STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA,

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AG[UC:Y CLEHii

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v.

BAYVIEW HOLDINGS, INC., d/b/a BAYVIEW RETIREMENT HOME,

Respondent.

AHCA Nos. 2007006069

2007010233

2007007823

2008006525

RENDITION NO.: AHCA-09- U 2(1 -S-OLC

FINAL ORDER

Having reviewed the following administrative complaints: #2007006069 dated January 17, 2008; #2007010233, dated January 22,

2008; #2007007823, dated January 22, 2008, and #2008006525, dated July 24, 2008, attached hereto and incorporated herein (Ex. 1, 1A, 1B, and lC), 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.

   
   

   Filed July 27, 2009 3:13 PM Division of Administrative Hearings.

2. Respondent shall pay an administrative fine in the amount of

   
   

   $10,750.00 and a survey fee in the amount of $500.00. The administrative fine and survey fee are 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 these case numbers, 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 will be subject to statutory interest and may be collected by all methods legally available.

5. Respondent's petition for formal administrative proceedings is hereby dismissed.

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

   
   

7. The above-styled cases are hereby closed.

DONE and ORDERED this oi" ay of in Tallahassee, Leon County, Florida.

, 20 t'f,

Agency for Health 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:

Alice Barton Rothman Bayview Retirement Home 2625 NE 13 th Court

Fort Lauderdale, Florida 33304 (U. S. Mail)

Finance & Accounting Agency for Health Care Administration

Revenue Management Unit 2727 Mahan Drive, MS #14

Tallahassee, Florida 32308 (Interoffice Mail)

Jan Mills

Agency for Health Care Administration

2727 Mahan Drive, Bldg #3, MS #3

Tallahassee, Florida 32308 (Interoffice Mail)

Tria Lawton-Russell Assistant General Counsel

Agency for Health Care Administration 8350 NW 52nd Terrace, Suite #103

Miami, Florida 33166 (Interoffice Mail)

Hon. Eleanor M. Hunter Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060 (U.S. Mail)

Assisted Living Unit

Agency for Health Care Administration 2727 Mahan Drive, MS #30

Tallahassee, Florida 32308 (Interoffice Mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named persor,{3J and entities b U.S. Mail, or the

method designated, on this the .zz._ of-"""= =--------' 2007.'

Richard Shoop, Agency Cle

Agency for Health Care Administration 2727 Mahan Drive, Building #3

Tallahassee, Florida 32308-5403

(850) 922-5873

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

v.

BAYVIEW HOLDINGS, INC. d/b/a BAYVIEW RETIREMENT HOME

Respondent.

!

AHCA No.: 2007006069

Return Receipt Requested: 7002 2410 0001 4235 7042

ADMINISTRATIVE COMPLAINT

COMES NOW the Agency for Health Care Administration ( "AHCA") , by and through the undersigned counsel, and files this Administrative Complaint against Bayview Holdings, Inc. d/b/a Bayview Retirement Home (hereinafter "Bayview Retirement Home"), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2006), and alleges:

NATURE OF THE ACTION

1. This is an action to impose an administrative fine of $1,000.00 pursuant to Section 429.428, Florida Statutes (2006), for the protection of the public health, safety and welfare and $500.00 survey fee pursuant to Section 429.19 (·2) (a), and 429.19(10), Florida Statutes (2006)

   
   

   EXHIBIT

   I i

   JURISDICTION AND VENUE

   
   

2. This Court has jurisdiction pursuant to Sections

   
   

   120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code.

3. Venue lies in Broward County, pursuant to Section 120.57, Florida Statutes and Rule 28-106.207, Florida Administrative Code.

   PARTIES

   
   

4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2006), and Chapter 58A-5, Florida Administrative Code.

5. Bayview Retirement Home operates a 12-bed assisted living facility located at 2625 NE 13th Court, Fort Lauderdale, Florida 33304. Bayview Retirement Home is licensed as an assisted living facility license number AL10497, with an expiration date of July 12, 2008. Bayview Retirement Home was at all times material hereto a licensed facility under the 1icensing authority of AHCA and was required to comply with all applicable rules and statutes.

   COUNT I

   
   

   BAYVIEW RETIREMENT HOME FAILED TO MAINTAIN AN UP-TO-DATE AND ACCURATE MEDICATION OBSERVATION RECORD (MOR) FOR FIVE OF FIVE RESIDENT RECORDS REVIEWED

   Rule 58A-5.0185(5) (b), Florida Administrative Code (MEDICATION STANDARDS)

   
   

   CLASS II VIOLATION

   
   

6. AHCA re-alleges and incorporates paragraphs (1)

   
   

   through (5) as if fully set forth herein.

   
   

7. During the complaint investigation conducted on 4 / 3 0 / 0 7, and based on record review and interview with the Administrator, at approximately 11:00 AM on the day of the survey, the facility failed to maintain an up-to-date and accurate medication observation record (MOR) for five of five resident records reviewed. The provision of residents' medications without maintaining an accurate record directly threatens the physical health of these residents.

8. The facility did not have an accurate and current MOR for April 2007. The Administrator stated, during an interview, at approximately 11:30 AM, that she had assisted al1 five of the current residents that receive medications, with their 8:00 AM medications. The MOR was blank and there was no indication of the time at which the residents received assistance with their medications on the morning of 4/30/07

9. A review of the April 2007 MOR and medications for Resident #1 revealed that the resident was prescribed Depakote

   250 mg BID on the bottle label, while the MOR stated 1 tab daily. The Administrator stated that she was assisting the resident with this medication twice a day but there was no record of the medication assistance for the entire month of April 2007. The resident was prescribed stool softener 1 tab

   daily the MOR stated 2 tabs daily. This resident was also prescribed Digoxin 125 mcg 1 tab daily while the MOR stated

   125 mg and Furosemide 40 mg 2 tabs daily, while the MOR stated

   
   

   1 40 mg tab daily.

   
   

10. A review of the April 2007 MOR and medications for Resident #2 revealed that the resident was prescribed Atenolol

    50 mg 1 tab daily, the MOR stated 50 mg but did not state the frequency. The resident was also prescribed Klor-Con 8 meq, the MOR stated 8 mg.

11. A review of the April 2007 MOR and medications for Resident #3 revealed that the resident was prescribed Synthroid 50 mcg. on the bottle label while the MOR stated 50 mg. 1 tab daily.

12. A review of the April 2007 MOR for Resident #5 revealed that the resident was prescribed Synthroid 1 tab daily, Evista 60 mg 1 tab daily and Verapamil 240 mg 1 tab daily. These medications were not signed as assisted for 4/30/07. These medications were not available or present at the facility at the time of the survey. The Administrator stated that she assisted with these medications on the morning of 4/30/07. The empty bottles of these medications were not available and the administration of these medications could not be verified.

13. The absence of any accurate documentation of medication assistance and failure to maintain an accurate

    record, directly threatens the physical health of these residents.

14. This was confirmed by the Administrator on 4/30/07 at approximately 12:00 PM.

15. Based on the foregoing, Bayview Retirement Home violated Rule 58A-5. 0185(5)(b), Florida Statutes, a Class II deficiency, which carries, in this case, an assessed fine of

    $1,000.00.

    
    

    SURVEY FEE

    
    

    Pursuant to Section 429.19(10), Florida statutes, AHCA may assess a survey fee of $500.00 to cover the cost of conducting complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits.

    
    

    PRAYER FOR RELIEF

    
    

    WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief:

    1. Make factual and legal findings in favor of the

       
       

       Agency on Count I.

       
       

    2. Assess an administrative fine of $1,000.00 against Bayview Retirement Home on Count I for the violations cited above.

    3. Assess a survey fee of $500.00 against Bayview Retirement Home, pursuant to Sections 429 .19 (10), and

       429 .19 (2) (a), Florida Statutes (2006).

       
       

    4. Grant such other relief as this Court deems is just and proper.

Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2006) . Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for

Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873.

RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A

REQUEST FOR 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.

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IF YOU WANT HIRE AN ATTORNEY, /YOU HAVE THE RIGHl TO 'BE

REPRESENTED BY AN ATTORNEY IN T 'I, TT L;/ J'' // 1(//.//.

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1 rJ' t·LLI r i :t.U ,1l , .

ria La0ton-Russel ' Assistant General Counsel Agency for Health Care Administration

8350 N. W. 5 2 nd Terrace

Suite 103

Miami, Florida 33166

(305) 470-6805

Copies furnished to:

Diane Reiland

Field Office Manager

Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484

(Inter-office mail)

Karen Davis

Finance and Accounting

Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32308 (Inter-office Mail)

Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32308 (Interoffice Mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Alice Rothman, Administrator, Bayview

13t h Court, Fort Lauderdale, Florida

I

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SENDER: COMPLETE THIS SECTION

COMPLETE THIS SECTION ON DELIVERY

2. Article Number

7002 2410 0001 4235 7042

(Transfer from service label)

PS.Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

v.

BAYVIEW HOLDINGS, INC., d/b/a BAYVIEW RETIREMENT HOME,

Respondent.

!

AHCA No.: 2007010233

Return Receipt Requested: 7002 2410 0001 4235 9602

ADMINISTRATIVE COMPLAINT

COMES NOW the Agency for Health Care Administration ("AHCA"), by and through the undersigned counsel, and files this Administrative Complaint against Bayview Holdings, Inc. d/b/a Bayview Retirement Home (hereinafter "Bayview Retirement Home"), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2007), and alleges:

NATURE OF THE ACTION

1. This is an action to impose an administrative fine of $10,750.00 pursuant to Section 429.19, Florida Statutes (2007), for the protection of the public health, safety and welfare pursuant to Section 429. 28 (3) (c), Florida Statutes (2007) .

   JURISDICTION AND VENUE

   
   

2. This Court has jurisdiction pursuant to Sections

   
   

   120.569 and 120.57, Florida Statutes, and 28-106, Florida

   
   

   Administrative Code.

   
   

   EXHIBIT

   l ) fl

3. Venue lies in Broward County, pursuant to Section 120.57, Florida Statutes and Rule 28-106.207, Florida Administrative Code.

   PARTIES

   
   

4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2007), and Chapter 58A-5, Florida Administrative Code.

5. Bayview Retirement Home operates a 12-bed assisted living facility located at 2625 N.E. 13th Court, Fort Lauderdale, Florida 33304. Bayview Retirement Home is licensed as an assisted living facility license number AL10479, with an expiration date of July 12, 2008. Bayview Retirement Home was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes.

   COUNT I

   
   

   BAYVIEW RETIREMENT HOME FAILED TO MAINTAIN AN UP-TO-DATE AND ACCURATE MEDICATION OBSERVATION RECORD (MOR)

   Rule SBA-5.0185(5) (b), Florida Administrative Code (MEDICATION STANDARDS)

   
   

   CLASS II VIOLATION

   
   

6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.

7. During the second revisit conducted on 7/31/07 and based on record review and interview with the Administrator at approximately 11:00 AM, on the day of the survey, the facility failed to maintain an accurate Medication Observation Record (MOR) for one of six current resident records reviewed. The assisting of residents with medications and not maintaining an accurate record directly threatens the physical health of these residents.

8. A review of the July 2007 MOR and medications for Resident #1 revealed the resident was prescribed Depakote

   250 mg, 1 tab BID and Lasix 40 mg, 2 tabs BID. The Medication Observation Record (MOR) for this resident stated Depakote 1 tab BID and Lasix 40 mg, 2 tabs BID. The Administrator/facility staff signed the MOR when these medications were assisted in the AM and not in the PM for the entire month of July 2007.. The Administrator when interviewed stated she did not know that she had to sign the MOR each time she provided the resident with medication assistance per the physician's order.

9. The absence of accurate documentation of

   medication assistance as prescribed by the residents' physicians directly threatens the physical health of these residents.

10. This was confirmed by the Administrator on 7/31/07 at approximately 12:00 PM. This deficiency was previously

    cited during the 4/30/07 complaint investigation and the 6/20/07 follow-up visit.

11. Based on the foregoing, Bayview Retirement Home violated Rule 58A-5.0185(5) (b), Florida Administrative Code, a Class II deficiency, which carries, in this case, an assessed fine of $10,000.00. ($1,000.00 per day commencing on July 22, 2007)

    COUNT II

    
    

    BAYVIEW RETIREMENT HOME FAILED TO EMPLOY THE SERVICES OF A PHARMACIST AS WAS DIRECTED

    Section 429.42(1), Florida Statutes, and/or Rule SBA-5.033(4) (a)l., Florida Administrative Code

    (MEDICATION STANDARDS) UNCORRECTED CLASS III VIOLATION

12. AHCA re-alleges and incorporates paragraphs (1)

    
    

    through (5) as if fully set forth herein.

    
    

13. During the follow-up visit conducted on 6/20/07 and based on record review and interview with the Administrator, at approximately 12:00 PM on the day of the survey, the facility failed to employ the services of a pharmacist as was directed in the survey report of 4/30/07 pursuant to the provisions of Chapter 429.42 Florida Statutes, and SBA-5.033(4) Florida Administrative Code.

14. The facility at this survey did not maintain an accurate Medication Observation Record (MOR) for three of six current resident records reviewed. The assisting of residents with medications and not maintaining an accurate

    record directly threatens the physical health of these residents.

15. 
    

    
    

    storing

    The an

    facility was again unlabeled bottles

    found to of Over

    be centrally The Counter

    medications.

    
    

16. The above medication problems were found to be uncorrected at this survey on 6/20/07. The facility failed to employ or obtain the services of a pharmacist, as was directed in the survey report of 4/30/07, pursuant to the provisions of Chapter 429.42 Florida Statutes, and Rule 58A- 5.033(4) Florida Administrative Code, to correct and review the facility's medication practices. This was confirmed by the Administrator on 6/20/07 at approximately 12:00 PM. Mandated Correction Date: 7/21/07

17. During the second revisit conducted on 7/31/07 and based on record review and interview with the Administrator at approximately 11:30 AM, on the day of the survey, the facility failed to employ the services of a pharmacist as was directed in the survey report of 4/30/07 and 6/20/07 pursuant to the provisions of Chapter 429.42 Florida Statutes, and Rule 58A-5.033(4) Florida Administrative Code.

18. The facility at this survey did not maintain an accurate Medication Observation Record (MOR) for one of six current resident records reviewed. The facility's failure to provide appropriate assistance with medications to the

    residents and its failure to maintain an accurate medication observation record (MOR) directly threatens the physical health of these residents.

19. The above medication problem was found to be uncorrected at this survey on 7/31/07. The facility failed to employ or obtain the services of a pharmacist, as was directed in the survey report of 4/30/07, pursuant to the provisions of Chapter 429.42 Florida Statutes, and Rule 58A- 5.033(4) Florida Administrative Code, to correct and review the facility's medication practices.

20. This was confirmed by the Administrator on 7/31/07 at approximately 12:00 PM. This is an uncorrected deficiency from the 6/20/07 survey report.

21. Based on the foregoing, Bayview Retirement Home violated Section 429.42(1), Florida Statutes, and/or Rule 58A-5.033(4) (1), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $750.00.

    
    

    PRAYER FOR RELIEF

    
    

    WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief:

    1. Make factual and legal findings in favor of

       
       

       the Agency on Counts I and II.

    2. Assess an administrative fine of $10,750.00 against Bayview Retirement Home on Counts I and II pursuant to Sections 429.19, and 429.28(3)(c), Florida Statutes.

    3. Grant such other relief as this Court deems is just and proper.

Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2007) Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive,

Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873.

RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A

REQUEST FOR 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 AGENCY.

ORDER

ria

Assistant General Counsel Agency for Health Care Administration

8350 N. W. 52n d Terrace

Suite 103

Miami, Florida 33166

Copies furnished to:

Diane Reiland

Field Office Manager

Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484

(U.S. Mail)

Finance and Accounting Revenue and Management Unit

Agency for Health Care Administration 2727 Mahan Drive, MS #14

Tallahassee, Florida 32308 (Inter-office Mail)

Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32308 (Interoffice Mail)

CERTIFICATE OF SERVICE

lv

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Alice Rothman, Administrator and Registered Agent, Bayview Retirement Home,/ 2625 N.E. Court, Fort Lauderdale, 33304 o , 200€.

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: Bayview Holdings, Inc. d/b/a Bayview Retirement Home

CASE NO: 2007010233

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.

Your Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Administrative Complaint.

If your Election of Rights with your selected option is not received by AHCA within twenty­ one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency's proposed action and a final order will be issued.

(Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS:

Agency for Health Care Administration Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308.

Phone: 850-922-5873 Fax: 850-921-0158.

PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS

OPTION ONE (1) I admit to the allegations of facts and law contained in the

Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action.

OPTION TWO (2) I admit to the allegations of facts contained in the Administrative

Complaint, but I wish to be beard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced.

OPTION THREE (3) I dispute the allegations of fact contained in the Administrative

Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed

administrative action. The request for formal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain:

1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any.

2. The file number of the proposed action.

3. A statement of when you received notice of the Agency's proposed action.

4. A statement of all disputed issues of material fact. If there are none, you must state that there are none.

Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.

License type: (ALF? nursing home? medical equipment? Other type?)

Licensee Name: License number:

Contact person: _

Name Title

Address:

Street and number City Zip Code

Telephone No. Fax No. Email(optional) _

I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.

Signed: Date:

Print Name: Title:

Late fee/fine/AC

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

v.

BAYVIEW HOLDINGS, INC., d/b/a BAYVIEW RETIREMENT HOME,

Respondent.

---- -------------/

AHCA No.: 2007007823

Return Receipt Requested:

7002 2410 0001 4235 9558

ADMINISTRATIVE COMPLAINT

COMES NOW the Agency for Heal th Care Administration ("AHCA"), by and through the undersigned counsel, and files this Administrative Complaint against Bayview Holdings, Inc. d/b/a Bayview Retirement Home (hereinafter "Bayview Retirement Home") , pursuant to Chapter 429, Part I, and Section 12O. 6 O, Florida Statutes, ( 2 O 07) , and alleges:

NATURE OF THE ACTION

1. This is an action to impose an administrative fine of $4,500.00 pursuant to Section 429.19, Florida Statutes (2007), for the protection of the public health, safety and welfare pursuant to Section 429.28 (3) (c), Florida Statutes (2007).

   JURISDICTION AND VENUE

   
   

2. This Court has jurisdiction pursuant to Sections

   
   

   120.569 and 120.57, Florida Statutes, and 28-106, Florida

   
   

   Administrative Code.

   EXHIBIT

   I 1 i3

3. Venue lies in Broward County, pursuant to Section 120.57, Florida Statutes and Rule 28-106.207, Florida Administrative Code.

   PARTIES

   
   

4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2007), and Chapter 58A-5, Florida Administrative Code.

5. Bayview Retirement Home operates a 12-bed assisted living facility located at 2625 N.E. 13th Court, Fort Lauderdale, Florida 33304. Bayview Retirement Home is licensed as an assisted living facility license number AL10479, with an expiration date of July 12, 2008. Bayview Retirement Home was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes.

   COUNT I

   
   

   BAYVIEW RETIREMENT HOME FAILED TO ENSURE THAT THE ADMISSION PACKAGE CONTAINED ALL THE REQUIRED COMPONENTS

   Section 429.41(1)(e), Florida Statutes, and/or Rules SSA-5.024(1) (i), and SSA-5.0181(3), Florida Administrative

   Code

   (FACILITY RECORDS STANDARDS) UNCORRECTED CLASS III VIOLATION

6. AHCA re-alleges and incorporates paragraphs (1)

   
   

   through (5) as if fully set forth herein.

7. During complaint investigation conducted on 4/30/07 and based on record review and interview with the Administrator on the day of the survey at approximately 11:00 AM, the facility failed to ensure the admission package contained all of the required components.

8. During the Facility Records portion of the survey conducted on 4/30/07, it was noted that the facility's current admission package did not contain all of the required components. The package did not contain:

   1. A statement of the facility's policy

      
      

      concerning Directives.

      Do Not Resuscitate Orders and Advanced

   2. A copy of the facility's resident elopement response policies and procedures.

9. During an interview at approximately 12:00 PM the Administrator acknowledged the findings. Mandated Correction Date: 5/31/07.

10. During the revisit conducted on 6/20/07 and based on record review and interview with the Administrator and aide on duty, on the day of the survey at approximately 11:00 AM, the facility failed to ensure the admission package contained all of the required components.

11. During the Facility Records portion of the survey conducted on 6/20/07, it was noted that the facility's

    current admission package did not contain all of the required components. The package did not contain:

    1. A statement of the facility's policy

       
       

       concerning Directives.

       Do Not Resuscitate Orders and

       Advanced

    2. A copy of the facility's resident elopement response policies and procedures.

12. During an interview at approximately 12:00 PM, the Administrator acknowledged the findings and stated the facility did not have the above policies and procedures. This is an uncorrected deficiency from the 4/30/07 survey report.

13. Based on the foregoing, Bayview Retirement Home violated Section 429.41(1)(e), Florida Statutes, and/or Rules 58A-5.024(1)(i), and 5BA-5.0181 (3), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.

    COUNT II

    
    

    BAYVIEW RETIREMENT HOME FAILED TO ENSURE THAT THERE WAS A CURRENT SATISFACTORY FIRE INSPECTION

    Section 429.41(1)(a)l.m., Florida Statutes, and/or Rule 58A- 5.015(1)(a)3, Florida Administrative Code

    (FACILITY RECORDS STANDARDS) UNCORRECTED CLASS III VIOLATION

    
    

14. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.

15. During the complaint investigation conducted on 4/30/07 and based upon record review and interview with the Administrator on the day of the survey, the -facility did not ensure that there was a current and satisfactory fire inspection.

16. The Administrator, when requested by the surveyor

was unable

to produce a

current satisfactory

fire

inspection.

The

last

fire

department inspection

was

conducted on 4/27/07 and was classified as not satisfactory. 1 7. The Administrator, during interview conducted at approximately 12:00 PM on the date of this survey, confirmed

this finding. Mandated Correction Date: 5/31/07

1. During the revisit conducted on 6/20/07 and based upon record review and interview with the Administrator on the day of the survey, the facility did not ensure that there was a current satisfactory fire inspection.

2. The Administrator, when requested by the surveyor was unable to produce a current satisfactory fire inspection. The last fire department inspection was conducted on 5/18/07 and was classified as not satisfactory.

3. The Administrator, during interview conducted at approximately 12:00 PM on the date of this survey, confirmed this finding. This is an uncorrected deficiency from the 4/30/07 survey report.

4. Based on the foregoing, Bayview Retirement Home violated Section 429.41 (1) (a)l .m., Florida Statutes, and/or Rule 58A-5.015(1) (a)3, Florida Administrative Code, an uncorrected Class I II deficiency, which carries, in this case, an assessed fine of $500.00.

   COUNT III

   
   

   BAYVIEW RETIREMENT HOME FAILED TO DEVELOP ELOPEMENT POLICIES AND PROCEDURES

   Rule SSA-5.024(1) (q), Florida Administrative Code (FACILITY RECORDS STANDARDS)

   
   

   UNCORRECTED CLASS III VIOLATION

   
   

5. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.

6. During the complaint investigation conducted on 4/13/07 and based upon record review and interview with the Administrator, on the day of the survey at approximately 11: 30 AM, the facility did not develop elopement policies and procedures for this facility. The facility's current records did not address this issue.

7. The facility did not formulate and document

   
   

   policies and procedures to address a resident elopement or the procedures to be followed by staff in the event of a resident elopement. The 6 current residents of the facility were all found, upon interview to be confused and diagnosed with Dementia. This was confirmed by the Administrator of

   the facility at approximately 11:30 AM on the day of the survey. Mandated Correction Date: 5/31/07

8. During the revisit conducted on 6/20/07 and based upon record review and interview with the Administrator and aide on duty, on the day of the survey at approximately 11:30 AM, the facility did not develop elopement policies and procedures for this facility. The facility's current records did not address this issue.

9. The facility did not formulate and document policies and procedures to address a resident elopement or the procedures to be followed by staff in the event of a resident elopement. The 6 current residents of the facility were all found, upon interview to be confused and diagnosed with Dementia. This was confirmed by the Administrator of the facility at approximately 11: 3O AM on the day of the survey. This is an uncorrected deficiency from the 4/30/07 survey report.

10. Based on the foregoing, Bayview Retirement Home violated Rule SSA-5.024 (1) (q), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.

    COUNT IV

    
    

    BAYVIEW RETIREMENT HOME FAILED TO CONDUCT ELOPEMENT PREVENTION AND RESPONSE DRILLS

    Sections 429.41(1)(a)3. and 429.41(1) (1), Florida Statutes, and/or Rule SSA-5.0182(8) (c), Florida Administrative Code (FACILITY RECORDS STANDARDS)

    UNCORRECTED CLASS III

    
    

11. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.

12. During the complaint investigation conducted on 4/30/07 and based upon record review and interview with the Administrator, on the day of the survey at approximately 11:30 AM, the facility did not conduct elopement prevention and response drills.

13. The facility never conducted an elopement and response drill. The Administrator, upon interview, at approximately 11:30 AM, stated that she was aware of the requirement to conduct two drills per year as of June 2004 but had not conducted and documented any drills. This was confirmed by the Administrator at approximately 11:30 AM on the day of the survey. Mandated Correction Date: 5/31/07

31, During the revisit conducted on 6/20/07 and based upon record review and interview with the Administrator and aide on duty, on the day of the survey at approximately 11:30 AM, the facility did not conduct elopement prevention and response drills.

32. The facility never conducted an elopement and response drill. The Administrator, upon interview, at approximately 11:30 AM, stated that she was not aware of the requirement to conduct two drills per year as of June 2004 and had not conducted and documented any drills. This was

confirmed by the Administrator at approximately 11:30 AM on the day of the survey. This is an uncorrected deficiency

violated Sections 429.41(1)(a)3, and 429.41(1)(1), Florida Statutes, and/or Rule 58A-5.0182(8)(c), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.

COUNT V

BAYVIEW RETIREMENT HOME FAILED TO MAINTAIN AN UP-TO-DATE AND ACCURATE MEDICATION OBSERVATION RECORD (MOR)

Rule SSA-5.0185(5) (b), Florida Administrative Code (MEDICATION STANDARDS)

CLASS II VIOLATION

1. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.

2. During a revisit conducted on 6/20/07 and based on based on record review and interview with the Administrator, at approximately 11:00 AM on the day of the survey, it was determined that the facility failed to maintain an accurate Medication Observation Record (MOR) for three of six current resident records reviewed. The assisting of residents with medications and not maintaining an accurate record, directly threatens the physical health of these residents.

3. A review of the June 2007 MOR and medications for Resident #1 revealed that the resident was prescribed

   Pericolace 1 tab BID. The Medication Observation Record (MOR) for this resident stated 1 tab PRN. The resident was only being assisted with this medication 1 tab daily. This resident was also prescribed Furosemide 40 mg, 2 tab daily, while the MOR stated 4O mg 2 tabs BID. The resident was also prescribed Cosopt 0.5%, 2 drops in each eye BID on the last physician's order dated 12/06, the resident was being assisted with 1 drop in each eye.

4. A review of the June 2007 MOR and medications for Resident #4 revealed that the resident was prescribed Verapamil 240 mg 1 tab daily. The Medication Observation Record (MOR) stated 25 mg.

5. A review of the Juhe 2007 MOR and medications for Resident #6 revealed that the resident was prescribed Loratadine 10 mg, 1 tab PRN and being assisted when needed per the Administrator when interviewed. This medication was not 1isted on the MOR. This resident was also prescribed Zoloft 100 mg, 1 tab daily. The MOR for this resident did not include the strength of the medication.

6. The absence of accurate documentation of the medication assistance as prescribed by the residents' physicians directly threatens the physical health of these residents.

7. This was confirmed by the Administrator on 6/20/07 at approximately 12:30 PM. This deficiency was previously

   cited during the complaint investigation conducted on

   
   

   4/30/07

   
   

8. Based on the foregoing, Bayview Retirement Home violated Rule 58A-5.0185 (5)(b), Florida Administrative Code, a Class II deficiency, which carries, in this case, an assessed fine of $2,000.00.

   . COUNT VI

   
   

   BAYVIEW RETIREMENT HOME FAILED TO ENSURE THAT ALL OVER THE COUNTER DRUGS WERE PROPERLY LABELED

   Rule 58A-5.0185(8) (b), Florida Administrative Code (MEDICATION STANDARDS)

   
   

   UNCORRECTED CLASS III VIOLATION

   
   

9. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.

10. During the complaint investigation conducted on 4/30/07 and based upon observations made of the facility's medication storage and record review of the MOR, resident records, and interview with the Administrator on the day of the survey, at approximately 11:30 AM, it was revealed that the facility did not ensure that all centrally stored over­ the-counter (OTC) drugs were properly labeled for one of the five current residents being assisted with medication.

11. The facility was found to be centrally storing a small round plastic container for Resident #4 that was hand labeled with Multi-Vitamins and B6 vitamins, written on a label on the lid. There was no MOR for this resident. The

    plastic container was labeled with resident's name and the above information. It did not have the manufacturer's label with directions for use. The facility had no documentation to indicate that any efforts were made to notify the resident I s representative or physician that this was not permitted and to obtain a properly labeled supply. This was confirmed by the Administrator on 4/30/07, at approximately 12:00 PM. Mandated Correction Date: 5/31/07

12. During the follow-up conducted on 6/20/07 and based upon observations made of the faci1 ity's medication storage and record review of the MOR, resident records, and interview with the Administrator and an aide on duty, on the day of the survey, at approximately 11:30 AM, it was revealed that the facility did not ensure that all centrally stored OTC drugs were properly labeled for one of the six current residents being assisted with medication.

13. The facility was found to be centrally storing an unlabeled bottles of Tylenol, B-12 vitamins, and Metamucil tablets for Resident #6. The bottles of these OTC medications were not labeled with resident's name and the dosage information. The facility had no documentation to indicate that any efforts were made to notify the resident's representative or physician that this was not permitted and to obtain a properly labeled supply. This was confirmed by

the Administrator on 6/20/07 at approximately 12:00 PM. This is an uncorrected deficiency from the 4/30/07 survey report.

4 7. Based on the foregoing, Bayview Retirement Home violated Rule SSA-5. 0185(8)(b), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.

PRAYER FOR RELIEF

WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief:

1. Make factual and legal findings in favor of

   
   

   the Agency on Counts I through VI.

   
   

2. Assess an administrative fine of $4,500.00 against Bayview Retirement Home on Counts I through VI pursuant to Sections 429.19, and 429.28(3)(b) and 429.28(3)(c), Florida Statutes.

3. Grant such other relief as this Court deems is just and proper.

   
   

   Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2007) Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to

   the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873.

   RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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 AGENCY.

   ORDER

   
   

   ia

   Assistant General Counsel Agency for Health Care Administration

   8350 N. W. 52nd Terrace

   Suite 103

   Miami, Florida 33166

   
   

   Copies furnished to:

   
   

   Diane Reiland

   Field Office Manager

   Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484

   (U.S. Mail)

   
   

   Finance and Accounting Revenue and Management Unit

   Agency for Health Care Administration 2727 Mahan Drive, MS #14

   Tallahassee, Florida 32308 (Inter-office Mail)

   
   

   Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive

   Tallahassee, Florida 32308 (Interoffice Mail)

   CERTIFICATE OF SERVICE

   
   

   I HEREBY CERTIFY that a true and correct copy of the

   foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Alice Rothman, Administrator and

   Registered Agent, Bayview Retirement Home, Court, Fort Lauderdale, Florida 33304

   200S.

   N.E. u13/t h

   2} '

   ,.

   
   

   SENDER: COMPLETE THIS SECTION

   • Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired.

   • Print your name and address on the reverse

     so that we can return the card to you.

   • Attach this card to the back of the mailpiece, or on the front if space permits.

   COMPLETE THIS SECTION ON DELIVERY

   
   

   X

   B.

   
   

4. Is delivery address different from item 1?

   
   

   Yes

   1. Article Addressed to:

      1

      r. I.;:===================

      4i :!:,::?/i-l;::::a

      
      

      !k- .

      If YES, enter delivery address below:

      0 No

      .,; .- )' ,.-·· /f / J} ltL<:_ 'e-c.,: [

      ,.-,--, (,,-, ,: ,";; " ' '-- · 3. Service Type

      :3}?:f..:sJ □ Registered

      ·r/"-'71 J;>c·.•<, <-.A..:.,._,,l.t.:c_.l::. .-.. F'Li □'& rtified Mail

      0 Exp!%5 Mail

      rn·Ret rn Receipt for Merchandise

      
      

   2. Article Number

(Transfer from servi-~.,.,.,,.-··-

D Insured Mail □ C.O.D.

1. Restricted Delivery? (Extra Fee) 0 Yes

   
   

   7002 2410 0001 4235 9558

   PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1s«)''

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATION

   
   

   AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   v.

   
   

   BAYVIEW HOLDINGS, INC., d/b/a BAYVIEW RETIREMENT HOME,

   
   

   Respondent.

   
   

   AHCA No.: 2008006525

   Return Receipt Requested: 7008 0500 0002 0764 5246

   
   

   ADMINISTRATIVE COMPLAINT

   
   

   COMES NOW the Agency for Health Care Administration ("AHCA"), by and through the undersigned counsel, and files this Administrative Complaint against Bayview Holdings, Inc. d/b/a Bayview Retirement Home (hereinafter "Bayview Retirement Home"), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2007), and alleges:

   NATURE OF THE ACTION

   
   

   1. This is an action to impose an administrative fine of

      
      

      $1,000.00 pursuant to Section 429.19, Florida Statutes (2007), for the protection of the public health, safety and welfare pursuant to Section 429.19(2)(c), Florida Statutes (2007).

      JURISDICTION AND VENUE

      
      

   2. This Court has jurisdiction pursuant to Sections

      
      

      120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code.

      
      

      EXHIBIT

      I IC

   3. Venue lies in Broward County, pursuant to Section 120.57, Florida Statutes and Rule 28-106.207, Florida Administrative Code.

      PARTIES

      
      

   4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2007), and Chapter 58A-5, Florida Administrative Code.

   5. Bayview Retirement Home operates a 12-bed assisted living facility located at 2625 N.E. 13th Court, Fort Lauderdale, Florida 33304. Bayview Retirement Home is licensed as an assisted living facility license number AL10479, with an expiration date of July 12, 2008. Bayview Retirement Home was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes.

      COUNT I

      
      

      BAYVIEW RETIREMENT HOME FAILED TO PROVIDE VERIFICATION OF FREEDOM FROM TUBERCULOSIS FOR SOME EMPLOYEES

      Section 429.275(4), Florida Statutes, and/or Rule 58A-5.024(2) (a), Florida Administrative Code (STAFF RECORDS STANDARDS)

      
      

      REPEATED AND UNCORRECTED CLASS III VIOLATION

      
      

   6. AHCA re-alleges and incorporates paragraphs (1) through

      
      

      (5) as if fully set forth herein.

      
      

      2

   7. During the survey conducted on 6/08/06 and based on

      record review and interview, it was determined that the facility failed to ensure that 1 out of 4 staff members reviewed is free

      y

      from communicable disease (employee 4).

      
      

   8. During the Staff Records Standards portion of the survey conducted on 06/08/2006 at approximately 12 PM, it was noted that an employee record did not contain documentation to verify that the staff member is free from communicable disease. The employee has been employed at the facility for more than 30 days. The Administrator was interviewed on 06/08/2006 at

      approximately 4 PM and after investigation, finding.

      confirmed .the

   9. During the full biennial re-licensure survey conducted on 02/25/08 and based on record review and interview, it was determined that the facility failed to provide verification of freedom from communicable disease including tuberculosis for 4 out of 5 applicable sampled employees (Employees #2, #3, #4, and #5).

   10. During the Staff Records Standards portion of the survey, conducted on 02/25/2008 at approximately 12:00 PM, it was noted that the records for Employees #2, #3, #4, and #5 lacked documentation of a verification of freedom from communicable disease including tuberculosis, as required. Employee hire dates are as follows:

Employee #2: 04/23/2007

Employee #3: 11/12/2007

Employee #4: 02/06/2008

Employee #5: 02/21/2008

1. During an interview, conducted with the facility Administrator during the review, it was confirmed that the documentation was never obtained from the employees upon hire, as required. No further documentation was provided by the conclusion of the survey. This is a repeat deficiency from the survey of

   6/08/06.

   
   

2. During an Exit Conference, conducted with the facility Administrator and the Office Manager on 02/25/2008 at approximately 3:00 PM, the findings were acknowledged.

3. During the first review survey conducted on 4/16/08 and Based on record review and interview, it was determined that the facility continues to fail to provide verification of freedom from communicable disease including tuberculosis for 3 out of 4 applicable sampled employees (Employees #2, #3, and #4).

l3. During the Staff Records Standards portion of the survey, conducted on 04/16/2008 at approximately 2:00 PM, it was noted that the records for Employees #2, #3, and #4 still lack documentation of a verification of freedom from communicable disease including tuberculosis, as required. Employee hire dates are as follows:

Employee #2: 11/12/2007

Employee #3: 03/01/2008

Employee #4: 05/14/2007

1. During an interview, conducted with the facility Administrator during the review, it was confirmed that the documentation was not in the employee files at the time of the

   survey, and that no further documentation could be provided at that time.

2. During an Exit Conference, conducted with the facility Administrator and the Office Manager on 04/16/2008 at approximately 4:00 PM, the findings were acknowledged. This is a repeat deficiency from the 6/08/06 survey and uncorrected from

   the survey of 2/25/08.

   
   

3. Based on the foregoing, Bayview Retirement Home violated Section 429.275(4), Florida Statutes, and/or Rule 58A- 5.024(2)(a), Florida Administrative Code, a repeated and an uncorrected Class III deficiency, which carries, in this case, an assessed fine.of $1,000.00.

   PRAYER FOR RELIEF

   
   

   WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief:

   1. Make factual and legal findings in favor of the

      
      

      Agency on Count I.

      
      

   2. Assess an administrative fine of $1,000.00 against Bayview Retirement Home on Count I pursuant to Section 429.19(2)(c), Florida Statutes.

   3. Grant such other relief as this Court deems is just and proper.

Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57,

Florida Statutes (2007). Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care

Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A

REQUEST FOR A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT

WILL RESULT IN AN ADMISSION OF THE FAC COMPLAINT

Assistant General Counsel Agency for Health Care Administration

8350 N. W. 52nd Terrace Suite 103

Miami, Florida 33166

Copies furnished to:

Field Office Manager

Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484

(U.S. Mail)

Finance and Accounting Revenue and Management Unit

Agency for Health Care Administration 2727 Mahan Drive, MS #14

Tallahassee, Florida 32308 (Inter-office Mail)

Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32308 (Interoffice Mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return ReGeipt Requested to Alice Rothman, Administrator and Registered

Agent, Bayview Retirement Lauderdale, Florida 33304

.E. 13t h Court, Fort

/.-IV-.K......,.,,..,<-1---l,L--''---+--I 2008.

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

-----------------'/

SETTLEMENT AGREEMENT

Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the "Agency"), through its undersigned representatives, and Respondent, Bayview Holdings, Inc. d/b/a Bayview Retirement Home (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 an Assisted Living Facility, licensed pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes, Section 20.42, Florida Statutes, and Chapter 58A-5, Florida Administrative Code; and

WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to Chapter Chapter 429, Part I, Florida Statutes; and

WHEREAS, the Agency served Respondent with administrative complaints on the following dates: #2007007823, on or about January 23, 2008, notifying the Respondent of its intent to impose administrative fines in the amount of $4,500.00;

EXHIBIT

I 2

#2007006069, on or about January 18, 2008, notifying the Respondent of its intent to impose administrative fines in the amount of $1,000.00 and a survey fee in the amount of

$500.00; #2008006525, on or about July 25, 2008, notifying the Respondent of its intent to impose administrative fines in the amount of $1,000.00; #2007010233, on or about January 23, 2008, notifying the Respondent of its intent to impose administrative fines in the amount of $10,750.00; and

WHEREAS, Respondent requested formal administrative proceedings by selecting Option 3 on the Election of Rights forms; and

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 ofrelief in any court or quasi-court of competent jurisdiction; and agrees to waive compliance with the form of the Final Order (findings 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

   
   

   $10,750.00 in administrative fines and a survey fee in the amount of $500.00 to the Agency within thirty (30) days of the entry of the Final Order.

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 Agency asserts the validity of the allegations raised in the administrative complaint referenced herein. However, no agreement made herein shall preclude the Agency from imposing a penalty against Respondent for any deficiency/violation of statute or rule identified in a future survey of 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 estop 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 styled case.

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

   
   

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 thirty-one (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 funds 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.

15. The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. Respondent has the capacity to execute this Agreement. Respondent understands that it has the right to consult with counsel and has knowingly and freely entered into this Agreement without exercising its right to consult with counsel. Respondent affirms that Respondent understands counsel for the Agency represents solely the Agency and Agency counsel has not provided legal advice to or influenced Respondent in its decision to enter into this Agreement.

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 parties.

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 representativ s hereby acknowledge that they are duly authorized

to e1'lter into this Agre :ment.

Eliza eth Du /'-

Deputy Secretary

) r/luuJh

Agency for Health C,1 :e Administration 2727 Mahan Drive, B dg #1 Tallahassee, Florida . 2308

/'2-u .. "7 0

L' -

4/2/t??t) v?"".?a,L,,,<--

Alice Barton Rc,thman

Bayview Retirement Home 2625 Northeast 13111 Court

Fort Lauderdale, Florida 33304

1

DATED: 7/4jJ,

DATED: · .,. - 0 /?&J.

J stin Seni , General Counsel

Agency for Health Cn re Administration 2727 Mahan Drive, 11, ail Stop #3

Tallahassee, Florida:: 2308

I I '----

DATED: 7 /24/of/

Tria La\1/ton-Ri:.ssell '

Assistant Genernl Counsel

Agency for Health Care Administration

8350 NW 52nd Terrace, Suite 103

lo

Miami, Florida 33166

DATED: _2/_t; 9

Docket for Case No: 08-000814

Orders for Case No: 08-000814