Pa PE gm on ia, STATE OF FLORIDA te AGENCY FOR HEALTH CARE ADMINISTRAFIOBL 31 py \ AGENCY FOR HEALTH CARE STR A: 7 ADMINISTRATION, RIM GS. vp Petitioner, vs. Case Nos. 2002016661 AVANTE AT ORLANDO, INC., Ei ; Respondent. / oxebla W di ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafte~ Agency), by and through the undersigned counsel, and files this Administrative Complaint against AVANTE AT ORLANDO, INC (hereinafter Avante), pursuant to Section 120.569, and 120.57, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine against Avante in the amount of $2,500.00 based upon a cited isolated State Class II deficiency requiring Avante to provide necessary care and services to each resident. 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 all 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; Chapter 59A-4 Fla. Admin. Code, respectively. 4. Avante operates a 118-bed nursing home located at 2000 North Semoran Boulevard, Orlando, Florida, 32807, and is licensed as a skilled nursing facility, license number SNF1393096. 5. Avante 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. § 483.13(c), the facility must develop and implement writter: policies and procedures that prohibit mistreatment, neglect, and abuse of residents ancl misappropriation of resident property. 8. On January 31, 2002, the Agency conducted a complaint survey of Avante. 9. During that survey, based on observation, interview, and record review, the facility neglected to provide care to 1 of 3 sampled residents (#1). Findings: Resident #1 was admitted to the facility on 01/09/02 with diagnoses of status-post Hypothermia, status-post metabolic Acidosis, Insulin Dependent Diabetes Mellitus, and Hepatitis C. Review of the nursing admitting assessment revealed documentation of a "large open area coccyx". Admitting nurses note, dated 01/09/02, documented "Pt. has open area to coccyx." Nurse's note on 01/15/02 at 9:00 AM indicated "ARNP... in to see pt." Note at 10. 15:00 PM stated "appt for Wound Care Center at 0915 on 1/16/02." The next nurse's note, dated 01/16/02 at 5:00 AM documented "duoderm applied to res. coccyx." A total of seven (7) days passed before the facility provided treatment to the open area on the resident's coccyx. Initially also failed to document the size of the open area on the coccyx upon admission of the resident. Physician's progress note, dated 01/15/02, documented "skin breakdown - stage II-III decubitus. Review of medical status from the hospital prior to admission to the facility, dated 01/07/02 and located in the resident's medical record, indicated a "soft black/purple wound intact on sacral area [approximately] 6 cm. X 6 cm. [with] irregular shaped margins.” Therefore, the facility had information concerning the status of the resident's skin prior to admission and had an incomplete assessment of the skin upon admission and failed to provide care to the open area, which was documented in the medical record. Observation of the resident's coccyx area on 01/31/02 at 11:25 AM revealed the following: 4.5 cm length X 4.2 cm. width X 0.5 cm. depth with 3.8 cm. long yellow slough in the center of the open area, Stage III. Interview with staff on 01/31/02 revealed the facility failed to provide care to the open area on the resident's coccyx for six days. This observation was cited as an isolated, State Class II deficiency and was to be corrected by February 1, 2002. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500.00 against Avante, 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. 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 attention of: Lealand McCharen, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 922-5873. 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. a Respectfully submitted this_<* % _ day of June, 2003. Vane L£) Liege Wayne ight Fla. B fs 0136440 Counsel for Petitioner Agency for Health Care Admin. 525 Mirror Lake Drive, 330 L St. Petersburg, FL 33701 727.552.1435 (office) 727.552.1440 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by USS. Certified Mail Return Receipt No.7002 0510 0003 3404 1518 on June 26° 5 2003 to: Administrator, Avante at Orlando, Inc., 2000 North Semoran Boulevard, Orlando, Florida 32807 and U.S. Mail to Corporation Service Company, Registered Agent, 1201 Hays Street, [ allahassee, Florida 32301. Be Knight Copies furnished to: Corporation Service Company Registered Agent for Avante 1201 Hays Street Tallahassee, Florida 32301 (U.S. Mail) Administrator Avante at Orlando, Inc., 2000 Semoran Boulevard Orlando, Florida 32807 (U.S. Certified Mail) Wayne D. Knight Agency for Health Care Administration 525 Mirror Lake Drive, 330L St. Petersburg, Florida 33701

Docket for Case No: 03-002812