» ® (Certified Mail Receipt (7001 0360 0003 3804 6098) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, ~~ i f 5 7-1 [->47% ex AHCA NO.: 2004006752 2004007233 Petitioner, vs. THE MANOR AT GAINESVILLE, INC., Respondent. a / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against THE MANOR AT GAINESVILLE, INC., (“The Manor At Gainesville, Inc.”), pursuant to Section 120.569, and 120.57, Fla. Stat. (2004), alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Manor At Gainesville, Inc., pursuant to Section 400.23(8)(b), Fla. Stat. (2004), 42 C.F.R 483.25, and Section 59A-4.1288, Fla. Admin. Code (2004), The Agency also intends to impose a conditional rating effective July 1, 2004, pursuant to Section 400.23(7), Fla. Stat. (2004) case no. 2004007233. JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2004). 3. Venue lies in Alachua County, Gainesville, Florida, pursuant to Section 120.57, Florida Statutes (2004), and Chapter 59A4, Florida Administrative Code (2004). 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing skilled nursing facilities pursuant to Chapter 400, Part Il, Fla. Stat. (2004), and Chapter 59A4 Florida Administrative Code. 5. The Manor At Gainesville, Inc. is a for-profit corporation, whose 120-bed nursing home is located at 1000 S.W. 16" Avenue, Gainesville, Florida. The Manor At Gainesville, Inc. is licensed as a skilled nursing facility license #SNF10050951; certificate number 11584, effective July 1, 2004 through April 30, 2005. The Manor At Gainesville, Inc. was at all time material hereto, a licensed facility under the licensing authority of AHCA, and requested to comply with all applicable rules, and statutes. COUNT 1 THE MANOR AT GAINESVILLE, INC. FAILED TO PROVIDE THE NECESSARY TREATMENT AND SERVICES TO ALLEVIATE PAIN AND TREAT A WOUND IN ACCORDANCE WITH PHYSICIAN’S ORDER’S FOR 1 OF 24 (#19) SAMPLED LURE TO PROVIDE NECESSARY TREATMENTS AS ORDERS SED THE RESIDENT TO EXPERIENCE SEVERE FEDERAL TAG F309-QUALITY OF CARE Section 42 C.F.R. 483.25(a)-(m) QUALITY OFC ARE Section 400.23(8)(b), Fla. Stat. (2004) RULES; EVALUATION AND DEFICIENCIES; LICENSURE STATUS Section 59A-4.1288, Fla. Stat. (2004) EXCEPTION 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about July 1, 2004, AHCA conducted a licensure and recertification survey at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) The Manor At Gainesville, Inc. failed to provide the necessary treatment and services to alleviate pain and treat a wound in accordance with physician’s orders for 1 of 24 (#19) sampled residents. Failure to provide necessary treatments 2S ordered and to alleviate pain caused the resident to experience severe pain and anguish. 8. The above constitutes a violation of 42 C-F.R. 483.25, requiring that each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, . in accordance with the comprehensive assessment and plan of care. 9. The above constitutes a violation of 400.23(7), Fla. Stat. (2004), requiring that the agency shall, at least every 15 months, evaluate all nursing home facilities and make a determination as to the degree of compliance by each licensee with the established rules adopted under this part as a basis for assigning a licensure status to that facility. The agency shall base its evaluation on. the most recent inspection report, taking into consideration findings from other official reports, surveys; interviews, investigations, and inspections. The agency shall assign a licensure status of standard or conditional to each nursing home. 10. | The above constitutes a violation of 400.23(8)(b), Fla. Sat. (2004), requiring that a class Il deficiency is a deficiency that the agency determines has compromised the resident’s ability to maintain or reach his or her highest practicable physical, mental, and \ . psychosocial well-being, as defined by an accurate and comprehensive resident asséssment, plan of care, and provision of services. A class Il deficiency is subject to a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and $7,500 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class Il deficiencies during the last annual inspection OT any inspection OF complaint investigation since the ‘last annual inspection. A fine shall be levied notwithstanding the correction of the deficiency. 11... The above constitutes a violation of Section 59A-4.1288, Fla. Admin. Code (2004), requiring that nursing homes that participate. in Title XVIII must follow certification rules and regulations found. in 42 C.F.R. 483, Requirements for Long Térm . Care Facilities, September 26, 1991, which incorporated by reference. Non-certified facilities must follow the contents of this rule and the standards contained in the Conditions of Participation found in 42 C.E.R 483, Requirements for Long Term Care Facilities, September 26, 1991, which is incorporated by reference with respect to social services, dental services, infection control, dietary and the therapies. 12. The violation alleged herein constitutes a class Il deficiency, and warrants a fine of $2,500. WHEREFORE, ahca demands the following relief: 1. Each factual and legal findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of 2,500. a right to request an administrative hearing pursuant Respondent is notified that they have to 120.57, Florida Statutes (2004). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael Mathis, Senior Attorney. RESPONDENT IS FURTHER NOTIFIED THAT .THE FAILURE TO REQUEST 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. Respectfully Submitted this / S ts, of Begest 2004, Leon County, Tallahassee, Florida. Michael O. Mathis Fla. Bar. No. 0325570 Counsel for Petitioner, Agency for HealthCare Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 413-9313 (fax) Kriste Mennella Lealand McCharen Agency for Health Care Administration CERTIFICATE OF SERVICE . d correct copy of the foregoing has been served I HEREBY CERTIFY yy, a true an by certified mail on LE ge _ day of Avy - 1000 S.W. 16" Avenue, Gainesville, Gainesville, 2004 to: Darwin Olivent, Administrator, The Manor At Gainesville, Florida 32601 aDariaby Michael O. Mathis, Esq.

Docket for Case No: 04-003373