STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2014010989 CARPENTER’S HOME ESTATES, INC. d/b/a THE MANOR AT CARPENTERS, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against Carpenter’s Home Estates, Inc. d/b/a The Manor at Carpenters (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2014), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing September 27, 2014, to impose administrative fines in the amount of fifteen thousand dollars (815,000.00), and to impose a survey fees of six thousand dollars ($6,000.00) . with a two (2) year survey cycle based upon Respondent being cited for one (1) widespread State Class I deficiency. JURISDICTION AND VENUE 1, The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2014). 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 enforcement of applicable federal regulations, state statutes and rules governing. skilled nursing 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 seventy-two (72) bed nursing home, located at 1001 Carpenters Way, Lakeland, Florida 33809, and is licensed as a skilled nursing facility license number 1075096. 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 rules, and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That Florida law provides:, (1) Every facility shall, as part of its administrative functions, establish an internal risk management and quality assurance program, the purpose of which is'to assess resident care practices; review facility quality indicators, facility incident reports, deficiencies cited by the agency, and resident grievances; and develop plans of action to correct and respond quickly to identified quality deficiencies. The program must include: (a) A designated person to serve as risk manager, who is responsible for implementation and oversight of the facility’s risk managemient and quality assurance program as required by this section. (b) A risk management and quality assurance committee consisting of the facility risk manager, the administrator, the director of nursing, the medical director, and at least three other members of the facility staff. The risk management and quality assurance committee shall meet at least monthly. (c) Policies and procedures to implement the internal risk management and quality assurance program, which must include the investigation and analysis of the frequency and causes of general categories and specific types of adverse incidents to residents. (d) The development and implementation of an incident reporting system based upon the affirmative duty of all health care providers and all agents and employees of the licensed health care facility to report adverse incidents to the risk manager, or to his or her designee, within 3 business days after their occurrence. (e) The development of appropriate measures to minimize the risk of adverse incidents to residents, including, but not limited to, education and training in risk K management and tisk prevention for all nonphysician personnel, as follows: 1. Such education and training of all nonphysician personnel must be part of their initial orientation; and 2. At least 1 hour of such education and training must be provided annually for all nonphysician personnel of the licensed facility working in clinical areas and providing resident care. (f) . The analysis of resident grievances that relate to resident care and the quality of clinical services. (2) The internal risk management and quality assurance program is the responsibility of the facility administrator. . (3) In addition to the programs mandated by this section, other innovative approaches intended to reduce the frequency and severity of adverse-incidents to residents and violations of residents’ rights shall be encouraged and their implementation and operation facilitated. (4) Each internal risk management and quality assurance program shall include the use of incident reports to be filed with the risk manager and the facility administrator. The risk manager shall have free access to all resident records of the licensed facility. The incident reports are part of the workpapers of the attorney defending the licensed facility in litigation relating to the licensed facility and are subject to discovery, but are not admissible as evidence in court. A person filing an incident report is not subject to civil suit by virtue of such incident report. As a part of each internal risk management and quality assurance program, the incident reports shall be used to develop categories of incidents which identify problem areas. Once identified, procedures shall be adjusted to correct the problem areas. § 400.147(1 through 4), Fla. Stat. (2014). 8. That on September 27, 2014, the Agency completed an annual survey of Respondent and its facility. 9. That based upon observation, the review of records, and interview, Respondent failed to ensure its internal risk management and quality assurance programs identified and addressed known inadequacies in dietary services including its dish cleaning systems, both mechanical and _ manual, the same being contrary to the mandates of law and Respondent’s policy and procedure. 10. That on September 22, 2014, Respondent’s total census was sixty-three (63) residents with a predominantly elderly population who resided on three wings. 11. That there were three (3) dining rooms in service in the facility. 12. . That Petitioner’s representative reviewed Respondent’s policy and procedure entitled "Quality Assessment and Assurance Committee" (hereinafter “QA&A Committee”) with an effective date of 1/11/10, and noted as follows: i. Policy Statement - The facility shall establish and maintain.a Quality Assessment and Assurance Committee that oversees the identification, and handling of quality issues. ii. Policy Interpretation and Implementation - The Administrator shall delegate the necessary authority for actions and processes to the Quality Assessment and Assurance Committee. iii. Goals of the Committee: (a) To monitor and evaluate the appropriateness and quality of care provided within the framework of the Quality Assessment and Assurance Plan. (b) To oversee facility systems and processes related to improving quality of care and services. (c) To promote consistent facility . systems and processes and appropriate practices in resident care. (d) To help identify negative outcomes relative to resident care and resolve them appropriately. (e) To help departments, consultants and ancillary services implement plans to correct identified issues in quality of care. (f) To coordinate the development, implementation, monitoring, and evaluation of action plans to achieve specified quality goals. (g) To help departments, consultants and ancillary services establish accountability for care and quality. (h) To coordinate and facilitate communication regarding the delivery of quality resident care within and among departments and services, and between facility staff, residents, and family members. b. Committee Meetings: i. The committee will oversee the development and implementation of actions to correct quality concerns and promote overall quality of care and services in the facility. ii. Examples of actions that may be implemented to help address quality issues may include, but are not limited to: (a) Educational training programs. (b) New or revised policies and procedures. (c) Staffing changes. (d) Equipment changes. (e) Adjustment in admission, transfer, and/or discharge practice. (f) Adjustment in employment practices. 13. That Petitioner’s representative interviewed Respondent’s administrator on September 22, 2014, who indicated as follows: He confirmed that the facility had a QA&A Committee and that the committee was led by the Risk Manager. Staff members who attended were the administrator, the director of nursing, the medical director, department heads, and consultants. Front line staff were not part of the committee. The committee meets monthly on the last Thursday of the month at noon, and. as needed. He later added the additional information that the administrator leads the QA&A committee, not the risk manager. 14. That Petitioner’s representative toured Respondent’s facility on September 22, 2014 at approximately 10:00 a.m. and noted as follows: a. A black colored residue covered four ceiling vents in the dish wash and three compartment sink area. | b. The vents were leaking a water-like substance on top of clean dishes. c. In the three-compartment sink, dishes were not fully submerged in the sanitizing solution. 15. That Petitioner’s representative interviewed Respondent’s kitchen staff member “P” on September 22, 2014 at 10:12 a.m. who indicated: a. b. He had been employed there for three (3) weeks. Dishes and plates were placed in the chemical sanitation solution for twenty (20) seconds (The minimum time required to sanitize the dishes in the chemical sanitizing solution is 30 seconds). Staff member “G” had trained him to do the dishes. 16. That Respondent’s director of dining services indicated on September 22, 2014 at 10:15 a.m. that the maintenance director was aware of the vents and he was supposed to come clean and paint everything on Thursday. 17... That Petitioner’s representative observed and interacted with Respondent’s staff on September 22, 2014 commencing at 10:25 a.m. and noted as follows: a. b. Staff member “G” was observed operating the dish machine. Staff member “G” stated that she was unaware that the vents were leaking onto the clean dishes. At 0:28 a.m., the dish machine temperatures of wash was 155 degrees F and | final rinse was 161 degrees F. A second observation immediately following revealed a wash temperature of 155 degrees F and a rinse temperature of 171 degrees F. (The minimum dishwashing temperatures should be 150 degrees F to wash and 180 degrees F for the final rinse). At the time of the observations, Respondent’s director of dining services stated that the dishwasher was a high temperature machine. The instructions posted on the machine were for a low temperature machine and were listed as wash temperature 120-140 degrees and rinse temperature 50-180 degrees. The executive chef stated on at 10:36 a.m. that "I noticed the issue on Friday (9/19/14) and told the staff to do the dishes twice," (Washing the dishes twice will not sanitize the dishes, if the rinse temperature does not reach 180 degrees F) and stated that he had made a call on Friday and someone was to come to the facility to check the dish machine. h. The executive chef further stated that he told the supervisors over the weekend to check on it but he that he can't recall the supervisors! names and he would tell the staff to hand wash the dishes until the technician comes in. 18. That Petitioner’s representative interacted with Respondent’s staff member “G” on September 22, 2014 at 10:39 a.m. and the staff member indicated that no one had had told her to wash the dishes twice. 19. That Petitioner’s representative observed on September 22, 2014 at 10:46 a.m. that Respondent’s staff were running dishes in the dishwasher even though they had been told otherwise. 20. That at that time, Respondent’s director of dining services stated that “that does not make any sense it’s better to hand wash them." At which time Petitioner’s representative noted that a dusty old curtain had been placed on top of clean dessert plates. 21. - That Petitioner’s representative interviewed a technician from the dish machine company who arrived on September 22, 2014 at 12:26 p.m. and the technician indicated as follows: a. He had received a call an hour ago and he was here. b. He visits the facility monthly. c. The dish machine is a high temperature machine with a wash temperature of at least 150 degrees and that the incoming water was 140 degrees and that affected the overall temperature. | d. He stated that it was fixed now. e. He had received a call two weeks ago from the executive chef and had consulted over the telephone about how to reset the dish machine equipment h. i. due to a bad storm that had occurred in the area. The signage posted on the dish machine sticker was incorrect. He had brought it, and applied it to the dish machine, because the other signage had worn off, and that was the only label he had with him at the time. Staff was supposed to use the directions posted on the wall. The dish machine had been a high temperature machine since August 2011. 22. That Petitioner’s representative observed staff running the dishwasher on September 22, 2014 at 12:29 p.m. and noted: a. The wash temperature was observed to be 175 degrees F and the rinse temperature was 205 degrees F. b. Respondent’s director of dining services stated that they did not have any min- max thermometers or other thermometers to run through the dish machine to troubleshoot dish machine problems. 23. That Petitioner’s representative reviewed the temperature logs for the dish machine for the last six (6) months and noted as follows: a. August 10, 2014 - Final rinse 136 degrees F in the A.M. Final rinse 136 degrees F at noon, and 136 degrees F in the P.M. August 24, 2014 - Final rinse 175 degrees F at noon, and 179 degrees F in P.M. August 25, 2014 - Final rinse 136 degrees F in A.M., 140 degrees F at noon, and 140 degrees F in P.M. August 26, 2014 -Final rinse 142 degrees F in A.M., and 138 degrees F at noon, and 150 degrees F in P.M August 27, 2014 -Final rinse 139 degrees F in A.M. August 28, 2014 - Final rinse 136 degrees F in A.M., 138 degrees F at noon. August 31, 2014 -Final rinse 136 degrees F at noon and 138 degrees F in P.M. September 1, 2014 - Final rinse 137 degrees F in A.M., 132 degrees F at noon, 140 degrees F in P.M. September 2, 2014 -Final rinse 142 degrees F in A.M., 136 degrees F at noon, 140 degrees F in P.M. September 3, 2014 - Final rinse 139 degrees F in A.M. 140 degrees F in P.M. September 4, 2014 - Wash 140 degrees F at noon, wash 140 degrees F in P.M.; Final rinse 145 degrees F in A.M., 135 degrees F at noon, 138 degrees Fin P.M. September 5, 2014 -Wash 138 degrees F in A.M., 140 degrees F at noon, 138 degrees F in P.M.; Final rinse140 degrees F in A.M., 140 degrees F at noon, 140 degrees F in P.M. September 6, 2014 - Wash 139 degrees F in A.M.; Final rinse 142 degrees F in A.M., 140 degrees F at noon, 140 degrees F in P.M. September7, 2014 - Final rinse 138 degrees F in A.M., 140 degrees F at noon, 140 degrees F in P.M. September 8, 2014 - Wash 148 degrees F in A.M., 138 degrees F at noon, 139 degrees F in P.M.: Final rinse 132 degrees F in A.M., 139 degrees F at noon, 142 degrees F in P.M. September 9, 2014 - Final rinse 126 degrees F in A.M., 126 degrees F at noon, 130 degrees F in P.M. 10 bb. September 10, 2014 - Final rinse 138. degrees F in A.M., 138 degrees F at noon. | September 11, 2014 - Final rinse 144 degrees F in A.M., 140 degrees F at noon, 140 degrees F in P.M. September 12, 2014 - Final rinse 140 degrees F in A.M., 142 degrees F at noon, 140 degrees F in P.M. September 13, 2014 - Final rinse 140 degrees F in A.M., 142 degrees F at noon, 140 degrees F in P.M. | September 14, 2014 - Final rinse 138 degrees F in A.M., 140 degrees F at noon, 135 degrees F in P.M. . September 15, 2014 - Final rinse 138 degrees F in A.M., 158 F degrees at noon, 152 degrees F in PM. September 16, 2014 - Final rinse 148 degrees F in A.M., 142 degrees F at noon, 158 degrees F in P.M. September 17, 2014 - Final rinse 168 degrees F in A.M., 158 degrees F at noon, 155 degrees F in P.M. September 18, 2014 - Final rinse 157 degrees F in A.M., 152 degrees F at noon, 155 degrees F in P.M. September 19, 2014 - Final rinse 168 degrees in A.M., 162 degrees at noon, 165 degrees in P.M. September 20, 2014 - Final rinse 162 degrees F in A.M., 155 degrees F at noon, 160 degrees F in P.M. September 21, 2014 - Final rinse 158 degrees F in A, A.M.., 160 degrees F at ll noon, 159 degrees F in P.M. ce. September 22, 2014 - Final rinse 158 degrees F in A.M. dd. In addition, the September 2014, August 2014, May 2014, April 2014, March 2014, February 2014 and January 2014 Dish machine Temperature Logs did not monitor the PSI (water pressure). ee. The PSI is monitored on the July 2014 and June 2014 Dish machine Temperature Logs. 24. That Petitioner’s representative reviewed the "Clean Force Rental Agreement," dated October 30, 20117, and noted that the facility is leasing a high temperature dish machine from Clean Force. 25. That a second "Clean Force Rental Agreement," signed October 30, 2013, indicates that - the facility is leasing a booster heater from Clean Force. 26. That Petitioner’s representative reviewed the specification form and noted labeled Section 1: SPECIFICATION INFORMATION for the PA-C4 series dish machine was the following water requirements: a. WASH TEMPERATURE (PA-C4) 160-DEGREES F. b. ‘RINSE TEMPERATURE 180 DEGREES F. c. *NOTE: TEMPERATURES LISTED ARE MINIMUMS. d. FLOW PRESSURE (PSI) 20, PLUS OR MINUS 5. 27. That Petitioner’s representative reviewed the Pure Force service detail reports for the last 5 months and noted: a. September 22, 2014 - Jackson PA-C4 Preventative Maintenance - "Rinse pressure was slightly high at 30 PSI. Replaced solenoid disphram which was 12 restricting flow at rinse assembly. Adjusted PSI down to 25 PSI. Final rinse PSI slightly high at 30, adjusted to 25." b. August 4, 2014 - Jackson PA-C4 Preventative Maintenance - No concerns recorded, c. August 4, 2014 - Emergency Service Request- - Facility out‘of rinse. d. | July 25, 2014 - Jackson PA-C4 Preventative Maintenance - Cleaned debris from upper wash arm to improve spray pattern for better results. Cleaned wrappers from pump intake screen to improve flow through the pump. Replaced worn discharge hoses on the sink dispenser. e. June 25, 2014 - Jackson PA-C4 Preventative Maintenance - Machine interior cleaner than previous PMs, i.e. clogged wash arm nozzles. f. May 16, 2014 - Jackson PA-C4 Preventative Maintenance - No concerns were recorded. . 28. That on September 22, 2015 at 12:31 p.m., Petitioner’s representative noted a leak in the sanitizing compartment of the three compartment sink with water observed on the floor and a pipe broken. 29, That on September 22, 2014 at 12:33 p.m., Respondent’s dietary manager and executive chef stated that the leak had begun that morning and the director of dining services stated that the chef or the supervisors, staff “I” and staff “H,” were to check the dish machine temperatures on the weekends. 30. That Petitioner’s representative interviewed Respondent’s staff member “I,” a dining supervisor, on September 22, 2014 at 12:35 p.m. who indicated "I never was told to check temps. [have been here for 2 years. I don't even know how to do that." 13 31. That Petitioner’s representative interviewed Respondent’s administrator on September 22, 2014 at 4:55 p.m. who indicated: a. He was not aware of what the dish machine temperatures were today after lunch, but that the dish machine technician had said there was nothing wrong. He was assuming the dishes were washed at the proper temperature after lunch today because the tech had said nothing was wrong. He had become aware of the dish machine low temperatures this morning when the dining services director approached him about it. The plan was to wash the dishes by hand. This has not been an issue prior to the present time and that the issue had not been brought through the Quality Assessment and Assurance committee (QA&A committee). An in-service sign in was requested from the administrator related to the staff being educated on the dish machine problem and the emergency plan between the dates of September 19, 2014, when the problem was noted by the executive chef, and September 22, 2014, when the administrator had been made aware, and he stated that he would have to ask the dining services director about that. He had not personally observed the facility staff to ensure they had washed the dishes by hand, he could not say that the staff had been in-serviced, and he had not provided any other oversight of the issue. He was not aware of any gastrointestinal outbreaks (GI) in the facility. That would have been mentioned in QA&A Committee meeting. 14 Nn. His expectation for a problem with the dish machine was first, that the staff address the situation, then get the equipment fixed, then implement any interventions to prevent infection such as hand washing the dishes. He would have expected the director of dining services to educate the staff and also that he, the administrator, would have been notified immediately. He was not made aware of the dish machine problem on Friday September 19". . He is unaware if the kitchen staff had ever been in-serviced on emergency procedures such as sanitizing dishes by hand. The director of dining services manager was new. 32. That on September 22, 2015 at 5:15 p.m., Petitioner’s representative noted a basket was full of dirty linens next to clean plates at which time Respondent’s executive chef stated "It was brought here. These are the linens from the independent living. I do not know why they brought and left them here instead of the laundry.” 33. That Petitioner’s representative interviewed Respondent’s director of dining services on September 22, 2014 at 5:16 p.m. who indicated: a. b. His job duties were to oversee everything related to dining. He became aware of the dish machine temperatures being too low today at about 10:00 a.m. He spoke to the executive chef who had reported to him that there had been a problem on Friday with the dish machine pressures and that on Saturday the chef had become aware of the dish machine temperature issues and had informed the supervisor. 15 d, That on September 22, 2014, he had informed the staff to wash the dishes by hand at approximately 10:00 a.m. e. There was no in-service sign in sheet related to the dish machine issues or about hand washing the dishes. f. “Theoretically we should be going behind the others and be sure they are checking the sanitation in the three compartment sink." g. The proper procedure for sanitizing dishes in the three compartment sink would have included submerging the dish completely. h When asked if the staff have ever been trained in the proper operation and monitoring of the dish machine and the proper method of hand sanitizing. dishes in the three (3) compartment sink or any other emergency kitchen procedures, he replied that he was not sure. i. After the dish machine technician left today, he spoke with staff “Q” and staff “K” and told them that they were the only staff who were allowed to check the dish machine besides himself and the executive chef. j. They had both worked at the facility for a while so that is why they were chosen. k. He had not provided any training to staff “Q” or staff “K” regarding the dish machine temperatures and how to obtain them, monitor them, and how to report any issues. . 1. Staff “Q” had not had to do the dish machine but he will be good once he is trained. 34. That Petitioner’s representative randomly observed staff member “Y” and interacted with 16 the staff member on September 22, 2014 at 5:45 p.m. and noted as follows: a. In the Royal Palm Dining Room, staff “Y” buttered the bread for a resident with her bare hands. b. At approximately 6:01 p.m., staff “Y” confirmed that this was her usual practice for buttering rolls for the residents. c. . Staff “Y” then picked up the bread with her bare hands and fed the resident the roll with her bare hands. 35. That Petitioner’s representative interviewed Respondent’s director of maintenance on September 23, 2014 at 1:57 p.m. who indicated: | a. He did not know how to check the dish machine temperatures. b. If there were any problems with the dish machine the contractor was called because the machine was leased. 36. That Petitioner’s representative interviewed Respondent’s staff “L” who was operating the dish machine on September 23, 2014 at noon who stated that the only training he had received on the dish machine was an informal training by staff “Q” back when he had been hired, sometime in July 2014. 37. That Petitioner’s representative interviewed Respondent’s executive chef on September 23, 2014 at 12:07 p.m. who indicated: a. He had talked to all of the staff last night and this morning about the dish machine. b. He had no documentation of the content of the training he had provided to the staff or any sign-in sheets. 38. That Petitioner’s representative observed and interacted, with Respondent’s executive chef, Respondent’s staff member “O” on September 23, 2014 at 4:47 p.m. and noted the following: Staff “O” was wearing gloves. He was observed rinsing down dirty plates with his gloves on. He placed the dishes in a rack and he ran the dishes through the dish machine. The executive chef stated “Six times a day the dishwashers (staff) will take the temperatures. Then the supervisor will be here and they will write down the temperatures. They will have to initial the form. Everyone has begun to be educated about everything.” At 4:50 p.m., staff “O” was observed using the same gloves he had on to rinse the dirty dishes when he took the clean plates from the dishwasher and placed them on trays. Staff “O” was asked "How often do you change gloves?" and he stated, "When I go to the other side,” pointing to the three compartment sink. Staff “O” was asked "Do you use the same gloves when you rinse the dirty plates and take the clean plates off the machine?" and he responded "Yes. I just wash my hands," and proceeded to wash his hands with the dirty gloves on. 39. That Petitioner’s representative interviewed Respondent’s director of dining services on September 23, 2014 at5 8:05 p.m. who indicated: "I do not understand why [staff “O”] said that. The process is that they have to usé gloves. They have to change when they go from clean to dirty dishes and the other way around." b. During the interview a request was made for the in-service training in proper glove usage for all staff working in the dish room. And the response was “I am new here, I do not know. They must have it." 40. That Petitioner’s representative interviewed Respondent’s medical director on September 25, 2014 at 12:44 p.m. who indicated: a. He had been the medical director at the facility for a few months. b. He attended the QA&A Committee meetings. c. He visited the facility at least weekly. d. He had not been made aware of any GI outbreaks in the facility. e. If there had been any, they would have discussed it at the QA&A Committee meeting. 41. That Petitioner’s representative interviewed Respondent’s CDM and registered dietician on September 24, 2014 at 1:32 p.m. who indicated as follows: a. The dietician said that she is the substitute dietitian who had started working here in January 2014 and had come back in September 2014. b. The CDM stated that she participates in the QA&A meetings and "I do not recall any issues with the temperatures." c. The dietician did not recall any issues either and that when she comes to the facility, she goes to the kitchen to get a feeling of how things run. d. The dietician did not see anything out of the ordinary, the facility had no . issues with GI, vomiting, diarrhea, or weight loss that she could recall. e. The CDM said the executive chef was responsible for training the new employees and the previous director before him was responsible for training 19 42. the new employees. The CDM stated that she was responsible for the tray lines and the clinical. The Executive Chef was a.CDM (CDMs are Certified Food Protection Professionals (CFPPs), who are trained in food safety- www.cdmcareer.info) and he was responsible for the training and the kitchen aspect; “I do the in- services for the tray delivery for my department only. I have a sign- in log. If the Chef was not here the food service director should have the information needed. If someone was on isolation we would use disposable dishes. No one was in isolation at the moment. No one had a diagnosis related to GI or vomiting or diarrhea." That Petitioner’s representative interviewed Respondent’s administrator and controller, who is responsible for the financial management of the Respondent’s entire continuing care community campus and the former administrator, on September 25, 2014 at 2:27 p.m. who indicated: a. b. c. d. 43. The Controller stated that everyone wants to do the right thing, stating “We completely acknowledge we had a deficient practice,” but that the facility disagreed with the scope and severity. The Controller stated that the "punishment should fit the crime,” and that he had spoken to the staff physicians and they had no reports of GI outbreaks, He added that the facility feels that "they have not had one bad thing happen and maybe that was just luck ..." The Administrator had no comments during the interview. That Petitioner’s representative interviewed Respondent’s administrator on September 20 27, 2014 at 8:30 a.m. focusing on QA&A and the administrator indicated as follows: a. The QA&A committee was meeting monthly on the last Thursday of the month at noon, or more frequently if needed. He headed the QA&A committee. The director of nursing, medical director, and all department heads that were available, attended the meetings. Each department went through their section on a power point presentation. Any trends or concerns were discussed and the committee looked for a root cause. Action plans were developed by the committee and implemented by the appropriate department head. . The QA&A committee tracked and trended the progress. The committee did not meet September 25, 2014, due to the presence of surveyors conducting a survey in the facility. The last QA&A committee sign in page revealed a date of August 28, 2014. He confirmed that this was the last time the QA&A committee had met. The medical director had been at the facility on September 25, 2014, and the survey issues had been discussed with him by the director of nursing but that he, the administrator, had come in on the end of the meeting. The facility uses subcommittees, such as falls and weights, made up of department heads, and Abbacies (a survey- readiness program), and resident council] minutes, to help the QA&A committee identify quality concern issues. Front line staff members did not attend QA&A committee meetings or 21 subcommittee meetings. If front line staff members had issues they could have spoken to the administrator or director of nursing. The facility uses Abbacies which was a tool to perform "mock surveys" and that they had gone through stage 1 of mock survey prior to the arrival of the survey team on September 22, 2014 and had been working on the issues identified at that time to prepare for their annual survey. He confirmed that the registered dietician consultant (RD) had not identified the systemic system failure with the dish machine Logs and dish sanitation, and that the registered dietician and the administrator had not identified the systemic system failure of the dish machine logs and dish sanitation during the "mock survey" stage 1 held this month. The systemic problems with the dish machine sanitation and the dish machine logs had not been identified at all. The registered dietician consultant had been teaching him what to look for in the kitchen in September and that they had "missed" the dish machine temperature log problem, the three (3) compartment sink sanitation problems, and the vents covered -with the black substance dripping water - like liquid onto the clean dishes. The only kitchen issue that the QA&A committee had been addressing was dirty linen, a stained tablecloth had been used during a meal service, and timeliness of meal tray delivery on the units. The registered. dietician visited the facility weekly, had done an in-depth 22 kitchen review monthly, and had participated on the QA&A committee by submitting a monthly report. u. She had also participated in the weight subcommittee. 44. That according to the Centers for Disease Control (CC) using 2012 data, there were 4,563 hospitalizations and 68 deaths among infections with pathogens that are commonly transmitted through food. Among those affected, those aged 65 years and older were hospitalized the most frequently and had the highest death rate among the other age groups. (http://www.CDC. gov). 45.. That the Food and Drug Administration found that salmonella, a common food borne infectious organism, may cause acute symptoms of nausea, vomiting, abdominal cramps, diarrhea, fever and headache. Other complications included chronic symptoms which may commence approximately four weeks after infection and are arthritic like changes, and acute typhoid-like symptoms in which the mortality rate for some strains is up to 15 percent. It further reported that symptoms are most severe in the elderly. (www -MS#33 Tallahassee, FL 32308 AHGA.MyEFlorida.com Facebook.com/AHCAFlorida Youtube.com/AHCAFlorida Twitter.com/AHCA_FL SlideShare .net/AHCAFlorida nistration, authotized:i in stasis 400, art i Florida Statutes, 7 £0 Operate: the Aolow ae: MANOR AT CARPENTERS, THE! “1001 ‘Carpenters Way Hee "Lakeland, FL. ee : TOTAL: 2 BEDS LICENSE #: SNE 15096 SENDER: COMPLEZE THIS Arnold R: Tapawan Administrator *s Home Estates, Inc. d/b/a The Manor at Carpenters 1001:Carpenters Way . Lakeland, Florida 33809

Docket for Case No: 15-000640

Issue Date	Proceedings
May 19, 2015	Order Closing File and Relinquishing Jurisdiction. CASE CLOSED.
May 19, 2015	(Petitioner's) Motion to Relinquish Jurisdiction filed.
Apr. 02, 2015	Notice of Serving Defendent's Answers to Petitioner's Interrogatories - Response to Petitioner's Request for Production filed.
Mar. 30, 2015	Notice of Serving Respondent's Answers to Petitioner's Interrogatories filed.
Mar. 25, 2015	Order Granting Continuance and Re-scheduling Hearing (hearing set for June 2 and 3, 2015; 9:00 a.m.; Bartow, FL).
Mar. 24, 2015	(Respondent's) Motion for Continuance filed.
Mar. 20, 2015	(Respondent's) Notice of Serving Response to Petitioner's First Request for Admissions to Respondent filed.
Feb. 20, 2015	Order of Pre-hearing Instructions.
Feb. 20, 2015	Notice of Hearing (hearing set for April 14 and 15, 2015; 9:00 a.m.; Bartow, FL).
Feb. 20, 2015	Notice of Service of Agency's First Set of Interrogatories, Request for Admissions and Request for Production of Documents to Respondent filed.
Feb. 16, 2015	Joint Response to Initial Order filed.
Feb. 09, 2015	Initial Order.
Feb. 06, 2015	Petition for Formal Administrative Hearing filed.
Feb. 06, 2015	Administrative Complaint filed.
Feb. 06, 2015	Agency referral letter filed.