cater Time: 5:09 PM Page pipes Duration: 1 min 48 sec Pages: 6 Company’ Sender: 850 414 1989 seer Fax Number: 7 Type: Fax 858 414 1989 P.at DEC-21-2884 17:87 AHCA/LEGAL MEDICAL STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, a 7] ~( Is if p lL v. CASE NO. 2003-12760 VIOLETA ROQUE, C.N.A.,, RESPONDENT. Sy - ADMINISTRATIVE COMP T COMES Now, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Nursing against Respondent, Violeta Roque, C.N.A., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of nursing assistants Pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 464, Florida Statutes, 2, At all times material to this Complaint, Respondent was a Certified Nursing Assistant (C.N.A.) within the state of Florida, having been issued certificate number CX 9000004360. 1 VIOLETA ROQUE, C.N.A., 2003-12760 1 Pages: Sender: Fax Number: T 12/21/2004 Time: 5:09 PM 6 Duration: 1 min 48 sec 850 414 1989 Company: Subject: 858 414 1989 DEC-21-2004 17:87 AHCA/LEGAL MEDICAL . . ty -f 3. Respondent's address of record is 301 White Street, Apartment #17F, Key West, Florida 33040. 4. At all times material to this Complaint, Respondent was employed as a certified nursing assistant at Key West Convalescent Center, 5. At all times material to this complaint, LAT. was a resident at Key West Convalescent Center. L.FT. suffers from dementia. 6. On or about January 24, 2003, Resident L.RT. was being fed in the lunchroom and Respondent was assisting in feeding the residents. 7, Respondent hit Resident L.F.T. in the head with a lunch tray and L.F.T. cried out. Respondent next took a straw filled with apple juice and emptied it on L.F.T.’s head while laughing. 6. Section 464.204(1)(b), Florida Statutes (2002), provides that intentionally violating any provision of Chapter 464, Chapter 456, or the tules adopted by the board, constitutes grounds for disciplinary action by the Board of Nursing. 9. Section 464.018(1)(n), Florida Statutes (2002), provides that failing to meet minimal standards of acceptable and prevailing nursing practice constitutes grounds for disciplinary action by the Board of Nursing. 2 VIOLETA ROQUE, C.N.A., 2003-12760 2 Date: ates Duration: 1 min 48 sec Pages: any: Sender: 850 414 1989 Sunior 850 414 1989 P.@3 Fay Num pet o1-2aad 17:08 AHCA/LEGAL MEDICAL _— T —_— . : { 19..Respondent intentionally departed from minimal standards of acceptable and prevailing nursing practice when she hit patient L.F.T. in the head with a lunch tray and poured juice on L.F.T’s head. 11, Based on the foregoing and pursuant to Section 464.204(1)(b), Florida Statutes (2002), Respondent is subject to discipline for intentionally violating Section 464.018(1)(n), Florida Statutes (2002), by failing to conform to minimal standards of acceptable and prevalling nursing practice. WHEREFORE, the Petitioner respectfully requests that the Board of Nursing enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's certificate, restriction of practice, imposition of an administrative fine, issuance of a reprimand, Placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this \ day of 2004, John ©. A obi, M.D., M.B.A. FI LED Secretary, Department of Health DEPARTMENT OF HEALTH UTY CLERK oxen {licen CoSumcun pare__S=\G-Ouf VIOLETA ROQUE, -NLA., 2003-12760 3 Br ee ee pee were er ime: :09 PM Date: 12/21/2004 Time: 5 09 Pages: 6 Duration: 1 min 48 sec Sender: 850 414 1989 company: Suhiect Fax Niet 21-2004 17:88 AHCA/LEGAL MEDICAL g5a 414 1989 P.a4 T . i DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar No.: 374 OASU\3 2 (850) 414 - 8126 Telephone (850) 414 - 1991 Facsimile /ttm Reviewed and approved by: 7V4._ (initials) 2} Sf ox (date) PCP: Ao PCP Members: ~7)). 4 pA ‘Ss: an 4 VIOLETA ROQUE, C.N.A., 2003-12760 4 Ee ee Time: 5:09 PM Date: ates Duration: 1 min 48 sec Pages: any: Sender: 850 414 1989 Saneary 859 414 1989 Fay Niet ot -2ae4 17:08 AKCA/LEGAL MEDICAL 1 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested, NOTICE REGARDING ASSESSMENT OF COSTS P.@5 Respondent is placed on notice that Petitioner has incurred _ costs related to the investigation and Prosecution of this matter, Pursuant to Section 456.072(4), Florida Statutes, the Board shal! assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. 5 VIOLETA ROQUE, C.N.A., 2003-12760 5

Docket for Case No: 04-004579PL