STATE OF FLORIDA We AGENCY FOR HEALTH CARE ADMINISTRATION + Pu They, AGENCY FOR HEALTH CARE ¥ "e ADMINISTRATION, OD U4 Petitioner, AHCA No.: 2002045914 AHCA No.: 2002045915 Return Receipt Requested: 7000 1670 0011 4847 2314 GRAMERCY OPERATING COMPANY, INC. 7000 1670 0011 4847 2321 d/b/a GRAMERCY PARK NURSING CENTER, 7000 1670 0011 4847 2338 a v. Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Gramercy Operating Company, Ine. d/b/a Gramercy Park Nursing Center, (hereinafter “Gramercy Park Nursing Center”), pursuant to Chapter 400, Part II, Florida Statutes (“Fla. Stat.”) and Chapter 59A~4, Florida Administrative Céde (“Fla. Admin. Code”) and alleges: NATURE OF THE ACTION 1l. This is an action to impose an administrative fine of $2,500.00 pursuant to § 400.23(6), Fla. Stat. (2001), and an action cf Notice of Intent to Assign Well) cOGe co) AON cd PPS6 ON £ Conditional Licensure Status to Gramercy Park Nursing Center pursuant to § 400.23(7), Fla. Stat. (2001), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE Z. AHCA has jurisdiction pursuant to Chapter 400, Part TI, Fla. Stat., (2001). 3. Venue lies in Miami-Dade County, pursuant to § 400.121 (1) (2), Fla. Stat. And Rule 28.106.207, Fla. Admin. Code, PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement cof all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Fla. Stat. (2001), and Chapter 593-4 fla. Admin. By Gramercy Park Nursing Center operates a 180-bed skilled nursing facility located at 17475 S$. Dixie Highway, Miami, Florida 33157. Gramercy Park Nursing Center is licensed as a skilled nursing facility under license number SNFI180096. Gramercy Park Nursing Center was at all times material hereto a licensed facility under the licensing ‘d 796° ON Repl. 200e “AON 7 authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I GRAMERCY PARK NURSING CENTER FAILED TO SELF-IMPOSE A MORATORIUM ON NEW ADMISSIONS WHEN THEY FELL BELOW THE MINIMUM STANDARDS FOR LICENSED NURSING FOR TWO (2) CONSECUTIVE DAYS. TITLE 42 § 483.25, CODE OF FEDERAL REGULATIONS RULE 59A-4,.1288, FLA. ADMIN. CODE SECTION 400.141(15)(D), FLORIDA STATUTES SECTION 400.23, FLORIDA STATUTES (MORATORIUM FOR STAFF SHORTAGES) CLASS II 6. AHCA re~alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7, Gramercy Park Nursing Center was cited with one (1) Class II deficiency based on the annual Survey of April 25, 2002. 8. Because Gramercy Park Nursing Center participates in Tatle XVIII or XIX it must follow certification rules and regulations found in 42 Code of Federal Regulation 463. 9. Based on interview conducted on April 25, 7002 and review of the facility's census, facility and agency time sheets and nursing calculations, the nursing home failed to self-impose a moratorium on new admissions when they fell below the minimum standards for licensed hurses for 2 consecutive days. Findings include the following. w ‘d TRGG ON Wels t) 20d: “| “AO 10. Based on the state minimum requirements for licensed nursing staff, the facility failed to provide the minimum licensed nursing hours on 4/6/02 and 4/7/62. This shortage was confirmed during a review of the nursing staff time reports and agency time sheets. The State requirement as of 1/1/02 is 1.0 hour per resident per day. The census on 4/6/02 was 162 and the minimum licensed nursing hours should have been 162 nursing hours. However, the minimum licensed nursing hours was only 153 for the 24-hour period. This was acknowledged by the nursing home administrator. The census on 4/7/02 was 162 and the minimum licensed nursing hours also should have been 162. Based on the information provided by the administrator (facility time sheets/agency time sheets) the actual nursing hours were 122.25 nursing hours for the 24-hour period. dl. The facility continued to admit residents and failed to self-impose a moratorium on new admissions for 6 days following the 4/6/02 and 4/7/02 nursing hours shortage: On 4/7/02 the census 4/08/02 - the census 4/09/02 - the census fz = aw mp Mwannw wb w HH an ss 4/10/02 - the census was 164 4/11/02 » the census was 164 4/12/02 - the census was 163 4/13/02 - the census was 159 4/14/02 - the census was 163 ‘d | -PPS6° ON MSIL) C090 ° 1 AON 12. Based on the foregoing, Gramercy Park Nursing Center violated § 483.25, code of Federal Regulations as incorporated by kule 59A-4.1268, Florida Aduinistrative Code, § 400.141 (15) (ad), Fla. Stat. and § 400.23, Fla. Stat., herein classified as a Class IT violation pursuant to §400.23, which carries, in this case, a fine or $2,500.00 and gives rise to a conditional rating pursuant to §400.23(7). DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Gramercy Park Nursing Center shall post the license in a prominent place that is clear and unobstructed public view at or near the place where residents are being adinitted to the facility. The conditional License is attached hereto as Exhibit Ya” CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: “d PPSE ON MeSh sr) COle l. Enter a judgment in favor of the Agency for Health Care Administration against Gramercy Fark Nursing Center on Count I. ho Assess against Gramercy Park Nursing Center an administrative fine of $2,500.00 on Count I for violatizn of § 400.23, Fla. Stat. § 400.141(15) (d), Fla. Stat. and & 483.25, Code of Federal Regulations as incorporated by Rule §9R-4,.1289, Fla. Admin. Code. 3. Uphold the conditional rating on the license cf Gramercy Park Nursing Center pursuant to §400.23(7) 4. Assess costs related to the anvestigation and prosecution of this matter, if applicable 5. Grant such other relief as the court deems is just and proper on Count I. Respondent is notified that it has a right to request én administrative hearing pursuant to Sections 120.569 ard 120.57, Florida Statutes (2001). Specific options for adininistrative action are s¢t out in the attached Electicn of Rights and explained in the attached Explanation cf Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, ‘d p7So° ON WeGhe li cote AO Q First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Alba M. Rodriguez. 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. Ohno 2 ‘“ /- Ober Alba M. Rodrigueé i a Assistant General Counsel Agency for Health Care Administration 355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Castillo Field Office Manager Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 (Interoffice Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency for Health Care Adininistration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) "d7796°OH WYSE L) OGD TE AON ‘¢ PoE ON EXHIBIT “av” Conditional License License # SNF 1180096; Certificate No.: Effective date: Ud-25-2002 Expiration date: 06-30-2002 rr | “AGH O! CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Sidney L. Schiff, Administrator, Gramercy Park Nursing Center, 17415 5s. Dixie Highway, Miami, Florida 33157; Gramercy Operating Company, Inc., 1114 Wynwood Avenue, Cherry Hill, New Jersey 08002; Leonard ©. Shinsky, 1150 £. Hallendale Beach Blvd., Suite A, Hallendale, Florida 33003 on this _/ sv day of Oo Forbid 2002. Cdn } ST), Be JAGCA (2. Alba M. Rodriguez a 'd PPOG ON AVSIS LL COGO oI “AGN ea e oe i, MENG Y i MME Mh “ACTION EFFECTIVE DATE: 04/25/2002 cas CERTIFICATE #: 8881 State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION DIVISION OF MANAGED CARE AND HEALTH QUALITY SKILLED NURSING FACILITY CONDITIONAL This is to confirm that GRAMERCY OPERATING CO., INC. has complied with the rules and regulations adopted by the State of Florida, Agency For Health Care Administration, authorized in Chapter 400, Part I, Florida Statutes, and as the licensee is authorized to operate the following: GRAMERCY PARK NURSING CENTER 17475 S. DIXIE HWY. MIAMI, FL 33157 with [80 beds. Status Change LICENSE EXPIRATION DATE: 06/30/2002 p7G6 ON ‘¢ ral

Docket for Case No: 02-004421