph Saliba, Esquire, Settior! Attorney Fla. Bar. No. 0240389 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850) 921-0158 (fax) NOTICE NORTHPORT HEALTH SERVICES OF FLORIDA, L.L.C. d/b/a DAYTONA BEACH HEALTH AND REHABILITATION CENTER hereby 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 Richard Joseph Saliba, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida, 32308. NORTHPORT HEALTH SERVICES OF FLORIDA, L.L.C. d/b/a DAYTONA BEACH HEALTH AND REHABILITATION CENTER IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN TWENTY- ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN ‘THE ADMINISTRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY ACHA. Agency for Health Care Administration y \ - Yue 31 Vos Righard Joseph Saliba, Esquire, Senior Attorney Fla. Bar. No. 0240389 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850) 921-0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been sent by U.S. Certified Mail Return Receipt Requested (return receipt # 7106 4575 1294 2049 7616) to NORTHPORT HEALTH SERVICES OF FLORIDA, D/B/A Daytona Beach Health and Rehabilitation Center, 1055 Third Street, Daytona Beach, Florida 32017 this Jt day of May, 2002. Agency for Health Care Administration Esquire Senior Fla. Bar. No. 0240389 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850) 921-0158 (fax)

Docket for Case No: 02-004819