STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2004008233 AHCA No.: 2004008232 Vv. Return Receipt Requested: 7003 1680 0006 9825 9837 RIO PINAR HEALTH CARE 7003 1680 0006 9825 9844 ASSOCIATES, LLC d/b/a RIO 7003 1680 0006 9825 9851 PINAR HEALTH CARE, Respondent. ) a U ysl ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this administrative complaint against Rio Pinar Health Care Associates, LLC d/b/a Rio Pinar Health Care (hereinafter “Rio Pinar Health Care”) pursuant to Chapter 400, Part II and Section 120.60, Florida Statutes, (2003) hereinafter alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine in the amount of $2,500.00 pursuant to Sections 400.23(8) (b), Florida Statutes [AHCA No.: 2004008232]. ig 2. This is an action to impose a conditional licensure rating pursuant to Section 400.23(7) (b), Florida Statutes [AHCA No. 2004008233]. 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 Orange County, pursuant to Section 400.121 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. Rio Pinar Health Care is a skilled nursing facility located at 7950 Lake Underhill Road, Orlando, Florida 32822 and is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I RIO PINAR HEALTH CARE FAILED TO ENSURE THAT RESIDENTS RECEIVED ADEQUATE SUPERVISION AND ASSISTANCE DEVICES TO PREVENT FALLS. TITLE 42 SECTION 483.25(h), CODE OF FEDERAL REGULATIONS RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE (QUALITY OF CARE) CLASS II 7. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 8. Rio Pinar Health Care participates in Title XVIII or XIX, therefore, it must follow the certification rules and regulations found in Title 42 Code of Federal Regulation 483. 9. From July 19, 2004 through July 22, 2004, a complaint investigation was conducted in conjunction with a recertification survey. Based on observation, interview and record review, the facility failed to ensure that 1 of 26 sampled residents (#18) received adequate supervision and assistance devices to prevent falls, causing pain to the resident. The findings are as follows: 10. Resident #18 was admitted to the facility on 7/14/04 with diagnoses of organic brain syndrome, decubitus ulcers, renal failure and sepsis. The resident presented with a tracheostomy (breathing tube), urinary catheter and = was receiving all nutrition via a feeding tube. The initial 14 day minimum data set (MDS) had not yet been completed at the time of survey. It was due by 7/28/04. 11. Review of the occupational therapy (OT) evaluation and plan of treatment notes dated 7/15/04 revealed that the resident's primary diagnosis was head injury due to a motor vehicle accident on 5/18/04. The resident's family member reported that he/she has a left humerus plate, left hip plate, and bilateral lower extremity plates in the shin area. Further review of the OT plan of treatment revealed that the resident's functional level was total dependence upon staff, responds to name with eye contact, visually tracks well, correctly responded to pain, right upper extremity within functional limits, and left upper extremity non-functional with no active motor return. 12. A side rail screening was completed on 7/14/04 and indicated that the resident was not able to use side rails to position self in bed, was not able to position self in bed with other device, was not able to control movement of extremities, was not able to use call light consistently, and was not able to use side rail to assist with transfer. Resident was assessed to have full side rails. 13. The resident was placed in a bed with full side rails and a Microair Turn-Q Plus mattress. The Turn-Q Plus mattress is a therapeutic mattress for multiple pressure ulcers and pulmonary complications. Interview with the equipment representative and technician on 7/22/04 at 10:40 a.m. revealed that the mattress has 7 selectable turning modes and 4 automatic turning positions. The lateral rotation turns patients up to 40 degrees to reduce the risk of pulmonary complications. The mattress is also set 20 pounds above the patients weight and can provide a full or partial turn. The representative also stated that, "the mattress should be set at partial turn for quadriplegic patients or those with very limited mobility." 14. At the time the mattress was set up on the resident, it was set at 180 pounds (the residents weight on admission was 144 pounds) and full turn (lateral rotation at 40 degrees) . 15. Interview with the director of nursing, administrator, risk manager designee and maintenance person on 7/21/04 at 1:00 p.m. revealed that on 7/19/04; between 1:00 p.m. and 3:00 p.m., the maintenance person was asked to change the resident's bed because the head crank on the current bed had broken. A bed with half (1/2) side rails was given to the resident. The side rails were located at the top of the bed, from the head to waist area. The maintenance person stated that he "was never informed by nursing that the resident required full side rails for safety." 16. Review of the nursing progress notes dated 7/19/04 documented that at 9:00 p.m., the resident was "found lying face down on the floor". On assessment, the left clavicle appeared more protruding than right side. When asked if he/she is having pain, he/she nod head yes." "MD office was notified orders for stat x-ray was given." At 11:10 p.m., an X-ray of the left shoulder and clavicle was completed. No documentation could be found showing that pain medication was given or neurological checks started. On 7/20/04 at 1:00 a.m., the nurse's progress note stated: Patient found on floor on back next to the bed. Foley still attached, trach collar off, but cannula intact. All bed linen seen on floor with patient laying on it. Side rails (1/2) times 2 seen up. Assess patient and unable to communicate whether he/she hit head. No bumps or hematomas seen at this time. Started on neuro checks every 4 hours times 72 hours. Patient placed on a bed with full side rails times 2 temporarily (without mattress) . 17. On 7/20/04 at 3:00 a.m., “patient was asked by the nurse if his/her head hurt, he/she nodded yes. Tylenol, 2 given via feeding tube." No physician's order was obtained for the medication. No documentation could be found indicating that the physician was informed of the resident's headaches. At 5:00 a.m., the physician was called and the neurological checks were ordered "every 4 hours times 72 hours or 3 days". At 7:30 a.m., the nurse was notified that the x-ray was negative for fracture. 18. On 7/21/04 at 5:40 p.m., an interview with the nurse on duty at the time of the 9 p.m. fall was conducted. She stated, "I was shocked to see him/her on the floor the side rail was up, but lower than the mattress." 19. The facility failed to ensure that the resident had full side rails and no interventions were made after the first fall to prevent the second fall. On 7/20/04 on the 7 to 3 shift, the resident was placed back into a bed with top and bottom rails. On the last day of survey, 7/22/04, the resident was observed in bed and the topside rails were observed to be ina position lower than the mattress. The lateral rotation setting had been changed to a partial turn. 20. Interview with the director of nursing on 7/22/04 at 2:00 p.m., revealed "all residents will now be set at partial turn and that the facility had ordered higher side rails for the resident's bed". As of the time of exit, 6:00 p.m., the rails had not been replaced. 21. Based on the foregoing facts, Rio Pinar Health Care violated 483.25(h) (2), Code of Federal Regulation as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II violation pursuant to Section 400.23(8), Florida Statutes, which carries an assessed fine of $2,500.00. 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 Rio Pinar 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” EXHIBIT “A” Conditional License License # SNF 14370961; Certificate No.: Effective date: 07/22/2004 Expiration date: 11/30/2004 Standard License License # SNF 14370961; Certificate No.: Effective date: 08/26/2004 Expiration date: 11/30/2004 11652 11653 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 Count I. 2. Assess against Rio Pinar Health Care an administrative fine of $2,500.00 for the violation cited above. 3. Assess against Rio Pinar 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 (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 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. T¥ia Lawton-Russell, Esq. Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace ~- #103 Miami, Florida 33166 305-470-6804 Copies furnished to: Joel Libby Field Office Manager Agency for Health Care Administration 400 West Robinson Street - Suite S309 Orlando, Florida 32801 (U.S. Mail) Long Term Care Program office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) 10 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 James Mott, Administrator, Rio Pinar Health Care, 7950 Lake Underhill Road, Orlando, Florida 32822; Rio Pinar Health Care Associates, LLC, 10210 Highland Manor Drive - Suite 250, Tampa, Florida 33610; CT Corporation System, 1200 South Pine, Island Road, Plantation, Florida 33324 on this qth day of , 2004. Lawton-Russell, Esq. 11

Docket for Case No: 04-003597