STATE OF FLORIDA AGENCY FOR HEALTH CARE Pas ADMINISTRATION, ane Petitioner, AHCA No.: 2003003175 AHCA No.: 2003002983 v. Return Receipt Requested: 7002 2410 0001 4236 8031 LOURDES-~NOREEN MCKEEN RESIDENCE FOR Or N55N GERIATRIC CARE, INC., d/b/a LOURDES- ae) NOREEN MCKEEN RESIDENCE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter referred to as “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Lourdes-Noreen McKeen Residence for Geriatric Care, Inc., d/b/a Lourdes-Noreen McKeen Residence (hereinafter “Sourdes-Noreen McKeen Residence”), pursuant to Chapter 400, Part II, and Section 120.60, Fla. Stat. (2002), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $10,000 pursuant to Section 400.23(8), Fla. Stat. (2002), for the protection of the public health, safety and welfare. 2. In this action is also imposed a $6,000.00 survey fee pursuant to Chapter 400.19, Fla. Stat. 3. This is an action to impose a Conditional Licensure status to Lourdes-Noreen McKeen Residence, pursuant to Section 400.23(7) (b), Fla. Stat. JURISDICTION AND VENUE 4, This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2002), and Chapter 28-106, F.A.C. 5. Venue lies in Palm Beach County, pursuant to Section 400.121(1) (e), Fla. Stat. (2002), and Rule 28-106.207, Florida Administrative Code. PARTIES 6. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Fla. Stat., (2002), and Chapter 59A-4 Florida Administrative Code. 7. Lourdes-Noreen McKeen Residence is a 132-bed skilled nursing facility located at 315 Ss. Flagler Drive, West Palm Beach, Florida 33401. lLourdes-Noreen McKeen Residence is l.censed as a skilled nursing facility; license number SNF1298095; certificate number 10109, effective 04/17/2003, through 11/30/2003. Lourdes-Noreen McKeen Residence was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. 8. Because Lourdes-Noreen McKeen Residence participates in Title XVIII or XIX, it must follow the certification rules and regulations found in Title 42 C.F.R. 483, as incorporated by Rule 59A-4.1288, F.A.C. COUNT _I LOURDES-NOREEN MCKEEN RESIDENCE EXPOSED RESIDENTS TO WATER TEMPERATURES THAT POSED A POTENTIAL BURN HAZARD TITLE 42, SECTION 483.25(h) (1) CODE OF FEDERAL REGULATIONS, AS INCORPORATED BY RULE 59A-4.1288, and rule 59A-4.133(16) (d), F.A.C. (QUALITY OF CARE) CLASS I DEFICIENCY 9. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 10. During the re-certification survey conducted 4/14/- 17/03 and Based on interview, review of facility water temperature logs, and testing of water temperatures in the residents bathrooms, it was determined that the facility exposed residents to water temperatures that posed a potential burn hazard. Findings include: (a) On April 14, 2003, at 10:01 a.m., during tour of the fourth floor (four West), the surveyor noted that the water in the bathroom sink of room 438 felt hot. The surveyor had to pull his/her hand away from the running water due to the pain that the hot water caused. The survey team was notified of the condition, and thermometers (3) were calibrated using ice water. The temperatures were checked from 10:21 A.M., until 10:43 A.M., in the resident’s rooms and the results were as follows (all temperatures are in degrees Fahrenheit): Room Temperature 438 131.0 440 133.5 433 134.6 470 125.2 464 129.2 338 134.7 341 135.7 339 136.9 333 132.3 334 136.4 240 134.6 234 132.3 241 123.3 233 126.8 (bo) The administrator of the facility was notified of the hot water temperatures, as was the director of maintenance. During interview at 11:00 A.M., it was stated by the director of maintenance that the facility has been having sporadic problems with hot water temperatures. It was also stated that temperatures would spike every now and then, but that they have been unable to pinpoint where the problem is. It is believed to be a bleed-back problem from hot to cold. The rooms were being monitored in a random fashion. Review of facility maintenance department daily rounds sheet, dated March 05, 2003, reveals a spike in temperature of the bathroom water temperature to 122 degrees Fahrenheit. On the third floor, room 372 was found to have a temperature of 121 degrees. On March 10, 2003, documentation from maintenance saows room 234 with a temperature of 134.7 degrees, room 334 at 128.0 degrees, and room 475 at 120.8 degrees. On March 17, 2003, documentation shows temperatures of 129.0 degrees in room 252, 121.0 degrees in room 352, and 127.0 degrees in room 452. The director of maintenance was asked what action was taken to identify and correct the problem, and it was stated that the maintenance staff were monitoring the temperatures. Documentation of the monitoring was provided. The problem was attempted to be identified by the maintenance during March 2003, but it was stated that the staff were unable to locate the problem. It was stated by the director of maintenance at 11:00 A.M. on April 14, 2003, that the temperatures would be lowered in the boiler to bring temperatures down. ll. The temperatures in the residents’ rooms were again checked starting at 12:46 P.M., and it was found that the temperatures were lowering as follows: (a) Room Temperature 241 120.3 240 119.1 234 119.6 233 19.4 338 117.6 341 116.5 339 17.6 333 117.0 334 116.8 438 117.8 433 17.1 12. After recalibrating the thermometers at 1:30 P.M., bathroom sinks in resident rooms were again checked for temperature starting at 2:26 P.M. The results were as follows (temperatures are in degrees Fahrenheit): Room Temperature 368 123.6 363 122.5 367 122.1 362 123.4 366 122.1 361 123.4 365 121.2 360 123.8 364 121.4 462 123.2 471 122.3 464 123.6 472 121.1 465 122.7 466 123.2 467 123.1 13. The administrator and director of maintenance were notified that the temperatures were rising again. Review of the residents that were housed in the affected rooms revealed that there were residents who were able to use the water faucets in their bathrooms. Most of the residents were confused with poor safety awareness, and were at risk of burns by the elevated temperatures. 14. On April 14, 2003, the Fire Protection Specialist surveyor remained at the facility and tested the hot water temperatures with the assistant administrator between $-5:30 pm. At this time, all hot water temperatures were below 120 degrees Fahrenheit. As the Fire Protection Specialist was departing, he observed a plumbing contractor vehicle arriving at the facility. 15. A review of the plumber's work order for the evening April 14, 2003 indicated that a valve was found to be partially failing causing the temperature differences. The valve was repaired, cleaned, assured for positive shutoff, and tested when placed back in service. Temperatures were reassessed by the survey team and found to be acceptable. Jeopardy was abated prior to the surveyors exiting the survey. 16. Based on the foregoing, Lourdes-Noreen McKeen Residence violated Title 42, Section 483.25th) (1), Code of Federal Regulations as incorporated by Rule 59A-4.1288 and S9A-4.133(16) (d), Florida Administrative Code, herein classified as a Class I deficiency pursuant to Section 400.23(8) (a), Fla. Stat., which carries, in this case, an assessed fine of $10,000. This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT II ADDITIONAL FINE UNDER SECTION 400.19(3), FLORIDA STATUTES 17. This facility had a Class I deficiency found in a Survey completed on 4/17/03 and is 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 $6,000.00, one-half to be paid at the completion of each survey. DISPLAY OF LICENSE Pursuant to Section 400.23(7) (e), Florida Statutes Lourdes-Noreen McKeen Residence 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. The Conditional License is attached hereto as Exhibit “A” CLAIM 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 Count I. B. Assess an administrative fine of $10,000 against Lourdes-Noreen McKeen Residence on Count I. Cc. Make factual and legal findings in favor of the Agency on Count II. D. Assess a $6,000 survey fee against Lourdes Noreen McKeen Residence on Count II. E. Assess and assign a conditional license status to Lourdes-Noreen McKeen Residence in accordance with Section 400.23(7) (b), Florida Statutes. EF. 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, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk. Telephone (850) 922-5873, RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. Assistant General unsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive, Suite 100 West Palm Beach, FL 33407 (U.S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (