STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, D \ U q T % AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2008009069 2008009070 THE HEALTH CENTER OF MERRITT ISLAND, INC. d/b/a THE HEALTH CENTER OF MERRITT ISLAND, 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 THE HEALTH CENTER OF MERRITT ISLAND, INC. d/b/a THE HEALTH CENTER OF MERRITT ISLAND, (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2008), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing June 30, 2008 and ending July 9, 2008, and impose an administrative fine in the amount of one thousand dollars ($1,000.00), based upon Respondent being cited for one uncorrected State Class III deficiency. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2008). 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), Chapters 400, Part II, and 408, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 180-bed nursing home, located at 500 Crockett Blvd., Merritt Island, FL 32954, and is licensed as a skilled nursing facility license number 1365096. 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 pursuant to Florida law, all licensees of nursing homes 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 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 resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency. § 400.022(1)(1), Fla. Stat. (2007). 8. That Florida law provides the following: “‘Practice of practical nursing’ means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. The professional nurse and the practical nurse shall be responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing.” § 464.003(b), Fla. Stat. (2008). 9. That on or about May 22, 2008, the Agency completed a relicensure survey of Respondent’s facility. 10. That based upon observation, interview and record review, the facility failed to ensure that adequate and appropriate health care and protective and support services was provided to twelve (12) of twenty-four (24) sampled residents and one (1) randomly sampled resident, the same being contrary to law. 11. That Petitioner’s representative reviewed Respondent’s records regarding resident number five (5) during the survey and noted as follows: a. The resident was admitted to the facility with the diagnoses of altered mental status, urinary tract infection and advanced dementia; b. The resident’s significant change minimum data sheet (MDS) assessment, dated March 29, 2008, assessed the resident's cognition for daily decision making as moderately impaired, decisions poor, and cues/supervision required. For eating, the resident needed cueing and one person assist during all meals; The resident's care plan, dated March 2008, for potential for weight loss and dehydration due to leaving all solid food on tray listed approaches to assist the resident with meals intake as needed and monitor the resident’s food and fluid intake. 12. _ That Petitioner’s representative observed resident number five (5) during the noon meal of May 19, 2008 from 12:45-1:15 p.m. and noted as follows: a. Respondent's certified nursing assistant (CNA) uncovered the resident's food and placed the food on the table in front of the resident who, at that time, had eyes open and was awake; During the time of the observation, Respondent’s certified nursing assistant failed to cue, supervise, assist, or encourage the resident to eat; The only food consumed by the resident was the nutritional supplement Ensure; Respondent’s certified nursing assistant removed the resident’s meal tray and placed it back in the meal cart; Respondent’s certified nursing assistant stated, "[The resident] refuses to eat solid foods" and wheeled the resident back to the resident’s room. 13. That Petitioner’s representative interviewed the Bayside nurse on May 19, 2008 at 1:00 p.m. who validated the above observations. 14. That Petitioner’s representative observed resident number seventeen (17) on May 20, 2008 from 12:05-12:30 p.m. and noted as follows: a. b. The resident was in the 500 hall assisted dining room for lunch; The resident’s lunch meal was mashed potatoes and gravy, ground roast beef and ice cream; The resident was sitting in a reclining wheelchair with Respondent’s certified nursing assistant lettered “C” sitting beside the resident, Certified nursing assistant “C” asked the resident if the resident wanted a bite of the roast beef or mashed potatoes a few times; When the resident did not respond, certified nursing assistant “C” did not prompt the resident by putting a bit of food on the utensil and placing it by the resident’s mouth at those times; When certified nursing assistant “C” did put food by the resident's mouth, the resident ate what was on the utensil; Certified nursing assistant “C” spent most of her time talking to another certified nursing assistant at the table and paid little attention to resident number seventeen (17); Certified nursing assistant “C” did not consistently prompt resident number seventeen (17) to eat during this meal and the resident ate less than twenty-five percent (25%) of the meal. 15. That Petitioner’s representative reviewed Respondent’s records regarding resident number seventeen (17) during the survey and noted as follows: a. The resident’s minimum data set (MDS) with an assessment review date of May 17, 2008 reflected that the resident was totally dependent for eating and required - the assistance of one staff member; The resident had a private sitter at home and the sitter continued to be with the resident each day from morning to mid afternoon usually; c. When the sitter was with the resident, the resident consumes one hundred percent (100%) of the meal. 16. That Petitioner’s representative interviewed the private sitter of resident number seventeen (17) on May 21, 2008 at 12:30 p.m. who indicated that resident number seventeen (17) ate one hundred percent (100%) of the resident’s meal at lunch and that the resident will eat when a bite was placed at the resident’s mouth. 17. That Petitioner’s representative reviewed Respondent’s records regarding resident number two (2) during the survey and noted as follows: a. The resident’s Minimum Data Set assessment identified the resident as totally dependent on staff for all activities of daily living (ADLS): b. The resident had a history of cerebrovascular accident (CVA) with right side weakness; c. The resident has a history of urinary tract infections and was treated with antibiotics on February 8, 2008. 18. That Petitioner’s representative observed resident number two (2) on May 21, 2008 commencing at approximately 10:25 a.m. and noted as follows: a. The resident was found in bed, alert, but unable to verbalize needs; b. The resident’s fingernails were long; c. The left hand fingernails were trimmed but the thumb nail was not; d. The right hand fingernails were long and the hand was clenched causing the nail of the index finger to dig into the skin; e. Foley catheter care for the resident was performed; Respondent’s certified nursing assistant gathered her equipment, basin of soapy water and washcloths; The certified nursing assistant started washing the upper torso of the body because it had stains or drippings from the resident’s gastrostomy feeding; The resident was turned to the side and the back was also cleansed; Respondent’s certified nursing assistant did not change the basin of water after this torso and back cleaning but obtained two washcloths, wet them, applied soap from the bathroom, and started the catheter procedure; The certified nursing assistant started cleaning the perineal area, starting with the urinary meatus, going around back and forth and folding the washcloth several times in between cleansing and proceeded cleansing the Foley urinary catheter tube from the insertion site upwards and went back again two more times with the same strokes; That there was no method used to cleanse from the least contaminated to the most contaminated area; The certified nursing assistant continued cleansing the perineal area which was observed reddened with scattered rashes and had a foul odor; The certified nursing assistant sprayed directly onto the perineal area with a no rinse bath cleanser solution and with the second washcloth wiped the solution; The certified nursing assistant proceeded to cleanse the groin area and ran out of washcloth; The basin of water was not changed and used during the entire procedure of the catheter care; p.- The washcloths were not rinsed; q. The certified nursing assistant went to the bathroom and obtained wet paper towels and continued cleaning the groin area; r. That a second certified nursing assistant was asked to obtain more wash cloths so paper towels would not be used; Ss. The procedure was completed without drying the resident’s perineal area with a towel; t. The resident’s rectal area was not cleansed or washed and Respondent’s certified nursing assistant completed the procedure by applying a protective ointment; u. The resident’s catheter drainage bag had a dark amber, cloudy urine. 19. That Petitioner’s representative interviewed Respondent’s certified nursing assistant immediately after the observation of the resident who indicated as follows: a. That part of resident grooming was trimming and keeping nails clean b. That the resident’s rectal area was not cleansed during the perineal care. 20. That Petitioner’s representative reviewed Respondent’s policy and procedure regarding catheter care and noted that the procedure was not followed. 21. That Petitioner’s representative observed Respondent’s Foley catheter care given to resident number twenty-one (21) on May 21, 2008 at approximately 3:15 p.m. and noted as foliows: a. The resident was on contact isolation for a Clostridium Difficile infection; b. Respondent’s certified nursing assistant performing the procedure washed her hands and gathered her supplies consisting of wash cloths, body wash solution, gloves, basin and soapy water; c. A second certified nursing assistant positioned the resident during the procedure with gloved hands; d. The performing certified nursing assistant donned gloves and informed the resident of the ensuing procedure; e. The certified nursing assistant handled the Foley catheter collection bag and placed it at the bedside; f. She changed gloves; g. She then moistened a wash cloth in the soapy water and began to wipe the groin from front to back; h. She folded the cloth and again wiped front to back; i. She then moistened another wash cloth and cleaned the anal area folding the cloth several times as she cleaned from front to back; j. After the procedure, she repositioned the resident's feeding tube and bed linens; k. She then returned the supplies to their storage areas, and removed the gloves used in the procedure prior to washing hands; lL. The second certified nursing assistant removed gloves and used an alcohol cleansing solution to cleanse her hands. 22. That per a Center for Disease Control notice, alcohol hand cleanser is not effective in removing or killing Clostridium Difficile. 23. That Petitioner’s representative observed resident number twelve (12) resting in bed on May 19, 2008 at 3:10 p.m. 24. That Petitioner’s representative interviewed Respondent’s unit nursing supervisor during the survey who indicated as follows: a. That resident number twelve (12) often refuses care; b. That resident number twelve (12) did not receive any psychological consults within the past year; c. That resident number twelve (12) was not receiving any psychoactive medications and behaviors were not monitored. 25. That Petitioner’s representative interviewed Respondent’s director of social services and the social worker for resident number twelve (12) during the survey who indicated as follows: a. That resident number twelve (12) chose to stay in the resident’s room; b. That resident number twelve (12) participated in activities of choice a couple of times a week; c. That resident number twelve (12) no longer ate in the dining room, stating that the reason was to be in the resident’s room to watch television. 26. That Petitioner’s representative interviewed Respondent’s certified nursing assistant for resident number twelve (12) during the survey who indicated that the resident was aware of toileting needs but refused to use a bed pan due to pain. 27. That Petitioner’s representative reviewed Respondent’s records regarding resident number twelve (12) during the survey and noted as follows: a. The most recent annual assessment, completed September 6, 2007, and the quarterly assessment, completed February 21, 2008, indicated that the resident had no behaviors or mood concerns; b. The resident was assessed as totally incontinent. c. The social service notes and the clinical record reflected no efforts of positive reinforcement to replace the negative behaviors related to toileting or further 10 assessment to determine why there was a decline in socialization related to dining. 28. That Petitioner’s representative reviewed Respondent’s records regarding resident number one (1) during the survey and noted as follows: a. The resident's minimum data set quarterly assessment, dated March 11, 2008 assessed the resident as cognitively impaired and a fall risk; Clinical records reflect that the resident was found on the floor on February 29, 2008 and sustained a right hip fracture; Documented interventions after the fall were to apply hipsters at all times to prevent future injuries to the hips; Clinical records reflect that the resident was again found on the floor on May 10, 2008 and sustained ecchymosis/bruises to the right eye; New documented interventions were to place resident on a low bed with floor mats and apply self release seat belt when up on the wheelchair; The resident was care planned to continue with the hipsters and also implement the new interventions. 29. That Petitioner’s representative observed resident number one (1) on May 19, 2008 at 2 p.m. and noted as follows: a. b. Cc. The resident was in the wheelchair wheeling self along the hallway of the 200 wing; The resident was alert and was verbally responsive to communication; The hipsters as directed were not observed applied to the resident’s hips. 30. That Petitioner’s representative interviewed Respondent’s nurse while observing resident number one (1) who indicated that the ordered hipsters were not in place on the resident and the i nurse then entered the resident’s room and located the hipsters in a drawer. 31. That Petitioner’s representative observed during the initial tour of Respondent facility on May 19, 2008 at 10:25 a.m. a portable oxygen tank unsecured next to the refrigerator of resident number twenty-five (25). 32. That resident number twenty-five (25) used oxygen at all times and the tank was left unsecured by his/her sitter. 33. That Respondent’s nurse present at that time confirmed that the tank was unsecured and removed it at that time. 34. That Petitioner’s representative reviewed Respondent’s records regarding resident number six (6) and noted as follows: a. The resident was identified as having a significant weight loss of five percent (5%) in thirty (30) days; b. The resident had experienced a fall and sustained a fracture on March 19, 2008; c. Upon return from the hospital, the resident gradually declined in appetite; d. On March 26, 2008, the resident’s weight was one hundred sixty-eight point six pounds (168.6#), one hundred fifty-one point six pounds (151.6#) on May 2, 2008, and one hundred fifty point four pounds (150.4#) on May 18, 2008; e. The resident was given dietary supplements and care planned for the problem of weight loss; f. Documented interventions were to provide diet as ordered; assess food preferences and provide when possible; g. The dietician was to monitor food intake and intervene as needed; h. Monitor weekly weights. 12 35. That Petitioner’s representative interacted with resident number six (6) on May 20, 2008 at 12:45 p.m. and noted the following: a. The resident was in bed resting; b. The resident was alert, oriented and verbally responsive to communication; c. The resident’s lunch tray was left at the bedside covered; d. The resident stated the resident did not eat because the lunch the resident ordered was different was not what the resident received; e. The resident showed that the meal ticket which the resident filled for lunch meal order and the resident had specifically written fried chicken leg for lunch; f. The tray was contained a chicken breast instead of the ordered leg; g. There was no staff to follow up/monitor on the intake of the resident and staff did not set up tray to check if food ordered was served. 36. That Petitioner’s representative toured the Respondent facility on May 19, 2008 at approximately 11:04 a.m. noted that the oxygen concentrator for resident number twenty-six (26) was observed to be set at a flow rate of three (3) liters and the resident was using oxygen at this time. 37. That Petitioner’s representative reviewed Respondent’s records regarding resident number twenty-six (26) during the survey and noted that the physician orders for the resident dated March 10, 2008 provided "02 2 L via N/C (nasal canula) @ all times". 38. That resident number twenty-six (26) was not receiving oxygen at the prescribed rate on May 19, 2008 at approximately 11:04 a.m. 39. That Petitioner’s representative observed resident number one (1) on May 22, 2008 at 9:15 a.m. and noted as follows: a. The resident was observed in the resident’s room in bed and alert; b. The resident was assessed as cognitively impaired; c. The resident had long toe nails with some nails curving inwards. Interview with the staff at that time verified the nails were long and needed podiatry services. 40. That Petitioner’s representative interviewed Respondent’s staff at that time who indicated as follows: a. That the resident’s nails were long and needed podiatry services; b. That the podiatrist comes to the facility two times a month and residents are assessed who requires podiatry care. 41. That Petitioner’s representative reviewed Respondent’s records regarding resident number one (1) and noted that the last time the resident was seen by a podiatrist was December 19, 2007. 42. That Petitioner’s representative noted on May 21, 2008 at approximately 9:10 a.m. that resident number twenty (20) was asleep in bed and the oxygen concentrator for the resident was observed to be set at a flow rate of three point five (3.5) liters per minute. 43. That Petitioner’s representative reviewed Respondent’s records regarding resident number twenty (20) during the survey and noted that the physician telephone order for the resident dated May 19, 2008 provided O2 via nasal canula 2L/min. to keep oxygen saturation at 90%. 44. That Petitioner’s representative observed resident number twenty (20) on May 21, 2008 at 10:00 a.m. with Respondent’s nurse who noted that the oxygen was being administered at the rate of 3.5 liters per minute and confirmed that this was not at the level prescribed by the resident’s physician. 45. That resident number twenty (20) was not receiving oxygen at the prescribed rate on May 21, 2008. 46. That Petitioner’s representative reviewed Respondent’s records regarding resident number ten (10) during the survey and noted as follows: a. The resident’s controlled drug sign out sheets for the pain medication, Percocet, revealed that doses were taken out of the supply sixty-seven (67) times during the time period from March 20 through May 20, 2008; The resident’s medication administration records contained documentation of only twenty-one (21) doses during this time period; Of those recorded administrations of the medication, three (3) contained information regarding the pain level of the resident at the time of administration and the medications effectiveness in treating the pain; Nurses' notes failed to reveal any further evidence of monitoring of the resident’s pain level and effectiveness of the medication administered; A total of sixty-four (64) pain medication administrations were not monitored for the pain level necessitating administration or the effectiveness of the medication in relieving the pain; The doses given and those not monitored varied from one (1) to two (2) tablets of Percocet; No rationale was documented for administering one (1) tablet as opposed to two (2) tablets. 47. That Petitioner’s representative interviewed Respondent’s unit manager on the unit on which resident number ten (10) resided who confirmed that there was no other record pertaining to the administration of this medication. 48. That Petitioner’s representative reviewed Respondent’s records regarding resident number six (6) during the survey and noted as follows: a. That a recommendation was made by the pharmacist's to discontinue the use of Remeron on March 4, 2008; The resident was prescribed both Lexapro and Remeron medication, both of which are antidepressant medications; The attending physician then agreed with the recommendations and discontinued the Remeron; On May 6, 2008, the resident's weight had gradually declined from one hundred sixty-eight pounds (168#) on March 26 to one hundred fifty-one pounds (151#) on May 2, 2008; The dietician made recommendations to start the resident on Remeron 7.5 mg. as an appetite stimulant; On May 5, 2008, the attending physician ordered the Remeron; On May 7, 2008, the physician decreased the dose of the Lexapro, discontinue after two (2) weeks, and increased the Remeron to 15 mg. daily for two (2) weeks and increased it to 30 mg. daily every bedtime; There was no progress note documented by the attending physician for the rationale of increasing the dosage of the Remeron. 49. That Petitioner’s representative interviewed Respondent’s pharmacist on May 20, 2008 who indicated as follows: a. Remeron cannot be used as an appetite stimulant unless the physician has 16 documented the rationale for its use; b. The medication is used for diagnoses of depression and its side effect is increased appetite. 50. That Petitioner’s representative reviewed Respondent’s records regarding resident number thirteen (13) during the survey and noted as follows: a. The resident has diabetes and requires insulin coverage depending on the monitoring of the resident's blood sugar; b. The resident’s medication administration record for May 2008 reflected that the resident did not have blood sugar checks on May 16, 2008 at 4:30 p.m. and 8 p.m. and on May 18 and 19, 2008 at 6:30 a.m.; c. There was no documentation that insulin was administered on.May 3, 7, 8, and 11 through 14, 2008 at 4:30 p.m. d. Also documented as ordered was blood pressure checks every Wednesday; e. There was no documentation that the ordered blood pressure checks were conducted on May 7, 14, and 21, 2008. 51. That Petitioner’s representative interviewed Respondent’s unit manager on the Bayside wing who validated the above failures. 52. That Petitioner’s representative reviewed Respondent’s records regarding resident number twenty-three (23) during the survey and noted as follows: a. The resident had the following orders: "Zolpidem tab 5 mg, give 1 tablet by mouth at bedtime as needed for sleep" b. The Controlied Drug Record documented that the medication was withdrawn from the resident's supply on April 13 through 22, 2008; c. There was no mention in the medical record of the medication having been administered on these dates or that the resident was monitored for effectiveness of the medication. 53. That Petitioner’s representative interviewed Respondent’s pharmacy consultant on May 20, 2008 at 9 a.m. who confirmed that she had identified holes in medication administration record, and had concerns regarding the narcotics documentation where staff members were not signing the medication administration record. 54. That Petitioner’s representative reviewed Respondent’s records regarding resident number eighteen (18) during the survey and noted as follows: a. The resident was admitted to the facility on May 9, 2008 for rehabilitation after a fall at home; The resident was admitted to the facility with an order for Cardura 6 mg. every day; The order was transcribed to the physician order sheet (POS) as ordered but the medication administration record revealed that the prescription was transcribed as 2 mg. every day; The medication administration record reflected that the resident received this reduced, or one-third dosage of the ordered Cardura for twelve (12) days; Cardura was used to treat cardiac issues and benign hypertrophy of the prostate (BPH). 55. That Petitioner’s representative interviewed Respondent’s licensed practical nurse (LPN) who indicated that she had 2 mg. pills in the medication cart and that she was unaware that the order was for 6 mg. daily. She confirmed that the resident received the wrong dose for 12 days 56. That Respondent’s failure to ensure that adequate and appropriate health care and protective and support services are illustrated by the following: a. The failure to assess a resident after a fall to the floor, resident number five (5); The failure to assist with meals in order to maintain or help improve the residents ability to eat, resident-number five (5); The failure to provide dependent residents for eating and nail care, residents numbered two (2) and seventeen); The failure to provide proper indwelling catheter care, residents numbered two (2) and twenty-one (21); The failure to evaluate a decline in socialization for the potential of changes in behaviors, resident number twelve (12); The failure to monitor for protection from accidents and hazards for residents, related to prevention of falls, resident number one (1), and an unsecured oxygen tank, resident number twenty-five (25); The failure to monitor meal consumption, resident number six (6); The failure to administer proper treatment in the form of oxygen flow rates, residents numbered twenty (20) and twenty-six (26), and care of nails on the feet, resident number one (1); The failure of drug monitoring for medications administered to residents, residents numbered six (6), ten (10), thirteen (13), and twenty-three (23); The failure to administer the prescribed dose of a medication for twelve (12) days, resident number eighteen (18). 19 57. That these failures, collectively and individually, reflect Respondent’s failure to ensure that adequate and appropriate health care and protective and support services was provided to residents, the same being contrary to law. 58. That the Agency determined that this deficient practice was related to the personal care of the residents that will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being and cited Respondent for a patterned State Class III deficiency. 59. The Agency provided Respondent with a mandatory correction date of June 13, 2008. 60. That on or about June 30, 2008, the Agency completed the revisit to the relicensure survey of Respondent’s facility. 61. That based upon observation, interview and the review of records, Respondent failed to provide adequate and appropriate health care and protective and support services related to the care for an indwelling catheter for one (1) of fourteen (14) sampled residents, the same being contrary to law. 62. That Petitioner’s representative observed Respondent’s catheter care for resident number two (2) on June 30, 2008 at 12:10 p.m. with Respondent’s unit manager and noted that Respondent’s certified nursing assistant failed to ensure that the urinary meatus was fully exposed to allow adequate cleansing around the catheter's entry point into the body. 63. That Petitioner’s representative reviewed Respondent’s records regarding resident number two (2) and noted that the resident is completely dependent in all activities of daily living, including those related to hygiene, and has a history of urinary tract infections. 20 64. — That Petitioner’s representative interviewed Respondent’s director of nursing who displayed the demonstration model used for facility training of catheter care and confirmed that the model did not allow for full exposure of the urinary meatus for the demonstration of cleansing. 65. That these failures, collectively and individually, reflect Respondent’s failure to ensure that adequate and appropriate health care and protective and support services was provided to residents, the same being contrary to law. 66. That 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 uncorrected isolated State Class III deficiency. 67. The Agency provided Respondent with the mandatory correction date for this deficient practice of July 14, 2008. 68. That the second citation constitutes an uncorrected deficiency as defined by law. WHEREFORE, the Agency seeks to impose an administrative fine in the amount of $1,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(8)(c), Florida Statutes (2008). COUNT II 69. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I of this Complaint as if fully set forth herein. 70. Based upon Respondent’s one cited uncorrected State Class III deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida 21 Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7), Florida Statutes (2008). 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 June 30, 2008 and ending July 9, 2008. Respectfully submitted this x day of September, 2008. Thos J/Walsh II, Esquire Fla. ‘Bar. No. 566365 Agency for Health Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 (office) DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Fla. Stat. (2005), Respondent shall 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 IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. 22 CERTIFICATE OF SERVICE to: Leslie F. Williams, ‘Administrator, Health Center of Merritt Island, 500 Crockett Merritt Island, FL 32954, and by U.S. Mail to Corporation Service Company, Reg. Agent, f704 Hays Street, Tallahassee, FL 32301. Thomas ti alst , I, Esquire ee Copies furnished to: Leslie F. Williams, Administrator Corporation Service Company Health Center of Merritt Island Registered Agent 500 Crockett Blvd. 1201 Hays Street Merritt Island, FL 32954 Tallahassee, FL 32301-2525 (U.S. Certified Mail) (U.S. Mail) Patricia Caufman Thomas J. Walsh, II, Esquire Field Office Manager Senior Attorney 525 Mirror Lake Dr., 4" Floor Agency for Health Care Admin. St. Petersburg, Florida 33701 525 Mirror Lake Dr, 330G (Interoffice) St. Petersburg, Florida 33701 Unteroffice) . 23

Docket for Case No: 08-004973