04-4997 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE Certified Article Number ADMINISTRATION, 7UOb 4575 124 2049 S3aub ‘Petitioner, SENDERS RECORD AHCA CASENO: 2002036601 ATLANTIC COMMUNITY CARE, INC., D/B/A TANGERINE COVE, Respondent. ° ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION _ . (hereinafter referred to as AHCA), by and through its undersigned counsel, and files this Administrative Complaint against ATLANTIC COMMUNITY CARE, INC, D/B/A TANGERINE COVE (hereinafter referred to as “Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2001), and alleges the following: Nature of the Action 1. This is an action to impose an administrative fine upon Respondent pursuant to Sections 400.419(1)(b), Florida Statutes Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code. Parties 5. Pursuant to Chapter 400, Part III, Florida Statutes, and Rules S8A-5, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. Respondent is an assisted living facility located at 307 Howel Avenue, Brooksville, Florida, 34601. Respondent is and was at all times | material hereto a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code, having been issued license number 7622 COUNTE Respondent deprived Resident of civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the United State and the Constitution of the State of Florida. Section 400.428(1) Fla.Stat. (2001) Section 400.419 Fla.Stat. (2001) CLASS II DEFICIENCY 7. , “AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as ‘if fully set forth herein. 8. On or about May 7, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based on the findings below: to wit: Based on resident interview the facility failed to ensure that one resident (#2) of 8 interviewed was free from comments of a sexual nature, and was provided privacy in his/her room. Sexual comments made to the resident, and the uninvited invasion of the resident's privacy in his/her living area caused the resident to feel uncomfortable around a staff person. This affects the resident's ability to live in a decent living environment free from abuse. Findings: 1. Resident interview on 5/7/02 at 4:10 pm in the resident’s room revealed that the resident had asked a staff person for towels and washcloths in order to take a bath. When the staff person delivered the items the staff stated to the resident "I know what you and your "spouse" are doing". On a separate occasion the resident was in the nurse’s station talking with the same staff . person when the staff person began to question the resident regarding his/her sexua! relation with his/her spouse "Does your "spouse" eat you.” The resident stated this comment caused emotional confusion and anger. The resident now wants to seek another housing arrangement as s/he feels uncomfortable around the staff person. 2. Further interview with Resident #2 revealed that the same staff person had entered the residents room using a key, woke the resident up and asked to use the residents microwave to pop some popcorn. The staff person then sat down on top of the residents foot on the residents bed while waiting for the popcorn to pop. 9. Based on all of the foregoing, Respondent violated Section 400.428(1) Fla.Stat. (2001) by depriving the Resident of her civil or legal rights, privileges and/or benefits as guaranteed by this applicable section. 10. The foregoing violation is a class II violation in that it directly threatened the physical or emotional health, safety, or security of the eo facility’s residents. Pursuant to Section 400.419(1)(b), Florida Statutes, the Agency is authorized to impose a fine in the amount of $1,000. 41. . Respondent was provided a mandated correction date of May 7, 2002.° 12. Said violation constitutes an uncorrected Class II and warrants imposition of the fine of $1000. 13. Section 400.419(9) Fla.Stat. (2001) authorizes assessment ofa survey fee. In the context of the present facts and circumstances a survey fee is assessable. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the fotlowing relief: a) Make factua! and jegal findings in favor of AHCA. b) Impose a fine in the amount of $1000.00; and c) Impose and assess survey fee of $500.00 in addition to the assessed fine. d) Any other general and equitable relief as deemed appropriate. Agency for Health Care Administration Dated Wine 23, cw = dah al LZ ph Saliba, Esquire, Senior Attorney Fla. Bar. No. 0240389 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850) 921-0158 (fax) NOTICE Respondent, ATLANTIC COMMUNITY CARE, INC D/B/A TANGERINE COVE, hereby is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Richard Joseph Saliba, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, © 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE ADMINISTRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY AHCA. KRE ADMINISTRATION Fla. Bar. No. 0240389 Counsel! for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3.. 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850).921-0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent by U.S. Certified Mail, Return Receipt Requested, (Return Receipt # 7106 4575 1294 2049 5346) to ATLANTIC COMMUNITY CARE, INC D/B/A TANGERINE COVE, 307 Howell Avenue, Brooksville, Florida 34601, this 2-7f day of June, 2002. AGENCY FOR HEALTH CARE ADMINISTRATION Senior Attorney Fla. Bar. No. 0240389 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850) 921-0158 (fax)

Docket for Case No: 02-002907