This summer was a busy one for the owners of Avante at Boca Raton, Inc., the operators of the skilled nursing home of the same name in central Boca Raton. On four different visits from field office representatives of the Agency for Health Care Administration, or AHCA, the governing regulatory body of all heath care facilities in the state of Florida, dozens of deficiencies were cited between April 2014 and June 2014.
One of the visits, conducted over three days beginning on May 27 th, 2014, generated a Statement of Deficiencies summary report that is 81 pages long. This visit was a standard re-certification visit, which is required of a nursing home on the agency’s “Watch List”. Another report documents 59 pages of violations after agency workers were called to the facility unannounced in mid-May to investigate an official complaint of mistreatment and physical neglect.
Avante certainly isn’t the only poorly-performing Palm Beach County skilled nursing facility, more commonly known as a nursing home. But it is one that stands out among other homes in our area. The facility is currently on the ACHA’s Watch List for three active cases. The agency’s Watch List allows a nursing home to operate under a particular conditional status, allowing the owners the opportunity under direct scrutiny to cure extraordinary deficiencies or violations. In the most recent of the three pending cases, the facility was placed on the Watch List for a conditional timeframe of 103 days, beginning on May 16 th, 2014 – the same date the unannounced ACHA conducted its on-site investigation following the patient complaint described above.
Failure to resolve the deficiencies, or perpetuation of violations of applicable State and Federal law could result in the permanent revocation of Avante’s license to operate this particular facility, forcing a shutdown.
To be fair to Avante and other nursing homes in our area, the mere issuance of a Statement of Deficiencies does not constitute a penalty. It is only the results of an on-site inspection by the ACHA. Any facility cited with deficiencies has the right to appeal the findings. The Statement of Deficiencies requires the facility to create and implement a plan of correction for each deficiency cited. If and when the facility does correct the cited issues, and the agency can verify the correction on a follow-up visit, often there are no further civil or criminal penalties of any sort.
No Gold Stars for Avante
A quick and handy tool for consumers who are considering or comparing nursing homes is the Nursing Home Inspection Ratings ranker, which categorizes inspection and deficiency reports into a sortable data table on an ACHA-run website.
The tool uses graphical stars to depict how well one facility ranks against another based on several customizable inspection components. One easy way to see the “best” and “worst” is to simply rank the results by the “Overall Inspection” column, and then sort the results based on the highest stars (5), or the lowest stars (1). Avante at Boca Raton ranks at the very bottom of only seven facilities in Palm Beach County that have just one star. On the other end of the scale, Willowbrooke Court at St. Andrews Estates in Boca Raton has the highest number of stars across all categories.
Granted, the “one-star” approach doesn’t tell the whole story. The rankings are compiled in relation only to peer facilities in the same county. So for a county or state with a record of relatively high instances of care and scoring, a facility with only one star may still be “better” than a high-ranking facility in another county or state, and vice-versa. How does Florida compare to other states? According to a 2010 Government Accountability Office Report to Congressional Requesters on “poorly performing nursing homes”, Florida is ranked #8 in the nation for the highest scores of Special Focus Facilities, or SFFs, which are nursing homes that have caught the attention of Federal regulators for continually poor performance. (Source: GAO – Special Focus Facilities)
The ranker gives Avante a one-star score for most of its categories, including Overall Inspection, Quality of Care, Quality of Life, Nutrition and Hydration, Restraints and Abuse, and Decline.
The other six Palm Beach County facilities included in the ranker with only one star for Overall Inspection are:
- Coral Bay Heathcare (West Palm Beach)
- Darcy Hall (West Palm Beach)
- North Lake Rehabilitation (Lake Park)
- Signature Healthcare of Palm Beach (Lake Worth)
- Terraces of Lake Worth
- Wood Lake Health and Rehab (West Palm Beach)
Legal Actions Against Avante
Avante at Boca Raton has defended itself against more than half a dozen lawsuits brought by the State of Florida and the AHCA in only the last decade (records prior to 2014 were not immediately available on the FloridaHealthFinder.gov website at the time of publishing.) According to the most recent complaint filed in 2012, with a final order settled in January of 2013, Avante was charged with violating the dignity standards of at least six named patients. Some of these violations mentioned in the complaint, among many others, include:
- Failing to respond or deliberately ignoring resident call bells
- Deliberate restriction of patient access to common area bathrooms
- Staff behaving or responding rudely while fulfilling or performing basic and necessary tasks at the requests and care of patients, or ignoring those requests all together
- At least one instance in which a staff member placed a soiled bed pan among a resident’s personal items
According to available records, Avante has been fined at least $21,125 in the last ten years for various cases, violations, and complaints. In 2009, a complaint was filed by the AHCA alleging serious violations of the Life Safety Code, which are Florida laws that mandate minimum standards for safety precautions. On various occasions, the AHCA cites Avante at Boca Raton for the property’s deficient or improperly configured fire and smoke alarm systems during routine Life Safety Survey visits. The complaint described how management failed to adequately correct the violations, which are documented on multiple follow-up visits, leading to a long and arduous legal case that eventually settled for a $16,500 fine.
According to the research conducted and presented in and for this article, there is no other skilled nursing home facility in Palm Beach County with a record like Avante at Boca Raton’s record. The facility is the lowest-scoring of the bottom 10% of Palm Beach County facilities, according to the Nursing Home Inspection Ratings on the FloridaHealthFinder.gov website, a division of the Florida Agency for Health Care Administration. The facility has had more Statements of Deficiencies and lawsuits filed against it in ten years than its peers. Avante is also the only facility in Palm Beach County to be placed on three separate Watch Lists concurrently, as the result of and pending three separate, active, complaint-driven cases.
We highly suggest that you conduct your own research when comparing available nursing homes in Palm Beach County. If you suspect you or someone you love has been the victim of nursing home neglect or abuse, call the Law Offices of Craig Goldenfarb. There is no up-front cost to hire our firm to represent you or your family.