Division of Administrative Hearings STATE OF FLORIDA F | [ E D AGENCY FOR HEALTH CARE ADMINISTRATION a STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA CASE NO.: 2002046729 vs. NORTH HILL MANOR INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by through the undersigned counsel, and files this Administrative Complaint against NORTH HILL MANOR INC. (“North Hill Manor Inc.”), pursuant to Section 120.569, and 120.57, Florida Statutes, (2002), alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Summer Set ACLF, pursuant to Sections 400.419(1)(b), Fla. Stat. (2002), and Section 58A-5.019(4)(b), Fla. Admin. Code, (2002). JURISDICTION AND VENUE 2. This agency has jurisdiction pursuant to 400, Part III and Sections 120.569 and 120.57, Florida Statutes, (2002). 3. Venue lies in Escambia County, Pensacola, Florida, pursuant to Section 120.57, Florida Statutes, (2002); and 58A-5, Florida Administrative Code (2002), 28.106.207, Florida Administrative Code (2001). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes, (2002), and Chapter 58A-5 Florida Administrative Code (2002). 5. North Hill Manor Inc. is a for-profit corporation, whose 32-bed assisted living facility is located at 1120 North Palafox Street, Pensacola, Florida. North Hill Manor Inc. is licensed as an assisted living facility license #AL8639; certificate number 11573, effective November 21, 2001 through February 19, 2002. North Hill Manor was at all times material hereto, a licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT I NORTH HILL MANOR INC. FAILED TO HAVE SUFFICIENT QUALIFIED STAFF TO SUPERVISE THE RESIDENT MAY RESULT IN THE ABUSE AND INJURY TO THE RESIDENTS STATE TAG A523-STAFFING STANDARDS Section 400.419(1)(b), Fla. Stat. (2002) VIOLATIONS; ADMINISTRATIVE FINES Section 58A-5.019(4)(b), Florida Administrative Code (2002) STAFFING STANDARDS 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about August 8, 2002, complaint investigation at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) North Hill Manor, Inc. failed to have sufficient qualified staff to supervise four residents requiring assistance with ambulation were residing on the second floor. Review of the facility schedule for a two-week period beginning July 26 through August 8, 2002 revealed an eleven-hour period each day Monday through Friday and a twelve-hour period on Saturday and Sunday in which only one employee was on duty in the building. Sufficient staffing is not maintained on a twenty-four hour basis to assist all residents with potentially unscheduled services needs in the event the building required immediate evacuation. 8. The above constitutes a violation of Section 58A-5.019(4)(b), Fla. Admin. Code (2002), which requires that notwithstanding the minimum staffing requirements specified in paragraph (a) all facilities, including those composed of apartments, shall have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents scheduled and unscheduled service needs, resident contracts, and resident care standards as described in Rule 58A-5.0182, Fla. Admin. Code (2002). 9. The violation alleged herein constitutes an uncorrected class IL deficiency, and warrants a fine of $1,000.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $1,000.00. The above constitutes a violation of Section 400.419(1)(b), Fla. Stat. (2002), provides that 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 directly threaten the physical or emotional health, safety, or security of facility residents, other than class I violations. A class II violation is subject to an administrative fine not less than $1,000.00 and not exceeding $5,000 for each violation. A citation for a class II violation must specify the time within which the violation is required to be corrected. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2002). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation 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, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael O. Mathis, Senior Attorney. RESPONDENT IS FURTHER NOTIFED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL REASULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Florida. Michael O. Mathis Fla. Bar. No. 0325570 Counsel of Petitioner, Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 413-9313 (fax) Donah Heiberg Lealand McCharen Agency for Health Care Administration CERTIFICATE OF SERVICE T HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on ay of Ley lentber 2002 to Douglas Koontz, Administrator, North Hill Manor, 1120 North Palafox, Pensacola, Florida 32501. (Over Vani Michael O. Mathis, Esq.

Docket for Case No: 02-004245