me ae ; STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs, Case Nos. 2012000346 SOVEREIGN HEALTHCARE OF ORLANDO, LLC d/b/a HUNTERS CREEK NURSING AND REHAB CENTER, Respondent. ee ADMINISTRATIVE COMPLAINT. COMES NOW the Agency for Health Care Administration (hereinafter “Agency’), by and through the undersigned counsel, and files this Administrative Complaint against Sovereign - Healthcare of Orlando, LLC d/b/a Hunters Creek Nursing and Rehab Center (hereinafter “Respondent”), pursuant to §§120,569 and 120.57 Florida Statutes (2011), and alleges: ’ NATURE OF THE ACTION ~ This is an. action to change Respondent’s licensure status from Standard to Conditional commencing November 5, 2011, and ending December 5, 2011, and to impose an administrative fine in the amount of two thousand five hundred dollars ($2,500.00) based upon Respondent being cited for one Isolated State Class I deficiency. JURISDICTION AND VENUE 1, The Agency has jurisdiction pursuant to §§ 120.60 and 400,062, Florida Statutes (2011). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and enforcenient of applicable federal regulations, state statutes and rules governing skilled nursing 1 Filed March 28, 2012 4:04 PM Division of Administrative Hearings ) 28 / . ) facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), , Chapters 400, Part Il, and 408, Part Il, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a one hundred sixteen (116) bed nursing home, located at 14155 Town Loop Boulevard, Orlando, Florida 32873 and is licensed as a skilled nursing facility license number 130470987. 5. Respondent was at all times material hereto, a licensed nursing facility under the licensing ‘authority of the Agency, and was required to comply with all applicable tules, and statutes. | ) | COUNTI 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, all licensees of nursing homes facilities shall adopt and make: public a statement of the rights and responsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement shall assure the right to be free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints, except those restraints authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency. In case of an emergeficy, restraint may be applied only by a qualified licensed nurse who shall set forth in writing the circumstances requiring the use of restraint, and, in the case of use of a chemical restraint, a physician shall be consulted immediately thereafter. Restraints may not be used in lieu of staff supervision or merely for staff convenience, for punishment, or for reasons other than resident protection or safety. § 400.022(1)(0), Fla. Stat, (2011). 8. That on November 15, 2011, the Agency completed a complaint survey, CCR number 2 a 2011011756, of the Respondent facility. 9. That based upon the review of records, observation, and interview, Respondent failed to ensure residents are free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints, except those restraints authorized in writing by a physician for a specified and ‘limited period of time or as are necessitated by an emergency for two (2) of five (5) sampled residents, the same being contrary tothe mandates of law. | 10, That Petitioner’s representative reviewed Respondent’s records related to resident number one (1), during the survey and noted as follows: a. The resident was admitted to the facility on September 21, 2011 with a history of ventilator dependent respiratory failure, Methicillin Resistant Staphylococcus Aureus: (MRSA) pneumonia, Clostridium Difficile with isolation, pulmonary insufficiency, tracheotomy, gastrostomy tube placement, pulmonary. disease, diabetes, high blood pressure, stroke with right sided paralysis, and chronic ~ kidney disease. At the time of admission, the resident had a tracheostomy, but was no longer on the ventilator. The resident. was admitted to room 120, a private room and required total assist of 1-2 staff members for activities of daily living. The resident was oriented to name only and could nod the head yes or no to questions. A progress note dated September 21, 2011 at 2:49 p.m, revealed that the resident pulled out the tracheotomy tube and it was replaced by a respiratory therapist. A telephone order was obtained for a hand mitt to be placed on the resident’s left hand secondary to the resident pulling out the tracheotomy tube. 3 Ne g. The nurse who took the telephone order did not ascertain how long the restraint was to be applied, the frequency of release, and activities during restraint per facility policy. h. The order also did not specify whether or not the hand mitt was to be secured to’ the bed, i. The resident's care plan, dated September 21, 2011, reflected the focus of the care plan was the resident's removal of the tracheotomy cannula on September 21, 2011. j. | Care plan interventions indicated that the hand mitt was to be applied as ordered to maintain an open airway. . k. Certified nursing assistants' (CNA) daily flow sheets did not indicate any use of a left hand mitt as a restraint or to release the restraint every two (2) hours per . policy and procedure, . L That the resident was found at 3:40 a.m. on September 25, 2011, a code blue activated, and the resident was pronounced dead by emergency medical services at 4:00 a.m, 11. - The facility's Policy and Procedure Manual for Mitt Restraint #7 read that the mitt. was to be released and the extremity exercised at least every two hours. 12, Absent from the records for resident number one (1) was any order to evaluate the appropriateness of the restraint, 13. That Petitioner's representative interviewed Respondent’s director of nursing on November 15, 2011 who indicated that the team makes the decision to include respiratory therapy, nursing and physical therapy, but physical therapy was never instructed to evaluate the restraint for this resident. . 14, ‘That Petitioner’s representative interviewed Respondent’s certified nursing assistant 4 ~~ Y responsible for resident number one (1) on September 24, 2011 on the 11 p.m. - 7 a.m. shift who indicated as follows: a, She checked the resident around 11 p.m. and noticed the mitt was in place. b. She again saw the resident at 2 a.m. and again the mitt was in place. c. At 3:40 a.m., when the Code Blue was called, she noted that the mitt was on the floor next to the bed. 15. That -Petitioner’s representative interviewed Respondent’s certified nursing assistant working in the respiratory section of the facility on November 15, 2011 around 5:45 a.m. who indicated that she does not do anything with restraints or tracheostomy patients. 16. That Petitioner’s representative interviewed Respondent’s certified nursing assistant that cared for resident number one (1) on November 15, 2011 who indicated that she does not work with tracheostomy residents and she has not worked with any restrained residents. 17. That Petitioner’s representative interviewed Respondent’s director of nursing on November 15, 2011 who indicated that the facility did not have an assessment of the use of the restraint to ascertain the proper selection of restraint for the resident. 18. That: Petitioner’s representative reviewed Respondent’s records related to resident number two (2) during the survey and noted as follows: a. The resident had a history of MRSA with pseudomonas pneumonia, acute respiratory insufficiency, chronic respiratory insufficiency, status post tracheostomy, status post PEG tube placement dysphagia, anemia, febrile illness leukocytosis, seizure disorder, traumatic encephalopathy. b. A September 28, 2011 the. physician order sheet read apply mitt to right hand, check every 15 minutes for placement, release for care and service by 24 hours then reassess. ¢, A September 29, 2011 order read "hand mitt to right hand; to prevent patient self 5 de-cannulation. Removed for activities, ADL's, therapy, assess for placement, skin integrity, and circulation, removed as needed every 2 hours.” A physician order of October 15, 2011 read "de-cannulate the patient." The hand mitt was not discontinued at that time. ‘A physician order sheet contained an order to discontinue the hand mitt six (6) days later on October 21, 2011. The resident’s treatment sheet reflected the resident had hand mitt in use until the order to discontinue on October 21, 2011. The resident was de-cannulated on October 15, 2011 and the restraint was in use for six (6) days when it was not necessary to prevent self de-cannulation. There was no documentation of an assessment regarding the appropriateness of the restraint, 19. That Petitioner’s representative interviewed Respondent’s director of nursing on November 15,2011 who indicated that the facility did not have an assessment of the use of the restraint to ascertain the proper selection of restraint for the resident. 20... That the above reflects Respondent’s failure to ensure residents are free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints, except those restraints authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency including, but not limited to, Respondent’s failure to: a, b. Ensure that physician’s orders for restraints contain limitations of time. Ensure that restraints are utilized only for intended purposes. Ensure its policy and procedure mandates that restraints are removed, monitored, and limbs exercised every two (2) hours. . Timely remove ordered restraints when the underlying rationale is alleviated. 6 21. .. That the Agency determined that these failures 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 an Isolated State Class II deficiency. _ WHEREFORE, the Agency seeks to impose an administrative fine in the amount of two thousand five hundred ($2,500.00) against Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(8)(b), Florida Statutes (2011). COUNT Ii 22... . The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I of this Complaint as if fully set forth herein. a3 Based upon Respondent’s one 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, . oF: ‘the rales adopted by the Agency, a violation subjecting it to assignment of a conditional tioerianre status under § 400.23(7)(a), Florida Statutes (201 1. . 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 (2011) commencing November 5, 2011, and ending December 5, 2011. Respectfully submitted this i day of March, 2012. asJ. Walsh II, Esquire ik Bar. No. 566365 Agency for Health:Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1947 (office) DISPLAY OF LICENSE Pursuant to § 400, 23(7)(@), Fla. Stat. (2011); Respondent shall post the most current license in a prominent place that is in clear and unobstructed public view, at or near, the place where residents are being admitted to the facility. ~ 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 for administrative action are set out in the attached Election of Rights. All requests for hearing shall -bé made to the attention of: The Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Big #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. CERTIFICATE OF SERVICE THEREBY CERTIPY that a true and correct copy of the foregoing has been served by US. ‘Certified Mail, Return Receipt No. 7003 1010 0001 3600 4057 to National Corporate Research, Ltd., Registered Agent for Sovereign Healthcare of Orlando, LLC, 155 Office Plaza Drive, Tallahassee, Florida 32301, and by Regular U.S. Mail to Robert L. Beckman, Administrator, Sovereign Healthcare of Orlando, LLC d/b/a Hunters Creek Nursing and Rehab Center,14155 Town Loop Boulevard, Orlando, Florida 32873, on this ~~ day of March, 2012. of . Walsh II, Esquire Fla: Bar. No. 566365 geney for Health Care Admin. 525 Mirror Lake Drive, 330G - St. Petersburg, FL 33701 727.552.1947 (office) a Copies furnished to: National Corporate Research, Ltd, . Registered Agent for Sovereign Healthcare of Orlando, LLC 155 Office Plaza Drive Tallahassee, Florida 32301 (US Certified Mail) _ Theresa DeCanio Field Office Manager Agency for Health Care Admin, (Interoffice Mail) Robert L. Beckman Administrator Sovereign Healthcare of Orlando, LLC d/b/a Hunters Creek Nursing and Rehab Center 14155 Town Loop Boulevard Orlando, Florida 32873 (US Mail) Met Thomas J. Walsh, IT Senior Attorney Agency for Health Care Admin. 525. Mirror Lake Drive, #330G St. Petersburg, FL 33'701 (Interoffice Mail)

Docket for Case No: 12-001139

Orders for Case No: 12-001139