7 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2010009185 (Fine) 2010009186 (Cond.) CAPITAL HEALTH CARE ASSOCIATES, LLC, d/b/a CAPITAL HEALTHCARE CENTER, Respondent / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (“Agency”), by and through the undersigned counsel, and files this Administrative Complaint against Capital Health Care Associates, LLC, d/b/a Capital Healthcare Center (“Respondent”), pursuant to sections 120.569 and 120.57, Florida Statutes (2010), and alleges: NATURE OF THE ACTION This is an action against a skilled nursing facility to impose an administrative fine in the amount of $2,500.00, based upon one Class II deficiency and to impose conditional licensure status commencing August 19, 2010. JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2010). 2. The Agency has jurisdiction over the Respondent pursuant to Section 20.42 and Chapter 120, and Chapter 400, Part I, and Chapter 408, Part II, Florida Statutes (2010). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. Filed November 16,-2010 11:36 AM Division of Administrative Hearings PARTIES 4. The Agency is the licensing and regulatory authority that oversees skilled nursing facilities, more commonly referred to as nursing homes, in Florida and enforces the applicable federal regulations and state statutes and rules governing such facilities. Chs. 408, Part IJ, 400, Part H, Fla. Stat. (2010); and-Ch. 59A-4, Fla. Admin. Code. The Agency is authorized to deny an application for licensure, revoke or suspend a license, and impose an administrative fine for a violation of the Health Care Licensing Procedures Act, the authorizing statutes or the applicable rules. §§ 408.813, 408.815, 400.121, 400.23. Fla. Stat. (2010). In addition, the Agency may impose an additional six-month survey cycle fine for certain classes of violations that take place within a specified period of time, assign conditional licensure status, and assess costs related to the investigation and prosecution of this case. §§ 400.19(3), 400.23(7), 400.121(8), Fla. Stat. (2010). 5. The Respondent was issued a license (License Number 1073096) by the Agency to operate a 156-bed skilled nursing facility located at 3333 Capital Medical Blvd., Tallahassee, Florida 32308, and was at all times material required to comply with the applicable statutes and rules relating to skilled nursing facilities. COUNT I 6. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 7. Under Florida law, in addition to the grounds listed in part II of chapter 408, any of the following conditions shall be grounds for action by the Agency against a licensee: an intentional or negligent act materially affecting the health or safety of residents of the facility shall be grounds for action by the agency against a licensee. § 400.102(1), Fla. Stat. (2010). 8. That from August 16, 2010 through August 19, 2010, the Agency concluded an unannounced annual licensure survey of the Respondent’s facility. 9. That based on record reviews, observations and interviews the facility failed to provide 2 of 5 sampled residents in the Stage II care area of nutrition (#22, 182) a therapeutic diet to maintain acceptable parameters of nutrition resulting in significant weight loss for both residents. Resident #182 10. That resident #182 was admitted in April 2010 with a percutaneous enteral gastrostomy (PEG) tube. The resident’s weight on admission was 136.8 lbs. The resident was receiving the following formula via the feeding tube. Jevity 1.2 at 70 cubic centimeters (cc) per hour times (x) 20 hours(hr). Tube feeding (TF) is to be off at 10 AM and started again at 2 PM: 11. That the dietary note of 4/13/10 indicated, Jevity 1.2 at 70 cc provides 1680 Keals, approximately 78 grams (g) of protein, and 1300 ce of water (H20), will flush with 30 cc before (ac) and after (pc) medications and 75 cc every (q) 4 hours (h) for a total of 1880cc H20. Estimated needs for resident is approximately 1575, 62-74g protein, and 1860 fluids. 12. That a review of the resident's weight was as follows: 4/12/10-137 pounds (#) 5/1/10--128# 6/1/10--130# 7/13/10--116# 8/1/10--116# 8/17/10--112.2# 13. That the dietary note of 7/6/10 indicated the following: " Weight(wt)/Tube Feeding (TF) review-current weight 121# down from 130# in June. Resident continues to receive Jevity 1.2 at 70cc/hr times (X) 20 hours which is adequate to meet resident needs. Wiil recommend weekly weights for resident and monitor, if weight continues to drop will make change to TF. " 14. That a record review indicated weekly weights were started on 7/13/10--116#, 7/2.0/10--138# and 7/27/10--116. 15. That an interview with the restorative nurse on 8/18/10 at approximately 3:15 PM’ indicated she questioned the weight of 138# on 7/20/10 and immediately re-weighed the resident with a weight of 137.5# obtained, there was no re-weigh following the weight of 116# one week later. 16. That an interview with the Registered Dietician on 8/18/10 at 1:30 PM, indicated once a significant weight loss has occurred she makes recommendations to monitor weight weekly and monitors the resident weekly, She indicates there should be a note each time a review is completed. 17. That there was no weekly review by the dietician following the recommendation on 7/6/10, . 18. That the next dietary note was entered on 8/6/10, at which time the dietician identified a 9.38% weight loss in 3 months and recommended to change the formula to Jevity 1.5 at 70 cc times 20 hours. This would provide 2100 Keal, 90g protein, and 1064 H20. 19. That the dietary note of 8/17/10 indicated the following "current weight was 112.3# down from 116 # on 8/1/10. No change to TF since last review, was increased to Jevity 1.5 at 70 cc/hr x 20 hr. Spoke with nursing who said resident isn't always back from therapy in time to be hooked back up at scheduled time. Spoke with therapy who said they will try to get resident back in time. 4 Will continue to monitor weights. " 20. That an interview with the Occupational Therapist (OT) on 8/18/10 at 10:15 AM indicated she sees the resident in the afternoon always after lunch but on no set time. 21. That an interview with UM on 8/18/10 at 10: 20 AM indicated resident #182 is losing weight and we discussed therapy time and will monitor to see if therapy gets him back on time to reconnect tube feeding as scheduled. Interview with staff nurse on 8/18/10 at approximately 11AM, who provides medications indicated the resident's tube feeding is reconnected when s/he gets back from therapy. Maybe not at 2 PM but is reconnected by the end of my shift (3 PM). 22, That an interview with the Dietician on 8/18/10 at 4PM, indicated she thought the weight loss was because the resident's tube feeding was not reconnected timely following therapy. She admitted she had not recalculated the residents needs following the weight loss, nor did she make a further recommendation for a change in formula or rate following the first weight loss from 6/10 to 7/10, 23. That observations on 8/17/ 10 at 2:15 PM indicated the resident was in bed with the tube feeding of Jevity 1.5 infusing at 70cc per hour as ordered. Additional observation on 8/18/10 at 8:40 AM and 2:15 PM indicted the tube feeding was infusing as ordered, Resident #22 24, Thata record review for sampled resident #22 revealed the resident was originally admitted to the facility on 10/29/2009. The resident suffers with vascular dementia, diabetes, hypertension and a stroke. 25. That a record review of the dietician progress notes for 06/08/2010 revealed the resident's weight was down 11.4 pounds for one month and triggered for significant weight loss for one month; current weight is well above ideal body weight range and some weight loss would be beneficial. 26. - That the dietician recommended fortified foods with lunch and dinner meals and 90 milliliters of medication pass (liquid nutritional supplement) three times a day with a goal of preventing further significant weight loss, as an interview with the resident revealed s/he did not " want to loss anymore weight. 27. That a continued review of the resident's chart failed to reveal where these recommendations were implemented. : 28. That an interview with the dietician on 08/18/2010 at approximately 1:57 PM revealed s/he just discovered the 06/08/2010 recommendation for the fortified meals and medication pass was given to the wrong facility Unit and the resident never received the fortified meals and medication pass to possibly prevent further weight loss. 29, That a continued record review revealed the dietician assessed the resident's nutritional needs on 07/16 and 07/20/2010 with no new recommendations as weight was stable and some weight loss would be beneficial. 30. That a review of the dietician progress note for 08/06/2010 revealed the resident's weight down from 181 pounds to 177 pounds again a recommendation of fortified foods at meals and a new recommendation of large portions at lunch and dinner meals with a goal of preventing further weight loss. 31, That a record review of the physician's orders for 08/06/2010 revealed an order for fortified foods at meals and large portions at lunch and dinner. 32. . That an observation on 08/17/2010 at 5:44PM revealed the resident was served regular portions of potato salad, one whole ham/cheese sandwich, one piece of cake for dessert, _ one carton of 2 percent reduced fat milk, one bowl of vegetable soup, crackers, and tea. 33. That a review of the resident's dinner meal ticket revealed no indication of large portions at lunch and supper and no indication for fortified foods at meals. 34, That an observation on 08/18/2010 at 8:38AM revealed the resident ate all of the breakfast served, of eggs, grits and half piece of toast. Review of the breakfast meal ticket failed to reveal any indication for fortified foods at meals. 35, That an observation on 08/18/2010 at 12:20 revealed the resident was served beets, potatoes, one piece fried chicken, strawberries, milk, tea, water, one slice spiced apple ring, and one roll. 36. That an observation of the resident's meal ticket for this meal failed to reveal any indication for large portions or fortified foods at this meal. 37. That an interview with the dietician on 08/ 18/2010 at 12:55PM revealed the resident should be receiving large portions of food at lunch and dinner meals and fortified foods at meals. 38. That the surveyor and dietician made an observation of the resident's current lunch tray at this time and the resident's meal ticket revealed the resident is not currently receiving these fortified foods or large portions. 39. That an interview revealed the dietician writes the recommendation; the nurses write the physician orders and send the new recommendations to the dietary department who then implement the new orders. 40. That a continued interview with the dietician revealed after she researched these issues it was discovered there was a miscommunication and nursing did not write the recommendation to send to dietary so that the resident would get the large portions and fortified foods. 41. That the dietician confirmed that the resident had not been receiving the large portions at lunch and dinner and was not receiving the fortified foods at meals either since the physician order of 08/06/2010. 42. That the dietician stated the weight loss was beneficial but had a goal of preventing further weight loss. 43’ That the dietician informed the surveyor the resident would now be receiving the fortified foods and large portions at Junch and dinner. Sanctions 44. The Respondent’s actions or inactions constituted an isolated Class II deficiency. 45, _ Acclass II deficiency is a deficiency that the Agency determines has compromised the resident's ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. § 400.23(8)(b), Fla. Stat. (2010). 46. A class II deficiency is subject to a civil penalty of $2,500 for an isolated: deficiency, $5,000 for a patterned deficiency, and $7,500 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more “class T or class II deficiencies during the last licensure inspection or any inspection or complaint investigation since ‘the last licensure inspection. A fine shall be levied notwithstanding the correction of the deficiency. § 400.23(8)(b), Fla. Stat. (2010), 47, In this instance, the Agency is seeking a fine in the amount of two thousand five hundred dollars ($2,500), as an isolated Class II deficiency. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of $2,500.00. COUNT 48. The Agency re-alleges and incorporates by reference paragraphs 1 through 47. 49. A conditional licensure status means that a Facility, due to the presence of one or more class I or class II deficiéncies, or class III deficiencies not comected within the time established by the Agency, was not in substantial compliance at the time of the survey with criteria established under this part or with rules adopted by the Agency. If the Facility has no class I, class II, or class III deficiencies at the time of the follow-up survey, a standard licensure status may be assigned. § 400.23(7)(b), Fla. Stat. (2010). 50. Due to the presence of one or more state class II deficiencies, or class UI deficiencies not corrected within the time established by the Agency, the Respondent was not in substantial compliance at the time of the survey with criteria established under Chapter 400, Part II, Florida Statutes, or the rules adopted by the Agency. As a result of this deficiency, the Respondent was subject it the assignment of a conditional licensure status. The Agency issued the Respondent a conditional license with an action effective date of . August 19, 2010. A copy of the original certificate is attached as Exhibit A. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to assign a conditional licensure status on the Respondent as set forth above. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests a final order that: 1. Makes findings of fact and conclusions of law in favor of the Agency. 2. Imposes the above-referenced relief sought by the Agency. 3. Enters any other relief that is just and appropriate. Respectfully submitted this AX !) day of October, 2010. D. Carlton Enfinger, II, E V Florida Bar No. 793450 |’ Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Telephone: 850.412-3640 Facsimile: 850.921.0158 The Respondent has the right to request a hearing to be conducted in accordance with Sections 120.569 and 120.57, Florida Statutes, and to be represented by counset or other - qualified representative. Specific options for the administrative action are set out within the attached Election of Rights form. The Respondent is further notified if the Election of Rights form 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. The Election of Rights form shall be made to the Agency for Health Care Administration and. delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served to: 10 Thomas L. McDaniel, Administrator, Capital Healthcare Center, 3333 Capital Medical Blvd., Tallahassee, Florida 32308, by U.S. Certified Mail, Return Receipt No. 7001 0360 0003 3808 3031, and Anna Small, Esq. and Ramona Thomas, Esq., Broad and Cassel, Counsels for , Respondent, at 215 South Monroe Street, Suite 400, Tallahassee, FL 32301 by email on this af) day of October, 2010: D. Carlton Enfinger, I, tag

Docket for Case No: 10-010225