: STATE OF FLORIDA | AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR. IEALTH CARE ADMINISTRATION, i Petitioner, . : vs. Case Nos. 2011000225 2011000228 WINTER GARDEN HEALTH CARE i ASSOCIATES, LLC d/b/a COLONIAL LAKES HEALTH CARE, Respondent. | ADMINISTRATIVE COMPLAINT COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Agency” or “Petitioner’), by and through the undersigned counsel, and files this Administrative Complaint against WINTER GARDEN HEALTH CARE ASSOCIATES, LLC d/b/a COLONIAL LAKES HEALTH CARE, (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2010), and alleges: NATURE OF THE ACTION ~ This is an action to change Respondent’s licensure status from Standard to Conditional . ‘commencing 12/02/10 and ending 01/02/11, and impose an administrative fine in the amount of : Two Thousand Five Hundred and No/100 ($2,500.00) Dollars based upon Respondent being cited for one (1) State Class II deficiency. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2010). 2. Venue lies pursuant to Florida Administrative Code R. 28-106,207. Filed March 22, 2011 11:07 AM Division of Administrative Hearings area el PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapters 400, Part II, and 408, Part Ii, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 180-bed nursing home, located at 15204 W. Colonial Dr., Winter Garden, FL 34787, and is licensed asa skithd nnrsing facility license number 1610096. 5. Respondent was at all times matetial hereto, a licensed nursing facility under the: licensing authority of the Agency, and was required to coraply with all applicable rules, and Statutes. COUNT I (Tag N201 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That pursuant to Florida law, “fajl licensees of ‘nursing home facilities shall adopt and make public a statement of the rights and iesponsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement ghall assure each resident the following: The right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; - planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency.” See § 400.022(1)(1), Fla. Stat. (2010). 8. That Florida law, within the Nurse Practice Act of Chapter 464, defines “Practice of professional nursing” to mean: Page 2 of 11 enforcement of applicable federal _ regulations, state.statutes.and rules governing skilled nursing __ “,.. the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: (a) The observation, assessment, nursing diagnosis, planning, intervention, and_evaluation_of_care;_health_teachingand_counseling_of the—ill,injured,_or ens ae infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others, (b) The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments. (c) The supervision and teaching of other personnel in the theory and performance of any of the acts described in this subsection. A professional nurse is responsible and accountable for making decisions that are based upon the individual's educational preparation and experience in nursing.” See § 464.003(20), Fla. Stat. (2009). - 9. That pursuant to Florida law, 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, See § 400.102(1), Florida Statutes (2009). 10. That on or about 12/02/10, the Agency completed a Complaint Investigation Survey (CCR No. 2010012435) of Respondent’s facility. ll. That based on staff and resident interviews and record reviews, Respondent failed or _ refused to ensure each resident’s pain was managed to attain or to maintain the highest practicable physical, mental, and psychosocial well-being in eonordanes with the comprehensive assessment and plan of care (hereafter “POC”) for two (2) of four (4) sampled residents, specifically Resident No. 2 and Resident No. 3, hereafter “R2” and “R3”. 12. That regarding R2: a. Record teview for R2 revealed the resident was admitted to Respondent’s facility on 11/25/10 at 4:30 PM with diagnoses of anxiety, weakness, and history of Guillain-Barre. Page 3 of 11 R2’s admitting physician orders, verified on 11/25/10 at 5 PM by the nurse practitioner, included Oxycontin 120 milligrams (mg.) extended release every twelve-(12}-hours_for_pain-and_Oxycodone_(Oxyir)_60_mg_every four_(4) hours as needed for pain. ° During an interview with Respondent’s Director of Nursing (hereafter “DON”) on 12/02/10 at 11:30 AM, Respondent's DON stated that: » i. Both medications required a written prescription or a phone call by the physician to the pharmacy before they could be filled and sent to Respondent’s facility for administration to R2; and ii, The nurse practitioner, who verified the medications and was on call for, . the attending, could not write a prescription for these Class 2 narcotics, Nurse’s notes on 11/25/10 at 5:00. PM indicated R2 denied any pain at this time. However, on 11/26/10 at 12:00 AM, nursing notes indicated R2 was “complaining of severe pain 9/10 in [gender noted] lower back radiates to both legs. Requested pain medications for which [gender noted] is aware (the physician) will be faxing Rx in the morning. Gave patient the option to be _ transfer to the ER, patient refused. Encouraged repositioning every 2 hours,” ~ Another nurses’ note on 11/26/10 at 1:33 PM revealed R2 was “resting in bed ~ resident complaining of severe pain - still waiting script from doctor for pain medication - MD contacted on 11/25/10 two times at approximately 5 PM and 8:30 PM. Doctor was also contacted today at approximately 10 AM and given orders and facility fax number - script still not received. Resident refused [gender noted] skin check due to severe pain.” Page 4 of 11 A teview of the medication administration records (hereafter “MAR”) for 11/25-26/2010 revealed R2’s pain assessment indicated s/he was experiencing . either-severe-or-moderate-pain-each shift. Further record review revealed no POC for pain management was developed until 11/29/10 - four (4) days after admission to Respondent’s facility; the only intervention listed on the POC was to ask about and/or observe for pain/discomfort when interacting with R2. , . , During an interview with Respondent's Assistant Director of Nursing (hereafter “DON”) on 12/02/10 at 11:00 AM,. Respondent’s DON revealed she was on call over the weekend and was not notified about lack of pain medication for R2, During an interview with Respondent’s DON on 12/02/10 at 1:45 PM, Respondent's DON stated she talked to the nurse responsible for R2’s care on 11/25/10 and that nurse stated she did not know she should have called the supervisor or the medical director to get help with obtaining the script. During an interview with Respondent’s Corporate Clinical. Liaison and Respondent’s Admissions Coordinator on 12/02/10 at 12:30 PM, both stated the standard practice for new admissions from hospitals is for a script to be sent for residents receiving schedule 2 medications. During an interview with Respondent’s DON on 12/02/10 at 11:30 AM, Respondent's DON agreed the first dose of Oxycodone was not given until 8:52 PM on 11/26/10, more than twenty-four (24) hours after R2 was admitted to Respondent’s facility. Page 5 of 11 Although R2 was given Xanax 1 mg. on 11/25/10 at 10:10 PM and on 11/26/10 at 9:52 AM and Restoril 15 mg. .on 11/25/10 at 9:00 PM for . insomnia, the-only-other-pain-medication-s/he_received-was_Ultram 100_mg. on 11/26/10 at 2:16 PM and at 6:29 PM, which R2 stated was totally ineffective. During an interview with R2 on 12/02/10 at 11:15 AM, R2 stated his/her concerns included the following: i. R2 stated s/he has been on pain management for six (6) years and needed his/her meds to control her pain; _ fi, R2 was in excruciating pain for first twenty-four (24) hours after admission to Respondent's facility until an order was obtained for Ultram, which did not help at all; iii, R2 has been on Oxycontin ER 120 mg. every (q)12 hours (h) and Oxycodon 60 mg q4h as needed for breakthrough pain; iv. R2 did not receive his/her pain medications until after 8:00 PM; and v. R2 stated s/he did not understand why a physician who was on call could ~ not be reached to obtain a script for the medications s/he needed. 13. That Regarding R3: a. Record review for R3 revealed R3 was admitted to Respondent’s facility on 11/19/10 at 8:30 PM with diagnoses of chronic pain and S/P lumbar abscess surgery. i. R3’s Admission Data collection and Initial Plan of Care, done 11/19/10 at the time of admission, indicated R3’s current pain intensity level was 7/10, with severe aching lower back which was intermittent and was relieved Page 6 of 11 with pain medication. (a) No care plan for pain management had been developed since R3 had -been-admitted-to Respondent’s facility 11/19/10; (b) The Cate Management Summary, done 11/30/10, indicated R3’s pain was not controlled but no care plan was developed to address this. . (c) R3’s physician order for MS Contin 90 mg. every twelve (12) hours was verified at 7:40 PM; a script was available on the clinic record. " A seview of the MAR revealed R3 did not receive his/her MS Contin dose . ordered at 9:00 PM. i. Documentation on the MAR indicated R3 did not receive the 9:00 PM dose of the pain medication because the medication was a new order and Respondent’s facility was awaiting delivery from the pharmacy. ii, A review of the medications available in the Emergency Drug Kit (hereafter “EDK”) revealed the medication was available in the EDK. iti. R3’s pain assessment on the 3-11 shift on 11/19/10 revealed R3 had severe pain in his/her back; further pain assessment on the 11-7 shift on 11/20/10 indicated s/he continued to have moderate pain in his/her back. iv. Nurses’ notes on 11/20/10 at 12:00 AM revealed the “resident in bed alert and crying for'severe pain in tumbar area, Morphine 90 mg. given from EDK.” Page 7 of 11 vy. Further nurses’ notes on 11/20/10 at 3:00 PM revealed R3 was quiet. Cc. During an interview with Respondent’s DON on 12/02/10 at 1:45 PM, - i. The nurse said the resident was drowsy and not complaining of pain, so she did not give the medication. ii. The decision not to give the medication was neither documented on the MAR nor was the physician notified of the resident being drowsy. iii, Respondent’s DON also stated the computer program for the MARs automatically times the pain assessment for 5:00 AM, 1:00 PM, and 9:00 PM and that assessment could have been documented at any time during the shift. iv. Respondent’s DON agreed that R3 should have received the medication at 9:00 PM, as ordered. 14. That the Agency determined these failures relate to the operation and maintenance of Respondent’s facility or to the personal cate of residents which is a deficiency the Agency considers have 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 and cited this deficient practice as a State Class I deficiency.! 15. That the above facts show, inter alia, that Respondent consistently failed or refused to provide pain medication timely to multiple residents in Respondent’s care, contrary to law. '©A class II deficiency is subject to a civil penalty of $2,500 for an isolated declency, $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 I 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.” See § 400.23(8)(b). Page 8 of 11 Respendent?s-DON stated-she-talked-to the nurse responsible for-R3’s-care,——________ 16. That the same constitutes grounds for an isolated State Class II deficiency violation as defined by law. WHEREFORE, the Ageney-secks-to-impose-an-administrative fine -in-the amount-of Two. Thousand Five Hundred and No/100 ($2,500.00) Dollars against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(b) and 400.102, Florida Statutes (2010). . co Il (Conditional Licensure 17. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I, Count II, and Count III of this Complaint as if fully set forth herein. 18. Based upon Respondent’s one (1) cited State Class II deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Florida Statutes (2010). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(7), Florida Statutes (2010) commencing 12/02/10 and ending 01/02/11. 1A Respectfully submitted this (8 day of February, 2011. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION The Sebring Building §25 Mitror Lake Dr. N., Suite 330 - St. Petersburg, Florida’33701 Thoynas F. Asbury, Esq. Fla/Bar No. 567523 Page 9 of 11 - DISPLAY OF LICENSE Pursuant to § 400.23(7)(d), Fla. Stat. (2010), Respondent shall post the most current license in a prominent-place-and-e-list-of the deficiencies-of the facility-shall_be_posted-in-a-_prominent-place———______ that is in clear and unobstructed public view at or near the place where residents are being admitted to that facility. Licensees receiving a conditional licensure status for a facility shall prepare, within ten (10) working days after receiving notice of deficiencies, a plan for correction of all deficiencies and shall submit the plan to the agency for approval. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney . in this matter. Specific options fot administrative action are set out in the attached.Election of Rights. All requests for hearing shall be made to the attention of: The.Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 412-3630. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Page 10 of 11 I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt No. 7010 0780 0001 9835 6908 on this (¥—- day of —+-————F ebruary,-2011to-Respondent, ATEN: _Corporation-Service-Company,Registered-Agent, 15204 ——_______ W. Colonial Dr., Winter Garden, FL 34787 and via U.S. Mail t spondent, ATTN: David P. Jones, Administrator, 15204 W. Colonial Dr., Winter Garden, F } | CERTIFICATE OF SERVICE Copies furnished to: | | ‘Colonial Lakes Health Care ‘| ATTN: David P. Jones, Administrator 15204 W. Colonial Dr. Winter Garden, FL 34787 (U.S, Mail) Agency Field Office Manager Colonial Lakes Health Care ATTN: Corporation. Company, Registered Agent 1201 Hays Street. Tallahassee, FL 32301-2525 U.S. Certified Mail) Thomas F, Asbury, Esq. Service ATTN: Theresa DeCanio (Interoffice) Senior Attorney Agency for Health Care Admin. 525 Mirror Lake Dr, 330 St. Petersburg, Florida 33701 Interoffice Page 11 of 11 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION — RE: WINTER GARDEN HEALTH CARE CASE Nos.: 2011000225 ASSOCIATES, LLC d/b/a COLONIAL 2011000228 | ______LAKBS: HEALTHCARE ELECTION OF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice ¢ of Intent to Impose a Late Fine or Administrative Complaint. Your Election of Rights must be returned by mail or by fax within 21 days of the day ‘you receive the attached Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. . If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes and Rule 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk ‘ 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Phone: (850) 412-3630 Fax: (850) 921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) I adwit to the allegations of facts and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by. giving up my tight to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) L admit to the allegations of facts contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. - OPTION THREE (3) I dispute the allegations of fact contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. } —7——— 28-106.2015, Florida-A diministrative- Code, which requires thatit- contain: PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any; 2. The file number of the proposed action; 3. A statement of when you received notice of the Agency’s proposed action; and 4. A Statement of all disputed issues of material fact. If there are none, you must state that there are none. Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees, License type: (ALF? nursing home? medical equipment? Other type?) Licensee Name: License number: Contact person: Name Title Address: Street and number City Zip Code Telephone No. Fax No, E-mail (optional) Thereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name: Title: ‘Page 2 of 2 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ‘ RICK SCOTT ELIZABETH DUDEK GOVERNOR INTERIM SECRETARY February 15, 2011 COLONIAL LAKES HEALTH CARE 15204 W COLONIAL DR WINTER GARDEN, FL 34787 Dear Administrator: The attached license with Certificate #16641 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 a status change to Conditional Sincerely, Agency for Health Care Administration Division of Health Quality Assurance Enclosure cc: Medicaid Contract Management 2727 Mahan Drive, MS#33 co Re CARE Visit AHCA online at Taltahassee, Florida 32308 Oe ARE antics ahca.myflorida.com fF www.FloridaGompareCare.gov . se pur ‘s suonepisel TLOZ/OS/TT “ALVG NOLLVYIdXa C1OZ/CO/CT “ALVC FALLOS Ada AONVHO SNLVIS SCH 08F “TV.LOL L8LvE Td ‘NACIVD UALNIM Ud TVINOTOO AM p07TST aaVO BLIVAH SHAVT TVINOTOO BuLMoyOy at ayerodo 0} pozuoyne SI sesuaOT] Sy} 5 epuoya Teg ‘oop zardeyD wy pezromne ‘uoNENsIUMEpY are Wea] 10] Aoussy “epuoy,l Jo ares ayy 4q pardope pur sopnr om uy parjdutos sey DTT ‘SALVIOOSSV JUVD HLTVEH NACAVD UALNIM tp WAYWOS 0} SE STEEL TINOH DNISUAN FONVUNSSV ALIIVNO HLTVdH JO NOISIAIG NOLLV&LSININGV SavV0 HLIVAH YOd AONHDV EPLIO],] JO 3381S *# ASNAOIT : # DLVOMWILED FLORIDA AGENCY FOR HEALTH CARE ADMINSTRATION. ELIZABETH DUDEK RICK SCOTT GOVERNOR INTERIM SECRETARY February 15, 2011 COLONIAL LAKES HEALTH CARE 15204 W COLONIAL DR WINTER GARDEN, FL 34787 Dear Administrator: The attached license with Certificate #16642 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 a status-change to Standard Sincerely, Lobde Oo Agency for Health Care Administration Division of Health Quality Assurance Enclosure cc: Medicaid Contract Management FLORIDA GOMPARE CARE Health Gare In the Sunshine ' 2727 Mahan Drive, MS#33 Tallahassee, Florida 32308 Y www.FloridaGompareCare.gov Visit AHCA online at ahea.myfiorida.com TIOCOC/TI “ALVG NOLLValdxa TIOC/CO/10 “LV AALLOS ATA AONVHO SNIVIs . 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Docket for Case No: 11-001509