; STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner. AHCA—No+—2041009154 = a Return Receipt Requested: 7009 0080 0000 0586 4528 PARK PLAZA RETIREMENT RESIDENCE LLC d/b/a PARK PLAZA RETIREMENT RESIDENCE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency .for Health Care Administration (“AHCA”), by: and through the undersigned counsel, and files this Administrative Complaint against Park Plaza Retirement Residence LLC d/b/a Park Plaza Retirement Residence (hereinafter “Park Plaza Retirement Residence”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2010), 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 (2010), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. Filed October 5, 2011 3:26 PM Division of Administrative Hearings 3. Venue lies. pursuant to Rule 28-106,207, Florida Administrative Code. PARTIES licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2010), and’ Chapter 58A-5, Florida Code. 5. Park Plaza Retirement Residence operates a 120-bed assisted living facility located at 15520 N.W. 2" Avenue, North Miami Beach, Florida 33160. Park Plaza Retirement Residence is licensed as an assisted living facility license number AL7169, with an expiration date of 12/01/2011. Park Plaza Retirement Residence 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 PARK PLAZA RETIREMENT RESIDENCE FAILED TO ENSURE FACILITY’ S PHYSICAL STRUCTURE, INCLUDING INTERIOR AND EXTERIOR WALLS , FLOORS, ROOF AND CEILINGS ARE IN GOOD REPAIR Rule 58A-5.023(3) (a)3, Florida Administrative Code (PHYSICAL PLANT STANDARDS) ‘ UNCORRECTED CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7, During three complaint investigations conducted on 4/21/2011 and based on tour and interview, it was determined that the facility failed to ensure facility's physical structure, including the interior and exterior walls, floors, roof and ceilings shall be structurally sound and in good repair. i During—tour—on—April 21,2011 —at—0+ 05—am—the—fel towing (a) Bedroom #32 had a very strong smell of urine. | (b) Bedroom #57 had a very strong smell of urine and had gnats and other bugs on the table and on bed #1. (c) Bedroom #70 contained a leak in the bathroom which caused wet carpet near bed #1 and water damage on the shower wall, . (d) Bedroom #76 had peeling paint on the walls and on the bathroom door. . -9. An interview on 4/21/2010 at 11:00 ‘AM with med tech revealed that they would get the maintenance manager to repair “the rooms. Correction Date: 5/21/2011. 10. During the follow up conducted on 6/27/2011 and based on tour and interview facility, it was determined that the. failed to ensure facility's physical structure, including the interior and exterior walls, floors, roof and ceilings shall. be structurally sound and in good repair. ii. During tour on June 27, 2011 at 9:05 AM it was revealed that in bedrooms #4, #15, #37, #40, #42, and #73 there was a strong smell of urine, 12. An interview on 7/27/2011. at 5:00 PM with the Administrator, she advised they would get the housekeeper to clean. the rooms. This is an uncorrected deficiency from 4/21/2011. 13. Based on the foregoing, Park Plaza Retirement Residence violated Rule 59A-5.023(3) (a)3, Florida Administrative Code, an uncorrected Class III deficiency, which carries, in.this case, an assassed fine of S500 00, COUNT IT PARK PLAZA RETIREMENT RESIDENCE FAILED TO ENSURE THAT SOME STAYEF MEMBERS RECEIVED DO NOT RESUSCITATE ORDERS TRAINING. Rule 58A-5.0191(11), Florida Administrative Code (STAFF .RECORDS STANDARDS) 14. .-AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 15. During three complaint investigations conducted on 4/21/2011 and based on personnel record review and interview, it: was determined that the facility failed to ensure that 1 out of 6 (#1, 2, 3, 4, 5, and 6) sampled staff members receive Do Not Resuscitate Orders (DNROs) training. 16. Facility's record review on 4/21/2011 revealed that sampled staff #1 (hired 11/10/2010), #2 (hired 6/10/2010), #3 (3/01/2010), #4 (hired 05/12/2008), #5 (hired 10/23/2010) and #6 (hired 10/20/2010) did not have any documentation of completing the DNROs training within 60 days after the effective date of employment . 17. An interview with the facility's Administrator on April 21, 2011 at 4:30PM stated that he thought they had it. Correction Date: 5/21/2011. 18. During the follow-up conducted on 6/27/2011 and based 4 on personnel record review and interview, it was determined that the facility STILL failed to ensure that 1 out of 6 (#1, 2, 3, 4, 5, and 6) sampled staff members receive Do Not Resuscitate Orders revealed that sampled staff #1 (hired 11/10/2010), #2 (hired 6/10/2010), ‘#3 (3/01/2010), #4 (hired 05/12/2008), #5 (hired 10/23/2010) and #6. (hired 10/20/2010) . did. not ~ have any Facility's record review on 4/21/11 and 6/27/11 documentation of completing the DNROs training within 60 days after the effective date of employment. . 20. Interview with the facility's administrator on A at 4:30PM stated he thought they had it. Uncorrected deficiency from 4/21/2011. 21. Based on the foregoing, Park Plaza Retirement Residence violated Rule 58A-5.0191(11), 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: Agency on Counts I, and II. B. Assess an administrative fine of $1,000.00 against Park Plaza Retirement Residence on Counts I, and II, pursuant to Sections 429.19, Florida Statutes. 5 A. Make factual and legal findings in favor of the Cc. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a _xight. to request an <= = aaninistrative—hearing—pursuant—to—Ssections 120-569—and 120757," Florida Statutes (2010). Specific options for administrative action are set out in the attached Election of Rights Form. All vequests for hearing shall be made to the Agency for Health Care Adninistration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 412-3630. 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER, elson E, Rodney Assistant General Counsel Agency for Health Care Administration 8333 N.W. 5374 Street Suite 300 , Miami, Florida 33166 Copies furnished to: Field Office Manager ; Agency for Health Care Administration 8333 N.W. 53°¢ Street, Suite #300 Miami, Florida 33166 Mai} 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 Gary Solomons, Administrator, Park Plaza Retirement Residence, 15520 N.W. 24 Avenue, North Miami Beach, Florida 33160, on Sigler burn 2. , 2011. Nelson E. Rodney

Docket for Case No: 11-005129

Orders for Case No: 11-005129