STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 04 SEP 21 PM 4:45 AGENCY FOR HEALTH CARE DIV Is: ADMIN ADMINISTRATION, ‘ H ! TAGE AHCA No.: 2004006029 AHCA No.: 2004006031 v. Return Receipt Requested: 7002 2410 0001 4237 1543 7002 2410 0001 4237 1550 7002 2410 0001 4237 1567 Petitioner, SOUTHPOINT HEALTH CARE ASSOCIATES, LLC, d/b/a SOUTHPOINT NURSING AND REHABILITATION CENTER, Respondent. (" Y AH>SO 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 Southpoint Health Care Associates, LLC, d/b/a Southpoint Nursing and Rehabilitation Center (hereinafter ‘Southpoint Nursing and Rehabilitation Center”), pursuant to Chapter 400, Part II, and Section 120.60, Fla. Stat. (2003) and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $5,000.00 pursuant to Section 400.23(8), Fla. Stat. (2003), for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Southpoint Nursing and Rehabilitation Center, pursuant to Section 400.23(7) (b), Fla. Stat (2003). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2003), and Chapter 28-106, F.A.C. 4. Venue lies in Miami-Dade County, pursuant to Section 400.121(1) (e), Fla. Stat. (2003), 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., (2003), and Chapter 59A-4 Florida Administrative Code. 6. Southpoint Nursing and Rehabilitation Center is a 230-bed skilled nursing facility located at 42 Collins Avenue, Miami Beach, Florida 33139. Southpoint Nursing and Rehabilitation Center is licensed as a skilled nursing facility; license number SNF1507096; certificate number 11529 effective 05/17/2004, through 06/20/2004. Southpoint Nursing and 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. 7. Because Southpoint Nursing and Rehabilitation 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 SOUTHPOINT NURSING AND REHABILITATION CENTER FAILED TO PROPERLY AND TIMELY ASSESS RESIDENT’S SKIN CONDITION IN ORDER TO PREVENT PRESSURE SORES FROM DEVELOPING FOR 1 OF 5 (#1) SAMPLED RESIDENTS RESULTING IN DEVELOPMENT OF PRESSURE SORES IN THE FACILITY TITLE 42, SECTION 483.25(c), Code of Federal Regulations, as 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 a complaint investigation conducted on May 17, 2004 and based on clinical record review for resident #1 revealed the resident was admitted to the facility with diagnosis of Diabetes Mellitus, Hypertension, Peripheral vascular Disease, heart disease, Anemia and Pneumonia. Review of the nursing admission note dated 10-29-2003 revealed the resident was admitted with the skin to sacral area intact and no other skin break down. The "Braden Scale-- For Predicting Pressure Sore Risk" completed on 10-29-03 for the resident showed total score of 15. The legend on the form stated: "Total score of 12 or less represents HIGH RISK." 10. Review of the wound care nurse "weekly skin sweep" admission documentation dated 11-04-2003, revealed redness to sacral area with no break in skin. On 11-11-2003, weekly skin sweeps revealed redness to sacral area with no break in skin. On November 14, 2003 nurse's note revealed DuoDerm to sacral area two times a day (bid) and as needed (PRN). The facility did have this order in resident record. No documentation was noted on the following dates of weekly skin sweeps: 11-18- 2003; 12-02-2003; 01-08-2004-; 01-13-2004; 01-20-2004, and 02- 03-2004. Review of the nursing progress notes dated 3-01-2004 at 3:00 p.m. indicated that the resident had a redness in the buttocks area and between the thighs. However, there is no indication that the finding was reported to the wound care nurse or the physician. Further review of the weekly skin sweeps documentation revealed that on 03-09-2004 and 03-23- 2004 redness was found on the sacral area with no break down in the skin. On 03-30-2004 weekly skin sweeps documentation revealed a break down in skin to the sacral area and discoloration on upper part of both arms. However, there was no indication that any action was taken regarding the findings. In addition, review of the weekly skin sweeps indicated no documentation was made for 04-08-2004 and 04-13- 2004 for this resident. 11. Resident's initial care plan dated 10-29-2003 revealed the skin was intact. Plan was to check skin daily, keep skin clean and dry, protect/elevate elbows and heels, pressure reduction surface in bed and wheelchair and apply barrier cream after each episode of incontinence. The area under "turn Q (every) ___) was not checked. Care plan dated 02-05-2004 revealed resident has a stage IV decubitus to coccyx area, stage II to right ankle and left heel. Some of the approaches were to perform weekly skin assessment and turn and reposition every 2 hours and as needed. Review of the nurses! progress notes and wound care weekly sweeps did not indicate the resident's progressive decline in skin condition to the sacral, heel and ankle area (which had reached the stage II and IV levels). The decline was also not indicated in the care plan with the interventions not updated accordingly to address the resident's skin condition. The documentation in the care plan only indicated that the resident had developed a stage II to the ankle and heel and iv to the sacral, but did not indicate when the skin alteration was first observed, the size of the pressure sore and the treatments given. On 02-11-2004 the doctor wrote orders for Accuzyme dressing to sacral wound bid. However, no wound care treatment sheet for this time was in the resident's medical record or provided by the facility. 12. Interview with the DON and Risk Manager on 5-17-2004 in the afternoon, revealed all wound care residents are seen by the facility wound care doctor weekly and wound care nurse daily. The doctor does all of the staging of pressure sores. When asked as to the whereabouts of the nurse and doctor's pressure sore logs the risk manager stated that she did not know what happened to them. The DON revealed the wound care nurse who worked at the time, no longer work at the facility and the facility do not know what happen to the documentation. 13. Review of the facility's policy for "Prevention of Pressure Sores" states, routinely assess and document the condition of the resident's skin per facility wound and skin care program for any signs and symptoms of irritation or breakdown. Immediately report any signs of a developing pressure sore. However, there was no evidence provided to indicate that the skin breakdown was properly assessed and reported in a timely manner. The documentation failed to demonstrate that proper care and services were being provided to the resident to prevent on-set of new pressure sores and to timely treat the skin breakdown the resident had acquired in the facility. 14. The resident was transferred to the hospital on 04- 20-2004 with a stage IV pressure to the sacral area. 15. Based on the foregoing, Southpoint Nursing and Rehabilitation Center violated Title 42, Section 483.13(c), Code of Federal Regulations as incorporated by Rule 59A- 4.1288, Florida Administrative Code, herein classified as an isolated Class II deficiency pursuant to Section 400.23 (8) (b), Fla. Stat., which carries, in this case, an assessed fine of $5,000.00 (fine is doubled this time due to citing of Class I & II on 02/12/2004 annual survey). 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, Southpoint Nursing and Rehabilitation 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 $5,000.00 against Southpoint Nursing and Rehabilitation Center on Count I. c. Assess and assign a conditional license status to Southpoint Nursing and Rehabilitation 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 (2003). 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 for Health Care Administration, Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, telephone (850) 922- 5873. 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. if WL / “wan lr Kes 7 FL Bar No: 178081 Assistant General Counsel Agency for Health Care Administration Spokane Building, Suite 103 8350 N.W. 52°¢ Terrace Miami, Florida 33166 Copies furnished to: Diane Lopez Castillo Field Office Manager Agency for Health Care Administration Manchester Building 8355 N.W. 53%¢ 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) EXHIBIT “A” Conditional License License No. SNF 1507096 Certificate No. 11529 Effective date: 05/17/2004 Expiration date: 06/20/2004 Standard License License SNF 1507096 Certificate No. 11530 Effective date: 06/21/2004 Expiration date: 06/30/2004 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished U.S. Certified Mail, Return Receipt Requested to Marcia Ss. Couitt, Administrator, Southpoint Nursing and Rehabilitation Center, 42 Collins Avenue, Miami Beach, Florida 33139; Southpoint Health Care Associates, LLC, 10210 Highland Manor Drive, Suite 250, Tampa, Florida 33610, and to CT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324 on A aa , 2004. elson E. Rodney

Docket for Case No: 04-003380