STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION “08 Stay SF; STATE OF FLORIDA, AGENCY FOR’ "CanhiA HEALTH CARE ADMINISTRATION, Petitioner, | AHCA No.: 2006008162 . AHCA No.: 2006008159 v. . Return Receipt Requested: 7002 2410 0001 4235 2764 COVENANT VILLAGE OF FLORIDA, 7002 2410 0001 4235 2771 INC. d/b/a COVENANT VILLAGE 7002 2410 0001 4235 2788 CARE CENTER, _ ; Respondent. . —_— — - 6 Ol SOW ADMINISTRATIVE COMPLAINT COMES NOW the, State of Florida, Agency for Health Care Administration (hereinafter “AHCA”), by. and through the undersigned counsel, and files this. administrative complaint against Covenant Village of Florida, Inc. d/b/a Covenant Village Care Center (hereinafter “Covenant. Village Care Center’) pursuant. to. Chapter 400, Part II and Section 120-60, Florida Statutes (2006), hereinafter alleges: NATURE OF THE ACTIONS. 1. This is an action to impose an administrative fine in the amount. of $15,000.00 pursuant to Section. 400.23 (8) (b) Florida Statutes (2006) [AHCA No.: 2006008159] and a survey fee EXHIBIT “A” in the amount of 86,000.00 pursuant to 400.19 Florida Statutes (2006). 2. This is an action to impose a conditional licensure rating pursuant to Section 400.23(7) (b), Florida Statutes (2006) [AHCA No. 2006008162]. ‘JURISDICTION AND VENUE 3. Thia court has jurisdiction pursuant. to Section 120.569 and 120.57, Florida Statutes (2006)., and Chapter 28-106, Florida Administrative Code. 4. Venue lies in Broward County pursuant to Section 120/57, Florida Statutes (2006), and Rule 28-106.207, ‘Florida Administrative Code (2006). , ’ 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. Covenant. Village Care Center is a skilled nursing , facility located at 9211 W. Broward Blvd., Plantation, Florida 33324 and is licensed under Chapter 400, Part, II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. COUNT I COVENANT VILLAGE CARE CENTER FAILED TO ENSURE PRACTICHS WHICH WOULD AVOID FOOD CONTAMINATION AND COMPROMISED FOOD SAFETY. SECTION 400.141(1), FLORIDA STATUTES (ADMINISTRATOR REQUIRED) ‘CLASS, I 7. AHCA re-alleges. and incorporates (1) through (5) as if fully set forth herein. , 9. A re-certification survey was conducted on July 25, 2006. Based on observation of the main Icitchen and satellite - kitchen,. interview and record review, including facility “provided policies and procedures, at was, determined that due to the facility's sanitary. conditions in the area of food preparation and service, the health and safety of the residents was. jeopardized which constitutes immediate jeopardy. . 10. The facility failed to reduce practices which may result in food contamination and compromised food safety by not storing cold food at or below 41 degrees Fahrenheit, by not storing hot food at 140 degrees Fahrenheit or above, by not taking temperatures of food at the time of receiving,. by not having a mechanism to wash and sanitize food service equipment, _by not having hot water at the hand washing sink, by not maintaining clean equipment and a clean kitchen, by not having policies and procedures to ensure food’ safety, and not adhering to the consulting dietitians contract. The findings include the following. 11. During the initial tour of the facility, in the presence of the ‘Consulting Dietitian (RD). and the Campus . Director, of Dining Services, (FSD), the following was observed: 12. The surveyor proceeded to wash hands after. donning a hair restraint and entering the main kitchen, on 7/24/06, vat 11:45 AM. The hot. water was turned on; however, there was only cold water coming out of the faucet. The RD and then the FSD also washed their hands, in cold water. The ‘water ran for a few minutes and after it failed to become hot, the FSD was asked if there was a problem with the hot water. The FSD. responded that he/she did not know. Hot. water at the hand-washing sink must ‘be maintained at 100 degrees Fahrenheit (F) for adequate cleaning. 13. Continued observation of the kitchen disclosed a heavy black discoloration (potentially mold or heavy. dirt). on the walls, floors, throughout broken tiles, on the sandwich counter, and on three white cutting boards, located on the tray line. 14. A \ sized rectangular, pan full of rice was observed on top of the stove covered with plastic wrap and labeled with the date only (7/24/06). The FSD was asked for a cup of ice/water to calibrate the thermometer and the procedure kitchen staff use for washing and sanitizing thermometers. The FSD stated. that staff use alcohol wipes to. sanitize the thermometers and 4. proceeded to search for the wipes, but was'unable to locate any wipes in the kitchen. He/she was asked how ‘the thermometers were cleaned and responded that they were cleaned with the alcohol wipes. He/she was then asked the location of the 3-compartment sink and he stated that the sink and the dish machine had been moved into the new kitchen. , , 1S. After several minutes ,. the FSD brought a bucket with. a . bleach/water mixture for the thermometer. He/she was asked again what mechanism they have to. clean: the thermometer; he/she had no response. ) 16. Using the calibrated thermometer, the temperature of the Hoe was taken at 92 degrees F. 17, ‘On Epether review, "a .reach-in refrigerator was observed to house milk, lettuce, peaches, juices, green peppers, ° carrots, homemade salad with ° chicken, but no internal thermometer could be located. Temperatures of the items contained by the reach-in refrigerator were taken using a, calibrated. thermometer, which’ showed that the - temperature of milk was 50 degrees F.. It’ was stated by ‘the PSD, some of the food, such as the peaches, had only been in that refrigerator for 2 hours, but the milk and other items had been in there. longer and would be discarded. ) . 18. Observation of the walk-in refrigerator disclosed two internal thermometers;. both. reading. at. 50 degrees F. 5 Temperatures taken of ‘the 8-ounce containers of whole milk and skim milk, situated in the back left corner of the walk-in refrigerator, showed that both items were 50 degrees F. 19. The internal temperatures, taken from other items located in the walk-in refrigerator, revealed the followin: a relish, located in the front right of the refrigerator, was at 48 degrees F; b. sour cream, located at the front left (by the door), was at 50 degrees F; , c. Thousand Island dressing, located in the back right, was at 49 degrees F; and a. yogurt, located next. to the milk, was at 50 degrees F. 20, The FSD stated that. they had qust Rad a milk delivery and that is why the milk temperatures, were elevated. The FSD was asked if the temperatures of the milk were taken at receiving and the answer was "no." Temperatures of refrigerated/freezer foods should be taken at. the time of receiving to ensure food safety. 21. Review of the temperature logs, taped to the outside of. the refrigerator disclosed the 6:00 AM temperature recorded by staff was 32 degrees F (freezing) . “22. ~an interview conducted with the FSD on 7/25/06, at 10:30 AM,. disclosed that the reason the temperature log read 32 6 degrees F was that they have had "issues with the compressor" . and the thermostat may have been set lower to compensate and that. the "AC guy said it was at the end of its (compressor) life". The FSD was asked if the food at 6:00 AM was frozen at 32 degrees F, as per temperature log documentation, how the food could be at 50 degrees (22 degrees F higher) at 12 Noon, while being, maintained under refrigeration. there was no response by the. FSD to the inquiry. 23. On 7/24/06, at approximately 2:00 PM, the FDS provided a list with the items that were in the walk-in refrigerator. The list, entitled Food Items To Be Thrown Out, contained various types of food, including milk and dairy products, cut/prepared raw vegetables, diced cheese, eggs, juice, sauces, desserts, Salad dressings, meats, and others. 24.. Temperatures taken at the nursing home satellite kitchen on 7/24/06, at 12:30. PM, revealed that the 8-ounce containers of milk read 50. degrees F, for both skim and whole milk. Interview with the Clinical Nutritional Manager at that time disclosed that the milk had been delivered recently. She was asked what the receiving temperature was, and she stated that they do not take temperatures at. receiving. According to the Clinical Nutrition Manager, it was reported the nursing home ; obtains the milk from the milk company, while all, other food items are delivered to the nursing home ‘by the main kitchen... 25. At a later interview with the FSD, on 7/25/06, at 10:30 AM, he/she was asked if any staff had notified him that there was no hot water in the kitchen, He/she responded that they had not. The FSD was asked how staff would have been able to properly wash their hands for food preparation in the absence of hot, water, He/she responded that the kitchen has hand sanitizer and gloves. Hands must. be washed prior to. glove use or using a ‘and sanitizer. 26. The FSD was then asked for all departmental policy and procedures, including policies and .procedures regarding food Sanitation, food safety, and food service. He/she responded, he was reviewing them and that they were. at. his apartment on campus and would bring them over. Approximately one hour later, the departmental policy and procedure book was provided. Four of the policies, reviewed addressed Food Service. 27.. Approximately one hour later, after the policies were teceived ‘and reviewed, the FSD was called and asked if there were any other policies as there were only four food service policies. The FSD reiterated that those were the only policies . he/she had. 28. The policies were "entitled Food Temperature Management, Handling of Cold Food, Temperature Taking and Sanitation Round Checklist. The FSD did not provide any policies regarding topics such as administrative standards of the department, purchasing, training and development of staff, inventory control, food storage, continuous quality improvement, food. safety education, cleaning, employee heaith, food-borne illness response, waste/garbage disposal, glove use, damaged china, preparing and serving ice, and cleaning and sanitation. 29. Review of contractual agreement dated January 1, 2003, between the facility and Nurtition Resources, Inc. (consulting dietitian), revealed, under the section entitled RESPONSIBILITIES OF THE CONSULTANT, the Consulting. Dietitian was expected to "Review sanitation in accordance with current standards." 30. In an interview conducted with’ the Consultant on 1/24/06, in the afternoon, the: Consultant. stated that she/he had not. done a sanitary inspection of the main kitchen, but. has done such an inspection in the satellite kitchen. 31.. Review of the Dietary Sanitation Review, a tool used by the facility to evaluate the sanitary. conditions of food storage, food handling and preparation and dishwashing, dated 5/11/06. of the main kitchen, completed by a registered dietitian disclosed the following documentation: 32. Section A-Sanitary Conditions in Storage of Food. 3. Temperatures recorded daily, had the comment "not sure valid??" 7. Shelves clean, Eree of rust. and mold, had the comment "to be cleaned." 33. Section 3B-Sanitary conditions in Food Preparation Area, Food Handling. 7. Cold food held at 41 degrees F or below, had the comment "broken fridge.". “43, ‘Properly Sanitized, calibrated thermometers are used to take temperatures. includes, comments were, "absent." ; 34. Additional comments referred to storage ‘that “lacked ofganieation, no thermometers for cooks, mold on walls and backsplash, and dirty pans/pots placed on clean ones. 35. Pursuant to the quality of, food service deficiencies identified by the surveyor in food service, the. surveyor contacted the Department of Health: for furthér inspection and review of the kitchens. 36. A review of the Department of Health (DOH) County Health ; Department, " Food Inspection. Report dated 7/25/06 documented "remodeling main kitchen - have catered meals being brought in." ; . 37. Interview with the DOH Inspector on 7/25/06, at 1:40 ‘PM, disclosed that he/she notified the facility. that the meals ‘should continue to be catered until the completion of the new kitchen, ‘a8. Based on the foregoing facts, Covenant. Village Care Center violated Section 400.141(1), Florida Statutes - (2006), herein classified.as a widespread Class I violation pursuant to Section 400.23(8), Florida Statutes, which carries, in this 10 case, an assessed fine of $15,000.00. This also gives rise to- conditional licensure status pursuant to Section 400.23 (7) (b), ’ Florida, Statutes. SURVEY FEE pursuant to. Section 400.19, Florida Statutes, (2006), Covenant Village Care Center qualifies for a 6-month. survey cycle fee of $6,000.00. A survey fee of $6,000.00 has been assessed in this case. DISPLAY OF LICENSE Pursuant. to, Section 400.25(7), Florida -Statutes Covenant - village Care 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 “aA” EXHIBIT “A” Conditional License License # SNF 11080961; Certificate No.: Effective date: 07/25/2006 Expiration date: 02/28/2007 Standard License License # SNF 11080961; Certificate No.: ‘HEfective date: 09/07/2006 Expiration date:.02/28/2007 13827 13828 PRAYER: FOR RELTER. WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. ‘Make factual and legal findings in favor of the Agency on Count I. ‘2. Assess against .Covenant Village Care Center an administrative fine of $15,000.00 for the violation cited above. 3. Assess a “survey fee of 66,000.00 against Covenant ‘village Care Center pursuant to. Section 400.19, Florida Statutes (2006) . , 3. Assess against Covenant Village Care ‘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 (2006). ‘specific. options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration and delivered to-the Agency Clerk, Agency for 13 Health Care Administration, 2727 Mahan Drive, | MS #3, Tallahassee, Florida 32308. ‘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. rdes thee Ae eae Esq. a.. Bar No.: 997315, Assistant General Counsel. Agency. for Health Care Administration . 8350 N.W. 52 Terrace - #103 Miami,’ Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150. Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S... Mail) “Long, Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Jean Lombardi ° Pinance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308. (Interoffice Mail) 14 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 “Gilda Anderson, Administrator, Covenant Village Care Center, 9211 W. Broward Blvd., Plantation, Florida 33324; Covenant Village: of Florida, Inec., 5115 N. Francisco Avenue, Chicago, Illinois 60625; Corporation Services Company, 1201 Hayes Street, Suite 105, Tallalassee, Florida 32301 on this 14 ax of Mi. ' 2006. yurts, Wen ourdes A. Naranjo, Haq. 15

Docket for Case No: 06-005095