Certified Mail Receipt CX (O ws (7004 2890 0000 5527 3101) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ; AHCA NOS.: 2008000129 vs. 2008000130 CAREGIVERS OF PENSACOLA, INC. d/b/a SOUTHERN OAKS, Respondent. aaa S ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against. CAREGIVERS OF PENSACOLA, INC. d/b/a SOUTHERN OAKS . (hereinafter “Southern Oaks”), pursuant to Section 120.569, and 120.57, Fla. Stat. (2007), alleges: NATURE OF THE ACTION 1. — This is an action to impose one (1) administrative fine in the amount of Ten Thousand Dollars ($10,000.00), plus one (1) survey fee in the amount of Six Thousand ($6,000.00), against Southern Oaks for one (1) isolated class I deficiency, pursuant to Sections 400.23(8)(a), and 400.102(1)(a), Fla. Stat. (2007). The Agency also intends to impose a conditional rating effective October 26, 2007 through November 28, 2007, pursuant to Section 400.23(7), Fla. Stat. (2007) case no. 2008000130. JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to 400, Part II and Sections 120.569 and 120.57, Fla. Stat. (2007). 3. Venue lies in Escambia County, Pensacola, Florida, pursuant to Section 120.57 Fla. Stat. (2007); Rule 59A-4, Fla. Admin. Code (2007) and Section 28.106.207, Fla. Stat. (2007). PARTIES 4. AHCA, is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing home facilities pursuant to Chapter 400, Part II, Fla. Stat. (2007), and Chapter 59A-4, Fla. Admin. Code (2007). 5. Southern Oaks is a for-profit corporation, whose 210-bed nursing home facility is located at 600 West Gregory Street, Pensacola, Florida 32501. Southern Oaks is licensed as nursing. home license #SNF1556096; certificate number #14958, effective November 29, 2007 through March 31, 2009. Southern Oaks was at all times material hereto, licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNTI SOUTHERN OAKS FAILED TO PROVIDE MEDICATIONS TO PREVENT DETERIORATION, HOSPITALIZATION, AND DEALTH FOR 1 OF 4 RESIDENTS - #146; AND FAILED TO ENSURE 2 OF 39 RESIDENTS RECEIVED NECESSARY DIALYSIS CARE RELATED TO ADEQUATE MONITORING OF IN-HOUSE PERITONEAL DIALYSIS FOR RESIDENT #197 AND MONITORING OF THE HEMODIALYSIS ACCESS SITE FOR RESIDENT #166. STATE TAG N216-HEALTH AND SAFETY OF RESIDENT Section 400.23(8)(b), Fla. Stat. (2007) RULES EVALUATION, AND DEFICIENCIES; LICENSURE STATUS Section 400.102(1)(a), Fla. Stat. (2007) ACTLON BY AGENCY AGAINST LICENSEE; GROUNDS 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about October 26, 2007, AHCA conducted a complaint investigation survey at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a.) On or about October 26, 2007, Southern Oaks failed to provide medications to prevent deterioration, hospitalization, and death for 1 of 4 residents #146; and failed to ensure 2 of 39 residents received necessary dialysis care related to adequate monitoring of in-house peritoneal dialysis for resident #197 and monitoring of the Hemondialysis access site for resident #166. The Findings include: 1. Record review on 10/25/07 at 4:00 p.m. and continuing 10/26/07 at 8:30 a.m. and concluding at approximately 6:00 p.m., revealed resident #146 was admitted 6/15/06. Resident hospitalized 7/19/07, returned to nursing home facility 7/22/07, went to the emergency room 7/25/07 and returned the same day, resident expired in nursing home 8/6/07. Diagnoses for resident #146 included: Hypertensive renal disease with renal failure; Alzheimers disease; diabetes-type II; depressive type psychosis; enlargement of lymph nodes; anxiety state; urinary tract infection; hyperlipidemia; and congestive heart failure. Record review on 10/26/07 at 9:00 a.m. of resident #146 's Annual Minimun Data Set (MDS) with. Assessment Reference Date (ARD) of 5/30/07 revealed resident's long term memory was intact; moderately impaired decision making/supervision required; able to make self understood; responds adequately to simple direct communication; repetitive anxious complaints/concerns exhibited 5 ‘days a week, resists care behavior occurred 1-3 days in last 7 and behavior not easily altered; at ease interacting with others, at ease doing planned activities, accepts invitations into most gourp activities; required extensive asssitance with activities of daily living; wheelchair primary mode of locomotion; incontinent of bladder; unsteady gait; chewing and swallowing problems; leaves 25% or more of food uneaten at most meals, mechanically altered diet; pressure relieving devices; activity preferences talking or conversing; evaluation by a licensed mental health specialist in last 90 days, reorientation; restorative walking 5 days a week, eating or swallowing 7 days a week; abnormal labs in last 90 days; resident participated in assessment; walking when most self sufficient coded 51-149 feet, time walked 3-4 minutes, self performance walking with limited assistance, walking support one person physical assist. ]5 stability of conditions, end-stage disease, 6 or fewer months to live is not checked and section Plo hospice care is not checked. Section O number of medications 24. MDS with ARD date 7/24/07 Mecidare 5 day revealed condition declined in the following areas: resident did not walk in room or walk in corridor; resident totally dependent in all areas of activities of daily living except required 2 person physcial assist for bed mobility; incontinent of bowel; had indwelling foley catheter; resident conditions unstable, resident experiencing an acute episode or flare up of a recurrent or chronic problem; on a turning and positioning program; monitoring intake and output and acute medical condition; occupational therapy 2 days, only restorative eating or swallowing 7 days; section Q2 coded overall change in care needs coded deteriorated-receives more support. J5 stability of conditions, end-stage disease, 6 or fewer months to live is not checked. Section Plo hospice care is not checked. Section O number of medications 4. MDS with ARD date 7/26/07 significant change assessment J5 end-stage disease is not checked, Plo hospice is checked. Record review of resident #146 's care plan on 10/26/07 at 9: 30 a.m. dated 5/30/07 related to supervision with activities of daily living; short term memory problem and impaired decision making; risk of falls related to unsteady gait; risk for skin breakdown; risk of drug related side effects use of psychotropic meds; resists ADL cate, meds, rehab at times and is physically and verbally abusive; potential for upper respiratory and urinary tract infections; alteration in health status secondary to hypertension, diabetes, chronic renal failure, congestive heart failure, anemia, pain management and dementia; resident prefers to make independent choices regarding activities. ; Care plan problems, goals, and interventions were not changed from 5/ 30/07 until after the resident's return from the hospital on 7/22/07. 2. Resident #146 's record review on 10/26/07 at 10:00 a.m. revealed 6/4/07 social services note indicated resident's brother in to withdraw all of resident's money to pay for resident's life insurance policy. Because resident had not yet "been approved for Medicaid and is currently under “private pay status" thus until approved, all monies are applied to the balance of his account. Residents brother stated he understood but did not agree." Facility did not give brother any money. 6/14/07 social services note indicated attempts to contact resident's daughter to "discuss issues with resident financial status with bill at facility, family also not compliant with Medicaid for financial assistance". 6/18/07 social services note indicated resident continued to do well staff reports no problems. Resident up and well dressed state doing fine. 6/19/07 documented correspondence between pharmacy and facility revealed facility was notified resident 's balance was over $17,000 and facility would be responsible if not paid. : 6/28/07 documented correspondence between pharmacy and facility revealed facility trying to give resident a discharge notice because family lent no assistance. 6/28/07 social services note indicated resident was "issued 30 days discharge notice for repeated attempts to collect all necessary financial information unsuccessful. Family notified. Will follow’. 6/28/07 Nursing Home Transfer and Discharge Notice given to resident for "repeated attempts to collect all necessary financial information unsuccessful". Presented by administrator and signed by resident 7/2/07. Interview with Social Services Director on 10/26/07 at 1:55 p.m. revealed they had several conversations with resident #146 's brother related to financial issues. Social services director stated they did not recall talking to the family about physician orders to discontine resident #146's medications. Social services director recalled talking to the brother about facility instituting comfort measures. Social services director stated they were not aware if medications were discontinued because family did not pay pharmacy bill. Stated facility was not supposed to stop the medications and they would take that to the administrator, further stating resident has to have what they need and it should not have anything to do with money. Surveyor showed the social services director their own social services note dated 7/19/07 late entry for 7/13/07, the social services director then recalled pharmacy was owed something like $15,000 and did discuss medications with administrator. Social services director stated if residents are not approved for Medicaid and they were Medicaid pending, the administrator had to pay for everything. Social services director stated resident #146 was private pay-Medicaid pending at the time the medications were discontinued. The next social services note is dated 7/19/07 " pt. out to hosp. Left message on brother's phone to call regarding assistance with completing Medicaid process". _ 7/19/07 note has late entry for 7/13/07 "SW spoke with administrator regarding tes. financial status and pharmaceutical situation. Administrator states he was previously. made aware and has agreed to pay for meds. Pt. notified. Continue to follow." 3. Resident #146 's record review on 10/26/07 at 10:30 a.m. revealed from 7/2/7 to 7/19/07 resident received occupational therapy three times a week for 15 to 25 minutes at a time to demonstrate active assistive range of motion to upper extremities to assist with ADL's and joint (shoulder) pain. Inerview with Occupational Therapist (OT), on 10/26/07 at 2:23 p.m. revealed prior to resident #146's hospitalization, goals were to improve upper extremity active assistive range of motion without complaints of pain. Stated resident #146 began complaining of bilateral shoulder pain and OT was working on improving function. Residet #146 had been able to assist with bed mobility, was then hospitalized, had slight decline and needed OT to get back that ability. Because of the pain resident #146 was holding arms close to the body and would not abduct arms and staff was having difficulty bathing the resident. Record review at this time confirmed slight progress was made last two visits prior to hospitalization and resident was seen 7/16/07 and 7/18/07 and participated in exercises and bed mobility but refused hot packs. Record review with OT during interview revealed when resident #146 returned from hospital resident had an OT evaluation 7/24/07 with goal of passive range of motion, grip strength had slightly decreased, was to be seen 3 times/week for 3 weeks, however, was only seen twice because resident was admitted to hospice 7/26/07 for failure to thrive. 4. Record review on 10/26/07 of resident #146 ' s medication administration record (MAR) for 7/1/07 through 7/31/07 revealed the following medications where nurses wrote their initials and then circled their initials indicating the medication was not given. benicar (antihypertensive) circled 7/6-12/07; dyrenium {potassium sparing diuretic) circled 7/6-12/07; minoxidil (antihypertensive) circled 7/6-12/07; benazepril (antihypertensive) circled 7/6-12/07; norvasc (antihypertensive) circled 7/6-12/07; prozac (antidepressant) circled 7/6-12/07; calcitriol (calcium regulator) circled 7/6-12/07; vitamin D circled 7/6-12/07; coreg (antihypertensive) circled 7/6-12/07; ferrous sulfate (iron) circled 7 of 14 doses 1/6-12/07; hydralazine (antihypertensive) circled 7/6-12/07; seroquel (antipsychotic). circled 7/7/07 and 7/8/07; epogen weekly injection circled 7/11/07. Review of nurses notes 6/24/07 through 7/12/07 revealed there was no documentation resident #146 refused any medications. Review of the back of the MAR ' ss for July reveal no indication as to why the nurses circled their initials. Review of facility policy and procedure titled ° Caregivers Nursing Policy and Procedure Effective Date 12/01/02 Medications/Administering "#11 states." If the resident refuses medication, indicate failure to administer medication on the MAR and in the nurse 's notes. Notify the physician of repeated refusals to take medication ". Interview on 10/26/07 at 3:17 p.m. with third floor LPN #1, asked what the nurse does if the resident does not take medications, stated they circle their initials on the front of the MAR, write resident refuses medication on the back of the MAR, and throw away the medicine. If the resident refuses the next day they put in the physician log book. Log book is located at the nurses station in the chart rack. Surveyor asked how do you document if the medication is not available, stated circle my initials and document on the back of the MAR the medication is not available. Interview on 10/26/07 at 3:20 p.m. with LPN #2, policy is to attempt twice, then circle on the front of the MAR, and on the back of the MAR write patient refused, date, time, and write my name. If resident refuses continuous I'll call the physician. If medication is not available circle on MAR, write on the back unavailable, call the pharmacy and let them know the medication was not available. Stated they were aware pharmacy was not delivering resident #146's medications but unsure why. Interview on 10/26/07 at 3:23 p.m. with RN, ADON, stated unsure what the policy is regarding what nurses are to document when a resident refuses medications or medications are not available, but would make several attempts, discard the medication, and document by circling initials and write on the back of the MAR resident refused and I would write it in my nurses notes. Stated they would immediately inform physician that resident refused the medications. Stated they were unsure what the policy was regarding the physician discontinuing medications that are refused. Stated they were aware pharmacy was not sending pills for resident #146 and that shortly after that they were discontinue by the physician. Stated pharmacy was not sending pills for resident #146 because there was an outstanding debt. Surveyor asked how the nurse would document the medication was not available as opposed to resident refused, nurse stated the same with a circle, and think the nurses would write unavailable as opposed to refused on the back of the MAR. Interview on 10/26/07 at 5:40 p.m. with Director of Nursing (along with QA Director), revealed nurses document a resident's refusal of meds by circling their initials if a medication is not given for whatever reason, then write a nurses note as to the explanation as to why the medication was not given, either refused or not available. Stated she understood that some of the medications were available, even though they were not sent by the pharmacy, because there were some left over because the resident had sometimes refused medications. Stated if medications were not available the nurse would call the physician, see if the medication is in the emergency box. Stated this is the first time they had this problem. Stated when they (Administrator and DON) were called about the pharmacy not sending the medications she stated they said we would be responsible. Stated they never had this to happen before. The QA Director and DON both confirmed there was no policy or procedure in place related to what to do when a resident/family does not pay the pharmacy bill and the pharmacy does not send medications. 5. Record review on 10/26/07 of resident #146 ' s record revealed 7/9/07 physician progress note indicated apparently getting few meds as family is not making payments to pharmacy. 7/9/07 physician order" social services-problem with pharmacy payment? (family) if they won't pay for meds, then we need to pursue hospice consult he is DNR." 7/9/07 documentation between pharmacy and administrator revealed facility would be taking responsibility for resident ' s medications. 7/10/07 nurses notes indicated social services consult D/T (due to ) pharmacy won't send meds and probably see about putting-resident on hospice.- 7/10/07 Hospice of the Emerald Coase consult reveals "pt. is not appropriate for hospice at this time." "Does not meet criteria under hospice diagnosis. Also, pt. is currently receiving OT (occupational therapy) 3X/wk (three times a week). 7/12/07 physician progress note indicated see hospice eval, pt not taking meds, family aware. Physician orders to have "social services notify family that we will initiate comfort measures only for this pt." And discontnued the following meds: minoxidil (antihypertensive), benazepril (antihypertensive), megace (anorexia), norvasc(antianginal/antihypertensive), prozac (antidepressant), calcitrol (calcium regulator), vitamin D, prevacid (antiulcer), aspirin (analgesic/antiplatelet), benicar (antihypertensive), dyrenium (potassium sparing diuretic), coreg (antihypertensive), nitroglycerin (coronary vasodilator/antianginal), hydralazine (antihypertensive/direct-acting peripheral vasodilator), clonidine (antihypertensive), ferrous sulfate (iron), vitamin C, chronulac (ammonia detoxicant), seroquel (antipsychotic), epogen (antianemic), duoneb nebulizer (albuterol-bronchodilator), tylenol (analgesic). Interview: Attending physician 's Advanced Registered Nurse Practitioner (ARNP) for the resident called this surveyor. Interview on 10/26/07 at 4:57 p.m. with ARNP revealed ARNP remembered resident #146 had diabetes, hypertension, and congestive heart failure. Stated at times resident #146 would not take meds but ARNP understood that resident #146 was not receiving meds "for a while because pharmacy had not delivered for a while". ARNP stated they overheard someone say family had not paid pharmacy bill so pharmacy would not send medications. Stated reason resident #146 was not getting medications was because they (medications) were not there. ARNP stated they asked the nurses taking care of the resident #146 how resident #146 was doing and was told resident #146 was doing fine, blood pressure was good, ARNP stated they saw resident #146 sitting up in a wheelchair at the nurses station. Surveyor asked if ARNP was aware of why resident #146 was hospitalized, ARNP stated in retrospect thought resident #146 had a bad urinary tract infection that was not diagnosed, but then stated they knew resident #146 was sent to the hospital because the resident #146's blood pressure shot up. Surveyor asked if ARNP routinely, abruptly, discontinued diabetes, hypertension, or congestive heart failure medications, ARNP stated "me, no, honestly". ARNP stated "this situation stinks, this is the first time I heard of it, sure did put me in a bad situation". 6. Record review of resident #146 's record revealed vital sign flow sheet 5/27/07 to 7/18/07 indicated blood pressure taken daily and only once systolic over 164 and dystolic only over 90 once, on 7/11/07 blood pressure was 167/98, on 1/19/07 date of hospitalization blood pressure was recorded as 190/98 and 210/100. Nurses note 7/4/07 indicated blood pressure 206/127 clonidine given. 7/10/07 nurses note indicated received new orders for social services consult D/T (due to) pharmacy won.'t send meds and probably see about putting resident on hospice. 7/12/07 nurses note indicated majority of meds DC'd (discontinued) social services notified of comfort measures only. BP (blood pressute) this am at 0800 was 220/140 clonidine given. 7/13/07 physician progress note family aware of this situation and they have been difficult to reach. Will not pay for meds. Pt. is DNR with advanced dementia/CHF/ ...(resident) been off most meds 1 week no ...remained stable. Comfort measutes only - family aware. 7/13/07 nurses note indicated "social services given co of new order to. noti family of intimate comfort measures". 7/16/07 nurses note indicated blood sugar 44 and blood pressure 163/123. Physician progress note indicted hypoglycemia, lantus (long acting insulin) was discontinued. 7/17/07 nurse’s note indicated blood pressure 190/110 clonidine given. Physician ordered lortab (opiod analgesic) and saline nasal spray discontinued. 7/19/07 nurse’s note indicated blood pressure 190/98 clonidine given. Blood pressure at 10:30 a.m., 178/92. Blood pressure at 1:00 p.m., 210/100. 7/19/07 physician progress note not eating, marked confusion, low sugars, ordered resident to the emergency room for evaluation of altered mental status. Facility Resident Transfer Form dated 7/19/07 states reason for transfer of resident #146 " AMS (altered mental status, increased BP (blood pressure), SOB (shortness of breath) apnea. Admitted to acute care hospital. Readmitted to nursing home 7/22/07. Sent to acute care hospital emergency room 7/25/07 at 4:15 a.m. nursing home nurses notes indicated " unable to reduce B/P. Sent to Baptist ER to evaluate + treat HTN "." Resident returned to facility via EMS approximately 12:30 p.m.” . 1/23/07 physician progress noted indicated returned from hospital-more alert today.7/25/07 admitted to Emerald Coast Hospice with diagnosis of end stage Alzheimer's. Hospice Initial Certification and Plan of Care/Physician Orders not signed by two physicians. 7/26/07 physician progress note indicated uncontrolled hypertension. 7. Interview with Quality Assurance Director/Staff Educator (along with DON) on 10/26/07 at 5:40 p.m. revealed it was his understanding the resident #146 was not taking medications or resident #146 was refusing meds for 6 or 7 days and that the physician or ARNP discontinued meds and monitored the resident. Surveyor asked if QA included monitoring of residents refusal of medications or pharmacy not sending medications or medications being discontinued because pharmacy bills were not paid. Stated this situation did not come up in QA because he was not made aware. Stated he remembered resident #146 had medications discontinued because resident #146 was not taking them and seerned to be fine without them. Stated he knew insulin was discontinued but knew sliding scale insulin was still being given so it was not an issue. Stated he didn't know of any medications that were not available from the pharmacy for resident #146, and did not monitor this in QA. Stated if a resident does not have medications the nurse calls the on-call pharmacy number and the local pharmacy, Walgreens, sends the medications. Stated he was perplexed hearing all this today. 8. Interview on 10/26/07 at 4:20 p.m. with administrator confirmed facility did provide discharge notice to resident #146 related to bill at the facility not being paid. Stated the discharge notice was given the later part of June. Administrator stated that during family July 4° vacation administrator was called by facility that the pharmacy was not being paid for resident #146 's medications. Administrator stated pharmacist told facility that the facility would have to pay the bill. ‘Administrator agreed to pay the bill from this point forward, however, does not know if the bill was paid. Stated thought the bill was several thousand dollars. Administrator stated since he knew the 30 day discharge notice was given he thought he would have to pay the pharmacy bill for about 30 days. Stated he was not aware pharmacy stopped sending medication for resident #146 after 6/30/07. Stated he became aware during this survey that the physician discontinued resident #146 's medications. 9. Interview with pharmacist, at Rx Advantage, on 10/26/07 at 10:10 a.m. revealed pharmacist was aware resident #146 ' s medications were discontinued by the physician due to non payment to the pharmacy. Surveyor asked if this was the routine practice pharmacist stated yes they (pharmacy) "give fair warning". Surveyor asked who was given the fair warning, pharmacist stated the pharmacy gave warning to the facility and the responsible party. Surveyor asked if the pharmacist had copies of fair warnings given, pharmacist replied they did and would fax to 850-437- 3733. Documentation of correspondence between the pharmacy and facility received and reviewed. 6/19/07 documented correspondence between pharmacy and facility revealed facility was notified resident ' s balance was over $17,000 tees and facility would be responsible if not paid. 7/9/07 documentation between pharmacy and administrator revealed facility would be taking responsibility for resident 's medications. : Interview with pharmacist again on 10/26/07 at 4:00 p.m. revealed pharmacy sent a 7 day supply of medications for resident #146 to the facility 6/30/07 and this was a 7 day supply. Stated the pharmacy always sent a seven day supply. Stated the supply would have run out July 6 or 7, 2007. Pharmacist stated the next time medications were sent for resident #146 was on July 23, 2007 when resident #146 was readmitted to the facility under Medicare Part A after a hospitalization. 10. Observation at 12:35 p.m. on 10/25/07 revealed resident #197 receiving peritoneal dialysis in his/her room. 7 minutes were remaining on the clock. Fluids were being drained through a line into the bathroom sink. Interview with the registered nurse on 10/25/07 at 2:15 p.m., revealed that she monitored the weight daily, and the drain amount should be recorded daily. A flow sheet was present. The residents in the connecting room are incontinent. Review of the monitoring record initiated 10/17/07 monitored weight, blood pressure, pulse on the 10/17,18, and 19/2007. Monitoring was not documented at all on 10/20 and 10/21/07. Review of the procedures given to the facility by the dialysis coordinator identified that drainage should be observed for blood or cloudiness. Interview with the nurse on 10/25/07 at approximately 2:45 p.m., confirmed that there was not any monitoring of the discharge fluid as stated in the handout provided by the dialysis center or monitoring of peritoneal dialysis process on 10/20 or 10/21/07. Interview with the unit manager also confirmed that there monitoring was not documented as being done on 10/20 or 10/21/07. 11. Interview with resident #166 on 10/25/07 at 6 pm, S/he stated the staff did not check bruit or thrill when s/he returned from dialysis or checked the site on non-dialysis days. S/he stated that "1 had been back since 3:30 pm or 4:00 pm have not received my meds yet." S/he was aware of what complication to look for and would call nurse if bleeding swelling or discoloration. Interview with the charge nurse, on 10/25/07 at 3:15 p-m., confirmed that the shunt site was not documented on the treatment sheet MAR's or skin assessment. There should have been documentation. Interview with the D.O.N. confirmed that the facility did not have a policy/procedure related to monitoring residents receiving dialysis services. Class I Isolated Correct by: Immediate 8. The regulatory provisions of the Fla. Stat. (2007) that is pertinent to this alleged violation read as follows: 400.23 Rules; evaluation and deficiencies; and licensure status- (8)(a) A class I deficiency is a deficiency that the agency determines presents a situation in which immediate corrective action is necessary because the facility's noncompliance has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in a facility. The condition or practice constituting a class I violation shall be abated or eliminated immediately, unless a fixed period of time, as determined by the agency, is required for correction. A class I deficiency is subject to a civil penalty of $10,000 for an: isolated deficiency, $12,500 for a patterned deficiency, and $15,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last licensure inspection ot any inspection or complaint investigation since the last licensure inspection. A fine must be levied notwithstanding the correction of the deficiency. a es 400.102 Action by agency against licensee; grounds.~ In addition to the grounds listed in part II of chapter 408, any of the following conditions shall be grounds for action by the agency against a licensee: (1) An intentional or negligent act materially affecting the health or safety of residents of the facility. 400.23 Rules; evaluation and deficiencies; licensure status.— (7) The agency shall, at least every 15 months, evaluate all nursing home facilities and make a determination as to the degree of compliance by each licensee with the established rules adopted under this part as a basis for assigning a licensure status to that facility. The agency shall base its evaluation on the most recent inspection teport, taking into consideration findings from other official reports, surveys, interviews, investigations, and inspections. In addition to license categories authorized under part Il of chapter 408, the agency shall assign a licensure status of standard or conditional to each nursing home. ~*~ * * 9. The violation alleged herein constitutes a class II deficiency, and warrants a fine of $10,000.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $10,000.00. COUNT II DUE TO THE ONE CITED CLASS I DEFICIENCIES, AN IMPOSITION OF A CONDITIONAL LICENSE AND SIX MONTH SURVEY CYCLE FOR A PERIOD OF TWO YEARS IS WARRANTED FINES TOTALLING $6,000 PURSUANT TO . Section 400, 19(3), Fla. Stat. (2007), RIGHT OF ENTRY INSPECTION Section 400.23(7)(b), Fla. Stat. (2007) RULES EVALUATION, AND DEFICIENCIES; LICENSURE STATUS 10. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 11. The agency shall every 15 months conduct at least one unannounced inspection to determine compliance by the licensee with statutes, and with rules promulgated under the provisions of those. statutes, governing minimum standards of construction, quality and adequacy of care, and rights of residents. The survey shall be conducted every 6 months for the next 2-year period if the facility has been cited for a class I deficiency, has been cited for two or more class II deficiencies arising from separate surveys or investigations within a 60-day period, or has had three or more substantiated complaints within a 6month period, each resulting in at least one class 1 or class II deficiency. In addition to any other fees or fines in this part, the agency shall assess a fine for each facility that is subject to the 6-month survey cycle. The fine for the 2-year period shall be $6,000, one-half to be paid at the completion of each survey. The agency may adjust this fine by the change in the Consumer Price Index, based on the 12 months immediately preceding the increase, to cover the cost of the additional surveys. The agency shall verify through subsequent inspection that any deficiency identified during inspection is corrected. However, the agency may verify the correction of a class III or class IV deficiency unrelated to resident rights or resident care without reinspecting the facility if adequate written documentation has been received from the facility, which provides assurance that the deficiency has been corrected. The giving or causing to be given of advance notice of such unannounced inspections by an employee of the agency to any unauthorized person shall constitute cause for suspension of not fewer than 5 working days according to the provisions of chapter 110. 12. The violation alleged herein constitutes a class I deficiency, and warrants a fine totaling $6,000. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $6,000. CLAIM FOR RELIEF 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, Il. 2. Southern Oaks an administrative fine in the amount of $16.000 for the violation cited above. 3. 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 Section 120.569, Florida Statutes (2007). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). 15 All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael O. Mathis, Senior Attorney. RESPONDENT IS FURTHER NOTIFED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL REASULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A rN ORDER BY THE AGENCY. Respectfully Submitted this _ 4" day of 2008, Leon County, Tallahassee, s Michael Oz. Mathis, Esquire Fla. Bar. No. 0325570 Counsel of Petitioner, Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5873 (office) (850) 921-0158 (fax) Florida. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on F™* day of febnsmem) 2008 to Clyde Church, Administrator, Southern Oaks, 600 West Gregory Street, Pensacola, Florida 32501. Michael O. Mathis, Esquire ie U:S. Postal Service: CERTIFIED MAIL... RECEIPT (Domestic Mail Only; No Insurance Coverage Provided). For delivery information visit our. website at WWW.USPS.COoms MVOFFICIAL USE en 7004 2890 0000 5527 3101 PS Formy:3800, June 2002: SENDER: COMPLETE THIS SECTION ™ 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 this card to the back of the mailpiece, or on the front if space permits. fa lyola, OF to: j ; i - n. ad \Wes + rege A= D. Is defivery address different from ttem 12 CJ Yes If YES, enter delivery address below: 01.No 3. Service Type pcariied Mail ° [1 Express Mall. CI Registered C1 Return Receipt for Merchandise O Insured Mail 1 C.0.D. 4, Restricted Delivery? (Extra Fee) 2. Article Number (Transfer from service label) 7oo4 2aqo anoo 552? 3101 PS Form 3811, February 2004 ie Return Receipt 102595-02-M-1540

Docket for Case No: 08-001055