STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, OS vs. AHCA NO: NINTH STREET HEALTH CARE ASSOCIATES, LLC, d/b/a HERITAGE HEALTHCARE & REHABILITATION CENTER, Respondent. ADMINISTRATIVE COMPLAINT MAGS -16¥ 2002048973 COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned coursel, and files this Administrative Complaint, against NINTH STREET HEALTH CARE ASSOCIATES, LLC, d/b/a HERITAGE HEALTHCARE & REHABILITATION CENTER, (hereinafter “Respondent”), pursuéent to Section 120.569, and 120.57, Florida Statutes (2002), ane. alleges: NATURE OF THE ACTION 1. This is an action to assign a conditional license to NINTH STREET HEALTH CARE ASSOCIATES, LLC, d/b/a HERITAGE HEALTHCARE & REHABILITATION CENTER, pursuant to Section 400.23(7), Florida Statutes (2002). A copy of the original conditional license is attached hereto as Exhibit “A” and incorporated herein by reference. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). 3. AHCA has jurisdiction pursuant to Chapter 400, Part II, Florida Statutes (2002). 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2002). PARTIES 5. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable Florida laws and rules governing skilled nursing facilities pursuant to Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 6. NINTH STREET HEALTH CARE ASSOCIATES, ULC, d/b/a HERITAGE HEALTHCARE & REHABILITATION CENTER, is a Florida = Limited Liability company with a principal address of 400 Perimeter Center Terrace, Suite 650, Atlanta, GA 30346. 7. HERITAGE HEALTHCARE & REHABILITATION CENTER is a 97- bed skilled nursing facility located at 777 - 9 Street North, Naples, Florida 34102. HERITAGE HEALTHCARE & REHABILITATION CENTER is licensed by AHCA as a skilled nursing facility having been issued license number SNF1224096 certificate number 9516, with an effective date of October 24, 2002 and an expiration date of November 30, 2002. 8. HERITAGE HEALTHCARE & REHABILITATION CENTER is and was at all times material hereto a licensed skilled nursing facility required to comply with Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I EFFECTIVE OCTOBER 24, 2002, AHCA ASSIGNED A CONDITIONAL LICENSURE STATUS TO HERITAGE HEALTHCARE & REHABILITATION CENTER BASED UPON THE DETERMINATION THAT HERITAGE HEALTHCARE & REHABILITATION CENTER WAS NOT IN SUBSTANTIAL COMPLIANCE WITH APPLICABLE LAWS AND RULES DUE TO THE PRESENCE OF THREE (3) CLASS II DEFICIENCIES AT THE MOST RECENT SURVEY OF OCTOBER 24, 2002. § 400.23(7) (b), Fla. Stat. 9. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. FIRST CLASS II DEFICIENCY 10. On or about October 24, 2002, AHCA conducted an annual survey at HERITAGE HEALTHCARE & REHABILITATION CENTER. A class II deficiency was cited against HERITAGE HEALTHCARE & REHABILITATION CENTER based on the findings below. 11. Based on the observations, staff interviews, anc record review, the facility failed to promote care for residents in a manner and in an environment that maintains or enharces their dignity or respect. 12. Specifically: (a) Review of the medical record on 10/23/02 for Resident #13 at approximately 2:30 P.M., revealed the resident having been admitted to the facility with multiple diagnoses including, not limited to, Intraspinal Abscess, Pre-Senile Depression, and Hypothyroidism. (b) The Minimum Data Set (MDS) dated 8/13/02 which was considered to be an "Annual Review", assessed the resident to be independent in her decision-making skills, and memory/recall ability tc be intact. The MDS did not reflect indicators of sad, depressed mood. (c) Interview with Resident #13 on 10/24/02 at 9:30 A.M., revealed the resident sitting in her wheelchair, verbalizing concerns of inability to ambulate and desire to participate in therapy. The resident requested clarification of her prior therapy treatment. The surveyor requested the treating therapist to speak with the resident regarding the resident's concerns. The therapist informed both the surveyor and resident that she "had 5 other people to treat." The therapist displayed lack of concern and attention to the resident's questions as indicated ky frequently interrupting the resident as she was speaking by stating, "Well, I won't remember all this" in a short, sharp tone which then brought the resident to tears. The therapist turned to the surveyor and in front of the resident stated, "She's known for this." The resident grabbed her tissue and began to sob. The resident stated to the surveyor, "you see, she's mad at me." The resident stated to the therapist, "I just don't want you mad at me, the therapist treated me before, I just wanted to know why you can't treat me now." The therapist replied to the resident in a direct manner, stating, "We've done all that we can. You just keep forgetting what we keep telling you. I feel we've tried our best, but you need to take it up with your Doctor." The resident became increasingly upset and began to sob. Her face was reddened, shoulders moving up and down. The resident grabbed another tissue and began to wipe her eyes and nose. Upon surveyor request, the therapist left the room to gather additional information. The resident stated to the surveyor that she felt very uncomfortable anytime she tries to talk to this therapist and continued to weep, stating, "She's very stern. She will not listen, and you will not change her mind. She's resentful ever since I went to another facility for therapy. Whatever she says goes. She just doesn't listen. I just won't say anything anymore, I'll be better off." (d) Interview with the Assistant Director of Nurses (ADON) on 10/24/02 at 11:45 A.M., confirmed the resident to receive an antidepressant medication anc. periodic counseling. The ADON stated that the resident did not have any psychiatric or delusional behaviors. The ADON confirmed that a care plan regarding mood was not addressed and would inform the Social Service Director of the resident's concerns regarding the Occupational Therapist and therapy services. (e) Observations of the lunch tray line 10/21/02, revealed trays were being set up with paper napkins. There were 3 bundles of silverware in cloth napkins observed on the tray line. Interview with tray line staff revealed, "Everyone gets paper napkins except those residents that try to 'eat' the paper napkins." (f) Observation on 10/21/02 at approximately 12:35 P.M., during lunch in the South 2 dining room, revealed all residents received paper napkins with their meals. Further observation revealed that Resident #21 did not receive any utensils or napkin with her meal when it was served to her at 12:38 P.M. A staff person said I will get you something to eat with. At approximately 12:40 P.M., he returned with utensils in a paper napkin and stated, "wait a minute, T'll get you a napkin." He then brought a cloth napkin to Resident #21. (g) Observation on 10/21/02 at approximately 12:45 P.M., during lunch on the first floor main dining room, revealed the tablecloths on two of the tables to be filled with holes. Three of the tables with tablecloths were varying in shades of color, giving the appearance of "bleach stains." Residents were sitting at each of these tables. (h) Observations of the table clothes in the first floor main dining room on 10/22/02 at 12:15 P.M., revealed several visible holes and discolorations. (1) Observation on 10/22/02 revealed none of the tables in the main dining rooms throughout the facility had tablecloths. (j) Interview with staff on 10/22/02 at 7:50 A.M., in the North 2 dining room, revealed "they never use table cloths at breakfast, only at lunch and dinner." (k) Interview with the Registered Dietitian at approximately 10:00 A.M., confirmed that the dining room tables should have tablecloths for all three meals. (1) During the initial tour of the facility on 10/21/02 at approximately 9:30 A.M., Resident #39 was observed with long dirty fingernails. Her fingernails were observed with encrusted dark color matter. The resident was also observed with long facial hairs. (m) During the initial tour of the facility on 10/21/02 at approximately 9:45 A.M., Resident #38 was observed with long dirty fingernails. 13. Based on the foregoing, HERITAGE HEALTHCARE & REHABILITATION CENTER violated Rule 59A-4.1288, Florida Administrative Code, incorporating by reference 42 CFR 483.15(a), and Section 400.022(1) (n), which require the facility to promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality, and the right to be treated courteously, fairly and with the fullest measure of dignity SECOND CLASS II DEFICIENCY 14. On or about October 24, 2002, AHCA conducted ar. annual survey at HERITAGE HEALTHCARE & REHABILITATION CENTER. A class II deficiency was cited against HERITAGE HEALTHCARE & R based on the findings below. REHABILITATION CENT ies 13. Based on the observations and staff interviews, the facility failed to provide a safe, functional, sanitary and comfortable environment. 14. Specifically, observations during facility tours from 10/21/02 through 10/24/02 revealed the following: (a) Room #102 - At the exterior wall the popcorn ceiling was damaged. Brown water marks running down the wall from the ceiling. Popcorn ceiling flaking, blackened areas behind the decorative border, which was furled away from the wall, pieces of spackling observed inside the air conditioning vent which was running, a bath blanket had been laid across the entire window sill which was moist, window sill was rusted. The baseboard and floor tile next to wall were not secured tightly, coming loose. The air conditioning vent contained a large amount of thick dust adhered to the vent panels. (b) Room #103 - At the exterior wall the popcorn ceiling was peeling away from the hard coat ceiling exposing a dark hole. Water was dripping from the upper window. The area above the window and between the walls had a rusty colored appearance. The decorative border was furling under, pulled away from the wall. Pieces of popcorn texture ceiling were falling into the running air conditioner below and could be seen through the air conditioning vent. Walls above the window were cracked, the windowsill was rusty, and the paint was chipping. (c) Room #104 - At the exterior wall the popcorn ceiling had a rusty tinge stain and was peeling from the hard coat wall. Watermarks were visible from the ceiling down to the wall. Pieces of popcorn texture ceiling were falling into the air conditioner and could be seen through the air conditioning vent. The metal shelf in the resident's bathroom above the sink had come loose and was dangling from the wall. (ad) Room #105 - At the exterior wall a large brown tainted area was visualized above the window. Pieces of textured ceiling were missing. The wall above the window was cracked. Pieces of popcorn texture ceiling were falling into the air conditioner and could be seen through the air conditioning vent. The window treatment was observed to have a thick line of dust at the top of the curtain. (e) Room #106 - The privacy curtain for the first bed was tied back with a plastic trash bag. (£) Room #107 - At the exterior wall the popcorr. ceiling was tainted a rusty-brown color. The popcorn ceiling was cracked and pieces of the popcorn-textured ceiling were observed in the air conditioning unit. (g) Room #108 - The privacy curtain for the first bed was observed to have large brown dried stains. At the exterior wall the popcorn ceiling was observed to have rust stains. Popcorn ceiling texture pieces were observed in the air conditioning vent. The air conditioning vent had a large amount of thick dust clinging to the vent panels. (h) Room #109 - At the exterior wall, the popcorn ceiling was flaking. Pieces of the ceiling were cracked. Popcorn ceiling textured pieces was visible in the air conditioning vent. (1) Room #110 - At the exterior wall, the popcorn textured ceiling was cracked, stained and peeling. The air conditioning unit was rusty. A bath blanket: had been placed on the windowsill to absorb the water that was leaking from the top of the window. The windowsill itself was cracked and the paint was chipped. The window treatment was covered with a large amount of dust. The room smelled musty. (5) Room #111 ~- Huge white matter was splattered across the resident's window. The exterior wall above the window was water stained. The popcorn ceiling above the window was water stained and the walls were eracked. The air conditioner had rusty vents. (xk) Room #112 - At the exterior wall the popcorn ceiling above the window was crumbling. The hard coat was pulling away from the wall. Pieces of popcorn- textured ceiling were observed in the air conditioning unit. (1) Room #113 - At the exterior wall by the window, it was observed the walls were cracked. The air conditioning vents were rusty and filled with a thickened gray matter. The resident's shower room floor had many missing and cracked tiles. A large brown hardened material was observed covering the shower floor. The resident's privacy curtain in between the beds was tied back with a plastic trash bag. (m) Room #115 - The window frame at the exterior wall was dry~-rotted. The wood above the air conditioner was "spongy" and cracked. Black material was observed above the top of the air conditioner on the wall. (n) Room #116 - At the exterior wall above the window the popcorn ceiling was missing in two areas whereby two ceiling holes were visible. A large pink- tinged stain was observed on the ceiling from the wall over to the head of the resident's bed. Water was observed dripping from the outside window. The inside window frame was cracked. The windowsill had chipped paint. The window treatment had a large amount of thick gray and white matter covering the top of the curtain, as well as the sides of the curtain. The privacy curtain by the first bed was tied back with a necktie. (o) The top of the doorframe, which housed the fire exit doors in front of Room 101, was missing. The internal wood that was visible was frayed and splintered, nails were exposed. Water stains were evident above the top of the door. The bottom of the doors was rusty with a large accumulation of dirt and debris. (p) The resident lounge area located on the first floor revealed the carpet by the window to be water Stained. A large area of carpet by the air conditioning unit had pieces of the popcorn ceiling, which had dropped, from the ceiling above the window. The window treatment had multiple brown stains on the panels, and the top of the curtain contained a thick layer of white popcorn material as well as dust. The drop ceiling tiles next to the left of the window treatment had large brown water stains. (q) Room #219 - At the exterior wall above the window the decorative border was furling under and falling down. The ceiling above the window was stained. The air-conditioning unit had thick layers of lint caked inside the vent panels. (x) Room #231 - At the exterior wall above the window the popcorn ceiling texture was crumbling. Chipped, flaking paint was observed above the air conditioning unit. The top frame of the windowsill was "spongy" and had cracked wood surrounding. Bubbled paint was observed to the left side of the frame, on the wall. The window treatment was coated with thick dust. Pieces of wood, chips of paint, and popcorn ceiling were observed inside the air conditioning unit. (s) The drop ceiling tiles above the nurse's station on 2 North had areas of brown water stains. (t) The drop ceiling tiles in the middle of the corridor on 2 North had multiple areas of water stains, some tainted brown. (4) Interview with the Corporate Regional Director and Administrator on 10/24/02 at approximately 10:30 A.M., confirmed the facility recognized the need to Administrative Code, incorporating by reference 42 CFR 483.70(h), and Section 400.141(8), Florida Statutes, which requires the facility to provide a safe, functional, sanitary and comfortable environment for residents, staff and the public. THIRD CLASS II DEFICIENCY 16. On or about October 24, 2002, AHCA conducted an annual survey at HERITAGE HEALTHCARE & REHABILITATION CENTER. A class II deficiency was cited against HERITAGE HEALTHCARE & REHABILITATION CENTER based on the findings below. 17. Based on the observations and interviews with two residents not identified because of confidentiality, the Respondent failed to maintain and implement written policies and procedures governing managing the facility in a safe and sanitary manner, by failing to maintain the facility premises and equipment and conduct its operations in a safe and sanitary manner. 18. Specifically, the facility failed to implement written policies and procedures governing managing the facility ina safe and sanitary manner that resulted in the following conditions: (a) Sixteen (16) residents' rooms had damaged ceilings and walls from leaking water. Residents expressed fears of falling ceilings and water on the floor. 12 continue renovations to the facility. The Regional Director stated that the "facility replaced several air conditioners downstairs, and had taken the older units upstairs. The facility needed to replace 33 additional air conditioners within the facility." He confirmed that the renovations began in June 2002. He further stated that, "the building definitely needed to be brought up to standard." The Regional Director could not provide a specific completion date for facility renovations. The Regional Director was aware that, although new air conditioners were replaced, the popcorn ceilings, torn borders, water stains, dirty air conditioners, cracked, rusted window sills, dusty and stained window treatments and curtains in the above mentioned rooms, were still prevalent. (v) Confidential interview of a resident on 10/22/02 at 11:00 A.M., revealed the resident pointing to the ceiling above her head, verbalizing, "I'm afraid to go to sleep at night. I'm afraid the ceiling is going to fall on my head." (w) Confidential interview of a resident on 10/24/02 at approximately 10:00 A.M., revealed the resident pointing to the floor by the air conditioning unit in her room. 5) She was pacing back and forth hurriedly, short of breath, brows furrowed, stating "Aqua, Aqua" and made a circle with her arms. She raised her foot to demonstrate a falling motion, pointing to the area below the air conditioning unit. She held onto the footboard of the bed, signifying her fear of falling from the leaks that came from the air conditioning unit. She continued to shake her head from side to side in a negative matter, stating "Aqua, Aqua." (x) Observation on 10/22/02 at 2:15 p.m., in the restorative dining room on the second floor revealec. that the table, where residents needing to rebuild their self-feeding skills are positioned, moved approximately 1-2 inches either way when checking its stability 15. Based on the foregoing, HERITAGE HEALTHCARE & REHABILITATION CENTER violated Rule 59A-4.1288, Florida il (b) There was dripping water from vents in hallways on the 2nd floor. (c) There was water dripping on clean linen in the laundry room. (ad) The facility kitchen was not maintained in a clean and sanitary condition 19. Based on the foregoing, HERITAGE HEALTHCARE & REHABILITATION CENTER violated Rule 59A-4.106(2), Florida Administrative Code, and Section 400.141(8), Florida Statutes, which requires the facility to implement and maintain written policies and procedures and governing managing the facility ina safe and sanitary manner. 20. AHCA assigned a conditional licensure status to HERITAGE HEALTHCARE & REHABILITATION CENTER based upon the determination that the facility was not in substantial compliance with applicable laws and rules due to the presence of three (3) class II deficiencies at the most recent survey on or about October 24, 2002. CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1) Make actual and legal findings in favor of AHCA on Count I; 2) Uphold the issuance of the conditional license with an effective date of 10/24/02, a copy of which is attached hereto as Exhibit “A”; and 3) Assess costs related to the investigation and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2002). DISPLAY OF LICENSE Pursuant to Section 400.23(7) (e), Florida Statutes, HERITAGE HEALTHCARE & REHABILITATION 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. NOTICE HERITAGE HEALTHCARE & 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 Michael P. Sasso, Senior Attorney, Agency for 14 Health Care Administration, 525 Mirror Lake Drive, #330K, St. Petersburg, Florida, 33701. RESPONDENT 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. Respectfully submitted on this /s™ day of January, 2003. Vccka lL lever Michael P. Sasso, Esquire Fla. Bar. No. 0167363 525 Mirror Lake Drive North, 330K St. Petersburg, Florida 33701 (727) 552-1435 (office) (727) 552-1440 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original Administrative Coraplaint and Exhibit “A” has been furnished via U.S. Certified Mai. Return Receipt No. 7002 2030 0002 7117 6383 to CT Corporation System, Registered Agent for Heritage Healthcare, 1200 South Pine Island Road, Plantation, Florida 33324 and a copy of the foregoing has been furnished via U.S. Certified Mail, Return Receipt No. 7002 2030 0002 7117 6390, to Laurence Reed, 15 Administrator, Heritage Healthcare, 777 - oO Street North, Naples, Florida 34102, on January [wr 2003. Michael P. Sasso, Esquire COPIES TO: CT Corporation System Registered Agent for Heritage Healthcare & Rehabilitation Center 1200 South Pine Island Road Plantation, FL 33324 (U.S. Certified Mail) Laurence Reed, Administrator Heritage Healthcare & Rehabilitation Center 777 — 9" Street North Naples, FL 34102 (U.S. Certified Mail) Michael P. Sasso, Esquire Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330K St. Petersburg, Florida 33701 Exhibit “A” CONDITIONAL LICENSE License # SNF1224096; Certificate #9516 Effective Date: 10/24/2002 Expiration Date: 11/30/2002

Docket for Case No: 03-001168