09-000931 Agency For Health Care Administration vs. Oakwood Nursing Center, Inc. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Monday, September 21, 2009.

STATE OF FLORIDA AIACA E

AGENCY FOR HEALTH CARE ADMINISTRATION AG Ef ICY CLERli

STATE OF FLORIDA AGENCY FOR DOAH No 09 001OCT 20 All 08

HEALTH CARE ADMINISTRATION

Petitioner

VS AHCA No 2008012947

2008012950

OAKWOOD NURSING CENTER INC RENDITION NO AHCA 09 1055 S OLC

Respondent

FINAL ORDER

Having reviewed the first amended administrative complaint dated

March 3 2009 attached hereto and incorporated herein Ex 1 and all

other matters of record the Agency for Health Care Administration

Agency has entered into a Settlement Agreement Ex 2 with the other

party to these proceedings and being otherwise well advised in the

premises finds and concludes as follows

ORDERED

1 The attached Settlement Agreement is approved and adopted as

part of this Final Order and the parties are directed to comply with the

terms of the Settlement Agreement

2 The Respondent shall pay the Agency an administrative fine of

ten thousand dollars 10 000 00 The administrative fine is due and

payable within thirty 30 days of the date of rendition of this Order

3 Checks should be made payable to the Agency for Health Care

Administration The check along with a reference to this case number

should be sent directly to

Agency for Health Care Administration

Office of Finance and Accounting

Revenue Management Unit

2727 Mahan Drive MS 14

Tallahassee Florida 32308

4 Unpaid amounts pursuant to this Order are subject to statutory

interest and may be collected by all methods legally available

5 The Respondent accepts conditional licensure status beginning

on October 31 2009 and ending on November 6 2009

6 Each party shall bear its own costs and attorney s fees

7 The above styled cases are hereby closed

DONE and ORDERED this day of 2009 in

Tallahassee Leon County Florida

Holly Bens Secretary

Agenc fo ealth Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED

TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY

OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA AND A

SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW WITH

THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE

AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES

REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH

THE FLORIDA APPELLATE RULES THE NOTICE OF APPEAL MUST BE FILED

WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED

Copies furnished to

Robert Hagan President John E Terrel Esquire

Oakwood Nursing Center Inc Law Offices of John Gilroy III P A

2021 SW 1St Avenue 1695 Metropolitan Circle Suite 2

Ocala Florida 344741 Tallahassee Florida 32308

U S Mail

Finance Accounting MaryAlice H David

Agency for Health Care Administration Assistant General Counsel

Revenue Management Unit Agency for Health Care Administration

2727 Mahan Drive MS 14 2727 Mahan Drive Bldg 3 MS 3

Tallahassee Florida 32308 Tallahassee Florida 32308

Interoffice Mail Interoffice Mail

Jan Mills Kriste Mennella

Agency for Health Care Administration Agency for Health Care Administration

2727 Mahan Drive Bldg 3 MS 3 14101 NW Hwy 141 Suite 800

Tallahassee Florida 32308 Alachua Florida 32615

Interoffice Mail I Interoffice Mail

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of this Final Order was

served on the above named person s and entities by U S Mail or the

method designated on this the 2 P day of f2009

Richard Shoop Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive Building 3

Tallahassee Florida 32308 5403

850 5873 922

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA AGENCY FOR

HEALTH CARE ADMINISTRATION

Petitioner Case No 09 931

vs FRAES Nos 2008012947 Fine

2008012950 Cond

OAKWOOD NURSING CENTER INC

Respondent

FIRST AMENDED ADMINISTRATIVE COMPLAINT

COMES NOW the Agency for Health Care Administration the

Agency and files this First Amended Administrative Complaint

against OAKWOOD NURSING CENTER INC the Respondent or

Respondent Facility pursuant to 120 569 and 120 57

Florida Statutes 2008 and alleges

NATURE OF THE ACTION

This is an action to change Respondent s licensure status

from Standard to Conditional commencing October 31 2008 and

ending November 5 2008 and to impose an administrative fine in

the amount of 20 000 00 based upon Respondent being cited for

two State Class II widespread deficiencies and a violation of

residents rights Specifically all 62 residents of the

Respondent facility were improperly discharged or transferred

in violation of applicable Florida law and in doing so

Respondent intentionally or negligently acted to materially

EXHIBIT

Filed March 3 2009 2 20 PM Division of AdminisMative Hearings I

affect the health or safety of Respondent facility s residents

JURISDICTION AND VENUE

1 The Agency has jurisdiction pursuant to H 120 60

400 062 and 408 802 3 Florida Statutes 2008

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 Chapter 400 Part II and

Chapter 408 Part II Florida Statutes and Chapter 59A 4

Florida Administrative Code

4 Respondent operates a 133 bed nursing home located at

2021 SW 1St Avenue Ocala Florida 34474 and is licensed as a

skilled nursing facility license number 1524096

5 At all times material to the allegations of this

administrative complaint Respondent was a licensed nursing

facility under the licensing authority of the Agency and was

required to comply with all applicable rules and statutes

6 On November 6 2008 all residents were gone from the

Respondent s facility and pursuant to the Respondent s request

Respondent was given an inactive license by the Agency

rOTTUT r

7 The Agency re alleges and incorporates paragraphs one

1 through six 6 as if fully set forth in this count

8 Section 400 0255 Florida Statutes requires

1 As used in this section the term

a

b Transfer means to move a resident from the

facility to another legally responsible institutional

setting

2 Each facility licensed under this part must

comply with subsection 9 and s 400 022 1 p when

deciding to discharge or transfer a resident

3 When a discharge or transfer is initiated by the

nursing home the nursing home administrator employed

by the nursing home that is discharging or

transferring the resident or an individual employed

by the nursing home who is designated by the nursing

home administrator to act on behalf of the

administration must sign the notice of discharge or

transfer Any notice indicating a medical reason for

transfer or discharge must either be signed by the

resident s attending physician or the medical director

of the facility or include an attached written order

for the discharge or transfer The notice or the order

must be signed by the resident s physician medical

director treating physician nurse practitioner or

physician assistant

4 a Each facility must notify the agency of any

proposed discharge or transfer of a resident when such

discharge or transfer is necessitated by changes in

the physical plant of the facility that make the

facility unsafe for the resident

b Upon receipt of such a notice the agency shall

conduct an onsite inspection of the facility to verify

the necessity of the discharge or transfer

5 A resident of any Medicaid or Medicare certified

facility may challenge a decision by the facility to

discharge or transfer the resident

6

7 At least 30 days prior to any proposed transfer

or discharge a facility must provide advance notice

of the proposed transfer or discharge to the resident

and if known to a family member or the resident s

legal guardian or representative except in the

following circumstances the facility shall give

notice as soon as practicable before the transfer or

discharge

a The transfer or discharge is necessary for the

resident s welfare and the resident s needs cannot be

met in the facility and the circumstances are

documented in the resident s medical records by the

resident s physician or

b The health or safety of other residents or

facility employees would be endangered and the

circumstances are documented in the resident s medical

records by the resident s physician or the medical

director if the resident s physician is not available

8 The notice required by subsection 7 must be in

writing and must contain all information required by

state and federal law rules or regulations

applicable to Medicaid or Medicare cases The agency

shall develop a standard document to be used by all

facilities licensed under this part for purposes of

notifying residents of a discharge or transfer Such

document must include a means for a resident to

request the local long term care ombudsman council to

review the notice and request information about or

assistance with initiating a fair hearing with the

department s office of Appeals Hearings In addition

to any other pertinent information included the form

shall specify the reason allowed under federal or

state law that the resident is being discharged or

transferred with an explanation to support this

action Further the form shall state the effective

date of the discharge or transfer and the location to

which the resident is being discharged or transferred

The form shall clearly describe the resident s appeal

rights and the procedures for filing an appeal

including the right to request the local ombudsman

council to review the notice of discharge or transfer

A copy of the notice must be placed in the resident s

clinical record and a copy must be transmitted to the

resident s legal guardian or representative and to the

local ombudsman council within 5 business days after

signature by the resident or resident designee

9 A resident may request that the local ombudsman

council review any notice of discharge or transfer

given to the resident when requested by a resident to

review a notice of discharge or transfer the local

ombudsman council shall do so within 7 days after

receipt of the request The nursing home

administrator or the administrator s designee must

forward the request for review contained in the notice

to the local ombudsman council within 24 hours after

such request is submitted Failure to forward the

request within 24 hours after the request is submitted

shall toll the running of the 30 day advance notice

period until the request has been forwarded

10 a A resident is entitled to a fair hearing to

challenge a facility s proposed transfer or discharge

The resident or the resident s legal representative

or designee may request a hearing at any time within

90 days after the resident s receipt of the facility s

notice of the proposed discharge or transfer

b if a resident requests a hearing within 10 days

after receiving the notice from the facility the

request shall stay the proposed transfer or discharge

pending a hearing decision The facility may not take

action and the resident may remain in the facility

until the outcome of the initial fair hearing which

must be completed within 90 days after receipt of a

request for a fair hearing

c If the resident fails to request a hearing within the

10 days after receipt of the facility notice of

proposed discharge or transfer the facility may

transfer or discharge the resident after 30 days from

the date the resident received the notice

11 Notwithstanding paragraph 10 b an emergency

discharge or transfer may be implemented as necessary

pursuant to state or federal law during the period of

time after the notice is given and before the time a

hearing decision is rendered Notice of an emergency

discharge or transfer to the resident the resident s

legal guardian or representative and the local

ombudsman council if requested pursuant to subsection

9 must be by telephone or in person This notice or as

shall be given before the transfer if possible

soon thereafter as practicable A local ombudsman

council conducting a review under this subsection

shall do so within 24 hours after receipt of the

request The resident s file must be documented to

show who was contacted whether the contact was by

telephone or in person and the date and time of the

contact If the notice is not given in writing

written notice meeting the requirements of subsection

8 must be given the next working day

12 After receipt of any notice required under this

section the local ombudsman council may request a

private informal conversation with a resident to whom

the notice is directed and if known a family member

or the resident s legal guardian or designee to

ensure that the facility is proceeding with the

discharge or transfer in accordance with the

requirements of this section If requested the local

ombudsman council shall assist the resident with

filing an appeal of the proposed discharge or

transfer

13 The following persons must be present at all

hearings authorized under this section

a The resident or the resident s legal

representative or designee

b The facility administrator or the facility s

legal representative or designee

A representative of the local long term care ombudsman

council may be present at all hearings authorized by

this section

14

15 a The department s office of Appeals Hearings

shall conduct hearings under this section The office

shall notify the facility of a resident s request for

a hearing

b The department shall by rule establish

procedures to be used for fair hearings requested by

residents These procedures shall be equivalent to the

procedures used for fair hearings for other Medicaid

cases chapter 10 2 part VI Florida Administrative

Code The burden of proof must be clear and convincing

evidence A hearing decision must be rendered within

90 days after receipt of the request for hearing

c If the hearing decision is favorable to the

resident who has been transferred or discharged the

resident must be readmitted to the facility s first

available bed

d The decision of the hearing officer shall be

final Any aggrieved party may appeal the decision to

the district court of appeal in the appellate district

where the facility is located Review procedures shall

be conducted in accordance with the Florida Rules of

Appellate Procedure

16 The department may adopt rules necessary to

administer this section

17 The provisions of this section apply to

transfers or discharges that are initiated by the

nursing home facility and not by the resident or by

the resident s physician or legal guardian or

representative

9 Rule 59A 4 106 1 f Florida Administrative Code

requires

1 Admission retention transfer and discharge

policies

f All resident transfers and discharges shall be in

accordance with the facility s policies and

procedures provisions of Sections 400 022 and

400 0255 F S this rule and other applicable state

and federal laws and will include notices provided to

residents which are incorporated by reference by using

AHCA Form 3120 0002 3120 0002A Revised May 2001

Nursing Home Transfer and Discharge Notice and

3120 0003 Revised may 2001 Fair Hearing Request

for Transfer or Discharge From a Nursing Home and

3120 0004 Revised May 2001 Long Term Care

Ombudsman Council Request for Review of Nursing Home

Discharge and Transfer These forms may be obtained

from the Agency for Health Care Administration Long

Term Care Unit 2727 Mahan Drive MS 33 Tallahassee

FL 32308 The Department of Children and Family

Services will assist in the arrangement for

appropriate continued care when requested

10 On or about October 27 31 2008 the Agency conducted

an unannounced Complaint Survey CCR 2008011798 at Respondent

Facility

11 Based on record review and interview the facility

failed to provide a 30 day notice of transfer to 62 of 62

residents when facility management decided to close the

building The facility s failure to provide appropriate notice

of closure caused widespread and significant psychosocial harm

confusion and grief to both the residents and families

12 Clinical record reviews of the sampled charts were

conducted on 10 17 08 at approximately 12 45 PM The following

were discovered in the records

12 1 Resident 13 s clinical record has a social

service note dated 9 24 08 that states received notice

from administrator that resident is transferring to another

SNF Administrator made all the discharge arrangements

A nurse s note on 9 23 08 at 1 30 PM states Spoke with

resident concerning transfer to nursing center in Crescent

City Resident began getting tearful and talking about

unrelated issues and then his her comments became non

coherent A call placed to sibling left message for

him her to call this writer to discuss his her

sibling There are no further entries as to whether or

not the facility reached the family member The MDS

assessment dated 9 3 08 coded Resident 13 s memory as a

problem and cognitive skills for daily decision making as

moderately impaired There is no 30 day notice in Resident

13 s chart The resident was discharged on 9 24 08

12 2 In Resident 14 s clinical record is a

social service note dated 9 26 08 Received notice that res

resident transferred to other SNF nursing home this

date This SW social worker did not participate in

his her transfer Administrator made all the D C

discharge arrangements There are no nursing notes

regarding the transfer The MDS assessment dated 9 3 08

reports that Resident 14 s memory is coded as short term

and long term memory is a problem The memory recall

section is coded as e none are recalled and the ability

to understand others is coded as a 3 rarely never

understands On a Department of Children and Families form

required for skilled nursing home placement there is a

note that the family is agreeable to placement of the

resident at Respondent Oakwood The signature on the form

is the Director of Nursing s DON from a facility in

Jacksonville where the interim administrator for

Respondent facility at this time is also the

administrator There are no notes of the family contact

anywhere in the record about this move from Oakwood A

doctor s telephone order dated 9 25 08 states Discharge to

XYZ nursing center The resident s discharge was on

9 26 08 There is no 30 day notice in Resident 14 s

chart

12 3 Resident 16 s clinical record contains the

memorialization of a verbal doctor s order dated 9 19 08

stating may discharge to LNC nursing home with meds

per family request A nurse s note of the same date

states assisted with transfer to another facility A

social service note dated 9 16 08 stated offered Res

resident res sibling transfer to other SNF per

Administrator directive Res and sibling agreed to

transfer DC transfer arrangements being made by

administrator The resident was discharged to another

facility on 9 19 08 There is no 30 day notice in Resident

16 s chart

12 4 In Resident 17 s clinical record there is a

social service progress note signed by the social worker

dated 9 24 08 that states received notice from the

administrator that Res transferring to another SNF This

SW did not participate in this Res D C plan Administrator

made all the D C arrangements The MDS Quarterly

assessment form dated 7 23 08 under cognitive skills for

daily decision making is coded as a 111 modified

independence and some difficulty in new situations under

ability to understand others he she is coded as a 1

that he she usually understands may miss some part or

intent of the message A nurse s note dated 9 24 08 at

12 30 PM states resident transferred to LNC via van and

LNC staff Again the Department of Children s and

Families form 3008 required for skilled nursing home

placement is signed by the DON from the Jacksonville

facility This form has checked that the resident is

confused wanders and is disoriented under the section of

mental and behavior status On the face sheet of this

record a family member and a phone number are listed

There is no mention of any attempts to contact the family

member or prepare this resident for discharge This

resident was transferred on 9 24 08 There is no 30 day

notice in Resident 17 s chart

12 5 The Assistant Director of Nursing ADON was

interviewed on 10 17 08 at 2 00 PM about why the above

residents were transferred to a different facility She

explained that she knew nothing of the reason for transfer

just that they were moving to another facility

12 6 At 2 30 PM on 10 17 2008 the Agency

surveyor conducted an interview with the previous interim

administrator who explained he is also the regional

supervisor for the management company s other facilities in

this area regarding the recent resident transfers The

interim administrator was asked when the anticipated change

in ownership with the new company was expected to be

completed He said the target date was November 15 2008

When asked why the residents were selected to be moved he

replied that he was told the facility would be under

construction and therefore he instructed his staff to ask

all the residents if they wanted to move to the other

facilities The staff was to tell the residents that they

were undergoing a change of ownership and the staff were

to ask each resident if they wanted to stay or transfer

He was asked if all families where involved in the

transfer and he responded he was told they were He was

unable to explain why there was no transfer planning and

why there were no discharge notices that could be reviewed

by the Agency survey team

13 In an interview on 10 28 2008 with the Agency surveyor

the interim administrator at 1 10PM revealed that residents were

being discharged and she was not included in the plans She

indicated all discharges were being handled by another

administrator from the management company and his Director of

Nursing DON and Licensed Practical Nurse LPN She confirmed

that the other administrator fired the Social Worker the prior

night 10 27 2008 and no discharge planners were in the

facility

13 1 Interview with Resident 22 on 10 28 2008 at

1 20PM revealed that he she had been notified Monday

10 27 08 that the building was closing and he she would

have to move He She began to cry and indicated that

his her parent had been there and took the notice home but

were told they needed to move immediately by the

administrator in a meeting that had occurred at 1 00 PM on

Monday 10 27 2008 Resident 22 was very upset and

crying He She expressed how he she was unsure where

he she would go and stated that no one had provided him her

or his her parent with discharge planning

13 2 Interview with Resident 23 s parent 88

years old on 10 28 2008 revealed he she had received a

call from the LPN from the management company indicating

that he she had to have his her adult child out of the

facility by 12 30 PM that day 10 28 2008 Resident 23 s

parent became upset and began to cry indicating that he she

did not know what to do and was afraid the facility would

put his her child out on the street He She indicated that

no one was assisting him her to find another placement

13 3 Interview with Resident 24 on 10 28 2008 at

1 45PM revealed that he she never received written notice

of discharge and that he she was attempting to get in touch

with family in California so they could contact his her

grandchildren in Florida to assist him her since the

facility was not providing assistance He She indicated

he she wanted to go to another city closer to his her

grandchildren but had not been provided discharge planning

or assistance

13 4 Interview with Resident 20 s spouse at 2 00

PM on 10 28 2008 revealed that his her adult child who is

Resident 20 s Power of Attorney POA received a letter

that day indicting the facility was closing and that he she

had to come down to the facility and pick Resident 20 up

that day The spouse was very upset and confused and asked

who could help him her as he she needed to take Resident

20 home but that he she could not care for him her

13 5 Interview with the Administrator from

another Skilled Nursing Facility SNF at 2 25 PM on

10 28 2008 revealed that he she had brought in his her

discharge planners to assist residents with moving as

he she had been told they had to be out of the facility in

a few days

13 6 Interview with Resident 25 on 10 28 2008 at

2 30 PM revealed he she received his her notice for

discharge on 10 24 08 and signed the form At this time

he she had requested to stay in the area and was told by

the nursing home management staff that he she would be

going to another city Observation on 10 28 2008 at 4 00

PM of a handmade discharge board in the office being

utilized by the management company s staff confirmed that

Resident 25 was going to be sent to a SNF in another city

13 7 Telephone interview with the spouse of

Resident 26 s power of attorney POA on 10 28 2008 at

2 38 PM revealed they had just received a call from the

facility indicating that it was being closed and that

Resident 26 would be moved today or tomorrow He She

expressed the shock and upset caused by the sudden news and

the lack of prior notification and planning He She

indicated he she wanted Resident 26 to stay in the area to

be close to them but would move him her wherever he she

would get the best care He She asked what their rights

were and if they the facility could kick him her out so

quickly

13 8 interview with Resident 4 s spouse on

10 28 2008 at 3 OOPM revealed that he she comes to the

facility daily and that he she was told Monday 10 27 2008

that the facility was closing by a resident who greeted

him her on his her way into the building He She spoke

with staff who were very upset and was notified about a

meeting the management company was having at 1 00 PM that

afternoon 10 27 2008 He She indicated he she had

attended the meeting which had only 12 residents present

and he she was the only family member and was conducted by

the management company s staff Administrator and LPN

Resident 41s spouse indicated that at this time he she was

told that the facility would try to help the alert and

oriented residents find placement but that everyone had to

be out before November 15 2008 He She indicated that

they pressured the residents and him her to move

immediately At this point he she began to cry and

indicated that since he she had visited his her spouse in

this facility everyday for 3 years that he she felt as if

they were being kicked out of their home He She stated

that the facility always had problems but that the staff

treated people like family and he she had no idea why this

discharge was conducted in this manner

13 9 Interview with Licensed Practical Nurse

LPN 1 on 10 28 2008 at 3 30 PM revealed that staff was

being told by the management company staff to pack up

residents belongings and get them onto vans She indicated

that 6 people had been discharged that morning alone to the

other Nursing Homes in Florida owned by the same management

company She indicated that she had stopped the transfer

of Resident 29 that morning as the resident was going to

be transported to a SNF in another city owned by the

management company but had begun to cry and asked that

his her sibling be called first The staff person

indicated she called the sibling who knew nothing of the

facility closing or where Resident 29 was being taken As

the resident was upset LPN 1 held Resident 29 back from

being moved and did not put him her on the van

14 Interview with the Administrator from the management

company and his LPN on 10 28 2008 at 4 00 PM revealed that the

30 day closure notice was mailed October 24 2008 to all

responsible parties Review of the discharge notice revealed it

to indicate the discharge date to be November 23 2008 The

Administrator confirmed the lack of a social worker or discharge

planners He asked if the other facilities could just use their

people to do the discharge planning He was told the

regulations indicate the facility itself is responsible to

notice and to provide adequate discharge planning and social

services He indicated that a discharge planner from another of

his facilities would be at the facility by 8 00 AM on 10 29 2008

to do the discharge planning When questioned about the meeting

on Monday he indicated that he had determined the date of

November 15 2008 for everyone to be moved as the facility was

scheduled for termination effective November 22 2008 A second

review of the discharge notice revealed that the facility could

not be opened the required 30 days as they had indicated in the

notices sent to residents and responsible parties as the notice

indicates a discharge date of November 23 2008 and the

facility would be forced to close November 22 2008 The

Administrator confirmed that calls were made to families

Interview at this time with the LPN revealed she called several

families and noticed them that the facility was closing and

that if they asked for a few days she would agree The

Administrator and LPN were unable to provide any documentation

that any discharge planning had been done in advance to prevent

the confusion created by the sudden notice or that social

services were provided to assist residents with transition

14 1 At 9 20 am on 10 29 2008 a telephone call

was received from Resident 23 s parent He She indicated

he she was very upset He She stated that the facility

management was sending his her adult child to another SNF

without his her knowledge and that he she did not want the

child to go there

14 2 Interview with Resident 30 at 9 30AM on

10 29 2008 revealed that no one told him her about being

moved where he she would be moving to or even asked where

he she would like to go He She indicated he she very

upset

14 3 Interview on 10 29 2008 at 9 45 AM with

Resident 3 revealed that he was willing to transfer to

another facility however he she stated he she was on

hospice and that the chaos that was happening was making

his her blood pressure shoot up and he she had to ask for

an anti anxiety pill to help calm him her down

14 4 A brief interview with Resident 31 s family

member on 10 29 2008 at 10 20 AM revealed that he she had

just received the letter and that they facility

management aren t explaining anything He she indicated

he she was very upset and confused by the situation and how

it was being handled

14 5 During Interview with alert and oriented

Resident 32 on 10 29 2008 at 11 00 AM he she revealed

that at this time he she had no idea where he she was going

to move and the facility had not provided assistance at

this point to assist in his her transfer

14 6 Observation on 10 29 2008 at approximately

1 00 PM revealed Resident 21s parent seated at his her

bedside with a Certified Nursing Assistant CNA packing

the resident s belongings At this time Resident 2 s

to

parent stated They were going to send Resident 2

south Florida without telling me He She stated a

facility staff person made a sneak call to him her and

he she come over right away The parent indicated that

Resident 2 had 3 children and needed to remain in this

area so that he she and the children could visit The

parent appeared distraught confused and upset

14 7 Interview at 2 00 PM on 10 29 2008 with

Resident 24 s POA revealed that he had received a call

from his her parent indicating that he she was moving to

another city Resident 24 s POA stated that he she knew

nothing of the move and had the resident removed from the

van as the facility was attempting to transport his her

parent when he she arrived He she indicated that facility

management had said they obtained approval for the move

from his her sibling who lived in California The POA

indicated he she was very upset and wanted answers about

how this could happen without his her knowledge

14 8 Observation by an Agency surveyor on

10 30 2008 at 8 50 am revealed Resident 33 nude in bed

with just a sheet covering him her Interview with

Resident 33 at this time revealed that he she was

extremely upset about moving He indicated that his her

child had made him her the bookshelf observed in the room

The resident indicated that facility management had

informed him her that he she could not bring the bookshelf

with him her as it did not fit into the van He she stated

that he she would not move without the bookshelf When

asked if he she was aware he she had up to 30 days to move

he she indicated that he she was not told that but that

he she would then just sit there for 30 days and move

with the bookshelf

15 Interview on 10 30 2008 at 9 20 am with the two Social

workers from the management company s other facilities revealed

that they did not know the residents as they had never worked in

the building and that they did not have a current list of where

and when residents were or would be transferred

16 On 10 30 2008 at 3 30 pm interview with the Interim

Administrator revealed that another resident had informed her

that Resident 20 s spouse had the resident in his her car and

was taking him her home The Interim administrator indicated

that the spouse was unable to care for Resident 20 as he she

would most likely require some personal assistance or placement

very soon She indicated she had to physically chase down the

car and stop the spouse to have Resident 20 returned to the

facility She indicated that neither staff nor management could

explain how Resident 20 s spouse had been able to remove the

resident from the building

17 In an interview with the Advance Registered Nurse

Practioner ARNP who provides services for the medical director

on 10 30 2008 at 4 00 PM the ARNP told the Agency surveyor that

her residents were very upset and that the course chosen by

facility management to transfer the residents was not an

as

appropriate method or in the best interests of the residents

no preparations had been made She indicated that staff members

who provide care are being told very little by the management

therefore they are unable to assist the residents with the

transfer process

18 The Agency determined that Respondent s failure to

provide residents with adequate notice of discharge or transfer

and failure to otherwise comply with the requirements of Florida

law regarding resident transfer and discharge was widespread

effecting all 62 residents of Respondent s facility and

compromised each 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 widespread State Class II

deficiency

WHEREFORE the Agency intends to impose an administrative

fine in the amount of 7 500 00 against Respondent a skilled

nursing facility in the State of Florida pursuant to 400 23

Florida Statutes 2008

tl TMTT TT

19 The Agency re alleges and incorporates paragraphs one

1 through six 6 and eleven 11 through seventeen 17 as

if fully set forth in this count

20 Section 400 022 Florida Statutes requires

1 All licensees of nursing home 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 each resident the following

1 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

n The right to be treated courteously fairly and

with the fullest measure of dignity and to receive a

written statement and an oral explanation of the

services provided by the licensee including those

required to be offered on an as needed basis

o

p The right to be transferred or discharged only

for medical reasons or for the welfare of other

residents and the right to be given reasonable

advance notice of no less than 30 days of any

involuntary transfer or discharge except in the case

of an emergency as determined by a licensed

professional on the staff of the nursing home or in

the case of conflicting rules and regulations which

govern Title XVIII or Title XIX of the Social Security

Act For nonpayment of a bill for care received the

resident shall be given 30 days advance notice A

licensee certified to provide services under Title XIX

of the Social Security Act may not transfer or

discharge a resident solely because the source of

payment for care changes Admission to a nursing home

facility operated by a licensee certified to provide Act

services under Title XIX of the Social Security

may not be conditioned upon a waiver of such right

and any document or provision in a document which

purports to waive or preclude such right is void and

unenforceable Any licensee certified to provide

services under Title XIX of the Social Security Act

that obtains or attempts to obtain such a waiver from

a resident or potential resident shall be construed to

have violated the resident s rights as established

herein and is subject to disciplinary action as

provided in subsection 3 The resident and the

family or representative of the resident shall be

consulted in choosing another facility

3 Any violation of the resident s rights set forth

in this section shall constitute grounds for action by

the agency under the provisions of s 400 102 s

400 121 or part II of chapter 408 In order to

determine whether the licensee is adequately

protecting residents rights the licensure inspection

of the facility shall include private informal

conversations with a sample of residents to discuss

residents experiences within the facility with

respect to rights specified in this section and

general compliance with standards and consultation

with the ombudsman council in the local planning and

service area of the Department of Elderly Affairs in

which the nursing home is located

21 On or about October 27 31 2008 the Agency conducted

an unannounced Complaint Survey CCR 2008011798 at Respondent

Facility

22 Based on record review and interview the facility

violated residents rights by failing to provide at least 30

days prior notice of transfer to 62 of 62 residents when

facility management decided to close the building

WHEREFORE the Agency intends to impose an administrative

fine in the amount of 5 000 00 against Respondent a skilled

nursing facility in the State of Florida pursuant to H 400 121

and 400 102 Florida Statutes 2008

COUNT III

23 The Agency re alleges and incorporates paragraphs one

1 through six 6 and eight 8 through nineteen 19 as if

fully set forth in this count

24 Section 400 102 1 a Fla Stat 2008 provides

1 Any of the following conditions shall be grounds for action

by the agency against a licensee a An intentional or

negligent act materially affecting the health or safety of

residents of the facility

25 Rule 59A 4 122 Florida Administrative Code requires

1 The facility shall provide a safe clean

comfortable and homelike environment which allows

the resident to use his or her personal belongings to

the extent possible

2 The facility shall provide

a Housekeeping and maintenance services necessary to

maintain a sanitary orderly and comfortable

interior

b Clean bed and bath linens that are in good

condition

c Private closet space for each resident

d Furniture such as a bed side cabinet drawer

space levels all

e Adequate and comfortable lighting in

areas

f Comfortable and safe temperature levels and

g The maintenance of comfortable sound levels

individual radios TVs and other such transmitters

belonging to the residentwill be tuned to stations of

the resident s choice

26 On or about October 27 31 2008 the Agency conducted

an unannounced Complaint Survey CCR 2008011798 at Respondent

Facility

27 Based on observation interview and review of facility

documentation the facility provided a substandard living

environment and created an atmosphere of anxiety confusion and

emotional pain by failing to provide adequate appropriate and

required medically related social services discharge planning

and discharge notice to 62 of 62 residents As a result of this

widespread problem residents and family member were confused

expressed emotional grief and confusion due directly to the

condition of the facility itself lack of proper notice and lack

of adequate organized discharge planning after the facility

determined to close the building

28 During an in depth tour of the facility on 10 16 08

commencing at 10 00 AM and continuing throughout the day until

6 00 PM the following interviews and observations were made

28 1 Interview conducted with Resident 11 on

10 16 08 at 10 30 AM revealed that on 10 13 08 his her bed

was replaced with a bed that was not as comfortable as

his her prior bed Continued interview with the resident

revealed that he she was not given a reason for the bed

change Further interview with the resident on the same

date and time revealed that his her air conditioner was

removed and replaced with a different unit and again

Resident 11 was provided no explanation for the change

Observation of the air conditioning unit on the same date

and time revealed an air conditioner with 3 gray duct tape

apparently taping the unit to the surrounding wall area

28 2 Continued interview with the resident on the

same date and time revealed that on 10 13 08 the 3

comfortable chairs and settee that were in the television

viewing area on the 200 wing had been removed and replaced

with straight back chairs with no arms which the resident

stated were uncomfortable and caused his her back to hurt

Due to not being comfortable the resident stated that

he she no longer spends time in the area

28 3 Interview conducted with Resident 2 on

10 16 08 at 11 30 AM with the assistance of the unit LPN

Licensed Practical Nurse the resident agreed that his her

bed had been replaced 2 days earlier and was given no

explanation Observation of the air conditioning unit in

his her room revealed an air conditioning unit in the wall

that appeared to be anchored in place by 3 gray duct tape

around the entire conditioning unit

28 4 Interview conducted with Resident 6 on

10 16 08 at 2 00 PM revealed that the prior seating in the

television viewing area had been moved out and straight

back chairs moved in in their place Further interview

with the resident revealed that he she doesn t see

residents watching television as much as they used to in

the past

28 5 Gray duct tape anchoring air conditioners

into the resident s bedroom walls were identified in the

following resident rooms 204 206 220 and 230 Rooms

208 210 and 226 had no air conditioning units in the area

where units had previously been and had been replaced by

plywood and duct tape securing the areas

28 6 A chest of drawers in room 256 was missing

large areas of the wood finishing and also missing a drawer

knob

28 7 Room 254 2 stained bedroom ceiling tiles

were observed

28 8 The lavatory sink was not secured to the

pedestal base in room 144

28 9 The lavatory cabinet of room 228 was

missing numerous areas of paint The adjacent wall to the

lavatory had a 6 area of missing sheet rock along the

wall The ceiling of the resident s room had 2 stained

ceiling tiles There was an area observed above the

resident s room mirror with no paint measuring 12 X 18

The bathroom floor tiles were discolored with a brownish

crusty substance

28 10 The bathroom in room 204 had a broken

ceiling light cover

28 11 The baseboard in the bathroom of room 220

was loose from the wall The baseboard and wall covering

in the resident s bedroom area was buckled extending 8

from the floor

29 The above listed failures to maintain the physical

environment of the Respondent facility were part of a widespread

practice throughout the facility to remove equipment and

furniture and not replace the equipment or furniture or to

replace the equipment or furniture with substandard equipment or

furniture in preparation for closing the facility

30 The Agency determined Respondent Facility s failure to

institute transfer and discharge procedures in accord with the

requirements of Florida law and failure to maintain a safe

clean and homelike environment for residents were intentional or

negligent acts which materially affect the health or safety of

residents of the facility and compromised each 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

widespread State Class II deficiency

WHEREFORE the Agency intends to impose an administrative

fine in the amount of 7 500 00 against Respondent a skilled

nursing facility in the state of Florida pursuant to H 400 23

and 400 102 Florida Statutes 2008

COUNT IV

31 The Agency re alleges and incorporates paragraphs one

1 through six 6 and Counts I II and III as if fully set

forth in this count

32 Based upon Respondent s two cited State Class II

deficiencies and Respondent s violation of residents rights

Respondent 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 2008

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

2008 commencing October 31 2008 and ending November 5 2008

J es H Harris Esq

Ft Bar No 817775

Assistant General Counsel

Agency for Health Care Administration

525 Mirror Lake Drive 330H

St Petersburg FL 33701

727 552 1435

DISPLAY OF LICENSE

Pursuant to 400 23 7 e Fla Stat 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 be made to the attention of The

Agency Clerk Agency for Health Care Administration 2727 Mahan

Drive Bldg 3 MS 3 Tallahassee Florida 32308 850 922

5873

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

I HEREBY CERTIFY that a true and correct copy of the

foregoing has been served by regular U S Mail to john F

Gilroy III P A 1695 Metropolitan Circle Suite 2

Tallahassee Florida 32308 8722 on tavcln

2009

ti

M s H Harris

s stant General Counsel

Uur w cuu i0 J1 0JU444UZ41 UlLKUY NH h HUt bL UI

STATE OF FLORIDA

AGENCY fOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA

AGENCY FOR HEALTH

CARE ADMINISTRATION

Petitioner

VS

DOAH Case No 090931

Case No s 2008012947

200801 2950

OAKWOOD NURSING CENTER INC

Respondent

SETTLE NT AGRENT

Petitioner State of Florida Agency for Health Care Administration hereinafter the

Agency through its undersigned representatives and Respondent Oakwood Nursing Center

Inc hereinafter Respondent pursuant to Section 120 57 4 Florida Statutes each

individually a party collectively as parties hereby enter into this Settlement Agreement

Agreement and agree as follows

WHEREAS Respondent is a Skilled Nursing Facility licensed pursuant to Chapter 4009

Part II Florida Statutes Section 20 42 Florida Statutes and Chapter 59A 4 Florida Administrative

Code and

WHEREAS the Agency has jurisdiction by virtue of being the regulatory and licensing

authority over Respondent pursuant to Chapter 400 Part II Florida Statutes and

WHEREAS the Agency served Respondent with an administrative complaint on or

about December 22 2008 notifying the Respondent of its intent to impose administrative fines

EXHIBIT

z

rib Zoo Lr uli lb 01 b0b4ZZUZZl U1LKUY F A F Aat bd b

in the amount of 00 15 000 later amended to fines of 00 000 20 and assigned a conditional

licensure status commencing October 31 2008 and ending November 06 2008 and

WHEIi EAS Respondent requested a formal administrative proceeding

WHEREAS the parties have negotiated and agreed that the best interest of all the parties

will be served by a settlement of this proceeding and

NOW THEREFORE in consideration of the mutual promises and recitals herein the

parties intending to be legally bound agree as follows

1 All recitals herein are true and correct and are expressly incorporated herein

2 Both parties agree that the whereas clauses incorporated herein are binding

findings of the parties

3 Upon full execution of this Agreement Respondent agrees to waive any and all

appeals and proceedings to which it may be entitled including but not limited to an informal

proceeding under Subsection 120 57 2 Florida Statutes a formal proceeding under Subsection

120 57 1 Florida Statutes appeals under Section 120 68 Florida Statutes and declaratory and

all writs of relief in any court or court quasi of competent jurisdiction and agrees to waive

compliance with the form of the Final Order finding of fact and conclusions of law to which it

may be entitled provided however that no agreement herein shall be deemed a waiver by either

party of its right to judicial enforcement of this Agreement

4 Upon full execution of this Agreement Respondent agrees to pay 10 000 00 in

administrative fines to the Agency within thirty 30 days of the entry of the Final Order

Respondent accepts the assignment of conditional licensure status commencing October 31 2008

and ending November 06 2008

Uo 401 L UU7 10 Jl ODU4ZZUzzl UlLKUY t A FIAUL b4 U i

5 Venue for any action brought to enforce the terms of this Agreement or the Final

Order entered pursuant hereto shall lie in Circuit Court in Leon County Florida

6 By executing this Agreement Respondent neither admits nor denies and the

referenced

Agency asserts the validity of the allegations raised in the administrative complaint

herein However no agreement made herein shall preclude the Agency from imposing a penalty

of

against Respondent for any deficiency violation of statute or rule identified in a fixture survey

Respondent which constitutes a repeat or uncorrected deficiency from surveys identified in

the administrative complaint The parties agree that in such a repeat or uncorrected case the

deficiencies from the surveys identified in the administrative complaint shall be deemed found

without further proof

7 No agreement made herein shall preclude the Agency from using the deficiencies

from the surveys identified in the administrative complaint in any decision regarding licensure of

Respondent including but not limited to licensure for limited mental health limited nursing

services extended congregate care or a demonstrated pattern of deficient performance The

Agency is not precluded from using the subject events for any purpose within the jurisdiction of

the Agency Further Respondent acknowledges and agrees that this Agreement shall not

preclude or stop any other federal state or local agency or office from pursuing any cause of

action or taking any action even if based on or arising from in whole or in part the facts raised

in the administrative complaint This agreement does not prohibit the Agency from taking action

regarding Respondent s Medicaid provider status conditions requirements or contract

8 Upon full execution of this Agreement the Agency shall enter a Final Order

adopting and incorporating the terms of this Agreement and closing the above stylcd case

9 Each party shall bear its own costs and attorney s fees

UUr LU LUUJ 10 J1 0JU4 4U441 UlLKUY rk rlf4ut UO ri l

10 This Agreement shall become effective on the date upon which it is fully executed

by all the parties

11 Respondent for itself and for its related or resulting organizations its successors

or transferees attorneys heirs and executors or administrators does hereby discharge the State

of Florida Agency for Health Care Administration and its agents representatives and attorneys

of and from all claims demands actions causes of action suits damages losses and expenses

of any and every nature whatsoever arising out of or in any way related to this matter and the

Agency s actions including but not limited to any claims that were or may be asserted in any

federal or state court or administrative forum including any claims arising out of this agreement

by or on behalf of Respondent or related facilities

12 This Agreement is binding upon all parties herein and those identified in

paragraph eleven 11 of this Agreement

13 In the event that Respondent was a Medicaid provider at the subject time of the

occurrences alleged in the complaint herein this settlement does not prevent the Agency from

seeking Medicaid overpayments related to the subject issues or from imposing any sanctions

pursuant to Rule 59G 9 070 Florida Administrative Code

14 Respondent agrees that if any funds to be paid under this agreement to the Agency

are not paid within one thirty 31 days of entry of the Final Order in this matter the Agency

may deduct the amounts assessed against Respondent in the Final Order or any portion thereof

owed by Respondent to the Agency from any present or future fiends owed to Respondent by the

Agency and that the Agency shall hold a lien against present and future funds owed to

Respondent by the Agency for said amounts until paid

UUe LW LUUJ 1U Jt 0JU4LLU4Z1 UlLMUY rk rr ut t HUt UZ Ub U

08 27 7009 1244 7709935497 STEELING HEAL KAPL

15 The undersigned have read and undemand this Agreement and have the authority

to bind their respective principals to it

16 This Agreement contains and incorporates the entire understandings and

agreements of the parties

17 This Agreement supersedes any prior oral or written agreements between the

patties

18 This Agreement may not be amended except in writing Any attempted

assignment of this Agreement shall be void

19 All parties agree that a facsimile signature suffices for an original signature

The following repm ntativcs herby acknowledge that they are duly autbozia ed to eater

into this Agreement

Robert Hagan PresideW

uty S Dalcwood Inc

t ncy fo Health Care Administration 2021 SW Nursing I Avenue Center

2727 M an Drive Ws 1 Ocala Florida 344741

Tallahassee Florida 323 8

D D DATED

Jo E Terrel Esquire

Ld Offices of John Gilroy M P A

49 Metropolitan Circle Suite 2

T8111thameE Florida 32308

DA Z ED

VVr till LVVJ LU Jl UJU4LLUG4I UILKUY rk r Aut Utl U

IZAK V

Ju n Seni General Counsel aryAlice David Esquire

Agency far Health Care Administration Assistant General Counsel

2727 Mahan Drive MS 3 2727 Mahan Drive MS 3

Tallahassee Florida 32308 Tallahassee Florida 32308

DATED 4 gyp Y DATED D