STATE OF FLORIDA Ep AGENCY FOR HEALTH CARE ADMINISTRATIONS yy STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA Nos: 2003008019 vs. 2003008018 CANAL, INC. d/b/a PETITE FRANCE HOLISTIC ALF, 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 Canal, Inc. d/b/a Petite France Holistic ALF (hereinafter “Respondent”) pursuant to Chapter 400 Part HI, and Section 120.60, Florida Statutes (2002), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the license of and impose administrative fines totaling $10,500 against Respondent, pursuant to Sections 400. 414 (1)(a), and 400.419(1)(b), Florida Statutes, (2002). This action incorporates by reference the Order of Immediate Moratorium dated October 17, 2003. 2. The Respondent is cited for the deficiencies set forth below as a result of complaint surveys conducted on October 15, 2003. JURISDICTION AND VENUE 3. This tribunal has jurisdiction over the Respondent pursuant to Sections 120.569 and 120.57, Florida Statutes (2002), and 28-106, Florida Administrative Code (2002). 4. Venue is Seminole County, Florida, pursuant to Rule 28-106.207, Florida Administrative Code (2002). PARTIES 5. The Agency is the state agency charged with the responsibility of regulating and licensing assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. 6. Respondent is licensed by the Agency to operate a ten (10) bed assisted living facility located at 2013 and 2015 Lake Drive. in Casselberry, FL 32707, having been issued license number AL9434, Certificate No. 13837. COUNTI RESPONDENT FAILED TO PROVIDE CARE AND SERVICES APPROPRIATE TO THE NEEDS OF RESIDENTS ACCEPTED FOR ADMISSION TO THE FACILITY, IN VIOLATION OF RULE 58-5.0182, F.A.C., INA MANNER WHICH DIRECTLY THREATENED THE PHYSICAL AND EMOTIONAL HEALTH, SAFETY, AND SECURITY OF RESIDENTS CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. A revisit survey was conducted on October 15, 2003. 9. On that date, based on observation, interview, and record review, the facility failed to provide supervision appropriate to the needs of 2 residents (#3, #10) ina sample of 11, directly threatening the physical and emotional health, safety and security of these residents. The findings include: a. Resident #10, who is diagnosed with Alzheimer's disease, osteoporosis and hypertension, eloped twice from the facility in a 2-month period. The resident was prescribed the anti-psychotic medication Zyprexa and the seizure medication Depakote. The medical examination report dated 7/30/03 revealed the resident required supervision with ambulation, bathing, dressing, eating, grooming toileting, and transfer. Upon admission to the facility, the resident was placed in Building 2015, which was separate from the building where residents were directly supervised by staff and received no supervision during the night. Review of a police report dated 10/2/03 revealed that Resident #10 “has dementia and has no ideas as to day, time or place.” Resident #10 continued to live without supervision in building 2015. While the officer was at the premises, resident #10 wandered away from the facility and began walking down the street. The road is dangerous because of the speed of traffic, and because it has no sidewalks. If not for another resident (#3), resident #10 would have wandered unnoticed by the care providers as they are not present in building 2015. Review of another police report narrative dated 10/4/03 of the incident involving resident #10 on 10/2/03 revealed the following entry: "(Resident #10) is clearly at risk without supervision and it is verified by other residents within the facility that he/she wanders off frequently. Resident #3 stated that he/she goes and brings resident #10 back like that all the time. This writer is concerned as he/she resides in the residence listed as independent and clearly requires supervision to insure his/her personal safety." Further review revealed yet another instance of the unsupervised wanderings of Resident #10. The police report dated 10/15/03 stated that Resident #10 was found at an apartment complex on 10/9/03. At first the resident appeared lost, made statements about himself/herself and then urinated on himself/herself without noticing he/she had done so. The resident was subsequently Baker Acted according to the police report and later transported to the hospital. Review of the hospital report of 10/9/03 revealed that resident #10 was "found wandering streets". The hospital report also stated that the "patient was not oriented to name, time, place". Interview with Seminole County Elder Services Specialist on 10/16/03 at 2:38 P.M. revealed that resident #10 was found at 11:20 P.M. on 10/9/03 three miles from the facility. An all-agency attempt to identify the person ensued and continued until 1:30 A.M. on 10/10/03. The resident was then taken to South Seminole Hospital for medical clearance or to be Baker Acted. At approximately 4:00 A.M. the Seminole County Sheriff's Department dispatcher identified the resident as being involved in a prior wandering incident, and that the resident lived at 2015 Lake Drive, Casselberry. A phone call was made to the facility and the sheriffs department left a voice message. A deputy was dispatched to the facility to notify them of the missing resident. At 5:40 A.M., the owner/assistant administrator called to notify the police she would make arrangements to pick up the resident at the hospital. Observations of resident #10 on 10/15/03 revealed the resident watching TV in the main building of the facility, Building 2013, at 11 A.M. Interview with the resident revealed the resident did not know what to do if he/she needed help in the event of an emergency when in his/her bedroom in the unsupervised separate building. Review of the charts of the residents housed in the auxiliary building revealed that 3 of 4 of the residents were confused with dementia or Alzheimer's disease. Residents in the separate building had been provided with alarms that they wore on a chain around the neck. By pushing a button on the alarm around the neck, a staff member would be alerted to come and help the resident. At the time of this interview, the resident was not wearing the alarm, and was unable to respond when asked how to call for help. Observation of the ALF revealed that the residents had to walk across a sidewalk from the unsupervised building in which they lived to eat their meals in the main building. b. Further record review conducted on 10/15/03 revealed that the earlier rescuer of Resident #10, Resident #3, had diagnoses of Bell's Palsy, dementia and wore a heart monitor according to a medical examination report dated 7/30/03. This resident also lived in the separate building (2015). A police report of 10/2/03 and interview on 10/15/03 also revealed that Resident #3 is in a state of dementia (suffers from memory deficit and has no real short term memory), and was the only person available to help resident #10 when he/she wandered away from the facility. The report states “On 10/2/03, the staff neglected resident #10 and Resident #3 by inadequately supervising them. Resident #3 and resident #10 lack capacity and they are taking multiple meds.” These observations were cited as a Class II deficiency and were to be corrected by October 16, 2003. Pursuant to Section 400.419 (1)(b), Florida Statutes, a Class II violation is a condition or occurrence related to the operation or maintenance of a facility, or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety or security of the facility residents, other than class I violations. Further, by its actions, respondent failed to provide care and services appropriate to the needs of residents accepted for admission to the facility, in violation of Rule 58-5.0182, F.A.C., in a manner that directly threatened the physical and emotional health, safety, and security of the residents.” 10. Therefore, as a result of the above actions of the Respondent, the Agency seeks the enhancement of the administrative fine to $5000.00 pursuant to Sections 400.419(2)(a) and 400.419(2)(c), which state that in determinin g if a penalty is to be imposed and in fixing the amount of the penalty the agency shall consider “[T] he gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated, as well as any previous violations. UU. Further, the Agency seeks to revoke Respondent's license pursuant to Section 400.414(1)(a), Florida Statutes (2002) which states in pertinent part that “The agency may deny, revoke, or suspend any license issued under this part, or impose an administrative fine in the manner provided in chapter 120, for ...... an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility.” COUNT IT RESPONDENT FAILED TO UPHOLD THE RESIDENT’S RIGHT TO LIVE IN A SAFE LIVING ENVIRONMENT, FREE FROM ABUSE AND NEGLECT, IN VIOLATION OF SECTION 400.428(1)(a), FLORIDA STATUTES. CLASS II DEFICIENCY 12. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 13. A complaint survey was conducted on October 15, 2003. 14. On that date, based on observation, interview, and record review, the facility failed to uphold the resident's right to live in a safe environment, free of neglect, threatening the health, safety, and well being of two residents (#7and #10) in a sample of 11. The findings include: a. Record review by the surveyors on 10/15/03 revealed that Resident #7 had diagnoses of dementia, oriented x 1 with occasional agitation, and osteoarthritis according to a health assessment dated 6/30/03. Review of the medication log revealed the resident was prescribed the anti-psychotic medication Seroquel and the anti-anxiety medication Ativan in addition to the anti-depressant Remeron. Review of a police report dated 8/12/03 revealed that on 8/11/03 the police responded to a report of a missing resident at the facility. Police notes revealed that on the day of the incident, a staff member claimed that resident #7 was left outside the facility at around 4:40 P.M., while the staff member went inside to cook dinner. A citizen stated that she found resident #7 about 4 miles away from the facility at approximately 4:30 PM and took the resident to the police station after trying to locate the resident's home. The police report verifies that the Respondent never called in a missing persons report. Record review on 10/15/03 revealed no evidence to validate that the Respondent had contacted the resident’s family. At 5:45 PM, the police contacted the resident's family using the ID bracelet they had given him/her in February of this year. When found, the resident was asked where he/she lived and the resident stated, "Puerto Rico". The resident could not provide his/her address, phone number, birth date or social security number. The police report stated, "It is this writer’s opinion that the staff at (the facility) was negligent in the care of resident #7 by leaving him/her unattended outside the facility, which by the way backs up to a large body of water and is not fenced in from the road, leaving Alzheimer/Dementia patients at risk." b. Resident #10 had diagnoses of Alzheimer's disease, osteoporosis and hypertension. The resident was prescribed the anti-psychotic medication Zyprexa and the seizure medication Depakote. Though the resident required direct supervision by staff due to his/her diagnosis, the resident was knowingly admitted into the ALF’s detached house, Building 2015, next door to the main ALF house, Building 2013, where no staff was maintained. Interview with Administrator in 9/03 confirmed that no staff is maintained in the building 2015 at night, but the Administrator maintains that staff was in that building in the daytime beginning at 10 AM. On 3 different visits to the ALF during daytime hours (7/30,31/03, 9/5/03, and 10/15/03), no staff was observed in Building 2015 supervising residents, although residents were present in the building. Record review revealed that 3 of 4 of the residents in 2015 were confused with dementia or Alzheimer's disease. Observation revealed that the residents had to walk across a sidewalk from the unsupervised 2015 building in which they lived, to eat their meals in the main building 2013, increasing the likelihood of elopement secondary to confusion. 15. Though police reports revealed several instances of elopement, record review on 10/15/03 revealed no plan of action, corrective action, or preventive measures were put into place by the ALF to minimize the possibility of further elopements and incidents, thereby failing to ensuring the resident's safety. Where a police report showed that Resident #10 had been missing from the facility for almost 6 hours, the ALF made no attempt to locate the resident, file a missing persons report with police, or contact the resident's family. Per interviews on 10/15/03 — 10/17/03, with the Assistant State Attorney and Elder Services Specialist for Seminole County, the co-owner/assistant administrator was arrested on 10/15/03 on 2 counts of neglect of the elderly. She bonded out with bond restrictions to not care for any person who lacks capacity, and was directed to be in compliance with all AHCA rules and regulations. The other co-owner was arrested on 10/16/03 for 3 counts of neglect of the elderly and was released on bond with the same limitations. 16. These observations were cited as a Class II deficiency and were to be corrected by October 16, 2003. Pursuant to Section 400.419 (1)(b), Florida Statutes, a Class II violation is a condition or occurrence related to the operation or maintenance of a facility, or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety or security of the facility residents, other than class I violations. Further, by its actions, Respondent failed to uphold the resident’s right to live in a safe living environment, free from abuse and neglect, in violation of Section 400.428(1)(a), Florida Statutes. 17. Therefore, as a result of the above actions of the Respondent, the Agency seeks the enhancement of the administrative fine to $5000.00 pursuant to Sections 400.419(2)(a) and 400.419(2)(c), which state that in determining if a penalty is to be imposed and in fixing the amount of the penalty the agency shall consider “[T] he gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated, as well as any previous violations.” 18. Further, the Agency seeks to revoke Respondent’s license pursuant to Section 400.414(1)(a), Florida Statutes (2002) which states in pertinent part that “The agency may deny, revoke, or suspend any license issued under this part, or impose an administrative fine in the manner provided in chapter 120, for ....an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility.” 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 and Count II; B. 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: Lealand McCharen, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Wayne D. Knight, Esquire AHCA - Senior Attorney Fla. Bar No. 0136440 525 Mirror Lake Drive North, 330L St. Petersburg, Florida 33701 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy hereof has been furnished to Theirry Lassalle, Administrator, CANAL, INC. d/b/a Petite France Holistic ALF, 2013 Lake Drive, Casselberry, FL 32707, Return Receipt No 7003 1010 0003 4303 8661 by U.S. Certified Mail on December, 2003, ayne D. Knight, Esquire Copies to: Theirry Lassalle, Administrator Petite France Holistic ALF 2013 Lake Drive Casselberry, FL 32707 (Certified U.S. Mail)

Docket for Case No: 04-000380