STATE OF FLORIDA a AGENCY FOR HEALTH CARE ADMINISTRATION pbk 20h CEC 20 P 12 So AGENCY FOR HEALTH CARE ADMINISTRATION, WISE CERTIFIED MAIL # 7003 1010 0000-9716 1226 Petitioner, 7003 1010 0000 9716 1233 ° vs. Case No. 2004008603 HARBORCHASE OF GAINESVILLE, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through its undersigned counsel, and files this Administrative Complaint against Harborchase Of Gainesville (hereinafter referred to as “Respondent”) pursuant to Fla. Stat. Sections 120.569, and 120.57 (2004), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine upon the Respondent, pursuant to Fla. Stat. Section 400, Part III (2004) and Fla. Admin. Code Chapter 58A-5 (2004). PARTIES 2. AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules, pursuant to Fla. Stat. Chapter 400, Part ITI and Fla. Admin. Code 58A-5. 3. The Respondent is an assisted living facility located at 1415 Fort Clarke Boulevard, Gainesville, FL 32606. The Respondent is and was, at all times material hereto, a licensed facility under Fla. Stat. Chapter 400, Part III (2004), and Fla. Admin. Code Chapter 58A-5 (2003), having been issued license number 9815. JURISDICTION AND VENUE 4. This Agency has jurisdiction pursuant to Fla. Stat. Chapter 400, Part IE, Sections 120.569 and 120.57, and Fla. Admin. Code Chapter 28-106. 5. Venue lies in Alachua County, Gainesville, Florida, pursuant to Fla. Stat. Section 120.57 (2004), Fla. Admin. Code, Rules 58A-5 and 28-106.207 (2004). COUNT I THE RESPONDENT FAILED TO ENSURE THAT AT LEAST 1 STAFF PERSON CERTIFIED IN CPR AND FIRST AIDE IS PRESENT IN THE FACILITY AT ALL TIMES State Tag No.-A525 Section 58A-5.019(4)(a)4, Fla. Admin. Code 6. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 7. On or about August 10, 2004, AHCA investigated a complaint at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: An unannounced complaint investigation for CCR#2004006918 was conducted on 08/1004. The complaint was not confirmed, however, a deficiency was identified during the investigation. The facility is not in compliance with Chapter 400, Part III, F.S and Chapter 58A-5 F.A.C. Based on record review and interview, the facility failed to ensure that at least 1 staff person certified in CPR and First Aide is present in the facility at all times. Failure to have staff working who are certified in CPR and First Aide may put the residents at great risk and possible harm when requiring assistance during a life threatening situation. Findings; 1. Review of the staff schedule and personnel files revealed that on July 10, 2004, July 16, 2004, July 19, 2004, July 23, July 24, July 25, and July 26, 2004 and July 30, 2004 the facility failed to have a staff person on duty during the 11PM to 7AM shift that had a current CPR and First Aide: a) July 10, 2004, 1 1PM to 7AM shift- staff #3, 5 and 7 were present. Review of their personnel files revealed that neither Staff #3, 5, or 7 were certified in CPR and First Aide. b) July 16, 2004, 11PM to 7AM shift- staff # 2,3,6,7 were present. Review of their personnel files revealed that neither Staff #2,3,6, or 7 were certified in CPR and First Aide. c) July 19, 2004, 11PM to 7Am shift- staff # 2,3,6 were present. Review of their personnel file revealed that neither Staff #2, 3, or 6 were certified in CPR and First Aide. d) July 23, 2004, 11PM to 7 AM shift- staff #5,2,9 were present. Review of their personnel file revealed that neither Staff #2, 5, or 9 were certified in CPR and First Aide. e) July 24, 2004, 11PM to 7AM shift- staff # 5,6,9 were present. Review of their personnel file revealed that neither Staff #5, 6, or 9 were certified in CPR and First Aide. f) July 25, 2004, 11PM to 7AM shift- staff #5,6,9 were present. Review of their personnel file revealed that neither Staff #5, 6, or 9 were certified in CPR and First Aide. g) July 26, 2004, 11PM to 7 AM shift- staff #2,3,5,6 were present. Review of their personnel file revealed that neither Staff #2, 3, 5, or 6 were certified in CPR and First Aide. h) July 30, 2004, 11PM to 7AM shift- staff # 3,6,9 were present. Review of their personnel file revealed that neither Staff #3, 6, or 9 were certified in CPR and First Aide. 2. Interview with the Director of Nursing on 08/10/04 at 2:00 PM revealed that the staff schedule for the month of July was accurate and that the staff indicated were not certified in CPR and First Aide. 8. ACHA mandated correction of the deficiency be made by August 30, 2004. 9. The regulatory provisions of the Florida Administrative Code and Florida Statutes that are pertinent to this alleged violation reads as follows: 58A-5.019 Staffing Standards. (4) STAFFING STANDARDS. (a) Minimum staffing: 1. Facilities shall maintain the following minimum staff hours per week: For every 20 residents over 95 add 42 staff hours per week. 2. At least one staff member who has access to facility and resident records in case of an emergency shall be within the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be left solely in charge of other residents while the facility administrator, manager or other staff are absent from the facility. 3. In facilities with 17 or more residents, there shal] be one staff member awake at all hours of the day and night. 4. At least one staff member who is trained in First Aid and CPR, as provided under Rule 58A-5.0191, F.A.C., shall be within the facility at all times when residents are in the facility. Number of Residents Staff Hours/Week 0-5 168 6-15 212 16- 25 253 26-35 294 36-45 335 46-55 375 56- 65 416 66-75 457 76-85 498 86-95 539 400.419 Violations; imposition of administrative fines; grounds — (1) The agency shall impose an administrative fine in the manner provided in chapter 120 for any actions or violations as set forth in this section. (2) Each violation of this part ad adopted rules shall be classified according to the nature of the violation and the gravity of the probable effect on facility residents. (2)(b) Class “I!” violations are those conditions or occurrences related to the operation and maintenance of a facility or 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. The agency shall impose an administrative fine for a cited class II violation in an amount not less than $1,000 and not exceeding $5,000 for each violation. A fine shall be levied notwithstanding the correction of the violation. 10. The foregoing violation constitutes an uncorrected class II violation, warranting a fine of $1,000. WHEREFORE, AHCA demands the following relief: 1. Entry of factual and legal findings as set forth in the allegations in all counts of this Administrative Complaint. 2. Imposition of fine of $1,000.00. Submitted on this 25 day of October 2004 on behal egcy for Health Care Administration by, anis. Rosenthal