STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION OX 067 “ at fy STATE |OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No: 2007012320 2007012321 vs. Return Receipt Requested 7002 2410 0001 4235 9688 MANORCARE HEALTH SERVICES, INC. 7002 2410 0001 4235 9695 d/b/a MANORCARE HEALTH SERVICES, 7002 2410 0001 4235 9701 Respondent. ADMINISTRATIVE COMPLAINT GOMES NOW the Agency for Health Care Administration (hereinafter referred to as “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Manorcare Health Services, Inc. d/b/a Manorcare Health Services (hereinafter “Manorcare Health Services”), pursuant to Chapter 400, Part II, and Section 120.60, Florida Statutes (2007)|, and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $5);000.00 pursuant to Section 400.23(8), Florida Statutes (2007)|, for the protection of the public health, safety and welfaye. status 400.23 This is an action to impose a Conditional Licensure to Manorcare Health Services, pursuant to Section (7) (ob), Florida Statutes (2007). JURISDICTION AND VENUE This Court has jurisdiction pursuant to Sections 9 and 120.57, Florida Statutes (2007), and Chapter 28- 106, Fllorida Administrative Code. 400.12 Florid 5}. licens govern Florid Admini 6. Venue lies in Palm Beach County, pursuant to Section 1(1)(e), Florida Statutes (2007), and Rule 28-106.207, fa Administrative Code. PARTIES AHCA is the regulatory authority responsible for ure and enforcement of all applicable statutes and rules ing nursing homes, pursuant to Chapter 400, Part II, Ia Statutes, (2007), and Chapter 59A-4 Florida istrative Code. Manorcare Health Services is a 180-bed skilled nursing facility located at 375 N.W. 51° Street, Boca Raton, Florid skille certif 12/31/ materi author applic la 33431. Manorcare Health Services is licensed as a id nursing facility; license number SNF1313096; icate number 14933, effective 09/21/2007 through 2008. Manorcare Health Services was at all times al hereto a licensed facility under the licensing ity of AHCA and was required to comply with all lable rules and statutes. COUNT I MANORCARE HEALTH SERVICES FAILED TO PROVIDE THE NECESSARY CARE AND |SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL WELL BEING FOR 2 OF 27 SAMPLED RESIDENTS Section 400.102(1) (a), Florida Statutes (HEALTH AND SAFETY OF RESIDENT) CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8). During the annual licensure survey conducted from 918/07) thru 9/21/07 and based on observation, record review and staff interviews, it was determined that the facility failed to provide the necessary care and services to attain or maintain the highest practicable physical well being for 2 of 27 sampled residents (#2 and #27) This is evidenced by: (1) failure to maintain acceptable blood glucose parameters for a resident (2) failure to ensure a resident receives medication to reliieve pain. 9. A review of the clinical record revealed that Resident #2 was diagnosed with Diabetes Mellitus during a recent} hospital admission, in September 2007. The resident's medicall history includes Congestive Heart Failure and Atrial Fibrillation, the resident is 94 years old and weighs 106-110 lbs. (a) The clinical record contained a 9/12/07 physician's order for: Lantus Insulin 20 units to be administered daily at 9PM Accucheck via finger stick 2 times daily before breakflast at 6:30 AM and before supper at 4:30 PM; Novolog (insulin) per sliding scale parameters according to the blood glucose results. (ob) This physician's order specifies, blood glucose "Less |than 70 and greater than 400, call MD"; indicating that the physician must be notified when the resident's blood glucose, accucheck test result is less than 79 or greater than 400. (c) The medication administration records document glucoge levels were less than 70 on 9/13/07, 9/14/07, 9/16/07 and 9/17/07. The normal blood glucose level is 70-110 mg/dl. (ad) The documented accuchex results were : 9/13/07, 6:30 AM = 55; 9/13/07, 4:30 PM = 53; 9/14/07, 6:30 AM= 68; 9/14/07, 4:30 PM = 64; 9/16/07, 6:30 AM = 65; (e) A lab report dated 9/17/07 at 4:50 AM documented blood glucose result less than 30 and at 6:30 AM, accuchex = 65. (£) There were no result for 9/15 at 6:30 AM accucheck testing and the result was not document in the nurse’|s notes. (g) A review of the nursing progress notes revealed that there was no documentation that the physician had been informed of the resident's unstable blood glucose levels for 5 days, 9/13, 9/14, 9/15, 9/16 and 9/17/07. (h) A nurse documents on 9/13/07, at 4:00 PM, "Resident lying in bed, lethargic Bl (blood) sugar 53. Resident given thickened juice when we were able to rouse him." | 9/13/07 and at 9:00 PM on the reverse side of the MAR, was a/notation that Lantus insulin 20 units was held because the blood sugar was 53. The notation did not indicate the physidian had been notified. Nursing progress note of 7:00 AM, 9/14/07, Blood sugar 68, orange juice given, repeat 80. the nurse jalso documented that the resident had poor appetite. The 9:00 PM Lantus insulin dose was also held on 9/14/09, without evidence that the physician was notified of the resident's condition. (i) A review of the resident food intake recorded on the ADL (activities of daily living) worksheet for 9/13/07 through 9/17/07 revealed that the resident has poor appetite and atte 25-50% of meals and nutritious frozen treats offered at lunch and dinner. (j) A nurse's note 9/16/07 5:30 PM "staff tried to assist} resident with meal, however resident refuses". Lantus insulin administered at 9:00 PM, without checking the blood sugar,| Accuchex at 4:30 PM was 84. {k) The medication administration record indicated that Lanus insulin (long acting insulin) was again admint stered at 9 PM on 9/17/07 without verifying that the blood jglucose level was within acceptable levels. (1) On 9/18/07 at 2:00 AM a nurse documents in a nursing progress note “Resident observed in bed gasping for air, ia sound in throat. ...... resident not responding to ve rescue still glucos hospit| reveal bal, vocal or tactile stimuli, blood glucose 106. 911 called at 2:15 AM, Rescue arrived on scene, resident not responding, BP 125/60, oxygen saturation 93%. Blood e taken by rescue 30. resident transported to .... (local al) at 9/18/07 2:35 AM, “family and MD notified" (m) A review of the hospital record dated 9/18/07 ed that an admitting diagnosis of "insulin induced hypoglycemia". The resident was treated with normal saline and intravenous glucose and returned to the facility on 9/18/07. The hospital discharge orders to discontinue the Lantus insuli In and monitor the blood glucose four times daily. (n) During interviews with two registered nurse on the afternoon of 9/21/07, the nurses acknowledged that the medical physic condit| transp 1 1:40 4H l record did not contain evidence to verify that a ian had been notified of the resident unstable medical ion until 9/18/07, after the resident had been jorted to a local hospital. 0. During an observation on the Williamsburg wing, at M, on 9/19/07, resident #27 was standing by the nurse's station, and complained of "terrible" pain. The Unit Manager stated on a scale of 1-10, what was the resident's pain. The resident replied, "A 10". The Unit Manager told the resident that he/she could not be a 10 because the resident was not "writhing" in pain. The resident responded, "Oh, ok, a 9". The Unit Manager again stated that the resident could not be a 9 because he/she could speak. The resident than said the pain was an "8". The Unit Manager then asked the resident if two Tylenol would help the pain, and the resident stated, "No". The Unit Manager told the resident that he/she would have to call the Physician to get an order for something else, and could |the Unit Manager give the Tylenol for now. The resident said gk, and took the Tylenol. The Unit Manager stated to the resident, "What do you want, Aleve". The resident replied, "Yes".| The Unit Manager took the resident to his/her room. (a) A review of the nurse's notes on 9/19/07 documented that at 1:50 PM, the resident complained of pain of the right hip at an 8. The resident was given Tylenol for pain, jand requested to get an order for Aleve. A call was placed to the Physician. An order for Aleve was received later in the day, and was discontinued on 9/20/07. The Aleve was not given. (b) The resident had complained of pain at a level 10, and was told by a Unit Manager that he/she could not be in that much pain. The resident had to change the pain level three jtimes until the Unit Manager was satisfied with the pain level.| The resident was medicated with Tylenol, when the resident had stated that it would not help their pain. The facility failed to give care to ensure the resident reached their highest practical physical and mental pain relief. 11. Based on the foregoing, Manorcare Health Services violated Section 400.102(1) (a), Florida Statutes, herein classiffied as an Class II deficiency pursuant to Section 400.23/(8) (b), Florida Statutes, which carries, in this case, an assessed fine of $5,000.00 for an isolated deficiency. This violatiion also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). DISPLAY OF LICENSE Pursuant to Section 400.23(7) (e), Florida Statutes (2007)|, Manorcare Health Services shall post the 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. The Conditional License is attached hereto as Exhibit “A” CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health| Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency] on Count I. B. Assess an administrative fine of $5,000.00 agains|t Manorcare Health Services on Count I. c. Assess and assign a conditional license status fo Manorcare Health Services in accordance with Section 400.23\(7) (ob), Florida Statutes. D. Grant such other relief as this 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 (2007). Specific options for administrative action are set out in the attached Election of Rights} and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health| Care Administration, and delivered to the Agency for Health| Care Administration, Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, telephone (850) 922- 5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUES FOR 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 OR BY THE AGENCY. Nelson E. Rodney Assistant General Covlnsel Agency for Health Care Administration Spokane Building, Suite 103 8350 N.W. 52™ Terrace Miami, Florida 33166 Copies furnished to: Diane |Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Finance and Accounting Revenue and Management Unit Agency, for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency) for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) EXHIBIT “A” Conditional License License No. SNF 1313096 Certificate No. Effective date: 09/21/2007 Expiration date: 12/31/2008 11 14933

Docket for Case No: 08-000667