STATE OF FLORIDA ele ED AGENCY FOR HEALTH CARE ADMINISTRATION 03 APR 28 PH 4: 32 AGENCY FOR HEALTH CARE ADMINISTRATION, i Petitioner, vs. Case Nos. 2003000200 SEMINOLE MERIDIAN LIMITED PARTNERSHP, O47 19 OD d.b.a. ISLAND LAKE CENTER, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against SEMINOLE MERIDIAN LIMITED PARTNERSHIP, d.b.a. ISLAND LAKE CENTER (hereinafter Island Lake), pursuant to §§ 120.569, and 120.57, Fla. Stat., (2002), and alleges: NATURE OF THE ACTION This is an action to change Island Lake’s licensure status from Standard to Conditional, commencing 12/12/02 and ending 02/03/03, and to impose an administrative fine in the amount of $5,000.00 based upon its one cited State Class II deficiency requiring Island Lake to provide the necessary care and services to promote the healing of existing pressure ulcer, to prevent infection, and prevent a new avoidable house acquired pressure ulcer from developing. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Fla. Stat. 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory agency responsible for licensure of nursing homes and enforcement of applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended); Chapter 400, Part II, Florida Statutes, and: Fla. Admin. Code R. 59A-4, respectively. 4. Island Lake operates a 120-bed nursing home located at 155 Landover Place, Longwood, Florida, 32750, and is licensed as a skilled nursing facility, license number SNF13460963. 5. Island Lake was at all times material hereto, a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Pursuant to 42 C.F.R. § 483.25(c), Island Lake must ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. 8. On or about December 12, 2002, the Agency conducted a complaint survey of Island Lake. 9. Based upon observations, staff interviews, and clinical tecord reviews, the facility failed to provide the necessary care and services to promote the healing of existing pressure ulcer, to prevent infection, and prevent a new avoidable house acquired pressure ulcer from developing for three (3) of six (6) sampled residents (#’s 1, 2 & 5). 10. Resident # 2 was identified on 12/12/02 at 10:25 AM, by the Unit Manager on the First floor as having a healed House Acquired Pressure Ulcer. The resident was observed positioned on his/her back throughout the tours and in the same position for a period of two and one half hours. ll. During pressure ulcer and skin observation, on 12/12/02, at 1:40 PM, the resident was observed lying on an incontinence pad, saturated with urine. The resident was confirmed to have a new stage II pressure ulcer on the right buttock that was red with a small open area in the center, non-blanchable, and was untreated at that time. 12. During an interview with a nurse, conducted on 12/12/02, at 1:40 PM, regarding pressure ulcer treatment and the facility’s knowledge of a new/reopened pressure ulcer on the right buttock, the nurse stated: “the pressure ulcer was signed on the treatment sheet as healed on 12/11/02 and last treatment signed to be given on 12/8/02, I will call to get a new treatment order to restart the treatment.” Observations confirmed the presence of a new house acquired pressure ulcer that measured .5 x .5 centimeters (cm) with a small opening in the center of the area, and was red and non-blanchable. The facility failed to identify the new pressure ulcer until 12/12/02 during the requested observations of skin assessment. 13. This failure to identify the new pressure ulcer placed the resident at risk for further development and/or improper healing of pressure ulcer. 14. Medical record review documented Resident # 2’s Minimum Data Set (MDS), dated 10/12/02 and 7/16/02 identified the resident as being without pressure ulcers. The first stage II house acquired pressure ulcer on the right buttocks was dated 12/2/02. The resident was coded as severely impaired for cognitive skill/decision making and total care, and dependant on staff for all activities of daily living. 15. Interviews were conducted with the Director of Nursing, Unit Manager, Certified Nursing Assistant (CNA), and wound nurse, on 12/12/02 at 2:00 PM, and again on 12/12/02, at 7:00 PM, with the Administrator also present during which the Staff confirmed the facility failed to properly monitor the care and services provided to Resident # 2. 16. The facility did not reposition the resident every two hours as documented 12/1/02 to care and treat this resident. 17. Resident # 1 was identified by the nurse on the Second floor, on 12/12/02 at 10:00 AM, as having a history of stage II and ITI pressure ulcers on the coccyx. The resident was observed positioned on his/her back throughout the survey tours. Further observations during random tours and times on 12/12/02, revealed the resident lying on his/her back in the same position for three hours. 18. An interview on 12/12/02 at 12:15 PM, with the Certified Nursing Assistance (CNA) of who is the assigned staff for resident #1, the CNA stated “I don’t have that resident today.” The assigned CNA was asked about the resident remaining in the same position for this length of time. The CNA stated: “this is my first day and the other CNA's told me to wait until the afternoon for the resident to get up when the family visit, but you are right to say, even if the resident is not getting out of bed, the resident should at least be repositioned.” 19. Further interview with the nurse was conducted on 12/12/02, at 1:00 PM, regarding: pressure ulcer treatment, assessment and the facility’s knowledge of the resident being observed in the same position, and the odor of feces. The nurse stated: “the resident was changed, I know at 12:30 PM.” When asked why the resident after being cleaned and changed was placed in the same position on his/her back, the nurse stated: “I don’t have an idea why the CNA's would replace the resident in the same position and not change the position.” 20. During skin observation, on 12/12/02 at 1:20 PM, the resident was observed lying in bed in a diaper full of a large stool. The resident was confirmed to have a stage III pressure ulcer on the coccyx at that time. During the observation of the pressure ulcer and wound care, the nurse was observed to cleanse the area. When wiping the area, the nurse wiped the rectum area and with the same cloth, moved to clean the outer edge of the pressure ulcer. When brought to the nurse’s attention about improper technique, the nurse stated: “I know better than that.” 21. Review of the MDS, dated 11/21/02, indicated Resident # 1 was coded as severely impaired for cognitive skill/decision making and total care, and dependant on staff for all activities of daily living. 22. Interview was conducted with the Director of Nursing, Unit Manager, CNA, and wound nurse on 12/12/02, at 2:00 PM, and again on 12/12/02, at approximately 7:00 PM, with the Administrator also present. Staff confirmed the facility failed to properly monitor the care and services provided to Resident # 1. 23. These observations constitute an isolated, State Class II deficiency. 24. On, or about, July 11, 2002, Island Lake had been cited for a prior State Class II deficiency, which subjects it to doubling of the administrative fine. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $5,000.00 against Island Lake, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8) and 400.102, Fla. Stat., and assess costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. COUNT II 25. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 26. Based upon Island Lake’s one cited Class II deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400 or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Fla. Stat. WHEREFORE, the Agency intends to assign a conditional licensure status to Island Lake, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(7) commencing 12/12/02 and ending 02/02/03. Respectfully submitted this j><< tf day of March, 2 Gerald §% Pickett Fla. Bar. No. 559334 Agency for Health Care Administration 525 Mirror Lake Drive, 330 L St. Petersburg, FL 33701 727.552.1526 (office) 727.552.1440 (fax) DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Fla. Stat., Island Lake shall post the most current 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. 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 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 the Agency for Health Care Administration, Sebring Bldg., 330L, 525 Mirror Lake Drive, St. Petersburg, FL 33701, Attention: Gerald L. Pickett, Senior Attorney. 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail return receipt no: 7002 2030 0007 8499 0018 on March 25° , 2003 to: Administrator, Island Lake Center, 115 Landover Place, Longwood, Florida 32750 and U.S. Mail to C T Corporation System, Registered Agent for Islgnd Lake ter, J2 outh Pine Island Road, Plantation, Florida 33324. _ Copies furnished: Gerald L. Pickett Administrator, Island Lake Center 115 Landover Place Longwood, Florida 32750 (U.S. Certified Mail) C. T. Corporation System Registered Agent for Island Lake Center 1200 South Pine Island Road Plantation, Florida 33324. (U.S. Mail) Agency for Health Care Administration $25 Mirror Lake Drive, 330 K St. Petersburg, FL 33701

Docket for Case No: 03-001503