RECEIVED STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION SEP 21 2006 STATE OF FLORIDA, AGENCY FOR HEALTH CARE Law Office of ADMINISTRATION, bo L | ia JOHN F. GILROY, Ill, P.A. Petitioner, QO vs. AHCA Nos. 2006007274 (Fine) 2006007275 (Conditional License) MADISON HEALTH INVESTORS, L.C., D/B/A LAKE PARK OF MADISON, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by . and through undersigned counsel, and files this administrative complaint against MADISON HEALTH INVENSTORS, L.C., D/B/A LAKE PARK. OF MADISON, (hereinafter “Respondent”), pursuant to Chapter 400, Part II, and Sections 120.569 and 120.57, Florida Statutes (2006). NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $12,500.00, ~based-upon-Respondent-being-cited-for-one-patterned-Class-I-deficieney;-pursuant to Sections 400.141(8) and 400.23(8) Florida Statutes (2005) (AHCA No. 2006007274). Additionally, this is an action to impose a conditional licensure rating beginning on April 25, 2006, pursuant to Section 400.23(7)(b), Florida Statutes (2005) (AHCA No. 2006007275). Finally, this is an action assessing a $6,000.00 survey fee pursuant to Section 400.19(3) Florida Statutes (2005), and a six month survey cycle for the next two years. JURISDICTION AND VENUE 2. The Agency has jurisdiction pursuant to Sections 120.569, 120.57, 120.60, and 400.062, Florida Statutes (2006). 3. Venue lies in Madison County, pursuant to Rule 28-106.207, Florida Administrative Code (2006). PARTIES 4. The Agency is the enforcing authority with regard to skilled nursing facilities licensure pursuant to Chapter 400, Part II, Florida Statutes (2006), and Chapter 59A-4, Florida Administrative Code. 5. Respondent operates a skilled nursing facility located at 259 SW Captain Brown Road, Madison, Florida 32340, having been issued license number 16360961. 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 RESPONDENT FAILED TO MAINTAIN THE FACILITY PREMISES AND EQUIPMENT IN A SAFE AND SANITARY MANNER SECTION 400.141(8), Florida Statues (2005) CLASS I PATTERNED DEFICIENCY 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. That on or about April 25, 2006, the Agency conducted an annual survey. 8. All findings below are based on observation, record review and interviews that _ took place on April 25, 2006: A continuous observation from approximately 10:30 a.m. to 11:30 am. revealed an unsupervised dining room with a buffet steam table that had visible steam coming from the four holding cells for metal dishes. The metal dishes were extremely hot and could not be touched by the surveyor without being burned. During this observation hour all four doors to the dining room were unlocked and four residents walked into the unsupervised dining room. The water and steam dishes were easily accessible from all four sides of the buffet steam table. ‘The second continuous observation from 1:31 p.m. through 1:35 p.m. found no change from the conditions outlined above. At 1:45 p.m. an agency surveyor burnt his arm while lifting the lid of a metal dish. The CDM (certified dietary manager) was asked to obtain the water temperature on the buffet steam table using the facility thermometer. The CDM reported that the temperature was 205 degrees Fahrenheit. The CDM reported that the steam table is turned on before breakfast and then left on for the whole day until after dinner. At the third continuous observation from 2:50 p.m. to 3:15 p.m. it was noted that two of the four dining room doors were unlocked and the water in the holding cells was temperature of 170 degrees Fahrenheit. The Facility administrator was interviewed at 3:30 p.m. regarding the normal procedure to ensure the safety of the residents from having access to the steam table. The administrator reported that the steam table is on all day, but that all four doors are to be locked when the dining room is unsupervised. However, the administrator reported that several employees had keys to the dining room, and there was no way of ensuring that each employee would relock each door. At 4:00 p.m. the water temperature was checked again, and found to be 207 degrees Fahrenheit. A review of CMS (Centers for Medicare and Medicaid Services) guidance states that “water temperature of 155 degrees can cause severe third degree burns to the elderly when exposed to the water for one second.” The guidance further states that as the water temperature increases to 160 degrees or above it takes only 5 seconds or less for an instantaneous burn to occur that would require surgery to heal. It also states that the elderly are more at risk due to thinning skin and decreased sensation, especially in the hands and feet, which may prevent them from realizing that something is too hot. Other factors putting the elderly at higher risk include changes in intellect, perception, memory, judgment, and/or awareness. The residents at this facility are most at risk as they are cognitively impaired and can ambulate on the unit either by walking or by wheelchair. Two residents are severely impaired and require minimal ambulation assistance; two other residents are also severely impaired, but require moderate assistance. Five of the moderately cognitively impaired residents require no ambulation assistance, eight require minimal ambulation assistance, and five residents require moderate ambulation assistance. 9. The above constitutes a violation of Section 400.141(8), Florida Statutes (2005). Scalding hot water left in steam trays with metal dishes in an unsupervised and unlocked dining room all day, where patients with cognitive impairments wander in and out, is a failure of the Facility to maintain facility premises and equipment in a safe and sanitary manner, pursuant to Section 400.141 (8), Florida Statues (2005). 10. The deficiency is class I patterned as defined in Sections 400.23(8) and 400.23 (8)(a), Florida Statutes (2005). COUNT I DUE TO THE CITED CLASS I PATTERNED DEFICIENCY, IMPOSITION OF A CONDITIONAL LICENSE IS WARRANTED SECTION 400.23(7)(b), FLORIDA STATUTES (2005) 11. The Agency re-alleges and incorporates paragraphs (1) through (10) as if fully set forth herein. 12. Based upon Respondent’s cited State Class I patterned deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part Il of Chapter 400, Florida Statutes (2005) or with rules adopted by the Agency, a violation subjecting it to assignment of conditional licensure status pursuant to Section 400.23(7)(b), Florida Statutes (2005). 13. Due to the presence of a Class I deficiency, a conditional license certificate number 13740 was issued to Respondent with an effective date of April 27, 2006. The conditional license is attached hereto as Exhibit “A.” ‘14. The Respondent was re-issued a standard license certificate number 13741 with an effective date of June 9, 2006. The standard license is attached hereto as Exhibit “B”. CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency on Count I and Count I; (B) Recommend administrative fines against Respondent in the amount of $12,500.00 for Count I, and a survey fee of $6,000.00, pursuant to Sections 400.23(8)(a) and 400.19(3), Florida Statues (2006). (C) Assess attorney’s fees and costs; and (D) Grant all other general and equitable relief allowed by law. 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 form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308, (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. Respectfully submitted this [Tay of September, 2006. orraine M. Novak, Esquire Fla. Bar. No. 0023851 Agency for Health Care Admin. 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 850.922.5873 (office) 850.921.0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 3366 to: Registered Agent John F. Gilroy, III, P.A., 1435 Piedmont Drive Hast, Suite 100, Tallahassee, Florida 32308, and by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 3373 to: Facility Administrator Joyce C. Denham, 259 SW Captain Brown Road, Madison, Florida 32340, on September 006. Lorraine M. Novak, Esquire Copies furnished to: Barbara Alford Field Office Manager Agency for Health Care Administration (Interoffice Mail) Registered Agent John F. Gilroy, TIT | : 1435 Piedmont Drive East mot 7004 L160 OO03 3734 336b Suite 100 Tallahassee, Florida 32308 FEAT ERATE a ‘THIS SECTION COMPLETE THIS SECTION ON DELIVERY A. Signature “a KEELE C1 Agent — o Addregsee B. Recelved by ( Printed Name) aa fe.of Gefivery gets &, bi eey fF, bb D. Is delivery address different from item 17 / CI Ye: / If YES, enter delivery address below: 0 No | SENDER: COMPLETE | © Complete items 1, 2, and 3. Also complete : item 4 if Restricted Delivery is desired, + & Print your name and address on the reverse so that we can return the card to you. @ Attach thls card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: Registered Agent John F. Gilroy, I 1435 Piedmont Drive East Suite 100 3. Service Type Tallahassee, Florida 32308 fi‘ Certified Wail 2 Express Mai Registered 0 Return Receipt for Merchandise Insured Mail = 1 C.0.0. 4, Restricted Delivery? (Extra Fee) I Yes 2. on __POO4 Libo 0003 3739 335bb » PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 Facility Administrator Joyce C. Denham cree 259 SW Captain Brown Road} ~ Madison, Florida 32340 PacaEeNANN 7004 11b0 o0043 3739 333 SENDER: COMPLETE THIS. SECTION COMPLETE THIS SECTION ON DELIVERY ™ Complete items 1,2, and 3. Also complete A. Signature | item 4 if Restricted Delivery is desired. x | ot 4] Agent j @ Print your name and address on the reverse ont en cd (Addressee { so that we can return the card to you. B. Recelved by ( Printed Nami C. Date of Dell ™ Attach this card to the back of the mailpiece, - “ ve a i. ©) rm a4 ° very “ PR Sag at aa glad VA Sy D. Is delivery address different from item 1? [ Yes i | } or on the front if space permits. ) | if YES, enter delivery address below: © No 1. Article Addressed to: Facility Administrator Joyce C. Denham 259 SW Captain Brown Road 3. Service Type Madison, Florida 32340 O Certified Mail) Express Mail Gr Registerad GReturn Receipt for Merchandise C1 Insured Mail = G.0,.D. 4, Restricted Delivery? (Extra Fee) Yes @ 7" Number | PS Form 3811, August 2001 Domestic Return Recelpt 102895-02-M-0835 vor 404 LUbO g003 3734 3373

Docket for Case No: 06-004112