STATE OF FLORIDA PILED AGENCY FOR HEALTH CARE ADMINISTRATION wor fore Ba 06 JUN I3 PH 4:23 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, DIVISION AD HINISTRATIVE Petitioner, vs. Case No. 2005010073 ANNA N. SORENSEN, D lo . ay 0 U “ Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against, ANNA N. SORENSEN (hereinafter Respondent), pursuant to Section 120.569, and 120.57, Florida Statutes, (2005), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of seven hundred fifty dollars ($750.00) based upon three cited State Class I deficiencies pursuant to §400.6196(1)(b) Fla. Stat. (2005). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, 400.6196 and 400.621, 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 adult family care homes and enforcement of all applicable federal regulations, state statutes and rules governing adult family care homes pursuant to the Chapter 400, Part VII, Florida Statutes, and Chapter 58A-14 Fla. Admin. Code, respectively. 4. Respondent operates a 5-bed adult family care home located at 3441 Dawn Court, Lake Mary, Florida 32746, and is licensed as an assisted living facility, license number 109. 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 Florida law, the department, in consultation with the Department of Health, the Department of Children and Family Services, and the agency shall, by rule, establish minimum standards to ensure the health, safety, and well-being of each resident in the adult family-care home. The rules must address the criteria and procedures for determining the appropriateness of a resident’s placement and continued residency in an adult family-care home. A resident who requires 24-hour nursing supervision may not be retained in an adult family-care home unless such resident is an enrolled hospice patient and the resident’s continued residency is mutually agreeable to the resident and the provider. §400.621(1)(f) Fla. Stat. (2005). 8. That pursuant to Florida law, the criteria for continued residency shall be the same as the criteria for admission, except that, inter alia, a resident with a stage 2 pressure sore must be discharged if the pressure sore has not healed within 30 days or has not been reduced to stage 1. R. 58A-14.0061(5)(a) Fla. Admin. Code. (Emphasis added.) 9. That on September 15, 2005, the Agency completed a complaint survey of Respondent. 10.‘ That based upon interview and the review of records, the facility failed to ensure that one w sampled resident with a Stage III decubitus ulcer, was timely discharged from the Respondent facility. 11. That the Petitioner’s representative reviewed the Respondent’s records regarding resident number two (2) which reflected the following: a. That the resident had diagnoses of diabetes type I] and hypertension; b. That the resident fell and broke his or her hip on March 25, 2005; c. That at some point after returning to the Respondent facility on March 30, 2005, the resident developed a stage II pressure sore on the coccyx; d. That when the resident was admitted to the care of hospice on July 22, 2005, the initial assessment by the hospice staff identified that the resident had a stage IT pressure sore on the coccyx; e. That nurse’s notes from March 25, 2005 through September 1, 2005 reflected no mention of the pressure sore; f. That their existed no plan of care for the pressure sore through July 21, 2005; g. That hospice notes dated July 27, 2005 documented that the resident had developed a 3 centimeter (cm) by 3 cm Stage III pressure sore on the coccyx and a.5 cm by .5 cm stage II pressure sore on the superior coccyx. 12. —‘ That the Petitioner’s representative interviewed the Respondent provider on September 12, 2005 who indicated the following: a. That the resident developed a red area on the lower back; b. That the time a which the redness was noted was unknown as there were no notes documenting this fact; c. That a physician’s order for treatment of the resident’s pressure sore was not sought; d. That application of the over-the-counter medication Lotrimon was begun to the pressure sore; e. That the Lotrimon had been given to the provider by a doctor but was never specifically prescribed for resident number two’s (2) pressure sore area; f. That a hospice nurse recommended that the resident be placed on hospice care shortly before July 22, 2005 due to the declining condition of the resident. 13. That the Respondent maintained the resident in the Respondent facility long in excess of thirty (30) days after the resident’s development of a stage II pressure sore, which worsened to a stage III pressure sore, and the Respondent maintained the Resident in the facility in excess of thirty days after the development of the stage III pressure sore. The same is a violation of law regarding the continued residency of individuals with stage Il pressure sores in adult family care homes. 14. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 15. That the Agency provided Respondent with a mandatory correction date of October 1, 2005. 16. That the same constitutes a Class II offense as defined in Florida Statute 400.6196(1)(b). WHEREFORE, the Agency intends to impose an administrative fine in the amount of two hundred fifty dollars ($250.00) against Respondent, an adult family care home in the State of Florida, pursuant to § 400.6196(1)(b), Fla. Stat. (2005). COUNT I 17, The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 18. That pursuant to Florida law, the AFCH provider shal] provide general supervision which includes being aware of the resident's general whereabouts and well-being while the resident is on the premises of the AFCH in order to ensure the resident’s safety and security, and reminding the resident of any important tasks or activities, including appointments, as needed by the resident. The provider is responsible for determining and providing adequate supervision however; under no circumstances shall a resident be left unattended for more than 2 hours. R. 58A-14.007(2)(a) Fla. Admin. Code. 19, That on September 15, 2005, the Agency completed a complaint survey of Respondent, 20. That based upon interview and the review of records, the Respondent provider failed to ensure that adequate general supervision to ensure resident safety and security was provided for two (2) cognitively impaired, bed bound residents and one (1) developmentally disabled resident. 21. That on September 12 and 14, 2005, the Petitioner’s representative interviewed a hospice care nurse who served the Respondent facility and disclosed the following: a. That the nurse visited the Respondent facility on the afternoon of July 21, 2005, arriving at 4:50 PM.; b. That the nurse was present in the facility from 4:50 PM until approximately 6:45 PM; c. That the hospice care nurse knocked on the door of the facility upon arrival, but no one answered; d. That the nurse called-out and eventually resident number three (3) came out to the fence to speak with the nurse; 6. That the nurse questioned the resident and determined that the resident was possibly developmentally disabled or otherwise incompetent; f. That resident number three (3) was not competent to care for patients, which the nurse noted; g. That when questioned about other adult caretakers in the facility, the resident indicated that he/she was alone; h. That the nurse was able to persuade the resident to allow entry into the facility where the nurse found two residents, residents numbered two (2) and five (5), in their rooms with the doors shut, lying in their beds with both bedrails in the up position; i. That both resident’s were totally bed bound, incontinent, and neither could give their name; j. That both resident’s appeared disoriented and incapable of caring for themselves; k. That the nurse called the police and an officer arrived at around 6:00 PM.; 1. That both the officer and nurse toured the facility and knocked on all of the interior doors seeking a staff person; m. That no one answered to the knocks on the doors. 22, That the Petitioner’s representative reviewed the police report written by the officer who responded to the facility on July 21, 2005 which revealed the following: a. That the officer arrived at the facility at 6 PM on July 21, 2005; b. That the officer met the hospice nurse who related the following: i. That it took "a long time” to summon someone to the door; ii, That resident number three (3), who was hard of hearing, finally came to the door; iii. That resident number three (3) was judged incapable of taking care of elderly residents in the estimation of the nurse; iv. That two (2) of the residents were in rooms behind closed doors and that "if something were to happen that [resident number three (3)] could not hear them or assist them;" v. That the nurse had been at the scene for an hour and the provider was not at the home during that time. That the police officer spoke with resident number three (3) and asked who was responsible for the house and patients in the house; That the resident stated the administrator's name but stated that he/she did not know how to contact the administrator; That the officer walked through the home and observed two (2) elderly females in two separate bedrooms; That both residents were observed with the side rails in the up position; That the nurse was observed to ask resident number three (3) questions about situations which might arise regarding the two (2) other residents; . That resident number three (3) was heard to state that he/she did not believe there would be a fire; That if a resident fell out of bed, resident number three (3) stated he/she would pick the resident up and put him/her back in bed; That resident number three (3) was questioned about a resident being found on k. his/her back or vomiting but the resident did not realize that in both situations the resident should be turned onto the side to prevent choking; That in both situations, resident number three (3) stated that he/she would call 911; That the officer opined that resident number three (3) appeared to lack the knowledge, training and skills required to ensure the safety of the residents there; m. That the provider had not returned by 6:35 PM on July 21, 2005. 23. That the petitioner’s representative reviewed the Respondent’s records regarding resident number two (2) which reflected the following: a. That the resident was re-admitted to the facility following a broken hip; b. That diagnoses of the resident included Alzheimer's disease, diabetes type II and hypertension; c. That hospice notes dated July 22, 2005 identified that the resident had a stage 2 pressure sore on the coccyx on this date; d. That facility notes documenting the weight of the resident revealed a thirty-one pound (31#) weight loss from October 7, 2004 through September 1, 2005; e. That the resident's weight according to the weight sheet was listed at eighty-four pounds (84#) on September 1, 2005. 24, That the Petitioner’s representative reviewed the Respondent’s records regarding resident number five (5) which reflected the following: a. b. That the resident was admitted in March 2005 following a hip fracture; That the resident’s diagnoses included Alzheimer's disease, pressure sores and upper respiratory infection; &. That pressure areas were note on the hip bone, heels and shoulders of the resident according to hospice notes on July 11, 2005; . That hospice notes of July 14, 2005 revealed the resident was incontinent of both urine and stool; That the resident had expired after having been discharged to a hospital. 25. That the Petitioner’s representative observed resident number two (2) on September 14, 2005 and noted the following: a, b. That the resident appeared to be confused; That the resident was seated for breakfast but was unable to carry on a normal conversation with other residents or caregivers; That the resident was observed to have lost weight as the photograph in the chart. of the resident showed a person with a full face and good skin tone; That the resident sitting at the table appeared gaunt with collapsed cheeks and deep skin lines; That the resident was heard to repeatedly say that he/she wanted to go back to bed. 26. That the Petitioner’s representative observed resident number three (3) on September 12, 2005 and noted the following: a. b. That the resident appeared to be developmentally disabled; That the resident lacked the capacity to provide care to other residents; That the resident was observed lying in bed after eating breakfast; That the resident was never observed providing care to residents or completing any tasks during the visit to the facility. 27. That the Petitioner’s representative interviewed the Respondent provider on September 12, 2005 who related that if away from the home for a period of time, the son of the provider was to come in from his bedroom in the home to monitor the residents from the living room or kitchen area. 28. That the Petitioner’s representative observed on September 12, 2005 that the son lived in a bedroom which had been a garage converted into living quarters. 29. That the Petitioner’s representative interviewed the son of the Respondent on September 12, 2005 who indicated that he was at the facility during the time interval of 4:50 PM until 6:45 PM on July 21, 2005 and that he walked through the facility every fifteen (15) minutes to check on residents. 30. That this statement does not agree with the observations of the police officer and hospice nurse who were in the Respondent facility during said time period on July 21, 2005 and the statement is not credible in that neither the nurse nor the police officer stated that the son was observed anywhere within the facility during the time interval of 4:50 PM until 6:45 PM when at least one of these individuals was present in the facility. 31. That the above reflects that the Respondent facility failed to provide general supervision which includes being aware of the resident’s general whereabouts and well-being while the resident is on the premises in order to ensure the resident’s safety and security by its failure to provide competent and capable supervision of residents who are incapable of meeting their needs, both anticipated and unanticipated. In addition, the Respondent left its residents without supervision for a verified period of near two hours, the same being substantially in conflict with law. 32. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 33. That the Agency provided Respondent with a mandatory correction date of October 1, 2005. 34, That the same constitutes a Class II offense as defined in Florida Statute 400.6196(1)(b). WHEREFORE, the Agency intends to impose an administrative fine in the amount of two hundred fifty ($250.00) against Respondent, an adult family care home in the State of Florida, pursuant to § 400.6196(1)(b), Fla. Stat. (2005). COUNT II 35. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 36. That pursuant to Florida law: “(1) A resident of an adult family-care home may not be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the State Constitution, or the Constitution of the United States solely by reason of status as a resident of the home. Each resident has the right to, inter alia, live in a safe and decent living environment, free from abuse and neglect and be treated with consideration and respect and with due recognition of personal dignity, individuality, and privacy...” §400.628(1) Fla. Stat. (2005). 37. That on September 15, 2005, the Agency completed a complaint survey of Respondent. 38. That based upon interview and the review of records, the provider failed to ensure the resident's right to live in an environment free from neglect was respected for one sampled resident who experienced extreme unplanned weight loss and developed stage IT and then.stage I] pressure sores while under the care of the provider, who did not seek medical attention for the resident. 39. That the Petitioner’s representative reviewed the Respondent’s records regarding resident number two (2) which reflected the following: a. b. That the resident had diagnoses of diabetes type II and hypertension; That the resident fell and broke his or her hip on March 25, 2005; That at some point after returning to the Respondent facility on March 30, 2005, the resident developed a stage II pressure sore on the coccyx; That when the resident was admitted to the care of hospice on July 22, 2005, the initial assessment by the hospice staff identified that the resident had a stage II pressure sore on the coccyx; That nurse’s notes from March 25, 2005 through September 1, 2005 reflected no mention of the pressure sore; That their existed no plan of care for the pressure sore through July 21, 2005; That hospice notes dated July 27, 2005 documented that the resident had developed a 3 centimeter (cm) by 3 cm Stage III pressure sore on the coccyx and a .5 cm by .5 cm stage II pressure sore on the superior coccyx; . That recorded weights for the resident beginning in March 2005 revealed the resident weighed one hundred eight pounds (108#) on March 5, 2005 and dropped to eighty-four pounds (84#) by September 1, 2005. 40. That absent from the resident’s chart was a plan for the care of the resident’s pressure ulcer until developed by hospice care personnel on July 22, 2005. 41. That the Petitioner’s representative interviewed the Respondent provider on September 12, 2005 who indicated the following: a. That the resident developed a red area on the lower back; b. That the time at which the redness was noted was unknown as there were no notes documenting this fact; c. That a physician’s order for treatment of the resident’s pressure sore was not sought; d. That application of the over-the-counter medication Lotrimon was begun to the pressure sore; e. That the Lotrimon had been given to the provider by a doctor but was never specifically prescribed for resident number two’s (2) pressure sore area; 42, That the Respondent neglected the care of resident number two (2) by the failure to address the resident’s health care needs presented by developed and untreated pressure sores and an ongoing unplanned significant weight loss, the same directly threatening the resident’s health, safety, and security. 43. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 44, — That the Agency provided Respondent with a mandatory correction date of October 1, 2005. 45. That the same constitutes a Class II offense as defined in Florida Statute 400.6196(1)(b). WHEREFORE, the Agency intends to impose an administrative fine in the amount of two hundred fifty ($250.00) against Respondent, an adult family care home in the State of Florida, pursuant to § 400.6196(1)(b), Fla. Stat. (2005). Respectfully submitted this / day of December, 2005. Va Thosiias J/Walsh, I Counsel for Petitioner Apenty for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 (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 Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT 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 THEREBY CERTIFY that a true and correct copy of the foregoing has been-sewed by U.S. Certified Mail, Return Receipt No. 7003 1010 0002 4667 1170 on December , 2005 to Anna N. Sorensen, Owner/Administrator, 3441 Dawn Court, Lake. ary, FL 32748. Vi A ThOmas J. Walsh , Esquire Tie ma q Copies furnished to: Anna N. Sorensen Thomas J. Walsh, II Owner/Administrator Agency for Health Care Admin. 3441 Dawn Court 525 Mirror Lake Drive, 330G Lake Mary, FL 32748 St. Petersburg, Florida 33701 (U.S. Certified Mail) (Interoffice) PILED PAYMENT FORM ” 06 JUN 13 py hr 24 DIVys ISION ar ADMIN Agency for Health Care Administration Hi HStRative 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. Anna N. Sorensen 2005010073 Facility Name AHCA No. f-SENDER: COMPLETE THIS SECTION ™ Complete Items\, _-, and 3, Also complete item 4 if Restricted Delivery Is desired. @ Print your name and address on the reverse so that we can retum the card to you. ™ Attach this card to the back of the mallplece, or on the front If space permits. D. Is delivery address different from ite! 1. Article Addressed to; \f YES, enter delivery address below: Anna N.S rencen DvirePAdwun eb-lar BEY/ Pawn Ch Lake Mary) Fe 3. Service Type | ied Mail () Express Malt Cl Registered }= = _EReturn Recelpt for Merchandiser” Cl Insured Mail 16.0.0. oe - coe ee cent te ee 4 Restricted Dellvery? (Extra Fea) Cl Yes 2, Article Number , . 4 : t (Transfer fom so 7003. LOLG) 0002 44h? 1270 + . : PS Form 3811, February 2004 Domestic Return Recelpt 102595-02-M-16KC:

Docket for Case No: 06-002048PL