OY4-0sas- fh omy STATE OF FLORIDA » fw ED D AGENCY FOR HEALTH CARE ADMINISTRATION 04 FEB 12 PM y:49 AGENCY FOR HEALTH CARE DIVIS ADMINISTRATION, ADMIN: rs 4s HEARINGS Petitioner, AHCA No.: 2003007500 Return Receipt Requested: Vv. 7002 2410 0001 4237 3455 7002 2410 0001 4237 3462 SWISS HOUSE, INC. d/b/a SWISS HOUSE 7002 2410 0001 4237 3479 INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Swiss House, Inc. d/b/a Swiss House Inc. (hereinafter “Swiss House” or “facility”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, (2002), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $2,807.00 [$2,500.00 administrative fine + $307.00 survey fee] pursuant to Sections 400.414 and 400.419, Florida Statutes 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 Florida Statutes, Chapter 28-106, Florida Administrative Code. 3. Venue lies in Palm Beach County pursuant to Section 120.57 Florida Statutes, 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 (2002) and Chapter 58A-5 Florida Administrative Code. 5. Swiss House, Inc. operates a 6-bed assisted living facility located at 3927 Buttercup Circle S, Palm Beach Gardens, Florida 33410. Swiss House, Inc. is licensed as an assisted living facility under license number 8135. Swiss House, Inc. 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 SWISS HOUSE, INC. FAILED TO PROVIDE WRITTEN DOCUMENTATION OF THEIR BUSINESS RECORDS. RULES 58A-5.021(2) & 61H1-20.007, FLORIDA ADMINISTRATIVE CODE (FISCAL STANDARDS) CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Swiss House, Inc. was cited with five (5) Class III deficiencies pursuant a biennial re-licensure survey. 8. Based on a biennial re-licensure survey conducted on August 7, 2003 and based on interview and record review the facility failed to provide documentation of their written business records as required by Rule 58A-5.021(2) which provides as follows: ACCOUNTING PROCEDURES. The facility shall maintain written business records using generally accepted accounting principles as defined in Rule 61H1- 20.007, Florida Administrative Code, which accurately reflect the facility’s assets and liabilities and income and expenses. Income from residents shall be identified by resident name in supporting documents, and income and expenses from other sources, such as from day care or interest on facility funds, shall be separately identified. 9. The findings were as follows: Review of the facility's records revealed that there was no documentation reflecting the facility's income, assets and liabilities. Upon request by the surveyor, the Administrator could not produce the requested documents. THE DEFICIENCY REMAINED UNCORRECTED ON DATE OF REVISIT 10. Based on a revisit survey conducted on September 25, 2003 and based on interview and record review the facility failed to provide documentation of their written business records. 11. The findings were as follows: Review of the facility's records revealed that there were no written business records reflecting the facility's income, assets and liabilities. Upon request by the surveyor, the person employee in-charge could not produce the requested documents. 12. Based on the foregoing, Swiss House, Inc. violated Rule 58A-5.021(2), Florida Administrative Code, herein classified as a Class III violation pursuant to Section 400.419, Florida Statutes, which warrants an assessed fine of $500.00. COUNT IT SWISS HOUSE FAILED TO PROVIDE DOCUMENTATION OF RESIDENT’S WEIGHT. RULE 58A-5.024 (3) (f), FLORIDA ADMINISTRATIVE CODE (RESIDENT RECORD STANDARDS) CLASS III VIOLATION 13. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 14. Based on a biennial re-licensure survey conducted on August 7, 2003 AHCA determined that the facility failed to provide documentation of weights for 1 of 3 sampled residents. The findings include the following. 15. Resident #2 was admitted to the facility on 05/19/03. Review of the resident's health assessment revealed that the form did not contain the resident's weight. Interview with the facility's Administrator revealed that the facility did not have any documentation of Resident #2's weight as required by Rule 58A.5.024 (3) (f£) which states as follows: (3) RESIDENT’S RECORDS. Resident’s records shall be maintained on the premises and include: (f) A weight record which is initiated on admission. Information may be taken from the resident’s health assessment. Residents receiving assistance with the activities of daily living shall have their weight recorded semi-annually. THE DEFICIENCY REMAINED UNCORRECTED AT TIME OF REVISIT 16. Based on a revisit survey conducted on September 25, 2003, the facility failed to provide documentation of weights for 1 of 4 sampled residents. The findings include the following. 17. During a review of Resident #2's record, it was noted that the resident was admitted to the facility on 05/19/03. Review of the resident's health assessment revealed that the form did not contain the resident's weight. Interview with the facility's staff member in charge during the revisit revealed that the facility did not have any documentation of Resident #2's weight. This deficiency remains uncorrected. 18. Based on the foregoing, Swiss House, Inc. violated Rule 58A-5.024 (3) (f£), Florida Administrative Code, herein classified as an uncorrected Class III violation pursuant to Section 400.419(1)(c), Florida Statutes, which warrants an assessed fine of $500.00. COUNT III SWISS HOUSE, INC. FAILED TO ENSURE THAT ALL RESIDENT’S HEALTH ASSESSMENTS WERE COMPLETED. RULE 58A-5.0181(2) (a)1-8, FLORIDA ADMINISTRATIVE CODE (ADMISSIONS CRITERIA STANDARDS) CLASS III VIOLATION 19. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 20. Based on a survey conducted on August 7, 2003 and based on record review AHCA determined that 1 of 3 residents records did not contain all of the required information on the medical examination form as required by Rule 58A.0181(2)a 1-8 which states as follows: (2) HEALTH ASSESSMENT. (a) Within 60 days prior to the residents admission to a facility but no later than 30 days after admission, the individual shall be examined by a physician or advanced registered nurse practitioner who shall provide the administrator with a medical examination report, or a copy of the report, which addresses the following: 1. The physical and mental status of the resident, including the identification of any health-related problems and functional imitations; 2. An evaluation of whether the individual will require supervision or assistance with the activities of daily living; 3. Any nursing or therapy services required by 6 the individual; 4. Any special diet required by the individual; 5. A list of current medications prescribed, and whether the individual will require any assistance with the administration of medication; 6. Whether the individual has signs or symptoms of a communicable disease which is likely to be transmitted to other residents or staff; 7. A statement that in the opinion of the examining physician or ARNP, on the day the examination is conducted, the individual’s needs can be met in an assisted living facility; and 8. The date of the examination, and the name, signature, address, phone number, and license number of the examining physician or ARNP. The medical examination may be conducted by a currently licensed physician or ARNP from anther state. 21. Resident #1’s was admitted to the facility on 7/9/02, Record review revealed that the resident's health assessment was incomplete. The assessment lacked the following evaluations: a. Resident’s physical and mental health status, b. Evaluation of the resident's Activities of Daily Living (ADL), Nursing and therapy services, Special diet, List of prescribed medications, Medication Mode, and Statement from the resident’s physician verifying that the resident’s needs can be met in an ALF, and the date of the exam. “2moaa THE DEFICIENCY REMAINED UNCORRECTED AT TIME OF REVISIT 22. Based on a revisit Survey conducted on September 25, 2003 and based on Based on record review 1 out of 4 resident records did not contain all of the required information on the medical examination forms (health assessments). The findings include the following. 23. Resident #1's was admitted to the facility on 07/09/02. AHCA determined the resident's health assessment was incomplete as it lacked the following: a. Evaluation of the resident’s physical and mental health status, b. Evaluation of the residents ADL's (Activities of Daily Living), c. Nursing and therapy services, d. Special diet, e. List of prescribed medications, f. medication mode, g. Statement from the resident's verifying that the resident's needs can an ALF, and the date of the exam. physician be met in 24. Based on the foregoing, Swiss House, Inc. violated Rule 58A-5.0181(2) (a)i - 8, Florida Administrative Code, herein classified as a Class III violation, which warrants an assessed fine of $500.00. COUNT IV SWISS HOUSE, INC. FAILED TO ENSURE THAT ALL RESIDENTS WERE FREE FROM RESTRAINTS, RULE 58A~5.0182(6) (H), FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE STANDARDS) CLASS III VIOLATION 25. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 26. Based on a biennial re-licensure survey conducted on August 7, 2003 and based on observation and interview, the facility failed to ensure that 1 out of 3 residents was free from restraints. The findings are as follows: 27. During a tour of the facility with a facility employee, the surveyor observed Resident # 2 sitting in a wheelchair with a lap buddy in use, which restricted the resident's movements and/or mobility. Upon observation and interview, it was noted that the resident appeared to be confused with episodes of dysphasia. Upon further observation and interview, Resident # 2 was unable to remove the restraint upon verbal cue of the surveyor. During and interview the Administrator stated that the resident utilizes the restraint device for "fall precautions". The Administrator also stated that she was unaware that the use of a lap buddy was prohibited from use in an ALF. THE DEFICIENCY REMAINED UNCORRECTED AT TIME OF REVISIT 28. Based on a revisit survey conducted on September 25, 2003 and based on observation and interview, the facility failed to ensure that 1 out of 4 residents were free from restraints. The findings are as follows. 29. During a tour of the facility the AHCA surveyor observed Resident # 2 resting in his/her bed positioned against the wall with an over-the counter 1/2 side rail in use, which restricted the resident's ability to get out of bed. During an interview the staff member left in-charge stated that the resident utilizes the restraint device for "fall precautions", and was supplied by the resident's family members. The staff member stated that the resident is unable to remove the 1/2 side rail by his/her self. During a review of the resident's record, there was no evidence of a physician's order, or consent for use by the resident and/or his responsible party. This is in violation of Rule 58A-5.0182(6) (h), Florida Administrative Code, which states as follows: (6) RESIDENT’S RIGHTS AND FACILITY PROCEDURES (h) Pursuant to Section 400.441, F.S., the use of physical restraints shall be limited to half-bed rails, and only upon the written order of the resident’s physician, who shall review the order biannually, and the consent of the resident or the resident’s representative. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance shall not be considered a physical restraint. 30. Based on the foregoing, Swiss House, Inc. violated Rule S8A-5.0182(6) (h), Florida Administrative Code, herein classified as a Class III violation pursuant to Section 400.419(1) (c), which warrants an assessed fine of $500.00. counT_v SWISS HOUSE, INC. FAILED TO ENSURE THAT ALL STAFF MEMBERS WERE TRAINED IN THEIR JOB DUTIES IN THE EVENT OF AN EMERGENCY. RULE 58A-5.026(3) (a), FLORIDA ADMINISTRATIVE CODE (EMERGENCY MANAGEMENT) CLASS III VIOLATION 10 31. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 32. Based on record review, the facility failed to provide documentation that 3 out of 4 employees received emergency preparedness and evacuation training as required by Rule 58aA- 5.026(3) (a), Florida Administrative Code and Section 400.441(1) (b), Florida Statutes. Rule 58A.026(3) (a), Florida Administrative Code states as follows: (3) PLAN IMPLEMENTATION. In the event of an internal or external disaster the facility shall implement the facility’s emergency management plan in accordance with Chapter 252, F.S. (a) All staff must be trained in their duties and are responsible for implementing the emergency management plan. 33. The findings include the following: During a review of the employee files, the agency determined that 3 of the facility's employees did not evidence of having received training of their job duties in the event of an emergency. THE DEFICIENCY REMAINED UNCORRECTED AT THE TIME OF REVISIT 34. The mandated correction date was designated as September 6, 2003. 35. During a revisit survey to the facility conducted on September 25, 2003 and based on record review, the facility failed to provide documentation that 3 out of 4 employees ii received emergency preparedness and evacuation training. The findings include the following. 36. During a review of the employee files during the revisit, the records did not contain verification that 3 of the facility's employees received training of their job duties in the event of an emergency. This deficiency remains uncorrected. 37. Based on the foregoing, Swiss House, Inc. violated Section 400.441(1) (b), Florida Statutes and Rule 58A- 5.026(3) (a), Florida Administrative Code, herein classified as a Class IIt uncorrected deficiency pursuant to Section 400.419(1) (c), Florida Statutes, which warrants an assessed fine of $500.00. SURVEY FEE 38. A survey fee of $500.00 to cover the cost of monitoring visits has been assessed in this case pursuant to Section 400.419 (9), Florida Statutes, which states as follows: (9) In addition to any administrative fines imposed, the agency May assess a survey fee, equal to the lesser of one half of the facility’s biennial license and bed free or $500, to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits conducted under s. 400.428(3)0© to verify the correction of the violations. a. A survey fee of $307.00 has been assessed in this case. 12 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 Swiss House, Inc. on Counts I through V. 2. Assess an administrative fine of $2,500.00 against Swiss House, Inc. on Counts I through V for the violations cited above. 3. Assess a survey fee of $307.00 against Swiss House, Inc. 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 (2002). 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 Clerk, Agency for 13 Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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. Cita, 1). Bochsguo, Alba M. Rodriguez’, Esq. a 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) Jean Lombardi 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) 14 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 Marianne Eichinger, Swiss House Inc., 3924 Buttercup Circle, S., Palm Beach Gardens, Florida 33410; Swiss House, Inc., 16396 72 Road North, Loxahatchee, Florida 33470; Marianne Eichinger, 16396 72 Road North, Loxahatchee, Florida ao 33470 on this |‘ day of November, 2003. Bei . Alba M. Rodriguez, 15

Docket for Case No: 04-000525