nl STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, 2 fh Petitioner, DS o\7| CASE NO: 2002047993 vs. ALTERRA HEALTHCARE CORP. BRIDGE OF WEST MELBOURNE d/b/a ALTERRA CLARE Respondent. / ADMINISTRATIVE COMPLAINT re administration COMES Now the Agency for Health Ca sel, by and through the undersigned coun aint against ALTERRA (hereinafter “AHCA”) 1 Administrative comp1 and files this LARE BRIDGE OF WEST HEALTHCARE CORP., a/b/a ALTERRA C MELBOURNE (hereinafter “pespondent”) and alleges the following NATURE _OF THE ACTION 1. This is an action to impose administrative fines on ction 400.419 (1) (ec), Florida Statutes .- ndent pursuant to sec Respo RISDICTION AND VENUE JU. as jurisdiction pursuant to Section 2. This court h hapter 28-106 Florida 120.569 and 120.57 Florida Statutes and C administrative Code. 3. AHCA, Agency for Health Care Administration, has jurisdiction over Respondent pursuant to Chapter 400 Part Ifl, Florida Statutes. 4. venue lies in Brevard County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28 Florida Administrative Code. PARTIES 5. Agency for Health Care Administration, State of Florida is the enforcing authority with regard to assisted living facility licensure law pursuant to Chapter 400, part III, Florida Statutes and Rules 58A-5, Florida Administrative Code. 6. Respondent is an assisted living Facility located at 7199 Greensboro Drive, Melbourne, FL 32904. Respondent, is and was at all times material hereto, a licensed facility under Chapter 400, Part Til, Florida Statutes and Chapter S8A-5, Florida Administrative Code, having been issued license number 9766. COUNT I RESPONDENT FAILED TO ENSURE THAT A HEALTH CARE PROVIDER’ S ORDER FOR CARE WAS OBTAINED PRIOR TO PROVIDING LIMITED NURSING SERVICES IN VIOLATION OF Fla. Admin. Code R.58A-5.032(2) (ce) (2002) UNCORRECTED CLASS I1Ift DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. On or about June 10, 2002, a survey was conducted at Respondent’s facility. 9. Based on record review and interview, Respondent failed to ensure that a health care provider's order for care was obtained prior to providing limited nursing services. The findings include: 1. Record review for resident admitted on 4/10/02 revealed nurse's note dated 4/30 "Brace wrong between toes, red areas bottom of left foot, wife upset". Note dated 5/26 “faxed order for LNS with leg brace". A physician's order dated 5/30 “apply elastic stocking, brace to left foot Q AM, remove Q PM". The order was obtained approximately 6 weeks after services were in progress. Administrator stated that the staff was applying the brace but it was not until 5/30, that the facility realized that resident needed to be identified as receiving LNS and an order was obtained. 2. Resident admitted 4/3/02 sustained a fall on 5/13/02 that resulted in the fracture of the right wrist. Notes dated 5/13 thru 5/24 document cast care/assessments conducted. However a physician's order for care was obtained on 5/24 "LNS right hand due to cast”, approximately 12 days after services were in progress. 10. Respondent was provided a mandated correction date June 11, 2002. 11. On or about October 1, 2002, a follow-up survey was conducted at the facility. At this survey, the above-listed deficiency remained uncorrected. 12. Based on record review and interview, Respondent failed to ensure that a health care provider's order for care was obtained prior to providing limited nursing services. The findings include: Resident record review for sampled resident #1 revealed the following: A note to physician dated 9/ 12/02 " fell out of wheelchair received two skin tears to right arm”. of Nurse's notes dated 9/9, 9/11 document treatment provided to skin tears to arm. Note dated "D/c from LNS" dated 9/14/02. A physician's order for care is not available. A note to physician dated 9/21/02 "presented with two skin tears to right lower oat shin and top of head scratched-area open" "no new orders". However, nurse's notes dated 9/17, 9/18 and 9/22/02 document treatment provided. A physician's order for care is not available. The administrator and DON stated that orders are not available, the nurses provided the care and failed to obtain the order. 13. The above actions or inactions are a violation of Rule 58A-5.031(2) (c), Florida Administrative Code, which requires that limited nursing services may only be provided as authorized by a health care provider’s order, a Copy of which shall be maintained in the resident’s file. 14. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility's residents. Pursuant to Section 400.419(1) (c), Florida Statutes, the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT IT RESPONDENT FAILED TO MAINTAIN MONTHLY NURSING ASSESSMENT ON EACH RESIDENT WHO RECEIVES A LIMITED NURSING SERVICE IN VIOLATION OF Fla. Admin. Code R. 58A-5.031(3) (c) (2002) UNCORRECTED CLASS IIT DEFICIENCY 15. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 16. On or about June 10, 2002, a survey was conducted at Respondent’s facility. 17. Based on record review and interview, Respondent failed to ensure that a complete nursing assessment was conducted at least monthly for resident receiving limited nursing services. The findings include: Resident admitted 4/10/02 was identified during tour as receiving LNS for application and removal of left leg brace. Record review revealed a physician's order dated 4/30 "Texas catheter on HS, off in AM". Nursing assessment dated 5/31/02 does not address the application and removal of the brace or the Texas catheter. 18. Respondent was provided a mandated correction date of July 10, 2002. 19. On or about October 1, 2002, a follow-up survey was conducted at Respondent’s facility. At this survey, the above- listed deficiencies remained uncorrected. 20. Based on record review and interview, Respondent failed to ensure that a complete nursing assessment was conducted at least monthly for one resident receiving limited nursing services. The findings include: Resident record review for resident #2 revealed that the resident had received LNS in the month of July for Epson salt soaks and dressing changes to left foot. Further review revealed that the July nursing assessment was not available. The administrator and DON confirmed that an assessment had not been conducted. Per nurse's notes, resident #1 received wound care treatment to skin tears to right arm during August. Resident received treatment to skin tears to left hand, assessment and removal to sutures to right eyebrow and treatment to skin tears to right shin during the month of September. Nursing assessments dated 8/28 and 9/21/02 do not address the resident's need for nursing services. 21. The above actions or inactions are a violation of Rule 58A-5.031(3) (c), Florida Administrative Code, which requires that a nursing assessment, conducted at least monthly, shall be maintained on each resident who receives a limited nursing service. 22. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility's residents. Pursuant to Section 400.419(1) (c), Florida Statutes, the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT III RESPONDENT FAILED TO ENSURE NURSING PROGRESS NOTES ARE MAINTAINED FOR EACH RESIDENT WHO RECEIVES LIMITED NURSING SERVICES IN VIOLATION OF Fla. Admin. Code R.58A-5.031(3) (b) (2002) UNCORRECTED CLASS III DEFICIENCY 23. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 24. On or about June 10, 2002, a survey was conducted at Respondent’s facility. 25. Based on record review and interview, Respondent failed to ensure that nursing progress notes are maintained for residents receiving limited nursing services. The findings include: Record review for resident admitted on 4/10/02 revealed a physician's order dated 5/30” apply elastic stocking, brace to left foot Q AM, remove Q PM". Nurse's note dated 4/30 "Brace wrong between toes, red areas bottom of left foot, wife upset". Note dated 5/26 "faxed order for LNS with leg brace”. Administrator stated that the staff was applying the brace, but it was not until 5/30, that the facility realized that resident needed to be identified as receiving LNS and the proper notations documented. 26. Respondent was provided a mandated correction date of June 25, 2002. 27. On or about October 1, 2002, a follow-up survey was conducted at the facility. At this survey, the above-listed deficiency remained uncorrected. 28. Based on record review and interview, Respondent failed to ensure that nursing progress notes are maintained for residents receiving limited nursing services. The findings include: Resident record review for sampled resident #1 revealed the following: 9/3/02 -physicians order for wound care daily to skin tears to left arm. No notes are available to document services provided on 9/5/02 and 9/6/02. Record review for sampled resident #2 revealed the following: 7/12/02- a physician's order for the application of bandages (wrap) to left knee for gout/cellulitis, no nursing notes are available. 8/9/02- wound care order, twice daily for a decubitus on the right big toe. Nurse's notes dated 8/15/02 and 8/18/02 document treatment provided only once. No written documentation is available to verify that services were rendered 8/22/02. 8/29/02- new wound care orders obtained- continue soaks to right foot- lukewarm water and Epson salt x 15 min. daily for 3 weeks, toe- continue Bactroban twice daily x 3 weeks. Nurse’s notes unavailable for 9/8/02. 9/12/02- orders to continue soaks for 2 weeks. No nurse's notes are available for 9/16/02 and 9/23/02. 29, The above actions or inactions are a violation of Rule 58A-5.031(3) (b), Florida Administrative Code, which requires that nursing progress notes shall be maintained for each resident who receives limited nursing services. 30. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (ec), Florida Statutes, the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration requests the Court to order the following: 1. Make factual and legal findings in favor of the Agency on Count I, Count II, and Count III; 2. Impose a fine in the amount of one thousand five hundred dollars ($1,500) for the violations cited in Count I, Count II, and Count Iil against the Respondent pursuant to Section 400.419(1) (c), Florida Statutes; and 3. Any other genera] and equitable relief as deemed appropriate. The 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 (one page) and Election of Rights (one page). All requests for hearing shall be made to the attention of Katrina D. Lacy, 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, Katrina . Lac AHCA - senion Attorney Fla. Bar No. 0277400 525 Mirror Lake Drive North, St. Petersburg, Florida 33701 Hale fates I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished via U.S. Certified Mail Return Receipt No. 7002 2030 0002 7117 6321, to CT Corporation System, Registered Agent for Alterra Healthcare Corporation, 1200 South Pine Island Road, Plantation, FL 33324, on December Lhe, Hi Tieaiis Si Ce Katrina D. Lacy, sqaure 2002. Copies furnished to: CT Corporation System Registered Agent for Alterra Healthcare Corp. 1200 South Pine Island Road Plantation, Fl 33324 (Certified U.S. Mail) Irene Byron, Administrator Alterra Clare Bridge of West Melbourne 7199 Greensboro Drive Melbourne, FL 32904-1432 (U.S. Mail) Katrina D. Lacy AHCA - Senior Attorney 525 Mirror Lake Drive Suite 330G St. Petersburg, Fl 33701 10

Docket for Case No: 03-000171