AHCA
Florida Agency For Health Care Administration
Better Health Care for all Floridians
December 16
Claudine Alexander-Leger, Administrator
Sun City Retirement Residence
3855 Upper Creek Drive
Ruskin, Fl 33573
Dear Ms. Alexander-Leger
This letter confirms the findings of a complaint investigation (CCR#2008013052) conducted on December 5, by Patric Halbert, HFEII, and Sharon McCrary, HFEII.
The allegations regarding dietary, rodents/insects, and lack of assessment were not confirmed. (author's notes: witness does verify roaches in kitchen)
Further, it was alleged that there issues regarding resident care, untrained/unqualified staff, resident rights, and the environment. These allegations were CONFIRMED and have been cited on the attached AHCA Form 3020 (Statement of Deficiencies and Plan of Correction). Please provide a plan of correction and return the original copy to this office within ten (10) calendar days of receipt.
Documents relating to State Licensure will be made available for the public disclosure as required by the Florida Statues.
The Quality Assurance Questionnaire has long been employed to obtain your feedback following survey activity. This form has been placed on the Agency's websight at www.fdhc. State. Fl.Us/Publications, as a first step in providing a web-based interactive consumer satisfaction survey system. You may access the questionnaire through the link under Forms on this page. Your feedback is encouraged and valued, as our goal is to ensure the professional and consistent application of the survey process.
If there are any questions concerning this report, please contact Ms. McCrary, of this office at (727) 552-1133.
Sincerely,
Kathleen Vargan (signature)
Patricia Reid Caufman
Field Office Manager
State Form 3QNQ11 AHCA Report Survey Completed: 12/05
21 pages
Page 1
A413 ADMISSIONS CRITERIA STANDARDS
A resident does not require 24-nursing supervision.
Investigator: This STANDARD is not met as evidenced by: Based on recored review, observation, and staff interview, the facility FAILED to ensure that 1 of 7 (#4) residents sampled did not require 24 hour nursing supervision.
FINDINGS include: Review of the medical chart of Resident #4 on 12/5/08 revealed a medical assessment signed by a health care professional. It was annotated that the resident requires 24 hour nursing. Observation of the resident during tour on 12/5/08 at around 4:30PM revealed a frail looking resident laying in a hospital bed with an air mattress and 1/2 side rails, she did not respond except to follow with eyes.in an interview with the facility care taker, the resident is seen by HHC and that the resident was pretty much bed to wheelchair with assistance, cannot transfer by self and is mostly bed bound.
A417 ADMISSIONS CRITERIA STANDARDS
The medical examination report shall address the following: 1. The physical and mental status of the resident, including the identification of any health-related problems and functional limitations; 2. An evaluation of whether the individual will require supervision or assistance with the activities of daily living; 3. Any nursing or therapy services required by the individual; 4. Any special diet required by the individual; 5. A list of current medications prescribed, and whether the individual will require any assistance with the administration of medication; 6. Whether the individual has signs or symptoms of a communicable disease which is likely to be transmitted to other residents or staff; 7. A statement that in the opinion of the examining physician, physician assistant, or ARNP, on the day the examination is conducted, the individual's needs can be met in an assisted living facility; and 8. The date of the examination, and the name, signature, address, phone number, and license number of the examining physician or ARNP. The medical examination may be conducted by a currently licensed physician or ARNP from another state.
AHCA Investigator: This STANDARD is NOT met as evidenced by: (further information on page 4 of 21).
A509 STAFFING STANDARDS
All employees hired on or after October 1,1998 who perform personal services shall be in compliance with Level 1 background screening.
AHCA Investigator: This STANDARD is NOT met as evidenced by: (further information on page 4 of 21).
A512 STAFFING STANDARDS
Staff who provide care to residents, who have not taken the core training program, shall receive a minimum of 1 hour in-service training within 30 days of employment that covers the following subjects: 1. Resident rights in an assisted living facility. 2. Recognizing and reporting resident abuse, neglect, and exploitation.
AHCA Investigator: This STANDARD is NOT met as evidenced by: (further information of page 5 of 21).
A513 STAFFING STANDARDS
Staff who provide direct care to residents, other than nurses, CNA's, or home health aides trained in accordance with rule 59A-8.0095, must receive three hours of in-service training within 30 days of employment that covers the following subjects: 1. Resident's behavior and needs. 2. Providing assistance with activities of daily living.
AHCA Investigator: This STANDARD is NOT met as evidenced by: (further information on page 6 of 21).
A522 STAFFING STANDARDS
Minimum staffing ratio (page 7 of 21)
AHCA Investigator: This STANDARD is not met as evidenced by: Based upon interviews with staff and family memebers as well as random observation on 12/5/08, the facility failed to provide sufficient staffing to meet the needs of 31 residents in the secure area of the facility.
Findings include: Observations were made in the secure memory care unit from approximately 5PM until approximately 7PM.
Initially upon entering the unit, 1 staff person was visible in the large common area. Observed at this time were about 20 residents sitting in the common area. The TV was on at low volume, Christmas music was playing. The SAME song repeated itself over and over. Residents were NOT involved in any activity and there was no consistent staff interaction. Some appeared to be resting with eyes closed, others were observed wandering. Two female residents walked in from the patio area arm & arm, 1 of these residents was in bare feet (December).
A staff person was asked how many staff were on duty and she responded there were 3 staff.
At about 5:30PM staff started bringing the 31 residents into the dining area. As staff sat residents down at tables and went to gather other resients, the residents who had been seated would get back up. Others were observed attempting to drink beverages using spoons. A resident was observed walking around in the staff office and medication room while staff were out of the room passing medications. This resident walked over to the medication cart and fumbled with papers on top of the cart, then picked up the telephone as it rang. Another female resident walked out to the dining area without pants on. (Witness observed late one evening while staff was not in the front room a resident walking around with a wet pull-up and sitting down on the cloth covered couch, until a staff member came back into the room and removed him).
One resident was observed feeding another resident some fruit cocktail that had been brought out (for dinner). The resident would use the same spoon she used for the resident she was feeding to feed herself. Staff being busy, did not notice. The resident continued to feed the other resident the main entree until about 6:10PM when the SURVEYOR finally brought it to staff's attention. The resident who was feeding the other resident was NOT eating her own meal. Several other residents were Not eating and were playing with their food or their neighbors food. One female resident asked the surveyor for help stating "Ma'am, I need some to help eat". A family member who was seated at a table with her father, was helping another female resident at the same table with her meal.
At 6:30PM when the surveyor went to observe the rest of the medication pass, some of the residents were still observed playing with their food, meal time assistance not provided due to staff attempting to intervene and re-direct those residents they could. Given the level of assistance the 31 residents in this secure area needed, it was IMPOSSIBLE for the 3-4 staff available to provide the care required and ensure residents RECEIVE MEAL TIME ASSISTANCE. (Witness did not observe administrator to be on property at this time).
ACHA Investigator: In conclusion, it was obvious that the staff available were NOT able to provide the level of care needed for these residents in the Memory Care unit. This LACK of assistance with eating puts residents' health AT RISK for unintended weight loss, malnutrition, and exposure to communicable illness.
A524 STAFFING STANDARDS (page 10 of 21)
At least one staff member who is trained in First Aid and CPR, as provided under Rule 58A-5.0191, shall be within the facility at all time when residents are in the facility.
AHCA Investigator: This STANDARD is NOT met as evidenced by: Based upon a review of 11 personnel records on 12/5/08,3 records (#3,4, & 5) did NOT contain documented evidence of current valid certification in CPR and 1st Aid.
Findings include: The personnel records for direct care staff (#4 & #5) proof of both CPR and 1st Aid certificaion and the personnel record for the LPN (#3) did NOT contain proof of CPR CERTIFICATION.
A615 MEDICATION STANDARDS (page 11 of 21)
AHCA Investigator: This STANDARD is NOT met as evidenced by: Based upon staff interview, observation of the evening medication pass and a review of the prescribed medications and medication observation records, the facility did NOT ensure that medication observation records were maintained accurately for 1 out of 4 resident records reviewed.
(Resident record reviewed that one resident needed medication for a cough and it was not being given as prescribed in a consistent manner.) "At no time in the past 3 months was it evident from the MOR's that the resident received the Tussin for a 7 day period.
Further discussion prior to exit with the administrator and wellness director (unqualified) brought up the fact that since the residents medication is passed by UNLICENSED STAFF and the resident is unable to let staff know when she needs the PRN medication, that the order should have been clarified with the physician. THIS LACK of classification for "as needed" medication puts the RESIDENT AT RISK for continued or WORSENING SYMPTOMS of the illness for which the medicaiton was prescribed.
Page 13 of 21 Refers to activities for patients.
AHCA INVESTIGATOR: This STANDARD is NOT met as evidenced by: Based upon observations in the memory care unit on 12/5/08 the facility FAILED to ensure that an on-going activity program was offered based upon residents needs and abilities.
A718 RESIDENT CARE STANDARDS
The facility will comply with the Resident's Bill of Rights 429.28 (1), F.S.
AHCA Investigator: This STANDARD is NOT met as evidenced by: Based upon interviews with staff, review of records and random observation on 12/5/08, the facility FAILED to ensure that the residents were provided services consistent with a high quality of life, were provided an environment which PROMOTES DIGNITY, adequate assistance, CARE and supervision and a meaningful activity program based upon the needs of the residents in the memory support unit.
A1003 PHYSICAL PLANT STANDARDS
Peeling paint or wallpaper, missing ceiling or floor tiles, or torn carpeting shall be repaired or replaced.
AHCA Investigator: This STANDARD is NOT met as evidenced by: Based on observation, the facility did NOT ensure that peeling paint or wallpaper, missing ceiling or floor tiles or torn carpeting was repaired or replaced.
Observation: The carpet in the secured unit dining room was badly stained. (Witness reported food stains on carpet along with fecal matter stains).
Staff was noted for NOT taking food-handling training, (A1108) within required 30 days of employment.
Findings include:
Record review on 12/5/08 and an interview with the administrator at 8:15PM determined that 8 of 11 current staff reviewed (all employed over 30 days) to serve food and had not received a minimum of 1-hour in-service training within 30 days of employment in SAFE FOOD HANDLING PRACTICES.
Claudine Alexander Leger was the administrator for this facility. She hired several employees that were her friends. A witness can VERIFY that many times, staff was seen to be sitting and talking while residents wandered aimlessly around the rooms. Adequate staff was not available in the secure unit at nighttime, as they would be out in the parking lot on breaks or working in other areas of the building on the other side of the locked doors in the memory care unit.
Public records can also be viewed through the Hillsborough County, Florida court system under the names of Claudine Leger/aka Claudine Alexander Leger married to Al Leger/aka Albert Leger.
Public records are available for factual information, which cannot be denied.
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