: : STATE OF FLORIDA AGENCY. FOR HEALTH CARE ADMINISTRATION 4 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2005006867 2005006866 INNOVATIVE HEALTH CARE PROPERTIES, INC., d/b/a SUMMER BROOK HEALTH CARE CENTER, Respondent. OS: Dek} / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against INNOVATIVE HEALTH CARE PROPERTIES, INC., d/b/a SUMMER BROOK HEALTH CARE 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 an administrative fine in the amount of $2,500.00 and assign a conditional licensure status commencing June 29, 2005, based upon one cited State Class I deficiency for the Respondent’s failure to develop a care plan with on-going specific approaches to direct staff in the care and services for the resident’s psychosocial status. . JURISDICTION AND VENUE | 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Fla. Stat. (2004). N 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 ap applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended); Chapter 400, Part II, Florida Statutes, and; Fla. Admin. Code R. 59A-4, respectively. 4, Respondent operates a 120-bed nursing home located at 5377 Moncrief Road, Jacksonville, Florida, 32209, and is licensed as a skilled nursing facility, license number 1132096. 5. Respondent was at all times material hereto, a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. That pursuant to law a facility is responsible to develop a plan of care which shall consist of, inter alia, a complete , comprehensive, accurate and reproducible assessment of each resident’s functional capacity which is standardized in the facility, and is completed within 14 days of the resident’s admission to the facility and every twelve months, thereafter. The assessment shall be ...reviewed promptly after a significant change in the resident’s physical or mental condition [and] revised as appropriate to assure the continued accuracy of the assessment. R. 59A-4.109(1) Fla. Admin, Code. . 8. That pursuant to Florida law, a facility is responsible to develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The care plan must describe the services that are to be furnished te sitain or maintain the resident’s highest practicable physical, mental and social well-being. The care plan must be completed within 7 days after completion of the resident assessment. R. 59A-4,109(2) Fla. Admin. Code. . ne nase 9. That a “Resident care plan” means a written plan developed, maintained, and reviewed not less than quarterly by a registered nurse, with participation from other facility staff and the resident or his or her designee or legal representative, which includes a comprehensive assessment of the needs of an individual resident: the type and frequency of services required to provide the necessary care for the resident to attain or maintain the highest practicable physical, mental, and psychosocial well-being; a listing of services provided within or outside the facility to meet those needs; and an explanation of service goals. Section 400. 021(17) Fla. Stat. (2004). 10. That on or about June 29, 2005, the Petitioner Agency conducted a complaint survey of the Respondent’s facility. 11. That based upon observations of the grounds surrounding the facility, interview with the Respondent’s director of nursing, a review of local news media reports, and the review of Respondent’s records regarding resident number one, the Respondent facility failed to develop a care plan and updated comprehensive assessment with on-going, specific approaches to direct staff in the care and services for the resident's psychosocial status. 12. That the Respondent failed to assess or plan to and provide services with goals and approaches or interventions which, had they been provided by staff of the Respondent facility, may have prevented the resident from leaving the facility and being found dead three days later ‘in a creek adjacent to the facility's property. 13. That the Petitioner’s representative reviewed the Respondent’s records regarding resident number one. 14. That Respondent’s records regarding resident number one reflect the following: a. That the resident was cognitively impaired and had been diagnosed with bipolar disorder; b. That the Respondent’s psychiatrist and physician assistant had identified the resident as oriented to self only; c. That on April 4, 2005, the resident’s records contain an entry reading “Notable change in behavior — feeling CNA up and down,” “Change in mental status - agpressive;” d. That on April 6, 2005, the resident’s records contain an entry reading “touching staff inappropriately;” ; e. That on April 7 through 10, 2005, the resident’s records contain several entries reading “Touching, fondling staff and visitors;” f. . That on April 13, 2005, the resident’s records contain an entry reading “wandering through the facility - begging cigarettes — intimidating other residents, touching staff,” g. That the resident’s assessment tool, the Minimum Data Set dated April 14, 2005, in Section E entitled “Mood and Behavior Patterns” coded the respondent as “0”, which indicates that the resident had not exhibited mood or behavior patterns in . the thirty days preceding the assessment; h. That on May 4, 2005, the resident’s records contain an entry indicating that the resident was in a wheelchair and “attempting to elope from the facility” at 7:00 PM. Entries further reflect that the resident climbed over the facility's fence on the Moncrief Road side snagging the resident's pants, but had no injury: i. . Those entries of May 4, 2005 continue to Teflect that the resident was assisted back to bed by staff. At 8:00 PM, on the same date, staff documented that resident number one was observed by other residents to be "leaving the facility". At 9:00 PM, records reflect that staff notified the police; j. That the records reflect that resident number one was returned to the facility on May 5, 2005 by local law enforcement. k. That on May 12, 2005, the resident’s records contain an entry reflecting that staff stopped resident number one from the resident’s attempt to leave the facility; 1. That on May 14, 2005, the resident’s records contain an entry reflecting that the resident eloped from the facility to the “Gates” service station, locate two blocks away and across a four lane busy highway, and was retumed to the facility by staff where the resident was medicated with Ativan; m. That on May 22, 2005, the resident’s records contain an entry reflecting that the resident was witnessed “leaving the facility;” n. That the resident’s records reflect that staff attempted to return the resident to the facility, but the resident became combative and ran from staff down a four lane road toward a second four lane road. Staff attempts to locate the resident by searching from a vehicle were unsuccessful; o. That police were notified; p. That a late entry to the resident s records dated June 23, 2005, read that the resident ".. ‘has been exhibiting aggressive behavior for the past month”. 15, That on or about June 25, 2005, the resident was located, deceased, in a creek adjacent to the Respondent facility. 16. . That the Respondent's care plan for resident number one contained no indicia of the resident’s behaviors as documented in the resident's records including the resident’s notable changes of behavior identified as fondling, aggression, fighting, agitation and attempts at elopement. 17. That the Respondent’s care plan and assessment had no interventions to address the resident’s well-being in light of these behaviors as required by law. 18. That the Respondent’s records reflect a pattern of behaviors ranging from aggression to attempts at elopement for a period commencing at least April 4, 2005, ten days before the Respondent’s last care plan, and continuing through the resident’s death. 19. That the Respondent’s records reflect a significant change in the residents behavior commencing April 4, 2005. 20. That the Respondent facility failed to recognize significant changes in the resident’s behavior as documented in it records when Respondent completed the resident’s Care Plan and comprehensive asseasment of April 14, 2005. 21. That the Respondent’s records indicate that the Respondent facility knew of the resident’s change in behaviors subsequent to the completion of the care plan, and failed to complete a comprehensive assessment with appropriate interventions promptly after a significant change in the resident’s physical or mental condition as required by law. 22. That the failure to initiate interventions for the resident’s significant behavioral changes when the same were known by the Respondent is a failure in the operation of the Respondent which directly threatened the resident’s physical or emotional health, safety or security. 23. . That the Petitioner’s representative.imerviewed the Respondent’s director of nursing on June 29, 2005 who indicated that no care plan was completed for the resident as the resident’s behavior was improving and that it wasn't time to do care plans. 24... That care plans and the comprehensive assessment must be conducted at such time as a significant change in the resident’s physical or mental condition occur, thus the time at which the resident’s reassessment was necessary occurred contemporaneous with the resident’s increasing changes in behaviors, including, but not limited to, efforts to elope. 25. That the Agency determined Respondent had not provided the necessary care and services and had compromised the resident's ability to maintain or reach his or her highest practicable physical, mental and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care and provision of services and cited this deficient practice as a State Class II deficiency. 26. That the Agency provided Respondent with the mandatory correction date for this deficient practice of July 29, 2005. ' WHEREFORE, the Agency intends to impose-an administrative fine in the amount of $2,500.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(b) and 400.102, Fla. Stat. (2004), and assess costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. (2004). COUNT IL 27. The Agency re-alleges and incorporates paragraphs (1) through (5) and (7) through (26) as if fully set forth herein. 28. Based upon Respondent’s one cited State Class II deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400, or the.:ules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Fla. Stat. (2004). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(7) commencing June 29, 2005. Respectfully submitted this 2 day,of'September, 2005. 7 f Thoms ¥. Walsh, IL, Esquire Fla. Bar. No. 566365 Agency for Health Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 (office) DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Fla. Stat. (2003), Respondent shall post the most current 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. 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: 7004 2890 0004 7600 5282 on September 4 , 2005 to Dewayne Harvey, Administrator, Summer Brook Health Care Center, 5377 Moncrief Road, Jacksonville, Florida, 32209, and by U.S. Mail to Alfred W. Clark, Esq., Registered Agent, 117 S. Gadsden St., #201, Tallahassee, Florida, 32301. LA a a MLE a Thortias J. Walsh, II, Esq. Copies furnished to: Dewayne Harvey Administrator Summer Brook Health Care Center 5377 Moncrief Road Jacksonville, FL 32209 (Certified U.S. Mail) Alfred W. Clark, Esq. Reg. Agent 117 S, Gadsden St. #201 Tallahassee, FL 32301 (U.S. Mail) Thomas J. Walsh, II Senior Attorney Agency for Health Care Admin. 525 Mirror Lake Drive, #330G St. Petersburg, FL 33701 (Interoffice Mail)

Docket for Case No: 05-003684