STATE OF FLORIDA D AGENCY FOR HEALTH CARE ADMINISTRATION 08 APp ~7 Py . 2 hy C&: VlOD STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2007013316 2007013317 INNOVATIVE HEALTH CARE PROPERTIES, INC., D/B/A SUMMER BROOK. HEALTH CARE 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 SUMMER BROOK HEALTH CARE CENTER (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2007), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing September 28, 2007 (Case no. 2007013317), pursuant to Section 400.23(7)(b), Florida Statutes, and to impose an administrative fine in the amount of $2,500.00 (case no. 2007013316), based upon Respondent being cited for one isolated Class II deficiency pursuant to Section 400.23(8)(b), Florida Statues (2007). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Chapter 400, Part II, and §§ 120.60 and 400.062, Florida Statutes (2007). 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 IJ, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 120-bed nursing home, located at 5377 Moncrief Road, Jacksonville, Florida 32209, and is licensed as a skilled nursing facility license number 1132096. 5. Respondent was at all times material hereto, a licensed nursing facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That Florida law 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... Has the right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if applicable; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency. § 400.22(1)(1), Florida Statutes (2007). 8. That on or about September 28, 2007, the Agency completed a Survey at Respondent’s facility. 9. Based on observation, interview with facility staff, and record review, the facility failed to provide care and services for pain management to Resident #35 who experienced pain with physical and psychosocial harm, and to Resident #93 for rehabilitation services for contractures, and Resident #107 for dialysis and medication administration, for three of thirty- seven sampled residents. 10. Resident #35 was in pain without relief. Failure to provide the appropriate action in the management of pain causes physical and psychosocial harm to a resident. 11. That the Florida Department of Professional Regulation, Chapter 464, section 464.003 @B) (a), "Practice of Professional Nursing" means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: 1. The administration of medications and treatments as prescribed or authorized by duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatment. 12. On 9/25/07 at 8:45 am., Resident #35 was observed crying and stating that they were in pain; they stated that he/she asked the staff not to put her/him into the chair to weigh him/her because it hurt her/his back and they did it anyway. She/he stated that they left him/her in the chair and were talking amongst themselves and she/he was crying because the pain was so bad. 13. The surveyor intervened and approached the medication nurse as the call bell was found lying on the floor and the resident stated he/she could not find it to call for the nurse. Following the administration of Darvocet at 9:45 a.m., the resident stated they were more comfortable. The licensed medication nurse told the resident to call for more pain medication but did not check for call bell placement; due to resident pain observed, the surveyor intervened and told the nurse that the call bell was not in resident reach. The nurse picked the call bell up off the floor and positioned it near the resident so it was within the resident's reach. 14. __ Interview with Resident #35 on 9/26/07 at 8:50 a.m. revealed that he/she remembered the situation and pain that she/he was in on 9/25/07 when the chair was used to weigh hinvher. A nurse rolled the chair in for another resident and Resident #35 stated "that's the chair that hurts me so when they use it”. 15. Review of the MAR for 9/07 revealed that Darvocet (pain medication) was given on 9/10/07 and 9/19/07 for leg pain. The pain medication given on 9/24, 9/25, and 9/26 was documented for back pain. Review of the MDS (Minimum Data Set) dated 7/25/07 documented that pain symptoms were coded a "2/2" for pain daily of moderate intensity. The significant change MDS dated 5/2/07 documented that the resident had pain in their joints. 16. During interview on 9/25/07 at 9:30 a.m. with the CNA (certified nursing assistant), who stated that they had been caring for Resident #35 since June, 2007, knew that the resident had pain in her/his lower back. The CNA stated that the resident had pain and therefore doesn't like to get up. The CNA stated that they get him/her up on Tuesday, Thursday, and Saturday for a shower and that when he/she gets in the shower she/he complains of pain. The CNA stated that she/he complains about the pain when he/she gets up in the chair for weighing. The CNA stated they didn't know if there was a pain medication that the resident could have. 17. Interview with the licensed nurse on 9/26/07 at 9:00 a.m. revealed that the nurses chart the pain medication on the MAR (Medication Administration Record) and then 1/2 an hour later are required to chart the effectiveness on a pain management sheet. 18. Interview with the MDS Coordinator on 9/26/07 at 9:50 a.m. revealed that she had just done the first pain assessment after reviewing the resident's chart and that she had done the first care plan for pain 9/26/07. She stated that pain assessments were to be done quarterly. During the interview with the MDS Coordinator, they were unaware of the pain that the resident was experiencing and that there was no care plan for pain and no approaches on the current care plans. She stated that there should be a care plan and communication to the staff that the resident would be pre-medicated prior to use of the weighing chair. She also stated that the side effects of the Fentanyl patch and Darvocet N were not care planned, although the resident received Fentanyl via patch daily. 19. Review of the current care plan dated 5/7/07 did not reveal a care plan specific to pain and there were no approaches to address the Fentanyl Patch 50 mcg every 72 hours ordered on 1/30/07. Darvocet N 1 tablet was ordered 2/5/07 every 8 hours prn for pain. 20. Review of the clinical medical record for Resident #93 revealed a care plan dated 10/4/06 for risk of pressure ulcers which stated the resident was admitted with contractures of legs. There was no mention of upper extremities being contracted. The thinned chart also had a Nursing Note dated 11/8/06 that stated the physician ordered a Physical Therapy and Occupational Therapy evaluation for a deformity of the resident's right wrist. There was no evidence the resident was ever evaluated until 1/7/07. 21. During an interview with the Occupational Therapist (OT) on 9/27/07 at 9:05 a.m., she stated the resident was evaluated by therapy on 1/7/07 and that the OT requested approval to provide therapy. She stated the process was for a referral to be made by nursing, the resident to be screened, the therapy recommendation to be forwarded to the facility assistant administrator, who stated she immediately hands the request off to the Administrator. 22. Interview with the Administrator on 9/27/07 at 9:40 AM noted that the only requests he gets are for residents that don't have funding and that he “almost always" signs off on them (approves). He further stated if therapy does not get the request back it must have gotten lost. When questioned about Resident #93, he stated he did not recognize the name. During interview with the OT at 9:05 AM, she stated that due to the resident's payer source she was unable to provide the therapy. Random observation of the resident on 9/24-9/27/07 and during interview with the resident it was noted the resident did not have the use of both arms. 23. Resident #107 was admitted to the facility on 8/30/06 and re-admitted on 8/ 10/07 with a diagnosis of end-stage renal disease, chronic renal failure and seizure disorder. The resident was scheduled to have dialysis treatments on Tuesdays, Thursdays and Fridays at 2 p.m. 24. Resident #107 had physician's orders to receive the following medications: Renagel (also known as Sevelamer) 1600 milligrams (mg) by mouth three times a day with meals at 8 a.m., 12 p.m. and 5 p.m., Dilantin 100 mg by mouth three times a day at 9 a.m., 1 p.m., and 5 p.m., Nephrovite 1 tablet by mouth at 5 p.m. and Phoslo 667 mg by mouth three times a day with meals at 9 am., 1 p.m., and 5 p.m. 25. Interview with the licensed practical nurse on the 7a.m.-3p.m. shift on 9/27/07 at 11:55 a.m. revealed that Resident #107 leaves to go to dialysis around 1:15 p.m. and returns around 7 p.m. on those days. Staff also stated that the resident did not receive 12 p.m. medications and 1 p.m medications at the same time; however, the Dilantin was given close to one hour after Resident #107 was given the Renagel. Staff stated that she gives the Dilantin after meals and the Renagel with meals. 26. According to the 2007 Nursing Drug Handbook, Sevelamer may bind to some drugs in the gastrointestinal tract and decrease their absorption. Changes in absorption or oral medications may have significant clinical consequences (such as antiarrythmic and antiseizure medications), these medications should be taken at least one hour before or three hours after a dose of Sevelamer. Resident #107's Dilantin, an anti-seizure medication, the absorption level could have been affected by being administered less than 3 hours after Sevelamer and could result in an increase in seizure activity. 27. The resident was ordered to receive several medications at 5 p.m., none of which could be given on dialysis days due to the resident usually returning to the facility around 7 p.m. 28. This action or inaction of the Respondent is in violation of Florida law. 29. The Agency determined Respondent had not provided the necessary care and services and had compromised the resident's ability to maintain or reach his or her highest practicable physical, mental and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care and provision of services and cited this deficient practice as an isolated Class II deficiency pursuant to Section 400.23(8)(b), Florida Statutes. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(a) and 400.102, Florida Statutes (2007). COUNT II 30. | AHCA re-alleges and incorporates paragraphs (1) through (30) as if fully set forth herein. 31. Based upon Respondent’s one cited State Class II deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Florida Statutes (2007). 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 (2007) commencing September 28, 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 the Agency on Count J and II. 2. Assess against Respondent an administrative fine of $2,500 for the violation cited above. 3. 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 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. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. 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 IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted this of Gay of Janus Log rac nalade ESQUIRE Florida Bar I.D. No. 0030942 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 - Telephone (850) 921-0158 - Facsimile 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: 7000 0520 0024 8388 2010 on : 4. 2008 to: Alfred Clark, Registered Agent, Summer Brook Health Care Center, 117 S. Gadsden St., Suite 201, Tallahassee, Florida 32301and by U.S. Mail to Summer Brook Health Care Center, 5377 Moncrief Rd., Jacksonville, Fl. 32209. Copies furnished to: Dewayne Harvey, Administrator Summer Brook Health Care Summer Brook Health Care Center | Center 2445 Dunn Ave #1320 Registered Agent. Jacksonville, Fl. 32218 Alfred Clark (U.S. Mail) 117 S. Gadsden St., Suite 201 Tallahassee, Florida 32301 | Nancy Marsh Zaynab Salman, Esquire Field Office Manager Agency for Health Care Admin. 921 N. Davis Street 2727 Mahan Dr, #3 Bldg. A, Suite 115 Tallahassee, Florida 32308 Jacksonville, Fl. 32209 : Interoffice) (Interoffice)

Docket for Case No: 08-001703