STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2005001054 AHCA No.: 2005001053 v. Return Receipt Requested: 7002 2410 0001 4234 2079 FAIR HAVENS CENTER, LLC d/b/a 7002 2410 0001 4234 2086 FAIR HAVENS CENTER, 7002 2410 0001 4234 2093 Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “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, Florida Statutes, (2004) hereinafter alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine in the amount of $4,000.00 pursuant to Sections 400.23(8) (c), Florida Statutes [AHCA No.: 2005001053]. 2. This is an action to impose a conditional licensure rating pursuant to Section 400.23(7)(C), Florida Statutes [AHCA No. 2005001054]. 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 Dade 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. Fair Havens Center is a skilled nursing facility located at 210 Curtiss Parkway, Miami Springs, Florida 33166- 5291 and is licensed under Chapter 400, Part I=, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I FAIR HAVENS CENTER FAILED TO IMPLEMENT MEASURES TO SAFE GUARD RESIDENTS FROM POSSIBLE INFECTION. TITLE 42 SECTION 483.65(a) (1)-(3), CODE OF FEDERAL REGULATIONS RULE 59A-4.106(4) (1), FLORIDA ADMINISTRATIVE CODE (INFECTION CONTROL) CLASS III 7. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 8. Because Fair Havens Center participates in Title XVIII or XIX, it must follow the certification rules and regulations found in Title 42 Code of Federal Regulation 483. 9. A licensure and re-certification survey was conducted from November 15, 2004 through November 18, 2004. Based upon observation and interview the facility failed to implement measures to safe guard residents from possible infection for one sampled resident (#16) and one randomly sampled resident (R#31) observed during provision of perineal care as well as one sampled resident (#4) and two randomly sampled residents (R#36 & R#37) who shared a room with a resident being treated for scabies infestation. The findings include the following: 10. On 11/17/04 at approximately 3:50pm, Certified Nursing Assistant (CNA) #2 was observed providing perineal care for resident #31 in the presence of the Unit Coordinator. The CNA was observed to clean the vulva without spreading the labia to expose the urethral area. The CNA then cleaned the resident's rectal area. During this time the resident urinated. The CNA wiped the rectal area again but did not clean the resident's vulva again after urination. The CNA then applied a clean adult incontinence brief and repositioned the resident on his/her back without washing her hands or changing gloves. IL. On 11/17/04 at approximately 3:35pm, Certified Nursing Assistant (CNA) #1 was observed providing perineal care for resident #16 in the presence of the Unit Coordinator. The CNA was observed first wiping the fold between the groin and the inner thighs and then using the same wipe spread the labia, exposing the urethral area and cleaned that in a tcp downward motion. 12. Review of the "Infection Control Log" requested from and provided by the facility revealed the following information: a. October 2004 - Total of 19 nosocomial (facility acquired) urinary tract infections. b. September 2004. - Total of 16 nosocomial (facility acquired) urinary tract infections. c. August 2004 - Total of 27 nosocomial (facility acquired) urinary tract infections. d. July 2004 - Total of 15 nosocomial (facility acquired) urinary tract infections. 13. During an interview with the Director of Nursing on 11/17/04 at approximately 4:00pm, she stated the staff was not following facility policy and an in-service on perineal care would be provided to them. On 11/18/04, the Director of Nursing supplied documentation of the in-services given on 11/17/04 and 11/18/04. 14. On 11/16/04 at approximately 3:00pm, review of the "Treatment Administration Record" for resident #4 revealed an order for Elimite (a topical medication for the treatment of head lice and scabies infestations). At that time, the Unit Coordinator was asked why the resident was receiving the Elimite. After checking with the medication nurse, she stated it had been written in error and that one of the resident's roommates had been placed on the Elimite. Review of the "Physician's Orders Sheet" revealed an order dated 11/14/04 for resident #38 that stated, "Elimite Cream apply on skin from head to soles remove in 14 hours by washing. Retreat in 14 days if itching present again. Dx Scabies." 15. Review of the "Scabies Protocol" requested from and supplied by the facility revealed it stated, "Monitor other residents in the same room for similar signs and symptoms. At approximately 3:50pm on 11/16/04, the Unit Coordinator was asked where the documentation of this monitoring could be found. She stated it would be in the nurses' notes. However, review of the "Nurses Notes" for the three roommates (#36, #37 & #4) revealed no evidence that they were being monitored for possible scabies infestation. 16. The mandated date of correction date was designated as December 18, 2004. 17. A follow-up licensure and recertification survey was conducted on December 28, 2004. Based on observation and interview, the facility failed to implement measures to safe guard residents from possible infection for one of five randomly sampled resident, R9, observed during provision of perineal care. The findings include the following: 18. On 12/28/04 at 1:50PM, during observation cf perineal care for resident R9, the Certified Nursing Assistant was observed washing the inner labia back to front. Wipine from back to front has the potential for causing urinary tract infections. After turning the resident and washing the rectal area, the CNA picked up a bottle labeled "Herbal Essence, Fruit Fusion purifying conditioner for normal to oily hair" and applied some to the resident’s sacral area. When the CNA was asked what she normally applies to residents' sacrum, she stated cream. When the CNA was informed of the labeling on the bottle, she stated "What, oh my god, but why was it in the bathroom?" 19. The Director of Nurses was informed of this finding at approximately 5:00PM. She stated that all the CNA's hed been in- serviced on proper perineal care. This included one-on-one demonstration by the CNA's. This is an uncorrected deficiency from the survey of November 18, 2004. 20. Based on the foregoing facts, Fair Havens Center violated 483.65(a) (1)-(3), Code of Federal Regulation and Rule 59A-4.106(4) (1), Florida Administrative Code herein classified as an uncorrected, isolated Class III violation pursuant to Section 400.23(8), Florida Statutes, which carries an assessed fine of $1,000.00. However, in this case, the Agency has doubled the $1,000.00 fine and has imposed an administrative fine of $2,000.00 pursuant to Section 400.23(8)(c), which requires that the fine be doubled if the facility was previously cited for a Class II deficiency. The facility was cited for a Class II violation during its annual inspection on September 25, 2003. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes. COUNT II FAIR HAVENS CENTER FAILED TO PROVIDE VISUAL PRIVACY IN RESIDENT ROOMS . TITLE 42 SECTION 483.70 (d) (1) (iv)&(v), CODE OF FEDERAL REGULATION RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE (PHYSICAL ENVIRONMENT) CLASS III 21. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 22. A follow-up licensure and re-certification survey was conducted on December 28, 2004. Based on observation, the facility failed to provide full visual privacy in nine (9) resident rooms and for two (2) of 27 sampled residents (R #7, #18). The findings are as follows: 23. During the initial tour of the facility, on 11/15/04 at approximately 9:45 am, surveyor observation revealed that the suspended privacy curtain tracks did not extend around the beds in several rooms. The rooms are 117, 126 A, 127 B, 132 C, 134A, between beds 134 C and 134 D, 138 C and 213 A and did not offer the residents full visual privacy. The curtain tracks for the beds did not extend all the way to the window or wall at the foot of the beds, leaving an approximate twelve (12) inch gap between the end of the track and the wall. 24. In rooms 117 and 126, the gap between the curtain and the bed is approximately 18-inches from the gap to the end of the curtain track and the bed for the resident in Bed A. Visitors or other residents could easily observe the residents in the beds while they were receiving care. In room 127 Bed B, the gap between the end of the curtain track and tne wall is approximately 18 inches. In room 132, bed C, the gap between the end of the curtain track and the wall is approximately three feet short. Bed A in room 134 is approximately twelve inches from the end of the curtain track. The gap between the C and D bed is approximately 12 inches from the end of the curtain track. The gap between beds C and D in room 138 and room 213 A is approximately 12 inches from the end of the curtain track. These gaps between the beds and the curtain tracks did not allow for full privacy of the residents. 25. During the initial tour on 11/15/04 at 10:05 a.m., the ceiling-suspended privacy curtain was pulled around the four beds in room 235. The privacy curtain between "c" bed and "d" bed was not long enough to provide full visual privacy. Additionally, the privacy curtain between "a" bed and "d" bed was not long enough to provide full visual privacy for these residents. , 26. During the initial tour on 11/15/04 at 10:05 a.m., the ceiling-suspended privacy curtain was pulled around the four beds in resident #7's room. The ceiling-suspended privacy curtain between resident #7's bed and his/her roommate was not long enough to provide full visual privacy. Additionally, on 11/16/04 at 11:35 a.m., a Licensed Practical Nurse (LPN) accompanied a surveyor to resident #7's room to observe the resident. The LPN drew the curtain between resident #7 and the roommate next to him/her. The ceiling-suspended privacy curtain between resident #7's bed and his/her roommate was not long enough to provide full visual privacy, as there was an approximate three feet space that the privacy curtain did not cover. 27. On 11/16/04 at 4:28 p.m., the ceiling suspended privacy curtain was drawn between resident #18 and his/her roommate. The privacy curtain was not long enough to provide full visual privacy between the two residents. 28. The mandated date of correction was designated as December 18, 2004. 29. A follow-up to the licensure and re-certification survey was conducted on December 28, 2004. Based on observation, the facility failed to provide full visual privacy in seven (7) resident rooms and for one sampled residents #7. The findings include the following: 30. During the tour of the facility on 12/28/04 at approximately 11:23 A.M., surveyor observation revealed that the suspended privacy curtain tracks did not extend around the beds in several rooms. In rooms 136B and 138A, the curtains were immobile and didn't extend around the beds. In room 212, the privacy curtain at the foot of the beds was missing. Also, in rooms 207, 216, 217, 218, and 219 the privacy curteins didn't close around beds offering the resident full visual privacy. The curtain tracks for these beds did not extend all the way to the window or wall at the foot of the beds, leaving an approximate twelve (12) inch gap between the end of the track and the wall. 10 31. The Director of Nursing was informed about’ the findings at 5:00 p.m. This is an uncorrected deficiency from the survey of November 18, 2004. 32. Based on the foregoing facts, Fair Havens Center Nursing violated Section 483.70 (d) (1) (iv)&(v), Code of Federal Regulation as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as an uncorrected, isolated Class III violation pursuant to Section 400.23(8), Florida Statutes, which carries an assessed fine of $1,000.00. However, in this case, the Agency has doubled the $1,000.00 fine and has imposed an administrative fine of $2,000.00 pursuant to Section 400.23(8) (c), which requires that the fine be doubled if the facility was previously cited for a Class II deficiency. The facility was cited for a Class II violation during its annual inspection on September 25, 2003. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statute. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Fair Havens Center 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” Il EXHIBIT “A” Conditional License License # SNF 1147096; Certificate No.: Effective date: 12/28/2004 Expiration date: 07/23/2005 12213 PRAYER FOR RELIEF WHEREFORE, the Petitioner, Health Care Administration requests the following relief: 1. Make factual and legal findings in favor of the Agency on Count I and Count II. 2. Assess against Fair Havens Center an administrative fine of $4,000.00 for the violations cited above. 3. Assess against Fair Havens Center 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 (2004). 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. 13 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. OC tle, Gleave 2 ourdes A. Naranjo, Assistant General Covhsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 305-470-6801 Copies furnished to: Diane Castillo Field Office Manager Agency for Health Care Administration Manchester Building 8350 NW 52 “¢ Terrace - Suite 103 Miami, Florida 33166 (Interoffice 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) 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 Neal Kjos, Administrator, Fair Havens Center, 201 Curtiss Parkway, Miami Springs, Florida 33166-5291; Pair Havens Center, LLC, 6865 N. Lincoln Avenue, Lincolnwood, Illinois 60712; Norman Ginsparg, 12221 W. Dixie Highway, North a Miami, Florida 33161 on this G day of QA; 2005. ourdes A. Naranjo, Esq:

Docket for Case No: 05-001124