STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION {2 ;,, yd 215 py : on co STATE OF FLORIDA on “od AGENCY FOR HEALTH Abisy: CARE ADMINISTRATION, H Petitioner, AHCA NO: 07-01-0145 Vs. HEALTHCARE AND RETIREMENT CORPORATION OF AMERICA D/b/a Regents Park, 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 HEALTHCARE AND RETIREMENT CORPORATION OF AMERICA d/b/a REGENTS PARK. (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the ‘amount of seventeen thousand five hundred » dollars ($17,500) dollars pursuant to Section 400.419 Florida Statutes. P:\Eileen\Regents Park ACcomplete.doc cepa coteagy on ogee Jurisdiction 2. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 3. Venue lies in Orange County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28 F.A.C. Parties 4, AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 5. Respondent, Regents Park, is a nursing home located at 558 North Semoran Boulevard, Winter Park. Florida. The facility is licensed under Chapter 400, Part IT, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I RESPONDENT FAILED TO ENSURE THAT ALL INCIDENTS INVOLVING MISTREATMENT, ABUSE OR NEGLECT, INCLUDING INJURIES FROM UNKNOWN SOURCES WERE THROUGHLY INVESTIGATED AND REPORTED TO THE APPROPRIATE AGENCIES 59A-4.1288, F.A.C. (adopting by reference 42 CFR 483.13(c) (1) (ii) and § 400.022 (1) (1) or (0) Fla. Stat. (2001) P:\Eileen\Regents Park ACcomplete.doc REET ree CLASS II DEFICIENCY 6. AHCA re-alleges and incorporates (1) through (5) as if fully set forth here. 7. During the annual recertification survey conducted 6/11-6/15/01, it was determined that the facility failed to ensure that all alleged resident abuse violations were thoroughly reported to the appropriate agencies for two (2) of 25 sampled residents and two (2) random sampled residents. 8. Based on the foregoing, the Respondent violated Fla. Admin. Code R. 59A-4.1288 adopting by reference 42 C.F.R. 483.13 (c) (1) (ii) (2), (3) and § 400.022 Fla. Stat. (2001), herein classified as a Class II violation, pursuant to § 400.23(8) (b)Fla. Stat. (2001). which carries, in this case, an assessed fine of $2500. COUNT II RESPONDENT FAILED TO PROMOTE AND MAINTAIN THE DIGNITY OF SIX RESIDENTS WHO REQUESTED OR REQUIRED STAFF ASSISTANCE TO MEET PERSONAL CARE NEEDS 59A-4.1288 F.A.C. (adopting by reference 42 C.F.R. 483.15(a) and § 400.022(1) (1),(n) Fla. Stat. (2001) CLASS II DEFICIENCY 9. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. P:\Eileen\Regents Park ACcomplete.doc el te ee as a les aa 10. During the annual recertification survey conducted 6/11-6/15/01, it was determined that the facility failed to promote and maintain the dignity of three (3) sampled residents and three random sampled residents who requested and/or required staff assistance to meet personal care needs in toileting and eating. 11. Based on the foregoing, Respondent violated Fla. Admin. Code R. 59A-4.1288 adopting by reference 42 C.F. R. 483.15 (a) and §400.022 Fla. Stat. (2001) herein classified as a Class II, pursuant to § 400.23(8) (b) Fla. Stat. (2001) which carries, in this case, an assessed fine of $2500.00. COUNT III RESPONDENT FAILED TO PROVIDE NECESSARY TREATMENT AND SERVICES TO PROMOTE HEALING OF PRESSURE SORES AND PREVENT NEW PRESSURE SORES FROM DEVELOPING 59A-4.1288 F.A.C. (adopting by reference 42 C.F.R.483.25(c) AND § 400.022(1) (1) Fla. Stat. (2001) CLASS II DEFICIENCY 12. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 13. During the annual recertification survey conducted 6/11-6/15/01, it was determined that the facility failed to provide the necessary treatment and services to P:\Eileen\Regents Park ACcomplete.doc aki id epererser rr ee eons or promote healing and prevent new sores from developing for three (3) of 25 sampled residents. 14. 14. Based on the foregoing, the Respondent has violated Fla. Admin. Code R. 59A-4.1288 adopting by reference 42 C.F.R. 483.25 (c) and § 400.022 (1)(1) Fla. Stat. (2001) herein classified as a Class II, pursuant to § 400.23(8) (b) Fla. Stat. (2001) which carries, in this case, an assessed fine of $2500.00. COUNT IV THE RESPONDENT FAILED TO ENSURE THAT EACH RESIDENT RECEIVED ADEQUATE SUPERVISION AND ASSISTANCE DEVICES TO PREVENT FALLS, ACCIDENTS AND/OR PROVIDE INTERVENTIONS TO ENSURE THEIR SAFETY 59A-4.1288 F.A.C. (adopting by reference 42 C.F.R 483.25(h) (2) and § 400.022(1)(1)) Fla. Stat. (2001) CLASS II DEFICIENCY 15. AHCA re-alleges and incorporates (1) through (4) as if fully set forth herein. 16. During the annual recertification survey conducted 6/11-6/15/01, it was determined that the facility failed to monitor and provide adequate supervision to prevent falls and interventions to ensure the safety of the residents for five (5) of the 25 sampled residents. 17. Based on the foregoing, the Respondent has violated Fla. Admin. Code R. 59A4.1288 adopting by P:\Eileen\Regents Park ACcomplete.doc seers oe Seca. aia ee oe oe aa ee ee oe ee reference 42 C.F.R. 483.25 (h)(2) and § 400.022 (1)(1) Fla. Stat. (2001). This is a Class II violation, pursuant to § 400.23(8) (ob) Fla. Stat. (2001). A conditional licensure status means that a facility, due to the presence of a Class II deficiency can assign a conditional licensure status. COUNT V AS INDICTATED BY DEFICIENCIES SET FORTH IN COUNTS I, II, III, AND IV, THE RESPONDENT FAILED TO PROVIDE SUFFICIENT NURSING STAFF AMD RELATED SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL AND PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT. Fla. Admin. Code R. 59A-4.1288 (adopting by reference 42 C.F.R. 483.30(a) (1)&(2)); Fla. Admin. Code R. 59A- 4.108(4) and § 400.022 (1) (1) Fla. Stat. (2001) CLASS II DEFICIENCY 18. AHCA re-alleges and incorporates (1) through (4) if fully set forth herein. 19. During the annual recertification survey conducted 6/11-6/15/01 it was determined that the facility failed to provide a sufficient number of nursing staff to ensure that; (1) residents were adequately monitored and supervised to prevent injury; (2) timely care was provided to incontinent residents; (3) care and services were provided to prevent and/or heal pressure ulcers. P:\Eileen\Regents Park ACcomplete.doc as cg ores (ah dite taitd ti atta andl, cca 15. 20. Based on the foregoing, Respondent has violated Fla. Admin. Code R. 59A-4.1288 adopting by reference 42 C.F.R. 483.30 (a) (1)&(2) ;Fla. Admin. Code R. 59A- 4.108 (4) AND § 400.022(1)(1) Fla. Stat. (2001). This is a Class II violation, pursuant to § 400.23(8)(b) Fla. Stat. (2001) which carries, in this case, an assessed fine of $2500.00. PRAYER FOR RELIEF WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Counts I through V; and B. Recommend an administrative fine of seventeen thousand five hundred dollars ($17,500) be imposed against the Respondent for Counts I through V; and C. Assess costs related to the investigation and prosecution of the this case pursuant to § 400.121 (10) Fla. Stat. (2001) D. All other general and equitable relief allowed by law. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, P:\Eileen\Regents Park ACcomplete.doc oe opr: rca nea a eyrer em Florida Statutes. Specific options for administrative action are set out and explained in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 525 Mirror Lake Drive, St. Petersburg, Florida, 33701; Eileen O'Hara Garcia, Senior Attorney. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submiéted, Eileen o! Senior Attorn Agency for Health Care Administration 525 Mirror Lake Dr. St. Petersburg, FL 33701 P:\Eileen\Regents Park ACcomplete.doc so cee * Soper ERR re TREE STR orr Reem re CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy of the foregoing Administrative Complaint has been furnished by Certified Mail Return Receipt (Z 170 444 539) to Registered Agent CT Corporation System, 1200 S. Pine Island Road Plantation, Fl 33324 and by Regular U.S. Mail to Administrator, 558 North Semoran Boulevard, Winter Park, Fl 32 this 99taay of Nowember 2001. BLl Eileen O'Hara Garci AHCA - Senior Attorney 525 Mirror Lake Drive Suite St. Petersburg, Fl 33701 Copies furnished to: Alfred Clark Esq., P.O. Box 623 117 South Gadsden St. Suite 201 Tallahassee, Fl 32301 (fax # 850-224-5222) Long Term Care Unit Agency for Health Care Administration 2727 Mahan Drive Mahan Drive Tallahassee, fl 32308 Area 7 Office Agency for Health Care Administration Hurston Tower South 400 W. Robinson Street, $309 Orlando, FL 33701 Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Mahan Drive Tallahassee, Fl 32308 Wendy Adams Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Fl 32308 ae ee oe ee oe ee es

Docket for Case No: 02-000668