Mar 31 2009 10:52 MAR-31-2089 11:65 AGENCY HEALTH CARE ADMIN 856 921 4158 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2009000318 2009000319 BON SECOURS — MARIA MANOR NURSING CARE CENTER, INC. d/b/a BON SECOURS MARIA MANOR NURSING 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 BON SECOURS - MARIA MANOR NURSING CARE CENTER, INC., d/b/a BON SECOURS MARIA MANOR NURSING CARE CENTER, (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 December 15, 2008 and ending December 23, 2008, impose an administrative fine in the sum of twenty thousand dollars ($20,000.00) and a survey fee of six thousand dollars ($6,000.00) for a total assessment of twenty-six thousand dollars ($26,000.00), based upon Respondent being cited for two Isolated State Class I deficiencies, P.14/42 Mar 31 2009 10:53 MAR-31-2089 11:65 AGENCY HEALTH CARE ADMIN 856 921 4158 P1542 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 [V, Subtitle C (as amended), Chapters 400, Part IJ, and 429, Part IL, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 274-bed nursing home, located at 10300 — 4" Street North, St. Petersburg, FL 33716, and is licensed as a skilled nursing facility license number 1055096, 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. COUNTI 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That pursuant to Florida law, 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 Mar 31 2009 10:53 MAR-31-2089 11:86 AGENCY HEALTH CARE ADMIN 856 921 4158 P. 1642 care plan, with established and recognized practice standards within the community, and with tules as adopted by the agency. § 400.022(1)()), Fla. Stat. (2008). 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, 4 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 December 15, 2008, the Agency completed a complaint survey (CCR#2008013854) of Respondent’s facility. 10. That based upon interview and the review of records, Respondent failed to ensure that residents received adequate and appropriate health care and protective services for one (1) of three (3) residents reviewed regarding an allegation of resident abuse, the same being contrary to law. 11. That Petitioner’s representative reviewed Respondent’s policy and procedure entitled "Abuse Investigation Report", dated 1/31/2006, and noted the following provisions: a "When a complaint or allegation of abuse, mistreatment, neglect, or other vulnerable adult issue arises, the supervisor is to be notified and the abuse investigation report initiated." b. Procedure: "Every employee is responsible for reporting suspected or observed abuse of residents to their supervisor. MAR-31-2089 11:86 f. Mar 31 2009 10:53 AGENCY HEALTH CARE ADMIN 856 921 4158 Supervisor begins the abuse investigation report by completing the checklist located in the yellow or highlighted left side of the report. Abuse investigation report is then given to the abuse officer or their designee. Abuse officer or designce completes the tasks in the yellow or highlighted left side of the report. Abuse officer or designee determines (based on findings) whether or not to notify the department of children and families (DCF), police, or licensing boards. Abuse officer, or designee, summarizes the findings and documents their determination of the results of the investigation on the lower right-hand side of the abuse investigation report. All copies of the resident's chart is given to DCF, interview notes, police reports, etc., along with the abuse investigation report is given to the risk manager to maintain. Risk manager, or designee, completes the required state and federal reports. 12. That Petitioner’s representative reviewed the written statement dated December 2, 2008 at 9:15 p.m., ofa Certified Nursing Assistant assigned to resident number one (1), which contained the following information: a. On December 2, 2008 at approximately 9:15 p.m., resident number one (1) was attempting to get out of bed unassisted, The bed alarm sounded and four Certified Nurses Assistants (CNA) and a male Licensed Practical Nurse (LPN), who was not assigned to the resident, responded to the alarm. P1742 MAR-31-2889 11°@6 Mar 31 2009 10:53 AGENCY HEALTH CARE ADMIN 856 921 4158 Upon entering the room, the resident said the resident wanted to be changed and wanted the call button. The CNA told the LPN she was going to change the resident and, at that time, the LPN told the CNA he was going to check the resident for a urinary tract infection, The LPN, "Did not explain to the resident what procedure he was doing. He opened up the resident's brief and began to exam the peri-area. He opened up the labia and looked to see if anything was unusual, after he checked he smelled both of his hands”. The CNA reported that she asked the LPN, "Why are you smelling your hands?" and told him “that was nasty”. The male LPN said he was checking for a urinary tract infection. The CNA felt uncomfortable and immediately reported the incident to the resident's assigned nurse. The nurse assisted the resident back to the resident’s room. The resident explained to the nurse that the resident "...could not understand why everything happened and felt [that the resident] had been violated". The resident wanted to know who was in charge and at that time, and the CNA went to the supervisor. Later in the shift, the male LPN asked the CNA to assist him as he was going to apologize to the resident, The resident told the male LPN that the resident had never experienced anything like before and will remember this experience until the day the P.18/42 MAR-31-2889 Mar 31 2009 10:54 AGENCY HEALTH CARE ADMIN 856 921 @158 resident dies. 13. Thata second statement was written by the CNA assigned to resident number one (1), dated December 2, 2008 at 9:15 p.m., with "2nd copy” written at the top which provides as follows: As per the first copy, the resident was attempting to get out of bed unassisted. Five CNAs and one male LPN responded to the bed alarm. The resident's assigned CNA said she was going to change the resident and get the resident up in the wheelchair because the CNA was concemed for the Tesident’s safety. The LPN said he was going to check for a urinary tract infection. The LPN did not inform the resident of the procedure he was performing. He ripped open the resident’s brief and opened up the labia, moved his index finger to the left labia and his thumb to the right labia as if he was checking for something. He did this twice and then brought his fingers to his nose to smell them. The CNA said, "Why are you smelling your fingers?” and the LPN said he was checking for a urinary tract infection. The CNA said, "That's nasty.” The CNA got the resident up and took the resident to the television room for closer monitoring. ‘The resident continued to say the resident wanted to talk to someone in charge. The resident felt like she had been "violated". The resident spoke with the nurse assigned to the resident and the supervisor. P1942 MAR-31-2089 11:8? Mar 31 2009 10:54 AGENCY HEALTH CARE ADMIN 856 921 4158 The CNA was asked by the male LPN to assist him as he was going to apologize to the resident "He tried to justify his actions, but the [resident] was still upset, The resident told the LPN {that the resident] was a 70 year old [person] and [the resident’s spouse] never did that [] and [the resident] will never forget that experience until the day [the resident] dies. 14. That Petitioner’s representative reviewed the written statement, with no time or date annotated, submitted by the unit manager which provided the following: a. After she was notified by the CNA of the occurrence for resident number one, (1), she immediately went to the room to ask the resident what happened. The resident stated, "A large black man came in and putt [the resident] back into the bed. The man opened one side of [the resident’s] diaper and put a hand into [the] diaper. He felt the outside of [the] vagina and then smelled his hand. The unit manager specifically asked the resident if there had been penetration and the resident stated “God No. The unit manager asked the resident if she felt afraid or threatened and the resident said, "No". The unit manager then questioned the LPN and he stated, "The patient's behavior was abnormal [] and he felt possibly she had a urinary tract infection". 15. That Petitioner’s representative interviewed on December 12, 2008, Respondent’s unit manager on duty the night of December 2, 2008 who indicated as follows: P.2a/42 MAR-31-2889 11:@? Mar 31 2009 10:54 AGENCY HEALTH CARE ADMIN 856 921 4158 That a CNA came to her and said the resident was upset and wanted to talk to her. The CNA gave the unit manager a brief description of the incident and the unit manager immediately went to the resident's room. She, the unit manager, asked the resident what happened and the resident said "A big black man came in and put his hand in the bed, opened up my diaper, stuck his hand in there, and then smelled his hand. The ‘girl’ said, 'god that was gross why would you do that?” She, the unit manager, asked the resident if the LPN had actually touched the vagina and the resident said "No, he just brushed the area”. The unit manager then asked the resident if the LPN had penetrated the vagina and the resident responded “Oh God No". When asked if the resident was fearful, the resident said, "No". The unit manager said the resident did not appear to be fearful and was perceived to not be in fear. The unit manager said the resident has periods of confusion, but that night was “cognitively very clear." The unit manager said, after the conversation with the resident she called the director of nurses (DON) at home to report the incident. The DON spoke with the male LPN on the phone and then spoke with the unit manager and determined the incident was "just bad nursing practice" not abuse. P2142 Mar 31 2009 10:55 MAR-31-2089 11:8? AGENCY HEALTH CARE ADMIN 856 921 4158 P2242 k. The DON told the unit manager the LPN was not to go in the resident's room without another staff member present, L The unit manager verified the proper procedure for assessing for a urinary tract infection does not include touching a resident's peri -area and then smelling one's fingers. 16. That Petitioner’s representative reviewed a written statement dated December 8, 2008 submitted by the second CNA that responded to the bed alarm which noted "Thursday (no date), [had the resident and [the resident] told me [the resident] had been violated. The male nurse sniffed the brief and [the resident] was not told what he was going to do and [the resident] would never forget it as long as [the resident] lived". 17. That Petitioner's representative reviewed written statements submitted by a third CNA that responded to the alarm, dated December 17, and December 7, 2008 respectively, which provided "{The LPN] proceeded to check for discharge or urinary tract infection by lightly spreading the resident's labia and briefly checking [the resident] and smelling for an odor while the CNAs were present. The brief was removed by the CNA", 18. That Petitioner’s representative telephonically interviewed on December 15, 2008 the third CNA that responded to the bed alarm who indicated as follows: a. She was not assigned to the resident but went to the room to answer the bed alarm. b, The aides (3-4) got the resident back to bed. c. The resident's CNA was going to get the resident up in the wheelchair but before she changed the diaper, the male LPN decided to check for a utinary tract infection (UTD). Mar 31 2009 10:55 MAR-31-2869 11:68 AGENCY HEALTH CARE ADMIN 856 921 @158 P2342 d. The LPN was standing on the left side of the bed. é. The CNA had taken off the diaper. f. The LPN did not say anything to the resident. g. The LPN did not spread the labia but did touch the front of the labia. h. He then smelled his hand. i, The resident did not say anything at the time. j- At the nurses’ station after the incident the resident was saying he had inserted his fingers in the vagina. 19. That Petitioner’s representative reviewed a written statement was submitted by the male LPN dated December 2, 2008 which indicated as follows: a, On December 2, 2008 at approximately 8:00 p.m. the LPN responded to the alarm for resident number one. b. The resident was observed to be dressed only in a diaper and sitting on the edge of the bed. G The resident was encouraged to get back in bed. a The LPN lifted the resident's feet/legs into the bed. e. "The CNA said [the resident] has been acting strange for the past couple days and {the CNA] was going to clean the resident up and put [the resident] in the wheelchair. I then observed the resident's diaper was wet and asked a CNA to pet me some gloves so [ could check the diaper for signs/symptoms ofa possible urinary tract infection (UTI). I stated my intentions were to check the resident for a possible UTI. With several female CNAs and I, the only nurse present, I looked at the diaper and observed yellow urine with no immediate Mar 31 2009 10:55 MAR-31-2089 11:88 AGENCY HEALTH CARE ADMIN 856 921 4158 P2442 foul odor. I then placed my hand to the resident's pubic area because I could see it was moist. I then attempted to smell an odor from my gloved hand, I did notice a foul odor and stated I would see about getting an order for a urinalysis and C & S. I then left the room and the CNA began to clean the resident”. . 20. That Petitioner’s representative reviewed the urinalysis and urine culture and sensitivity obtained via straight catheter on December 3, 3008 which revealed a result of negative for both laboratory tests. 21, That Petitioner’s representative telephonically interviewed the identified male LPN on December 15, 2008 at approximately 12:00 p.m. who indicated as follows: a. "My written statement is accurate. I haven't changed anything". Db. "On December 2, 2008, I worked an additional shift - 3:00 p.m, - 11:00 p.m. My regular schedule is 11:00 p.m. - 7:00 a.m. At approximately 9:00 p.m., the resident was climbing out of bed and I responded to the room at the request of the CNA. We helped the resident back to bed. The CNA said the resident was acting different from usual. The CNA was about to change the resident so I decided to check {the resident] for a UTI. I put on gloves, looked at the diaper and then placed my hand on the resident's mons pubis and then smelled my gloved hand and detected a strong odor. The resident did not say anything at the time but when the CNA got the resident up and took [the resident] to the nurse’s station, the resident complained to the unit manager that I did not tell her what I was doing. c. “1 later apologized to the resident. MAR-31-2089 11:88 Mar 31 2009 10:55 AGENCY HEALTH CARE ADMIN 856 921 4158 “My normal assignment is 11:00 p.m, - 7:00 a.m. and the resident was on my assignment on | 1:00 p.m. - 7:00 p.m. shift but not on the 3:00 p.m. - 1 1:00 p.m. shift. “I was instructed by the DON not to go in the room alone, “I worked December 2, 2008 3:00 p.m. - 11:00 p.m., December 3, 4, 5, and 6, 2008 11:00 p.m, - 7:00 p.m. without anyone saying a word to me about the incident on December 2, 2008. “] was off the weekend and called by the facility on Monday morning and told T was on suspension.” 22, That Petitioner’s representative reviewed the electronically generated nurses notes for resident number one (1) dated December 3 through 6, 2008 which verified that the male LPN did, in fact, have direct contact with resident number one (1) on December 3, 4, 5, and 6, 2008 with the last entry being December 6, 2008 at 5:13:25 a.m. 23. That Petitioner’s representative reviewed an undated written statement submitted by the weekend Registered Nurse supervisor which related as follows: a. On December 6, 2006, the registered nurse supervisor (RNS) was informed that resident number one (1) was anxious and weepy and telling the other residents that the resident had been violated by the nurse yesterday evening. The staff removed the resident from the dining room and took the resident to the resident’s room so the RNS could speak with the resident. The resident told the RNS the previous evening the male nurse came into the room with two other nurses present, took off the resident’s diaper and placed two fingers in the resident's vagina. P2542 MAR-31-2089 11:89 Mar 31 2009 10:55 AGENCY HEALTH CARE ADMIN 856 921 4158 ‘He then put his fingers close to his nose and sniffed them. The resident said, "No one ever did that to me before, not even my [spouse]." That the RNS further documented later that same evening a "friend" of the resident reported to her the resident had said the resident had been violated and the RNS told the friend the issue was being investigated. The resident's "friend" told the supervisor he was calling the resident's granddaughter and the protective services agency. The written statement also said, "The DON was notified of all the above events”. 24. That Respondent could provide no documentation of an investigation of the event of December 2, 2008 unti] December 7, 2008. 25, That Petitioner's representative interviewed Respondent’s Director of Nursing (DON) with the Respondent’s administrator present on December 12, 2008 who indicated as follows: a She was called on December 2, 2008 at approximately 9:30 p.m. with a report from the supervisor that the male LPN had opened up the resident's diaper, placed his hand in the diaper, yemoved his hand, and then sniffed his hand. The DON instructed the unit manager to ask the resident what happened and bring the LPN to the nurses’ station. The DON."counseled" the LPN on the phone and instructed him not to go in the room without another staff member present. The DON verified the proper procedure for assessing for a urinary tract infection does not include touching a resident's peri - area and then smelling one's fingers. P2642 MAR-31-2889 11:9 Mar 31 2009 10:55 AGENCY HEALTH CARE ADMIN 856 921 4158 The DON called the administrator at home to inform him of the situation. The CNA got the resident upset because she questioned the LPN in front of the resident. After the unit manager spoke to the resident, it was determined the resident was more upset because the LPN did not tell the resident who he was or what he was about to do. The issue was determined to be a dignity issue with “odd" nursing technique with no sexual contact or intent, The DON called the administrator at home to inform him of the situation. She also asked the staff present during the incident to write a statement and put it under her door. The DON said she received the written statements from the staff on the morning of December 3, 2008. The male LPN was not assigned to the resident. An abuse investigation was not started, the abuse hot line was not called, the one day and fifteen state reports were not filed because the resident was not upset about the physical contact but rather the lack of explanation from the LPN. The DON, risk manager, or administrator did not follow up with the resident the following day. The issue was deemed to be resolved "in house" with no further investigation conducted. Pardo Mar 31 2009 10:55 MAR-31-2089 11:89 AGENCY HEALTH CARE ADMIN 856 921 4158 p. On December 6, 2008 at approximately 7:30 p.m, she received a call from the weekend registered nurse supervisor to inform her that the resident was at the nurses’ station crying and was very anxious. a. At that time, the DON told the supervisor about the incident on December 2, 2008. I The DON was questioned as to why the facility would call her at home about a resident having increased anxiety and tearfulness and she said, "Oh they call me for everything". 8. When questioned as to whether or not the supervisor told her the resident was telling the staff that the resident had been "violated", the DON said, "No". 26, That Petitioner’s representative noted in a written statement by the weekend registered nurse supervisor dated December 6, 2008 the following: "The LPN asked that I go to D wing as [resident number one] was in the dining room telling the other residents [the resident] had been violated by a nurse yesterday evening.” 27. That Petitioner’s representative noted in a written statement by the Registered Nurse Supervisor (RNS) the resident reported, "On the previous evening the male nurse came in [the] room, with two other nurses present, took off [the] diaper, placed two fingers in [the] vagina, and then put them close to his nose and sniffed his fingers,” further documenting later that same evening a "friend" of the resident reported to her the resident had said the resident had been violated and the RNS told the friend the issue was being investigated. 28. That the written statement of the RNS continued to note thet the resident's “friend” told the supervisor he was calling the resident's granddaughter and the protective services agency and that "The DON was notified of all the above events”. P2842 Mar 31 2009 10:57 MAR-31-2089 11:89 AGENCY HEALTH CARE ADMIN 856 921 4158 P.2o-d42 29. That the above reflects conflicts in that: a. No evidence of an investigation into the December 2, 2008 allegation of abuse was presented until December 7, 2008; b. The DON said she was not aware of the resident telling the other residents of the alleged incident and being violated. c. The male LPN was assigned to the resident, contrary to the DON’s assertion as verified by the LPN, Respondent’s assignment schedules, and the nurse’s notes for resident number one (1) after the December 2, 2008 incident. 30. That Respondent’s abuse investigation report revealed the Respondent did not file a one day report, start an abuse investigation, or prepare one and fifteen day state reports within the mandated timeframe and did not do so until December 7, 2008. 31. That Respondent's administrator indicated to the Petitioner's representative that “If we had heard the word ‘violated’ on the first night we would have started the protocol and investigation the same night,” though the initial written statement by the CNA dated December 2, 2008 and received by the DON on December 3, 3008 stated the resident "Felt ... violated," that the written statement of Respondent’s RNS dated December 6, 2008 read "The resident reported to [the resident’ s] friend [the resident] felt violated.”. 32. That Respondent failed to initiate an investigation until December 7, 2008 after, the resident's granddaughter requested the police be called on that date. 33. That when Respondent’s administrator and DON were questioned as to why they had not acted on the CNA's initial statement that specifically said, "the resident felt violated", they were unable to provide an answer despite a number of direct witnesses. Mar 31 2009 10:57 MAR-31-2089 11:18 AGENCY HEALTH CARE ADMIN 856 921 4158 P3842 34. That the resident was expressing and physically showing signs of anxiety and tearfulness four nights after the occurrence and yet the male LPN was never removed from the assignment with the resident, the incident was not reported to the contracted psychological services provider for follow up, and after the incident, the primary care physician, the family, and contracted provider were not notified. 35. That Petitioner’s representative reviewed Respondent’s records regarding resident number one (1) and noted as follows: a. The quarterly minimum data set (MDS), dated December 7, 2008, coded the resident with long and short term memory loss with moderately impaired decision making; b The resident's care plan, dated December 16, 2008, noted the resident's mental function varies throughout the course of the day; c The resident requires extensive to total assistance with activities of daily living and mobility. d. That a consultant's report dated December 2, 2008 provides "Staff reports improved cognition.” e. ‘The resident was admitted to the hospital on December 9, 2008 due to anemia, mild congestive heart failure and urinary tract infection. 36. That Petitioner’s representative interviewed resident number one (1) at the hospital on December 15, 2008, noting the resident alert and oriented to name, place, and situation, but was not clear on time of year or date, and the resident indicated as follows: "There were three female nurses on my left. A large black man came in the room, and just as I was about to ask him who he was and what he wanted, he stuck his hand in my diaper and went in my vagina with his Mar 31 2009 10:57 MAR-31-2869 11:18 AGENCY HEALTH CARE ADMIN 856 921 @158 fingers. He did not tell me who he was or what he was doing. He came to my room about three hours later and apologized. That is all that is on my mind. At first I couldn't sleep but now I can.” The resident did not offer any additional information. 37, That the above reflect failures which place residents at risk and reflect Respondent’s failure to ensure the resident’s 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 as follows: a. The failure to conduct appropriate health assessments, both physical and emotional, to determine potential injury to the resident as result of the alleged incident; b, The failure to contact the resident’s physician and responsible parties when the resident alleged an abusive incident had occurred; Cc. The failure to address noted increased agitation and nervousness of the resident after the alleged incident, d. The failure to implement interventions to protect the resident, and other resident’s from the individual alleged to have committed abuse. 38. That the Agency determined that this deficient practice presented a situation in which immediate corrective action was necessary because Respondent’s non-compliance had caused, or was likely to cause, serious injury, harm, impairment, or death to a resident receiving care in Respondent's facility and cited Respondent with an Isolated State Class I deficiency. P3142 Mar 31 2009 10:53 MAR-31-2869 11:18 AGENCY HEALTH CARE ADMIN 856 921 @158 P3242 39. The Agency provided Respondent with the mandatory correction date for this deficient practice of December 18, 2008. WHEREFORE, the Agency seeks to impose an administrative fine in the amount of ten thousand dollars ($10,000.00) against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(a) and 400.102, Florida Statutes (2008). COUNT I 40. The Agency re-alleges and incorporates paragraphs one (1) through five G) and eleven (11) through thirty six (36), as if fully set forth herein. 41, 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 be free from mental and physical abuse... § 400.022(1)(0), Fla- Stat. (2008). 42. That pursuant to Section 415.1034(1)(a), Florida Statutes (2008): MANDATORY REPORTING.-- (a) Any person, including, but not limited to, any: 1, Physician, osteopathic physician, medical examiner, chiropractic physician, nurse, paramedic, emergency medical technician, or hospital personnel engaged in the admission, examination, care, or treatment of yulnerable adults; 2. Health professional or mental health professional other than one listed in subparagraph 1; 3, Practitioner who relies solely on spiritual means for healing; 4. Nursing home staff; asaisted living facility staff; adult day care center staff; adult family-care home staff; social worker, or other professional adult care, residential, or institutional staff: MAR-31-2889 43. 44. Mar 31 2009 10:53 11:44 AGENCY HEALTH CARE ADMIN 856 921 4158 5, State, county, or municipal criminal justice employee or law enforcement officer; 6. An employee of the Department of Business and Professional Regulation conducting inspections of public lodging establishments under s. 509.032; 7. Florida advocacy council member or long-term care ombudsman council member; or 8. Bank, savings and loan, or credit union officer, trustee, or employee, who knows, or has reasonable cause to suspect, that a vulnerable adult has beet or is being abused, neglected, or exploited shall immediately report such knowledge or suspicion to the central abuse hotline. That pursuant to Section 415,1034(1)(b), Florida Statutes (2008): (b) To the extent possible, a report made pursuant to paragraph (a) must contain, but need not be limited to, the following information. 1. Name, age, race, sex, physical description, and location of each victim alleged to have been abused, neglected, or exploited. 2. Names, addresses, and telephone numbers of the victim's family members. 3, Name, address, and telephone number of each alleged perpetrator. 4, Name, address, and telephone number of the caregiver of the victim, if different from the alleged perpetrator. 5. Name, address, and telephone number of the person reporting the alleged abuse, neglect, or exploitation. 6, Description of the physical or psychological injuries sustained. 7. Actions taken by the reporter, if any, such as notification of the criminal justice agency. 8. Any other information available to the reporting person which may establish the cause of abuse, neglect, or exploitation that occurred or is occurring. That based upon the review of records and interview, Respondent failed to take actions to prevent resident abuse and neglect including, but not limited to, the failure to immediately report 20 P3342 MAR-31-2869 14:11 Mar 31 2009 10:53 AGENCY HEALTH CARE ADMIN 856 921 @158 an allegation of abuse to the central abuse hotline for and allegation of abuse, said failure to report the allegation of abuse lessening the availability of resources to afford residents optimum protection and being contrary to law. 45, That these failures places residents at risk and reflect Respondent's failure to ensure the resident’s 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 as follows: a. b. The failure to implement its abuse procedure and protocol, The failure to conduct a timely investigation of reported abuse; The failure to timely report alleged abuse to the abuse hotline in accord with policy and procedure; The failure to timely report alleged abuse to the Agency for Health Care Administration in accord with law and policy and procedure. The failure to timely report alleged abuse to law enforcement in accord with law and policy and procedure. The failure to implement interventions to protect the resident, and other resident’s from the individual alleged to have committed abuse; The failure to evaluate corrective measures or taken interventions to prevent recurrence of like events in accord with Respondent's policy and procedure related to abuse or other risk management protocols. 46, That these failures places residents at risk in the failure to protect residents from an alleged abusive individual, or other similar or like occurrences, where Respondent's systems to 21 P3442 Mar 31 2009 10:59 MAR-31-2869 14:11 AGENCY HEALTH CARE ADMIN 856 921 @158 P3542 promptly act when abuse, neglect, or exploitation have failed as demonstrated herein. 47. That the Agency determined that this deficient practice presented a situation in which immediate corrective action was necessary because Respondent’s non-compliance had caused, or was likely to cause, serious injury, harm, impairment, or death to a Tesident receiving care in Respondent's facility and cited Respondent with an Isolated State Class I deficiency. 48. The Agency provided Respondent with the mandatory correction date for this deficient practice of December 18, 2008, WHEREFORE, the Agency seeks to impose an administrative fine in the amount of ten thousand doliars ($10,000.00) against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(a) and 400.102, Florida Statutes (2008). co Ill 49. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Counts I and J] as if fully set forth herein. 50. Respondent has been cited for two (2) State Class I deficiencies and therefore is subject to a six (6) month survey cycle for a period of two years and a survey fee of six thousand dollars ($6,000) pursuant to Section 400.19(3), Florida Statutes (2008). WHEREFORE, the Agency intends to impose a six (6) month survey cycle for a period of two years and impose a survey fee in the amount of six thousand dollars ($6,000.00) against Respondent, a skilled nursing facility in the State of F lorida, pursuant to Section 400.19(3), Florida Statutes (2008). » COUNT IV 51. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Counts I and Ii of this Complaint as if fully set forth herein. 22 Mar 31 2009 10:59 MAR-31-2089 11:12 AGENCY HEALTH CARE ADMIN 856 921 4158 52. Based upon Respondent's two cited State Class I deficiencies, 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 Hcensure status under § 400.23(7)(a), 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 (2008) commencing December |5, 2008 and ending December 23, 2008. 5 Respectfully submitted this <-__ day of March, 2009. Th Walsh II, Esquire Fla/ Bat, 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, , 23 P, 3642 MAR-31-2089 11:12 Mar 31 2009 10:59 AGENCY HEALTH CARE ADMIN CERTIFICATE OF SERVICE 856 921 4158 | HEREBY CERTIFY that a true and correct copy of the foregoing has begn served by U.S. Certified Mail, Return Receipt No: 7004 2890 0000 5526 5 076 on March , 2009 to: Larelle Ann Szumski, Administrator, Bon Secours Maria Manor Nursing Care, 10300 - 4" Street North, St. Petersburg, FL 33716, and by U.S. Mail to Dale 8. Webber, Rooney, PC, 401 E. Jackson St., Suite 2500, Tampa, Florida 33602, Registered Agent, 1311 SW 16" Street, Gainesville, Florida 32608. Copies furnished to: Buchanan Ingersoll & J¢ Walsh, II, Esquire Larelle Ann Szumski, Administrator Bon Secours Maria Manor Nursing Care 10300 - 4" Street North Dale §. Webber/ Reg. Agent Buchanan Ingersoll & Rooney, PC 401 E. Jackson St., Suite 2500 24 St. Petersburg, FL 33716 Tampa, Florida 33602 (U.S. Certified Mail) (U.S. Mail) Patricia Caufman Thomas J. Walsh Il, 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 (nteroffice) St. Petersburg, Florida 33701 (interoffice) _| Pardo

Docket for Case No: 09-001660