Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: ANDIES, INC., D/B/A WILLOW MANOR RETIREMENT HOME
Judges: PATRICIA M. HART
Agency: Agency for Health Care Administration
Locations: Fort Lauderdale, Florida
Filed: Aug. 04, 2004
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, November 3, 2004.
Latest Update: Sep. 04, 2024
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Petitioner, AHCA No.: 2004004328
Return Receipt Requested:
v. 7002 2410 0001 4237 7392
7002 2410 0001 4237 7408
ANDIES, INC. d/b/a WILLOW MANOR
RETIREMENT HOME Oe ( OT! (,
Respondent. ‘
ADMINISTRATIVE COMPLAINT
COMES NOW the Agency for Health Care Administration
(“AHCA”), by and through the undersigned counsel, and files this
administrative complaint against Andies, Inc. d/b/a Willow Manor
Retirement Home (hereinafter “Willow Manor Retirement Home”),
pursuant to Chapter 400, Part III, and Section 120.60, Florida
Statutes, (2003), and alleges:
NATURE OF THE ACTION
1. This is an action to impose an administrative fine of
$10,000.00 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 Broward 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 (2003) and Chapter 58A-5 Florida
Administrative Code.
5. Willow Manor Retirement Home operates a 165-bed
assisted living facility located at 150 Stirling Road, Dania,
Florida 33004. Willow Manor Retirement Home is licensed as an
assisted living facility under license number 6122. Willow Manor
Retirement Home 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
WILLOW MANOR RETIREMENT HOME FAILED TO PROVIDE PERSONAL
SUPERVISION FOR A RESIDENT, INCLUDING GENERAL AWARENESS OF
RESIDENT’S WHEREABOUTS.
RULE 58A-5.0182(1) (b) and (c), FLORIDA ADMINISTRATIVE CODE
(RESIDENT CARE STANDARDS)
CLASS I VIOLATION
6. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
7. Willow Manor Retirement Home was cited with one (1)
Class I deficiency due to a resident elopement/death appraisal
conducted on January 20, 2004.
8. Based on a resident-elopement/death appraisal visit
conducted on January 20, 2004 and based on record review and
interview, the facility did not provide personal supervision,
including general awareness for one of three residents in the
sample (Resident #1). The findings are as follows.
9. On the morning of 1/16/04, Resident #1, who had a
diagnosis of dementia, eloped from the facility and was hit by a
car and died around 10:45 AM. The Medication Observation Record
on 1/16/04 showed the resident's three 12:00 PM medications and
one 1 PM medication were not given. On 1/20/04 at 9:35 AM, the
Administrator stated the nurse assisting with these medications
was aware the resident had missed the medications but did not
follow-up on the resident's absence because of the nurse became
busy meeting the needs of other residents. The facility
continued in not being generally aware of this resident’s
absence until after the evening meal. Based on the facility's
notes, the resident was not present at the evening meal. The
nurse checked his room and hallway. As the nurse was calling the
front desk to inquire where the resident could be, the
resident's daughter appeared asking for her father stating that
the FHP had called the family to report he had been hit and
killed.
10. The mandated correction date was designated as
February 19, 2004.
11. Based on a revisit survey conducted on April 6, 2004
and based on additional information, record review, and
interview, the facility failed to provide appropriate
supervision for a confused resident as evidenced by the staff
being unaware that the resident was missing during the noon time
meal and yet not searching for the resident until dinner time.
In addition, it could not be determined that the resident was
wearing the secure alarm system ankle bracelet, as the facility
had no system in place to ensure that it was being functional
and being utilized. The findings are as follows.
12. Resident #1 was admitted to the facility on 05/05/03.
The admission health assessment dated 05/12/03 documented that
the resident was memory impaired. The resident was independent
for ambulation, and independent for dressing, eating,
transferring, and toileting, but required assistance for
bathing. The resident was not in a room in the locked dementia
unit. The record further documents that the resident was visited
on a regular basis by both the primary physician and the
psychiatrist. The last changes in the medications were in
November when the resident had an episode of agitation. The
psychiatrist documented on 01/15/04 that the resident was
"alert, wanders looking for wife, less agitated."
13. The November monthly summary completed by staff
documented that the resident was of independent ambulation,
continent, had only occasional inappropriate responses,
confused, poor memory, wanders, normal speech, interacts with
peers. "Very nice person but confused and wanders around."
14. During review of the MOR, it was noted that on
01/16/04, the resident did not receive noontime medications or
dinnertime medications. The nurses’ notes documented that the
resident was not present at the evening meal and so they checked
the resident's room. When the resident could not be located, the
nurse instituted a search. When she started to call the family,
the daughter arrived at the facility asking for her father, and
stating that the family had been told by law enforcement that
the resident had been hit by a car and died as a result.
15. Interview with the administrator revealed the
following: While the resident was diagnosed with Dementia, the
facility evaluated the resident as knowing his name, knowing
staff names, being continent, no elopement behavior and so able
to reside in the main part of the building and not requiring the
more costly Alzheimer's wing.
16. The CNA is responsible for being aware of the
resident's whereabouts, however on 01/16/04 she was given an
extra assignment. The nurse who noted that the resident was not
present for lunch medications became distracted and did not
follow-up on his absence. The dining room staff who also noted
the resident's unusual absence from lunch was going to check on
the resident, but instead became sidetracked assisting another
resident and so did not follow-up on his absence. According to
staff interviews and record reviews, the resident was aware of
his name and names of staff. He knew where the dining room was
and where his room was.
17. The administrator reported that at the time of the
incident there was a receptionist at the front door, but that
the front door was not kept locked. The resident would
frequently go to the front desk and ask for his wife. The
receptionist would call the wife for the resident to speak to
her. According to the administrator, the resident never tried to
leave by the front door.
18. The resident's record contained a form titled "ALF
Resident Monitoring System." The form was noted to be signed by
the resident's wife and dated 05/05/03. This form stated that a
6
secure alarm ankle bracelet would be provided to the resident at
no charge. However, further record review revealed that there
was no mention of the ankle bracelet including whether the
resident was wearing it or not. The administrator could not
explain how the staff would ensure that the bracelet (which
worked by triggering the front door to lock) was being worn by
the resident.
19. The administrator reported that the resident must have
left the facility sometime after breakfast. The search for the
resident did not start until after 5pm even though several staff
throughout the day noticed he was missing. The resident was
fatally hit by a car that morning.
20. Based on the foregoing, Willow Manor Retirement Home
violated Rule 58A-5.0182(1)(b) and (c), Florida Administrative
Code, herein classified as a Class I violation, which warrants
an assessed fine of $10,000.00.
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 Willow Manor Retirement Home on
count I.
2. Assess an administrative fine of $10,000.00 against
Willow Manor Retirement Home on Count I for the violation cited
above.
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 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 (2003). 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
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 ORD BY THE AGENCY.
Assistant General Counsel
Agency for Health Care
Administration
8350 N.W. 52 Terrace - #103
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)
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 Maryann Signore, Willow Manor Retirement
Home, 150 Stirling Road, Dania, Florida 33004; Mary Ann Signore,
210 SAE. 2™ Terrace, Dania, Florida 33004 on this [Sth day of
{ur - 2004.
’
Margaret
Docket for Case No: 04-002716
Issue Date |
Proceedings |
Jun. 22, 2005 |
Final Order filed.
|
Nov. 03, 2004 |
Order Closing File. CASE CLOSED.
|
Nov. 02, 2004 |
Agreed Motion to Close File (filed by Petitioner via facsimile).
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Oct. 21, 2004 |
Petitioner`s Supplemental Response to Respondent`s Request for Production (filed via facsimile).
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Oct. 13, 2004 |
Amended Notice of Hearing (hearing set for November 16 and 17, 2004; 9:00 a.m.; Fort Lauderdale, FL; amended as to dates and location of hearing).
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Oct. 11, 2004 |
Order Denying Respondent`s Motion for Summary Judgment.
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Oct. 07, 2004 |
Notice of Taking Depositions Duces Tecum (J. McKee and A. Thomas) via efiling by Dominick Graziano.
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Oct. 06, 2004 |
Notice of Taking Deposition Duces Tecum (S. Powell) filed via facsimile.
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Sep. 29, 2004 |
Respondent, Andies, Inc. d/b/a Willow Manor Retirement Home`s, Supplemental Response to Petitioner`s First Set of Interrogatories (filed via facsimile).
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Sep. 29, 2004 |
Respondent, Andies, Inc. d/b/a Willow Manor Retirement Home`s, Supplemental Response to Petitioner`s Request for Production (filed via facsimile).
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Sep. 28, 2004 |
Petitioner`s Response to Respondent`s Request for Production (filed via facsimile).
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Sep. 28, 2004 |
Petitioner`s Response to Respondent`s Request for Admissions (filed via facsimile).
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Sep. 28, 2004 |
Notice of Service of Petitioner`s Response to Respondent`s Request for Admissions and Production (filed via facsimile).
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Sep. 27, 2004 |
Respondent, Andies, Inc. d/b/a Willow Manor Retirement Home`s, Response to Petitioner`s Request for Production filed.
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Sep. 27, 2004 |
Respondent, Andies, Inc. d/b/a Willow Manor Retirement Home`s, Response to Petitioner`s Request for Admissions filed.
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Sep. 27, 2004 |
Respondent, Andies, Inc. d/b/a Willow Manor Retirement Home`s, Notice of Serving Response to Petitioner`s First Set of Interrogatories filed.
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Sep. 24, 2004 |
Petitioner`s Opposition to Respondent`s Motion for Summary Judgement (filed via facsimile).
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Sep. 20, 2004 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for November 17 and 18, 2004; 9:30 a.m.; Lauderdale Lakes, FL).
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Sep. 17, 2004 |
Motion for Continuance (filed by Petitioner via facsimile).
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Sep. 17, 2004 |
Respondent`s Motion for Summary Judgment filed.
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Aug. 25, 2004 |
Notice of Service of Petitioner`s First Set of Request for Admissions, Interrogatories, and Request for Production of Documents (filed via facsimile).
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Aug. 24, 2004 |
Order of Pre-hearing Instructions.
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Aug. 24, 2004 |
Notice of Hearing (hearing set for October 7 and 8, 2004; 9:30 a.m.; Lauderdale Lakes, FL).
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Aug. 18, 2004 |
Amended Response to Initial Order (filed by Petitioner via facsimile).
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Aug. 12, 2004 |
Response to Initial Order (filed by Petitioner via facsimile).
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Aug. 05, 2004 |
Initial Order.
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Aug. 04, 2004 |
Election of Rights for Administrative Complaint filed.
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Aug. 04, 2004 |
Response to Administrative Complaint and Request for Formal Hearing Pursuant to 120.57(1) Florida Statues filed.
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Aug. 04, 2004 |
Administrative Complaint filed.
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Aug. 04, 2004 |
Notice (of Agency referral) filed.
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