Wali hoy gob ¢ LLi33 fefWIelaan PATH SA AL tle rtd Ld fot ee Do Division of Administrative Hearings STATE OF FLORIDA c AGENCY FOR HEALTH CARE ADMINISTRATION . STATE OF FLORIDA, AGENCY FOR HEALTH CARE Date GAito7 | ADMINISTRATION, OTH My Petitioner, : vs. Case Nos. 2007007090 (Fines.) 2007007091 (Cond.) COUNTRYSIDE HEALTH CARE ASSOCIATES, LLC, d/b/a COUNTRYSIDE HEALTHCARE CENTER, 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 COUNTRYSIDE HEALTH CARE ASSOCIATES, LLC, d/b/a COUNTRYSIDE HEALTHCARE CENTER, (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2006), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing May 25, 2007 and ending May 25, 2007, and impose an administrative fine in the sum of ten thousand dollars ($10,000.00) and a survey fee of six thousand dollars ($6,000.00) for a total assessment of sixteen thousand dollars ($16,000.00), based upon Respondent being cited for one State Class J deficiency. JURISDICTION AND VENUE L. The Agency has jurisdiction pursuant to §§ 120.60, 408.802(13) and 400.062, Florida Statutes (2006). Wor vor ene tie or faerdsed +e PUT Whe NAL AL StL teat | Fat hee 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and enforcement of applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapter 400, Part IT, Florida Statutes, and Chapter 59A-4, Florida Administrative Code, 4, Respondent operates a 120-bed nursing home, located at 3825 Countryside Blvd., Palm Harbor, FL 34684, and is licensed as a skilled nursing facility license number 11060962. 5. Respondent was at all times material hereto, a licensed nursing facility under the licensing authority of the Agency, and was required ta comply with all applicable rules, and statutes. COUNTI 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That pursuant to Florida law, an intentional or negligent act materially affecting the health or safety of residents of the facility shall be grounds for action by the agency against a licensee. § 400.102(1)(a), Florida Statutes (2006). 8. That Florida Jaw provides that all licensees of nursing home facilities shall adopt and make public a statement of the rights and responsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement shall assure each resident the following...the right to receive 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 iy sea Wor mor enh sl. oo Cet ddd et PU RT Sethe thee 8 resident care plan...the right to be free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints... § 400.022, Florida Statutes (2006). 9. That on or about May 25, 2007, the Agency conducted an extended Survey at Respondent’s facility. 10. Based on record review and staff interview, the facility failed to provide adequate and appropriate health care and protective and support services to meet the needs of one of twelve sampled residents, resident #1, related to the negligent or intentional failure to communicate abnormal laboratory values to the resident's physician in a timely manner resulting in a delay in medical treatment and possible decline in health status. 1]. Per the Physician's Order Sheet of April 2007, resident #1's diagnoses included atrial fibrillation, urinary tract infections, peripheral vascular disease and dementia. Physician ordered medications included the blood thinner, Coumadin 2mg by mouth everyday and cardiac/blood pressure/diuretic medications including Digitek 0.125mg by mouth three times a week, Diltiazem 30mg by mouth everyday, Aldactone 25mg by mouth everyday, and Torsemide 30 mg. everyday. 12. Physician orders of April 4, 2007, included Jaboratory tests for Chemistry Panel, Prothrombin Time PT), and International Normalized. Ratio (INR). Clinical record review revealed the laboratory tests were processed on April 6, 2007, and the results included; a. BUN 60mg/dL (normal range 6-26); b. Creatinine 2.2mg/dL (normal range 0.7-1.5); c. BUN/Creatinine Ratio 28 (normal range 6-19); d. PT 53.4 seconds (reference range 9.6-13.6); TA IL INDE dea Ne Fhe Eel tal hee TS ee e. INR 3.44 (therapeutic range 2.0-3.0); 13. A note on the laboratory report read "faxed 04/09", which was three days following receipt of the laboratory results. 14. There was no documentation in the resident's record indicating which physician was faxed the results (the neurologist or the attending physician). There was no evidence in the record to show that any follow up with the physician was initiated related to the abnormal results. 15. Per nurses’ notes of April 11, 2007, at 9:00 a.m., the resident was scheduled to go out of the facility to see a professional behavioral consult and the family member would meet hinvher there. Per nurses’ notes of April 11, 2007, at 2:30 p.m., the resident's family member made the decision to have the resident transported from the consultant's office to the hospital for medication management for the resident's delirium. 16. Laboratory results dated April 11, 2007, and April 12, 2007, drawn at the hospital included: a. BUN 112 mg/dl; b. Creatinine 4.7 mg/dl; c BUN/Creatinine Ratio 26; 17. Neurology Consultation of April 12, 2007, included references to laboratory values as follows: a BUN 121 mp/di: b. Creatinine 4.7 mg.dl; c. PT 91 second; d. INR 5.3; Bai bby cboe Lissa fefaoel 4a PTT SR NACHT AL etd Aitken em BOE eee 18. The neurology consultant's assessments included Acute Renal Failure and Coagulopathy. 19. On May 17, 2007, at approximately 2:20 p.m., in an interview with the Unit Manager for the south wing where resident #1 resided, it was revealed that the resident's physician had no record of the laboratory results. Per the Unit Manager, the facility's policy is that when an abnormal laboratory report is obtained, the attending physician is called. If there is no response, the nurse continues to follow up throughout the shift. If there is still no response, the nusse reports the need for follow up to the nurse working the next shift. The Unit Manager confirmed that this procedure was not followed relative to the abnormal laboratory results for this resident. 20. An Agency interview on May 24, 2007, at 1]:15 am, with the Regional Clinical Consultant and the Unit Manager revealed lab results were completed and printed to the facility in the evening or early morning the next day of the lab draw. The laboratory report indicates that the Jab draw occurred on April 6, 2007. 21. An Agency interview on May 24, 2007, at approximately 10:30 a.m., with a Licensed Practical Nurse (LPN) working in the 100 Unit of the south wing where resident #1 resided. revealed that sometimes the results of lab work are printed at a printer on the opposite unit from that in which the resident is staying, in which case the nurse has to hand deliver the faxed results to the appropriate unit, the unit in which the resident resides. All lab values are to be called to the physician for any additional orders. Hard copies of the labs are delivered the next day ona normal work week. Labs draws obtained on the week-end or holiday are delivered the following week day. The unit manager reviews all hard copies of the lab results. The next day the lab results are given to the Unit Manager, and the Unit Manager takes the hard copy and compares it to the patient 's chart, to the printed copy of the lab results printed on the lab computer in the medication room at each nursing station. Weel SD! ality the PO at ee dT A De Net Se EE ee 22. Agency interview with the Unit Manager revealed that sometimes there is not a printed copy on the chart. In the event there was not a printed copy from the lab, the unit manager would notify the nurse of the hard copy and the hard copy results were called or faxed to the physician. All labs were to be faxed to the physician's office. 23. Interview with the Unit Manager and Regional Clinical Consultant in the incident of resident's #1 lab results revealed the Unit Manager was on vacation, and there was no follow-up on the lab results for resident #1. Interview with the Regional Clinical Consultant revealed no evidence of a policy or procedure in place for notifying, or follow-up with, the physician of the abnormal lab work of a patient. 24. — Interview with the Regional Clinical Consultant on May 24, 2007, revealed the facility was still handling the lab result reporting in the same manner, as during the initial complaint investigation on May 14, 2007. The Regional Consultant stated that no procedure for the correction of the findings of deficient practice had been implemented for the facility. The facility was waiting for the Agency for Health Care Administration to deliver “the 2567,” the Agency’s investigative report of the cited deficiencies. 25. On May 25, 2007, during an extended survey, a review of the medication administration record of patient #1 dated January 24, 2007, through April 10, 2007, revealed that resident #1 was administered Coumadin 2 mg every day. Further review of resident #1's Coumadin record in the Medication Administration Record revealed no reference to the results of a February 21, 2007, lab result. A reference was noted on March 20, 2007, for a notation to continue resident #) on Coumadin 7.5mg every day and to obtain PT and INR testing on April 3, 2007. 26. Interview with the Regional Clinical Manager on May 25, 2007, revealed the reference note of March 20, 2007, was entered in resident's #1 Coumadin Medication Administration Barratt tb. ot fet Ide L FACS CALI the athe Record and was an error. The Regional Manager revealed the reference note was intended to be tecorded on another Resident's Coumadin record. Review of the Coumadin record revealed no evidence of any additional PT or INR results or changes in resident #1's Coumadin therapy. 27. Agency interview with the Unit Manager and Regional Clinical Consultant revealed that for those on Coumadin therapy, if PT and INR testing were not ordered on a monthly basis, the facility staff would notify the physician to request if the physician would order PT and INR testing. There was no evidence that resident #1’s physician was notified in March for PT and INR testing for resident #1. 28. The Agency determined that this deficient practice presented a situation in which immediate corrective action was necessary because Respondent’s non-compliance had caused, or was likely to cause, serious injury, harm, impairment, or death to a resident receiving care in Respondent's facility and cited Respondent with a State Class J deficiency. Specifically, the respondent facility owed resident #1 a duty to provide resident #1 with adequate and appropriate care; the respondent facility breached that duty by negligently or intentionally failing to provide resident #1’s physician with laboratory test results in a timely manner, contrary to respondent facility’s own internal policy and procedure for communication and follow-up; resulting in no intervention to prevent harm to resident #1 until five (5) days later when resident #1 had to be transported to a hospital and was diagnosed with Acute Renal Failure and Coagulopathy, serious life-threatening conditions. Further review of the Medication Administration Record for resident #1 revealed that since at least February of 2007, Respondent facility had not consistently managed the administration of Coumadin to resident #1, by failing to monthly test and record the results of such tests, or why resident #1’s physician felt such testing was unnecessary. Moreover, even following the April 12, 2007, hospitalization of resident #1, and an initial Vette naling Tet SDE NAN Ake ets he eT at Agency complaint investigation May 14, 2007, Respondent facility had taken no steps as of May 24, 2007, to review and correct its procedure and policy for handling residents’ laboratory . results, thereby potentially threatening the Respondent facility’s up to 120 residents with equally serious injury, harm, impairment or death for Respondent facility’s failure to timely report abnormal laboratory results to residents’ physicians. 29. The Agency provided Respondent with the mandatory correction date for this deficient practice of May 28, 2007. WHEREFORE, the Agency seeks to impose an administrative fine in the amount of $10,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(a) and 400.102, Florida Statutes (2006). COUNT II 30. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I as if fully set forth herein. 31. Respondent has been cited for one (1) State Class I deficiency and therefore is subject to a six (6) month survey cycle for a period of two years and a survey fee of $6,000 pursuant to Section 400.19(3), Florida Statutes (2006). WHEREFORE, the Agency intends to impose a six (6) month survey cycle for a period of two ycars and impose a survey fee in the amount of $6,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to Section 400.19(3), Florida Statutes (2006). COUNT JIT 32. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I of this Complaint as if fully set forth herein. 33. Based upon Respondent’s one cited State Class I deficiency, it was not in substantial WA bb ebb Lili 3 fPe¢a342144b ANGE NACE lll PPM RE RN ‘compliance at the time of the survey with criteria established under Part IT of Florida Statute 400, ot the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Florida Statutes (2006). 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), Florida Statutes (2006) commencing May 25, 2007, and ending May 25, 2007. nw Respectfully submitted this 23 day of August, 2007. F Bar. No. 81 1775 Assistant General Counsel Agency for Health Care Administration $25 Mirror Lake Drive, 330H St. Petersburg, FL 33701 727-552-1435 DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Fla. Stat. (2005), Respondent shal] 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. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights. : 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, Tallahassee, 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 JN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Wal Of ew tbs 9 fede dT PAE SPE edhe Pom °F Theme Nettetteet Sarthe ee 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: 7007 0710 0004 0429 1587 on August 2% . 2007 to: Stella Pappas, Administrator, Countryside Healthcare Center, 3825 Countryside Blvd., Palm Harbor, FL 34684 and by U.S. Mail to Corporation Service Company, Reg. Agent., 1201 Hays Street, Tallahassee, FL 32301-2525. Assistant General Counsel Copies furnished to: Stephen W. Webber, Administrator Corporation Service Company Countryside Healthcare Center Registered Agent for 3825 Countryside Blvd. Countryside Healthcare Center Palm Harbor, Florida 34684 1201 Hays Street (U.S. Certified Mail) ; - | Tallahassee, Florida 32301-2525 (U.S. Certified Mail | Patricia R. Caufman James H. Harris, Esquire Field Office Manager Senior Attorney §25 Mirror Lake Drive, 4" Floor Agency for Health Care Admin. St. Petersburg, Florida 33701 §25 Misror Lake Dr, 330H (Interoffice) ; St. Petersburg, Florida 33701 - (Interoffice)

Docket for Case No: 07-004186