STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2003002357 v. Return Receipt Requested: 7000 1670 0011 4847 5740 GJS HOLDINGS, INC. d/b/a HALLANDALE 7000 1670 0011 4845 5757 REHABILITATION CENTER, 7000 1670 0011 4845 5801 Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“ACA”), by and through the undersigned counsel, and files this administrative complaint against GJS Holdings, Inc. d/b/a Hallandale Rehabilitation Center (hereinafter “Hallandale Rehabilitation Center”) pursuant to Chapter 400, Part I1, and Section 120.60, Florida Statutes, and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine totaling $5,000.00 pursuant to Section 400.23(8) (b), Florida Statutes for the protection of the public health, safety and welfare. a. The conditional license status issued previously under AHCA case number 2002047685 continues pursuant to Section 400 .23(7) (b). JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part II, Florida Statutes. 3. Venue lies in Broward County pursuant to Section Rule 28.106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing skilled nursing facilities pursuant to Chapter 400, Part Il, Florida Statutes and Chapter 59A-4 Florida Administrative Code. 5. Hallandale Rehabilitation Center operates a 141-bed skilled nursing facility located at 2400 East Hallandale Beach Boulevard, Hallandale Florida 33009. Hallandale Rehaoilitation Center is licensed as a skilled nursing facility. Hallandale Rehabilitation Center 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. COUNT I HALLANDALE REHABILITATION FAILED TO PROVIDE NECESSARY TREATMENT AND SERVICES TO PROMOTE HEALING AND PREVENT NEW SORES FROM DEVELOPING TO A RESIDENT WHO WAS ADMITTED TO THE FACILITY WITH A PRESSURE SORE. THE RESIDENT DEVELOPED 3 PRESSURES SORES AFTER ADMISSION THAT WERE AVOIDABLE. TITLE 42 SECTION 483.25(c) CODE OF FEDERAL REGULATION RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE (QUALITY OF CARE) CLASS II 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Because Hallandale Rehabilitation Center participates in Title XVIII or Title XIX, it must follow certification rules and regulations found in 42 Code of Federal Regulation 483. 8. Based on a complaint investigation that took place on March 17, 2003, AHCA surveyors determined that the facility did not provide the necessary care and services to promote healing and prevent new sores from developing to one resident. 9. Resident #2 was admitted to Hallandale Rehabilitation with one pressure sore and developed three more areas subsequent to admission that were avoidable. On the day cf the investigation, March 17, 2003, Resident #2 was noted to be in bec lying on his back with his eyes closed and the head of his bed elevated approximately 45 degrees. The resident was roted to have a tracheotomy. The resident's arms were at his side with both hands covered by a mitt. A pump with a feeding bag labeled Nutrivent at 70 cc/hr hung by the bed but the pump was not on and the tube feeding was not infusing. 10. Subsequent observations of the resident on 3/17/03 at 10:43 AM, 11:45 AM and 12:04 PM revealed the resident lying on his back. w 11. On 3/17/03 at 1:45 PM, the resident's family members reported to AHCA surveyors that they told the nurse at the nurse's station about ten minutes before that the xsesident's tube feeding pump was beeping and had turned off and that the nurse had still not shown up at the resident’s recom. The surveyor located the nurse assigned to the resident and asked if she was notified regarding a feeding pump beeping. The nurse admitted she had been told but expressed that she had been busy with another resident. 12. The nurse went to the room of Resident #12 and turned on the feeding pump. The pump began to beep, and the screen on the pump read "batt lo," and then shut off. The respiratory therapist and nurse observed that the electric plug to the pump was unplugged from the electric outlet. The DON was made aware of the observation and reported at 1:52 PM that even if not plugged in, the pumps can operate on battery (if kattery is charged). The 1000cc feeding bag hanging at the resident's bedside and connected to a pump was labeled Nutrivent at 70 cc/hr and that it was hung at 3 am. The DON revealed that only approximate.y 275 cc had infused into the bag by 1:45 PM. The amount of feeding that should have infused via the gastrostomy tube would have been approximately 750 cc since the bag was replaced at 3 am. The resident did not receive approximately 6 hours of feeding. 13. During the observation of the resident's wounds at 3/17/03 at 3:45 PM, the wound care nurse removed the sheet covering the resident's legs and revealed the resident's feet were placed on a pillow. The wound care nurse present during this observation revealed that the resident's legs were not properly positioned and should be "off loaded," so as to prevent further pressure to be placed on the resident's heels. The wound care nurse revealed that the resident had a stage I wound to the left heel measuring 3.5 in diameter and described it to have a "greenish black center with outside area red." A dark colored area was noted to the outer left heel, but the wound care nurse reported that she was not going to measure it, because "I'm not sure that's an area because it may just be stained by the accuzyme. I'll just monitor it over the next few days." The wound care nurse then measured an area to the left lateral ankle and described it as "..a darkened area, not open, measuring 2.1 x 1." The wound care nurse examined the right hip and reported that it used to be a blister, had improved as the fluid from the blister had been absorbed, but revealed that there was an increase in the amount of redness and measured the total area to be 9.9 XK 4.8. 14. The last area examined by the wound care nurse was the resident's sacral area, Upon removal of the resident's incontinence brief, a white thin material which the wound care wa nurse confirmed to be "toilet tissue" was noted covering the resident's wound. She confirmed subsequent to this observation that it was not protocol nor appropriate to cover any wound with toilet tissue. In addition, a black brown substance was noted on the right buttock of the resident. The wound care nurse reported that it appeared to be fecal matter that may not have been cleaned off adequately as the resident's incontinence brief did not contain any fecal matter. The wound care nurse assessed the sacral wound and revealed that the base of the wound was black with soft surrounding tissue - red. She continued to describe the wound to have minimal amount of bloody drainage and that she "should not be seeing this much eschar" indicating that the resident's wound was getting worse. The wound care nurse also reported that the resident usually will assist with turning and hold onto the opposite side rail when instructed, but the resident was not observed to follow any command during the observation of the resident's skin status. The following is a comparison of the latest wound measurements as compared to the admission of the resident on 3/4/03 and/or first observation: left inner heel (acquired in-house) 3/12 3.6 X 3.5 red area with purple center 3/17 3.5 X 3.5 area red with green black center right hip (acquired in house) 3/12 3X 2 area red blister 3/17 9.9 x 4.8 area red with loose skin 6 left lateral ankle (acquired in house) 3/12 0.5 X 0.4 dark brown in color 3/17 2.1K 1 dark area buttock center upper fold (on admission) 3/5 (on admission) 4X 1.7 X 0.2 wound bed pink with yeliow fibrin 3/17 9X 8.7 X 0.2 wound bed dark brown with surrounding area red 15. Review of the care plan identified on 3/4/03 which addressed the problem of "impaired skin integrity ...... stage II sacral area" had the goals of "existing open area will heal" and "existing area will be decreased in size." The left inner heel, left lateral heal, and right hip, were three new areas identified on 3/12/03. In addition, the open area to the sacrum identified on admission had not improved as of 3/12/03, but no evidence that the care plan was reviewed and/or revised to reflect the changes. 16. The wound care nurse reported on 3/17/03 at 4:15 PM that they have a weekly wound meeting where all resident with wounds are discussed. The notes from the last meeting on 3/13/03, documented that the development of the resident’s wounds to the right hip and ankle were reviewed, however, the staff nurse responsible for the revision of the care plans revealed that since the wound care nurse did not have the measurements for the wounds during the meeting on 3/13/03, she was going to update the care plan on their next scheduled meeting on 3/18/03. 17. The development of the new pressure sores and worsening of the pressure sore found on admission was avoidable. The facility did not consistently provide the necessary treatment and service to promote healing and prevent new sores from developing. 18. Based on the foregoing, Hallandale Rehabilitation Center violated 483.25(c), Code of Federal Regulation as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II violation pursuant to Section 400.23(8) (b), Florida Statutes, which carries an assessed fine of $5,000.00 (the fine is doubled pursuant to Section 400.23(8) (b)), Florida Statutes. Additionally, the conditional license status imposed by AHCA case number 2002047685 continues pursuant to Section 400.23(7) (b). WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Hallandale Rehabilitation Center on Count I. 2. Assess against Hallandale Rehabilitation Center an administrative fine of $5,000.00 on Count I for the violations cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4, Grant the conditional licensure status puxzsuant to Section 400.23(7) (b), Florida Statutes. 5. Grant such other relief as the court deems is just and proper on Count I. 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 Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308, Telephone (85) 922-5873 RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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. jew M. cece pe) Assistant General Counsel 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 E. tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (Interoffice Mail) Jean Lombardi Finance and Accounting Agency for Eealth 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) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Administrator, Hallandale Rehabilitation Center, 2400 E. Hallandale Beach Blvd., Hallandale, Florida 33009; GJS Holdings, Inc., 3370 N. W. 47 Terrace, Lauderdale Lakes, Florida 33319; Garson L. Lambert, 3370 N. W. 47 Terrace, Lauderdale Lakes, Florida 33319 on this ny day of August (leas 1. Kodugu Alba M. Rodriguez 10 2003.

Docket for Case No: 03-003092