a STATE OF FLORIDA : AGENCY FOR HEALTH CARE ADMINISTRATION . STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos.: 2011006254 . 2011006252 LAKESHORE LIVING, INC., : Respondent. f ADMINISTRATIVE COMPLAINT. COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Petitioner” or “Agency”), by and through the undersigned , counsel, and files this Administrative Complaint against Lakeshore Living, Inc. (hereinafter “Respondent”), pursuant to Section § 120.569 and Section § 120.57, Fla. Stat. (2010), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of three thousand dollars ($3,000.00) based upon three (3) State Class II deficiencies pursuant to Section § 429.19(2)(b), Fla. Stat. (2010) and the imposition of a survey fee of five hundred dollars ($500.00) pursuant to the provisions of Section § 429.19(7), Fla, Stat. (2010) for a total assessment of three thousand five hundred dollars ($3,500.00). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Section § 20.42, Section § 120.60 and Chapters 408, Part II, and 429, Part I, Fla. Stat. (2010). 2. Venue lies pursuant to Florida Administrative Code Rule 28-106.207. Filed September 29, 2011 2:36 PM Division of Administrative Hearings PARTIES 3, . The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part II, and 429, Part I, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. 4, Respondent operates a 10-bed assisted living facility (hereafter “ALF”) located at 10919. Mistletoe Drive, Thonotosassa, FL 33592, and is licensed as an ALF, license number 10832. 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. COUNT I - tag A429 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 7. Regarding admissions to an assisted living facility and residency, there are particular procedures and documentation required for the protection of the residents: Records. The facility shall maintain the following written records in a form, place and system ordinarily employed in good business practice and accessible to...Agency staff: FACILITY RECORDS. Facility records shall include an up-to-date admission and discharge log listing the names of all residents and each resident’s: 1, Date of admission, the place from which the resident was admitted, and if applicable, a notation the resident was admitted with a stage 2 pressure sore; and 2. ' Date of discharge, the reason for discharge, and the identification of the facility to which the resident is discharged or home address, or if the person is deceased, the date of death. Fla. Admin. R. 58A-5.024(1)(b) 1 STAGING OF DECUBITUS ULCERS: Stage I: Intact skin...; its color may differ from surrounding area. Stage II: Partial-thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater. — from Fundamentals of Nursing, Classification of Pressure Ulcers, p. 1282 7 Ed. Lippincott, 2009) 2 aK RESIDENT RECORDS. Resident records shall be maintained on the premises and include: (b) A copy of the medical examination described in Rule 58A-5.0181, F.A.C. Fla, Admin, R. 58A-5.024(3)(b) Ona ADMISSION CRITERIA. An individual must meet the following minimum criteria in order to be admitted to the facility holding standard, limited nursing or limited mental health license: (i) Not be bedridden. (j). Not have any stage 3 or 4 pressure sores. A resident requiring care of a stage 2 pressure sore may be admitted provided that: 1. The facility ‘has a LNS license? and services are provided pursuant to a plan of care issued by a physician, or the resident contracts directly with a licensed home health agency or a nurse to provide care; 2. The condition is documented in the resident’s record; and 3. If the resident’s condition fails to impréve within 30 days, as documented by a licensed nurse or physician, the resident shall be discharged from the facility. Fla. Admin. R. 58A-5.0181 2G ae CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (e) of this subsection, criteria for continued residency in any licensed facility shall be the same as the criteria for admission. As part of the continued residency criteria, a resident must have a face-to-face medical examination by a licensed health care provider at least every 3 years after the initial assessment, or after a significant change, whichever comes first. A significant change is defined in Rule 58A-5.0131, FA.C? The results of the examination must be recorded on AHCA Form 1823, which is incorporated by reference in paragraph (2)(b) of this rule. The form must be completed in accordance with that paragraph. After the effective date of this rule, providers shall have up to 12 months to comply with this requirement. (a) The resident may be bedridden for up to 7 consecutive days. ? Limited Nursing Services. * DEFINITIONS: A Stage I ulcer is a “significant change.” Fla, Admin. R..58A-5.0131 3 8. a ~~ (b) A resident requiring care of a stage 2 pressure sore may be retained provided that: 1. The facility has a LNS license and services are provided pursuant to a plan of care issued by a licensed health care provider, or the resident contracts directly with a licensed home health agency or a nurse to provide care; 2, The condition is documented in the resident’s record; and 3. Ifthe resident’s condition fails to improve within 30 days, as documented by a licensed health care provider, the resident shall be discharged from the facility. , (a) The administrator is responsible for monitoring the continued appropriateness of placement of a resident in the facility (emphasis supplied). Fla, Admin. R. 58A-5.0181(4) On May 5, 201 1, the Agency conducted a complaint inspection, CCR #2011002016, of Respondent’s facility, an assisted living facility, and found the facility out of compliance with the above Rules. 9. Based on review and interview with the administrator, the administrator failed to observe and determine the appropriateness of placement for a resident. Findings included: Four resident's records were reviewed. During a 10:00 AM interview, the re administrator admitted that Resident #2 was readmitted from a local hospital with multiple decubitus ulcers. The facility holds a standard license and does not have an LNS license. The decubitus ulcers rendered the resident inappropriate for readmission. Home Health care was ordered by the resident’s physician to consult and evaluate the decubitus ulcers, However, little was documented. There was no documentation regarding the stages of the resident’s ulcers. As the resident’s condition declined, his physician recommended hospice. The family refused. The resident should have been discharged the moment that a Class Il ulcer was identified. The administrator did not obtain the required medical evaluation at re-admission, kept the resident after Stage II decubitus ulcers were present despite the facility’s lack of a license to do so, did not require appropriate documentation or staging of the ulcers and, thus, did not monitor the continued appropriateness of placement for Resident #2. do. _. When the resident deteriorated and the wounds finally required hospitalization, Resident #2 was transferred to a hospital where the two of the wounds were classed as Stage IV. He then went to a skilled nursing facility where he passed away. 10. The above facts demonstrate that the facility administrator failed to monitor the appropriateness of placement for the resident in violation of Florida law. 11. The Agency determined that this deficient practice was related to the operation and maintenance of the facility, or to the personal care of facility residents, and directly threatened the physical or emotional health, safety, or security of the facility residents. 12. The Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2010). WHEREFORE, the Agency intends to impose an administrative fine in the amount of one - thousand dollars ($1,000.00), against Respondent, an ALF in the State of Florida, pursuant to Section 429.19(2)(b), Florida Statutes (2010). . COUNT Il - tag A700 13. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein, ~ . 14. Anassisted living facility is required as a matter of law to provide care and services appropriate to the needs of residents accepted for admission to the facility. Specifically: SUPERVISION. Facilities shall offer personal supervision, as appropriate for each resident, including the following: (b) Daily observation by designated staff of the activities of the resident while on the premises, and awareness of the general health, safety, and physical and emotional well-being of the individual. (d) Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out. 5 15, od (e) A written record, updated as needed, of ary significant changes as defined in subsection 58A-5.0131(33), F.A.C., any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services. ok RESIDENT BILL OF RIGHTS. No resident shall be deprived of any civil or legal rights, benefits or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident shall have the right to live in a safe and decent living environment, free from abuse and neglect [and to] be treated with consideration and respect and with due recognition of personal dignity... Section 429.28(1)(a-b), Fla. Stat. (2010) On May 5, 2011, the Agency conducted a complaint inspection, CCR #201100201 6, of Respondent’s facility, an assisted living facility. 16. Based on records reviewed and an interview with the administrator, the facility failed to provide care and services appropriate to the needs of one resident (Resident #2), Medication observation records also revealed that medication for another resident (Resident #4) was not administered as ordered by the physician. Findings included: Resident #2 Documentation from a physician's office for Resident #2, dated November 4, 2010, included a physical exam with a plan to continue present medications and supportive care. Resident #2 was hospitalized from December 22 - 28, 2010, with no reports of open skin area or ulcerations. His history included diabetes, gastroesophageal reflux disease (GERD), hypertension, Parkinson’s disease, osteoporosis and dementia. After being transferred to a local hospital following a syncopal episode, the resident was returned to the facility. The hospital admission assessment indicated that the resident had a Braden score of less than 15 and no rash, swelling, bruising, contusions or lacerations. The discharge records did not contain documentation regarding the resident’s condition at his transfer back to the assisted living facility. There was no health assessment documentation on a form 1823. The facility asserts that the resident returned with multiple decubiti. On January 6, 2011, the resident’s physician found sacral and heel decubitus ulcers at stage II. The resident was ordered confined to bed. The physician noted that he needed help with routine activities of daily living (ADLs); he ordered i home health to evaluate and treat the wounds. Home health was to clean the sacral decubitus ulcers, evaluate all ulcers periodically and use heel protectors when the resident was in bed. The home health records lacked any measurements or staging of the ulcers. On January 17, 20 11, the resident was admitted to another local hospital for dehydration and wound care. The hospital records included staging of the pressure ulcers as follows: e Stage IV pressure ulcer to the sacrum, approximately 6 inches and draining serosanguinous fluid and eschar; © StageIV pressure ulcer to the left heel, approximately 1 inch draining serosanguinous fluid and eschar; and e Stage I to the left side of the foot without drainage. The hospital records also indicated that the resident had been received with foul smelling catheter intact draining cloudy urine. A social worker and the Department of Children and Families became involved in the resident’s care. The resident passed away and was not readmitted to the assisted living facility. Resident #4 The medication observation record (MOR) for Resident #4 revealed that the administrator had instructed the medication technician to withhold Lisinopril 5 milligrams, a medication ordered for the resident, without a physicians order. During an interview, the medication technician stated, "It was an executive decision.” 17. The above facts indicate neglect and/or abuse and demonstrate that the resident’s basic rights were ignored and that the facility failed to provide care and services appropriate to the needs of its residents. 18. The Agency determined that these deficient practices were related to the operation and maintenance of the facility, or to the personal care of facility residents, and directly threatened the physical or emotional health, safety, or security of the facility residents. 19. The Agency cited the Respondent for a Class Ill violation in accordance with Section 429,19(2)(b), Florida Statutes (2010). WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand dollars ($1,000.00), against Respondent, an ALF in the State of Florida, pursuant to Section 429.19(2)(b), Florida Statutes (2010). COUNT Til — tag A1116 20. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 21. Anassisted living facility is required to screen employees who are hired to provide personal services to residents. Specifically: Background screening - The agency shall require level 2 background screening for personnel as required in s. 408.809(1)(e) pursuant to chapter 435 and s. 408.809. Section 429.174, Fla, Stat. (2010) ok k Background screening; prohibited offenses — Level 2 background screening pursuant to chapter 435 must be conducted through the agency on each of the following persons, who are considered employees for the purposes of conducting screening under chapter 435: (e) Any person, as required by authorizing statutes, seeking employment with a licensee or provider who is expected to, or whose responsibilities may require him or her to, provide personal care or services directly to clients or have access to client funds, personal property, or living areas;.and any person, as required by authorizing statutes, contracting with a licensee or provider whose responsibilities require him or her to provide personal care or personal services directly to clients. Evidence of contractor screening may be retained by the contractor’s employer or the licensee. ‘ Section 408.809(1), Fla. Stat. (2010) ae ae Level 2 screening standards - All employees required by law to be screened - pursuant to this section must undergo security background investigations as a condition of employment and continued employment which includes, but need not be limited to, fingerprinting for statewide criminal history records checks through the Department of Law Enforcement, and national criminal history records checks through the Federal Bureau of Investigation, and may include local criminal records checks through local law enforcement agencies. Section 435.04(1)(a), Fla. Stat. (2010) 22. On May 24, 2011, the Agency conducted a complaint inspection, CCR #2011003536, of Respondent’s facility, an assisted living facility. 23. Based on review of employee records, the administrator failed to screen one employée who was hired to provide personal services to residents. Findings included: On review of employee records, there was no documentation to indicate that the facility had required Employee #4 to submit to Level 2 screening prior to hire on April 11, 2011. The employee was providing personal services to the residents. . 24, — The facility’s failure to conduct the Level 2 screening of the employee is unacceptable and a violation of Florida law. 25. The Agency determined that this deficient practice was related to the operation and maintenance of the facility, or to the personal care of facility residents, and directly threatened the physical or emotional health, safety, or security of the facility residents. 26. The Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2010). WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand dollars ($1,000.00), against Respondent, an ALF in the State of Florida, pursuant to Section 429,19(2)(b), Florida Statutes (2010). COUNT IV 27. The Agency re-alleges and incorporates the entirely of this complaint as if fully set forth herein. 28. Pursuant to Section § 429.19(7), Fla. Stat. (2010), “[i]n 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 of a violation that was the subject of the complaint or monitoring visits-conducted under s. 429.28(3)(c) to verify the correction of the violations.” 29. On May 5, 2011, the Agency conducted a complaint inspection, CCR #2011002016, of Respondent’s facility that resulted in violations found that are the subject of the complaint to the Agency. | 30. Pursuant to Section § 429.19(7), Fla. Stat. (2010), such a finding subjects the Respondent toa survey fee equal to the lesser of one half of the Respondent’s biennial license and bed fee or five hundred dollars ($500.00). “31. Respondent is therefore subject to a complaint survey fee of five hundred dollars ($500.00), pursuant to Section § 429.19(7), Fla, Stat. (2010). WHEREFORE, the Agency intends to impose a survey fee of five hundred dollars ($500.00) against Respondent, an ALF in the State of Florida, pursuant to Section §429.19(7), Fla, Stat. (2010). NOTICE OF RIGHTS Respondent is notified that it has a right to request an administrative hearing pursuant to §120. 569, Florida Statutes, Respondent has the right to retain, and be represented by an attorney in this 10 matter. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg. #3, MS #3, Tallahassee, FL 32308; Telephoné (850) 412-3671. 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 IHEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been served by U.S. Certified Mail, Return Receipt No. 7003 1010 0001 3600 3333, to Edwin B. Kagan, Registered Agent, 2709 Rocky Point Drive, Suite 102, Tampa, FL 33607 and by US mail to David W. Caldwell, Administrator, Lakeshore Living, Inc., 10919 Mistletoe Drive, Thonotosassa, FL 33592, this | YNs, of July, 2011, STATE OF FLORIDA, AGENCY FOR HEALTHCARE ADMINISTRATION The Sebring Building 525 Mirror Lake Dr. N., Suite 330H St. Petersburg, Florida 33701 Telephone: (727) 552-1945 Facsimile: (727) 552-1440 Copy provided to: Kathleen Varga, HFE | SENDER: COMPLETEgiggltS S COMPLETE THIS SECTION ON DELIVERY gewin B. Kagan Registered Agent for Lakeshore Raving, Inc. 2709 Rocky Point Drive, Suite 102 Tampa, FL 33607 : “ET Registre 2) Insured Mall

Docket for Case No: 11-005069

Orders for Case No: 11-005069