(2 Ff 10 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2003004849 AHCA No.: 2003004508 v. Return Receipt Requested: 7000 1670 0011 4849 4903 FORT PIERCE HEALTH CARE 7000 1670 0011 4849 4910 ASSOCIATES, LLC d/b/a FORT 7000 1670 0011 4849 4965 PIERCE HEALTH CARE, 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 Fort Pierce Health Care Associates, LLC d/b/a Fort Pierce Health Care (hereinafter “Fort Pierce Health Care”) pursuant to 28-106.111, Florida Administrative Code and Chapter 120, Florida Statutes hereinafter alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine in the amount of $4,000.00 pursuant to Section 400.23, Florida Statutes [AHCA No.: 2003004508]. 2. This is an action to impose a conditional licensure rating pursuant to Section 400.23(7) (b), Florida Statutes [AHCA No. 2003004849]. JURISDICTION AND VENUE 3. This court has jurisdiction pursuant to Section 120.569 and 120.57, Florida Statutes and Chapter 28-106, Florida Administrative Code. 4, venue lies in St. Lucie County, pursuant to Section 120.57 and Section 121(1)(e), Florida Statutes and Chapter 28- 106.207, Florida Administrative Code. PARTIES 5. AHCA is the enforcing authority with regard to skilled nursing facilities licensure pursuant to Chapter 400, Part II, Florida Statutes and Rule 59A-4, Florida Administrative Code. 6. Fort Pierce Health Care is a nursing home located at 611 S. 13 Street, Fort Pierce, Florida 34950 and is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I FORT PIERCE HEALTH CARE FACILITY STAFF DID NOT FOLLOW PLAN OF CORRECTION BY REPORTING ALLEGATIONS OF ABUSE OF WHICH STAFF HAD KNOWLEDGE . TITLE 42 SECTION 483.13(c) (2) (3), CODE OF FEDERAL REGULATIONS RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE (STAFF TREATMENT OF RESIDENTS) CLASS III 7. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 8. Because Fort Pierce Health Care participates in Title XVIII or XIX it must follow the certification rules and regulations found in Title 42 Code of Federal Regulation 483. 9. During a complaint investigation conducted on April 17, 2003 and based upon interviews with staff and residents, clinical record review and personnel file review, the facility failed to follow proper procedures for investigating an allegation of verbal mistreatment by 1 of 5 sampled residents (Resident #4). The findings include the following. 10. During an interview with Resident #4 on 4/17/03 at 10:05 a.m., the resident described two separate altercations that were encountered with two different nurses. The first altercation was with a nurse who stated she was "tired of the resident's shit” and another was with a nurse who the resident thought may have threatened to dispense the wrong medication for the resident. The DON and Nurse Consultant were interviewed at approximately 12:00 p.m. The DON verified that she was aware that both of the altercations had occurred, the first one in ue January. She also verified that the nurse who cursed at the resident had admitted to saying the profanity and had been disciplined for this through a counseling session. This nurse was with the DON at this time and verified this information. The DON stated that documentation of the session would be in the nurse's personnel file. ll. The nurse's personnel file was subsequently reviewed with the Nurse Consultant and no evidence of a reprimand pertaining to this incident was found. The Nurse Consultant immediately contacted the DON and no explanation was given as to why documentation of the counseling session was not in the file. The Abuse Coordinator was interviewed at 1:00 p.m. with the Nurse Consultant and stated that he had never known of any incident that had occurred with the resident and this nurse. The grievance log was reviewed and did not have any documentation of this incident. The Administrator was also present during the interview at 1:00 p.m. with the Nurse Consultant and Abuse Coordinator and did not have any knowledge of this incident. No evidence of an investigation was found and the incident was not reported to the administrator and other officials as required. 12. The mandated correction date was designated as May 17, 2003. 13. Based on a revisit due to the complaint investigation, which was conducted on June 39, 2003, the following is an uncorrected deficiency from the April 17, 2003 complaint investigation: 14. Based on interview with residents, staff, and clinical record review, it was determined that staff did not follow facility policy and procedures by reporting allegations of abuse to the abuse coordinator upon learning of the allegations. The findings include the following. 15. During an interview with resident #8 on June 10, 2003, at 12:30 P.M., the resident stated to the surveyor that about one month ago, a nurse aide was trying to get him/her into a wheelchair, and he/she did not want to, and he/she was resisting. The resident stated that the nurse aide hit the resident with a slap on the shoulder. The resident stated it didn't hurt. The resident was asked if the aide did it ina playful way. It was stated that the aide was mad at him/her because he/she would not get into the wheelchair, and that he/she was angry. The resident stated that he/she told the unit Manager about the incident. The resident was asked if anything was ever done about the incident. The resident stated that the aide never took care of him/her again, and that he/she thinks the aide quit. There was no documentation about the incident in the resident's clinical record, although review of the nurses notes dated March 29, 2003, at 6:30 P.M., revealed an incident where the resident complained that an aide treated him/her wa roughly, and slammed the lid of the food tray down on his/her hand, wiped the crumbs from the resident's face roughly, and slapped a towel across the resident's face. It was also documented that the writer, who is a night supervisor, spoke with both the resident and aide and that the aide would ask the resident before taking anything or touching him/her, that he/she would treat the resident gently. The unit manager was interviewed at 1:00 P.M., about the incident. It was stated that the resident never told him/her of the incident, and that the resident fabricates things all the time. It was asked if he/she knew what happened with the March, 2003 incident, but denied knowing the details of the occurrence. On June 11, 2003, at 9:10 A.M., the resident was again asked about the incident, and if he/she was sure he/she told the unit manager. It was stated now he/she wasn't sure because the unit manager came into his/her room after I (the surveyor) left on June 10, 2003, and told her (the resident) he/she never said anything about being slapped. The resident was asked if his/her spouse knew of the incident, but he/she did not know. On June 11, 2003, at 10:20 A.M., with the resident's permission, the spouse was called at home by this surveyor. It was asked if he/she knew of any incident where the resident was slapped by an aide. It was stated that he/she knew of the incident. It was asked how he/she found out, and it was stated that , the unit manager told him/her. The risk manager was asked if there was an incident report for the two incidents that occurred, but none was found. The risk manager denied ever being told about the incidents, as he/she would have made an incident report had he/she known. The corporate nurse consultant was interviewed about this occurrence. It was stated that policy calls for all incidents of possible abuse to be reported immediately to the abuse coordinator, and that the person reporting has to fill out an incident report immediately. The unit manager of the Emerald unit never reported the occurrence, or completed an incident report on the incident occurring approximately one month ago, even though he/she had direct knowledge of the occurrence, and even though the surveyor had pointed out the occurrence to him/her on June 10, 2003. In addition, the unit manager was made aware of the March, 2003, incident, which was possible abuse, but did not report it to the abuse coordinator or file an incident report when it was pointed out. The staff member did not follow policy and procedures for reporting two incidents of alleged abuse, of which he/she had knowledge. 16. Based on the foregoing, Fort Pierce Health Care violated 483.13(c) (1) (ii), Code of Federal Regulation as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class III violation pursuant to Section 400.23(8), Florida Statutes, which warrants an assessed fine of $2,000.00. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes. COUNT II FORT PIERCE HEALTH CARE FAILED TO CONDUCT LEVEL 2 SCREENING FOR AN EMPLOYEE THAT HAD NOT RESIDED IN THE STATE CONTINUOUSLY FOR THE PAST FIVE YEARS. SECTION 400.215, FLORIDA STATUTES (BACKGROUND SCREENING REQUIREMENTS) CLASS III 17. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 18. During a complaint investigation conducted on April 17, 2003 and based upon record review and interview, it was determined that the facility failed to follow-up on a possible disqualifying offense listed on a criminal background screening (Employee #1); and failed to obtain a Level II screening for an employee who did not maintain continuous residency for 5 years in the state of Florida (Employee #5). The findings include the following. 19. On 4/17/03, seven personnel records were reviewed with the Administrator and Nurse Consultant. Employee #1 had a battery charge that had not been dismissed and had a disposition of "held" (adjudication withheld). The Administrator was interviewed at 12:30 p.m. and stated that facility staff were unaware that if a charge of battery had a disposition of "held" (adjudication withheld) that it could be a disqualifying offense if a minor or elderly person had been the victim and that this was not looked into. The Administrator then contacted the facility's attorney who verified that the offense could be disqualifying, according to Florida Statutes. The Administrator subsequently requested the employee to obtain the arrest record to verify that a minor or elderly person had not been the victim in relation to the charge of battery. 20. Employee #5's record was also reviewed during this time. This record had evidence that the employee had lived out of the state of Florida in the previous 5 years and the facility had not conducted a Level II screening as required by Florida statutes. The Administrator verified this during an interview at approximately 12:30 p.m. 21. The mandated correction date was designated as May 17, 2003. 22. Based on a revisit due to the complaint investigation, which was conducted on June 9, 2003, the following is an uncorrected deficiency from the April 17, 2003 complaint investigation 23. Based on record review and interviews with staff, it was determined that the facility failed to obtain a Level II screening for an employee who did not maintain continuous residency for five years in the sate of Florida prior to hiring (Employee #1). The findings include the following. 24. On 6/11/03, six personnel records were reviewed with the Human Resources representative and the Risk Manager/Abuse Coordinator. Employee #1 had signed a statement indicating that he/she had not lived in Florida for the previous five years prior to hiring. Additionally, the employee's application listed prior experience in another state within the previous five years. Evidence of only a Level I Screening was in the record. The screening was reviewed with the Human Resources representative and the Administrator. Both were unaware that the screening had evidence of a Level I completion only. AHCA's Background Screening Unit was contacted by phone at approximately 11:00 am and verified that the screening was interpreted correctly and that a Level IT screening had not been conducted on this employee. 25. Based on the foregoing, Fort Pierce Health Care violated Section 400. 215, Florida Statutes, herein classified as a Class III violation Pursuant to Section 400.23(8), Florida Statutes, which warrants an assessed fine of $2,000.00. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Fort Pierce Health Care shall post the license in a prominent place that is 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” i EXHIBIT “A” Conditional License License # SNF 10040953; Certificate No.: Effective date: 06-09-2003 Expiration date: 11-30-2003 PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. Make factual and legal findings in favor of the Agency on Counts I and II. 2. Assess against Fort Pierce Health Care an administrative fine of $4,000.00 for the two (2) Class III violations on Counts I and II cited above. 3. Assess against Fort Pierce Health Care a conditional license in accordance with Section 400.23(7), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, if applicable. 5. Grant such other relief as the 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 Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT? OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. } Alba M. Seer Assistant General Counsel Agency for Health Care Administration 8355 NW 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 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 14 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 Vincent Cacciatore, Administrator, Fort Pierce Health Care, 611 S. 13 Street, Fort Pierce, Florida 34950; Fort Pierce Health Care Associates, LLC, 10210 Highland Manor Drive - Suite 410, Tampa, Florida 33610; CT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324 on this 21st day of August, 2003. Le) 2. fads guts y Alba M. Rodriguez 15

Docket for Case No: 03-003870