D3 ~ 301P a Neawery STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE Certified Article Number ADMINISTRATION, 7idb 4575 be 2044 at SENDERS RECORD Petitioner, AHCA CASE NO. 2002030421 2002030431 v. 2002029591 Q, is : A . RIVER OAKS A.L.F., L.C. “ey ar ° D/B/A RIVER OAKS ASSISTED - e LIVING, ‘ y x on Respondent. : . ? / OZ D ow 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 RIVER OAKS A.L.F., L.C., d/b/a RIVER OAKS ASSISTED LIVING (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, and an action to deny Respondent’s application for licensure renewal, brought pursuant to Section 400.419 Fla.Stat. (2001); and Section 400.414 Fla.Stat. (2001). Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. seal eet 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400 Part IIT, Florida Statutes. 4. Venue vests pursuant to Rule 28-106.207, Florida Administrative Code. Parties 5. Pursuant to Chapter 400, Part III, Florida Statutes, and Rules 58A-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 10845 W. Gem Street, Crystal River, Florida 34428. Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5S, Florida Administrative Code, with 95 beds and having been issued license number 5997. COUNT I RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO MAINTAIN AN UP-TO-DATE RECORD OF MAJOR INCIDENTS OCCURRING WITHIN THE LAST TWO YEARS. CHAPTER 58A-5.024(1) (d) FLORIDA ADMINISTRATIVE CODE. (2001); Section 400.441; and Section 400.419 Fla.Stat. (2001) 7. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. nll ad 8. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on facility record review and staff interview, the facility failed to maintain an up- to-date record of major incidents for two residents, (#1,3) which occurred in the last two years, as required. Findings: 1. Review of facility records revealed no documentation of major incidents occurring recently or in the last two years. 2. Record review for resident #1, admitted 6/11/00, revealed a nursing note dated 7/23/01 documenting the resident being found on the floor. The resident was sent out to the emergency room where it was determined that the resident had fractured the left hip. No incident report was filled out on this fall. 3. Record review for resident #5, admitted 1/14/02 at 11:00 am, revealed a nursing note documenting the resident fell on 1/14/02 at 7:05 pm in the secured unit of the facility, and was sent out to the emergency room. The resident was diagnosed as having a left hip fracture. No incident report was filled out on this fall. 4. Interview with the facility administrator and the administrative assistant on 1/23/02 at 2:30 pm and 1/24/02 at 6:00 pm, revealed they were unable to provide an up-to-date record of major incidents for the last two years. Class III Correction Date: 2/23/02 9. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on facility record review and staff interview, the facility failed to maintain an up- to-date record of major incidents, as required for 3, (#1,#2,#3) of 4 residents reviewed, which occurred since date of the last survey. Findings: 1. Record review for resident #1 revealed nurse documentation on 2/12/02 at 8:00 am, in the Interdisciplinary Progress Notes, of swelling to the top of resident #1's arm and shoulder area. A mobile X-ray was done at the facility at 2:05 pm which revealed a right shoulder fracture humeral neck, non-displaced. There was no documentation in the incident report file presented to this surveyor. Interview with the facility administrator on 3/14/02 at 11:30 am revealed the incident reports presented were a complete file. 3 all New 2. Record review for resident #2 revealed the resident had fallen or reported to staff he/she had fallen five times on dates 2/02/02, 2/16/02, 2/17/02,2/20/02 and 3/06/02. Skin tears occurred on 2/16/02, 2/17/02 and received an injured finger on 2/20/02. These falls were not documented in the incident report file presented to this surveyor. Interview with the administrator on 3/14/02 at 11:30 am revealed the incident reports presented were a complete file 3. Record review for resident #3 revealed the resident had fallen in his/her room which resulted in the resident being transferred to the hospital and subsequently diagnosed with a fractured left hip. Review of the incident report file revealed this fall had not been documented as a major incident. Class III Correction Date 4/14/02 10. Based on the foregoing, Respondent has violated s. 58A-5.024(1) (da), Florida Administrative Code, and Section 400.441(1) (e) Florida Statutes by reason of the fact that Respondent failed to provide the Residents of the facility their legal rights as delineated within the Administrative Code and the Florida Statutes. Specifically, Respondent failed to maintain an up-to-date record of major incidents occurring within the last two (2) years. | 11. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is 4 Nt wow’ required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 12. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 13. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. COUNT IIL RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO POST A COPY OF THE LAST INSPECTION REPORT OF THE AGENCY FOR THAT FACILITY IN A PROMINENT LOCATION WITHIN THE FACILITY SO AS TO BE ACCESSIBLE TO ALL 5 Newel’ ww RESIDENTS AND TO THE PUBLIC. Section 400.435; and Section 400.419 Fla.Stat. (2001) 14. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 15. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observation and staff interview, the facility failed to post in a prominent location, and make accessible to all residents and the public, a copy of the last agency inspection report. Findings: 1. During the initial tour of the facility on 1/23/02 at 10:30 am, no agency inspection report was observed to be posted anywhere in the facility. There was, however, a note taped in the front lobby stating the inspection report was located in the front business office and could be reviewed upon request during regular business hours. 2, Interview with the facility administrator revealed the agency inspection report was kept in a book in his office, which was not readily accessible to residents or the public. Interview with a staff member that works in the front business office revealed he/she had been employed at the facility for approximately three months and had never seen the inspection report or the report book. Class IIT Correction Date: 2/23/02 16. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’ s facility. AHCA cited Respondent based upon the findings below: Based on observation, the facility failed to post a copy of the last inspection report of the agency in a prominent location within the facility, as required. Findings: Observation on 3/14/02 at 9:20 am revealed the biennial survey results dated 1/24/02 were not posted in the facility and accessible to all residents and the public. Class Il Correction Date 4/14/02 _ vw 17. Based on the foregoing, Respondent has violated Section 400.435(2001) by reason of the fact that Respondent failed to post a copy of the last inspection report of the Agency for that facility in a prominent location within the facility so as to be accessible to all residents and to the public. 18. The foregoing violation constitutes a Class IIT violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class IIT violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 19. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 20. Section 200.419 (9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. COUNT IIT RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO MAINTAIN A RECORD OF ALL ADVERSE INCIDENTS WHICH HAVE OCURRED WITHIN THE LAST TWO YEARS. Section 400.423(2); and Section 400.419 Fla.Stat. (2001) 21. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 22. . On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on facility record review and staff interview the facility failed to maintain an up- to-date record of adverse incidents, as required. Findings: — — 1. Review of facility records failed to provide documentation of all adverse incidents occurring since the required date of May 16, 2001. 2. Interview with the facility administrator on 1/24/02 at 3:15 pm, revealed the facility had no system for identifying, reporting, or recording all adverse incidents. Class TI Correction Date: 2/23/02 23. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review the facility failed to maintain a record of all adverse incidents which occurred within the last two years. Findings: Review of resident # 1's clinical record on 3/14/02, revealed he/she was found to have swelling to the top of his/her arm and shoulder area on 2/12/02. An X-ray revealed a right shoulder fracture of the humeral neck, non-displaced. Review of the facility Adverse Incident file revealed, even though this injury was unexplained, there was no documentation of a one day or fifteen day adverse incident report. An interview with the Director of Nursing was done on 3/14/02 at 10:15am. She reported that resident #1 was diagnosed with osteoporosis and the shoulder fracture was spontaneous due to brittle bones. Further review of the clinical record on 3/14/02, provided no documentation of the diagnosis of osteoporosis, brittle bone disease, degenerative joint disease, or other diagnosis which would indicate the resident had a spontaneous fracture. Class Il ; Correction Date 4/14/02 24. Based on the foregoing, Respondent has violated Section 400.423 Fla.Stat. (2001) by reason of the fact that Respondent failed to maintain a record of all adverse incidents (as defined by Florida Statute §400.423(2)) which occurred within the last two (2) years. 25. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class IIf violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 26. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 27. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00. c) Impose and assess survey fee of $500.00 in addition to 10 — the assessed fine. d) Any other general and equitable relief as deemed appropriate. counr_IVv RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO SUBMIT PRELIMINARY REPORTS OF ADVERSE INCIDENTS TO AHCA WITHIN ONE BUSINESS DAY OF THE OCCURRENCE. Section 400.423(3); and Section 400.419 Fla.Stat. (2001) 28. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 29. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on facility record review and staff interview the facility failed to submit to the Agency (AHCA) two reports of adverse incidents for 2 residents, (#1,3) within one business day after the occurrences. Findings: 1. Record review for resident #1 revealed a nursing note dated 7/23/01 stating the resident had been found on the floor in the secured unit. The record noted that a nursing assistant reported that the resident was pushed by another resident. The resident was transferred to the emergency room where it was determined the resident had received a left hip fracture. Review of the facility records failed to produce documentation that the facility had submitted preliminary reports of this adverse incident. 2. Record review for resident #5 revealed a nursing note stating the resident had been admitted to the facility on 1/14/02 at 11:00 am. At 7:05 pm on 1/14/02, the resident fell in the secured unit, and was transferred to the emergency room where it was determined the resident had received a left hip fracture. Review of facility records failed to provide documentation that the facility had submitted preliminary reports of this adverse incident. 3. Interview with the facility administrator on 1/24/02 at 3:15 pm revealed no documentation that preliminary reports of the adverse incidents had been submitted to AHCA, as required. 11 Class If Correction Date: 2/23/02 30. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on interview of staff and record review the facility failed to submit to the Agency for Health Care Administration (AHCA) reports of all adverse incidents within one day after the occurrence. Findings: Review of resident #1's clinical record on 3/14/02, revealed documentation the resident was found on 2/12/02 with some swelling to the top of his/her arm and shoulder area. A mobile X-ray was performed at the facility at 2:05 pm revealed a right shoulder fracture of the humeral neck, non-displaced. Review of the facility adverse incident reports revealed no documentation of a one day report being submitted to AHCA regarding this incident. Interview with the facility administrator on 3/14/02 at 11:45am provided no additional information related to a one day adverse incident report having been submitted as required. The reports provided to the surveyors were represented as complete. Class IIT Correction Date 4/14/02 31. Based on the foregoing, Respondent has violated Section 400.423 Fla.Stat.(2001) by reason of the fact that Respondent failed to submit to the Agency a preliminary report of any and all “adverse incidents” (as defined in Florida Statute §$400.423(2)) within one (1) business day after the occurrence. 32. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, 12 . Nowe \— other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 33. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 34. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b).Impose a fine in the amount of $500.00 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. 13 counr_v RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO PROPERLY ADDRESS ALL HEALTH-RELATED CONCERNS ON RESIDENT HEALTH ASSESSMENTS; CHAPTER 58A-5.0181 FLORIDA ADMINISTRATIVE CODE. (2001); and Section 400.419 Fla.Stat. (2001) 35. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 36. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review, 4 of 4 resident health assessments (#1,2,3,4) failed to address all health-related concerns, as required. Findings: Review of the health assessments for residents #1,2,3 and 4 revealed the resident diagnoses were listed, but no information was provided on the form regarding: a. Physical or sensory limitations b. Cognitive or behavioral status c. Nursing/treatment/therapy service requirements d. Special precautions Information regarding the above health-related concems is required. Class III Correction Date: 2/23/02 37. On or about March 14, 2002, AHCA performed a follow-up survey at ‘Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review, 4 of 4 resident health assessments (#1 ,2,3,4) completed since the date of the last survey, failed to address all health-related concerns, as required. Findings: 14 oe —_ Review of the health assessment for resident #1 revealed no information was provided on the form regarding: a. Cognitive or behavioral status d. Special precautions Review of the health assessments for residents #2 (dated 2/16/02) and resident #3 (dated 2/16/02) revealed the resident diagnoses were listed, but no information was provided on the form regarding: a. Physical or sensory limitations b. Cognitive or behavioral status c. Nursing/treatment/therapy service requirements d. Special precautions Review of the health assessment for resident #4 (dated 1/18/02) revealed no information was provided on the form regarding: a. Special Precautions b. Cognitive or behavioral status c. Medications Information regarding the above health-related concems is required. Class III Correction Date 4/14/02 38. Based on the foregoing, Respondent has violated Chapter 58A-5.0181 by reason of the fact that Respondent failed to properly address all resident health-related concerns on resident health assessments. 39. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is 15 uw all required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class IIT violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 40. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 41. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 c) Impose and assess survey fee of $500.00 in addition to the assessed fine. da) Any other general and equitable relief as deemed .appropriate. COUNT VI RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT’S ADMINISTRATOR FAILED TO OBTAIN ANY INFORMATION NOT CONTAINED IN THE MEDICAL EXAMINATION REPORT CONDUCTED PRIOR TO THE INDIVIDUAL’S ADMISSION TO THE FACILITY, 16 all " WITHIN THIRTY DAYS AFTER ADMISSION. Chapter 58A-5.0181; and Section 400.419 Fla.Stat. (2001) 42. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 43. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on staff interview and record review, the administrator failed to obtain information that was not present on 4 of 4 health assessments reviewed ,(#1,2,3,4), as required. Findings: Record review of resident health assessments for resident #1,2,3 and 4 revealed the resident diagnoses were listed, but no information was provided on the form regarding: a. Physical or sensory limitations b. Cognitive or behavioral status c. Nursing/treatment/therapy service requirements d. Special precautions Interview with the administrator on 1/24/02 at 4:25 pm regarding the missing information revealed that the administrator did not attempt to obtain the information from the physician. He stated, "I can't help what the doctor fills in on the form”. Class TI Correction Date: 2/23/02 44. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on staff interview and record review, the administrator failed to obtain information that was not present on 4 of 4 health assessments completed since date of last survey, for residents #1,2,3,and 4, as required. Findings: Record review of resident health assessments for resident #1; #2 (dated 2/16/02); #3 (dated 2/16/02) and #4 (dated 1/18/02), revealed the resident diagnoses were listed, but information was missing in one or more of the following areas regarding: a. Physical or sensory limitations 17 wot b. Cognitive or behavioral status c. Nursing/treatment/therapy service requirements d. Special precautions Interview with the administrator on 3/14/02 at 3:30 pm regarding the missing information revealed he was not aware the physician was not completing the health assessments in entirety. Class III Correction Date 4/14/02 45. Based on the foregoing, Respondent has violated Chapter 58A-5.0181 Florida Administrative Code (2001) by reason of the fact that Respondent’s administrator failed to obtain any information not contained in the medical examination report conducted prior to the individual’s admission to the facility, within 30 days after admission. 46. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is 18 nal — authorized to impose a fine against Respondent in the amount of $500. 47. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 48. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. COUNT VII RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT'S ADMINISTRATOR FAILED TO PARTICIPATE IN TWELVE (12) HOURS OF CONTINUING EDUCATION IN TOPICS RELATED TO ASSISTED DURING THE PAST TWO YEARS. Section 400.452; CHAPTER 58A-5.0191 FLORIDA ADMINISTRATIVE CODE (2001); and Section 400.419 Fla.Stat. (2001) 49. AHCA re-alleges and incorporates by reference 19 oll — paragraphs one (1) through six (6) above as if fully set forth herein. 50. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on interview and review of facility records, the administrator failed to participate in twelve hours of continuing education related to assisted living for the past two years, as required. Findings: Review of facility records and interview on 1/24/02 at 3:15 pm with the administrator revealed no documentation of the administrator participating in any continuing education in topics related to assisted living. Class II Correction Date: 2/23/02 51. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on interview and review of facility presented in-service records, the administrator failed to participate in twelve hours of continuing education related to assisted living for the past two years, as required. Findings: Interview with the facility administrator on 3/14/02 at 10:00 am revealed the administrator had completed 4 hours of assisted living continuing education, not the 12 hours,as required. Class II Correction Date 4/14/02 52. Based on the foregoing, Respondent has violated Section 400.452 Fla.Stat.(2001); and Chapter 58A-5.0191 Florida Administrative Code (2001) by reason of the fact that Respondent’s administrator failed to participate in twelve (12) 20 hours of continuing education related to assisted living over the last two years. 53. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 54. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 55. “Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. 21 al ao" CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 c) Impose and assess survey fee of $500.00 in addition to the assessed fine. da) Any other general and equitable relief as deemed appropriate. COUNT VIII RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT’S DIRECT CARE STAFF (OTHER THAN NURSES, CNA’S, AND HOME HEALTH AIDES) FAILED TO RECEIVE THREE (3) HOURS OF IN-SERVICE TRAINING WITHIN THIRTY (30) DAYS OF EMPLOYMENT. CHAPTER 58A-5.0191 FLORIDA ADMINISTRATIVE CODE (2001); and Section 400.419 Fla.Stat. (2001) 56. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 57. On or about January 23-24, 2002, AHCA performed a Survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: | Based on in-service/personnel record review, the facility failed to provide documentation of a 3 hour training in the areas of resident behavior needs and assisting with activities of daily living, as required for 2 of 2 aides reviewed, employed over 30 days. . . - ita Findings: The facility failed to provide documentation of a 3 hour training in the areas of resident behavior needs and assisting with activities of daily living for 2 of 2 aides employed over 30 days,as required. The following employee in-service/personnel files were reviewed: a. Employee T.B. (aide) hire date 3/05/01 b. Employee K.M. (aide) hire date 12/13/01 22 ~~ — Class III Correction Date: 2/23/02 58. On or about March 14 , 2002, AHCA performed a follow-up Survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on in-service/personnel record teview, the facility failed to provide documentation of a 3 hour training in the areas of resident behavior needs and assisting with activities of daily living, as required for 2 of 2 aides reviewed, employed over 30 days. Findings: The facility failed to provide documentation of a3 hour training in the areas of resident behavior needs and assisting with activities of daily living for 2 of 2 aides employed over 30 days,as required. The following employee in-service/personnel files were reviewed: a. Employee T.B. (aide) hire date 3/05/01 b. Employee K.M. (aide) hire date 12/13/01 Interview with the administrator on 3/14/02 at 3:00 pm revealed no documentation could be produced regarding this three hour training, as required. Class II Correction Date 4/14/02 59. Based on the foregoing, Respondent has violated Chapter 58A-5.0191 Florida Administrative Code (2001) by reason of the fact that Respondent’s direct care staff (other than nurses, C.N.A.‘’s, and home health aides) did not receive three (3) hours of in-service training within thirty (30) days of employment . 60. The foregoing violation constitutes a Class III violation, Class "III" violations are those conditions or occurrences related to the operation and maintenance ofa facility or to the personal care of residents which the agency determines” indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, 23 neal ed other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 61. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 62. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b)-Impose a fine in the amount of $500.00 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. 24 COUNT IX RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO COMPLY WITH THE RESIDENT BILL OF RIGHTS BY NOT ALLOWING RESIDENTS TO BE FREE FROM RESTRAINTS. Section 400.428 Fla. Stat. (2001); and Section 400.419 Fla.Stat. (2001) 63. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as iff fully set forth herein. 64. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observation, resident interview and record review, the facility failed to comply with the Resident Bill of Rights by not allowing the residents to be free from restraints,(#1,5,6), free egress to ones own room, and not treating the residents with dignity, (resident #2 plus 3 random observations). Findings: 1. Observation in the secured unit on 1/23/02 at 12:00 pm and 1/24/02 at 8:45 am and 12:15 pm revealed resident #1 restrained to his/her dining room chair. Interview with the administrator revealed this resident to be a behavior problem, and would get up and down continually during the meals, and could fall. Observation on 1/24/02 at 8:45 am also revealed resident #5 and #6 were tied to their dining room chairs during breakfast. Resident #5 was described as a fall risk, and resident #6 was also described as a resident who would get up from the table and not finish her meal. All three restrained residents sat quietly during the morning meal, and did not attempt to leave the table. Residents were not allowed to be free from restraint. 2. Initial tour of the facility on 1/23/02 at 10:15 am revealed all resident rooms are locked, Interview with the administrator revealed the resident rooms remain locked to prevent residents from wandering in and disturbing other resident's personal items. Random observations with confidential interviews on 1/24/02 at 11:25 am, tt:50 am and 1:50 pm in the front/open unit revealed two separate residents who were not able to enter their own rooms. Assistance was requested in all three instances, without response from facility staff. No documentation was presented regarding the facility practice of locking resident doors. Failure to provide residents the right to free access to their own room prohibits the right to privacy. 3.Observations in the facility 1/24/02 revealed four examples of residents not being 25 siete tad and Ne? treated in a dignified manner. a. At 9:25 am in the dining room of the front/open unit, resident #2 was prevented from being assisted to the bathroom until he/she finished the last one ounce of the liquid chocolate drink. Review of this resident's health assessment lists him/her as being independent in ambulation and transferring, but requires supervision in toileting. The administrator was alerted that the resident required assistance, he did not assist, but instead told the resident to "finish your drink", and stated the resident had a "behavior problem". He then stated that it is "not an urgent need right now, it can wait awhile”, and left the resident sitting alone in the dining room, as other residents were assisted out. Review of the resident's record revealed no information regarding a behavior problem. Requiring the resident to sit and wait, and not provide the resident with the requested assistance does not treat the resident with consideration and respect of their personal dignity. b. Two separate, independent random observations on 1/24/02 revealed two residents being transported within the facility in an undignified manner. 1. At 10:45 am a female resident was being pushed through the common area of the front open unit. The aide pushing the resident had pulled the front two wheels of the chair up off the floor and leaned the chair and resident back onto the two back wheels. The resident's feet hung in between the two foot rest pedals, which had been folded up, preventing the resident from placing her feet on the foot rests. The resident was positioned in a 35-45 degree angle so that the resident could not view where she was going or what was in front of her. The aide continued through the front area of the facility down the first hall, turned right and stopped at the entrance of the secured unit to enter the code to open the door. Interview with the aide at this time revealed she transported the resident in this manner because "it is quicker”. 2. At approximately 6:00 pm a male resident was being pushed through the dining room, in between tables by a second, different aide. The wheelchair was leaning back with the resident positioned in a 35-45 degree angle. The front two wheels were off the floor and the chair was leaned, back onto the back two wheels. The resident could not view where he was going or what was directly in front of him. - - Transporting residents in this manner does not treat the residents with consideration and respect of their personal dignity. c. Observation on 1/24/02 at 8:45 am in the secured unit revealed a staff person standing feeding a male resident. The resident's food was placed out of reach. The resident was able to use his arms and hands, but the resident was instructed to wait for each bite until he crossed his hands on the table in front of him. The aide would say, "hands in front, hands in front". The administrator instructed the aide to assist the resident in crossing his hands in front of him and wait to see if they remain in place, and then feed him. Inquiry with the administrator into this method of feeding this resident revealed that the resident was "getting his food all over, would put his hands in the food and pour his drink in it, so now he has to be 26 ad ~ fed". The administrator stated they are working with him to control this grabbing behavior and if he reaches over to grab the food, he should be assisted to put his hands in front of himself. Failure to allow a resident the right to feed himself and withholding foods in a behavior management program is not allowing the resident to be treated with consideration and respect of their personal dignity. Class III Correction Date: 2/23/02 65. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on random observations, the facility failed to comply with the Resident Bill of Rights by not allowing the residents to be free from restraints. Findings: Observation in the secured unit on 3/14/02 at 9:30 am revealed 5 residents restrained to his/her dining room chairs and 1 resident restrained to his/her gerichair, Observation on 3/14/02 at 12:30 pm revealed 6 residents restrained to their dining room chairs. Residents have a right to be free from restraint. Class Ill - Correction Date 4/14/02 66. Based on the foregoing, Respondent has violated Section 400.428 Fla.Stat.(2001) by reason of the fact that Respondent failed to comply with the Resident Bill of Rights by not allowing residents to be free from restraints. 67. The foregoing violation constitutes a Class IIT violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) {ce}, Florida 27 ‘ww ~~ Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 68. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 69. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. ) COUNT X RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE 28 — ww CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO HAVE A WRITTEN POLICY OR PROCEDURE ADDRESSING RESIDENT GRIEVANCES OR COMPLAINTS. CHAPTER 58A-5.0182 FLORIDA ADMINISTRATIVE CODE (2001); and Section 400.419 Fla.Stat. (2001) 70. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 71. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observation, record review, resident and staff interview, the facility failed provide the residents with a grievance procedure to voice concems and complaints, as required. Findings: Record review of the facility's admission packet and resident contract failed to produce any form of a grievance procedure for the resident's, family and/or visitors to lodge a complaint. Interview with the facility administrator on 1/24/02 at 2:30 pm revealed the facility does not have a written policy or procedure addressing grievances or complaints. The usual procedure is for the residents or their nurse or aide to relay any concerns to the administrator. Random observation on 1/24/02 at 3:30 pm revealed a resident voicing a concern over some missing clothing. She said she had told the people at the front office, but felt that the "book people are in on it". The resident went on to say that, "Things are missing, I think there were more valuable things in there (closet), but now they are gone.” The resident was visible upset and stated, "My memory is not gone". The resident expressed concern that nothing would be done. Class Ik Correction Date: 2/23/02 72. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: 29 eal ‘ww Based on observation, record review, resident and staff interview, the facility failed provide the residents with a grievance procedure to voice concerns and complaints, as required. Findings: Record review of the facility's admission packet and resident contract failed to produce any form of a grievance procedure for the resident's, family and/or visitors to lodge a complaint. Interview with the facility administrator on 3/14/02 at 3:00 pm revealed the facility does not have a written policy or procedure addressing grievances or complaints. The usual procedure is for the residents or their nurse or aide to relay any concerns to the administrator. Class TI Correction Date 4/14/02 73. Based on the foregoing, Respondent has violated Chapter 58A-5.0182 by reason of the fact that Respondent failed to have, and provide to residents, a written policy or procedure addressing resident grievances or complaints. 74. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant .to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class IIT 30 ead — violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 75. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 76. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b a Impose a fine in the amount of $500.00 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. COUNT XI RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT UTILIZES RESTRAINTS ON RESIDENTS BEYOND THE LIMITS ALLOWED BY THE STATE OF FLORIDA. CHAPTER 58A- 5.0182 FLORIDA ADMINISTRATIVE CODE (2001); and Section 400.419 Fla.Stat. (2001) 77. AHCA re-alleges and incorporates by reference 31 — —_ paragraphs one (1) through six (6) above as if fully set forth herein. 78. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observation, record review, and staff interview the facility used physical restraints, on three facility residents, (#1,5,6) beyond the limits allowed by the State of Florida. Findings: 1. Observation of resident #1 on 1/23/02 at 12:00 pm, revealed the resident was sitting in a chair in the dining room of the secured unit with a gait belt around his/her waist. The gait belt was secured around the chair and fastened with a plastic clip at the back of the chair, out of reach of the resident. Resident #1 was observed again on 1/24/02 at 8:45AM and 12:15 pm restrained to chair in the same manner. Observation of the secured unit dining room on 1/24/02 at 8:45 am (breakfast) revealed residents #5 and #6 sitting in chairs with gait belts attached around their waists and fastened behind the chair out of their reach. 2. Review of resident #1's medical records revealed a signed form stating that the resident was to be "secured" for safety purposes. 3. Interview with the facility administrator on 1/23/02 at 12:00 pm and 1/24/02 at 8:45 am revealed facility staff had been instructed to "secure" residents #1, #5, and #6 when they are out of bed in chairs, for safety purposes. Class HI Correction Date: 2/23/02 79. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on random observations, the facility restrained 6 residents beyond the limits allowed by the State of Florida. Findings: Observation in the secured unit on 3/14/02 at 9:30 am revealed 5 residents restrained to his/her dining chairs and 1 residents restrained to his/her gerichair. Observation on 3/14/02 at 12:30 pm revealed 6 residents restrained to their dining room chairs, which is beyond allowed limits by the State of Florida. 32 Class III Correction Date 4/14/02 80. Based on the foregoing, Respondent has violated Chapter 58A-5.0182 Florida Administrative Code (2001) by reason of the fact that Respondent improperly restrained residents beyond the limits allowed by the State of Florida. 81. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 82. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 33 Saal — 83. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. COUNT XII RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO ENSURE THAT FACILITY STAFF WHO HAVE REGULAR CONTACT WITH OR PROVIDE DIRECT CARE TO RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DISORDERS, OBTAINED FOUR (4) HOURS OF INITIAL TRAINING WITHIN THREE (3) MONTHS OF EMPLOYMENT. CHAPTER 58A-5.0191 FLORIDA ADMINISTRATIVE CODE (2001); CHAPTER 58A-5.024 FLORIDA ADMINISTRATIVE CODE (2001); Section 400.4178 Fla.Stat (2001); and Section 400.419 Fla.Stat. (2001) 84. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 85. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: 34 — — Based on review of 5 employee in-service personnel files, for employees who have been employed for over three months, 5 failed to have received the initial 4 hour training in Alzheimer's disease, as required. Findings: Review of employee in-service personnel files for employees who have been employed at the facility for over three months, 5 of 5 employees failed to have had the initial 4 hour training in Alzheimer’s disease, as required. The employees are as follows: a. Employee T.B. hire date 3/5/01 b. Employee D.C. hire date 5/28/01 c. Employee L.D. hire date 9/23/01 d. Employee P.W. hire date 5/15/01 e. Employee H.H. hire date 3/27/00 Class I Correction Date: 2/23/02 86. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on review of 5 employee in-service personnel files, for employees who have been employed for over three months, 5 failed to have received the initial 4 hour training in Alzheimer's disease, as required. Findings: Review of employee in-service personnel files for employees who have been employed at the facility for over three months, 5 of 5 employees failed to have had the initial 4 hour training in Alzheimer's disease, as required. The employees are as follows: a. Employee T.B. hire date 3/5/01 b. Employee D.C. hire date 5/28/01 c. Employee L.D. hire date 9/23/01 d. Employee P.W. hire date 5/15/01 e. Employee H.H. hire date 3/27/00 Interview with the administrator on 3/14/02 at 3:00 pm revealed no training had been completed in the area of Alzhemier’s disease education since the date of the last survey. Class III Correction Date 4/14/02 87. Based on the foregoing, Respondent has violated Chapter 58A-5.0191 Florida Administrative Code (2001), Chapter 58A-5.024 Florida Administrative Code (2001), and Section 35 all — 400.4178 Fla. Stat. (2001) by reason of the fact that Respondent’s staff, who have regular contact with or provide direct care to resident’s with Alzheimer’s disease and related disorders, did not receive four (4) hours of initial training within three (3) months of employment. 88. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 89. ‘The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 90. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a 36 atl — survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. COUNT XIII RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO ENSURE THAT FACILITY STAFF WHO PROVIDE DIRECT CARE TO RESIDENTS WITH ALZHEIMER’ S DISEASE AND RELATED DISORDERS, OBTAIN AN ADDITIONAL FOUR (4) HOURS OF TRAINING WITHIN NINE MONTHS OF EMPLOYMENT. CHAPTER 58A-5.0191 FLORIDA ADMINISTRATIVE CODE (2001); CHAPTER 58A-5.024 FLORIDA ADMINISTRATIVE CODE (2001); Section 400.4178 Fla.Stat (2001); and Section 400.419 Fla.Stat. (2001) 91. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 92. -On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on employee in-service/personnel record review, 1 of 1 employee who has been employed for over 9 months has not obtained the additional 4 hours of training in Alzheimer's disease, as required. 37 Findings: - Review of the employee in-service/personnel file for Employee T.B. revealed the hire of 3/5/01. This person works as an aide part time, and gives direct care. No documentation was provided regarding the 4 additional hours of training in Alzheimer’s disease that is required. Class IIL Correction Date: 2/23/01 93. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on employee in-service/personnel record review, 1 of 1 employee who has been employed for over 9 months has not obtained the additional 4 hours of training in Alzheimer's disease, as required. Findings: Review of the employee in-service/personnel file for Employee T.B. revealed the hire of 3/5/01. This person works as an aide part time, and gives direct care. No documentation was provided regarding the 4 additional hours of training in Alzheimer's disease that is required. Interview with the administrator on 3/14/02 at 3:00 pm revealed no additional hours of training had been completed by this employee since the date of the last survey. Class III Correction Date 4/14/02 94. Based on the foregoing, Respondent has violated Chapter 58A-5.0191 Florida Administrative Code (2001); Chapter S8A-5.024 Florida Administrative Code (2001); and Section 400.4178 Fla.Stat (2001) by reason of the fact that Respondent’s staff, who provide direct care to residents with Alzheimer’s disease and other related disorders, failed to obtain an additional four(4) hours of training within nine (9) months of employment . 38 Neo — 95. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 96. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 97. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: 39 ial New a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. COUNT XIV RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT’S ECC ADMINISTRATOR FAILED TO COMPLETE THE MINIMUM SIX (6) HOURS OF CONTINUING EDUCATION IN REQUIRED SUBJECTS RELATED TO ECC. Section 400.4275 Fla.Stat (2001); Chapter 58A-5.0191 Florida Administrative Code (2004; Chapter 58A-5.024 Florida Administrative Code (2001); and Section 400.419 Fla.Stat. (2001) 98. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 99, On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on facility record review and interview with the facility administrator, 6 hours of continuing education had not been completed over the past two years in the designated subjects,as required. Findings: Review of facility records revealed the facility administrator was designated as the ECC supervisor. Interview with the administrator on 1/24/02 at 3:15 pm revealed the administrator did not complete continuing education in the designated areas, as required. Class Tl Correction Date: 2/23/02 100. On or about March 14, 2002, AHCA performed a follow-up 40 — —_ survey at Respondent’s Eacility. AHCA cited Respondent based upon the findings below: Based on facility record review and interview with the facility administrator, 6 hours of continuing education had not been completed over the past two years in the designated subjects,as required. Findings: Review of facility records revealed the facility administrator was designated as the ECC supervisor. Interview with the administrator on 3/14/02 at 3:00 pm revealed the administrator did not complete continuing education in the designated areas, as required. Class II Correction Date 4/14/02 101. Based on the foregoing, Respondent has violated Chapter 58A-5.0191 Florida Administrative Code (2001); Chapter 58A-5.024 Florida Administrative Code (2001); and Section 400.4275 Fla.Stat (2001) by reason of the fact ‘that Respondent’s administrator, who was designated as the ECC supervisor, failed to complete continuing education in the designated areas, as required. 102. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of voeoidents which the agéncy determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class [II violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is 41 ail ~— required to be corrected. After the time for correction iias expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $500. 103. The facility was given a mandated correction date (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 104. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $500.00 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. COUNT XV RESPONDENT FAILED TO MEET MINIMUM LICENSURE STANDARDS AS EVIDENCED BY THE FACT RESPONDENT WAS CITED AS HAVING TWENTY-TWO (22) CLASS III. DEFICIENCIES DURING THE JANUARY 24, 2002 LICENSURE RENEWAL SURVEY, OF WHICH FOURTEEN (14) OF THESE DEFICIENCIES WERE NOT CORRECTED PRIOR TO THE AGENCY’S FOLLOW-UP SURVEY ON MARCH 14, 2002. IN ADDITION, ONE (1) NEW CLASS III 42 DEFICIENCY WAS FOUND DURING THE FOLLOW-UP SURVEY. Section 400.414 FLA.STAT. (2001) 105. AHCA re-alleges and incorporates by reference paragraphs one (1) through one hundred four (104) above as if fully set forth herein. 106. On or about January 23-24, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent for twenty-two (22) class III deficiencies during this survey. 107. The facility was given a mandated correction date (Class III offenses) in accordance with Section 400.419(1) (c), Florida Statutes of February 23, 2002. 108. On or about March 14, 2002, AHCA performed a follow-up survey at Respondent’s facility. AHCA cited Respondent for fifteen (15) Class III deficiencies during the follow-up survey. Of the fifteen (15) deficiencies cited, fourteen (14) of these were uncorrected deficiencies from the January 23-24, 2002 survey. 109. Based upon the foregoing, Respondent has failed to meet minimum license standards, which failure is grounds for the denial of a renewal of Respondent’s licensed pursuant to the language of Section 400.414 Fla.Stat. (2001) (Please see AHCA’s Notice of Intent to Deny Renewal dated April 30, 2002 and attached as “Exhibit A” to the Administrative Complaint). CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Deny renewal of Respondent’s facility license. 43 A an nuessen eames all ewe” c) Any other general and equitable relief as deemed appropriate. Dated: June 27, 2002 Agency for Health Care Administration SS Page, foe , Senior Attorney Fla. Bar. No. 0174629 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax) 44 NOTICE Respondent, RIVER OAKS A.L.F. LC, d/b/a RIVER OAKS ASSISTED LIVING hereby is notified that Respondent 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 Blection of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Jodi C. Page, 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. Dated: June 27, 2002 ALTH CARE ADMINISTRATION a, Senior Attorney Fla. Bar. No. 0174629 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-6362 (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 8699) to RIVER OAKS A.L.F., LC, 10845 W. Gem Street, Crystal River, Florida, 34428 this 27th day of June, 2002. AGENCY FOR HEALTH CARE ADMINISTRATION Senior Attorney Fla. Bar. No. 0174629 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5865 (office) (850) 921-0158 (fax) 46 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES (To be used in conjunction with Election of Rights form — attached) In response to the allegations set forth in the Administrative Complaint issued by AHCA for Health Care Administration (“AHCA” or “Agency”), you must make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint. Please make your election on the attached Election of Rights form and return it fully executed to the address listed on the form. OPTION 1. If you do not dispute the allegations in the Administrative Complaint and waive your right to be heard, you should select OPTION 1 on the election of rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Administrative Complaint. You will be provided a copy of the final order. OPTION 2. If you do not dispute any material fact alleged in the Administrative Complaint (you admit each of them), you may request an informal hearing pursuant to Section 120.57(2), Florida Statutes (2001) before AHCA. At the informal hearing, you will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, you should select OPTION 2 on the Election of Rights form. OPTION 3. If you dispute the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing ‘pursuant to Section 120.57(1), Florida Statutes (2001). To obtain a formal hearing, select OPTION 3 on the Election of Rights form. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. IN ORDER TO PRESERVE YOUR RIGHT TO A HEARING, YOUR ELECTION OF RIGHTS IN THIS MATTER MUST BE DIRECTED TO AHCA BY FILING WITHIN TWENTY - ONE (21) DAYS FROM THE DATE You RECEIVE THE ADMINISTRATIVE COMPLAINT. IF YOU DO NOT RESPOND AT ALL WITHIN TWENTY-ONE (21) DAYS’ FROM RECEIPT OF THE ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ISSUED FINDING YOU GUILTY oF THE VIOLATIONS CHARGED AND IMPOSING THE PENALTY SOUGHT IN THE ADMINISTRATIVE COMPLAINT. 47 LP, tee am AAG i j STATE OF FLORIOA 9 ~ om er to aw . ag { A ty cen MANAGED CARE & HEALTH QUALITY miseeruvere Frvhetiss | erin este pee ES ST AGENCY FOR HEALTH CARE ADMMISTRATION CASE 200209454) AGENCY FOR HEALTH CARE ADMINISTRATION co BO ian JEB BUSH, GOVERNOR « RHONDA M. MEDOWS, MO, F; . SECRETARY CERTIFIED MAIL RETURN Certified Article Number RECEIPT REQUESTED 7Ue0 3901 9844 8373 4519 April 30, 2002 SENDERS RECORD . . Daniel Ward, Administrator River Oaks Assisted Living tic 5447 10845 W. Gem Street Crystal River, FL 34428 RE: License renewal for: River Oaks Assisted Living 10845 W. Gem Street Crystal River, FL 34428 NOTICE OF INTENT TO DENY itis the decision of this Agency that River Oaks Assisted Living renewal application for an assisted living facility license be DENIED. The Specific Basis for this determination is: * The applicant's failure to meet minimum licensure standards. During the license renewal survey conducted on January 24, 2002, twenty-two (22) Class.Il deficiencies were cited in the required compliance areas of Facility Records Standards, Resident Records Standards, Admissions Criteria Standards, Staffing Standards, Resident Care Standards, Staff Records Standards, and Staffing Requirements. During the follow-up survey conducted on March 14, 2002, fourteen (14) Class Ill deficiencies cited during the January, 24, 2002 survey were found to be uncorrected in the required compliance areas of Facility Records Standards, Admissions Criteria Standards, Staffing Standards, Resident Care Standards, Staff . Records Standards, and Staffing Requirements. in addition, one (1) new Class Ill deficiency in Medication Standards was cited. Failure to meet minimum license standards is grounds for denial, pursuant to Section 400.414 (1}{e), Florida Statutes (FS.). Visit AHCA online at 2727 Mahan Drive © Mai! Stop # 30 www fdhe. state fl.us Tallahassec, FL 32308

Docket for Case No: 02-003018