STATE OF FLORIDA ane AGENCY FOR HEALTH CARE Te asrpirib “3 Py STATE OF FLORIDA Uliyre. M4: 16 amp AM AGENCY FOR HEALTH CARE ADMIN s ify - ADMINISTRATION, HEA RINGS VE Petitioner, ve AHCA NO. 2001054131 07-01-0218-ALF CARING HEARTS OF LAKE MARY INC. 02-0318 “IG, d/b/a CARING HEARTS, Respondent. / ee eeeeeeeeSSSSSSSFSF FINAL ORDER Having reviewed the administrative complaint dated December 20, 2001, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Joint Stipulation with the parties to these proceedings, and being otherwise well advised in the premises, finds and concludes as follows: _The attached Joint Stipulation (Ex. 2), is approved and adopted as part of this Final Order and the parties are directed to comply with the terms of the Joint Stipulation. ORDERED: 1. The attached Joint Stipulation is approved and adopted as part of this Final Order and the parties are directed to comply with the terms of the Joint Stipulation. Lee eas ueGarunusnissneneneesese 2. A fine of $4,250.00 is hereby imposed upon the Respondent. The fine is 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 this Case number, should be sent directly to Gloria Collins Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, Mail Stop # 14 Tallahassee, Fl. 32308. : 4. Unpaid fines will be subject to Statutory interest, and may be collected by all methods legally available. DONE and ORDERED this_/Aday of —Aefeeat_ 2002, in Tallahassee, Leon County, Florida, Rhonda M, dows, MD, Secretary Agency for Hdalth Care Administrati Eee A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY Copies furnished to: Antonio B. Cahue, Esquire Cahue’ Consulting Inc. 237 Oak Park Place Casselberry, FL 32707 (U. S. Mail) ; Vincent A. Acardi 908 Florida Blvd. Altamonte Springs, FL 32701 (U.S. Mail) Michael P, Sasso, Esq. Senior Attorney Agency for Health Care Administration 525 Mirror Lake Dr. N. #330K St. Petersburg, FL 33701 (Interoffice Mail) Gloria Collins Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) William R, Cave, ALJ Div. of Administrative Hearings The DeSoto Bldg. 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) Wendy Adams Agency for Health Care Administration 2727 Mahan Drive, Bldg #3 MS #3 Tallahassee, FL 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I CERTIFY that a copy hereof has been furnished to the above-named Person(s) and entities by U.S. Mail, or the method designated, on f v6, vst SO , 2002, Lealand McCharen, Agency Tlerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 921-8177 2 EEE EXHIBIT ¢ 2 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ABCA NO: 2001054131 vs. 07-01-0218-ALF 02-0318 CARING HEARTS OF LAKE MARY, INC., d/b/a CARING HEARTS Respondent. ey | STIPULATION: AND SETTLEMENT AGREEMENT EES EMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency” ) through their undersigned representatives, and Caring Hearts of Lake Mary, Inc., d/b/a Caring Hearts (hereinafter “Respondent” ) pursuant to Sec. 120.57(4), Florida Statutes each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Caring Hearts is an Assisted Living Facility licensed pursuant to Chapter 400 Part III, Florida Statutes, and Rule 58A-5, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Caring Hearts pursuant to Chapter 400, Florida Statutes; and WHEREAS, the Agency served Caring Hearts with an Administrative Complaint on January 23, 2002, notifying the Party of its intent to impose an administrative fine in the amount of $5,500.00, and; WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; 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 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, Caring Hearts agrees to a withdrawal of its Petition for Formal Administrative Proceedings; agrees to waive any and all appeals and proceedings; agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), a formal Proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court (DOAH) of competent jurisdiction. 4, Upon full execution of this Agreement, Caring Hearts agrees to pay $4,250.00 (Four Thousand Two Hundred Fifty Dollars & 00/100) in administrative fines to the Agency, which includes a $500.00 re-survey fee in accordance with Section 400.419(9) Florida Statutes, within 30 days of the entry of the Final Order. Venue for any action brought to enforce the terms of this in the Circuit Court in Leon County, Florida, 5. Caring Hearts admits to the allegations raised in the administrative complaint referenced herein. The Agency agrees that it will not impose any further penalty against Caring Hearts as a result of the 06/26/01 & 08/09/01 surveys, however, no agreement made herein shall preclude the Agency from imposing a penalty against Caring Hearts for any deficiency/violation of statute or rule identified ina future Survey of Caring Hearts, which constitutes a “repeat” deficiency from the 06/26/01 & 08/09/01 Surveys. The parties agree that in such a “repeat” case, the deficiencies from the 06/26/01 «& 08/09/01 surveys shall be deemed found without further proof. 3 —— LS ee a une 6. Upon full execution of this Agreement, the Agency Shall enter a Final Order adopting and incorporating the terms of this Agreement and dismissing the above-~styled case. 7. Each party shall bear its own costs and attorney fees, 8. This Agreement shall become effective on the date upon which it is fully executed by all the Parties. 9. Caring Hearts 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 Caring Hearts or related facilities. 10. This Agreement is binding upon all party’s herein and Agreement. eee 11. The undersigned have read and understand this 12. This Agreement contains the entire understandings and agreements of the parties, 13. This Agreement Supercedes any prior oral or written agreements between the Parties. 14. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Vincent A. Accardi 908 Florida Boulevard Altamonte Springs, FL 32701 Deputy ecretary, Managed)}Care and Heal Quality Assurance Agency for Health Care Administration DATED: VA paTep: 6-|®~- 2002. ac ee William H. Roberts Acting General Counsel, Agency for Health Care Admin. 2727 Mahan Drive Tallahassee, Florida 32308 DATED: gf ¢/ Q—~ _ ee f ( EXH STATE OF FLORIDA TBIT # AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA NO: 07-01-0218-aLF CARING HEARTS OF LAKE MARY, INC., d/b/a CARING HEARTS 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 Caring Hearts of Lake Mary Inc. d/b/a Caring Hearts, (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine on Respondent in the amount of five thousand five hundred dollars ($5,500) pursuant to Sections 400.414 (1) (e) and 400.419(1) (c) Florida Statutes, 2. On or about August 09, 2001 a follow-up survey was conducted of respondent’s facility. The deficiencies set forth in counts I through XI below were originally cited during a re-licensure survey conducted on or about June 26, 2001. Jurisdiction And Venue 3. This Court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes and Chapter 28-106 Florida Administrative Code. 4. Venue lies in Seminole County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28 Florida Administrative Code. Parties 5. 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. 6. Respondent, is an assisted living facility located at 2080 Wayside Drive, Sanford, Florida. Respondent, is and was at all times material hereto, a _ mn, C licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code. COUNT I RESPONDENT FAILED TO MAINTAIN AN UP-TO-DATE RECORD OF MAJOR INCIDENTS OCCURRING WITHIN THE LAST TWO YEARS; VIOLATING : 58A-5.0124(1) (a), F.A.C. CLASS III DEFICIENCY 7, AHCA re-alleges and incorporates Paragraphs (1) through (6) as if fully set forth herein. 8. Based upon record review, staff interviews and resident interviews it was determined that the facility failed to write an adverse incident report concerning an incident occurring on or about August 03, 2001. 9, This is a violation 58A-5.024 (1) (d) F.A.c, which requires the respondent to maintain an up~to-date record of major incidents occurring within the last two years. 10. The above referenced violation constitutes the grounds for the imposed Class III deficiency and for which a fine of five hundred dollars ($500) is authorized under Sections 400.414(1) (e) and 400.419(1) (c) Florida Statutes, CLASS I1Ir DEFICIENCY 11. AHCA re-alleges and incorporates Paragraphs (1) through (6) as if fully set forth herein. 12. Based upon record review and staff interview it was determined that the facility failed to obtain an annual fire inspection from the local fire marshal. 13. This is a violation 58A~5.015(1) (a)3 F.A.C. and Section 400.441(1) (a)2,m Florida Statutes which requires the respondent to obtain an annual fire inspection from the local fire marshal. 14. The above referenced violation constitutes the grounds for the imposed Class III deficiency and for which a fine of five hundred dollars ($500) is authorized under Sections 400.414(1) (e@) and 400.419(1) (c) Florida Statutes, CLASS III DEFICIENCY 15. AHCA re-alleges and incorporates Paragraphs (1) through (6) as if fully set forth herein. 16, During the Survey it was determined that the facility did not have available any staff files, which would be necessary to determine whether the Staff had been Properly trained to care for the residents. 17. This is @ violation S8A~5.024 (4) (a) F.A.C. which staff of the agency, the department, the district long-term care ombudsman council and the advocacy center for Persons with disabilities. 18. The above referenced violation constitutes the a fine of five hundred dollars ($500) is authorized under Sections 400.414(1) (e) and 400.419(1) (c) Florida Statutes, 58A~5.025(1) F.A.C. and Section 400.424 (1) Florida Statutes CLASS IIr DEFICIENCY 19. AHCA Te-alleges and incorporates Paragraphs (1) through (6) as if fully set forth herein, 20. Based upon resident record review it was determined that the facility failed to execute a Contract with two residents in the facility. 21. This isa violation of 98A~5.024 (3) (4) and 58a- 5.025 (1) FLAC, and Section 400.424 (1) Florida Statutes which requires the facility to execute a contract with each a fine of five hundréd dollars ($500) is authorized under Sections 400.414 (1) (@) and 400.419(1) (a) Florida Statutes, 23. AHCA tTe~alleges ang incorporates Paragraphs (1) through (6) as if fully set forth herein, 24. Based upon resident record reviews and Staff have a nurse available to administer medications to a resident requiring 4sSsistance with medication administration, 25. This isa violation of S8A-5.0181(1) (e)2 F.ALC, which requires that a facility excepting a resident 26. The above referenced violation constitutes the a fine of five hundred dollars ($500) is authorized under Sections 400.414 (1) (ey and 400.419(1) (c) Florida Statutes. 27. AHCA re-alleges and incorporates Paragraphs (1) through (6) as if fully set forth herein, 28. Based UPON resident record reviews and staff interviews it was determined that the facility failed to ensure that the records for three residents contained al] information necessary to determine that the resident’s needs could be met in an assisted living facility that was not a medical, nursing or PS8ychiatric facility. 29. This is a violation of S8A-5.0181(2) (ay1-9 PLAC, which requires the facility to ensure that medical examination reports contain the necessary information to determine “PPropriateness of admission and to develop an individualizeg Plan of Care. 30. The above referenced violation constitutes the @ fine of five hundred dollars ($500) is authorized under Sections 400.414 (1) (e) and 400.419(1) (¢) Florida Statutes. 33. This is a violation of S8A~5.0191(1) (¢) F.A.C. and section 400.452(4) Florida Statutes which requires administrators to Participate in continuing education for a minimum of twelve (12) contact hours every two (2) years, 34. The above referenced violation constitutes the a fine of five hundred dollars ($500) is authorized under Sections 400.414 (1) (e) and 400.419(1) (cg) Florida Statutes, COUNT viiItT RESPONDENT FAILED To MAINTAIN AN UP-TO-DATE MEDICATION OBSERVATION RECORD FoR EACH RESIDENT RECEIVING ASSISTANCE WITH MEDICATIONS; VIOLATING 58A~5.0181(2) P.A.c, CLASS IIr DEFICIENCY 36. Based Upon resident tecord reviews and staff interviews it was determined that the facility failed to maintain up-to-date medication administration Tecords at least one (1) resident. 37. This is a violation of °8A-5.0185 (5) (b) P.A.C, assistance with Self-administration or medication administration, 38. The above referenced violation constitutes the ‘ ( grounds for the imposed Class Iir deficiency and for which a fine of five hundred dollars ($500) is authorized under Sections 400.414(1) (e) and 400.419(1) (c) Florida Statutes. STATE oF HEALTH ; VIOLATING 58A-5.0182(1) (e) F.A.C, CLASS rrr DEFICIENCY 39. AHCA re-alleges and incorporates Paragraphs (1) through (6) as if fully set forth herein, 40. Based upon resident tecord reviews and staff resident’s state of health, 41. This is a violation of 58A-5.0182(1) (e) F.A.C, which requires the facility to maintain a written record of any significant changes in the resident’s normal appearance or State of health, any illnesses which resulted in medical attention, Major incidents, Changes in the method of medication administration, Or other changes which resulted in the Provision of additional services. 42. The above referenced violation constitutes the a fine of five hundred dollars ($500) is authorized under Sections 900.414 (1) (a) and 400.419(1) (c) Florida Statutes, 43. AHCA re-alleges ang incorporates Paragraphs (1) through (6) as if fully set forth herein, 44. Based upon a facility record review and staff 45. This is a violation of 58A-5.026(2) (c) FLAC, which requires a facility, who’s Ownership has been transferred, to submit an emergency Management Plan within 30 days of obtaining a license, 46. The above referenced violation constitutes the a fine of five hundred dollars ($500) is authorized under Sections 400.414 (1) (@) and 400.419(1) (c) Florida Statutes. 47. ANCA te-alleges ang incorporates Paragraphs (1) through (6) as if fully set forth herein. 48. Based upon resident tecord reviews and staff 49. This is a violation of 58A-5.024 (2) (a) F.A.C, 50. The above referenced violation constitutes the a fine of five hundred dollars ($500) is authorized under Sections 400.414 (1) (e) and 400.419(1) (@) Florida Statutes, WHEREFORE , AHCA intends to impose a4 fine against the respondent under Sections 400.414 (1) (e) and 400.419 (1) (g) Florida Statutes in the amount of five thousand five hundred dollars ($5,500). 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 requésts for hearing Shall be made to the attention of Michael p, Sasso, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr., St, Petersburg, Florida, 33701, Respect fully Submitted, Michael Pp, Sasso, Esquire AHCA - Senior Attorney 525 Mirror Lake Drive North, St. Petersburg, Florida 33701 to Caring Hearts of Lake Mary, Inc., through its Registereg SPRINGS FL 32701, on the Qo” day of Qecon fo, + 2001. Michael P, Sasso, Esquire Copies furnished to: Caring Hearts aLp Brook ose, Administrator i ive Vincent A, Accardi 908 Florida Blvd. Altamonte Springs, FL 32701 (U.S, Certified Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration (Inter-office Mail) 525 Mirror Lake Drive North, Suite 3106 St. Petersburg, Florida 33701

Docket for Case No: 02-000318