STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ' AGENCY FOR HEALTH CARE ADMINISTRATION, : Petitioner, ABHCA Case No. 2005009262 MAGNOLIA PLACE, INC., Respondent. / ee ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or “the Agency”), by and through the undersigned counsel, and files this Administrative Complaint against Magnolia Place (“Respondent”) pursuant to Sections 7 ym oe , 120.569 and 120.57, Florida Statutes (2005). NATURE OF THE ACTION This is an action to impose administrative fines in the amount of $40,000 based upon six (6) class I deficiencies’ and ten: (10) class II deficiencies pursuant to Section 400.419 (2) (a) and (b), Florida Statutes (2005). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes, and Sections 120.569 and 120.57, Florida Statutes. e - @ 2. Venue lies in Leon County, Tallahassee, Florida, pursuant to Section. 120.57, Florida. Statutes, Chapter 58A-5, Florida Administrative Code, and Rule ,28-106.207(1), Florida Administrative Code. PARTIES 3. Pursuant to Chapter 400, Part III, Florida Statutes, and Chapter 58A=-5, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 4. Respondent is an assisted living facility located at 2767 Raymond Diehl Road, Tallahassee, Florida 32308. Respondent is, and was at all times material hereto, a licensed facility under Chapter 400, Part rit, | Florida Statutes, and Chapter 58A-5, ‘Florida. Administrative Code, having been issued license number 9699. 5. On September 30, 2005, the Agency, with its authorized personnel, conducted a biennial licensure survey. During the survey, the Agency cited the Respondent for six (6) class I deficiencies regarding staffing and medication standards. Additionally, Respondent was cited for ten (10) class IT deficiencies regarding facility records, medication standards, staff records, emergency management standards, and fire safety standards. COUNT I FAILURE TO CONDUCT ANNUAL FIRE INSPECTION 2 Section 400.441 (1) (a)2.m., Florida Statutes (2005) Rule 58A-5.015(1) (a)3, Florida Administrative Code (2005) Class II deficiency 6. The Agency re-alleges and incorporates paragraphs (1) ‘through (5) as if fully set forth herein. a ; 7. During an interview with the owner/acting administrator on September 30, 2005 at 9:50 a.m., the acting administrator confirmed that she could not provide proof that an annual fire inspection. was conducted in’ 2004 and 2005." 3. Pursuant to Section 400.441(1) (a)2.m., Florida Statutes, “fa]ll licensed facilities must have an annual .fire inspection “conducted by the local fire marshal or authority having jurisdiction.” . 9, Pursuant to Rule 58A-5.015(1) (a)3, | Florida < 4 Sree, Administrative Code, vw... {dJocumentation of a satisfactory fire safety inspection shall be provided at the time of the agency's biennial survey.” 10. This violation is a class II deficiency. 11. Pursuant to Section 400.419(2) (b), Florida Statutes, “(t]he Agency shall impose an administrative fine of not less than $1,000 for a class II violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count I. 2. Impose a fine in the amount of $1,000 3 @ - @ COUNT IZ FAILURE TO CONDUCT A MINIMUM OF TWO RESIDENT ELOPEMENT PREVENTION AND RESPONSE DRILLS PER YEAR Section 400.441 (1) (a)3, Florida Statutes (2005) ‘ Class II deficiency 12. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. . 13. Record review and interview with the facility owner/acting administrator on September 30, 2005 at 2:05 p.m., revealed that the facility did not conduct a minimum of two resident elopement prevention and response drills per year for 2004 through September 30, 2005. 14. Pursuant to Section 400.441 (1) (a)3, Florida Statutes, a minimum of two resident “[flacilities are required to conduct elopement prevention and response drills per year...” 15. This violation is a class II deficiency. 16. Pursuant to Section 400.419(2)(b), Florida Statutes, “[t]he Agency shall impose an administrative fine of not less than $1,000 for a class II violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count If. 2. Impose a fine in the amount of $1,000. COUNT III @ vy @ FAILURE TO ENSURE THAT A WEIGHT RECORD WAS INITIATED UPON ADMISSION OR WAS OBTAINED OR RECORDED ON THE HEALTH ' ASSESSMENT FORM Rule 58A-5.024(3) (f), Florida Administrative Code (2005) Class II deficiency ' 47. The Agency, re-alleges paragraphs (1) through (5) as if fully set forth herein. 18. Based on resident record review and interview with the owner/acting administrator, the surveyor determined that the facility failed to ensure a weight - record was obtained or ' “ , ’ . recorded on the health assessment form upon admission, for six (6) of thirteen (13) residents (residents #3, #7, #10, #11, #12, and #13). -19.° Record review documented Resident #3 had. a Health mga Assessment Form completed, but not dated, with a weight recorded { ayes of 116 pounds. The med tech reported the Health Assessment form was sent from another facility (facility #2) upon admission. At the bottom of the Health Assessment Form a name of another facility and date of 8/18/03 was imprinted as being faxed from facility #2. During an interview with the med tech at 11:50 a.m. on September 30, 2005, the med tech was unable to provide the initial weight for Resident #3. 20. Record review revealed Resident # T's Health Assessment Form was not dated and was blank where the weight was to be recorded. "3 Ba 21. Record review revealed Resident #10's Health ‘ Assessment Form was not dated but had a weight recorded of 149 pounds. ; 22. Record review revealed the Health Assessment Form for residents #11 and #12 were dated but were blank where the weight was to be recorded. 23. Record review revealed resident #13's Health Assessment Form was incomplete in the resident’s chart. Page 1 of the Health Assessment was in the record, and a weight of 120 ' pounds was recorded. Page 2, which includes the date of the examination and the signature of the provider, was missing from The med’ tech reported at 12:00 p.m. on September 30, 2005,. that she was unable to locate the second the resident’s file. page of the Health Assessment or the initial weight for Resident #13. 24. During an interview with the owner/acting administrator on September 30, 2005 at 12:00 p.m., the administrator reported that she was unable to provide the initial weight records for Residents #3, #7, #10, #11, #12, and #13. 25. In accordance with Rule 58A-5.024(3)(f), Florida Administrative Code, resident records shall be maintained on the premises and include “[a] weight record which is initiated on admission. Information may be taken from the resident’s health “a assessment.... t e. - e 26. This violation is a Class ITI deficiency. 27. Pursuant to Section 400.419(2)(b), Florida Statutes, “[t]he Agency shall impose an administrative fine of not less than $1,000 for a class II violation.” ' WHEREFORE, the Agency demands the following relief: iw 1. Enter factual and legal findings in favor of the Agency on Count III; 2."°* Impose a fine in the amount ‘of $1,000. COUNT IV ( ‘ FAILURE TO PROVIDE AT LEAST ONE STAFF MEMBER WHO IS TRAINED IN FIRST AID AND CPR TO BE WITHIN THE FACILITY AT ALL TIMES WHEN RESIDENTS ARE IN THE FACILITY Rule 58A-5.019(4) (a)4, Florida Administrative Code (2005) ’ Class II deficiency eee 28. The Agency re-alleges paragraphs (1) through [ awe, (5) as if fully set forth herein. 29. Record review and interview with the facility owner/acting administrator at on September 30, 2005 2:30 p.m., revealed that no evidence existed that the facility had at least one staff member who is trained in First Aid and CPR within the facility at all times when occupied by residents. 30. Pursuant to Rule 58A-5.019(4) (a) 4, Florida Administrative Code, “[a]t 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.” @. a @ Hy 31. The violation is a Class II deficiency. 32.. .Pursuant to Section 400.419(2) (b), Florida Statutes, “[t]he Agency shall impose an ‘administrative fine of not.less than $1,000 for a class II violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count IV; 2. Impose a fine in the amount of $1,000. COUNT V FAILURE TO ENSURE THAT ALL MEDICATIONS WERE KEPT IN A LOCKED CART ‘AT ALL TIMES Rule 58A-5.0185(6).(b)1, Florida Administrative Code (2005) : : CLASS II VIOLATION 33. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. 34. Based on observation and interview with the medication technician, it was determined that the facility failed to ensure all medications were kept in a locked cart at ali times. 35. The medication cart was observed unlocked with a bottle of Plavix (this is a blood thinner used to prevent clots, which could pose a danger if taken without consulting with a physician) on top at approximately 4:20 p.m. on September 30, 2005. The medication cart was left unattended for approximately 15 minutes in a sitting room with three residents sitting watching television, while several other residents, family @ e members, and children were walking through the sitting room. Two white pills were also lying on the arm of a couch. . 36. When interviewed the medication technician stated, “I thought I locked the cart. I was taking out the garbage.” When asked if he/she knew about the two white pills lying on the arm of the couch, he/she stated, “I don’t know what they are, but I found them in the bottom of the drawer. I was going to throw them away.” 37. In accordance with Rule 58A~5.0185(6) (b)1, “ fe] entrally stored medications must be kept in a _ locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times.” ) 1 3B This violation is a Class II deficiency. 39. Pursuant to Section 400.419(2) (b), Florida ‘ ( ’ we, Statutes, “[t]he Agency shall impose an administrative fine of not less than $1,000 for a class II violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count V; 2. Impose a fine in the amount of $1,000. COUNT VI FAILURE TO PROVIDE WRITTEN EVIDENCE THAT ALL STAFF WERE TRAINED IN THEIR DUTIES TO IMPLEMENT THE EMERGENCY MANAGEMENT. PLAN Section 400.441(1) (b), Florida Statutes (2005) e a . @ oa Class II deficiency 40... The Agency:re-alleges paragraphs (1) through (5) as. if. fully set forth herein. 41. Based on record review and interview with the facility owner/acting administrator on September 30, 2005 at 12:30 p.m., it was determined that the facility failed to provide .evidence that all staff (19 of 19) were trained in their duties to implement the emergency management plan. 42. Pursuant to Section 400.441(1) (b), Florida’ Statutes, the Agency,’ in consultation with other agencies, shall adopt sules, policies, and procedures telated to “(t]he preparation and annual update of ‘a comprehensive emergency managemert plan.” 43. In accordance with Rule 58A-5.026(3) (a), Florida Administrative Code, “{ajil staff must be trained in their duties and are responsible for implementing the emergency management plan.” 44. This violation is a Class II deficiency. 45, Pursuant to Section 400.419(2) (b), Florida Statutes, “[t]he Agency shall impose an administrative fine of not less than $1,000 for a class II violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count VI; 2. Impose a fine in the amount of $1,000. 10 COUNT VII FAILURE TO PROVIDE WRITTEN EVIDENCE THAT EMPLOYEES ARE FREE FROM COMMUNICABLE DISEASE, INCLUDING TUBERCULOSIS Section 400.4275(4), Florida Statutes (2005) Rule 58A-5.024(2) (a), Florida Administrative Code (2005) ' 7 Class II deficiency : 46. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. aT." Based upon record review and interview with the facility owner/acting administrator on September 30, 2005 at oy 10:30 a.m., it was determined that the facility failed to provide evidence that 11 of 19 (#1, #2, #3, #6, #9, #10, #11, #12, #13, #14, and #18) employees’ personnel records contained verification of freedom from communicable disease including. tuberculosis. Tree 48. Pursuant to Section 400.4275(4), Florida Statutes, “[t]he department may by rule clarify terms, establish requirements for financial records, accounting procedures, personnel procedures, insurance coverage, and reporting procedures, and specify documentation as necessary to implement the requirements of this section.” 49, In accordance with Rule 58A-5.024 (2) (a), Florida Administrative Code, “[p]ersonnel records for. each staff member shall contain verification of freedom from communicable disease including tuberculosis.” 50. This violation is a class II deficiency. 11 oe. / @ 51. Pursuant to Section 400.419(2) (b), Florida Statutes, “[t]he Agency shall impose ;an administrative fine of not less than $1,000 for a class ITI violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency ‘on Count’ VII; 2. Impose a fine in the amount of $1,000. COUNT VIIT: FAILURE TO PROVIDE WRITTEN EVIDENCE THAT EMPLOYEES ARE FREE FROM COMMUNICABLE DISEASE, INCLUDING TUBERCULOSIS, WITHIN 30 DAYS OF HIRE Rule 58A-5.019(2) (a), Florida Administrative Code (2005) Rule 58A-5.024(2) (a), Florida Administrative Code (2005) Class II deficiency ; ! 52. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. 53. Based upon record review and interview with the facility owner/acting administrator on September 30, 2005 at 10:30 a.m., the Agency determined that the facility failed to provide evidence that 11 of 19 (#1, #2, #3, #6, #9, #10, #11, #12, #13, #14, and #18) employees had submitted a statement health care provider verifying freedom from from a communicable disease, including tuberculosis, within 30 days of hire. 54, In accordance with Rule 58A-5.019(2) (a), Florida Administrative Code, “[nJewly hired staff shall have 30 days to submit a statement from a health care provider, .based on examination conducted within the last six months, that the person does not have any signs or symptoms of a communicable disease including tuberculosis.” ' 55, In accordance with: Rule 58A-5.024(2) (a), Florida Administrative Code, “[plersonnel records for each staff member shall contain, ... verification of freedom from communicable disease including tuberculosis.” 56. This violation is a class II deficiency. 57. Pursuant to Section 400.419(2) (b), Florida Statutes, “[t]he Agency shall impose an administrative fine of not Less than $1,000 for a class II violation.” ' WHEREFORE, the Agency demands the following relief: , i. Enter factual and legal findings in favor of the Agency on Count VIII; 2. Impose a fine in the amount of $1,000. COUNT ix FAILURE TO PROVIDE EVIDENCE THAT EMPLOYEES’ PERSONNEL RECORDS CONTAINED ANNUAL VERIFICATION OF FREEDOM FROM COMMUNICABLE DISEASE, INCLUDING TUBERCULOSIS Rule 58A-5.019(2) (a), Florida Administrative Code (2005) Class II deficiency 58.. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. 59. Based upon record review and interview with the facility owner/acting administrator on September 30, 2005 at 13 cy ‘ . : 10:30 a.m., it was determined that the facility failed to provide evidence that 11 of 19 (#1, #2, #3, #6, #9, #10, #11, #12, #13, #14, and #18) employees’ personnel records contained . annual verification of freedom from communicable disease, including tuberculosis. 60. In accordance with Rule 58A-5.019(2) (a), ‘Florida Administrative Code, “...{[flreedom from tuberculosis must be documented on an annual basis...” 61. This violation is a class II deficiency. 62. Pursuant to Section 400.419(2) (b), Florida Statutes, “{t]he Agency shall impose an administrative fine of not less than $1,000 for a class II violation.” WHEREFORE, the Agency demands the following relief: ‘1. Enter factual and legal findings in favor of the Agency on Count Ix; 2. Impose a fine in the amount of $1,000. COUNT X FAILURE TO PROVIDE EVIDENCE THAT UNLICENSED STAFF WHO PROVIDE ASSISTANCE WITH SELF-ADMINISTERED MEDICATIONS RECEIVE A MINIMUM OF 2 HOURS OF CONTINUING EDUCATION TRAINING ANNUALLY Rule 58a-5.0191(5) (c), Florida Administrative Code (2005) Rule 58A-5.024(2) (a)1, Florida Administrative Code (2005) Class II deficiency 63. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. 64. Based upon record review and interview with the facility owner/acting administrator on September 30, 2005 at 12:30 a.m., it was determined that the facility failed to provide evidence that 5 of 7 (#5, #7, #8, #16, and. #17) employees personnel records contained documentation of annual i 1 a F , 2 hour .continued education on providing assistance with self- administration of medications. 65:\ In accordance with Rule 58A-5.0191(5)(c), Florida Administrative Code, “[u]nlicensed persons, as defined in section’ 400.4256(1)(b), F.S., who provide assistance with self-administered medications and have successfully completed the initial 4 hour training, must obtain, annually, a minimum of 2 hours of continuing education training on providing assistance with self-administered medications and. safe che me medication practices... a“ 66. Pursuant to Rule 58A-5.024 (2) (a)l, Florida Administrative Code, personnel records for each staff member shall contain “{d]Jocumentation of compliance with all staff training required by Rule 58A-5.0191, F.A.C.” 67. This violation is a class II deficiency. 68. Pursuant to Section 400.419(2) (b), Florida Statutes, “{t]he Agency shall impose an administrative fine of not less than $1,000 for a class II violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the 15 e. @ they ‘ wy Agency on Count xX; 3. Impose a fine in the amount of $1,000. COUNT XI $ FAILURE TO COMPLY WITH BACKGROUND SCREENING REQUIREMENTS Section 400.4174 (2),, Florida Statutes (2005) Section 435,03(1), Florida Statutes (2005) Rule 58A-5.019(3) (a), Florida Administrative Code (2005) : Class I deficiency 69. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. ‘ 70. Based upon record review of personnel records, and interview with the facility owner/acting administrator on 30, 2005, the Agency determined that the facility September failed to perform a ‘Level 1 background screening on seven (7) of fourteen (14) employees hired on' or after October 1, 1998(#2, #3, #5, #7, #8, #10, and #14). 71. This violates Section 400.4174(2)., Florida Statutes, which states, in pertinent part, “[t]he owner or administrator of an assisted living facility must conduct level 1 background screening, as set forth in chapter 435, on all employees hired on or after October 1, 1998, who perform personal’ services as defined in s.400.402(17)...” 72. Moreover, pursuant to Section 435.03(1), Florida Statutes, “[aJll employees required by law to he screened shall be required to undergo background screening as a condition of employment and continued employment...” 16 73. %Inm accordance with Rule 58A-5.019(3) (a),-° Florida , ‘ Administrative Code, “[a]il staff, hired on or after October 1, 1998, to provide personal services to residents must be screened in accordance with Section 400.4174, F.8., and. meet the' ‘screening standards of Section 435. 03, F.S.” j 1. This ‘violation is a class I deficiency. 75. Pursuant to Section 400.419(2) (a), Florida Statutes; “(t]he Agency shall impose an administrative fine for a cited class I violation in an’ amount not less than $5, 000 ond not exceeding $10,000 for each violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the “Agency on Count XI; | | 2. Impose a fine in the amount of $5,000. COUNT XII FAILURE TO ENSURE THAT A LICENSED PERSON ADMINISTERS MEDICATION Section 400.4255(1) (a), Florida Statutes (2005) Class I deficiency 76. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. | 77. Based on observation, interviews, and record review, the Agency determined that the facility did not have a licensed staff member in the facility to administer medication to the residents. @. @ 78. ‘The clinical. record for resident #1 revealed a Resident Health: Assessment indicating for nursing/treatment/therapy services requirements “medication supervision and medication administration.” 79, The clinical record for resident #8 revealed a Resident " Health | Assessment indicating - for Nursing/treatment/therapy service requirements “administering of medications and with bathing.” dO. The clinical record for resident #9 revealed a Resident Health Assessment indicating for nursing/therapy service requirements “medication: administration, staff to administer to ensure-compliance.” ‘gL. The clinical record for resident #12 revealed a Resident . Health . Assessment ' indicating for nursing/treatment/therapy service requirements “dispense medications, needs them given to her at appropriate times.” 82. Review of September and October calendars and interview with the owner/acting administrator on September 30, 2005 at 3:00 p.m., revealed technicians were scheduled to administer medications every day except Saturday and Sunday from 6 a.m. to 9 p.m., when the licensed nurse was scheduled to be in the facility. 83. Observation on October 3, 2005 at approximately 9:05 a.m. revealed a medication technician administering. medications to resident #8. Review of the Resident Health 18 Assessment revealed a physician’s order that medication ‘ ‘ administration was to be performed by a licensed nurse. 84. Interview with residents #1, #8, #9, and #12 confirmed that the technicians administered medications except on the weekends when the nurse ‘was on duty. uw ‘ 85, Interview with medication technician #1 and #2, confirmed that they administer medication to residents. They acknowl'edged that they did not know the difference between assisting and administering medications. co , 1 woe " ‘a6. This violates Section 400.4255(1)(a), Florida Statutes, which states, in pertinent part, “[plersons under contract to the facility, facility staff, or volunteers, who are’ licensed according to part I of chapter 464, or those persons, exempt under 8.464.022(1), and others as defined by rule, may administer medications to residents...” 87. This violation is a class I deficiency. 88. Pursuant to Section 400.419(2) (a), Florida Statutes, “{t]he Agency shall impose an administrative . fine for a cited class I violation in an amount not less than $5,000 and not exceeding $10,000 for each violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count XII; 2. Impose a fine in the amount of $5,000. 19 @., } . COUNT XIII FAILURE TO ENS THAT ALL STAFF WERE ASSIGNED DUTIES CONSISTENT WITH THEIR LEVEL OF EDUCATION , TRAINING, PREPARATION , BAND EXPERIENCE Rule 5ea~5.019(2) (b), Florida Administrative Code (2005) Class I deficiency 89. THe Agency: re-alleges paragraphs (1) through (5) as if fully set forth herein. 90. . Based’ on observation, interviews, and record review, the Agency determined that the facility did not" have a licensed staff member in the facility to administer medication to the residents. 91. The clinical record for resident #1 revealed a Resident Health. Assessment | indicating for nursing/treatment/therapy servites requirements “medication supervision and medication administration.” 92. The clinical record for resident #8 revealed a Resident Health Assessment indicating for nursing/treatment/therapy service requirements “administering of medications and with bathing.” 93. The clinical record for resident #9 revealed a Resident Health Assessment indicating for nursing/therapy service requirements “medication administration, staff to administer to ensure compliance.” 94. The clinical record for. resident #12 revealed a Resident Health Assessment indicating for 20 nursing/treatment/therapy service requirements “dispense ' . “ medications, needs them given to her at appropriate times 95. Review of September and October calendars and interview with the owner/acting administrator on September 30, 2005 at, 3:00 p.m. revealed technicians were scheduled to he ' administer medications every day except Saturday and Sunday from 6 a.m. to 9 p.m., when the licensed nurse was scheduled to be in’ the facility. 96. Observation on October 3, 2005 at approximately 9:05 4 ood Jou a.m. revealed a medication technician administering medications to resident #8. Review of the Resident Health Assessment revealed a physician’s order that medication administration was to be performed by a licensed nurse. (OTe Interview with residents #1, #8, #9, and #12 i we confirmed that the technicians administer medications except on the weekends, when the nurse is on duty. 98. Interview with medication technician #1 and #2 confirmed that they administer medication to residents. These technicians acknowledged that they did not know the difference between assisting and administering medications. 99. In accordance with Rule 58A-5.019(2) (b), Florida Administrative Code, “faJll staff shall .be assigned duties consistent with his/her level of education, training, preparation, and experience. Staff providing services 21 S . @ Ny requiring licensing or certification must be appropriately licensed or certified...” ! 100. This violation is a class I deficiency. 101. Pursuant to Section 400.419(2) (a), Plorida Statutes, “[t]he Agency shall impose an administrative fine for a cited class I violation in an amount not less. than $5,000 and not exceeding $10,000 for each violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of ‘the Agency on Count XIII; 2. Impose a fine in the amount of $5,000. COUNT XIV FAILURE TO MEET WEEKLY STAFF MINIMUMS Rule 58A-5.019(4) (a)1, Florida Administrative Code (2005) Class I deficiency 102. The Agency re-alleges paragraphs (1) through (5) as if fully set forth herein. 103. an interview with the facility owner/acting administrator at 12:30 p.m. on September 30, 2005 revealed that the facility could not demonstrate that it had met minimum weekly staffing requirements. 104. In accordance with Rule 58A-5.019(4) (a)1, Florida Administrative Code, “[f£lacilities shall maintain the following minimum staff hours per week...335 hours per week for 36 - 45 residents...” 22 105. This violation is a class I deficiency. 106. Pursuant to Section 400.419(2) (a), Florida Statutes, “[t]he Agency shall impose an administrative fine for a cited class I violation in an amount not less .than $5,600 and not exceeding $10,000 for each violation.” , iHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count XIV; 2. Impose a fine in the amount of $5,000. moe COUNT xv FAILURE TO PROVIDE ENOUGH QUALIFIED STAFF Rule 58A-5.019(4) (b), Florida Administrative Code (2005) ae Class I deficiency ' 107. The Agency re-alleges paragraphs (1) through eh am (5) as if fully set forth herein. 108. Based on record review and interview with facility owner/acting administrator, the Agency determined that the facility was unable to produce staffing hours sufficient to meet minimum requirements. Personnel files were incomplete or did not exist and did not contain nursing license confirmation, employee background screening, or verification that employees had CPR and first aid training. Further, no evidence existed regarding required continuing education, or yerification that staff were free from communicable disease The owner/acting and from signs and symptoms of tuberculosis. 23 administrator stated that personnel records had been removed from. the facility, bpt she did not know when, how, why, or by" whom, and she did not, report this information to the police. “The owner/acting administrator could not provide evidence of current fire inspection, elopement drills, staff awareness of emergency management’ plan, adequate staff to provide necessary assistance with activities of daily living, licensed nurse to administer medications, there was a qualified desighee to act in the absence of the administrator, medications not" locked. Conditions exist which pose an imminent threat to residents.” 109. In accordance with Rule 58A-5.019(4)(b), Florida Administrative Code, “[nJotwithstanding the minimum staffing requirements specified in paragraph (a), all facilities, ineluding “those composed of apartment's, shall have enough qualified staff to provide resident supervision...” 110. This violation is a class I deficiency. 111. Pursuant to Section 400.419(2) (a), Florida Statutes, “[t]he Agency shall impose an administrative fine for a cited class I violation in an amount not less than $5,000 and not exceeding $10,000 for each violation.” WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count XV; 2. Impose a fine in the amount of $5,000. COUNT XVI 24 FAILURE TO PROVIDE LICENSED STAFF TO ADMINISTER MEDICATION IN : ACCORDANCE WITH THE PHYSICIAN'S ORDER : Rule 58A-5.0185(4) (a), Florida Administrative Code (2005) Class I deficiency | 112. The Agency re-alleges paragraphs (1) through (5) as #£ fully set forth herein. ‘ ’ 113. Based on observation, interviews, and record review, the Agency determined that the facility did not have a licensed staff member in the facility to administer medication to the residents. 114. The clinical record for resident #1 revealed a Resident Health Assessment “indicating for nursing/treatment/therapy services requirements “medication supervision and medication administration.” i\'4~8 The clinical record. for resident #8 revealed a Resident Health Assessment indicating for nursing/treatment/therapy service requirements. “administering of medications and with bathing.” 116. The clinical record for resident #9 revealed a Resident Health Assessment indicating for nursing/therapy service requirements “medication administration, staff to administer to ensure compliance.” 117. The clinical record for resident #12 revealed a Resident Health Assessment indicating for 25 eo. @ as oY nursing/treatment/therapy service requirements “dispense medications, needs them given to her at. appropriate times.” 118. Review of September and Octeber calendars and interview with the owner/acting administrator on September 30, 2005 at 3:00 p.m. revealed that technicians were scheduled to administer riedications every day except Saturday and Sunday from 6 a.m. to 9 p.m., when the licensed nurse was scheduled to be in the facility. 119. Observation on October 3, 2005 at approximatély 9:05 a.m. revealed a medication technician administering medications , to resident #8. Review of the Resident Health physician’s order that medication Assessment revealed a administration was to'be performed by a licensed nurse. 120. Interview with residents #1, #8, #9, and #12 confirmed that the technicians administer medications except on the weekends, when the nurse was on duty. 121. Interview with medication technicians #1 and #2 confirmed that they administer medication to the residents. These technicians acknowledged that they did not know the difference between assisting and administering medications. 122. This violation is a class I deficiency. 123. Pursuant to Section 400.419(2) (a), Florida Statutes, “[t]he Agency shall impose an administrative fine for a cited class I violation in an amount not less than $5,000 and not exceeding $10,000 for each violation.” 26 WHEREFORE, the Agency demands the following relief: 1. Enter factual and legal findings in favor of the Agency on Count XVI; 2. Impose a fine in the amount of $5,000. ' CLAIM FOR RELIEF " ae i | WHEREFORE, the Petitioner, State of Florida, Agency for Health care Administration, requests the following relief: Le Make factual and legal findings in favor of the Agency ‘on Counts I through XVI. ‘20 Assess against Respondent administrative fines of $40,000.00 for the violations cited above. 3. Assess costs related to the investigation and . prosecution of this matter, if applicable. , 4; Grant such other relief as the court deems is just and proper. Respondent is notified that it has a right to request and administrative hearing pursuant to Sections 120:569 and 120.57, Florida Statutes (2005). 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. 27 “a @ : Nt ay RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE OR REQUEST -A, HEARING WITHIN TWENTY-ONE. (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED, ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, or Donna La Plante, Esquire Fla. Bar No: 0966193 Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 Phone: (850) 922-5873 Fax: (850) ,921-0158 or (850) 413- 9313 ‘ 1 Copies furnished to: Barbara Alford Field Office Manager Agency for Health Care Administration (Interoffice Mail) 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 (receipt # 7004 1160 0003 3739 1706), to: Magnolia 28 Place, Inc., Attention: Administrator, 2767 Raymond Diehl Road, ‘ Tallahassee, Florida 32308, and by U.S. Certified Mail, Return Receipt Requested (receipt # 7004 1160 0003 3739 1713), to: Carolyn D. Olive, Registered Agent, 2639 Centre Pointe. Blvd., Suite 201, Tallahassee, Florida 32308 on this \Zs day of December 2005. ay Lu Esquire 29 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY H Complete items 1, 2, and:3. Also complete item 4 if Restricted Delivery Is desired. @ Print your name and address on the reverse so that we can return the card to you. @ Attach this card to the back of the mallpiece, or on the front if space permits. 1. Article Addressed to: Carolyn LD. Olive Kegistered Ageot 2639 Crrbrfeinrblvd. Ste #0) - : Tatla hesdSoe, EL F238 8. Recelved by ( Printed Name} C. Dai’ ofPeliy : ew) oe Dy Is delivery address different from item 1? C1 Yes I YES, enter delivery address below: 1 No 3. Service Type ified’ Mail C1 Express Mait Registered C Return Receipt for Merchandise 1 insured Mail [7-C.0.D. 4. Restricted Delivery? (Extra Fee) 1 Yes 102595-02:M-1035 i

Docket for Case No: 06-000119