STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2003005541 AHCA No.: 2003005540 v. Return Receipt Requested: 7002 2410 0001 4236 9250 GRAMERCY OPERATING CO., INC., 7002 2410 0001 4236 9267 d/b/a GRAMERCY PARK NURSING CENTER, 7002 2410 0001 4236 9274 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 Gramercy Operating Corp., d/b/a Gramercy Park Nursing Center (hereinafter “Gramercy Park Nursing 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 $2,500.00 pursuant to Section 400.23(8), Fla. Stat. (2002), for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Gramercy Park Nursing Center, pursuant to Section 400.23(7) {b), Fla. Stat (2002). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2002), and Chapter 28-106, F.A.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 responsible 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. Gramercy Park Nursing Center is a 180-bed skilled nursing facility located at 17475 South Dixie Highway, Miami, Florida 33157. Gramercy Park Nursing Center is licensed as a skilled nursing facility; license number SNF1180096; certificate number 10553, effective 05/27/2003, through 06/30/2003. Gramercy Park Nursing 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. 7. Because Gramercy Park Nursing 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 GRAMERCY PARK NURSING CENTER FAILED TO IMPLEMENT THE PROCEDURES ESTABLISHED IN THEIR ABUSE POLICY BY NOT ENSURING THAT ALL ALLEGATIONS OF ABUSE/MISTREATMENT WERE INTERNALLY INVESTIGATED AFTER ITS OCCURRENCE FOR TWO RESIDENTS AND FOR NOT PROTECTING THE RESIDENT FROM FURTHER ABUSE/MISTREATMENT BY FAILING TO REMOVE THE STAFF FROM PROVIDING CARE TO THE RESIDENT TITLE 42, SECTION 483.13(c) (1) (i) CODE OF FEDERAL REGULATIONS, INCORPORATED BY RULE 59A~-4.1288, FLORIDA ADMINISTRATIVE CODE (STAFF TREATMENT OF RESIDENTS) CLASS II DEFICIENCY 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During the annual Certification survey conducted on 5/27-30/2003 and based on interviews and record review the facility failed to implement the procedures established in their Abuse Policy by not ensuring that all allegations of abuse/mistreatment were internally investigated after its occurrence for two (#8 and 16) of 21 sampled residents and for not protecting the resident from further abuse/mistreatment by failing to remove the staff from providing care to the resident. Findings include: (a) Review of clinical records for resident # 8 revealed the resident was readmitted to the facility on 11/19/02. According to a quarterly Minimum Data Set (MDS) dated 2/27/03, resident is coded as "0" for cognitive skills with no short or long term memory problems. Resident is identified also as having some behavior problems i.e. repetitive health complaints and anxious complaints, insomnia and resists care at times. Resident also requires total dependence for ADL-self performance (activities of daily living). (b) Interview with resident on 5/28/03 at 2:40pm revealed that about 2 or 3 months ago a Certified Nursing Assistant (CNA) was mean to the resident and his/her roommate. Resident had pressed the call bell around 7:00am and the CNA came to their door and said in a loud voice: "I have been in this damn room all night long. What do you want now?". Resident told the CNA that he/she understood he was acting like that because he was exhausted, and the CNA replied: "Don't you ever tell me I am exhausting". As per resident he/she reported to the Administrator and the DON and they both agreed to meet with the CNA in resident's room. Resident said that the CNA admitted what he has done but did not apologize to him/her. Then again about 6 weeks ago about 3:00pm the resident had diarrhea and requested to be cleaned. Another nurse came to his/her room and told the resident that she was going to call the CNA for him/her. Resident heard the same CNA screamed in the hall "I am not cleaning any more shit today. I am out of here". CNA never came to his/her room to clean resident. The resident again reported the incident to the Administrator and CNA was removed from his/her care. A follow up interview with the resident on 5/29/03 at 10:55 am revealed that during the first incident his/her roommate was afraid thinking that the CNA was going to hurt him/her. Resident also added that during the second incident he/she was crying and felt very sad because the CNA broke his/her heart because of the comment he made. Resident said that he/she is very concerned about that CNA working so many hours and feels that the facility is responsible for allowing the CNA to work so many hours and be overwhelmed. {c) Interview with Administrator on 5/29/03 at li:iSam revealed that for the first incident and investigation was completed but the CNA was not removed from resident's care based on resident's request and resident verbalizing that he/she was satisfied with intervention and _ resolution. Regarding the second incident, she had no recollection of it. Administrator remembered that the resident mentioned the incident of diarrhea to her but that the CNA denied it. At an that point a decision was made to remove the CNA from resident's care and resident agreed. (d) Interview with Certified Nurse Assistant on 5/29/03 at 12:05pm revealed that the CNA denied the allegations for the first incident. He further reported that during the meeting with the resident and the administrator the resident apologized to him because he (the CNA) was tired or exhausted. Regarding the second allegation he never went to the resident's room because nobody told him that the resident needed to be cleaned. The CNA also reported that the Administrator and DON removed him from caring for the resident to prevent any more problems. (e) Review of the CNA's personnel file revealed no documentation of counseling or any type of intervention after the incidents were reported by resident #8. (f) Review of the internal investigation documents revealed that they were completed between March 24 and March 28, 2003. The investigation report includes: written report of allegations signed by resident # 8 and his/her roommate, a statement signed by DON on 3/28/03 confirming that the CNA must be working many shifts and he was encouraged to review stress management and the effects of fatigue as it relates to tolerance during working hours. He was also urge to be aware of burnout, a summary report dated 4/2/03, an Employee Conduct Investigation Form dated 3/25/03 and Acknowledgement of resident's rights was given to CNA on 3/26/03. (g) Review of the facility's Abuse Policy and Procedures for Staff to resident Abuse, Neglect & Mistreatment revealed that the facility will make reasonable efforts to ensure that residents are free from verbal, sexual, physical and mental abuse. The policy also established that "a prompt and thorough investigation will be conducted immediately” and "the facility will report cases of suspected abuse as soon as reasonably practicable to the appropriate jurisdictional authorities. (h) Based on findings mentioned, the facility did not ensure that various factors, such as employee burn out, was monitored and handled immediately to prevent abuse/neglect. In addition, the facility failed to follow its policy and procedure of thoroughly investigating and reporting the allegation of abuse to appropriate state agencies. 10. Resident # 16 was readmitted to the facility on 2/8/02. According to the annual Minimum Data Set dated 5/20/03 resident's cognition is coded as (1), modified independence with no problems with short/long term memory. Resident is able to communicate in Spanish, his/her speech is clear. Resident requires total care with ADL's and has some behavior problems i.e. persistent anger, repetitive health complaints and anxious complaints, insomnia, verbally abusive behavior and resists care. 11. During the quality of life group interview on 5/28/03 at 10:30 am resident #16 stated that about a month ago a Registered Nurse told him/her "lisiado" (crippled) and other derogatory terms. Resident stated that he/she spoke with the Administrator who told the resident that the nurse won't be assigned to him/her anymore. However, this same nurse continued giving medications to him/her as usual which was distressing to the resident. 12. Private interview with resident #16 on 5/29/03 at 1:50 pm revealed that about a month ago a registered nurse (RN) told him/her that he/she was a "lisiado" (crippled), they exchanged few a words in Spanish and the RN told the resident "Te voy a caer a galleta" (I am going to slap your face). Resident stated that he/she got very sick after the incident because he/she was very upset, and felt emotionally bad because the nurse was mean to him/her. Resident developed a rash as a reaction to the problem. The next day the resident spoke with the administrator who promised him/her that the nurse was going to be removed away from resident, however, this never happened and the nurse continued to have contact with the resident by giving medications. 13. Interview with Administrator on 5/29/03 at 2:40 pm revealed that resident # 16 had an argument with a Registered Nurse(RN) and exchanged some words. She remembers that the word "lisiado" (crippled) was used. Administrator stated that she spoke with the resident at that time and offered him/her to change the nurse and the RN was not going to pass medications to him/her anymore. Administrator stated that the matter was resolved at that point because resident agreed to resolution of changing the nurse. As per Administrator, she was not sure if counseling was provided to the nurse. Review of the Nurse's notes through 5/29/03 revealed no information or any type of intervention from the facility regarding the incident with the RN on 4/25/05. The facility was unable to indicate that the incident was investigated and appropriate actions taken to resolve the problem. 14. Review of the facility's Abuse Policy and Procedures for the Abuse, Neglect & Mistreatment- Staff to resident revealed that the facility would make reasonable efforts to ensure that residents are free from verbal, sexual, physical and mental abuse. The policy also established that "a prompt and thorough investigation will be conducted immediately”. According to the facility investigation procedures the Director of Social Services or designee as assigned by the Administrator will begin the internal investigation promptly after notifying the Administrator. The investigation procedures also includes: Record statements of interviews of the resident, suspect (if one is identified), preserve as evidence relevant material/documentation pertaining to the allegation and examine the alleged victim promptly (if injury was suspected) and document the findings as part of the investigation report. 15. Interview with Administrator on 5/29/03 at 2:40 pm revealed that she was not aware that the RN had been giving medications to the resident even after the agreement was made to remove RN from providing care to the resident. Review of the resident's Medication Administration Record (MAR) for May 2003 revealed that the Registered Nurse had been giving medications to resident #16 after the incident, as confirmed by the resident. 16. Review of the investigation report provided by the facility only included the following documents: 1) Summary report prepared and signed by the Administrator on 5/29/03 revealing that degrading words in Spanish were used by the staff and the resident. At the end of the report the following statement was written: " She denied allegation and implied that if she used that word "lisiado" it was not intended to be derogatory" and 2) Memo sent to Administrator by the Director of Nursing on 4/25/03 regarding a problem with a Registered 10 Nurse and resident # 16. No additional information was provided by the facility as evidence of the internal investigation being completed according to the facility policy. 17. On 6/2/03 the following documentation was furnished by the facility, a document signed by a resident's friend (significant other) confirming that she agrees with the facts as referred by Administrator for the record information dated May 29, 2003 in relation to the incident between the resident and the RN on April 25, 2003. A document signed by the Social Services Director on 6/2/03 revealing that the abuse line was contacted by the Administrator today at 10:45am, that the Director of Social Services met with resident to provide emotional support and that the Psychiatrist and Psychotherapist met with the resident today. 18. Based on the foregoing, Gramercy Park Nursing Center violated Title 42, Section 483.135(c) (I) (i), Code of Federal Regulations as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II deficiency pursuant to Section 400.23(8) (b), Fla. Stat., which carries, in this case, an assessed fine of $2,500.00 This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). DISPLAY OF LICENSE Pursuant to Section 400.23(7) (e), Florida Statutes, Gramercy Park Nursing 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 “A” 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 $2,500.00 against Gramercy Park Nursing Center on Count I. c. Assess and assign a conditional license status to Gramercy Park Nursing 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 12 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, Manchester Building, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Nelson E. Rodney. 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, Nels E. Rodney Assistant General Coungel 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°74 Street Miami, Florida 33166 (U.S. Mail) 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)

Docket for Case No: 03-004596