Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: CYPRESS MANOR HEALTH CARE ASSOCIATES, LL, D/B/A CYPRESS COMMUNITY CARE CENTER
Judges: LAWRENCE P. STEVENSON
Agency: Agency for Health Care Administration
Locations: Fort Myers, Florida
Filed: Sep. 16, 2003
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Friday, November 7, 2003.
Latest Update: Dec. 26, 2024
Fal
STATE OF FLORIDA U2 be
AGENCY FOR HEALTH CARE ADMINISTRATION |
, ui
STATE OF FLORIDA, Niele
AGENCY FOR HEALTH CARE ADMINISTRATION, hi
Petitioner,
AHCA NO:2003004452
vs.
CYPRESS MANOR HEALTH CARE ASSOCIATES, LL,
d/b/a CYPRESS COMMUNITY CARE CENTER
Respondent.
ADMINISTRATIVE COMPLAINT
COMES NOW the Agency for Health Care Administration
(hereinafter “AHCA”), by and through the undersigned counsel,
and files this Administrative Complaint against CYPRESS MANOR
HEALTH CARE ASSOCIATES, LL, a/b/a CYPRESS COMMUNITY CARE CENTER,
(hereinafter “Respondent”) and alleges:
Nature of the Action
1. This is an action to impose a conditional licensure
status effective May 22, 2003 pursuant to Sections 400.23(7) (b)
and 400.23(8) (b). The original conditional license is attached
hereto as Exhibit “A”.
2. The Respondent was originally cited for two Class I
deficiencies during the six-month survey conducted on or about
May 19-22, 2003.
Jurisdiction and Venue
3. The Agency has jurisdiction over the Respondent
pursuant to Chapter 400, Part II, Florida Statutes.
4. Venue lies in Lee County, Division of Administrative
Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28,
Florida Administrative Code.
Parties
5. AHCA is the enforcing authority with regard to nursing
home licensure law pursuant to Chapter 400, Part II, Florida
Statutes and Rules 59A-4, Florida Administrative Code.
6. Respondent is a nursing home located at 7173 Cypress
Drive §.W., Fort Myers, Florida. The facility is licensed under
Chapter 400, Part II, Florida Statutes and Chapter 59A~4,
Florida Administrative Code.
COUNT I
EFFECTIVE MAY 22, 2003, AHCA ASSIGNED A CONDITIONAL LICENSURE
STATUS TO THE RESPONDENT BASED UPON THE DETERMINATION THAT THE
RESPONDENT WAS NOT IN SUBSTANTIAL COMPLIANCE WITH APPLICABLE
LAWS AND RULES DUE TO THE PRESENCE OF TWO (2) CLASS I
DEFICIENCIES AT THE MOST RECENT SURVEY OF MAY 19-22, 2003.
§400.23(7), Fl. Stat. (2002)
CLASS I
7. AHCA re-alleges and incorporates (1) through (6) as if
fully set forth herein.
8. An annual survey was conducted on May 19-22, 2003.
9. On that date, based on observation, interview and
record review, the facility failed to provide adequate
supervision and assistive devices for 5 (#21, #22, #24, #26, and
# 28) of 9 residents identified as lacking safety awareness with
smoking. The facility failed to remove smoking materials and
secure them as outlined in their facility Safe Smoking Screen
for 4 (#21, #26, #27 and #28) of 8 reviewed and 2 (#40 and #41)
random residents with a history of smoking in their rooms and/or
pocr safety awareness. This created a potential fire hazard for
all residents. This failure of facility practice placed all the
residents in the facility in danger of serious injury or death.
10. The findings of the surveyors include the following:
a. On 5/21/03 at approximately 3:30 PM Resident # 21
was observed in the center courtyard to self propel the
wheelchair to a table in the covered area of the courtyard
(gazebo). The wheelchair was positioned at the table facing
the east side of the building. One column from the gazebo
obstructed the view from the covered patio attached to the
activity room. The resident was not visible from this dark
screened enclosed patio adjacent to the courtyard. The
surveyor observed a staff person in the far right corner of
the screen-enclosed patio approximately 100 feet from the
resident.
b. The resident was observed to remove a cigarette
and a red lighter from a "fanny pack" attached to her
waist. The resident attempted to light a cigarette while
holding the lighter approximately 2 inches from the end of
the cigarette. This attempt was unsuccessful. The resident
was observed to try four more times to light the cigarette
in the same manner. The resident asked the surveyor for
assistance. Interview with the resident revealed the
resident has difficulty lighting cigarettes. Observation
during the interview revealed the resident had two small
dark areas on her left middle finger and one on the
fingernail. The resident was observed to hold the cigarette
between the left index finger and middle finger. When
questioned about the dark areas on her finger, the resident
stated, "they came from cigarette burns." Further
observation revealed the left pant leg from the thigh to
the knee had numerous scorch marks.
c. Record review revealed the facility Safety
Smoking Screen dated 3/10/03 indicated the resident needed
assistance to light her cigarette, did not demonstrate safe
use of a lighter due to slight right hemi paresis, must be
reminded to use the ashtray, has difficulty finding ashtray
due to impaired vision, cigarettes to be kept at desk with
lighter and the resident requires a smoking apron to be
worn.
d. Review of the MDS (Minimum Data Set) completed on
4/7/03 revealed the resident has moderately impaired
cognitive skills for daily decision-making and arn, hand,
leg and foot as partial loss limited to one side.
e. The Care Plan dated 10/15/02 revealed the
resident has a self care deficit, requires extensive assist
with most activities of daily living tasks due to CVA
(Cerebral Vascular Accident) with right sided weakness and
right sided visual loss. Further review of the Care Plan
revealed a potential for injury related to smoker- related
to limited motor skills with potential for burns to self
and clothing.
£. Observation of the resident room on 5/21/03 at
approximately 4 PM revealed the resident had a blue lighter
in the right corner of top drawer of the bedside table.
g. Interview with the Unit Manager of West Wing on
5/21/03 at approximately 4:10 PM revealed the resident
always carried her cigarettes and lighter on her person in
the "fanny pack". Further interview revealed the Unit
Manager was unaware of the approaches that were indicated
on the Smoking Safety Screen and in the Care Plan. The Unit
Manager identified 5 residents whose cigarettes were kept
at the Nurses Station in an unlocked drawer.
h. Further interview revealed the facility had a
staff assigned to the enclosed patio to assist residents
with lighting cigarettes. She further stated that staff
throughout the building were assigned to do this in 20-
minute intervals on the 7-3 and 3-11 shift. A copy of the
schedule was provided to the surveyors for the 3-11 shift
on 5/21/03.
1. At approximately 4:21 PM on 5/21/03, the
surveyors observed no staff present in the dark screened
enclosed patio or in the open courtyard. 6 residents were
observed in the smoking area. Resident #27 was noted to be
smoking in the enclosed area. Resident #24 was observed to
have a burn hole on the left pant leg. The surveyors left
the area at 4:33 PM. There was no staff observed to be
present in the smoking area from 4:21 PM to 4:33 PM. A
staff member was observed coming out of the building to the
outer courtyard and spoke to 2 residents and returned to
the building.
j- On 5/21/03 at approximately 4:45 PM the facility
Staff Development Nurse furnished the surveyors in-services
given to staff, on the facility smoking policies conducted
on 5/16, 5/17, 5/18 and 5/19. Attached to the in-services
were a group of safety smoking screens for residents in the
facility who were known to smoke.
k. The surveyors reviewed the facility in-service
given to staff on the above dates, the contents include;
Fire safety/procedures, Smoking in-service. The topics
covered in the smoking in-service were:
1. All resident have been assessed for smoking
safety.
2. The assessment drives the safety precautions
we must take for each resident.
3. There is a smoking assignment at each nurses
station, this assignment is where you will
find the time that you should report to the
patio to assist the smokers.
4. There is a list of the safety precautions that
need to be taken for each resident, located in
the blue and white box on the patio on the lid
--- THIS LIST MUST BE KEPT CONFIDENTIAL!!
5, Please follow the safety precautions as
listed. .
6. If the precautions are not being followed, for
any reason, please contact the Risk Manager.
1. Interview with the Risk Manager on 5/21/03 at
approximately 5:10 PM revealed a brief overview cf the
facility policy regarding smoking. She stated, "there is a
smokers box in the patio area which contains smoking aprons
and a list of smokers". She further stated that the
facility, using a smoking assessment tool, identifies
residents who need to have smoking materials kept by the
nurses. Those materials are locked in the med room and only
available to the nurses. She stated, "the facility has a
schedule for staff to be available to residents in the
courtyard. The staff rotates every 20 minutes from 7 AM to
11 PM." She also stated that she thought there was list of
those residents who smoke kept at the Nurses Station. She
was not aware there was a problem with the safety of the
smokers.
m. Because of the concerns for the safety of
residents at 5:30 PM the surveyors asked administrative
staff to provide them with an action plan for safety while
smoking.
n. At approximately 5:50 PM surveyors went to the
east and west wing to determine which residents required
assistance while they smoked. Interview with the Unit
Managers on East and West Wing revealed there was no list
of smoking residents at the Nurses Station.
oO. At approximately 6 PM the surveyors observed 11
residents in the center courtyard and the enclosed patio
area. There was no staff observed to be present. No
residents were observed to have smoking aprons on. Four
aprons were observed to be in the smoking area. Resident
#29, #28, #27, #26 and #25 were observed to be smoking in
the enclosed patio area. The surveyors went into the
building to elicit the help of the Activities person to
identify the residents.
p. At approximately 6:10 PM Resident #22 was
observed seated in her wheelchair facing a set of double
doors approximately 7 feet from the building. The resident
had a cotton-quilted lap robe on. A heavy layer of ashes
was noted to be covering the resident from just below the
neckline of her dress, on the cotton quilted lap robe and
extending to her knees. The resident had a purse wedged
between her body and the left side of the wheelchair. Ashes
were observed on the top portion of her purse. The resident
had her eyes closed and appeared to be sleeping. A staff
member came from the building to the courtyard, roused the
resident and asked if she could clean the ashes from her
person.
q. Record review of the Facility Smoking Screens for
residents who were further observed revealed the following:
Yr. Resident #22 had a Smoking Safety Screen
performed on 3/10/03 indicating the resident is rot safe to
independently smoke, is not safe to use a lighter, does not
use ashtrays appropriately, is unable to keep ashes from
dropping on self, is unable to extinguish a cigarette by
self, requires a smoking apron and a cigarette holder. The
resident was observed on 5/20/03 at approximately 11 AM to
be smoking unattended with no smoking apron and no
cigarette holder. Review of the MDS indicated the resident
is moderately impaired for cognitive skills for daily
decision-making, has partial loss of motion to hand, leg,
and foot which is limited to one side. A Care Plan dated
3/10/03 for potential injury with smoking related to
impaired cognition indicated the resident requires a
smoking apron, cigarette holder and smoking materials to be
kept at the nurses station.
s. Resident #24 had a Smoking Safety Screen
completed on 3/10/03 indicating the resident is unable to
smoke independently, does not demonstrate safe use of
lighter, does not demonstrate appropriate use of ashtray,
is unable to keep ashes from dropping on self, is unable to
extinguish a cigarette, requires a smoking apron and
smoking materials to be kept at nurses station. An MDS
dated 3/17/03 indicated the resident is moderately impaired
in cognitive skills for daily decision-making and partial
loss of motion to arm and leg, limited to one side. A Care
10
Plan dated 3/17/03 for potential for injury with smoking
related to impaired cognition indicated the resident
requires a smoking apron and smoking materials to be kept
at the nurses station.
t. Resident #25 had a Smoking Safety Screen
completed on 3/10/03 which indicated the resident had
episodes of smoking in room, can physically use lighter and
had episodes of ignition in room, smoking materials may be
kept on person and may smoke independently after cigarette
is lit by staff. An MDS dated 3/6/03 indicated the resident
has modified independence in cognitive skills for daily
decision-making. A Care Plan dated 3/12/03 for pozential
for injury when smoking related to poor coordination
indicated the resident requires assistance with lighter.
u. Resident #26 had a Smoking Safety Screen
completed on 3/10/03 indicating the resident is now
compliant with the Smoking Policy, however had episodes of
smoking in room and requires smoking materials kept at
nurses station. An MDS dated 4/30/03 indicated the resident
is independent in cognitive skills for daily decision-
making and, partial loss of motion to leg, limited to one
side. A Care Plan dated 4/30/03 for resident at risk for
smoking failed to include that smoking materials should be
stored at the nurses station.
ll
Vv. At approximately 6:10 PM Resident #26 wes
observed to be seated in a wheelchair which was positioned
with the back of the wheelchair toward the enclosed patio.
There was a package of cigarettes and a lighter in a tissue
box which the resident had on her lap. The resident had
just lit a cigarette.
w. Resident #27 had a Smoking Safety Screen
completed on 4/16/03 which indicated the resident is
instructed to keep cigarettes at the nurses station and is
able to smoke with minimal supervision. An MDS dated
4/30/03 indicated the resident is moderately impaired in
cognitive skills for daily decision-making. A Care Plan
dated 4/30/03 indicated non-compliance in all aspects of
facility life except for taking medications and snowers. A
Care Plan dated 5/5/03 indicated the resident is a smoker
and needs supervision for smoking safety.
x. During observation of resident #27 on 5/20/03 at
approximately 11 AM the resident was observed seated at a
table in the screened enclosed area with a pack of
cigarettes in her hand.
y. Resident #28 had a Smoking Safety Screen
completed on 5/1/03 indicating the resident requires
assistance with lighter, smoking materials to be kept at
nurses station, is able to smoke with minimal supervision
12
related to Parkinson's symptoms. An MDS dated 5/15/03
indicated the resident is moderately impaired in cognitive
skills for daily decision making, mental function varies
over course of day and partial loss of movement to foot,
limited to one side. A Care Plan dated 5/14/03 indicated
resident has changes in cognition from day to evening time
similar to Sundowners Syndrome. A Care Plan dated 5/19/03
indicated resident is a smoker, requires assistance with
lighter and supervision.
Z. Resident #29 had a Smoking Screen completed on
3/10/03 indicating the resident has memory loss, is
forgetful, cigarettes to be kept at nurses station, given 2
at a time, resident falls asleep, is non compliant with use
of ashtray and requires a smoking apron. An MDS dated
3/17/03 indicated the resident is moderately impaired in
cognitive skills for daily decision making, mental function
varies across the course of the day, partial loss of
movement of leg and foot and limited to one side. A Care
Plan dated 3/10/03 for potential for injury when smoking
related to poor safety awareness, falls asleep and non
compliant with use of ashtray. Observation in the closed
patio area at approximately 6:15 PM revealed resident #29
was seated in a wheelchair and staff assisted the resident
13
with lighting a cigarette. The staff member did not offer
the resident a smoking apron.
aa. At approximately 8:00 PM on 5/21/03 the facility
Administrative staff presented surveyors with a list of
residents they identified as needing supervision with
smoking. The facility also submitted an Immediate Jeopardy
Remedy for Smoking. The plan was as follows:
I. A full time monitor will be provided for
residents while in the designated smokirg area.
II. A designated smoking area will be provided
on the screened lanai for the smokers who need
supervision.
III. Supervised residents have been ideritified,
interviewed and smoking materials obtained and
stored in a smoking box, kept in the meclication
room when not in use.
IV. Education will be provided to these
residents regarding safe smoking guidelines.
Vv. Residents who have been identified at risk
for smoking in the building will have at least
every 15 minutes and continued re-enforcement to
use the designated smoking areas. Staff will
assure these checks by initialing the monitoring
sheets.
14
bb.
VI. Aprons will be provided for supervised
smoking residents to prevent burn holes to their
clothing and decrease risks associated with
smoking.
VII. All staff will be educated on the revised
policies regarding the designated smoking area,
identified supervised smoker, new smoking box,
smoking log and use of aprons for those
supervised smokers.
VIII. Staff will document the time that all
smokers are in bed, on the log and return to
their regular assignment, assuring they make
checks on smoking areas during their shift every
half hour.
The facility Administration on 5/21/03 at
approximately 8:10 PM stated staff conducted a sweep of the
rooms of residents whose Smoking Safety Screen indicated
that their smoking materials should be stored at the nurses
station.
This was done to ensure no smoking materials were
in those resident rooms.
ec.
At approximately 8:20 PM the surveyors left the
facility with the assurance that the facility would follow
their plan.
15
dd. On 5/22/03, at approximately 8:15 AM the
surveyors entered the facility and conducted an observation
of the designated smoking areas. A staff member was
observed to be in the area. A log containing staff
initials, including times, was reviewed, to ascertain the
ability of the facility to implement their plan from
5/21/03.
ee. On 5/22/03 at approximately 8:30 AM the
Administrator came to the surveyors and stated "he had
monitored staff in the facility for compliance with the
facility's new Smoking Plan from 3:00 AM until 5:30 AM". He
further stated, "the Regional Nurse Consultant and facility
Staf£ Developer were also in the facility from 6:30 AM to
present."
ff. On 5/22/03 at approximately 9:00 AM the surveyors
reviewed resident Smoking Safety Screens to determine those
residents identified by the facility who should have
smoking materials stored at the nurses station.
gg. On 5/22/03 at approximately 9:45 AM an
observation of the designated smoking area revealed a nurse
assisting Resident #22 with lighting her cigarette. The
resident was seated in a wheelchair in a slumped position.
The cigarette was noted to be ina holder in the resident's
mouth. Without adequate concern for safety, the tip of the
16
cigarette was approximately one inch from the resident's
clothing when it was lit. The nurse turned away from the
resident to reach a smoking apron and then placed the apron
on the resident.
hh. At approximately 10:00 AM (with resident:
permission) the surveyors requested staff to accompany them
on a tour of rooms of residents identified as hav-ng all
smoking materials stored at the nursing station. During the
tour the surveyors observed as the facility staff
discovered the following:
ii. Room 111 - Resident #28 had an unopened pack of
cigarettes in a bag located in her closet. The resident
stated "her family member had brought the bag in when the
resident was admitted" (5/1/03). The Nursing Assistant
removed the cigarettes and brought them to the East Wing
nurses station to have a nurse secure the cigarettes. The
facility Staff Development Nurse told the nursing assistant
"all smoking materials were to be kept at the West Wing
nurses station".
jj. Interview with the nursing assistant while
walking to the west wing revealed the nursing assistant
thought the smoking materials were to be kept on the unit
the resident resided on. Further interview revealed she
V7
had not attended the smoking in-services done on the
weekend as she was off.
kk. Room 226 - Resident #21 was observed to have a
functioning dark blue lighter in the right corner of the
top drawer in her bedside table. The nurse doing the tour
removed the lighter and brought it to the nursing station.
11. Room 210 - Resident #40 had a functional Scripto
long neck lighter (type used to start outdoor grills or
fireplaces) in the 2nd drawer of his bedside table.
mm. Room 218 - Resident #41 had a container of
Ronunol lighter fluid, 12 oz. size approximately half full
in ----- , a Zippo lighter, and loose tobacco in a Wal-Mart
bag. Review of this resident's Safety Smoking Screen
indicated the resident was independent to smoke, however
materials were to be kept at the nurses station.
nn. At approximately 10:50 AM a surveyor interviewed
the facility laundry staff. The staff confirmed residents,
#21, #22 and #24 had their laundry done by the facility so
any "holes" observed in resident's clothing who smoke, most
likely occurred while the resident was living in the
facility.
oo. On 5/22/03 at approximately 11:15 PM an interview
was conducted with the facility Staff Development nurse
regarding in-service about the new Smoking Policy. She
18
stated, "it had been completed during the evening of 5/21."
She further stated "I don't understand all the rooms were
searched last night and staff reported no smoking material
were at the bedside. I don't know where all this material
came from."
pp. The facility failed to demonstrate compliance
with their new Smoking Policy and adherence to their
submitted Immediate Jeopardy Plan. The facility failed to
demonstrate adequate supervision and assistance with
smoking for residents at risk with smoking and thereby,
endangered the health and safety of all residents in the
facility.
CLASS I
11. AHCA re-alleges and incorporates (1) through (6) as if
fully set forth herein.
12. An annual survey was conducted on May 19-22, 2003.
13. On that date, based on observations, record review,
staff and resident interviews, the Administration failed to
monitor and ensure implementation of the smoking policies in use
at the facility on 5/21/03. Also, the facility administration
failed to monitor the implementation of the revised smoking
policies put in place after 8:00 PM on 5/21/03 and was intended
to prevent potential harm for those residents identified at risk
for smoking issues, (Residents #21, #22, #24, #26, #27, #28,
19
#29, #40, #41) as well as the entire resident populaticn of the
facility. The failure of the administration placed all residents
in jeopardy to their health and safety.
14. The findings of the surveyors include the following:
a. Observations were made of smoking residents from
5/20-22/03. Residents identified by the facility as being
at risk were observed lighting their cigarettes without
supervision, no smoking apron on the residents, burn holes
in the resident garments, cigarette ashes coverine resident
and smoking supplies not located at the proper nursing
station areas. See F-324 for complete details.
b. On 5/21/03 at approximately 4:45 PM the facility
Staff Development Nurse furnished the surveyors in-services
given to staff on the facility smoking policies conducted
on 5/16, 5/17, 5/18 and 5/19. Attached to the in-services
were a group of safely smoking screens for residerits in the
facility who were known to smoke.
c. The surveyors reviewed the facility in-service
given to staff on the above dates, the contents include;
Fire safety/procedures, Smoking in-service. The topics
covered in the smoking in-service were:
1. All resident have been assessed for smoking
safety.
20
2. The assessment drives the safety precautions we
must take for each resident.
3. There is a smoking assignment at each nurses
station, this assignment is where you will find the time
that you should report to the patio to assist the smokers.
4. There is a list of the safety precautions that
need to be taken for each resident, located in the blue and
white box on the patio on the lid --- THIS LIST MUST BE
KEPT CONFIDENTIAL! !
5. Please follow the safety precautions as listed.
6. If the precautions are not being followed, for
any reason, please contact the Risk Manager.
d. Interview with the Risk Manager on 5/21/03 at
approximately 5:10 PM revealed a brief overview of the
facility policy regarding smoking. She stated, "there is a
smokers box in the patio area which contains smoking aprons
and a list of smokers." She further stated, "the facility
identifies smokers using a smoking safety screen,
identifies residents who need to have smoking materials
kept by the nurses and those materials are locked in the
med room and only available to the nurses." She stated,
"the facility has a schedule for staff to be available to
residents in the courtyard. The staff rotate every 20
minutes from 7 AM to 11 PM and thought there was list of
21
those residents who smoke kept at the Nurses Station." She
was not aware there was a problem with the safety of the
smokers.
e. At approximately 8:00 PM on 5/21/03 the facility
Administrative staff presented surveyors with a list of
residents they identified as needing supervision with
smoking. The facility also submitted a Immediate Jeopardy
Remedy for Smoking. The plan was as follows:
I. A full time monitor will be provided for
residents while in the designated smoking area.
II. A designated smoking area will be provided on the
screened lanai for the smokers who need supervision.
III. Supervised residents have been identified,
interviewed and smoking materials obtained and stored
in a smoking box, kept in the medication room when not
in use.
IV. Education will be provided to these residents
regarding safe smoking guidelines.
Vv. Residents who have been identified at risk for
smoking in the building will have at least every 15
minutes and continued re-enforcement to use the
designated smoking areas. Staff will assure these
checks by initialing the monitoring sheets.
22
VI. Aprons will be provided for supervised smoking
residents to prevent burn holes to their clothing and
decrease risks ass located with smoking.
VII. All staff will be educated on the revised
policies regarding the designated smoking area,
identified supervised smoker, new smoking box, smoking
log and use of aprons for those supervised smokers.
VIII. Staff will document the time that all smokers
are in bed, on the log and return to their regular
assignment, assuring they make checks on smoking areas
during their shift every half hour.
f. The facility Administration on 5/21/03 at
approximately 8:10 PM stated staff conducted a sweep of
resident rooms whose Smoking Safety Screen indicated that
their smoking materials should be stored at the nurses
station to ensure that all materials were not in those
resident rooms.
g. At approximately 8:20 PM the surveyors left the
facility with the assurance that the facility would follow
their plan.
h. On 5/22/03 at approximately 8:30 AM the
Administrator came to the surveyors and stated "he had
monitored staff in the facility for compliance with the
facility's new Smoking Plan from 3:00 AM until 5:30 AM."
23
He further stated "the Regional Nurse Consultant and
facility Staff Developer were also in the facility from
6:30 AM to present."
i. At approximately 10:00 AM the surveyors requested
staff to accompany them on a tour of resident rooms, who
had been identified as having all smoking materials stored
at the nursing station. During the tour the surveyors
observed the facility staff discover the following:
j- Room 111 - Resident #28 had an unopened pack of
cigarettes in a bag located in her closet. The resident
stated "her family member had brought the bag in when the
resident was admitted" (5/1/03). The Nursing Assistant
removed the cigarettes and brought them to the East Wing
nurses station to have a nurse secure the cigarettes. The
facility Staff Development Nurse told the nursing assistant
"all smoking materials were to be kept at the West Wing
nurses station".
k. Interview with the nursing assistant while
walking to the west wing revealed the nursing assistant
thought the smoking materials were to be kept on the unit
the resident resided on. Further interview revealed she
had not attended the smoking in-services done on the
weekend as she was off.
24
1. Room 226 - Resident #21 was observed to have a
functioning dark blue lighter in the right corner of the
top drawer in her bedside table. The nurse doing the tour
removed the lighter and brought it to the nursing station.
m. Room 210 - Resident #40 had a functional Scripto
long neck lighter (type used to start outdoor grills or
fireplaces) in the 2nd drawer of his bedside table.
n. Room 218 - Resident #41 had a container of
Ronunol lighter fluid, 12 oz. size approximately half full
in ----- , a Zippo lighter, and loose tobacco in a Wal-Mart
bag. Review of this residents Safety Smoking Screen
indicated the resident was independent to smoke, however
materials were to be kept at the nurses station.
°. On 5/22/03 at approximately 11:05 A.M., during a
conversation with one surveyor, the regional nursing
consultant said, "I don't know why they are doing this
search. We went through all the rooms last night."
p- On 5/22/03 at approximately 11:15 PM an interview
was conducted with the facility Staff Development nurse
regarding in-service about the new Smoking Policy. She
stated, "It had been completed during the evening of 5/21."
She further stated, "I don't understand, all the rooms were
searched last night and staff reported no smoking materials
25
were at the bedside. I don't know where all this material
came from."
q. The facility failed to demonstrate compliance
with their new Smoking Policy. The facility failec to
demonstrate adequate supervision and assistance with
smoking for residents at risk with smoking and thereby,
endangered the health and safety of all residents in the
facility.
15. The Agency seeks to impose a Conditional Licensure
Status effective May 22, 2003, based on two (2) Class I
deficiencies as authorized under Sections 400.23(7) (b),
400.23(8) (a) and 400.022(3), Florida Statutes.
WHEREFORE, AHCA requests this Court to order the following
relief:
A. Make factual and legal findings in favor of the Agency
on Count I;
B. Recommend that the change of licensure status
effective May 22, 2003, from Standard to Conditional be upheld;
and
Cc. All other general and equitable relief allowed by law.
26
DISPLAY OF LICENSE
Pursuant to Sections 400.062(5) and 400.23(7) (e), Florida
Statutes, CYPRESS MANOR HEALTH CARE ASSOCIATES, LLC, d/b/a
CYPRESS COMMUNITY CARE CENTER, shall post the license ina
prominent place that is in clear and unobstructed public view at
or near the place where residents are being admitted to the
facility.
The 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 Explanation of Rights (one page) and
Election 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
GarcYa, Esquire
AHCA - Seniof£ Attorney
525 Mirror take Drive North
St. Petersburg, Flor:da 33701
27
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a copy hereof has been furnished to
C T Corporation System, 1200 South Pine Island Road, Plantation,
FL 33324 Return Receipt No. 7002 2030 0007 8499 7253 by U.S.
Certified Mail and to Administrator, Cypress Community Care
Center, 7173 Cypress Drive S.W., Fort Myers, FL 33907, by U.S.
Mail, on August of , 2003.
'Hara Garcia, Esquire
Copies furnished to:
C T Corporation System
Registered Agent for
Cypress Community Care Center
1200 South Pine Island Road
Plantation, FL 33324
(U.S. Certified Mail)
Administrator
Cypress Community Care Center
7173 Cypress Drive S.W.
Fort Myers, FL 33907-2994
(U.S. Mail)
Eileen O’Hara Garcia
AHCA ~ Senior Attorney
525 Mirror Lake Drive Suite 330D
St. Petersburg, Fl 33701
28
Docket for Case No: 03-003326
Issue Date |
Proceedings |
Dec. 02, 2003 |
Final Order filed.
|
Nov. 07, 2003 |
Order Closing File. CASE CLOSED.
|
Nov. 07, 2003 |
Motion to Remand without Prejudice (filed by Respondent via facsimile).
|
Oct. 03, 2003 |
Order of Pre-hearing Instructions.
|
Oct. 03, 2003 |
Notice of Hearing (hearing set for November 18 and 19, 2003; 9:00 a.m.; Fort Myers, FL).
|
Oct. 02, 2003 |
Order of Consolidation. (consolidated cases are: 03-003325, 03-003326)
|
Sep. 30, 2003 |
Joint Response to Initial Order (filed by D. Stinson via facsimile).
|
Sep. 18, 2003 |
Initial Order.
|
Sep. 16, 2003 |
Conditional License filed.
|
Sep. 16, 2003 |
Administrative Complaint filed.
|
Sep. 16, 2003 |
Request for Formal Administrative Hearing filed.
|
Sep. 16, 2003 |
Notice (of Agency referral) filed.
|