Pwr r tes gs STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION (03 APR 30 PH 4:49 AGENCY FOR HEALTH CARE ADMINISTRATION, PRAVNVE HEARINGS Petitioner, AHCA No.: 2002048680 Return Receipt Requested: ve 7000 1670 0011 4847 1577 7000 1670 0011 4847 1584 QUALITY ELDERCARE OF FLORIDA, LLC 7000 1670 0011 4847 1621 d/b/a EMBASSY RETIREMENT HOME OF MARGATE, OA-}HB4 Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Quality Eldercare of Florida LLC d/b/a Embassy Retirement Home of Margate (hereinafter ‘Embassy Retirement Home of Margate”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $10,500.00 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 assisted living facilities, pursuant to Chapter 400, Part III, Florida Statutes (2001), and Chapter 58A-5 Florida Administrative Code. °. Embassy Retirement Home of Margate operates a 35- bed assisted living facility located at 6093 N. W. 9 Court, Margate, Florida 33063. Embassy Retirement Home of Margate is licensed as an assisted living facility under license number 8668. Embassy Retirement Home of Margate 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 EMBASSY RETIREMENT HOME OF MARGATE FAILED TO BE ADMINISTERED ON A SOUND FINANCIAL BASIS IN ORDER TO MEET RESIDENT NEEDS. SECTION 400.4275, FLORIDA STATUTES RULES 58A-5.021(1) AND 58A-5.020(2) (h), FLORIDA ADMINISTRATIVE CODE (FISCAL STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Embassy Retirement Home of Margate was cited with two (2) Class II deficiencies pursuant to complaint investigation conducted on October 31, 2002. 8. Based on the complaint investigation conducted on October 31, 2002, (during Hurricane Season) and based on observation and interview, AHCA determined that the facility was not being administered on a sound financial basis to ensure adequate resources to meet resident needs. The findings include the following: 9. During an interview with the Administrator via the phone on 10/31/02 (he/she was not in the facility at the time of the complaint investigation on 10/31/02 and was called on the telephone by one of the 2 Managers present), it was disclosed by the Administrator that electrical power to the facility had been turned off due to lack of payment. A tour of the facility revealed that in 3 resident common bathrooms inspected, 3 did not have paper towels, 2 did not have toilet paper and 1 had less than 1/4 roll of toilet paper. The bathrooms inspected were by the activity room, by resident room 111 and by resident room 113. 10. The emergency food supply was examined and found to be very inadequate for the current resident census. The licensed capacity for the facility is 35. The census on 10/31/02 was 29. There was a posted emergency supply list on the cabinet door with the required foods and amounts for 35 residents by the facility's dietician. The foodstuff observed appeared to be less than 1/3 of the required amount. ll. The emergency water supply was also examined. 40 gallons was observed in 2 areas - the emergency food closet and another closet around the corner from the emergency food closet. Much of the water noted had expired the shelf life as documented by the expiration dates on the containers. All the l1-gallon containers in the emergency food closet had expired between the dates of 7/98 and 3/02. 3 of the l-gallon containers were misshapen and shriveled due to leakage and/or evaporation. 1 of the 6 - 5-gallon containers noted had a 12/06/99 expiration date. The other 5 containers did not have readable expiration dates. None of the foodstuffs nor the water containers had labels on them of when the facility put them into the storage closets. 12. The kitchen was also toured. There appeared to be sufficient food for the evening meal and the following day's breakfast meal as listed on the menu. It was observed that there was little food in the kitchen other than for the 2 meals noted. 13. The Manager was interviewed and after investigation, confirmed the findings. 14. Based on the foregoing, Embassy Retirement Home of Margate violated Section 400.4275, Florida Statutes (2002) and Rules 58A-5.021(1) and 58A-5.020(2) (h), Florida Administrative Code, herein classified as a Class II violation pursuant to § 400.419(1)(b), which carries an assessed fine of $5,000.00. COUNT II EMBASSY RETIREMENT HOME OF MARGATE FAILED TO ENSURE THAT A THREE-DAY SUPPLY OF NON-PERISHABLE FOODS AND WATER BASED ON THE CENSUS WAS ON HAND AT ALL TIMES. RULE 58A-5.020(2) (h), FLORIDA ADMINISTRATIVE CODE (NUTRITION AND DIETARY STANDARDS) CLASS II VIOLATION wn 15. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 16. Based on the complaint investigation conducted on October 31, 2002 (during Hurricane Season) and based on observation and interview, the facility failed to have a 3- day supply of non-perishable food, based on the facility's census, on hand at all times. The findings include the following. 17. The emergency food supply was examined and found to be very inadequate for the current resident census. The licensed capacity for the facility is 35. The census on 10/31/02 was 29. There was a posted emergency supply list on the cabinet door with the required foods and amounts for 35 residents by the facility's dietician. FOODSTUFF REQUIRED SEEN (FOR 35) Tomato Juice 15 7 Orange Juice 15 0 Cereal - OK Evaporated Milk - OK #5 Can Chicken Noodle Soup #5 Can Vegetable Soup 5 Can Mushroom Soup Canned Tuna #10 Can Ravioli #10 Can Macaroni & Cheese 10 Can Beef Stew 10 Can Green Beans 10 Can Mixed Vegetables 10 Can Carrots 10 Can Peaches WWWW th PB wWOM Mo goo 0000 0N000 #10 Can Pears 3 0 #10 Cans Apple Sauce 5 ) #10 Can Fruit Cocktail 3 0 #10 Can Pineapple 3 0 #10 Can Pudding 5 0 Graham Crackers 1 Case (200) 0 Saltines 750 each 0 18. The emergency water supply was also examined. 40 gallons of water were observed in 2 areas - the emergency food closet and another closet around the corner from the emergency food closet. Much of the water noted had expired the shelf life as documented by the manufacturers expiration date on the containers. All l-gallon containers in the emergency food closet had expired between the dates of 7/98 and 3/02. 3 of the i1-gallon containers were misshapen and shriveled due to leakage and/or evaporation. 1 of the 6 - S-gallon containers noted had a 12/06/99 expiration date. The remaining 5 containers did not have readable expiration dates. None of the foodstuffs nor any of the water containers had labels on them of when the facility put them into the storage closets. 19. The Manager was interviewed and after investigation, confirmed the findings. 20. Based on the foregoing, Embassy Retirement Home of Margate violated Rule S8A-5.020(2) (h) Florida Administrative Code, herein classified as a Class II violation pursuant to § 400.419(1)(b), Florida Statutes (2002) which carries an assessed fine of $5,000.00. SURVEY FEE Pursuant to Section 400.419(9), Florida statutes, AHCA may assess a survey fee of $500.00 to cover the cost of initial complaint investigations. A survey fee of $500.00 was assessed in this instance. 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 Embassy Retirement Home of Margate on Counts I and II. 2. Assess an administrative fine of $10,000.00 against Embassy Retirement Home of Margate on Counts I and II for the violations cited above. 3. Assess a survey fee of $500.00 against Embassy Retirement Home of Margate pursuant to Section 400.419(9), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs 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, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Alba M. Rodriguez. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. Cas m. hk Alba M. Rodriguez 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 David J. Koss, Administrator, Embassy Retirement Home of Margate, 6093 N. W. 9 Court, Margate, Florida 33063; Quality Eldercare of Florida LLC, 6093 N. W. 9 Court, Margate, Florida 33063; Jeremy A. Koss, Esq., 4000 Hollywood Blvd. Suite 305, Hollywood, Florida 33021 on this aq aay of January, 2003. Alba M. Rodriguez r . 10

Docket for Case No: 03-001539