STATE OF FLORIDA Qn os, AGENCY FOR HEALTH CARE ADMINISTRATION “2 9 ‘iy Me é bey ad STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, : Case Nos. 2005008488... 2005008487 05-42 YO’ ADMINISTRATIVE COMPLAINT VS. « PALM BAY MEDICAL INVESTORS, LLC, d/b/a LIFE CARE CENTER OF PALM BAY, Respondent. / COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against Palm Bay Medical Investors, LLC, d/b/a Life Care Center of Palm Bay (hereinafter “Respondent”), pursuant to §§ 120.569 and 120.57 Fla. Stat. (2005), and alleges: NATURE OF ACTION ay This is an action to change Respondent’s licensure status from Standard to Conditional, commencing 07/14/05 and ending 08/25/05, and impose an admirustrative fine in the amount of Two Thousand Five Hundred Dollars ($2,500.00) based upon the Respondent being cited for one ‘State Class Il deficiency. ) ; JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Fla. Stat. (2005). 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 state statutes and rules governing skilled nursing facilities pursuant to the Chapter 400, Part II, Florida Statutes, and; Fla. Admin. Code R. 59A-4, respectively. \ 4. Respondent operates a i4}-bed nursing home located at 175 Villanueva Road, Palm Bay, Florida 32907, and is licensed as a skilled nursing facility license number SNF130471030. 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. . COUNT I 6. The Agency re-alleges and incorporates paragraphs (1) throngh (5), as if fully set forth herein. 7. Pursuant to § 400.102(1)(a), Fla. Stat. (2005), the Respondent must ensure that residents suffer no intentional or negligent act that materially affects the health or safety of the residents of the facility. 8. Pursuant to § 400.022(1)(1), Fla. Stat: (2005), the Respondent must assure each resident receivés. adequate and appropriate health care and protective and support services, including social services; mental health services, if available;, planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency. 9. Pursuant to § 400.022(1)(o), Fla. Stat. (2005), the Respondent must assure that each resident be free from mental and physical abuse. 10. On or about 07/14/05, the Agency conducted an anrmal recertification survey at Respondent’s facility. 11. | Based on observation, record review and staff interview, the facility failed to ensure that residents suffer no intentional or negligent act that materially affects the health or safety of the residents by failing to provide appropriate personal care and avoid unnecessary pain to one of thirty five sampled residents (Resident # 13). Resident # 13 was admitted to the Respondent's facility with diagnoses including cerebral 12 tes vascular accident, abdominal pain, aphasia, rhabdomyolysis, and right sided hemiplegia and catheter related to benign prostate hypertrophy (BHP). Currently, the resident was on antibiotics for chronic urinary tract infections. 13. Review of Resident # 13's Minimum Data Set (MDS), dated 05/06/05, revealed that extensive one-person assistance was necessary for hygiene and total dependence, with one- person assistance, for toileting. 14, | Review of rehabilitation services notes of 07/01/05, 06/20/05, 06/15/05, 06/09/05, 06/06/05 and 06/02/05 indicated the resident complained of pain ir, the right upper extremity. 15. During observation of a certified nursing assistant (CNA), on 07/12/05, while performing perinéal/catheter care on Resident # 13, the CNA explained to the resident that his undergarments needed to be changed. 16. Asthe CNA proceeded to remove the resident's outer shorts and incontinent brief the resident attempted to resist care, causing the resident to groan and grimace facially. 17. The CNA informed the surveyor that she needed additional assistance with the resident and left the room, leaving the resident exposed and the catheter bag on the floor. 18. Retuming to the room with another staff member, they turned the resident, without a roll sheet, onto the resident's right side, to the point at which the resident had previously complained of, or exhibited, pain. The resident again groaned and grimaced in discomfort, grabbing the side rails with his left hand. 19. The care continued, despite the resident's continued groans and grimaces, as the CNA used the underpad to clean the resident's anal area which was covered with feces, not using a moist or wet washcloth. 20. The CNA sprayed the resident's anal area with an antimicrc bial solution on the buttocks, wiping with a towel from his/her anus to the lower back area. 21 Still moaning and grimacing in discomfort, the resident was then rolled over on his back. 22... After spraying the resident's groin area, the CNA took a wet washcloth and proceeded to clean the groin area and the perineal area, using the same wash cloth, consistently cleaning from the perineal area up to the area of the catheter tubing. | 23. The cleaning procedure was performed in a manner not using a clean-to-dirty or front-to- back method. 24. During the entire procedure, the CNA's failed to address the resident's signs of pain and 1 the resident's resistance to the care. 25. ~ The condition of the resident was known to the Respondent, or existed for a sufficient length of time so that the Respondent knew, or should have known, of it and the resulting dangers. 26. The Respondent owes a duty to its residents, including Resident #13, to protect them from foreseeable harm, as would a reasonably prudent and similarly situated nursing home, including, but not limited to, rendering care and services in a safe and beneficial manner. 27. The Respondent breached its duties of rendering reasonable and ordinary care in protecting Resident # 13 from undue pain, rendering adequate and appropriate health care. 28. Aga direct and proximate result of the aforementioned conduct of the Respondent, Resident # 13 sustained discomfort and pain while receiving inadecuate health care and services. 29. The Agency determined that Respondent’s negligent failure to provide the necessary care and services 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. 30. The Agency provided Respondent with the mandatory correction date for this deficient practice of 08/05/05. 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. (2005). ) COUNT 0 31. The Agency re-alleges and incorporates paragraphs (1) through (5) and (7) through (29) as if fully set forth herein. 32. Based upon Respondent’s one cited Class II deficiency, it was not in substantial compliance at the time of the survey with criteria established unde: Part If of Florida Statute 400, or the rules adopied by the Agency, a violation subj ecting it to assignment of a conditional licensure status under § 400.23(7)(b), Fla. Stat. (2005), ' , 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), Fla. Stat. (2005) commencing 07/14/05 and ending 08/25/05. Respectfully submitted this ErAaay of he. 2005. erald L. Pickett Fla. Bar. No. 559334 Agency for Health Care Administration 525 Mirror Lake Drive, 330K. St. Petersburg, FL 33701 727.552.1526 (office) 727.552.1440 (fax) DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Fla. Stat. (2005), 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: The Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Taliahassee, 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 IHEREBY CERTIFY that a true and correct copy of the foregoing has been sexved by U.S. Certified Mail, Return Receipt No: 7005 1160 0002 2254 762:0 on November _‘% , 2005 to: Nancy McGoldrick, Administrator, Life Care Center of Palm Bay, 175 Villanueva Road, Palm Bay, Florida 32907, and by U.S. Mail to: C.T. Corporation, Registered Agent, Life Care Center of Palm Bay, 1200 South Pine Island Road, Plantation, Flo ») jf ; yj L. Pickett, Esquire Copies furnished to: Nancy McGoldrick C.T. Corporation Gerald L. Pickett, Esquire Administrator Registered Agent Senior Attorney Life Care Center of Palm Bay Life Care Center of Palm Bay Agency for Health Care 175 Villanueva Road 1200 South Pine Island Road Administration Palm Bay, Florida 32907 Plantation, Florida 33324 425 Mirror Lake Dr, 330K (U.S. Certified Mail) (U.S. Mail) St. Petersburg, Florida 33701 (Interoffice)

Docket for Case No: 05-004340