STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2009006773 (Fine) 2009006776 (CL) THE HEALTH CENTER OF PORT CHARLOTTE, INC. d/b/a CHARLOTTE HARBOR HEALTHCARE, 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 PORT CHARLOTTE, INC. d/b/a CHARLOTTE HARBOR HEALTHCARE (hereinafter “Respondent”), pursuant to Sections 120.569 and 120.57 Florida Statutes (2008), and alleges: NATURE OF THE ACTION This is an action against a skilled nursing facility to impose an administrative fine of TWENTY SEVEN THOUSAND FIVE HUNDRED DOLLARS ($27,500.00) pursuant to Section 400.23(8)(a), Florida Statutes (2008), based upon two (2) Class I deficiencies; to assess a survey fee in the amount of SLX THOUSAND DOLLARS ($6,000.00) based upon Respondent being cited for. . two (2) Class I deficiencies pursuant to Section 400.19(3), Florida Statutes (2008), and to assign conditional licensure status beginning on May 28, 2009, and ending on July 19, 2009, pursuant to Section 400.23(7)(b), Florida Statutes (2008). The original certificate for the conditional license is Filed November 3, 2009 12:51 PM Division of Administrative Hearings. attached as Exhibit A and is incorporated by reference. The original certificate for the standard license is attached as Exhibit B and is incorporated by reference. JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2008). 2. The Agency has jurisdiction over the Respondent pursuant to Section 20.42, Chapter 120, and Chapter 400, Part II, Florida Statutes (2008). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the regulatory authority responsible for the licensure of skilled nursing facilities and the enforcement of all applicable federal and state statutes, regulations and rules governing skilled nursing facilities pursuant to Chapter 400, Part II, Florida Statutes (2008) and Chapter 59A-4, Florida Administrative Code. The Agency is authorized to deny, suspend, or ’ revoke a license, and impose administrative fines pursuant to Sections 400.121 and 400.23, Florida Statutes (2008); assign a conditional license pursuant to Section 400.23(7), Florida Statutes (2008); and assess costs related to the investigation and prosecution of this case pursuant to Section 400.121, Florida Statutes (2008). 5. Respondent operates a 180-bed nursing home, located at 4000 Kings Highway, Port Charlotte, Florida 33980, and is licensed as a skilled nursing facility, license number 16190961. Respondent was at all times material hereto, a licensed skilled nursing facility under the licensing authority of the Agency, and was required to comply with all applicable state rules, regulations and statutes. COUNT I The Respondent Failed To Ensure That The Facility Premises And Equipment Was Maintained And That It Conducted Its Operations In A Safe And Sanitary Manner In Violation Of Section 400.141(8), Florida Statutes (2008) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, every licensed facility shall comply with all applicable standards and rules of the Agency and shall maintain the facility premises and equipment and conduct its operations in a safe and sanitary manner. Section 400.141(8), Florida Statutes (2008). 8. On or about May 27, 2009 through May 28, 2009, the Agency conducted a Complaint Survey (CCR# 2009005091) of the Respondent’s facility. 9. Based upon observations of the facility on May 27, 2009 and May 28, 2009, interviews with the staff, and resident record reviews, the facility failed to ensure the resident environment remains free of hazards to the extent possible, which includes environmental hazards, that are likely to cause serious and immediate harm resulting in Immediate Jeopardy to residents exposed to bio- growth/molds, especially to residents with diseases of the respiratory system. 10, This is evidenced by mold in mechanical rooms A, B, C, and D. 11. The pervasive presence of mold and accumulations of dust and dirt on multiple surfaces in resident rooms, heating, ventilating, and air conditioning, and common areas is likely to adversely impact the health of residents, and placed all residents in Immediate Jeopardy. 12. A review of Pharmacy Diagnosis and Medication lists provided by the facility reveal that seventy-seven (77) of one hundred seventy (170) residents, including Resident number one (1), Resident number four (4), Resident number five (5), Resident number six (6), Resident number eight (8), Resident number nine (9), Resident number ten (10), Resident number thirteen (13), Resident number fourteen (14), Resident number fifteen (15), Resident number eighteen (18), and Resident number twenty-three (23) are at elevated risk levels due to respiratory diagnoses, and have a physician's order for routine or as needed medications used to treat residents with the following medical conditions: Shortness of Breath/Wheezing, Chronic Obstructive Pulmonary Disease, Asthma, Respiratory Distress, and Hypoxemia (insufficient oxygenation of the blood). 13. An observation and review of the Roster/Sample Matrix provided by the facility revealed that thirty-four (34) residents have a physician's order for routine or as needed oxygen. According to the Centers for Disease Control website, http://www.cdc.gov/mold/pdfs/stachy.pdf, residents with chronic respiratory disease such as chronic obstructive pulmonary disorder and asthma may experience difficulty breathing when exposed to mold. The Centers for Disease Control also states that people with allergies may be more sensitive to molds and immunocompromised persons and persons with chronic lung diseases like chronic obstructive pulmonary disorder are at an increased risk for opportunistic infections and may develop fungal infections in their lungs. 14. Observations of common areas such as corridors, the beauty shop, and the classroom demonstrates the residents' have free access to areas with thriving mold and mildew. 15. Mold from the heating, ventilating, and air conditioning system spreads mold throughout the facility exposing all building occupants. The Centers for Disease Control web site indicates that people with allergies or immune suppression or underlying lung disease are more susceptible to fungal infections. These people may experience symptoms such as nasal stuffiness, eye irritation, wheezing, or skin irritation and severe reactions would include fever and shortness of breath. Immunocompromised persons and persons with chronic lung diseases like chronic obstructive pulmonary disease are at increased risk for opportunistic infections and may develop fungal infections in their lungs. Federal Emergency Management Agency's website, http://www.fema.gov/pdf/rebuild/recover/fema mold brochure english.pdf states, "The potential for health problems occurs when people inhale large quantities of the airborne mold spores. For some people, however, a relatively small number of mold spores can cause health problems. Infants, children, immune-compromised patients, pregnant women, individuals with existing respiratory conditions, and the elderly are at higher risks for adverse health effects from mold." 16. On May 27, 2009 at 11:10 a.m., an inspection of the four (4) main air conditioning systems in their respective mechanical rooms was conducted. The reheat coil valves were observed to be shut down and the actuators were deteriorated and showed signs of leaking for an extended period of time. When asked, the Maintenance Director stated he was unsure of how long the actuators were shut down. 17. An observation in the mechanical room on A wing at 11:10 a.m. on May 27, 2009 revealed visible mold on the heating ventilator and air conditioning equipment. Mold was identified on the unit, the reheat coil shut off, inside the air conditioning unit and in the fan cage. There was standing water observed on the floor of the room. 18. Am observation in the B Wing mechanical room at 11:15 am. on May 27, 2009 revealed visible mold on the heating ventilator and air conditioning equipment. Mold was identified on the reheat coil shut off, inside the air conditioning unit and in the fan cage. There was standing water observed on the floor of the room. 19. An observation in the C Wing mechanical room at 11:25 a.m. on May 27, 2009 revealed mold on the heating ventilator and air conditioning equipment, on the reheat coil shut off, inside the air conditioning unit and in the fan cage. There was standing water observed on the floor of the room. 20. . An observation in the D Wing mechanical room at 11:40 a.m. on May 27, 2009 revealed mold on the heating ventilator and air conditioning equipment, inside the air conditioning unit and in the fan cage. There was standing water on the floor and the reheat coil was halfway open and leaking. 21. An interview with the Maintenance Director on May 27, 2009 at 11:40 a.m. revealed there were four (4) proposals provided to the facility by different companies to make the necessary repairs to remove and replace the reheat coils and plumbing. These proposals had dates ranging from November 2007 to January 2009. The Maintenance Director stated the proposals were submitted to the administrator for approval. 22, During an interview on May 28, 2009 at 5:40 p.m., the administrator declined to give a reason as to why one of the proposals was not approved and the repairs were not completed. . The administrator stated that whenever there is a mold problem, he takes care of it by having the maintenance staff make the necessary surface repairs. 23. There was no documentation that the administrator acted upon the information of the reoccurrences of mold and mildew or triggered an investigation to determine the root cause of the mold infestation. 24. An observation during a tour of the facility, completed on May 27, 2009 through May 28, 2009, revealed the following common areas were observed to have visible mold: a. On the wall at the vinyl cove trim molding located on the dining cortidor by the nurses! station on C Wing. b. On the air conditioner supply vent at the entrance to the main dining room. c. On the wall adjoining the C Wing mechanical room. d. On the light lens of the C Wing soiled utility room. e. Behind the floor trim molding (carpet) by the nurses' station in C Wing. f In the facility's beauty shop on the window ledge, on the wall at the floor and vinyl cove trim molding, on the air conditioning vent, and on the ceiling in all four (4) light lenses. The beauty shop manager said, "I do about twenty-five (25) residents each week." g. The facility classroom was observed to have mold on ceiling tiles and on the ceiling by the air conditioning vent. Theré was a very musty odor in the room. 25. An observation during a tour of resident rooms completed on May 27, 2009 through May 28, 2009 revealed visible mold was observed in the following resident rooms: a. On the window ledge in Room #130. b. The ceiling tiles in Room #105 were observed to be bowing and mold was observed in the shower room. c. Mold was observed on the shower room wallpaper in Room #214. d. Room #215 was observed to have a hole in the wall with visible mold by the air conditioner and resident number fifteen (15) in this room was observed to be receiving oxygen via nasal cannula, ftom concentrator equipment. . e. On Room #203's and #204's shower grout. f. Room #231 had mold on the wallpaper in the shower area. g. On the tile behind the shower seat in Rooms #205 and #206. h. Room #226 had mold behind the shower room seat, behind the wallpaper border and in the wall expansion joint in the corner of the shower room. " 1, Room #225 had mold on the wallpaper in the shower. j. In the closet in Room #314. k. At the top of the wall in Room #334, 1. Room #101 had mold on the carpet outside the wall. m. On the wall behind the toilet and on and behind the vinyl cove trim molding in Room #233. 26. An observation during a tour of the facility, completed on May 27, 2009 through May 28, "2009 also revealed the following: a. On May 27, 2009 at 4:45 p.m., the air conditioning supply vents in the kitchen had condensation and were dripping. b. The Portable Honeywell HEPA 99.97% Humidifier in Rooms #102, #110, and #209 had dusty air vents surrounding the humidifier. c. Air conditioner vent directional slats were dusty in Rooms #103, #113, #201, #224, #204, #207, #208, #211, #214, #215, #216, #221, #224, #226, #303, #306, #307, #312, #321, #325, #326, #329, #220 and #334. d. Rooms #225 and #302 had dusty air conditioning vents that were making loud noises. e. Rooms #314, #316, #317, and #319 had dusty air conditioning vents and visible dust on the upper vents. f. Room #320 had a dusty air conditioner vent that was moist to the touch. g. Both C Wing and D Wing had areas where fire proofing from the underside of the roof decking had fallen down and weighed heavy on the ceiling grid. 27, A review of the current Pharmacy Diagnosis and Medication lists provided by the facility reveal that seventy-seven (77) of one hundred seventy (170) residents, including Resident number one (1), Resident number four (4), Resident number five (5), Resident number six (6), Resident number eight (8), Resident number nine (9), Resident number ten (10), Resident number thirteen (13), Resident number fourteen (14), Resident number fifteen (15), Resident number eighteen (18), and Resident number twenty-three (23) are at elevated risk levels due to respiratory diagnoses, and have a physician's order for routine or as needed medications used to treat residents with the following medical conditions: Shortness of Breath/Wheezing, Chronic Obstructive Pulmonary Disease, Asthma, Pneumonia, Respiratory Distress, and Hypoxemia (insufficient oxygenation of the blood). These residents are at higher tisk for complications due to dust and mold being pervasive throughout the facility per the Centers for Disease Control website. | 28. An observation and review of the Roster/Sample Matrix provided by the facility revealed that thirty-four (34) residents have a physician's order for routine or as needed oxygen. Nine (9) - residents, including Resident number six (6), Resident number fourteen (14), Resident number fifteen (15) and Resident number twenty-three (23), of the thirty-four (34) residents with orders for oxygen are residing in rooms with visible mold. According to the. Center for Disease Control's website, http://www.cde.gov/mold/pdfs/stachy.pdf, residents with chronic respiratory disease such as chronic obstructive pulmonary disorder and asthma may experience difficulty breathing when exposed to mold. The Centers for Disease Control also states that people with allergies may be more sensitive to molds and immunocomprised persons and persons with chronic lung diseases like chronic obstructive pulmonary disorder are at an increased risk for opportunistic infections and may develop fungal infections in their lungs. 29. A review of clinical records for twenty-six (26) residents, Resident number one (1) through Resident number twenty-six (26), who either have diseases of the respiratory system, are receiving medications and/or oxygen, and/or reside in rooms with visible mold revealed the following: a, Resident number ten (10): A review of the clinical record on May 28, 2009 at 10:43 a.m. revealed the resident was admitted on May 1, 2009 for rehabilitation after a knee replacement and had no history of respiratory diseases or problems. A review of the Admission Data Collection/Interim Plan of Care, dated May 1, 2009 revealed the resident had regular respiration and lungs sounds were clear on both the left and right side. “b. A review of the nurse's notes dated May 23, 2009 revealed contact with the physician's office regarding the resident's dry cough times three (3) days, now "wet sounding.” c. A review of the physician orders dated May 23, 2009 revealed Robitussin DM 5 milliliters every six (6) hours, as needed, was added to the resident's medication regimen for cough. d. On May 24, 2009, the nurse documented: "Con't (Continues) to have "wet sounding" cough. LS (Lung Sounds) : Rhonchi heard in upper right lobes, minimal wheezes on expiration. Robitussin DM given with relief." 30. A review of the clinical record dated May 25, 2009 revealed the physician issued new orders for an upper respiratory infection, including Mucinex (a medication that loosens the mucus that causes chest and nasal congestion and works as a cough suppressant) 600 milligrams by mouth (PO) twice a day for ten (10) days. The physician also ordered Azithromycin (an antibiotic) 500 mg po times 1 day, then 250 mg po every day (qd) times 4 days, and Prednisone ( a medication used to treat allergies) 40 mg po qd times 2 days, then 30 mg po qd times 2 days, then 20 mg po every day for 2 days, then 10 mg po daily for 1 day. On May 27, 2009, the Licensed Nurse documented: "Occ. (occasional) unproductive cough.” A review of the Medication Administration Record for May 2009 reveals Resident number ten (10) received Robitussin on May 24, 2009; May 25, 2009; May 27, 2009; and May. 28, 2009 for complaint of cough. 31. Resident number one (1): A review of a clinical record on May 28, 2009 at 11:19 a.m. revealed an admission date to the facility of April 14, 2009 for rehabilitation after a joint replacement. The resident also had a diagnosis of shortness of breath and a physician's order for a nebulizer treatment (device to administer medication in a mist form into the lungs) every four (4) hours as needed. A review of the physician order dated April 30, 2009 revealed a chest x-ray was ordered for the resident's cough. On May 8, 2009, the physician ordered Robitussin 5 ml po Q6H (every 6 hours), as necessary for cough for Resident number one (1). 32. Resident number four (4): A review of the clinical record on May 28, 2009 revealed an admission date of May 15, 2009, with diagnoses including, but not limited to, Chronic Obstructive . Pulmonary Disease and Congestive Heart Failure and the resident requires the use of oxygen continuously for Chronic Obstructive Pulmonary Disease. The medication regimen for May 2009 included the use of Duoneb respiratory treatment (nebulizer) every six (6) hours while awake. Resident number four (4) also received Prednisone 40 milligrams by mouth for seven (7) days, then Prednisone 30 milligrams by mouth for seven (7) days, and then 20 milligrams by mouth daily for a _ diagnosis of Chronic Obstructive Pulmonary Disease. A diagnosis of Chronic Obstructive Pulmonary Disease places the resident at an increased risk for opportunistic infections. 33. Resident number five (5): A review of the clinical record on May 28, 2009 revealed an admission date of October 20, 2006. The diagnoses included, but were not limited to, respiratory insufficiency. The resident requires the continuous administration of oxygen. On March 15, 2009, the licensed nurse documented that Resident number five (5) had aspiratory wheezing and chest congestion and complained of cough. A chest x-ray was done on March 11, 2009. The results noted that the lungs were clear without mass, infiltrate dr effusion. The physician ordered a nebulizer treatment every six (6) hours as needed on April 2, 2009. A second chest x-ray was done on April 11, 2009 and the results noted bilateral infiltrate (infiltrate in both lungs), fibrosis, and Chronic Obstructive Pulmonary Disease. On May 13, 2009, the licensed nurse documented that Resident number five (5) "C/O (complained of) feeling choked" and audible high pitched wheezing was noted. The oxygen saturation was 92%. . 34. Resident number six (6): A review. of the clinical record on May 28, 2009 revealed an admission date of April 27, 2009, with diagnoses including, but not limited to, respiratory failure. On April 29, 2009 at 12:15 p.m., the licensed nurse documented that the resident was sent out to the hospital for decreased level of consciousness and labored breathing at times. An observation on May 28, 2009 at approximately 11:00 a.m. revealed mold at the top of the wall in Resident number six’s (6) room. 35. Resident number eight (8): A review of the clinical record on May 28, 2009 at 10:00 a.m. revealed the resident was admitted on May 15, 2009 with a primary diagnosis of a Cardio-Vascular Accident. A review of the resident diagnosis list from the pharmacy provided by the facility revealed the resident also has a diagnosis of Chronic Obstructive Pulmonary Disease and has a physician's order for nebulizer treatments four (4) times a day. A review of the admitting note revealed a history of Chronic Obstructive Pulmonary Disease and oxygen use at two (2) liters per minute via nasal canula. A review of the nurse's notes since admission revealed Resident number eight maintained an oxygen saturation level between 90% to 95%. The resident also uses a continuous positive air pressure machine at night for sleep apnea. 36. Resident number nine (9): A review of the clinical record on May 28, 2009 at 10:10 a.m. revealed the resident was re-admitted to the facility from an acute care hospital on May 26, 2009. A further review of the record revealed the resident was transferred to the hospital on May 20, 2009 due to intractable nausea and vomiting accompanied with back pain. The facility re-admission diagnosis was a compression fracture of thoracic spine number twelve (12). A medical record review revealed a therapy note dated May 27, 2009 that documents the resident's complaint of severe headache and stated, "I just feel real sick right now." Therapy was omitted for that date and time, due to the resident's comments. The resident has a history of Chronic Obstructive Pulmonary Disease. A review of the hospital records in the resident's clinical record reveals the resident receives three (3) respiratory medications, Spiriva (Drug Information Handbook for Nursing, 9th Edition states it is used for bronchospasm associated with Chronic Obstructive Pulmonary Disease), Singulair (used for treatment of asthma and allergies per Drug Information Handbook for Nursing, 9th Edition), and Albuterol nebulizer (used for asthma and Chronic Obstructive Pulmonary Disease per Drug Information Handbook for Nursing, 9th Edition). 37. Resident number thirteen (13): A review of the clinical record on May 28, 2009 at 5:20 p.m. revealed the resident was admitted on August 26, 2008 with diagnoses that include, but are not limited to, respiratory insufficiency, and a history of bilateral pheumonia, bilateral pleural effusions and Congestive Heart Failure. A review of the physician's orders revealed an order dated August 12 31, 2008, for Singulair (used for treatment of asthma and allergies per Drug Information Handbook for Nursing, 9th Edition), 10 milligrams daily at bedtime. An observation of the resident's room on May 28, 2009 revealed mold on the tile behind the shower seat in the resident's bathroom. 38. Resident number fourteen (14): A review of the clinical record on May 28, 2009 revealed the resident was originally admitted to the facility on April 19, 2004 with diagnoses including, but not limited to, Chronic Obstructive Pulmonary Disease and emphysema. The current physician's orders included the use of oxygen at two (2) liters via nasal canula as needed for complaints of shortness of breath. A review of the list of medications from pharmacy provided by the facility reveals the resident receives Advair (used for maintenance treatment of Chronic Obstructive Pulmonary Disease and asthma per Drug Information Handbook for Nursing, 9th Edition) one (1) puff every twelve (12) hours; Spiriva (Drug Information Handbook for Nursing, 9th Edition states it is used for bronchospasm associated with Chronic Obstructive Pulmonary Disease) one (1) inhalation every day, and Combivent (treatment of Chronic Obstructive Pulmonary Disease in those people who are on a regular bronchodilator who continue to have bronchospasms and require a second bronchodilator per Drug Information Handbook for Nursing, 9th Edition) every six (6) hours as needed for shortness of breath. The resident also uses oxygen when needed. An observation on May 28, 2009 revealed mold in the resident's bathroom on the shower wallpaper. 39, Resident number fifteen (15): A review of the clinical record on May 28, 2009 revealed the resident was readmitted to the facility on March 13, 2009. The diagnoses included, but were not limited to, Chronic Obstructive Pulmonary Disease, right lower lobe pneumonia and the resident was treated with Vancomycin (antibiotic used for treatment of infections per Drug Information Handbook for Nursing, 9th Edition) for seven (7) days on March 25, 2009. A review of the physician's note dated April 13, 2009 revealed the resident had a fungal respiratory infection and had diminished breath sounds and an exacerbation of Chronic Obstructive Pulmonary Disease. The physician recently signed a statement of terminal condition. The physician's orders included the use of Duoneb (treatment of Chronic Obstructive Pulmonary Disease per Drug Information Handbook for Nursing, 9th Edition) inhalation therapy every four (4) hours, as needed, for shortness of breath. The resident requires the use of continuous oxygen. An observation on May 28, 2009 revealed the resident is in a private room and there was a hole in the wall with visible mold by the air conditioner. The resident was in the room and was receiving oxygen via a nasal cannula from a room ait concentrator. 40. Resident number eighteen (18): A review of the clinical record on May 28, 2009 revealed the resident was admitted to the facility on July 3, 2007 with diagnoses that include, but are not limited to, Chronic Obstructive Pulmonary Disease. A review of the clinical record revealed on May 26, 2009 the resident had nasal congestion and sneezing. 41, Resident number twenty-three (23): A review of the clinical record on May 28, 2009 reveals the resident has diagnoses that include, but are not limited to, Coronary Artery Disease and Dementia, Physician progress notes dated February 17, 2009 document the resident has a harsh cough and wheezes throughout the upper pulmonary fields and acute bronchitis. Physician orders dated February 17, 2009 are for Robitussin (cough medicine) Sml Q6 prn (may be given every 6 hours as needed) and Mucinex (used to loosen phlegm and to thin bronchial secretions per Drug Information Handbook for Nursing, 9th Edition) 600mg to be given every twelve (12) hours as needed for congestion. On February 18, 2009, the physician ordered oxygen to be administered at two (2) liters via nasal cannula, as needed. The resident was prescribed nebulizer treatment every six (6) hours as needed for shortness of breath. A review of nurses! notes dated May 2, 2009 at 1:10 a.m. reveals Resident number twenty-three (23) received Robitussin Sml for a cough. At 1:15 a.m. on May 2, 2009 the resident received a nebulizer treatment for complaint of shortness of breath. An observation on May 28, 2009 at 2:15 p.m. reveals a nebulizer is at the resident's bedside. An 14 observation on May 28, 2009 revealed Resident number twenty-three (23) is in the bed by the window and there is visible mold on the window ledge. 42. 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. The Agency cited Respondent for a widespread Class I deficiency as set forth in Section 400.23(8)(a), Florida Statutes (2008). 43. The Agency provided Respondent with a mandatory correction date of June 28, 2009. WHEREFORE, the Agency intends to impose an administrative fine in the amount of FIFTEEN THOUSAND DOLLARS ($15,000.00) against Respondent, a skilled nursing facility in the State of Florida, pursuant to Sections 400.23(8)(a) and 400.102, Florida Statutes (2008). COUNT I . The Respondent Failed To Ensure A Right To Privacy In Violation Of Section 400.022(1)(m), Florida Statutes (2008) . 44. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 45. Pursuant to Florida law, 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: The right to have privacy in treatment and in caring for personal needs; to close room doors and to have facility personnel knock before entering the room, except in the case of an emergency or unless medically contraindicated; and to security in storing and using personal possessions. Privacy of the resident's body shall be maintained during, but not limited to, toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance. Residents’ personal and medical records shall be confidential and exempt from the provisions of Section 119.07(1). Section 400.022(1)(m), Florida Statutes (2008). 46. | Onor about May 27, 2009 through May 28, 2009, the Agency conducted a Complaint Survey (CCR# 2009005091) of the Respondent’s facility. 47. Based on observations made during a tour of the facility on May 27, 2009 and May 28, 2009, interviews with facility staff, residents and/or legal representatives, and a review of the facility and resident records, it was determined that the facility failed to attain and maintain the residents’ right to personal privacy. 48. This failure is evidenced by the facility failure to notify eight (8) of twenty-six (26) sampled residents who currently reside in the facility or their legal representative and obtain consent to install Digital Video Recorded Cameras in resident rooms, Resident number one (1), Resident number two (2), Resident number three (3), Resident number thirteen (13), Resident number eighteen (18), Resident number twenty-four (24), Resident number twenty-five (25) and Resident number twenty-six (26). This breach of resident privacy is likely to cause psychosocial harm to the resident, once the resident or their legal representative has knowledge the resident's actions are being secretly watched and recorded. 49. While on an initial tour of the facility on May 27, 2009 at about 10:00 a.m., Resident number twenty-four’s (24) room was being inspected for mold and the surveyor had cause to look above the lay-in ceiling. While inspecting the interstitial space, a wire and surveillance camera were observed. On May 27, 2009 at about 10:00 a.m., the administrator stated this was a surveillance system. The administrator stated the reason for the system installation was for preventing or proving theft of resident items. 50. During an interview on May 27, 2009 at 10:45 a.m. the administrator stated, "We do not have oral or written consent for 24-hour unlimited video monitoring from the residents or their representatives and the facility does not have any consent forms." The administrator also stated the facility did not notify residents or families of the installation of the cameras. The administrator stated the monitoring is not limited to closed circuit television; there is an internet address on "ViewDVR.com.", a name and password allows access to the unlimited monitoring. 51. The administrator stated the cameras had been installed “about a year ago" and an in-service was done for employees in the summer of 2008 in which the employees were told cameras were being installed due to theft. 52, The administrator was asked to provide invoices or any documents for the installation of the cameras but was unable to provide these. 53. \ Anobservation on May 27, 2009 revealed significant amounts of cable attached to the surveillance cameras. The administrator stated there is enough cable on the cameras to place them anywhere in the facility anytime and he planned to add more cameras. Resident number one (1) and Resident number three’s (3) rooms are monitored, in addition to Resident number twenty-fout’s (24) room. The cameras are in Rooms 305, 131 and 216. 54, When asked about the location of the monitor, the administrator took the surveyors to his office. An observation revealed the office door was open to the corridor and no one was in the room. The monitor was located on the wall by the door to the corridor and could be viewed by anyone entering the office. 55, The monitor was split in four sections, one for each camera, the fourth being in the staff lounge. A female resident was observed in bed while the nurse assistant was getting the resident ready for morning care. The aide was removing personal care items from the drawer and the resident had bandages across the chest area that was clearly visible on the monitor. 56. At 5:40 p.m. on May 27, 2009, the administrator stated he can monitor from anywhere in the world via the internet. The administrator said he had gone online to monitor this system only one time but did not remember the internet address or the password. At 6:00 p.m., on May 27, 2009, the administrator came into the conference room and stated to the surveyors that he had spoken to the company that had installed the system. The administrator then stated that he had never gone online because the system had never been set up. 57, Anobservation on May 28, 2009 at approximately 2:00 p.m. revealed the door to the administrator's office was open and the monitor was visible upon taking two (2) steps into the room. The administrator came to his office approximately five (5) minutes later. The administrator stated the cameras were installed in the room at the farthest end at each of the three halls and in the employee lounge due to a problem with theft. 58. Aninterview on May 28, 2009 at 2:35 p.m. with the owner of the company that installed the system revealed the company would not have installed this system until the facility said they ‘notified the residents. The owner stated the facility Director of Nursing had informed him that the residents were notified that monitoring cameras were being installed. [Additional information was received during a telephone interview on June 12, 2009 at 3:16 p.m., the Director of Nursing stated she had not told the owner of the company that installed the system the residents had been notified. ] 59, Interviews with Resident number one (1), Resident number two (2), Resident number three (3), Resident number thirteen (13), Resident number eighteen (18), Resident number twenty-four (24), Resident number twenty-five (25), and Resident number twenty-six (26), and/or their personal representatives revealed none had any theft issues and did not know of any theft issues. | 60. - An interview with the representative for Resident number twenty-four (24) on May 27, 2009 at 2:05 p.m. revealed they had not had any issues concerning theft of personal items and were not aware a camera was being utilized to monitor his/her parent. 61. An interview with Resident number thirteen’s (13) spouse on May 27, 2009 revealed he/she were not aware the room was equipped for monitoring. 62. During an interview with the legal representative for Resident number twenty-five (25) on May 27, 2009, the legal representative stated “I feel very uncomfortable and believe it is a violation of my rights." The legal representative stated he/she did not have any theft issues. 63. During an interview on May 27, 2009 at 2:30 p.m., Resident number one (1) stated that if he/she knew there was a camera in the room he/she would not have given consent or allowed the installation. Resident number one (1) continued to say, "I don't know why they would have something like that. If it's there I want it taped over or taken out. I've been here two (2) weeks and did not know. They wouldn't have done it if ] had known about it." 64. Aninterview on May 27, 2009 at 3:10 p.m. with Resident number two (2) yielded the response: "I don’t want anybody watching me when I take off my clothes." Resident number two (2) said he/she saw it there and thought it looked like a bullet hole but didn't say anything. Resident number two (2) continued to say, "These young people today don't know how to settle a dispute.” Resident number two (2) added, "They should feed starving people instead of using money to put in the camera just for one person's foolishness." 65, An interview with the representative for Resident number twenty-six (26) on May 27, 2009 revealed no theft issues. When asked about utilizing a camera to monitor his/her parent, the representative stated he/she would have preferred to know his/her parent's room was being monitored. 66. During a telephone interview on May 28, 2009 at 3:25 p.m. with the legal representative for Resident number three (3) to discuss the installation of a surveillance camera in Resident number three’s (3) room, the personal representative stated, " wasn't notified and I would not give my permission for this and I want it removed immediately." Resident number three’s personal representative stated he/she would only allow this for medical purposes. He/she said he/she had no knowledge of any theft issues. 67. A teview of the minutes from the Resident Council meetings for the past two (2) months revealed no complaints of thefts. 68. A review of the grievance logs for the past three (3) months revealed a few missing items but most of these items were found. There was no documentation of anything listed as a theft. 69. The results of the resident interviews and the statements by the administrator that there was no consent forms signed and residents or their legal representatives were not notified of the use of monitoring cameras, confirms the facility's failure to preserve the privacy rights of residents at Respondent’s facility. This breach of resident privacy is likely to cause psychosocial harm to the resident, once the resident or their legal representative has knowledge the resident's actions are being secretly watched and recorded. 70. 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. The Agency cited Respondent for a‘patterned Class I deficiency as set forth in Section 400.23(8)(a), Florida Statutes (2008). 71. The Agency provided Respondent with a mandatory correction date of June 28, 2009. WHEREFORE, the Agency intends to impose an administrative fine in the amount of TWELVE THOUSAND FIVE HUNDRED DOLLARS ($12,500.00) against Respondent, a skilled nursing facility in the State of Florida, pursuant to Sections 400.23(8)(a) and 400.102, Florida Statutes (2008). COUNT IU Assignment Of Conditional Licensure Status Pursuant To Section 400.23(7)(b), Florida ‘ Statutes (2008) 72. The Agency re-alleges and incorporates by reference the allegations in Count J and Count II. 73. The Agency is.authorized to assign a conditional licensure status to skilled nursing facilities 20 pursuant to Section 400.23(7), Florida Statutes (2008). 74. Due to the presence of two (2) Class I deficiencies, the. Respondent was not in substantial compliance at the time of the survey with criteria established under Chapter 400, Part II, Florida Statutes (2008), or the rules adopted by the Agency. 75. The Agency assigned the Respondent conditional licensure status with an action effective date of May 28, 2009. The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference, 76. The Agency assigned the Respondent standard licensure status with an action effective date of July 19, 2009. The original certificate for the standard license is attached as Exhibit B and is incorporated by reference. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the Respondent conditional licensure status for the period beginning May 28, 2009 and ending on July 19, 2009 pursuant to Section 400.23(7)(b), Florida Statutes (2008). COUNT IV Assessment Of Survey Fee Pursuant To Section 400.19(3), Florida Statutes (2008) 77. The Agency re-alleges and incorporates by reference the allegations in Count I and Count II. 78. The Respondent has been cited for two (2) Class I deficiencies and therefore is subject to a six (6) month survey cycle for a period of two (2) years and a survey fee of SIX THOUSAND DOLLARS ($6,000.00) 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 (2) 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 Florida, pursuant to Section 400.19(3), Florida Statutes (2008). 21 CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief against the Respondent as follows: 1. - Make findings of fact and conclusions of law in favor of the Agency on Count I through Count IV. 2. Impose an administrative fine against the Respondent in the amount of TWENTY SEVEN THOUSAND FIVE HUNDRED DOLLARS ($27,500.00), and assess a survey fee in the amount of SIX THOUSAND DOLLARS ($6,000.00) for a total of THIRTY THREE THOUSAND FIVE HUNDRED DOLLARS ($33,500.00). 3. Assign a conditional license to the Respondent for the period beginning May 28, 2009, and ending July 19, 2009. 4, Assess costs related to the investigation and prosecution of this case. 5. Enter any other relief that this Court deems just and appropriate. Respectfully submitted this 944 day of dehelen, , 2009, dons Fics J Lys Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 338-3203 22 NOTICE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE 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 AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE : ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 922-5873. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to: Corporation Service Company, Registered Agent for The Health Center of Port Charlotte, Inc. d/b/a Charlotte Harbor Healthcare, 1201 Hays Street, Tallahassee, Florida 32301, by United States Certified Mail, Return Receipt No. 7008 1140 0003 8889 1189 and to Thomas J. Bell, Administrator, The Health Center of Port Charlotte, Inc. d/b/a Charlotte Harbor Healthcare, 4000 Kings Highway, Port Charlotte, Florida 33980, by United States Certified Mail, Return Receipt No. 7008 1140 0003 8889 1172 on this fA. day of Oobebes. , 2009. Mantricy J ae Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 338-3203 23 Copies furnished to: {Thomas J. Bell, Administrator d/b/a Charlotte Harbor Healthcare 4000 Kings Highway Port Charlotte, Florida 33980 (U.S. Certified Mail) The Health Center of Port Charlotte, Inc. Mary Daley Jacobs, Assistant General Counsel Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) Corporation Service Company Registered Agent for d/b/a Charlotte Harbor Healthcare 1201 Hays Street Tallahassee, Florida 32301 (U.S. Certified Mail) The Health Center of Port Charlotte, Inc. Bruce A. Henderson, LHRM Health Services and Facilities Consultant Bureau of Long Term Care Services Agency for Health Care Administration Fort Knox #3, Room 1231 Tallahassee, Florida 32308 (Interoffice Mail) Harold Williams Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) 24 Exhibit A Original Certificate of Conditional License The Health Center Of Port Charlotte, Inc. d/b/a Charlotte Harbor Healthcare Certificate No. 15862 License No. SNF16190961 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST GOVERNOR August 24, 2009 - CHARLOTTE HARBOR HEALTHCARE 4000 KINGS HWY PORT CHARLOTTE, FL 33980 Dear Administrator: HOLLY BENSON SECRETARY The attached license with Certificate #15862 is being issued for the operation of your facility, Please review it thoroughly to ensure that all information is correct and consistent with your records, If errors or omissions are noted, please make corrections on a copy and mail to: Agency for Health Care Administration Long Term Care Section, Mail Stop #33 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 Issued for status change to Conditional. Sincerely, ry Tracey Weatherspoon Agency for Health Care Administration Division of Health Quality Assurance Enclosure ce: Medicaid Contract Management Certificate of Need FLORIDA COMPARE CARE Health Care In the Sunshine fp vnntionsacomparecere gov 2727 Mahan Drive, MS#33 Tallahassee, Florida 32308 Visit AHCA online at http://ahca.myflorida.com aoueimssy Ayend Mea} JO UOISIAIC SAI a a O10Z/0€/60 :ALVC NOLLVWIAXA ASNT 6007/8¢/S0 ‘ALVG gALLOadda NOLLOV. _ GONWHO SALVIS $daa 08T “IVLOL™ 086€€ ‘Td ‘ALLOTAVHO 1YOd AMH SOND 000¢ ~ PaVOHLIVaK YOUVE ALLOTEVHO “Suumoyyoy om ayerado 0} ‘pezuoymne ST QQSUIOI] ay) se pus ‘somieis epuopy Ty wed ‘Oop Jaideyo WE pezuorme. ‘uonensMarUpy oe yeep] Joy Aouesy. ‘epuoyy jo amg ain &q Pardope SUORU IESE pue sayna ot Hil Ponginge sey SH" “ONT ALLOTIVHO Lad AO UaLNID HITVAH Ie UUOS OF ST STAT dINOH SNISUON | AONVUNSSY ‘ALITVAD HLTvaH dO NOISIAIC - _NOLLVALLSINUNGLY Ta OH. ‘TV cH wos AONAOV : == I960619TANS “# ASNAONT Exhibit B Original Certificate of Standard License The Health Center Of Port Charlotte, Inc. d/b/a Charlotte Harbor Healthcare Certificate No. 15863 License No. SNF16190961 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST GOVERNOR August 24, 2009 CHARLOTTE HARBOR HEALTHCARE 4000 KINGS HWY PORT CHARLOTTE, FL 33980 Dear Administrator: HOLLY BENSON SECRETARY The attached license with Certificate #15863 is being issued for the operation of your facility. Please review it thoroughly to. ensure that all information is correct and consistent with your records. If errors or omissions are noted, please make corrections on a copy and mail to: Agency for Health Care Administration Long Term Care Section, Mail Stop #33 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 Issued for status change to Standard. Sincerely, SO OK Tracey Weatherspoon Agency for Health Care Administration Division of Health Quality Assurance Enclosure ce: Medicaid Contract Management Certificate of Need # FLORIDA COMPARE CARE Haalth Care In the Sunshine 2727 Mahan Drive, MS#33 Tallahassee, Florida 32308 #7 www.FloridaGompareCare.gov Visit AHCA online at http://ahca.myflorida.com fee SRO 010Z/0€/60 -ALVG NOILValdxa ASNSONI - 600Z/61/L0 ALVA AALLOSIII NOLLOV BONWHO SALVLS” Sdad O81 "VIOL O86EE qd “aL1OTEVHO Laod -.,, AMMH SONIA 0007. SAVOHLTVaH womvH @LLOTAVHO® ‘ : oul Oy SI "| .8u} Se. pur ‘sayngeys epHojy ‘TE ued “OOK qaydeyD ur pezuioyyne. “uOneNSTUIUpy. arep Tyeey 104 Koussy epuop jo aig ou} Kq.. palon? suonensax pue sont 7 UIA Poriduioo sey SHL “ONE “ALLOTYVHO LuOd 30. WAIN HITaH? ae maaguoo, OYST sm ‘T9606TSTANS # ASNAOIT COMPLETE THIS SECTION ON DELIVERY SENDER: COMPLETE THIS SECTION AS Signature ~°."." : CO) Agent x T BAR Cl Addressee B. Recelved by ( Printed Name) G. Date of Delivery ; li Complete items 1, 2; and 3. Also complete { . {tem 4 if Restricted Delivery Is desired. | m Print your name arid address on the reverse so that we can return the card to you. ~ ; lf Attach this.card to the back of the malpienss Hl or on the front if space permits. i : 1. Article Addressed ‘to: LOOFOUCTIB +E CO176 Thomas J, Bet/, Admmiih | Charlotte Harbor Hee rcare 41000 Kou Mashony Port Charlotte F anda Dy Is delivery address different from item 7 1 Yes mi YES, enter delivery address below: ~ 1 No 3. Service Type . : C1) Certified Mail’ . [1 Express Mall “C1 Registered C1 Return Receipt for Merchandise Clingured Mat! ~~ 2.c.0.0. 4. Restricted Delivery? (Extra Fee) 7004 L140 -o003 84484 1172 1 PS Form 381 1, February 2004 Domestic Return Recelpt 102595-02-M-1540 First-Class Malt : Postage & Feos Paid] USPS iP: Permit No. G-10 | , Mary Jacobs, Senior Attorney 2 » Agency for Health Care Administration ; Office of the General Counsel ; 2295 Victoria Avenue, Room 346B Fort Myers, Florida 33901-3884 Dithillbbdbiabolblibdluldlhullalhd

Docket for Case No: 09-006023