STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2004010329 PALM BAY HEALTH CARE ASSOCIATES, fom) Pony LLC, d/b/a THE PALMS REHABILITATION & HEALTHCARE CENTER, a Ts : 1 C5 C¥SE wre Bote Respondent. Ze / an co sued ADMINISTRATIVE COMPLAINT = COMES NOW the Agency For Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against PALM BAY HEALTH CARE ASSOCIATES, LLC, d/b/a THE PALMS REHABILITATION & HEALTHCARE CENTER, (hereinafter “Respondent”), pursuant to §§ 120.569, and 120.57, Fla Stat., (2004), and alleges: NATURE OF THE ACTION This is an action to impose upon the Respondent an administrative fine in the amount of $2,000.00, based upon one (1) uncorrected State Class III deficiency. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Fla. Stat. (2004), 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and enforcement of applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title [V, Subtitle C (as amended); Chapter 400, Part II, Florida Statutes; and, Fla. Admin. Code R. 59A-4. 4. Respondent operates a 120-bed nursing home located at 5405 Babcock Street NE, Palm Bay, Florida 32905, and is licensed as a skilled nursing facility (License # SNF 130470985). 5. Respondent was at all times material hereto a licensed nursing facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNTI 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Pursuant to Fla. Admin. Code R. 59A-4.1288, incorporating by reference 42 C.F.R. § 483.20(k)(3)(i), the services provided or arranged by a skilled nursing facility must meet professional standards of quality. 8. On or about 08/23/04 through 08/26/04, the Agency conducted a recertification survey (hereinafter “08/26/04 survey”) of the Respondent's facility (hereinafter “Facility”). 9. Based on record review and interview, the Respondent failed to meet professional standards of quality by failing to follow the plan of care regarding medication for one (1) of twenty-three (23) sampled residents (Resident #4). 10. A review of the medical record of Resident #4 revealed the following physician order of 2/6/04: “Duragesic patch 24 mcg. [micrograms] Q [every] 3 days due 2/8.” Tt. Examination of Resident #4’s Medication Administration Record (hereinafter “MAR”) for 02/08/04 revealed that the Duragesic patch was not administered on 02/08/04. as ordered. 12. A review of a nurse’s note entry on 2/9/04 at 3:25 p.m. confirmed the above- mentioned failure to administer the Duragesic patch as ordered. It stated: “MD made aware Duragesic patch was not applied 02/08/04 per orders”. 13. There were no entries in the medical record that provided any sort of justification or explanation for the failure of the Duragesic patch to be administered as ordered. 14. Based on the above, the Agency determined that the Respondent failed to meet professional standards of quality by failing to follow the plan of care regarding medication for one (1) of twenty-three (23) sampled residents (Resident #4). 15, | The Agency determined that this deficient practice will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental. or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 16. The Agency cited the Respondent for a Class III violation, pursuant to § 400.23(8)(c), Fla. Stat. (2004). 17. The Agency provided Respondent with a mandatory correction date of 09/16/04. 18. On or about October 6, 2004, the Agency conducted a complaint investigation in conjunction with a revisit survey of the Facility. 19. Based upon record review and resident and staff interviews, the Respondent failed to meet professional standards of quality by failing to follow physician’s medications orders for two (2) of fourteen (14) sampled residents (Residents #3 & #5), and failing to follow physician's orders regarding the use of a mechanical lift for one (1) of fourteen (14) sampled residents (Resident #11). 20. Review of Resident 3's clinical record indicated diagnoses including Parkinson disease, cerebral vascular accident, difficulty walking, dementia, gait abnormality, gait unsteadiness and vertigo. 21. Review of the 07/08/04 Minimum Data Set (hereinafter “MDS”) for Resident #3 revealed that the resident was moderately cognitively impaired, non-ambulatory and dependent upon the assistance of two (2) staff members to transfer. 22. Review of the 10/04 physician's order sheet indicated that Resident #3 was to be transferred by a mechanical (Hoyer) lift with the assistance of two (2) nursing staff members. 23. Review of the 04/15/04 risk for falls and activities of daily living (hereinafter “ADL”) care plans for Resident #3 indicated that the resident was to be transferred by a mechanical (Hoyer) lift with the assistance of two (2) nursing staff members. The same care plans were located in the certified nursing assistants (hereinafter “CNA”) ADL manual. 24. Review of the nurses progress note dated 09/23/04, in the clinical record for Resident #3, indicated that Facility staff members were educated regarding the mandatory use of the mechanical (Hoyer) lift with he assistance of two (2) nursing staff members for Resident #3, and that at that time Resident #3 continued to need the lift. 25. The CNA responsible for Resident #3 was interviewed on or about 10/06/04 at approximately 2:30 p.m. When asked how Resident #3 was transferred out of bed, the CNA stated that two (2) staff members hold the resident under the arms, lift the resident from a sitting to a standing position using their arms, and then pivot and place the resident into the wheelchair. When asked if a mechanical (Hoyer) lift was used for the transfer, the staff member indicated that he/she never used the mechanical (Hoyer) lift to transfer Resident #3. 26. Resident #3 was interviewed with on or about 10/06/04 at approximately 3:00 p.m. The unit nurse manager was present for this interview. When asked how Facility staff transferred him/her from the bed into a wheelchair, Resident #3 indicated that two (2) nurses or CNAs place their arms under each of his/her arms, lift him/her, twist him/her around and place him/her into the wheelchair. Resident #3 further indicated that although he/she was occasionally transferred using the mechanical (Hoyer) lift, the last time he/she was so transferred was approximately one (1) month ago. 27. Review of Resident #11's clinical record revealed diagnoses including insomnia, end stage Alzheimer's disease, anxiety, depressive disorder, paranoia, delusions, anorexia and psychosis. 28. Review of the 08/13/04 MDS for Resident #11 indicated that the resident was severely cognitively impaired. 29. Review of the 08/04, 09/04, and 10/04 physician’s order sheet for Resident #11 indicated that one (1) 15 milligrams (mgs.) tablet of Remeron be administered to Resident #11 at night. 30. Review of the 08/04 MAR for Resident #11 revealed that, during that month, the Remeron was administered nightly as per the physician’s order. 31. Review of the 09/04 and 10/04 MAR for Resident #11 revealed that the Remeron was discontinued, with the last dose administered on 08/31/04. 32. Review of the clinical record for Resident #11 revealed no evidence that a physician wrote an order to discontinue the administration of Remeron. 33. In an interview conducted on or about 10/06/05 at approximatcly 3:30 p.m., the unit nurse manager confirmed that Resident #11 did not receive Remeron in 09/04, or from 10/01/04 to 10/05/04. In that same interview, the unit nurse manager indicated that she was unable to find any physician's order to discontinue the Remeron. 34. Resident #5 was admitted to the Facility on 06/28/04 with diagnoses including congestive heart failure, aortic stenosis, persistent insomnia, renal failure and senile delusions. 35. Review of Resident #5’s 10/04 MAR revealed that the resident was receiving Risperdal, 0.25 mg. by mouth, every night. 36. Review of Resident #5’s clinical record revealed a psychiatric consultation dated 07/28/04, which read, "D/C [discontinue] Risperdal...assess after D/C [discontinue] Risperdal." 37. Review of Resident #5’s clinical record revealed a physician order dated 06/30/04, which read "D/C [discontinue] Risperdal tomorrow night." 38. Review of Resident #5's MAR for the months of July, August, September and October 2004, revealed that Resident #5 did not receive Risperdal during the months of July and August 2004, but, beginning in September 2004, Resident #5 again started receiving Risperdal, despite the absence of a physician’s order to do so. 39. In an interview conducted on or about 10/06/04 at approximately 1:30 p.m., the unit manager confirmed that the Risperdal was discontinued during the months of July and August 2004, but was re-initiated in September 2004, without a physician’s order. 40. Record review revealed that Resident #5 received the Risperdal during September 2004, through October 6, 2004, the date of the complaint investigation/revisit survey. 41. Based on the above, the Agency determined that the Respondent failed to meet professional standards of quality by failing to follow physician’s medications orders for two (2) of fourteen (14) sampled residents (Residents #3 & #5), and failing to follow physician’s orders regarding the use of a mechanical Jift for one (1) of fourteen (14) sampled residents (Resident #11). 42. The Agency determined that this deficient practice will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 43. The Agency cited the Respondent for an uncorrected Class III violation, pursuant to § 400.23(8)(c), Fla. Stat. (2004). 44, The Agency provided Respondent with a mandatory correction date of 10/26/04. 45. Pursuant to § 400.23(8)(c), the fine amount shall be doubled for each class I[t deficiency if the skilled nursing facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. 46. During a recertification survey/inspection conducted on or about 08/23/04 through 08/26/04, the Respondent was cited for two (2) Class II deficiencies. 47. Accordingly, the Agency is required to double the fine imposed for the uncorrected Class III deficiency described in this count. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(c) and 400.102, Fla. Stat. (2004). Respectfully submitted this _ /* day of February, 2005. Brian T. Mulligan Fla. Bar. No. 0676543 Agency for Health Care Admin. 525 Mirror Lake Drive, 330L St. Petersburg, FL 33701 727.552.1439 (office) 727.552.1440 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the attention of: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail, return receipt no: 7003 1010 0003 0279 4393 on February _/ 7 2005 to Todd Werthman, Administrator, The Palms Rehabilitation & Healthcare Center, 5405 Babcock Street, NE, Palm Bay, Florida 32905 and U.S. Mail to CT Corporation System, Registered Agent for The Palms Rehabilitation & Healthcare Center, 1200 South Pine Island Rd., Plantation, Florida, 33324. LF 7 < Brian T. Mulligan Copies furnished to: Todd Werthman Administrator The Palms Rehab. & Healthcare Center 5405 Babcock Street NE Palm Bay, FL 32905 (U.S. Certified Mail) CT Corporation System Registered Agent The Palms Rehab. & Healthcare Center 1200 South Pine Island Rd. Plantation, FL 33324 (U.S. Mail) Brian T. Mulligan Senior Attorney Agency for Health Care Administration 525 Mirror Lake Drive, Suite 330L St. Petersburg, FL 33701 PAYMENT FORM Agency for Health Care Administration Finance & Accounting Post Office Box 13749 Tallahassee, Florida 32317-3749 Enclosed please find Check No. in the amount of $ , which represents payment of the Administrative Fine imposed by AHCA. The Palms Rehab. & Healthcare Ctr 2004010329 Facility Name AHCA No.

Docket for Case No: 05-000856