STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA ; AGENCY FOR HEALTH : CARE ADMINISTRATION, Petitioner, vs. (Lakeland Health Care Center, Inc., | MEADOWVIEW LIFE CENTER d/b/a Meadowview Life Center), i Respondent. O|- ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that after twenty one (21) days from receipt of this Complaint, the Agency for Health Care Administration (hereinafter referred|to as the "Agency") intends | to impose a civil penalty in the amount of $33,600.00 upon Meadowview Life Center (hereinafter referred to as "Respondent"). As grounds for the imposition of this civil penalty, the Agency alleges as follows: (1) The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. (2) Respondent is licensed to operate as a Nursing Home at 1350 Sleepy Hill Road, Lakeland, Florida 33810, in compliance with Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. (3) The Respondent has violated the provisions of Chapter 400, Part II, Florida Statutes, and provisions of Chapter 59A-4, Florida Administrative Code, in that it repeated and/or failed to correct, within the mandated time frame, (7) deficiencies cited during the survey of April 10,/1998. These deficiencies set forth below, were still uncorrected when a follow-up visit was made on May 10, 1998: (a) The Respondent failed to develop written policies and procedures for the admission of residents to the locked Alzheimer’s area. This is a violation of Sections 400.102, 400.121, 400.23, and 400.022(0), Florida Statutes. Fine: $700.00. (b) The Respondent failed to maintain the facility, equipment, and furniture, clean and repaired, and provide adequate housekeeping in such a way to prevent unsafe and/or unsanitary interior. This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule 59A-4.122(2)a, Florida Administrative Code. Class III deficiency. Fine: $700.00. (c) The Respondent failed to develop a comprehensive care plan for each resident). This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule 59A-4.109(2), Florida Administrative Code. Class II deficiency. Fine: $1,500.00. (d) The Respondent failed to ensure that the resident ' : | * environment remains as free of accident hazards as Is possible. This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule S9A-4.122(1), Florida Administrative Code. Class I deficiency. Fine: $10,000.00. (e) The Respondent failed to employ sufficient support personnel competent to carry out the functions of the dietary service. This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule 59A-4.1288, Florida Administrative Code. Class I deficiency. Fine: $10,000.00. (£) The Respondent failed to ensure that meals were served in a palatable manner. This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule 59A-4.1288, Florida Administrative Code. Class III deficiency. Fine: $700.00. (g) The Respondent failed to store, prepare, distribute and serve food under sanitary conditions. This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule 59A-4.1288, Florida Administrative Code. Class I deficiency. Fine: $10,000.00. (4) The above referenced violations constitute grounds to levy this civil penalty pursuant to Section 400.102(1)c, Florida Statutes, in that the above referenced conduct of Respondent constitutes a violation of the mindimm standards, rules and | regulations for the operation of a nursing home. (5) Notice was provided in writing to the Respondent of each of the above violation(s) and the time frame for correction. (6) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.57, Florida Statutes, to be represented by counsel (at its expense), to take testimony, to call or cross-examine witnesses, to have subpoenas and/or subpoenas duces tecum issued, and to present written evidence or argument if it requests a hearing. Chapter 59-1, Part II, Florida Administrative Code, constitutes the Agency's procedural rules for administrative proceedings resulting from this complaint. In order to obtain a formal proceeding under Section 120.57(1), Florida Statutes, your request for an administrative hearing must conform to the requirements in Rule 29-5. 201, Florida Administrative Code, and must state which issues of material fact you dispute. Failure to dispute material issues of fact in your request for a hearing may be treated by the Agency as an election by you of an informal proceeding under Section 120.57(2), Florida Statutes. All requests for hearing shall be made to the Agency for Health Care Administration, Division of Health Quality Assurance, 6800 North Dale Mabry Highway, Suite 220, Tampa, Florida 33614; Attention: Thomas W. Caufman, Senior Attorney. Payment of fines shall be sent to the Agency for Health Care Administration, P.O. Box 13749, Tallahassee, Florida 32317-3749. (Please reference the case number and facility name on the front of your check). (7) RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY ONE (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. I HEREBY CERTIFY that a true copy was sent by U.S. Certified Mail, Return Receipt (Number Z 259 496 131), to Steven R. Bradley, Registered Agent for Lakeland Health Care Center, Inc., 1901 Morrill Street, Suite 208, Sarasota, Florida 34236, on the £37 day of Aprek _, 1999. gency for Health Care Administration Division of Health Quality Assurance Copies furnished to: Administrator Meadowview Life Center 1350 Sleepy Hill Road Lakeland, Florida 33810

Docket for Case No: 01-001352