STATE OF FLORIDA on, AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR ral HEALTH CARE ADMINISTRATION, a Petitioner, AHCA NO.: 2005001152 (Fine) AHCA NO.: 2005001742 (Conditional License) vs. GAINESVILLE COUNCIL ON AGING, INC. d/b/a GAINESVILLE HEALTH CARE CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW Petitioner, the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter referred to as “AHCA” or the “Agency”), by and through its undersigned counsel, and files this Administrative Complaint against Respondent, GAINESVILLE COUNCIL ON AGING, INC. d/b/a GAINESVILLE HEALTH CARE CENTER, (hereinafter referred to as “Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTION 1. This is an action against Respondent to: (Count I) impose an administrative fine in the amount of $2,500 (AHCA NO.: 2005001152); and (Count II) assign a conditional licensure status commencing January 27, 2005 (AHCA NO.: 2005001742), pursuant to the various citations, statutes, and rules cited in the counts below. Administrative Complaint Page 1 of 12 PARTIES 2. ACHA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable Florida laws and rules governing skilled nursing facilities, pursuant to Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code (2004). 3. Respondent is a skilled nursing facility, located at 1311 S.W. 16™ Street, Gainesville, Florida 32608. Respondent is licensed by AHCA as a skilled nursing facility, having been issued license number 1568096. 4. Respondent is and was at all times material hereto a licensed skilled nursing facility required to comply with Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code, respectively. JURISDICTION AND VENUE 5. AHCA has jurisdiction pursuant to Chapter 400, Part II, Florida Statutes (2004); Sections 120.569 and 120.57, Florida Statutes (2004); and Chapter 28-106, Florida Administrative Code (2004). 6. Venue lies in Alachua County, Gainesville, Florida, pursuant to Section 120.57, Florida Statutes (2004); Chapter 59A-4, Florida Administrative Code (2004); and Rule 28-106.207, Florida Administrative Code (2004). COUNT I THE RESPONDENT FAILED TO ENSURE THAT 13 OF 14 RESIDENTS INTERVIEWED IN A GROUP AND ONE SEPARATE INDIVIDUAL RESIDENT Administrative Complaint Page 2 of 12 WERE COMFORTABLE TO EXPRESS CONCERNS OVER THEIR CARE AND MEALS WITHOUT FEAR OF FUTURE CONFLICTS WITH STAFF RELATED TO CARE ISSUES. Class II Deficiency Federal Tag Number - F165 State Tag Number - N188 42 CFR 483.10(f£) (1) - Resident’s Rights Section 400.022(1)({d), Florida Statutes (2004) - Resident’s Rights Section 400.23(8) {b), Florida Statutes (2004) - Rules, Evaluation and Deficiencies; Licensure Status 7. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through six (6) as if fully set forth herein. 8. On or about January 27, 2005, AHCA conducted an annual survey at the Respondent’s facility. On or about January 27, 2005, AHCA cited the Respondent’s facility based on the findings below, to wit: a. Based on observation, confidential interviews and staff interview, the facility failed to ensure that 13 of 14 residents interviewed in a group and one separate individual resident were comfortable to express concerns over their care and meals without fear of future conflicts with staff related to care issues. Failure to allow residents to express their concerns caused the residents to experience psychosocial harm. b. Findings: Confidential interview on 1/25/05 at 11:15 AM with a group of 14 alert and oriented residents revealed 13 residents felt the staff that cared for them were frequently uncaring, leaving them to wait long periods of time when needing assistance. The group failed to give any CNA names (Certified Nursing Assistants), stating, "Oh no, I'm not giving out any names!" c. Further interview on 1/25/05 at 2:00 to 3:15 PM with 6 residents from the original group revealed the concern over staff attitude was something they spoke of amongst themselves frequently, during small groups and hoped the Administrative Complaint Page 3 of 12 State Survey Team could help them. They stated they have expressed their concerns to the Administrator in the past, but nothing ever changes. Examples were given related to staff attitude of "disrespect" that made the residents "afraid" to ask for assistance. Staff were said to "roll their eyes" and give the resident a "dirty look" at the request for a toothbrush and tooth paste to be utilized for oral hygiene. The resident was in fear to ask, but realized it was a reasonable request that he/she made, and then got "attitude" from the CNA. The resident refused to give the Certified Nursing Assistant's name, for fear that the CNA would make his/her life more difficult. . One resident required total assistance related to incontinence care, but daily has to work up courage to ask for assistance. The resident stated, "It's around 3:00 PM now, and I'm going to need help getting changed when I go back upstairs, but I'll have to see who is working and will have to wait to ask until they are ready to help me, usually around 4 O'clock". The resident stated he/she was dreading having to ask, worried it would result in a conflict with staff. - Another resident stated a CNA was in his/her room and another aide came in to inform the first aide that a resident needed help, and the two proceeded to argue loudly about who was going to help the resident. - Another resident stated the aides are always tired, and they come tired to work. This resident stated he/she has no control over his/her body and will get changed at the begining of the 3-11 shift, but then the aide "hides". This resident stated, about 1 or 2 months ago he/she "had messed the bed so bad, and no one would come help", so he/she phoned a family member in tears. The resident stated he/she could hear the aides out in the hall talking about their weekend, and when the family member called the nurses station, an aide came in to assist him/her, but "treated him/her like a piece of Sugar. ". The resident would not give any CNA names. Administrative Complaint Page 4 of 12 g. Another resident expressed that his/her food is frequently cold, and has.voiced this in the Main Dining Room in front of staff, but stated it was cold again this morning, referring to the morning of 1/25/05. Observation of the breakfast meal in the Main Dining Room on 1/26/05 at 8:30 AM revealed approximately 10 residents seated, waiting for their breakfast with coffee, juice and hot chocolate being consumed. At 8: 53 AM, staff began delivering meal trays by carrying them individually out of the kitchen, bringing them directly to the table and setting up the residents to eat. Each resident had a diet card that accompanied their meal identifying them and their diet. The resident who had expressed that his/her food is frequently cold was served in order after the table next to him/her. This resident stated, "This is ice cold! Come and see this!" The resident gave permission to touch the underside of his/her ceramic plate, which revealed the plate was ice cold to the touch, as if it was from a refrigerator. Inquiry with the resident revealed the food was also cold. Inquiry with the 3 residents who had just been served prior to him/her revealed their plates were warm to the touch and their food was warm. Inquiry with personnel in the kitchen on 1/26/05 at approximately 8:58 AM, revealed the staff could not give a rationale why only one plate was ice cold, and failed to answer questions related to the resident in question. Interview on 1/26/05 at 9:05 AM with 2 additional residents, (served after the person with the cold plate), revealed their food and plates were warm. h. Individual interview on 1/25/05 at 9:30 AM, with a resident requested that the interview be confidential, revealed the resident had concerns over a lot of aspects of life at the nursing home. The resident stated "there was no use to complain, the staff would get back at you". When asked to clarify, the resident stated, "there would be reprisals and it was best to keep your mouth shut". During the interview, a CNA came to the door and the resident became quiet and stared at the ceiling until the CNA left. The resident stated, "there are a lot of things I would like to say, but Administrative Complaint Page 5 of 12 I'll keep my mouth shut, I don't want to start anything. I don't want my name mentioned". i. Interview with the Administrator and the Director of Nurses on 1/27/05 at 11:50 AM revealed they were aware of the residents having fear of reprisal in the past. Further interview revealed they thought the residents had gotten comfortable with the current Administration, enough to give out names of staff not providing good care. 9. On or about January 27, 2005, AHCA cited the deficiency as a Class II violation. 10. ACHA mandated correction of the deficiency be made by February 27, 2005. 11. The above constitutes a violation of 42 CFR 483.10(£) (1), which states, “Grievances. A resident has the right to--(1) Voice grievances without discrimination or reprisal. Such grievances include those with respect to treatment which has been furnished as well as that which has not been furnished...” 12. The above constitutes a violation of Section 400.022(1)(d), Florida Statutes (2004), which provides that “{t]Jhe right to present grievances on behalf of himself or herself or others to the staff or administrator of the facility, to governmental officials, or to any other person; to recommend changes in policies and services to facility personnel; and to join with other residents or individuals within or outside the facility to work for improvements in resident care, free from restraint, interference, coercion, Administrative Complaint Page 6 of 12 discrimination, or reprisal. This right includes access to ombudsmen and advocates and the right to be a member of, to be active in, and to associate with advocacy or special interest groups. The right also includes the right to prompt efforts by the facility to resolve resident grievances, including grievances with respect to the behavior of other residents.” 13. The above constitutes a violation of Section 400.23(8) (b), Florida Statutes (2004), which provides that “a class II 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 assessment, plan of care, and provision of services. A class II 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 II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A fine shall be levied notwithstanding the correction of the deficiency.” Administrative Complaint Page 7 of 12 14. The above referenced violation is grounds for the imposition of the administrative fine, pursuant to Section 400.23(8) (b), Florida Statutes (2004). This is a Class II deficiency, subjecting the Respondent to a fine of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500), pursuant to Section 400.23(8) (b), Florida Statutes (2004). WHEREFORE, AHCA demands the following relief: 15. Factual and legal findings as set forth in Count I of this Administrative Complaint, and; 16. Uphold the imposition of the administrative fine in the amount of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500). COUNT II ASSIGNMENT OF CONDITIONAL LICENSURE STATUS: GAINESVILLE HEALTH CARE CENTER WAS NOT IN SUBSTANTIAL COMPLIANCE WITH SECTION 400.022(1) (dad), FLORIDA STATUTES (2004), AND 42 CFR 483.10(f) (1) (2004), AT THE ANNUAL SURVEY OF JANUARY 27, 2005, RESULTING IN THE CITATION OF A “CLASS II” DEFICIENCY AGAINST THE FACILITY Section 400.23(7) (b), Florida Statutes (2004) Section 400.023(8) (b), Florida Statutes (2004) 42 CFR 483.10(f£) (1) (2004) 17. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through sixteen (16) as if fully set forth herein. 18. On or about January 27, 2005, AHCA conducted an annual survey at the Respondent’s facility, wherein it cited the facility for the foregoing Class II violation. 19. The foregoing Class II violation warrants the assignment of a conditional licensure status, pursuant to Administrative Complaint Page 8 of 12 Section 400.23(7), Florida Statutes (2004), which provides, “400.23.Rules; evaluation and deficiencies; licensure status.—..(7) 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..(b) A conditional licensure status means that a facility, due to the presence of one or more class I or class II deficiencies, or class III deficiencies not. corrected within the time established by the agency, is not in substantial compliance at the time of the survey with criteria established under this part or with rules adopted by the agency. If the facility has no class I, class II, or class III deficiencies at the time of the follow-up survey, a standard licensure status may be assigned.” § 400.23(7) (b), Fla. Stat. 20. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the actions of Administrative Complaint Page 9 of 12 Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 21. Factual and legal findings as set forth in Count II of this Administrative Complaint; 22. Uphold the imposition of conditional licensure status commencing January 27, 2005; and 23. Impose such other relief as this tribunal may find appropriate. DISPLAY OF LICENSE 24. Until a subsequent standard license is issued, Respondent is required to post its conditional license in a prominent place that is clear and unobstructed public view at or near the place where residents are being admitted to facility pursuant to Section 400.23(7)(d) and (e), Florida Statutes, which reads as follows: “400.23 Rules; evaluation and deficiencies; licensure status.—..(7) 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..(d) The current licensure status of each facility must be indicated in bold print on the face of the license. A list of the deficiencies of the facility shall be posted in Administrative Complaint Page 10 of 12 a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to that facility. Licensees receiving a conditional licensure status for a facility shall prepare, within 10 working days after receiving notice of deficiencies, a plan for correction of all deficiencies and shall submit the plan to the agency for approval. (e) Each licensee shall post its license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility” 25. The following licenses are attached hereto as follows: Exhibit “A”: Conditional License Certificate # 12253 with an effective date of 01/27/2005 and an expiration date of 01/31/2005. Exhibit “B”: Conditional License Certificate # 12254 with an effective date of 02/01/2005 and an expiration date of 01/31/2006. NOTICE OF RIGHTS 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 Election of Rights (one page) and explained in the attached Explanation of Rights (one page). Purther, all requests for hearing shall be made to the Agency for Health Care Administration, and delivered to: Attention: Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive Building #3, Mail Stop #3 Tallahassee, Florida 32308 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. Administrative Complaint Page 11 of 12 Respectfully submitted on this 8th day of March 2005, Leon County, Tallahassee, Florida, on behalf of the Agency for Health Care Administration by, Tracie Wilks Assistant General Counsel Fla. Bar. No. 0559921 Agency for Health Care Administration . 2727 Mahan Drive Bldg. 3, MSC #3 Tallahassee, Florida 32308 (850) 922-5873 (office) (850) 921-0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent by U.S. Certified Mail, Return Receipt Requested, to Attention: Mr. Jeffrey Bradley, Administrator, Gainesville Health Care Center, 1311 S.W. 16" Street, Gainesville, Florida 32608; and a copy to: R. Bruce McKibben, Jr., Registered Agent, 1301 Miccosukee Road, Tallahassee, Florida 32308, on the 8th day of March 2005. nau Wk) Tracie Wilks Assistant General Counsel Administrative Complaint Page 12 of 12

Docket for Case No: 05-001123