STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA NO: 2002048273 DELTA HEALTH GROUP, INC., O- Ol GY d/b/a MAITLAND HEALTH CARE CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint, against DELTA HEALTH GROUP, INC., d/b/a MAITLAND HEALTH CARE CENTER, (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the total amount of two thousand five hundred dollars ($2,500) pursuant to Sections 400.102(1) (a) and (d), 400.022(3), and 400.23(8) (b), Florida Statutes. 2. The Respondent was cited for the deficiencies set forth below as a result of a complaint survey conducted on or about October 12, 2002. JURISDICTION AND VENUE 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 4. Venue lies in Orange County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28-106.207 F.A.cC. PARTIES 5. AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 6. Respondent is a nursing home located at 1700 Monroe Avenue, Maitland, Florida 32751. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I RESPONDENT FAILED TO MAINTAIN AN ENVIRONMENT FREE OF PHYSICAL AND VERBAL ABUSE FOR ONE (1) RESIDENT, VIOLATING RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE, INCORPORATING BY REFERENCE 42 CFR 483.13(b), AND SECTION 400.022(1) (L), FLORIDA STATUTES. CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. Based on the observations, staff interviews and clinical record reviews, the facility failed to maintain an environment free of physical and verbal abuse for one (1) resident (Resident #9). 9. Specifically: (a) Resident #9 was admitted to the facility in July of 2002 with diagnoses of Huntington's Chorea, Dementia, Psychosis, and Schizophrenia. Review of the Minimum Data Set Assessment completed 7/16/02 noted the resident to have short and long term memory loss and moderate cognitive loss. Behaviors indicated he/she was resistive to care. The resident also required assistance with dressing (ADL). The plan of care dated 8/12/02, for memory impairment documented a goal to maintain understanding of others as evidenced by continued ability to follow directions. The Approaches included, "follow the same routine for ADL's", and use a "calm voice and repeat if necessary." (6) During observation in resident #9's room, on 10/09/02 at approximately 3:00 PM, two Certified Nursing Assistants (CNA's) brought him/her into the room to change a soiled shirt. The roommate was in bed observing the staff and resident #9. The resident became somewhat resistive and sat him/herself down on the floor near the bathroom and then preceded to lie down on the floor. In very loud voices the CNA's told him/ her " Pull yourself up". CNA#1 began pushing him up. The other CNA #2 told CNA #1 to "leave the resident alone." Interview with the roommate during this interaction revealed that the CNA's that same morning was talking very loudly to the resident while coaxing him/her up. The resident was sleeping in a chair in the room. Resident #9's roommate also stated that he/she heard resident #9's head bump something that morning. The roommate was very upset at his/her observations of the treatment to his/her roommate. 10. Based on all of the foregoing, MAITLAND HEALTH CARE CENTER violated Rule 59A-4.1288, Florida Administrative Code, incorporating by reference 42 CFR 483.13(b), and Section 400.022(1) (1), which require the facility to maintain and environment free of physical and verbal abuse, and provide adequate and appropriate protective and support services. 11. The above referenced violation constitutes the grounds for the imposed Class II deficiency and for which a fine of two thousand five hundred dollars ($2,500) is authorized pursuant to Section 400.23(8) (b), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I; B. Impose a fine of two thousand five hundred dollars ($2,500) for the violation cited in Count I, against the respondent as authorized under Sections 400.102(1) (a,d), and 400.23(8) (b), Florida Statutes; Cc. Attorney’s fees and costs and D. All other general and equitable relief allowed by law. NOTICE The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the attention of Michael P. Sasso, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr., St. Petersburg, Florida, 33701. 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. Respectfully submitted, Juche l | shove Michael P. Sasso, Esquire AHCA - Senior Attorney Fla. Bar No. 0167363 525 Mirror Lake Drive North St. Petersburg, Florida 33701 I HEREBY CERTIFY that the original Administrative Complaint and Exhibit “A” has been furnished via U.S. Certified Mail Return Receipt No. 7002 2030 0002 7117 6345 to James Richardson, Administrator, Maitland Health Care Center, 1700 Monroe Avenue, Maitland, Florida 32751 and a copy of the foregoing has been furnished via U.S. Certified Mail, Return Receipt No. 7002 2030 9002 7117 6499, to Sondra McCrory, Registered Agent for Maitland Health Care Center, 2 North Palafox Street, Pensacola, 32501, on December@3™ 2002. Vuckul bichege Florida Michael P. Sasso, Esquire COPIES TO: Sondra McCrory Registered Agent for Maitland Health Care Center 2 North Palafox Street Pensacola, FL 32501 (U.S. Certified Mail) James Richardson, Administrator Maitland Health Care Center 1700 Monroe Avenue Maitland, FL 32751 (U.S. Certified Mail) Michael P. Sasso, Esquire Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330K St. Petersburg, Florida 33701

Docket for Case No: 03-000194