STATE OF FLORIDA oti Ep AGENCY FOR HEALTH CARE ADMINISTRATION, ia AR STATE OF FLORIDA, AGENCY FOR 30 Pit 4: 43 HEALTH CARE ADMINISTRATION OM Stes: | F ADMINIS TR, a) ve Petitioner, -_ AHCA No.: 2007000217 GisApINGS v. AHCA No.: 2007000219 (conditional license) SILVERCREST MANOR, Respondent. O 7 - | U Ky ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through undersigned counsel, and files this Administrative Complaint against Silvercrest Manor (hereinafter “Respondent”) and alleges: NATURE OF THE ACTIONS 1. This is an action to impose upon Respondent, pursuant to Sections 400.23(7)(b), 400.102(1)(a) and 400.23(8), Florida Statutes (2006), an administrative fine in the amount of $2500.00. The imposition of this fine is based on a Class II deficiency. 2. Additionally, this is an action to impose a conditional license pursuant to Section 400.23(7)(b), Florida Statutes (2006). JURISDICTION AND VENUE 3. AHCA has jurisdiction over licensure of skilled nursing home facilities, pursuant to Chapter 400, Part II, Florida Statutes (2006), and Rule 59A-4, Florida Administrative Code (2006). 4. Venue lies in Okaloosa County, pursuant to Rule 28-106.207, Florida Administrative Code (2006). PARTIES 5. AHCA is the enforcing authority with regard to skilled nursing home facility licensure pursuant to Chapter 400, Part II, Florida Statutes (2006), and Chapter 59A-4, Florida Administrative Code (2006). 6. Respondent runs a skilled nursing home facility located at 103 Ruby Lane, Crestview, FL 32539. COUNT I FACILITY NEGLIGENTLY OR INTENTIONALLY FAILED TO OBTAIN ROUTINE AND/OR EMERGENCY DENTAL SERVICES THAT MET THE HEALTH NEEDS OF 1 OF 14 SAMPLED RESIDENTS (RESIDENT #9) SECTION 400.102(1)(a), FLORIDA STATUTES (2006) CLASS II 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth 8. AHCA conducted a survey of the Respondent’s facility on or about November 8, 2006. 9. The findings are: A. Based on observation, interview, and record review, it was determined the facility failed to obtain routine and/or emergency dental services that met the needs of 1 of 14 sampled residents (#9). Failure to obtain dental services in a timely manner resulted in the resident experiencing pain for extended periods of time, preventing him/her from reaching his/her highest practicable physical, mental and psychosocial well being. B. Review of the clinical record of resident #9 revealed social service notes dating back to 10/27/05 indicating the resident was complaining of tooth pain. A dentist appointment was made for 1/13/06 and later rescheduled for 1/27/06 due to transportation problems. Following the visit to the dentist, a referral was made io an oral surgeon and an appointment was scheduled. The consultation report 2 from the dentist recommended extraction of all teeth. There is no further mention in social service’s notes of the resident's dental problems or impending treatment between 1/27/06 and 10/11/06 (over eight months) at which time the social worker documents, "Awaiting arrangements from oral surgeon regarding hospitalization for removal of (his/her) teeth. Spoke with (oral surgeon's) office manager who is working between (hospital, oral surgeon, resident physician) for a common date.” : C. On 4/10/06, the resident was examined by the oral surgeon and a diagnosis of "chronic/acute periodontitis, decayed teeth and multiple root tips" was made. Review of the consultation report from the oral surgeon revealed a recommendation that treatment be completed in the hospital ("in the operating room") due to the resident's medical history. D. Further review of the resident's clinical record revealed the following: E. Nurse’s notes dated 8/14/06 at 11:10 AM document the resident became very angry and upset with staff and was both verbally and physically abusive. The resident was given Ativan 0.5 milligrams (mg) for increased anxiety and agitation. Additional documentation at 12. PM on the same. day. reveal the resident is complaining of tooth pain and both sides of his face appear swollen. A call was placed to the physician and an order was given for Keflex, 500 mg four times a day for ten days for mouth infection. Documentation over the next two weeks state the resident continued to complain of mouth pain and was medicated with Percocet 5 mg on an "as needed" basis. On 8/28/06, a staff nurse placed a call to the oral surgeon's office in reference to scheduling the teeth extraction. The office manager explained that the schedule had not been completed and she would try to get it done some time that week. There was no further documentation regarding the resident's dental condition or schedule for treatment until 9/28/06 (one month later) when it is noted the resident is again complaining of teeth pain. A note written by the Director of Nursing on 11/8/06 following conversation with the survey team on 11/7/06 regarding the status of the resident's dental treatments reads, "Spoke with (MD) this morning regarding (resident) oral surgery. (MD) stated he has been in touch with consultant at hospital regarding (resident) being scheduled for surgery and he-will call again today."-----—~- -- . ca F. Physician progress notes dated 2/22/06 through 10/24/06 address the resident's dental problems on the 8/21/06 and 10/24/06 notes only. On 8/21/06 the physician documents the resident is "still having some dental pain and needs a full mouth extraction. The oral surgeon recommended that this be done in a hospital environment due to (his/her) multiple medical conditions." On 10/24/06 the physician documents, "(He/she) has severe problems with (his/her) dentition. We are trying to arrange for dental extractions. The oral surgeon would prefer to have jt done in the hospital setting.” 3 G. Pain assessments completed on 2/13/06, 8/14/06, and 11/6/06 assess the resident as displaying non-verbal symptoms of "grimacing to face, teeth pain" and increased irritability. The assessment also states the resident is "using PRN (as needed) (pain medications) many days between 7 AM and 1 PM for complaints of pain." On 11/8/06 the nurse documents that the current medication (Percocet 5/325 every four hours PRN) is usually effective, but the resident's pain is not totally alleviated. A new order was obtained for routine administration of Percocet 5/325 twice a day along with the order for every four hours as needed for breakthrough pain. "Unstable Pain Flowsheets” dating from 11/14/05 through 11/8/06 reveal the following complaints of tooth ache by the resident and subsequent administration of PRN pain medication to the resident: 11/05 - 8 times; 12/05 - 4 times; 1/06 - 2 times; 4/06 - 1 time; 5/06 - 5 times; 7/06 -18 times; 8/06 - 43 times; 9/06 - 32 times; 10/06 - 27 times; and, 11/06 - 3 times. H. A nttritional assessment completed on 2/14/06 documents that the resident's "teeth are in poor condition" and "often hurt.” I. Care plans written for the resident in August of 2006 address the resident's chronic pain, infected teeth, and the resident's risk for weight loss and malnutrition with poor oral intake and mouth/teeth pain. Review of the resident's weight history reveals a six pound weight gain during the month of August 2006, with a subsequent 9.4 pound weight loss during September 2006. J. On 10/4/06, the resident was seen in consultation by his/her cardiologist and given clearance for the hospital procedure. K. On 11/6/06 at approximately 12:30 PM, resident #9 approached two surveyors asking for help. When asked what type of help was needed, the resident stated, "I need help getting to a dentist. My teeth hurt so bad." The facility social worker overheard the resident's request and proceeded to remind him/her that she was working on getting a date set to have his/her teeth pulled. The social worker then took the resident off to find a nurse to request pain medication. Again on 11/7/06 at approximately 11:30 AM, the resident indicated to the surveyor that his teeth hurt and again asked if she could help him get his teeth pulled. L. On 11/7/06 at approximately 5:00 PM, the DON and administrator were questioned regarding the status of the resident's dental treatment. The following day at approximately 9:05 AM, the DON responded that facility staff felt as though they had managed to effectively control the resident's pain and that the social worker had contacted the oral surgeon’s office-on 11/7/06 to find out if the resident had been scheduled for surgery. The DON further stated that he felt the only problem had been with the coordination between the resident's physician and the oral surgeon regarding the resident's admission to the hospital. : M. During interview on 11/8/06 at approximately 5:30 PM, a member of the resident's family stated that they have not been able to get any definite answers to 4 at the time of survey with criteria established under Section 400, Part Il, Florida Statutes (2006), or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under Section 400.23(7)(b), Florida Statutes (2006), commencing November 8, 2006 and ending January 11, 2007. CLAIM FOR RELIEF WHEREFORE, Petitioner, State of Florida, Agency for Health Care Administration, requests the following relief: 1. Make factual and legal findings in favor of AHCA on Count I. 2. Make factual and legal findings in favor of AHCA on count II. 3. Assess against Respondent an administrative fine of $2500.00 for the violation cited above. 4. Uphold the imposition of a conditional license from November 8, 2006 through January 11, 2007. 5. Assess costs related to the investigation and prosecution of this matter, if applicable. 6. Grant such other relief as the court deems is just and proper. NOTICE OF RIGHTS 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 form. All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, T allahassee, Florida 32308. lf you want to hire an attorney, you have the right to be represented by an attorney in this matter. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE OR 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. Da nale ESQUIRE Florida Bar I.D. No. 0030942 Agency for Health Care Administration ° 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308-5403 (850) 922-5873 , (850) 921-0158 Facsimile CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail to Owner/Administrator, Silvercrest Manor, 103 Ruby Lane, Crestview, FL 42539 on this\”*day oftelerna , 2007 to: Copies furnished to: Field Office Manager Agency for Health Care Administration (Interoffice Mail) Owner/Administrator Silvercrest Manor 103 Ruby Lane Crestview, FL 32539 pb SMe an, vo Ss Qed & Nee & Tekdon ste edu pi. Nes 7003 L010 0000 9715. e415 USPS - Track & Confirm Page 1 of 1 Track & Gon’ Track & Confirm Search Results Label/Receipt Number: 7003 1010 0000 9715 2415 Status: Delivered Enter Label/Receipt Number. Your item was delivered at 2:34 PM on February 20, 2007 in CRESTVIEW, FL 32539. 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Docket for Case No: 07-001486