STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINIST. STATE OF FLORIDA \ ADMINISTRATION, rm 10 ioe AGENCY FOR HEALTH CARE Petitioner, vs. AHCA NO: 07-01-0131-ALF CASSELBERRY ALF, INC., Ol- LOR d/b/a EASTBROOK GARDENS Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Casselberry ALF, Inc., d/b/a Eastbrook Gardens (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine on Eastbrook Gardens in the amount of two thousand five hundred dollars ($2,500) pursuant to Sections 400.414(1) (a) and 400.419(b) Florida Statutes. EGER. ce cape pepe ae Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes and Chapter 28-106 Florida Administrative Code. 3. Venue lies in Seminole County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28 Florida Administrative Code. Parties 4, AHCA, Agency for Health Care Administration, State of Florida, is the enforcing authority with regard to assisted living facility licensure law pursuant to Chapter 400, Part III, Florida Statutes and Rules 58A-5, Florida Administrative Code. 5. Respondent, Eastbrook Gardens, is an assisted living facility located fat 201.—«ON. Sunset Drive, Casselberry, Florida. Eastbrooke Gardens, is and was at all times material hereto, a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code. Lets COUNT I RESPONDENT FAILED TO PROVIDE CARE AND SERVICES APPROPRIATE TO THE NEEDS OF THE RESIDENTS, VIOLATING 58A-5.0182, F.A.C. and 400.428(1) (a) Fla. Stat. CLASS II DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) sage chor agges ope ess cage gee eae mae ee ongrers = Or oe Ea ee” RR RRR eR UPR cr rpm eer ae eon through (5) as if fully set forth herein. 7. On or about June 01, 2001 a survey was conducted of respondent’s facility. 8. Based upon observations made by the surveyor, resident record reviews, incident report reviews and interviews conducted at the facility, it was determined that the facility failed to provide the care and services appropriate to meet the needs of the residents. This deficiency was based upon the facilities failure to take sufficient measures to prevent resident to resident abuse and to minimize the potential for falls resulting in injuries, to wit: a. On June 1, 2001 a surveyor observed Resident 1A with two black eyes. She learned from record review that Resident 1A, whose primary diagnosis is Alzheimer’s dementia, had wandered into the room of Resident 4A on May 29, 2001, and sustained a black eye in an ensuing altercation. There was no documentation of first aid, nor of notice to the resident’s physician. The only measures documented by the facility to prevent reoccurrence were noted in the incident report: “Resident was put to bed several times but kept wandering. Will monitor.” Resident 1A was observed with two black eyes, though only one was bbs ki documented in connection with the May 29, 2001 accident. There was no documentation of monitoring, and Resident 1A was apparently not monitored, since the administrator was unable to explain to the surveyor why nursing notes did not mention the second - black eye. b. A June 1, 2001 review of the nurse’s notes on Resident 4A, also diagnosed with Alzheimer’s, indicated that on March 24, 2001 she was found on the floor with a skin tear to the right arm and stated that another resident made her fall. There was an incident report on March 24, 2001 indicating that the resident's family was notified. Documentation after another incident. on “May 29, 2001 indicated that Resident 4A stated that another resident came in her room and grabbed her arm and that she hit her defending herself. Resident 4A thus had two incidents caused by other residents. c. A nurse's note dated February 19, 2001 indicated that Resident 3A wandered to room 27 and was scratched, resulting in a small skin tear. This is another indication that measures need to be taken to prevent residents from wandering into other residents’ rooms and sustaining injuries while so doing. d. According to an interview with the administrator on June 1, 2001, Resident 4A is not aggressive but became scared and hit Resident 1A. e. According to the administrator interviewed on June 1, 2001, no measures had been established to prevent residents wandering into other resident’s rooms or resident-to-resident abuse. f. Despite the agency’s requirement on June 1, 2001 that the facility’s failure to take proactive measures to prevent resident-to~resident abuse be corrected immediately, this deficiency was found to be uncorrected on a revisit on July 16, 2001. g. On June 1, 2001, Resident 2A, who had a diagnosis of senile “dementia, was observed by a surveyor with a dressing covering her forehead that went around and over her head. Facility documentation indicated that Resident 2A, who was not able to ambulate without the assistance of 2 persons, was found on the floor on December 22, 2000 and February 5, 2001, and that she fell out of her wheelchair and hit her head on April 22, 2001 and May 23, 2001. She returned to the facility from the hospital after the May 23 incident with 12 sutures, but fell forward reopening the sutures on 5/31/01. A review of EY WEE EE TRE EP opener ie roe simmer eee mee pro ee incident reports indicated that on April 22, 2001 the preventive measure to be taken was “monitor resident in wheelchair.” For the May 23, 2001 incident no documentation of measures to prevent reoccurrence was available - that part of the incident report was blank. The preventive measure documented in the May. 31, 2001 incident report was merely “different wheelchair that leans backwards.” No proactive measures were instituted to address this resident’s needs effectively to prevent recurrent falls. h. On June 1, 2001, Resident 5A, who had a diagnosis of Alzheimer’s disease, was observed with a bruised face and left arm. Record review indicated that this resident had*fallen, resulting in skin tears on February 18, 2001 and April 25, 2001. The preventive measure documented in the April 25, 2001 incident report was “ . . . remind resident not to get out of bed without assistance.” Resident 5A was again found on the floor with bruising to her forehead and left eyebrow area on May 14, 2001. The intervention initiated by the facility is an inadequate measure where a resident has a disease involving memory impairment. a | en eet ee 6. The above referenced actions and or inactions, are violations of Rule 58.5-0182 F.A.C.; requiring that an assisted living facility shall provide care and services appropriate to the needs of its residents, and Section 400.428 (1) (a) Florida Statutes; requiring that every resident of a facility have the right to live in a safe and decent living environment, free from abuse and neglect. 7. The above referenced violations constitute the grounds for the imposed Class II deficiency for which a fine of two thousand five hundred dollars ($2,500) is authorized under Sections 400.414(1) (a) and 400.419(1) (b) Florida Statutes. WHEREFORE, AHCA intends: to impose a fine against the Respondent under Sections 400.414(1) (a) and 400.419(1) (b) Florida Statutes in the amount of two thousand five hundred dollars ($2,500). The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, .Florida Statutes (2001). Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the 12) pee oe eepertege es 7 attention of Michael P. Sasso, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr., St. Petersburg, Florida, 33701. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Yucehal fesheon,— Michael P. Sasso, Esquire " AHCA - Senior Attorney 525 Mirror Lake Drive North, St. Petersburg, Florida 33701 (727) 552-1435 I HEREBY. CERTIFY that a true and correct copy of the foregoing has been furnished via U.S. Certified Mail Return Receipt No. Z 170 444 164, to Casselberry ALF, Inc., d/b/a Eastbrook Gardens through its Registered Agent, Rex A. Paggeot, ,750 Starkey Road, Largo, FL 34641, on the / , day of , 2001. Michael P. Sasso, Esquire ie be CR RE ORES CORRENTE ORE RT CER ae ore EE OORT Nee TE Copies furnished to: ALF Section Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Area 7 Office Agency for Health Care Administration Hurston Tower South 400 W. Robinson Street, $309 Orlando, Florida 33701 Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Wendy Adams Agency for Health Care Administration -2727 Mahan Drive Tallahassee, Florida 32308 Administrator Eastbrook Gardens 201 N. Sunset Dr., Casselberry, Florida 32707 ae. ee

Docket for Case No: 01-004648

Orders for Case No: 01-004648