Florida regulators moved to shut down Floridian Gardens Assisted Living Facility in South Miami-Dade on Thursday, a 180-bed elder care center operated by the owner of a Hollywood Hills nursing home where 11 people died when their air-conditioning unit stopped working for days after Hurricane Irma.
The Agency for Health Care Administration said that the facility at 17250 SW 137th Ave., owned by Jack Michel and Larkin Community Hospital, “has a history of regulatory issues.” Inspections last year found widespread deficiencies — chronic understaffing, repeated incidents of residents hospitalized after falling, ignoring complaints from female residents when a male resident sexually harassed them, and systemic failures relating to medication, training and records.
In a strongly worded order, AHCA attempted to deny a renewal of the ALF’s license in December and imposed an immediate moratorium on new residents. Larkin challenged the action in administrative court, and the case is pending.
READ MORE: “From care center to purgatory to ‘hellhole’: How 11 frail elders died after Irma”
But on Aug. 24, AHCA lifted the moratorium suggesting that “necessary corrections” had been completed. On Thursday, after waiting more than nine months to take additional action, the agency cited the deaths at the Rehabilitation Center at Hollywood Hills, where the 11 elderly patients died, and removed Floridian Gardens from the Medicaid program, essentially starving it of two-thirds of its revenue source.
“Our agency will continue to hold healthcare facilities accountable, and we are fully committed to doing everything in our power to protect patients in Florida,” AHCA Secretary Justin Senior said in a statement Thursday. “The Floridians Gardens Assisted Living Facility and Rehabilitation Center at Hollywood Hills have demonstrated without a doubt that they do not deserve to be trusted with patient’s lives, especially those who are vulnerable and unable to care for themselves.”
Senior said the agency will work with the Department of Children and Families, and the state’s long-term care ombudsman, to relocate the 177 residents of the ALF.
The action is likely to spawn more legal action.
“The proposed actions to deny renewal of the facility license and to terminate the facility from the Medicaid program are completely unwarranted and are not supported by any facts or law that would allow for such actions by the AHCA,” said Geoffrey D. Smith, lawyer for the ALF and nursing home, in a statement on Thursday. He said Floridian Gardens will seek a hearing before an administrative law judge.
“We are confident that the proposed punitive actions by AHCA will not be supported by the evidence and that the judge will enter an order in favor of Floridian Gardens,” Smith said. “We look forward to our day in court.”
This is the second time in two weeks state regulators, which do not have a history of aggressively pursuing sanctions against the state’s 683 nursing homes and more than 3,100 ALFs, have moved to close down a facility operated by Larkin after the post-Irma tragedy.
READ MORE: Nursing homes used to Florida regulators’ soft touch scramble to meet a hard deadline
But the warning signs against Floridian Gardens, next door to Zoo Miami, had been mounting long before Thursday’s action.
In December, AHCA cited frequent falls by residents and a lack of supervision by staff and administrators as reasons for imposing the moratorium on new residents.
“The residents are currently living in an environment where a systemic process to protect residents from abuse and neglect has not been devised and implemented,” AHCA wrote in its moratorium order.
At least eight residents had suffered falls at the home in the “recent past,” the order said, adding that Floridian Gardens had “failed to demonstrate an understanding of its obligation to ensure all residents … must be protected.”
State inspectors who visited the ALF on Dec. 1, 2016, heard from an 88-year-old resident who needed help with everyday activities, such as using the bathroom and grooming. She had fallen three times.
Another resident, who was 97 and used a walker, had fallen in October 2016 and had to be rushed to a hospital emergency room, the records state. And inspectors reported that an 84-year-old resident was found in the bathroom at 3:50 a.m., also in October 2016, with wounds to the arms, legs and “hit in the face,” the report says, which required the resident to be rushed to a hospital emergency room.
In yet another falling incident, a 68-year-old resident was found on the floor of the ALF at 2:50 a.m. in October 2016, the order states. The resident complained to inspectors that a roommate had come to help because “staff is not around and never seen at night,” the order states.
ALF administrators could not show AHCA inspectors that they had taken any steps to ensure that residents prone to falling did not hurt themselves, the agency’s order said. Nor had the nursing home filed adverse incident reports for any of the falls.
Frequent falls and lack of supervision were not the only deficiencies at the ALF, however. State inspectors also reported receiving complaints about a male resident who had been inappropriately touching and kissing female residents of the facility.
But the ALF’s administrator had ignored complaints from relatives of the female residents who had been harassed by the male resident, the report states, and the facility’s staff kept no record of the incidents — despite a state law requiring healthcare workers to report any instances of neglect or abuse.
Further, the ALF’s administrators kept no written policies or procedures for staff to recognize, report or investigate instances of abuse and neglect of its residents, regulators said. Nor did the ALF’s administrators have a system in place for receiving and responding to complaints of neglect and abuse.
The facility’s staffing levels were also lacking, the order states, citing an internal report dated Oct. 21, 2016, which documented that a resident had not gotten out of bed in three days and had developed “red spots” to the lower body.
“The licensed practical nurse completing this report, dated Nov. 20, 2016, indicated that the facility was understaffed with only three nursing assistants on duty,” the order states. The nursing home had 146 residents at the time.
According to the moratorium order, the ALF had understaffed the facility in November 2016, falling below the level prescribed by law by at least two full-time equivalent positions.
For three of the four weeks in November 2016, the ALF staffed the graveyard shift on its south wing, from 9 p.m. to 7 a.m., with just two caregivers for 80 residents. Two staff members were also on shift in the facility’s west wing, where about 70 residents lived, including 17 who were under hospice care.
Meanwhile, inspectors continued to find problems. As recently as July 17, state inspectors continued to find evidence that Floridian Gardens did not provide adequate protections for residents to prevent falls. One resident, diagnosed with Parkinson’s disease who needed assistance from staff , was hospitalized with an acute kidney injury and had to have surgery after falling while going to the bathroom after staff had left his room.
Regulators, however, lifted the moratorium on Aug. 24 after another inspection on Aug. 1 found no deficiencies. In a letter to the ALF’s administrator, AHCA noted that, “Field office staff reported to this office that the necessary corrections have been made.”
Jeff Johnson, state director for AARP Florida, said the tragedy in Hollywood Hills has “exposed gaps in the state’s long-term care system” that he hopes the state will address.
“But AHCA shouldn’t have to cite what happened at the nursing home in Hollywood in order to do its job,” he said. “If their regulators find issues with a facility that jeopardize the health and even the lives of residents, they need to act on them immediately, not wait until after a tragedy happens.”
Meanwhile, a criminal investigation is underway over whether or not the Hollywood Hills nursing home was negligent when it failed to call 911 or transfer patients to the adjacent hospital before they died from the sweltering conditions after their air conditioner failed.