STATE OF FLORIDA og AGENCY FOR HEALTH CARE ADMINISTRATION | Ge! af “y, STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, CASE NO: 2003007799 vs. EUNICE SULLIVAN. d/b/a BRAYBROOK 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 EUNICE SULLIVAN d/b/a BRAYBROOK (hereinafter “Respondent”) and alleges the following: NATURE OF THE ACTION 1. This is an action to impose an administrative fine and survey fee on Respondent pursuant to Sections 400.419(1) (c) and (ad) and 400.419(9), Florida Statutes (2003). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57, Florida Statutes (2003) and Chapter 28-106, Florida Administrative Code (2003). 3. AHCA, Agency for Health Care Administration, has jurisdiction over Respondent pursuant to Chapter 400, Part III, Florida Statutes (2003). 4. Venue lies in Pasco County, Division of Administrative Hearings, pursuant to Section 120.57, Florida Statutes (2003), and Chapter 28, Florida Administrative Code (2003). PARTIES 5. Agency for Health Care Administration, State of Florida, is the enforcing authority with regard to assisted living facility licensure law pursuant to Chapter 400, Part III, Florida Statutes (2003) and Rules 58A-5, Florida Administrative Code (2003). 6. Respondent is an assisted living facility located at 7211 Beaconwoods Drive, Hudson, FL 34667. Respondent is, and was at all times material hereto, a licensed facility under Chapter 400, Part III, Florida Statutes (2003) and Chapter 58A- 5, Florida Administrative Code (2003), having been issued license number 10115. COUNT I RESPONDENT FAILED TO MAINTAIN AN UP-TO-DATE RECORD OF MAJOR INCIDENTS OCCURRING WITHIN THE LAST 2 YEARS. Fla. Admin. Code R.58A-5.024(1) (d) (2003) Fla. Admin. Code R.58A-5.0182 (1) (e) (2003) Fla. Admin. Code R. 58A-5.0131(20) (2003) Section 400.441(1) (e), F.S. (2003) UNCORRECTED CLASS IV DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 9. Based on review of available documentation and on interview with facility staff, Respondent failed to maintain an up-to-date record of major incidents occurring within the last two years. Findings: 1. A review was made of Resident #1’s file-the file contained medical records indicating that the resident sustained a fall resulting in injuries (fractured wrist and ribs) which occurred on June 13, 2003. However, the record did not contain any record of the fall itself. When asked, in the facility dining room on August 11, 2003, at 11:10 a.m., if the facility had any actual documentation relating to the fall, the facility manager replied that she thought an incident report had been completed. However, it could not be found. 10. Respondent was provided a mandated correction date of September 11, 2003. 11. On or about October 3, 2003, a follow-up survey was conducted at Respondent’s facility. 12. Based on a review of available documentation and interview with facility staff, Respondent failed to maintain an up-to-date record of major incidents occurring within the last two years. ue Findings: A review was made of Resident #1's file-the file contained medical records indicating that the resident sustained a fall resulting in injuries (fractured wrist and ribs) which occurred on June 13, 2003. However, the record did not contain any record of the fall itself. When asked, in her office on October 3, 2003, at 10:50 am., if the facility had any actual documentation relating to the fall, the Administrator acknowledged that an incident report could not be found and produced the facility "communication book.” However, the entry in the "communication book" merely stated that the resident had been transferred to the hospital with his/her injuries. 13. The above actions or inactions are a violation of Rule 58A-5.0131(19), Florida Administrative Code, which requires an up-to-date record of major incidents occurring within the last 2 years must be maintained and contain: a. A clear description of the incident; b. The time, place, names of individuals involved; c. Witnesses; d. Nature of injuries; e. Cause, if Known; f. Action taken; g. A description of medical or other services provided; h. By whom such services were provided; i. Any steps taken to prevent recurrence. These reports must be made by individuals having first hand knowledge of the incidents, including paid staff, volunteer staff, emergency and temporary staff, and student interns. 14. Said violation constitutes the grounds for the imposed uncorrected Class IV deficiency in that it does not threaten the health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (ad), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of one hundred dollars ($100). COUNT II RESPONDENT FAILED TO ENSURE THAT RESIDENT CONTRACTS CONTAINED A PROVISION GIVING AT LEAST 30 DAYS’ WRITTEN NOTICE PRIOR TO ANY RATE INCREASE. Fla. Admin. Code R.58A-5.025(1) (d) (2003) UNCORRECTED CLASS III DEFICIENCY 15. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 16. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 17. Based on a review of available documentation, one of three resident contracts reviewed lacked the provision giving at least thirty days written notice prior to any rate increase. Findings: The contract of Resident #1 was reviewed and was found to contain a clause that "Braybrook will inform resident or responsible party of rate changes, in writing, thirty days prior to rate change." However, the contract also contains a provision that "In the event a resident is admitted into Hospice... the monthly rate would increase by 20% on the day the resident is admitted. If admitted into Hospice in the middle of the month, the remaining days would be prorated." This “hospice clause" does not provide for giving the resident 30 days’ notice of rate increase. 18. Respondent was provided a mandated correction date of September 11, 2003. 19. On or about October 3, 2003, a survey was conducted at Respondent’s facility. 20. Based on a review of available documentation, one of three resident contracts lacked the provision giving at least thirty days written notice prior to any rate increase. Findings: The contract of Resident #1 was reviewed and was found to contain a clause that "Braybrook will inform resident or responsible party of rate changes, in writing, thirty days prior to rate change." However, the contract also contains a provision that "In the event a resident is admitted into Hospice... the monthly rate would increase by 20% on the day the resident is admitted. If admitted into Hospice in the middle of the month, the remaining days would be prorated.” This "hospice clause” does not provide for giving the resident 30 days’ notice of rate increase. In an interview conducted in her office on October 3, 2003, at 10:55am, the Administrator stated that although new a contract had been drafted, the contract currently being used had not been changed or replaced as the Administrator wasn't "an attorney and didn't want to write the wrong thing." 21. The above actions or inactions are a violation of Rule 58A-5.025(1) (d), Florida Administrative Code (2003), which requires that each resident contract contain a provision giving at least 30 days written notice prior to any rate increase. 22. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (ce), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT III RESPONDENT FAILED TO ENSURE THAT EACH RESIDENT CONTRACT CONTAINS A REFUND POLICY. Fla. Admin. Code R.58A-5.025(1) (g) (2003); Section 400.424(3), Florida Statutes (2003) UNCORRECTED CLASS III DEFICIENCY 23. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 24. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 25. Based on a review of available documentation, none of three resident contracts reviewed contained a refund policy, which provided for refund of any unused portion of payment to the resident’s beneficiary in case of death of the resident. Findings: The contracts of Residents #1, #2 and #3 contained a clause which reads, "In the event of death or discharge due to medical reasons determined by the resident’s doctor, the notice of termination is waived and there would be no refund (sic)." 26. Respondent was provided a mandated correction date of September 11, 2003. 27. On or about October 3, 2003, a survey was conducted at Respondent’s facility. 28. Based on a review of available documentation, none of the three of four resident contracts reviewed contained a refund policy, which provided for refund of any unused portion of payment to the resident’s beneficiary in case of death of the resident. Findings: The contracts of Residents #1, #2 and #3 contained a clause which reads, "In the event of death or discharge due to medical reasons determined by the residents doctor, the notice of termination is waived and there would be no refund (sic)." In an interview conducted in her office on October 3, 2003, at 10:55am, the Administrator stated that although new a contract had been drafted, the contract currently being used had not been changed or replaced as the Administrator wasn't "an attorney and didn't want to write the wrong thing.” 29. The above actions or inactions are a violation of Rule 58A-5.025(1) (g), Florida Administrative Code (2003), which requires pursuant to Section 400.424, F.S., each resident or the resident's legal representative shall, prior to or at the time of admission, execute a contract with the facility which contains a refund policy which shall conform to Section 400.424(3), F.S. 30. Additionally, Section 400.424 (3), Florida Statutes (2003), provides that the contract shall include a refund policy to be implemented at the time of a resident's transfer, discharge, or death. The refund policy shall provide that the resident or responsible party is entitled toa prorated refund based on the daily rate for any unused portion of payment beyond the termination date after all charges, including the cost of damages to the residential unit resulting from circumstances other than normal use, have been paid to the licensee. 31. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT IV RESPONDENT FAILED TO OBTAIN COMPLETED HEALTH ASSESSMENT FOR RESIDENT. Fla. Admin. Code R.58A-5.0181(2) (a) (2003) UNCORRECTED CLASS IV DEFICIENCY 32. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 33. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 34. Based on a review of available documentation, the file of one of three residents did not contain a medical examination report based on an examination conducted within 60 days prior to, or 30 days after the residents’ admission to the facility. Findings: Resident #3 was admitted to the facility on October 15, 2002; however, the health assessment in the resident's file was undated and unsigned. 35. Respondent was provided a mandated correction date of September 11, 2003. 36. On or about October 3, 2002, a survey was conducted at Respondent’s facility. 37. Based on a review of available documentation, the file of one of three residents did not contain a medical examination report based on an examination conducted within 60 days prior to, or 30 days after the residents’ admission to the facility. Findings: Resident #3 was admitted to the facility on October 15, 2002; however, the health assessment in the resident's file was undated and unsigned. In an interview with the Administrator in her office on October 3, 2003, at 11:15am, she stated that the Resident's health assessment had been "sent over" to be signed, but that a signed copy had not yet been received in the facility. 38. The above actions or inactions are a violation of Rule 58A-5.0181(2) (a), Florida Administrative Code (2003), which requires that, within 60 days prior to the resident’s admission to a facility, but no later than 30 days after admission, the individual shall be examined by the physician or advanced registered nurse practitioner who shall provide the administrator with a medical examination report, or a copy of the report. 39. Said violation constitutes the grounds for the imposed uncorrected Class IV deficiency in that it does not threaten the health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (ad), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of one hundred dollars ($100). COUNT V RESPONDENT FAILED TO OBTAIN REQUIRED NUMBER OF CONTINUING EDUCATION HOURS. Fla. Admin. Code R.58A-5.0191(1) (c) (2003); Section 400.452(4), Florida Statutes (2003) UNCORRECTED CLASS III DEFICIENCY 40. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 41. On or about August 3, 2003, a biennial survey was conducted at Respondent’s facility. 42. Based on a review of available documentation and on interview with staff, the facility Administrator has not participated in 12 hours of continuing education, in topics related to assisted living, in the last two years. Findings: A review was made of the Administrator's personnel file and was found to lack documentation of the required number of continuing education hours. When asked, in her office on August 11, 2003, at 12:45 p.m., the Administrator acknowledged that she has not obtained 12 continuing education hours in assisted living topics in the last two years. 43. Respondent was provided a mandated correction date of September 11, 2003. 44. On or about October 3, 2003, a follow-up survey was conducted at Respondent’s facility. 45. Based on a review of available documentation and on interview with staff, the facility Administrator has not participated in 12 hours of continuing education, in topics related to assisted living, in the last two years. Findings: When asked, in her office on October 3, 2003, at 11:45am, whether she had received the requisite 12 hours of continuing cducation in assisted living topics, the Administrator presented certificates indicating she had received training in depression, infection control, HIPPA and assistance with self-administration of medications. However, the trainings constituted only seven of the required 12 hours; the Administrator acknowledged that she has not obtained 12 continuing education hours in assisting living, stating that not enough trainings had been available in the fifty days since the deficiency was previously cited. 46. The above actions or inactions are a violation of Rule 58A-5.0191(1) (c), Florida Administrative Code (2003), which requires administrators and managers to participate in 12 hours of continuing education in topics related to assisted living every 2 years as provided under Section 400.452, Florida Statutes (2003). 47. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT VI RESPONDENT FAILED TO CONDUCT LEVEL 1 BACKGROUND SCREENING ON EMPLOYEES. Fla. Admin. Code R.58A-5.019(3) (2002) SECTION 400.4174(2), F.S. (2002) UNCORRECTED CLASS III DEFICIENCY 48. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 43. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 50. Based on interview with facility staff and on a review of the employee files of four individuals who perform personal services, Respondent failed to obtained Level 1 background screenings for two employees. Findings: The files of two employees, dates of hire February, 2003 and June, 2003, respectively, were reviewed and neither file contained documentation of a successful completion of the Level 1 background screening. When asked about this, in her office on August 11, 2003, at 12:50 p.m., the Administrator acknowledged that she did not have the required information, but stated that she had recently submitted the request on one of the two employees. 51. Respondent was provided a mandated correction date of September 11, 2003. 52. On or about October 3, 2003, a follow-up survey was conducted at Respondent’s facility. 53. Based on interview with facility staff and on a review of the employee files of four individuals who perform personal services, Respondent failed to obtained Level 1 background screenings for two employees. Findings: The files of two employees, dates of hire February, 2003 and September, 2003, respectively, were reviewed and neither file contained documentation of successful completion of the Level 1 background screening. When asked about this, in her office on October 3, 2003, at 11:25am, the Administrator acknowledged that she did not have the required information, but stated that she had recently submitted the request on one of the two employees; she also stated that the other employee was employed at another facility and that a Level 1 background screening had been done for the employee there; however, the Administrator acknowledged that she did not have a copy of the report and had not requested one. 54. The above actions or inactions are a violation of Rule 58A-5.019(3), Florida Administrative Code (2003), which requires that all employees hired on or after October 1, 1998, who perform personal services to residents, must be screened in accordance with Section 400.4174, Florida Statutes (2003), and meet the screening standards of Section 435.03, Florida Statutes (2003). 55. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT VII RESPONDENT FAILED TO ENSURE THAT AT LEAST ONE STAFF MEMBER, WHO IS TRAINED IN FIRST AID AND CPR, IS WITHIN THE FACILITY AT ALL TIMES WHEN RESIDENTS ARE IN THE FACILITY. Fla. Admin. Code 58A-5.019(4) (a)4 (2003) UNCORRECTED CLASS III DEFICIENCY 56. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 57. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 58. Based on a review of four employees’ files, the files of two employees who, at times, are the sole employees in the facility, did not contain documentation of their respective training in First Aid. Findings: The First Aid certification of the Manager, who works during the day, but is at times, the sole employee in the building, was found to have expired in May, 2002; there was no First Aid certification for an overnight employee, date of hire June, 2003. 59. Respondent was provided a mandated correction date of September 11, 2003. 60. On or about October 3, 2003, a survey was conducted at Respondent’s facility. 61. Based on a review of four employees files, the files of two employees who, at times, are the sole employees in the facility did not contain documentation of their respective training in First Aid. Findings: The First Aid certification of the Manager, who works during the day, but is at times, the sole employce in the building, was found to have expired in May, 2002. There was also no First Aid or CPR documentation for one individual who was the sole employee in the facility upon entry on October 3, 2003, at 10:15am. When this was brought to the attention of the Administrator in her office on October 10, 2003, at 11:20am, she stated that the employee worked in another facility and that the employee was properly certified, but acknowledged that she did not have a copy of the certification and that she had not seen the original cards. 62. The above actions or inactions are a violation of Rule 58A-5.019(4) (a)4, Florida Administrative Code (2003), which requires that at least one staff member who is trained in First Aid and CPR, as provided under Rule 58A-5.0191, Florida Administrative Code (2003), is within the facility at all times when residents are in the facility. 63. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT VIII RESPONDENT FAILED TO MAINTAIN A WRITTEN WORK SCHEDULE WHICH REFLECTS THE FACILITY’S 24-HOUR STAFFING PATTERN FOR A GIVEN TIME PERIOD. Fla. Admin. Code R.58A-5.019(4) (c) (2003) UNCORRECTED CLASS IV DEFICIENCY 64. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 65. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 66. Based on a review of available documentation and on interview with facility staff, Respondent failed to maintain a written work schedule which reflects the facility’s 24-hour staffing pattern for a given time period. Findings: The facility manager was asked for a copy of the current schedule on August 11, 2003, at 10:00 a.m.; she replied that one had not been completed, but that it was "being worked on." The schedule was reviewed and was noted to be incomplete. 67. Respondent was provided a mandated correction date of September 11, 2003. 68. On or about October 3, 2003, a survey was conducted at Respondent’s facility. 69. Based on a review of available documentation and on interview with facility staff, Respondent failed to maintain a written work schedule which reflects the facility’s 24 hour staffing pattern for a given time period. Findings: The facility Administrator was asked for a copy of the current schedule, in her office on October 3, 2003, at 11:30am; she replied that she did not have one for review as the facility manager was "still working on it.” 70. The above actions or inactions are a violation of Rule 58A-5.019(4) (c), Florida Administrative Code (2003), which requires a facility to maintain a written work schedule which reflects the facility’s 24-hour staffing pattern for a given time period. 71. Said violation constitutes the grounds for the uncorrected Class IV deficiency in that it does not threaten the health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (d), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of one hundred dollars ($100). COUNT IX RESPONDENT FAILED TO MAINTAIN AN ACCURATE MEDICATION OBSERVATION RECORD (MOR). Fla. Admin. Code R.58A-5.0185(5) (b) (2003) UNCORRECTED CLASS IV DEFICIENCY 72, AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 73. On or before August 11, 2003, a biennial survey was conducted at Respondent’s facility. 74. Based on a review of available documentation and on interview with facility staff, Respondent failed to maintain a daily, up-to-date medication observation record (MOR) for three of three residents. Findings: 1. The MOR’s of Residents #1, #2 and #3 were reviewed; all three MORs lacked notations of medications which were to be given to the resident during the morning shifts of July 28, 2003, July 30, 2003, and July 31, 2003. 2. The MOR of Resident #2 indicated that the resident is to receive one can of MS Complete Nutrition Drink three times a day; however, there were no entries to indicate the resident received the medication as prescribed for dates July 17, 2003 — August 9, 2003 inclusive. When asked about this on August 11, 2003, at 10:45 a.m., the facility manager stated that the facility had decided to stop giving the resident this supplement as his/her weight had improved; however, a review of the resident's file did not reveal a physician's order to discontinue the medication. 75. Respondent was provided a mandated correction date of September 11, 2003. 76. On or about October 3, 2003, a follow-up survey was conducted at Respondent’s facility. 77. Based on a review of available documentation and on interview with facility staff, Respondent failed to maintain a daily up-to-date medication observation record (MOR) for three of three residents. Findings: 1. The MORs of Residents #1, #2 and #3 were reviewed; none of the three MORs had any entries indicating that medications which were to be given to those residents on August 29, 2003 were actually given to the residents. When asked about this, in her office on October 3, 2003, at 11:35am, the Administrator stated that there had been an outing on that date and that the residents "didn't miss them, we just didn't enter it (on the MOR)." 2. Additionally, Resident #1's MOR was noted to lack entries for the following medications on September 10, 2003 and September 11, 2003: alprazolam .Smg 1/2 bid Zoloft 100mg qd Singulair 10 mg qhs Lasix 40 mg qd potassium chloride 20 meq qd Lipitor 10mg qd and for Theophylline ER 200 mg bid on 9/3, 9/4, 9/5, 9/8, 9/10, 9/10, 9/29 and 9/30. 3. Resident #2's MOR was noted to lack entries for the medication Risperdal .Smg qpm on September 10, Scptember 11, and October, 2002. 78. The above actions or inactions are a violation of Rule 58A-5.0185(5) (b), Florida Administrative Code (2003), which requires the facility to maintain a daily up-to-date, medication observation record (MOR) for each resident who receives assistance with self-administration or medication administration. 79. Said violation constitutes the grounds for the imposed uncorrected Class IV deficiency in that it does not threaten the health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (d), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of one hundred dollars ($100). COUNT X RESPONDENT FAILED TO COMPLY WITH THE RESIDENT BILL OF RIGHTS. Section 400.428(1), Florida Statutes (2003) UNCORRECTED CLASS III DEFICIENCY 20 80. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 81. On or about August 11, 2003, a biennial survey was conducted at Respondent’s facility. 82. Based on a review of available documentat ion, Respondent failed to comply with the Resident Bill of Rights by requiring the resident to forego certain contractual rights. Findings: I. The contracts of Residents #1, #2 and #3 were reviewed and were found to contain the following provision: "It is Braybrooks (sic) policy that under no circumstances will a resident or responsible party hire an employee for any services required for the resident of Braybrook and or responsible party for the period of up to six months after discharge of the resident. The resident and or responsible party agree to pay all legal fees if they voile (sic) this policy.” A former resident may not be restricted in his/her personal contracts with others. 2. Resident #1's contract was reviewed and was found to contain a provision whereby if the resident's account becomes delinquent by more than 15 days, the resident must provide a security deposit; if the security deposit is not made on the 16th day, the facility will give the resident a 45-day notice of discharge. However, the contract then provides that the "Resident waives all recourse to any legal action to stay such a discharge." The Resident may not be required to forgo his/her legal rights. 83. Respondent was provided a mandated correction date of September 11, 2003. 84. On or about October 3, 2003, a follow-up survey was conducted at Respondent's facility. 21 85. Based on a review of available documentation, Respondent failed to comply with the Resident Bill of Rights by requiring the resident to forego certain contractual rights. Findings: |. The contracts of Residents #1, #2 and #3 were reviewed and were found to contain the following provision: "It is Braybrooks (sic) policy that under no circumstances will a resident or responsible party hire an employee for any services required for the resident of Braybrook and or responsible party for the period of up to six months after discharge of the resident. The resident and or responsible party agree to pay all legal fees if they voile (sic) this policy.” A former resident may not be restricted in his/her personal contracts with others. 2. Resident #1's contract was reviewed and was found to contain a provision whereby if the resident's account becomes delinquent by more than 15 days, the resident must provide a security deposit; if the security deposit is not made on the 16th day, the facility will give the resident a 45-day notice of discharge. However, the contract then provides that the "Resident waives all recourse to any legal action to stay such a discharge." The Resident may not be required to forgo his/her legal rights. In an interview conducted in her office on October 3, 2003, at 10:55am, the Administrator stated that although new a contract had been drafted, the contract currently being used had not been changed or replaced as the Administrator wasn't "an attorney and didn't want to write the wrong thing." 86. The above actions or inactions are a violation of Section 400.428(1), Florida Statutes (2003), which requires the facility to comply with the Resident Bill of Rights. 87. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes (2003), the Agency is 22 authorized to impose a fine in the amount of five hundred dollars ($500). 88. Pursuant to Section 400.419(9), Florida Statutes (2003), AHCA is authorized to, in addition to any administrative fines, assess a survey fee equal to the lesser of one-half of the facility’s biennial license and bed fee, or $500, to cover the cost of conducting the initial complaint investigations that result in the finding of a violation that was the subject of the complaint, or for monitoring visits conducted under 400.428(3) (c), Florida Statutes (2003), to verify the correction of the violations. In this case, AHCA is authorized to request a survey fee in the amount of $500. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration requests the Court to order relief with a fine against the Respondent pursuant to Sections 400.419(1) (c) and (d) and 400.419(9), Florida Statutes (2003), in the amount of three thousand nine hundred dollars ($3,900). 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). 23 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, Katrina D. Lacy, Esqu?7 AHCA - Senior Attorne Fla. Bar No. 0277400 525 Mirror Lake Drive North, St. Petersburg, Florida 33701 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished via U.S. Certified Mail Return Receipt No. 7003 1010 0003 4303 8777 to Eunice Sullivan, Owner/Administrator, Braybrook, 7211 Beaconwoods Drive, Hudson, FL 34667 dated on January [S 7 2004. atrina D. Lacy, Esqus 24 Copies furnished to: Bunice Sullivan Owner/Administrator Braybrook 7211 Beaconwoods Drive Hudson, FL 34667 (Certified U.S. Mail) Katrina D. Lacy AHCA ~- Senior Attorney 525 Mirror Lake Drive Suite 330G St. Petersburg, Fl 33701 25

Docket for Case No: 04-001196