STATE OF FLORIDA Ig AGENCY FOR HEALTH CARE ADMINISTRATION On Pry 1 bY TS AGENCY FOR HEALTH CARE i IST ADMINISTRATION, A ini aa Petitioner, AHCA No.: 2003004532 AHCA No.: 2003003531 v. Return Receipt Requested: 7002 2410 0001 4236 8598 JACKSON PLAZA, INC., d/b/a JACKSON 7002 2410 0001 4236 8581 PLAZA NURSING & REHAB CENTER. 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 Jackson Plaza, Inc., d/b/a Jackson Plaza Nursing & Rehab Center (hereinafter “Jackson Plaza & Rehab Center”), 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 $3,000.00 pursuant to Section 400.23(8), Fla. Stat. (2002), fer the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Jackson Plaza Nursing & Rehab Center, pursuant to Section 400.23(7) (bo), Fla. Stat (2002). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2002), and Chapter 23-106, FVA.C. 4. Venue lies in Miami-Dade County, pursuant to Section 400.121(1)(e), Fla. Stat. (2002), and Rule 28- 106.207, Florida Administrative Code. PARTIES 5. AHCA is the regulatory authority respons:ble 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. 6. Jackson Plaza Nursing & Rehab Center is a 129-bed skilled nursing facility located at 1861 N.W. gt" Avenue, Miami, Florida 33136. Jackson Plaza Nursing & Rehab Center is licensed as a skilled nursing facility; license number SNF12550°6; certificate number 10315, effective 05/21/2003 through 12/31/2003. Jackson Plaza Nursing & Rehab Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required tc comply with all applicable rules and statutes. 7. Because Jackson Plaza Nursing & Rehab Center 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 JACKSON PLAZA NURSING & REHAB CENTER FAILED TO REDUCE THOSE PRACTICES TO PREVENT THE SPREAD OF FOOD BORNE ILLNESS TITLE 42, SECTION 483.35(h) (2) CODE OF FEDERAL REGULATIONS, INCORPORATED by RULE 59A-4.1288,F.A.C. (DIETARY SERVICES) CLASS III DEFICIENCY 8. CA re-alleges and incorporates paragraohs (1) through (7) as if fully set forth herein. 9. During the Licensure Re-certification survey conducted 4/15-17/03 and based on observation, and record review the facility failed to reduce those practices to prevent the spread of food borne illness, which may result in food contamination and compromised food safety for nursing home residents. 10. The following was observed during the initial tour of the kitchen at 9:15 am on 4/15/03: {a) The ice scoop holder was observed to have bio-growth on the bottom of the unit. The bio-growth may contaminate the ice scoop and the ice that comes into contact with the scoop increasing the risk of food-borne illness in residents. (ob) Staff member #1 was observed washing equipment in the 3-compartment sink. Staff member #2 who was placing soiled dishware in the dishwasher called to the first staff member to assist him with the clean side. Without washing his hands staff member #1 individually handled the resident's plates and stacked them onto a cart, potentially cross-contaminating the clean dishware. ‘This was observed in the presence of the food service director. (c) Staff member #1 was observed washing equipment in the 3-compartment sink. The staff member washed the items, immersed them in water and then immersed them in the sanitizer for approximately one second. However, the staff did not follow manufacturer's directions since based on the directions the equipment should be immersed from 1 to 2 minutes for adequate sanitation. il. The following was observed during the comprehensive tour of the kitchen on 4/16/03 starting at 11:00 am: (a) The cook was observed throwing away eggshells with his hands into the garbage while holding the whole eggs on cardboard in his other hand. The cook then pulled a piece of aluminum foil and held it (still holding the whole eggs), then stirred the eggs with a spatula (the ones that he had previously cracked), then pulled a pair of gloves to put on. The food service director stopped him and while he was talking the cook put down the whole eggs and proceeded to wash his hands. The cook turned off the faucet prior to pulling the paper towels down, recontaminating his hands. The cook risked contaminating all foods being handled as he prepared for the resident lunch line by handling the cracked eggshells. Based on the FDA (food and drug administration) "fresh eggs may contain Salmonella Enteritidis, which may cause intestinal infections. Most people recover from these infections from 4-7 days, but they can lead to severe and even fatal illness, especially for those more vulnerable to food borne disease, young children, the elderly and persons with immune systems weakened by to health problems." (b) An aqua colored cutting board was observed leaning on top of the water faucet by the steam table. Observation of the cutting board disclosed discoloration indicative of bio-growth. The food service director discarded the board when it was brought to his attention. Use of this cutting could contaminate the food items that are cut cn the board, with potential development of food- borne illness in residents. (c) Temperatures were taken using a calibrated thermometer of the cold potentially hazardous food items on the first resident cart prior to leaving the kitchen. The temperature of the first carton of 8-ounce milk (first tray) had a reading of 55 degrees Fahrenheit (F); tae next five containers of whole milk had a reading of 50 degrees F. One thickened milk had a reading of 46 degrees 7. Cold food (potentially hazardous) should leave the kitchen at 41 degrees F or below. Correction date: 5/17/03 12. During the follow up visit conducted on 5/21/03 and based on observation, interview and record review the facility failed to maintain the ice scoop in sanitary condition and ensure proper air-drying of food service eguipment to retard bacterial growth. Findings include: During an initial tour of the kitchen on 5/21/03 at approximately 10:00am the following observations were made: (a) The clear plastic ice SCOOp was removed from its container and found to have black residue on the inside surface. This was shown to a staff member who acknowledged that it was soiled and returned it to the three-compartment sink area to be washed and sanitized. (b) Two plastic bins used for food preparation were seen to be stacked together upside down on the storage rack. The bins were found to be wet when pulled apart and not allowed to properly air dry. 13. During the second observation of the kitchen on 5/21/03 at approximately 11:45am the following observations were made: (a) At least 25 dish covers or domes were taken from the clean side of the dish washing machine and stacked on a cart abutting the tray line while still wet énd not properly air dried. (b) At least 25 to 30 plates were taken from the clean side of the dish washing machine and stacked in the plate lowerator without being air-dried. There were visible droplets of water on the surface of the plates. When this was called to a staff member’s attention the staff member said it was okay because the heat would dry them. Hcwever, the plates were seen to extend at least five to six inches above the inside of the lowerator and were not exposed to any heat. (c) Review of the mechanical dish machine policy reveals that instructs staff to, “Allow all dish washed items to be air dried before placed in service". 14. Not allowing for adequate air-drying of food service equipment promotes the growth of bacteria and may lead to food borne illness. 15. Based on the foregoing, Jackson Plaza Nursing & Rehab Center violated Title 42, Section 483.35(h) (2), Code of Federa. Regulations as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified an uncorrected Class III deficiency pursuant to Section 490.23(8) (c), Fla. Stat., which carries, in this case, an assessed fine of $3,000.00 This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (9). DISPLAY OF LICENSE Pursuant to Section 400.23(7)(e), Florida Statutes, Jackson Plaza Nursing & Rehab 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. The Conditional License is attached hereto as Exhibit MAY 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 $2,000.00 against Jackson Plaza Nursing & Rehab Center on Count I. Cc. Assess and assign a conditional license status to Jackson Plaza Nursing & Rehab Center in accordance with Section 400.23(7) (b), Florida Statutes. 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 (2002). 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, Building 3, Mail Stop #3, Tallahassee, Florida 32308, attention Lealand McCharen, 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. —— Nelson E. Rodney / Assistant General Counse Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Lopez Castillo Field Office Manager Agency for Health Care Administration 8355 N.W. 53° Street Miami, Florida 33166 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) EXHIBIT “A” Conditional License License No. SNF1255096 Certificate No. Effective date: 05/21/2003 Expiration date: 12/31/2003 il 10315 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished U.S. Certified Mail, Return Receipt Requested to Michele Merilus, Administrator, Jackson Plaza Nursing & Rehabilitation Center, 1861 N.w. 8t Avenue, Miami, Florida 33136, and to William Zubkeff, Registered Agent, 320 Collins Avenue, Miami Beach, Florida 33139 on Ni 4 at , 2003. Nelson E. Rodney >

Docket for Case No: 03-002958