oe » STATE OF FLORIDA *. a AGENCY FOR HEALTH CARE ADMINISTRATION. b=" gpaare OF RLORIDA; AGENCY FOR © “| ©). HEALTH CARE ADMINISTRATION, vs. - || 7... BLO SAND POINT, LLC, ao | "= d/bla SAND POINT SENIOR LIVING, | . Respondent. _. / i = " ADMINISTRATIVE COMPLAINT . COMES NOW: the STATE OF FLORIDA, AGENCY FOR HEALTH:GARE. ae | ADMINISTRATION (hereinafter “Petitioner” or “Agency”), by and through the undersigned ie counsel, and files this Administrative Complaint against BLC SAND POINT, LLC., db/a SAND~ “bel | | . POINT SENIOR LIVING (hereinafter “Respondent”), pursuant to Section § 120. 569. and Section § 120.57, Fla. Stat. (2009), and alleges*” | . : NATURE OF THE ACTION ‘| . This is an action to impose an administrative fine in the amount of one thousand dollaits ($1,000.00) based upon one (1) State Class II deficiency pursuant to Section § 429.192\(, Fla, 7 Stat, (2009) and the imposition ofa survey fee of five hundred. dollars ($500.00) pursuant to the ‘provisions of Section § 429.19(7), Fla. Stat. (2008) for a total si8esiment of one thousand five hundred dollars ($1,500.00). : JURISDICTION AND VENUE, 1, The Agency has jurisdiction pursuant to Section § 20: 42, Section § 120.60 and Chapters 408 Part I; and 429; Part I, Fla. Stat. nee ne Harrison Stréet, Titusville, Florida 432780, and is licensed as an ALF, license number 5758 ner a - : (hereafter “Facility”), 5. Respondent was at all times material hereto a licensed facility under the licensing authority-of the Agency, and was required to comply with all applicable rules and statutes, - “ COUNTI: 6. The Ageticy r re- alleges andi ‘incorporates paragraph ‘one (1) through five 6) asif fully set forth herein, - meee : 7. From February 24, 2010 through March-5, 2010, the Agency conducted a complaint ~ Eamapreee inspection CCR#2019000493 of Respondent’s facility, an assisted living facility with Limited” . | : Nursing Services (“LNS”). . a 8 Based on record review and interview, the facility failed to ‘provide care and services ee ‘appropriate to the néeds of 1 of 3 residents (#2) -who. developed multiple pressure" ioe. oe . Specifically, the facility’ failed i in its responsibilities regarding supervision and arrangentents for proper health care services as required by Rule S8A-5. 0182, Florida Administrative Code. . 9, Rule 58A-5.0182(1) requires: SUPERVISION, Facilities shall offer personal s supervision, as appropriate for each resident, including the following: () Daily observation by - designated staff of the a activities of the reside vil d emotional well-being of the individual. - a : - OD oc ae -@ Contacting the resident’s health care-provider and other appropriate’ party. ; : tote cs a such as the resident’ family; guardian, healtli care surrogate or-case manager if the Bee oe en - vr. resident exhibits. a. signific t change ; De ona - “thee ot (2) A weltten record, updated:as ‘needed, of any-~ signifiaat changes s defined . in in 58A- 5.0131(33), F:A.C., arly illnesses which resulted in medical attention, = ; major incidents, chatiges in the method of medication administration, or other Tn we changes which resulted-in the provision of addi onal services. ~ a document aresident’s skin integrity on admission and periodically thereafter, including when the resident returnéd from being hospitalized. It further required regular documentation of any changes i in condition on Skin Observation Forms and, if the Braden ~ score was 16 or less, prevention strategies had to be instigated. Resident #2 : Ws “Ar review of Resident W's Assisted Living Facility (ALF) Health Assessment Form _ (1823) dated November 26, 2008 indicated diagnoses | of Parkinson's disease, hypertension, dementia and weakness. The resident was independent eating, ‘needed supervision with ambulation, grooming, toileting and transferring and needed assistance with bathing and dressing and assistance with self-administration of medications. 12, On October 13, 2009, for Resident #2; ‘the Braden Scale for Predicting Pressure Sore Risk; a.skin observation form, indicated: ; . : Sensory Pereeption=2=Very Limited; Moisture Occasionally Moist; Activity=3= walks occasionally; Mobility=3 Slightly Limited; Nateition-2-Probably Tnadequate; “friction and shear=3= No apparent Problem. a ; The Total Braden, Score for Resident #2 was 16- - prevention strategies required The facility was awate that the resident needed attention to this problem. ition Form was signed by the nurse who completed the form, ‘The form ~ ._fintber stated: * “reviewed/personal service plan Snes as as indicated. ” The form was tobe sigted a Policy All residents should have documentation of. eis ieir. _esiodiclly thereafter. os panne saepee nine SENN = condition resulting i in increased caté needs over a period of two weeks, and upon return j . from hospital. If the Braden Scale score is 16 or less, prevention strategies should be identified by the Nurse and placed on the Personal Service Plan and review with : associates, . “4 ‘15. Despite its own policy, the facility continuously failed to asstire that} Prevention interventions were pati in ‘place to prevent the development of skin breakdown, These failures __ breakdown escalated. This reflects a lack on the part of the administrator to-supervise the continued appropriateness of the recident's placement in relation to the facility’s ability to meet ~ the resident’s health care needs as required by Rule 58A-5.01 82, Florida Administrative Gode. 16. Facility Notes documented: , oO i © 10/26/09 at 3 PM _- Resident observed on floor i in sitting position, unable to.recall how s/he fell,.friend witnessed fall and reports.i injury to head, complained of increased back Pain, Tight leg and.hip Pat. 911 called, resident taken to hospital. minor head i injury. ns ves * 11/4/09 at 10 PM - Staff informed this nurse of increased confusion ‘and need to ’ be toileted every 2 hours'and as needed. Wanders. . © 11/5/09 Orders for labs and urinalysis received. - “11/5/09 at 6:30 PM - Spoké to family member regarding increase in confusion and wandering. Family member has noticed a change this past week, will continue to monitor. oe 11/6/09 2 at 12:15 PM - Resident sleeping dnwing breakfast and lunch, ewtng lab . Orthopedic physician. Fax-sent to another physician for wheelchair due to- "increased difficulty with, ambulation: - mm , : >-A1/10/09 at 10 AM~ ‘Resident has: wheelchair available:.".. i 11/6/09 at 9:45 AM - * Resident unsteady on feet, confiused and neoded assistance with meal. ~~ eo 11/9/09 at 8:30 “AM « “Phone call from farnily member who stated s/he would like: an order for wheelchair for tesident. Resident refused to follow up with “~-more listless: ‘Resident had head-trauma on’ anne went to Eitiérgency Room <0. 0. (ER) and had a negative ER evaluation. Resident had significant confusion at baseline per staff and family. Discussed moving resident into Memory Care Unit rather than his/her independent apartment, Diagnoses: Failure to thrive, dementia, Parkinson's disease, lethargy/tialaise/fatigue and unspecified head injury. Discontinue Aricept due to lack of effect in advanced dementia. Weight in November 2009 was 150, resident was on Boost. . 11/12/09 - Moved to memory care unit,’ 11/21/09 - 11-7.AM noted bruise to resident's right thigh, unsure of origin, voicéd’”: no complaints. At-10 PM - Refused to get in bed, sleeping i in recliner with feet elevated. 11/22/09 at 9.AM - Bruising to-back of enitire right thigh remains, color is dark purple, no,change in resident's mobility, but does-complain of pain. - 11/23/09 at 7:15 AM - Bruise to right thigh dark purple. . 11/24/09 at 2:25 PM - Continues to have bruise on right thigh/groin. Has no _complaints. Physical therapy (PT) here and resident participated in therapy. 11/25/09 at 2:38 PM - Continues with bruise to Tight thigh/groin, no complaint, PT here. 11/26/09 at 12:15 PM - Bruising remmairis’ on right thigh/groin area, no complaints voiced. 1 PM + While toileting the resident, the aides observed a red/firm area on coccyx approximately the size of a half dollar, area blanchable but sore. Will ask therapy to start nursing visits. 11/26/09 at 7:50 PM-- Bruising to right thigh from behind right knee up to right buttocks going into groin area. Discolored black/blue and red areas.:Physician ~ notified, orders received for x-ray right knee and hip. Area remains red on coceyxe 2... en 11/27/09 at 9:30 AM spoke to therapy regarding nursing services for red area to eoccyx, x-rays negative for fractures, ow 10:42:AM - Bruising to thigh and groin area, no complaints. "12:15 PM - No nursing services at this time per therapy. -®° 12:30 PM.- Therapy with resident, repositioned after, due to. red coceyx. | * 2PM - Therapy requested xray left hip. 7: _. A review of the 11/27/09 Medication Observation: Records (MOR) noted that, at 9:00 AM, ‘the attending physio ordered Zine Oxide ointment for red: area on: Coccyx every oe 30°PM 2x: Tay: ‘egative... . cents ~ 8 PM.- area.to buttocks now Open, treatment in ‘progress,- s,-will, obtain home. wee _ health order on Monday (ql 1730/09), limit out of bed time. 18. The MOR was blank (for Zinc Oxide) on 11/28/09 at 8 AM, 2 PM and 10 PM, no initials ° in the box, © 19. On 11/25/09, the nurses’ ’ documentation ‘was limited to: 10:45 AM- “Resident out of bed at this time, treatment applied, will x return to bed by: 2 PM and keep side to side #...6:30 PM» on right side, ane 08: 30, PM - Resident répositionéd with draw sheet, an * On the MOR: “Zine Oxide ointment to coccyx every shift until healed at 6 AM, 2PM and 10 PM” was still noted, However, at 6 AM-and 10 PM the. initials were circled, An initial Al appeared in the box for 2 PM. — 20.5 On 11/30/09 ‘at 9: 30 AM, facility notes indicate that the physician ordered Home Health™ to treat the large open pressure ulcer on resident’s coceyx. 21. The MOR c on nl 1/30/09 continued to reflect that Zine Oxide be applied to resident's covey every shift a at 6 AM, 2 PM and 10 PM until healed: Yet, the MOR was blank for 2PM... seit ‘with no initials i in the box. ‘The nutse’s initials were circled. for 6 AM and 10 PM. The back of a the MOR did not explain the failure to poly the ointment on 11/21, 11/28 and 11/29/09 except , to say that Zinc Oxide: was 8 ot available from the phasmnacy There ‘was no documentation to indicate the physician was n notified about this. The failure t apply Zine Oxide to o the resident’s © covey continued trough December 3, 2009 when the Zine Oxide treatment was discontinued The back of the MOR reflected: 12/1, "Zine Oint not on, hot available,” 122; " Zine. ointment not on; 12/3 unable’ to. Jocate Zinc oint:* 2 . 23,7 “Al review w of turning schedule. dated. 1 13 709. tough 12 15/09 revealed the: facility .. arted the resident was reposiisiie. every. hots around the clock However, before 1 1728/09 no 10 documentation indicated that: the he fact had repositioned the resident, put any. interventions _ in in place for repositioning or pressure relict [such as] a wheelchair cushion: or heel protectors to” ae ees prevent skin breakdown. : 24, - On 12/1/09, the physician ordered: Home Health:Care Vitamin C (for wound healing) 500 milligrams (mg) daily Zinc Sulfate (for wound, healing) 220-mg-daily and -. net protein powder (for wound healing) - 2 scoops three times a day in 4 oz. milk or juice. . BS. A 12/1/09 Physician follow-up note stated: i Cees cae Noted a a , coceygeal ulcer formed and is now ins service with the Home Healthcare — - Agency utilized by the facility for ongoing dressing changes. The staff in the facility will continue to turn from side to side in an effort to heal the lesion:“The “yésident has'remained with a decreased level of consciousness, which may be his/her baseline. . 26. Home Health Cate was in to evaluate on.12/2/09 at 2:24 PM and noted it would request _ an.order for the resident to be treated at a wound care clinic. They documented pressure ulcers ai on resident’s feet. Pressure ulcer stage II to low back. A Plan of Care was implemented for ns trough 1/3 of 10. The 12/2/09 HEC Comprehensive Adult Assessment documented integumentary status for pressure ulcers and stages as: one stage 1, two stage. III's and one stage Iv. Wound ; measurements included: a) "Coccyx 5 centimeters (om) x 3 om, s IL, eddehed ae -b) Left buttocks 5 em x 2 cmyno drainage, covered with eschar. (unstageable) ieee _. ©) Left heel - blister - purple, not open, no measurements ~~ ee =) Right he heel - ‘blister, purple, n not He ie “no: meagurements, 29, On 4214/09, a review of the Hospice Comprehensive Assessmeit revealed the. resident wewwas unable to-walk, ‘bedbound, confused; total care, and with, “pressure ulcers on the. coccyx and co bilateral heels x4, Areview of the Hospice Apptopriate Evaluation the same day cited the i __ reason for the referral was increased lethargy, increased sleeping, pressure wounds x 3 (above stated 4) refusal to eat, It noted the resident suffered neuromuscular disease, sttoke/coma and ) -chronic Dementi/Alzhelmer'/Cerebrel degeneration: : . » . pete tees 30., A 12/4/09 review of the Wound Information Progress Report noted: OT cae - -S Wound #1 on’ ‘Bice wr was 5X £2 xe (centimeters or millimeters no stated), ‘s stage 2° ; “” pressure, surrounding skin had edema and erythema, wound tissue 10% slough, , 90% granulation, minimal serous drainage with no odor. . ¢ Wound #2 on coccyx was 5 x 3 x 6, stage 3 pressure with black eschar, oo om surrounding skin had edema, erythema.and was macerated. The wound tissue was : 10% slough, 10% necrotic: and 80% granulation with scant serous 18 drainage and no odor. e Wound #3 on right heel was $1. 2 x 1.0 inches, stage 2 pressure with edema, erythema and black maceration. The wouid tissue was 10% slough, 10% necrotic and 80% granulation with scant serous drainage with no odor. . © Wound #4 on left heel was 1.25 x 1 inches, stage 2 pressure with edema, a . . erythema and black maceration. The wound tissue was 10% slough, 10% necrotic, and 80 % granulation . ° _ Woundeare performed by Hospice. paso v9 aa nears cron 31.» At7:30 PM. on 12/4/90, the facility noted: “Hospice m nurse will be here 12/5/09, will nin os heel pistectors, hospital bed and side rails, Ait mattress in use. Family will pick up bed as soon as possible. ” Based on record review, the Resident was receiving Hosples ¢ Care by, December 11, o “2009. and thereatter, er, clearly the facility failed in its duty to prevent these sores from - a delivered from Hospice and now in’ place Hospice changed duoderm, on coceyx. “ordered, Heal protectors ad-air mattress i in-use.” “11 PM- ‘medicated for pain? * 33. “At 8: 15 AM on 12/1 109, the facility noted! “Phione call to ) Hospice, waiting for nurse ‘to: » sondition of coceye: wound and Hospice’ s instruction. 32: At 2 PM on 12/5/09, the~ facility noted: “Resident continues on turning schedule, heel ysician catled fox sttonger pain medications.’ “7: 301 M - Lortab (rarctio pain reliever) - vo doa . call ‘back regarding coveyx: -wound draining. copius amount. of. purulent discharges hew Allevyn: dressing had to be. applied in AM, Also note approximate size of pencil eraser-noted on far right edge of wound. Hospice stated to apply new Allevyn dressings as needed and continue turning, , Hospice will come on 12/14/09 to reassess.” “2 PM - Executive Director notified of change in 13, The facility provided wound care for 12/11 and 12/ 12/09. The resident should have been ~ On limited nursing services for those two days. However, the Wwourid Care was not charted as | . .. done. 14.. On 12/42/09, the facility noied: “Coccyx wound has large areas of éschar in middle of wound. Wound draining large amounts of smelly foul drainage. Patient in pain upon turning and also lying still.” “10:30 (AM or PM not noted) - Wound soaking through dressing quickly, Temperature 100.4 orally, Hospice changed dressing.” ‘15. There was no documentation that the facility nurse followed d Hospice instructions between 12/ 11/09 at's: 15 ‘AM and12/ 12/09 at 10:30 (AM or PM: not noted) when Hospice “~~ arived, for a wound that had copious amounts of drainage. Interviews with 3 facility nurses on nay 10 at t approximately 3: 00 PM revealed none had any information a as to whether the: ; treatments had been done. sf the facility noted M Roxana Coatote for mai) ordered. ‘ pean on _ #6 PM - Lortab (narcotic for-pain) given around the clock. = . aan a “10 PM - Continued to have foul odor to to drainage. Temperature, 98. 6 vallay On 12/15/09 at-1:05 PM=the” aly notéd: “=D wil be decusing al alternative ibe sain As ne! with fail, either hospital’ or nursing home.” 19, On 12/16/09 at 8:10 AM, the facility n noted: “Discontinue Hospice services, s, physician order to admit resident to hospital.” 20. Interview with the licensed n nurse #1 on said date at about 3 PM who stated, “The a | resident rnoved inside as s s/he adedied nore care. S/he had: asore on his/her coccyx, I think from. "Poor nutrition, then had sores on the heels, s/he- stopped eating, we tuned her every 2 2 ‘hours and ose ee ements “yeferred him/her to hospice.” " 21. Interview on said date at about 3: 30 PM on 2/24/09 with the Health and Wellness Director who stated she had worked i in the facility a few weeks and ‘was not employed when resident #2 was at the ALF. . _ . | ' 22. The above facts show, inter alia, that Respondent consistently failed or refused to provide care and services appropriate to the needs of residents accepted for admission to the oo facility, which is a deficient practice placing residents at great risk of not receiving proper care, — 23... The above reflect Respondent's failure to provide cate and ; services in accotd with the physician and hospice? 8 orders for repositioning to prevent pressure on the ulcers that were | forming and for wound care... Gy 49. The Ageney deterinined that this deficient practice was related to the operation and... - the physical or emotional health, safety, or security: -of the Facility residents, Bat 50, 429.1 3(2)0) Florida Statutes (2008). od maintenance-of the Facility, or to the personal care of Facility residents, and directly threatened--- + The Agency: ited the Respondent fora Class, I violati 0 in accordance with Section ; WHEREFORE, the Agency intends to: impose ‘ar administative fine i in the amount of o ‘one- a - “thousand dollars (81, 000. .00); against Respondent, an ALF i in the State of Florida, pursuant to. Section 429.19(2)(b), Florida Statutes (2009). COUNT. - 51. The Agency re-alleges and i incorporates the entirely of this s complaint as if fully set forth herein. 52, . . Pursuant to Section 3 409, 1975; Fla. Stat. (2009), “{ijn addition to any administrative fines imposed, the agency may assess a survey fee, equal to the lesser. of one half of the facility's . biennial license and bed fee or $500, to cover the cost of conducting initial complaint investigations that result in the finding ofa violation that. was the subject of the complaint ore monitoring visits conducted under Ss. 429.283)() to verify the correction of the violations,” _ 53. ° From February 24, 2010 through March 5, 2010, the Agency conducted a complaint inspection CCR#2019000493 of Respondent’ s facitity that resulted in violations that are the subject of the complaint to the Agency. 54. Pursuant to Section § 429. 19(7), Fla: Stat. (2009), such a finding subjects the 1e Respondent tp a survey fee equal ty to the esse of o one hale of the Respondent's biennial Hicense and bed fee or . : five hundred dollars (8500. 00). 55. Respondent is therefore subject. to a a complaint survey fe of five hundred dollars ($500, 00); pursuant to Section : #29. 5190 Fla. Stat 2009), * Respondent: is notified that it has a a right: toreqi 569, Florida Statur Respond has" the tight delivered to-Agency Clerk, Agency for. Health Care Administra "#3, MS #3; Tallahassee, FL 32308; Telephone (85 0) 922-5873. $ Administato Drive, Bldg... RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE.TO REQUEST 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. ~ CERTIFICATE OF SERVICE THEREBY CERTIFY that a tme and correct, Copy « of the foregoing Administrative oe Complaint has been served by U. 8, Certified Mail, Return Receipt No. 7008 0500 000i 9560. 8735 to CT Coxporation System, Registered Agent, 1200 South Pine Island Road, Plantation, F FL 33324 and by US ‘mail to Michelle Tersigni, kN Sand Point Senior Living, 1800 “Harrison Street, Titusville, Florida 32780, this. 30 "4 day of November, 2010. STATE OF FLORIDA, AGENCY FOR —_ HEALTHCARE ADMINISTRATION The Sebring Building 525 Mirror Lake Dr. N., Suite 3301. ~ St. Petersburg; Florida.33701 : . Telephone: (727) 552-1945 |... O. Faosirniler (727) 552-1440 io? Co Registered Agent. . Manor, Care-Nursing & Rehab -- : 1200. § Sout “Pine. TbLavid’ ‘Read xation syatam J} COMPLETE TI “TION ON DELIVERY ofttie malls, cs ; armits:: oe Bethe wenn ee . _ aftitain. see io igh

Docket for Case No: 10-010887

Orders for Case No: 10-010887