STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE BY ADMINISTRATION, |) -28 Petitioner, AHCA No.: 2010000945 v. Return Receipt Requested: 7009 0080 0000 0586 5006 ORCHID ISLAND MANOR, LLC d/b/a ORCHID ISLAND MANOR, LLC, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Orchid Island Manor LLC d/b/a Orchid Island Manor, LLC (hereinafter “Orchid Island Manor, LLC”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2009), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,000.00 pursuant to Section 429.19, Florida Statutes, for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies pursuant to 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2009), and Chapter 58A-5, Florida Administrative Code. 5. Orchid Island Manor, LLC operates a 24-bed assisted living facility located at 1914 2187 Street, Vero Beach, Florida 32960. Orchid Island Manor, LLC is licensed as an assisted living facility license number AL4941 with an expiration date of December 10, 2010. Orchid Island Manor, LLC was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I ORCHID ISLAND MANOR, LLC FAILED TO ENSURE RESIDENTS MEET THE MINIMUM CRITERIA TO BE AN ALF FOR ONE OF TWO RESIDENTS FILES REVIEWED Rule 58A-5.0181(1) (5), Florida Administrative Code (ADMISSION CRITERIA STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During a monitoring visit conducted on 11/12/09 and based on observation, interview, and record review, it was determined that the facility failed to ensure residents meet the minimum criteria to be in an AFL, for one of 2 resident files reviewed, Resident #2. Resident #2 had two (2) documented unstageable wounds. 8. Resident #2 was not listed on the ECC (extended congregate care) log. Interview with the Administrator and owner via phone at approximately 10:20 AM revealed that there were no residents receiving ECC services. Observation of Resident #2 at approximately 11:30 AM revealed that the resident had bilateral wounds to each heel, approximately 25 cent piece size, that were black and dry. The area around the wounds was red and shiny. The resident was wearing bilateral booties for protection that had a hole in the heel area. Interview with the resident revealed he/she had the wounds for a long time, could not remember how long, but was told they came from laying in bed too much. The resident seemed alert & oriented and self propelled self in a wheelchair. 9. Review of the record for Resident #2 revealed that the resident was admitted on 11/22/2008 with diagnoses that included chronic obstructive pulmonary disease, Hypertension, Diabetes, Hypothyroidism, Depression and Pneumonia. There were no wounds identified on the health assessment (1823) of 12/12/2008. Interview with the owner again revealed that the resident had gone to the hospital in the spring of 2009, possibly in June for respiratory issues, but there was no documentation of this in the file. There was no assessment when the resident returned to the facility. Further review of the record. revealed that there was no documentation of when the wounds developed or for Home Health to see the resident. There was a physician order dated 10/5/09 for "Granulex spray every 12 hours"; one dated 8/4/09 "“Granulex spray, apply both heels every 12 hours, dispense one can"; and an order dated 7/14/09 for "Granulex spray apply bilateral heels daily". The only indication that the resident was in hospital was there was a discharge sheet from the hospital dated 6/2/09 for congestive heart failure but did not include orders for any wounds. 10. An interview with the owner (also identified by her as being a Registered Nurse (RN)) at approximately 10:40 AM, who had come to the facility, revealed that this resident is seen by the nurse from home health and goes twice a week to the Wound Care Center. An interview with the Home Health nurse (RN) at approximately 10:50 AM via phone revealed she makes a visit to the facility two times a day to apply Granulex spray to each heel wound. She agreed that the heel wounds were necrotic with eschar tissue but were dry and had no drainage. She stated the pressure ulcers/wounds remain classified as unstageable and the resident will soon be seeing a vascular surgeon. 11. An interview with the ARNP (Advanced RN Practitioner) via phone at 11:15 AM revealed that the resident had bilateral unstageable heel wounds that had no open areas and appeared necrotic so was sent to the Wound Care Center (there were no wound care center notes to review). She was not sure how long the resident had the wounds but thought possible a couple of months. Review of the ARNP's notes located in a basket in the Administrator office, revealed documentation for 12/12/08 and 9/30/09 only. Review of the 12/12/08 notes, revealed that the resident had no wounds. Review of the 9/30/09 ARNP's notes revealed that she came to the facility to evaluate the resident and documented "resident with bilateral heel wounds, History of heel decubs in past...complains of pain in heels with ambulation. .laying flat in bed with heels elevated...bilateral heels with black caps, positive erythemia without discharge, skin pulling." Under the Impression/Diagnoses section, the ARNP documented: Bilateral unstageable heel wounds, orthostatic hypotension, DM II (diabetes); ...wound care center...". The owner could not locate any other notes for this resident in the basket or in the file. 12. An interview with the nurse in charge of the Home Health Agency (HHA) at approximately 12:15 PM revealed that the wounds were classified as being unstageable. Review of the ‘description of wounds' by NPUAP 2007 (National Pressure Ulcer Advisory Panel) faxed by the HHA revealed the following: "Unstageable: full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, brown) and/or eschar (tan, brown or black) in the wound bed.; "Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore the stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as ‘the body's natural (biological) cover' and should not be removed." 13. A review of the HHA nurse's notes, dated 6/4/09 included documentation that the resident went to the ER (emergency room) last week and had no changes on return. On 8/6/09, the HHA nurse documented "...continue to monitor skin prep applied to heels bilaterally, off load with pillows..."; On 10/18/09, the HHA nurse documented twice during the day: "Granulex heels with boots"; On 10/20/09, bilateral heels eschar/Granulex; On 10/21/09, nurse documented “hospital bed, pressure mattress, Granulex to heels bilateral, offload Boots". There was non-consistent documentation for twice a day visits. On 11/3/09, the HHA nurse documented "bilateral heels tender ~- eschar, 1+ edema right pedal/ankle, trace edema left pedal/ankle, pulses week, left heels 2.8 X 2.5; right heel 2.3 X 3.3". On 11/7/09, the last documentation for this resident by the nurse, revealed: AM: Eschar heels; and PM: vital signs and Granulex. 14. Further review of the documentation in the file, documentation provided by fax from the HHA during the survey, and provided by the facility revealed the following: there was no documentation in the file or on the observation notes for the resident by the facility of the wounds the resident had developed; No documentation of the improving or worsening of the heels wounds; there was non-consistent documentation of twice a day visits by the HHA nurse; there was no documentation when wounds initially developed of the notification to the physician or initial treatment orders; and no order in the file for HHA to provide services to the resident. 15. Based on the foregoing, Orchid Island Manor, LLC violated Rule 58A-5.0181(1)(j), Florida Administrative Code, a Class II deficiency, which carries, in this case, an assessed fine of $1,000.00. ‘ PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I. B. Assess an administrative fine of $1,000.00 against Orchid Island Manor, LLC on Count I pursuant to Section 429.19, Florida Statutes or revocation of the license. Cc. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2009). Specific options for administrative action are set out in the attached Flection of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. If YOU WANT TO HIRE AN ATTORNEY, you HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. Agency for Health Care Administration 8350 N. W. 52° Terrace Suite 103 Miami, Florida 33166 Copies furnished to: Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (Inter-office mail) Finance and Accounting Management and Revenue Unit, MS #14 Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Inter-office Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive, MS #30 Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Diane Lubrano, Administrator/Registered Agent, Orchid Island Manor, LLC, 1914 21°* Street, Vero Beach, Florida 32960, on Morel. 10 , 2010. Nelson E. 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Docket for Case No: 10-002834