STATE OF FLORIDA De ES | AGENCY FOR HEALTH CARE ADMINISTRAFEON jp _ “4 PH 2: 55 STATE OF FLORIDA ACENCY FOR HEALTH CARE ADMINISTRATION, HEA AHCA No: soltshiehee | Petitioner, Return Receipt Requested 7000 1670 0011 4845 8592 vs. ZANT FLORIDA DEPARTMENT OF VETERANS O>% oO] 70 AFFAIRS, d/b/a ALEXANDER NININGER STATE VETERANS’ NURSING HOME, Respondent / a ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through undersigned counsel, and files this Administrative Complaint against Florida Department of Veterans Affairs, d/b/a Alexander Nininger State Veterans’ Nursing Home (hereinafter “Alexander Nininger State veterans’ Nursing Home”) pursuant to 28- 106.111, Florida Administrative Code (2001) (F.A.C.), and Chapter 120, Florida Statutes (hereinafter ‘Fla. Stat.”), and alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine against Alexander Nininger State Veterans’ Nursing Home in the amount of eleven thousand ($11,000.00) dollars pursuant to Section 400.23 Fla. Stat. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 3. venue lies in Broward County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4. AHCA is the enforcing authority with regard to nursing home licensure, pursuant to Chapter 400, Part Il, Fla. Stat. and Rule 59A-4 F.A.C. 5. Alexander Nininger State veterans’ Nursing Home is a nursing home located at 8401 W. Cypress Drive, Pembroke Pines, Florida 33025 and is licensed under Chapter 400, Part If, Fla. Stat., and Chapters S9n-4, F.A.C., license number SNF130471019. COUNT I ALEXANDER NININGER STATE VETERANS’ NURSING HOME FAILED TO PROVIDE THE NECESSARY CARE AND SERVICES TO MEET THE NUTRITIONAL NEEDS FOR ONE RESIDENT Title 42, Section 483.25, C.F.R., 59A-4.1288, F.A.C. (QUALITY OF CARE) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Because Alexander Nininger State Veterans’ Nursing Home 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. 8. During survey conducted on 7/13/02 and based on record review, observation and interview, it was determined that the facility did not provide the necessary care and services to meet the nutritional needs for one resident (#4) out of the five sampled residents. 9. Based on record review on 5/13/02, it was determined that resident #4 receives Hospice services and has diagnoses of Alzheimer's Disease, Seizure Disorder and Coronary Artery Disease. Resident #4 was admitted on 4/6/02, has a history of weight fluctuation, and had an admission weight of 184 lbs, height of 70 inches. Based on observations on 5/13/02 on the Delta wing at approximately 11AM, it was determined that resident #4 requires total care in all activities of daily living and is non- ambulatory. Further review of the clinical record revealed that on 4/9/02 the Dietitian recorded the initial nutrition assessment. This assessment summarized that the resident needed to be fed, oral intake varies, that nursing reported the resident needed a puree diet, and therefore, the Dietitian recommended a speech therapy evaluation. on 4/29/02, the next nutritional progress note documented that the resident's weight decreased by 14 lbs to 170 lbs, due to appetite varies 25% to 100% intake at meals. A recommendation was made by the Dietitian in this note for Ensure supplement twice daily to "help avoid rapid weight loss." It was also recommended by the Dietitian that another nutritional supplement "magic cup" be given at 2 PM and 8 PM to provide additional calories. Based on record review, review of the Medication Administration Record (MAR) and interview with nursing staff, it was determined there was no follow up on the recommendation for speech therapy nor nutritional supplements. on 5/9/02, the Dietitian wrote on the next nutritional progress note that on 5/8/02 further weight loss had occurred as evidenced by a weight of 152 lbs documented by nursing. In this note the Dietitian again re-recommended Ensure and Magic Cup twice daily, because the supplements were never ordered. In addition, a re-weight was also requested by the Dietitian due to the nursing documentation of a 32 lb weight loss. Continued record review on 5/13/02 by the surveyor and interview with nursing staff, revealed the re- weight was not done. Furthermore, the nutritional supplements nor the speech therapy evaluation were not ordered. 10. An interview with the Director of Nurses (DON) regarding this rapid weight decline on 5/13/02, revealed that resident #4 was on the "Nutrition at Risk/Wound Care Committee”, which the DON attended weekly, but the Dietitian had not attended. A review of these meeting minutes revealed that on the meeting dated 4/25/02, resident #4 was noted to have declined to 175 lbs (-9 lbs) by 4/22/02. However, no interventions were noted other than puree diet. one week later on 5/2/02, the meeting minutes, documented the resident had lost an additional 5 lbs and weighed 170 lbs (-14 lbs) on 4/29/02. The documentation on the minutes indicated "Magic Cup" between meals. The next meeting on 5/9/02 recorded that on 5/8/02 a weight of 152 lbs was obtained, with recommend Ensure twice daily and offer "Magic Cup" at 2 PM and 8 PM. At the surveyor's request on 5/13/02, resident #4 was weighed on the bed scale by staff at 2 PM and a weight of 157 lbs (-27 lbs) was obtained. The DON informed the surveyor that she would have the doctor come in STAT. At 3:15 PM the attending physician did an evaluation of the resident and documented that the resident's primary diagnosis of End Stage Alzheimer's Disease in this case is causing a "hyper metabolic state and weight loss despite adequate oral intake." At this time double portions at meals and supplemental feedings were ordered by the physician. 11. Further review of the interdisciplinary care plan revealed that resident #4 had not been identified as at risk for weight loss due to diagnosis of End Stage Alzheimer's Disease by facility staff. In fact, the only care plan for dietary/nutritional concerns had been documented on 4/11/02 with a problem recorded by the dietary manager as "Mechanically altered diet, puree due to chewing difficulties, DBW: 149-183 lbs, Wt. 184 lbs. There was no documentation that Hospice nor the Dietitian had participated in this care plan. The goal was identified as "Resident will consume meals as provided." Approaches included: "provide diet as ordered by M.D., Monitor wt. per facility protocol, Monitor food consumption per facility protocol." Even though resident #4 had sustained a rapid weight decline since admission, no other care plans were identified concerning nutritional status by the facility staff with the inclusion of Hospice staff. In addition, there was no update or revision of the resident's dietary care plan already in place. A review of the interdisciplinary summary dated 4/24/02 and signed by the DON, revealed the MDS coordinator had recorded the following: "weight at 175 lbs, as of 4/22/02, on 4/8/02 weight was 184 lbs, 4/15/02 was 180 lbs...will refer Lo R.D. to assess for need of recommendation for magic cups, resident is bedridden. 12. Based on the foregoing, Alexander Nininger Sate Veterans’ Nursing Home violated 483.25(c), C.F.R., incorporated by 59R-4.1288, F.A.C., herein classified as a Class Il! violation, which carries, in this case, an assessed fine of $5,000.00. COUNT II ADDITIONAL FINE UNDER SECTION 400.19(3), FLORIDA STATUTES 13. This facility had a Class II deficiency found in a survey completed on 3/27/02. Because the facility has had two Class Il deficiencies arising from separate surveys within a 60-day period they are subject to a 6-month survey cycle. The Agency, 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. PRAYER 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 Counts I and ITI. B. Assess an administrative fine of $11,000.00 against Alexander Nininger State veterans’ Nursing Home for the Class II violation in Count I, in accordance with Section 400.23(8) (b) and 400.19, Fla. Stat., and the survey fee according to Section 400.19(3), Fla. Stat. Cc. Award the Agency for Health Care Administration costs related to the investigation and prosecution of the case in accordance with Section 400.121(1), Fla. Stat., if costs are applicable, and D. 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 NW 53** street, Miami, Florida 33166; Alba M. Rodriguez, Assistant General Counsel. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted. Cb bn 2?) lat C i ia : Alba M. Rodriguez ‘ mi) Assistant General Counsel Agency for Health Care Administration 8355 NW 53 Street Miami, Florida 33166 (305) 499-2165 Copy to: Alba M. Rodriguez, Assistant General Counsel Agency for Health Care Administration Manchester Building 8355 NW 53°° Street Miami, Florida 33166 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Gloria Collins, Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Charles T. Bringle, Administrator, Alexander Nininger State Veterans’ Nursing Home, 8401 W. Cypress Dr., Pembroke Pines, Florida 33025, on t 5 Codekes, 2002 Cina 7 Bed a Alba M. Rodriguez 10

Docket for Case No: 03-000770