STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION flix 215 1.1 oe eu, AGENCY FOR HEALTH CARE bes ADMINISTRATION, ADMIriz HEARIHGS Petitioner, AHCA No.: 2003007962 AHCA No.: 2003007959 Vv. Return Receipt Requested: 7002 2410 0001 4236 9687 FAIR HAVENS CENTER, LLC., d/b/a 7002 2410 0001 4236 9694 FAIR HAVENS CENTER, 7002 2410 0001 4236 9700 Réspondent. ; / 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 Fair Havens Center, LLC, d/b/a Fair Havens Center (hereinafter “Fair Havens 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 $10,000.00 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 Conditional Licensure status to Fair Havens 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. Fair Havens Center is a 269-bed skilled nursing facility located at 201 Curtiss Parkway, Miami Springs, Florida 33166-5291. Fair Havens Center is licensed as a skilled nursing facility; license number SNF1147096; certificate number 10636, effective 9/25/2003, through 07/23/2004. Fair Havens 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 Fair Havens 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;A- 4.1288, F.A.C. COUNT _I FAIR HAVENS CENTER FAILED TO ENSURE THAT THE RESIDENT’S POOR ORAL INTAKE WAS APPROPRIATELY ADDRESSED AND TIMELY TREATMENT AND INTERVENTIONS PROVIDED FOR ITS MANAGEMENT 483.25(i) (1), Code of Federal Regulations, incorporated by Rule 59A-4.1288, Florida Administrative Code (QUALITY OF CARE) CLASS II DEFICIENCY 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During the unannounced Licensure and Re-certification survey conducted on 9/21-25/2003 and based on observations, interviews and medical record reviews, the facility failed to ensure that the resident's poor oral intake was appropriately addressed and timely treatment and interventions provided for its management, which led to a significant weight loss and low visceral protein levels for 1 out of 30 residents (R# 26). 10. Review of the clinical record for resident #26 on 9/23/03 noted that the resident has diagnoses of chronic heart failure (CHF), left below knee amputation, Ischemic heart disease (ASHD), hypothyroidism, dry eyes, digoxin toxicity, hypertension, diabetes and allergic rhinitis. Further review of the record indicated that resident's weight on 3/12/03 was 130 pounds (Lbs) and on 6/24/03 the resident had an albumin level of 3.0 (normal 3.5-4.8). 11. Review of the nutritional progress notes dated 7/25/03 reflected a new weight for the resident of 120 Lbs. This decreased weight status was not reflected in the nutritional progress note as the Dietary Technician (DTR) stated, "weight remains stable". Review of the resident's nutritional care plan created 6/10/03 did not address any decline in the resident's weight status until 9/10/03. Review of the weight sheet revealed that the resident's new weight for 9/10/03 was 116 Lbs indicating a significant weight loss on 14 lbs in 3 months, or about 10% weight loss. According to the Minimum Data Set oral/nutritional status in section K, a weight loss of 10 % or more over the past 6 months is considered to be a significant weight loss. Review of the nutritional progress note, however, stated that the resident had a "slow progressive weight loss over the past six months." Nutritional progress note and care plan for period 9/10/03 also indicated that resident presented with albumin levels of 3.0 on 6/24/03, and a recommendation by the DTR for protein powder was indicated at this time (9/10/03). There was no documentation noted by nutritional services in the previous assessment of 7/25/03 or anytime thereafter until 9/10/03 addressing or evaluating the need for increased protein needs secondary to this decreased lab value. 12. In addition, interview with resident #26 on 9/24/03 at 11:45am indicated that a contributing factor to the resident's weight loss was poor oral food intake since the resident reported that he/she did not eat the facility meals. The reason given was because the facility's food "had no taste, that it was bland, was not attractive and that food was cold when he/she received it." He/she also stated that if his/her son did not come to the facility and bring him/her foods that he/she" did not eat anything”. Resident also stated that he/she had "complained to dietary about the meals on numerous occasions but there was still no change," and that he/she was very "concerned about his/her weight loss". Resident also stated that when he/she ask for snacks, he/she is told that they are "out of them and that they are finished", with no substitutions offered. Observations of the resident for two meals, dinner 9/23/03 and lunch 9/24/03, revealed that resident did not consume any of his/her meals. Observation of the Certified Nursing Assistance (CNA) on 9/24/03 revealed that the lunch meal was delivered to the resident's room and was left without asking if the meal was to his/her liking or whether he/she wanted anything else, as this was one of the interventions dietary had implemented for the resident. 13. During an interview on 9/24/03) at 2:30pm = diet technician (DTR) stated that the resident was a "picky eater" and that the food “is like that of an institutional setting". She stated that interventions were put in place for the resident mn whereby dietary was "providing resident with Mrs. Dash, providing resident a selective menu, providing alternates as desired and hand delivering resident's tray". However, based on observation and interview with the resident as indicated above, the facility failed to ensure that the interventions were resident centered and were followed through. Further interview with the DIR revealed when asked whether there were other interventions that could be implemented to help with the weight loss the resident was experiencing the DTR was unable to answer. When DTR was asked why there was no new evaluation of resident's albumin needs until three months after the lab values were established, and why after making the recommendation for the protein powder on 9/10/03 in the progress note did it take 11 days to obtain the order on 9/23/03, DTR was unable to answer. 14. Interview with the RD previously on 9/22/03 indicated a 72-hour turnover for recommendations made to the physician by dietary. It was revealed in the interview with the DTR that neither the physician nor the RD was informed of the resident's weight loss. Phone interview with the RD on 9/ 25/03 at 12:15 confirmed that she had not previously been made aware of this and that she had reviewed the clinical record the evening before. 15. The facility failed to meet the resident's nutritional needs in providing foods the resident enjoyed, and failed to implement nutritional interventions in a timely manner, which resulted in a significant weight change and potentiaily compromised the nutritional status of the resident. 16. Based on the foregoing, Fair Havens Center violated 483.25, Code of Federal Regulations, 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). COUNT II FAIR HAVENS CENTER FAILED TO COMPLY WITH THE STATE MINIMUM STAFFING REQUIREMENTS FOR 2 CONSECUTIVE DAYS AND SELF-IMPOSING AN ADMISSIONS MORATORIUM WHILE MEETING THE MINIMUM STAFFING REQUIREMENTS FOR A PERIOD OF 6 CONSECUTIVE DAYS FOR 3 SEPARATE 2-WEEK WORK PERIODS Section 400.141(15) (dad), Fla. Stat. (MORATORIUM FOR STAFF SHORTAGE) CLASS IT 17. AAHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 18. During the unannounced Licensure and Re-certification survey conducted on 9/21-25/2003 and based on Based on interview and review, it was determined that the facility failed to comply with the state minimum-staffing requirements for 2-consecutive days and self-imposing an admissions moratorium while meeting the minimum staffing requirements for a period of 6 consecutive days for 3 separate 2-week work periods. 19. Based on interview, review of the facility census and nursing services staffing worksheets, it was determined that the facility failed to meet the minimum staffing requirement for certified nursing assistants (CNA) for three - 2 week pay periods reviewed. 20. Based on the state minimum requirements for certified nursing assistants (CNA), the facility failed to provide the minimum CNA hours for the 6 weeks staffing schedule provided by the facility, with the exception of one day (3/13/02). 21. This shortage was noted during a review of the facility's census and review of nursing services staffing worksheets completed by the facility. The State requirement is 2.6 hours of direct resident care per resident per day. 22. Interview with the Director of Nursing (DON) on 9/25/03 at 2:00 pm, regarding the shortages reviewed stated that staff (CNA) works a 7.5 workday, but the calculations provided on the worksheets were based on a 8 hour day, "I've always done it that way". 23. Interview with staff members #4 and #5 on 9/23/03 in the afternoon disclosed that they are now working a 7 1/2 hour workday. The 1/2 hour they used to have for shift report is gone and they have 1/2 hour for their lunch meal. the Staffing for Long Term Care Facilities’ 24. The following is the shortages of CNA hours based on information provided by the facility on the "Calculating form and time sheets: Date Census Required Hours Actual Hours Hours Short 2003 3/7 265 689 652.5 36.5 3/8 265 689 652.5 36.5 3/9 265 689 652.5 36.5 3/10 262 681.2 660 21.2 3/11 261 678.6 675 3.6 3/12 262* 681.2 652.5 28.7 3/14 256 665.6 660 5.6 3/15 254 660.4 645 15.4 3/16 251 652.6 637.5 15.1 3/17 259% 673.4 660 13.4 3/18 264* 686.4 660 26.4 3/19 260 676 645 31. 3/20 263* 683.8 660 23.8 6/7 269 699.4 660 39.4 6/8 266 691.6 652 39.6 6/9 265 689 682.5 6.5 6/10 267* 694.2 690 4.2 6/11 267 694.2 690 4.2 6/12 267 694.2 660 34.2 6/13 269% 699.4 667.5 31.9 6/14 269 699.4 660 39.4 6/15 268 696.8 675 21.8 6/16 267 694.2 660 34.2 6/17 265 689 667.5 21.5 6/18 269* 699.4 667.5 31.9 6/19 269 699.4 667.5 31.9 6/20 269 699.4 667.5 31.9 9/7 264 686.4 652.5 33.9 9/8 259 673.4 652.5 20.9 9/9 263* 683.8 652.5 31.3 9/10 259 673.4 645 28.4 9/11 261* 678.6 637.5 41.1 9/12 264* 686.4 652.5 33.9 9/13 260 676. 667.5 33.9 9/14 261* 686.4 675 11.4 9/15 261 678.6 660 18.6 9/16 265* 689 652.5 36.5 9/17 261 678.6 645 33.6 9/18 266* 691.6 652.5 39.1 9/19 264 686.4 675 11.4 9/20 268* 696.8 667.5 29.3 * denotes admissions. 25. An example of the facility's non-compliance is on 3/7 and 3/8/03 the facility failed to meet the minimum staffing requirement by 36.5 hours for each day. The facility continued to fall below minimum staffing-requirements until 3/13/03 and then continued to fail to meet the minimum requirement and admitted new residents on 3/12, 3/17, and 3/18 while still continuing to fall below the minimum requirement. 26. Interview with the Director of Nursing (DON) on 9/25/03 at 2:00 pm, regarding the shortages reviewed stated that staff (CNA) works a 7.5 workday, but the calculations provided on the worksheets were based on a 8 hour day, "I've always done it that way". 27. Review of above 6 weeks of staffing disclosed that the minimum staffing requirement had not been met and the facility failed to self impose an admission moratorium at any point for 6 consecutive days. 28. Based on the foregoing, Fair Havens Center violated Section 400.141(15) (d), Fla. Stat., herein classified as a Class Il deficiency pursuant to Section 400.23(8)(b), Fla. Stat., 10 which carries, in this case, an assessed fine of $7,500.00. 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, Fair Havens 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 Counts I and II. B. Assess an administrative fine of $10,000.00 against Fair Havens Center on Counts I and II. Cc. Assess and assign a conditional license status to Fair Havens 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 i 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, Mail Stop #3, Tallahassee, Florida 32308, attention Lealand McCharen, Agency Clerk. Telephone No. (850) 922-05873 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. 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)

Docket for Case No: 04-000026