STATE OF FLORIDA Med : AGENCY FOR HEALTH CARE ADMINISTRATION 03 whe 1 PH t: 08 AGENCY FOR HEALTH CARE +h ss ADMINISTRATION, Again As ie . HEARINGS Petitioner, AHCA No.: 2001037641 Return Receipt Requested: Vv. 7000 1670 0011 4847 1706 7000 1670 0011 4847 1713 FLORIDA HOUSING CORPORATION d/b/a 7000 1670 0011 4847 2062 PAIM BEACH ASSISTED LIVING FACILITY, 07 O95% Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Florida Housing Corporation d/b/a Palm Beach Assisted Living Facility (hereinafter “Palm Beach Assisted Living Facility’), pursuant to Chapter 400, Part III, and Section 120.60, Plorida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,000.00 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 Palm Beach County, pursuant to Section 120.57 Fla. Stat, and Rule 28-106.207, Florida Administrative Code. PARTIES 4. BHCA 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. Palm Beach Assisted Living Facility operates a 120-bed assisted living facility located at 534 Datura Street, West Palm Beach, Florida 33401. Palm Beach Assisted Living Facility is licensed as an assisted living facility under license number 7617. Palm Beach Assisted iving Facility was at ail 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 PALM BEACH ASSISTED LIVING FACILITY FAILED TO ENSURE THAT RESIDENTS RECEIVED PROPER CARE AND SERVICES. RULE 58A-5.0182(1) (b), FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 7. Palm Beach Assisted Living Facility was cited with one (1) Class II deficiency pursuant to a complaint investigation conducted on June 11, 2001. 8. Based upon record review and interview during the follow up survey conducted on June li, 2001 it was revealed that the facility did not ensure that proper care and services for the residents was provided. 9. Resident #1 was diagnosed by his/her dermatologist with Scabies, a highly contagious skin infestation, on June 6, 2001. Staff members were also made aware of the diagnosis on that date. However, staff members took no action at that time to protect other residents from this highly contagious infestation. 10. The facility administrator was made aware of the resident’s diagnosis of Scabies two days later on dune 8, 2001. The administrator also failed to take actions to protect other residents from contagious skin infestation. 11. It was not until five (5) days later on June 1 2001, during the follow up survey that the facility sought to address the needs of the other residents by calling the dermatologist and house physician for treatment orders. When called, the house physician gave orders for the treatment of other residents exhibiting symptoms of Scabies. Orders were also given for the proper washing of clothing and shampooing of rugs and furniture. In addition both the house physician and dermatologist made plans to visit the facility the same day to evaluate all of the facility’s other residents. Unfortunately, by this time at least two other residents, Resident #1's roommate, and Resident #1’s friend were already exhibiting signs of Scabies. 12. The facility did not take proper action in oa timely manner to provide for the care of residents at the facility in that it did not’ take action to protect residents from catching this contagious skin disease until the surveyor brought this medical need to the facility's attention. 143. Based on the foregoing, Palm Beach Assisted Living Facility violated Rule 58A-5.0182(1) (b), Florida Administrative Code herein classified as a Class II violation which carries an assessed fine of $1,000.00. 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 Palm Beach Assisted Living Facility on Count I. 2. Assess an administrative fine of $1,000.00 against Palm Beach Assisted Living Facility on Count I for violation of Rule 58A-5.0181(1) (b), Florida Administrative Code. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. Grant such other relief as this Court deens 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 an Agency for Health Care Administration, Manchester Building, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Alba M. Rodriguez. RESPONLENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAIN? WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. (Qttras tp. Radienutoy 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 E. 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) Assisted 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 Denise P. Wasielewski, Administrator, Palm Beach Assisted Living Facility, 534 Datura Street, West Palm Beach, Florida 33401; Florida Housing Corporation, 534 Datura Street, Suite 420, West Palm Beach, Florida 33401; Joseph Glucksman, 534 Datura Street, Suite 200, West Palm Beach, Florida 33401 on this 7 died day of Alba M. Romer , } ‘a January, 2003.

Docket for Case No: 03-000956