Division of Administrative Hearings STATE OF FLORIDA | L E AGENCY FOR HEALTH CARE ADMINISTRATION hake as AGENCY FOR HEALTH CARE ADMINISTRATION, Date 04 -Olef Petitioner, AHCA No.: 2002047312 Return Receipt Requested: Vv. 7000 1670 0011 4847 1867 7000 1670 0011 4847 1874 BAYVIEW RETIREMENT HOME, INC. d/b/a BAYVIEW RETIREMENT HOME, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Bayview Retirement Home, Inc. d/b/a Bayview Retirement Home (hereinafter “Bayview Retirement Home”), pursuant to Chapter 400, Part TIf, and Section 120.60, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $5,450.00 pursuant to Section 400.419, Florida Statutes (2001), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57 Fla. Stat., Chapter 28-106, Florida Administrative Code. 3. Venue lies in Broward County, pursuant to Section 120.57 Fla. Stat, Rule 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing adult living facilities, pursuant to Chapter 400, Part III, Florida Statutes (2001), and Chapter 58A-5 Florida Administrative Code. 5. Bayview Retirement Home operates a 12-bed adult living facility located at 2625 N. E. 13 Court, Ft. Lauderdale, Florida 33304. Bayview Retirement Home is licensed as an adult living facility under license number 6639. Bayview Retirement Home was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I BAYVIEW RETIREMENT HOME FAILED TO PROVIDE PROPER TREATMENT FOR A STAGE 2 PRESSURE SORE. RULE 58A-5.0181(4) (b)1, FLORIDA ADMINISTRATIVE CODE (ADMISSIONS CRITERIA STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7, Bayview Retirement Home was cited with one (1) Class If deficiency pursuant to complaint investigation conducted on September 13, 2002. 8. Based on the survey conducted on September 13, 2002 and based on record review, one of two residents in the sample (Resident #1) developed a stage 2 pressure sore and a home health agency or nurse were not provided. The findings include the following. 9. Resident #1 was admitted on 5/31/02 with no decubiti. The facility's notes on 7/4/02 state she was red on her bottom and the Administrator bought cream for her. On 7/6, she is still red on her bottom. On 8/4, patient's buttock appears red and bed sore cuts upper center of buttock, clean area with sodium chloride and apply Vitamin A & D ointment. On 8/5, clean affected area and apply A & D ointment & change position every 2 hours. On 8/6, clean affected area & apply A & D ointment and change position every 2 hours. Based on a written statement provided by the facility, the Administrator took the resident to the hospital on 8/19/02 for treatment of the pressure sore as the resident's primary doctor was on vacation. The discharge plan from the hospital showed follow-up with private doctor as soon as possible and a referral for wound care. A registered nurse from the HMO evaluated the wound 8/23/02 & 8/26/02 but no treatment was given. The Administrator took the resident to the hospital on 8/27/02 as the wound looked very bad. The resident was admitted to the hospital and did not return to the facility. 10. Based on the foregoing, Bayview Retirement Home violated Rule 58A-5.0181(4) (b)1, Florida Administrative Code herein classified as a Class II violation pursuant to § 400.419, which carries in this instance an assessed fine of $5,000.00. SURVEY FEE Pursuant to Section 400.419(9), Florida statutes, AHCA assessed a survey fee of $450.00 in this matter to cover the cost of monitoring visits. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Bayview Retirement Home on Count I. 2. Assess an administrative fine of $5,000.00 against Bayview Retirement Home on Count I for violation of Rule 58A-5.0181(4) (b)1, Florida Administrative Code. 3. Assess a survey fee of $450.00 against Bayview Retirement Home pursuant to Section 400.419(9), Florida Statutes. 4, Assess any other costs related to the investigation and prosecution of this matter that the Court finds applicable. 5. Grant such other relief as this Court deems is just and proper. Respondent 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 and explained in the attached Explanation of 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, a 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. (Cisas mm Bedupee,/ Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 B. Tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (U. S. Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Adult Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) 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 Alice B. Rothman, Administrator, Bayview Retirement Home, 2625 N. EB. 13 Court, Ft. Lauderdale, Florida 33304; Bayview Retirement Home, Inc., 2626 N. E. 13 Court, Ft. Lauderdale, Florida 33304; on this 7] jar tay of December, 2002, Qeias “ae Radu gucn, Alba M. Rodrighez

Docket for Case No: 03-000161