STATE OF FLORIDA é AGENCY FOR HEALTH CARE ADMINISTRATION), ¥y ‘7? 2; STATE OF FLORIDA AGENCY FOR "5 HEALTH CARE ADMINISTRATION, Case Nos’! Petitioner, 2005008160 2005010379 vs. 2006002075 2006002077 CLEARVIEW MANOR, INC., d/b/a CLEARVIEW MANOR, . va l i Olo- | Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against CLEARVIEW MANOR, INC., d/b/a CLEARVIEW MANOR, (hereinafter Respondent), pursuant to Sections 120.569 and 120.57, Florida Statutes, (2005), and alleges: NATURE OF THE ACTION This is an action to impose upon the Respondent administrative fines in the sum of SIXTEEN THOUSAND AND NO/100 DOLLARS ($16,000.00) based upon twenty-two (20) uncorrected or repeat Class III violations cited pursuant to Section 400.419(2)(c), Florida Statutes (2004) and (2005). JURISDICTION AND VENUE L. The Agency has jurisdiction pursuant to Sections 20.42, 120.60 and 400.407, Florida Statutes (2005). 2. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2005). PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable statutes, rules, and regulations governing assisted living facilities pursuant to Chapter 400, Part II, Florida Statutes (2005), and Chapter 58A-5 Florida Administrative Code. 4. Respondent operates a 15-bed assisted living facility located at 1080 South Clearview Avenue, Tampa, Florida 33629, and is licensed as an assisted living facility, license number 9643. 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I 6. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 7. Pursuant to Section 400.426(4), Florida Statutes (2003) and (2004), each assisted living facility resident shall be “examined by a licensed physician or a licensed nurse practitioner within 60 days before admission to the facility. The signed and completed medical examination report shal! be submitted to the owner or administrator of the facility who shall use the information contained therein to assist in the determination of the appropriateness of the resident's admission and continued stay in the facility. The medical examination report shall become a permanent part of the record of the resident at the facility and shall be made available to the agency during inspection or upon request.” 8. Pursuant to Rule 58A-5.024(3)(b), Florida Administrative Code (2003) and (2004), assisted living facility resident records shall be maintained on facility premises and shall Ne include a copy of the medical examination described in Rule 5 8A-5.0181, Florida Administrative Code. 9. Pursuant to Rule 58A-5.0181(2)(a), Florida Administrative Code (2003) and (2004), within sixty (60) days prior to a resident’s admission to an assisted living facility, but no later than thirty (30) days after admission, such individual shall be examined by a physician or advanced registered nurse practitioner who shall provide the assisted living facility administrator with a medical examination report. 10. On or about February 26, 2004, the Agency conducted a complaint investigation (CCR #2004001 532) of the Respondent’s assisted living facility (hereinafter “Facility”). 11. Based upon record review and interview, the Agency determined that the Respondent failed to maintain, in the resident records for three (3) of five (5) sampled residents, a signed and completed medical examination report, in violation of Section 400.426(4), Florida Statutes (2003), and Rules 58A-5.024(3)(b) and 58A-5.01 81(2)(a), Florida Administrative Code (2003). 12. During the February 26, 2004, survey, review of the medical records for Resident #5 revealed that that resident was admitted to the Facility on or about September 15, 2003. 13. Further review of the medical records for Resident #5 revealed no medical examination report for that resident, 14. In an interview conducted on or about February 26, 2004, at approximately 1:00 p.m., the Facility administrator (hereinafter “Administrator”) indicated that when she assumed her current position at the Facility, she was informed that many documents were missing. During that same interview, the Administrator further indicated that she was in the process of replacing missing documents. 15. During the February 26, 2004, survey, review of the medical records for Resident #10 revealed that that resident was admitted to the Facility on or about June 6, 2003. 16. Further review of the medical records for Resident #10 revealed no medical examination report for that resident. 17. In an interview conducted on or about F ebruary 26, 2004, at approximately 11:00 a.m., the Administrator indicated that she was unable to locate a medical examination report for Resident #10. 18. During the February 26, 2004, survey, review of the medical records for Resident #11 revealed that that resident was admitted to the Facility on or about October 1, 2003. 19, Further review of the medical records for Resident #11 revealed no medical examination report for that resident. 20. In an interview conducted on or about F ebruary 26, 2004, at approximately 11:00 a.m., the Administrator indicated that she was unable to locate a medical examination report for Resident #11. . 21. Based upon the above, the Agency determined that the Respondent failed to maintain, in the resident records for three (3) of five (5) sampled residents, a signed and completed medical examination report, in violation of Section 400.426(4), Florida Statutes (2003), and Rules 58A-5 -024(3)(b) and 58A-5.0181(2)(a), Florida Administrative Code (2003). 22. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 23. The Agency cited the Respondent for a Class II violation in accordance with Section 400.419(2)(c), Florida Statutes (2003). 24, The Agency provided a mandated correction date of March 26, 2004. 25. On or about January 25, 2005, the Agency conducted a revisit to the February 26, 2004, complaint investigation (CCR #2004001532) of the F. acility. 26. Based upon record review and interview, the Agency determined that the Respondent failed to maintain, in the resident records for four (4) of twelve (12) sampled residents, a signed and completed medical examination report, in violation of Section 400.426(4), Florida Statutes (2003), and Rules 58A-5.024(3)(b) and 58A-5 .0181(2)(a), Florida Administrative Code (2003). 27. During the January 25, 2005, survey, review of the medical records for Resident #1 revealed that that resident was admitted to the Facility on or about December 1, 2004. 28. Further review of the medical records for Resident #1 revealed no medical examination report for that resident. 29. In an interview conducted on or about January 25, 2005, at approximately 12:30 p.m., the Administrator indicated that she had just recently contacted a physician to come to the Facility to perform a medical examination of, and complete a medical examination report for, Resident #1. 30. During the January 25, 2005, survey, review of the medical records for Resident #8 revealed that that resident was admitted to the Facility on or about February 9, 2004. 31. Further review of the medical records for Resident #8 revealed no medical examination report for that resident. . 32. During the January 25, 2005, survey, review of the medical records for Resident #10 revealed that that resident was admitted to the Facility on or about November 11, 2004. 33. Further review of the medical records for Resident #10 revealed no medical examination report for that resident. 34. During the January 25, 2005, survey, review of the medical records for Resident #12 revealed that that resident was admitted to the Facility on or about November 17, 2004. 35. Further review of the medical records for Resident #12 revealed no medical examination report for that resident. 36. Based upon the above, the Agency determined that the Respondent failed to maintain, in the resident records for four (4) of twelve (12) sampled residents, a signed and completed medical examination report, in violation of Section 400.426(4), Florida Statutes (2004), and Rules 58A-5.024(3)(b) and 58A-5.0181(2)(a), Florida Administrative Code (2004). 37, The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 38. The Agency cited the Respondent for a continuing uncorrected and/or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 39. | The Agency provided a mandated correction date of February 25, 2005. 40. Respondent’s failure to maintain in each resident record a signed and completed medical examination report, in. violation of Section 400.426(4), Florida Statutes (2004), and Rules 58A-5.024(3)(b) and 58A-5.0181(2)(a), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT I 41. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 42. Pursuant to Section 400.4275(2), Florida Statutes (2003) and (2004), the administrator or owner of an assisted living facility shall maintain personnel records for each. staff member which contain documentation of compliance with all training requirements of Chapter 400, Part III, Florida Statutes, or rules enacted pursuant thereto. 43. Pursuant to Rule 58A-5.0191(2)(a), Florida Administrative Code (2003) and (2004), an assisted living facility is required to ensure that facility staff (other than nurses, certified nursing assistants, or certain home health aides) who provide direct care to residents receive a minimum of one (1) hour of in-service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents. 44. — Pursuant to Rule 58A-5.024(2)(a)(1), Florida Administrative Code (2003) and (2004), personnel records for each assisted living facility staff member shall contain documentation of compliance with all staff training required by Rule 58A-5.0191, Florida Administrative Code. 45. Pursuant to Rule 58A-5.024(4)(a) and (d), Florida Administrative Code (2003) and (2004), an assisted living facility is required, at all times, to maintain all records required pursuant to Rule 58A-5.024, Florida Administrative Code, and to make such records available for inspection by the Agency. 46. Onor about February 26, 2004, the Agency conducted a complaint investigation (CCR #2004001532) of the Respondent’s assisted living facility (hereinafter “F acility’). 47. Based upon record review and interview, the Agency determined that the Respondent failed either: (1) to ensure that facility staff (other than nurses, certified nursing assistants, or certain home health aides) who provide direct care to residents receive a minimum of one (1) hour of in-service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents, in violation of Rule 58A-5.0191(2)(a), Florida Administrative Code (2003), or (2) to maintain documentation of compliance with such training requirement and/or to make such documentation available for inspection by the Agency, in violation of Section 400.4275(2), Florida Statutes (2003), and Rule 58A-5.024(4)(a) and (d), Florida Administrative Code (2003). 48. In an interview conducted on or about February 26, 2004, at approximately 11:00 a.m., the Facility’s administrator (hereinafter Administrator”) indicated that she had been employed in such capacity since January 2, 2004. 49. Record review and/or interview revealed that the Facility’s administrator (hereinafter “Administrator”) provided direct care to residents at the F acility. 50. Review of the Administrator’s personnel file revealed no documentation that she had undergone the minimum of one (1) hour of in-service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to Facility residents. 51. In an interview conducted on or about February 26, 2004, at approximately 11:00 a.m., a caregiver at the Facility indicated that she had been employed at the Facility for a period of eight (8) days. 92. Record review/interview revealed that that caregiver provided direct vare to residents at the Facility. 53. Based upon the above, the Agency determined that the Respondent failed either: (1) to ensure that facility staff (other than nurses, certified nursing assistants, or certain home health aides) who provide direct care to residents receive a minimum of one (1) hour of in- service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents, in violation of Rule 58A-5.0191(2)(a), Florida Administrative Code (2003), or (2) to maintain documentation of compliance with such training requirement and/or to make such documentation available for inspection by the Agency, in violation of Section 400.4275(2), Florida Statutes (2003), and Rule 5 8A-5.024(4)(a) and (d), Florida Administrative Code (2003). 54, The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 55. The Agency cited the Respondent for a Class If] violation in accordance with Section 400.419(2)(c), Florida Statutes (2003). 56. The Agency provided a mandated correction date of March 26, 2004. 57. On or about January 25, 2005, the Agency again conducted a revisit to the February 26, 2004, complaint investigation (CCR #2004001532) of the Facility. 58. Based upon record review and interview, the Agency determined that the Respondent failed either: (1) to ensure that facility staff (other than nurses, certified nursing assistants, or certain home health aides) who provide direct care to residents receive a minimum of one (1) hour of in-service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents, irviolation of Rule 58A-5.0191(2)(a), Florida Administrative Code (2004), or (2) to maintain documentation of compliance with such training requirement and/or to make such documentation available for inspection by the Agency, in violation of Section 400.4275(2), Florida Statutes (2004), and Rule 58A-5.024(4)(a) and (d), Florida Administrative Code (2004). 59. During the January 25, 2005, survey, record review revealed no documentation that either Employee #1 or Employee #2, each of whom provided direct care to residents and neither of whom was a nurse, certified nursing assistant, or home health aid, had completed the required minimum one (1) hour of in-service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents. 60. During an interview conducted January 25, 2005, at approximately 10:00 am., the Administrator indicated that the Facility owner (hereinafter “Owner”) might possess the documentation of compliance with the aforementioned training requirement. The Administrator further indicated that such documentation might be located at another facility owned by the Owner. 61. Prior to the conclusion of the January 25, 2005, survey, the Owner provided to the Agency surveyor a list of the in-service training that allegedly had been provided to Facility staff. The documentation submitted by the Owner did not list any in-service training in infection control and had not been signed by either employee of the F acility. 62. Based upon the above, the Agency determined that the Respondent failed either: (1) to ensure that facility staff (other than nurses, certified nursing assistants, or certain home health aides) who provide direct care to residents receive a minimum of one (1) hour of in- service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents, in violation‘uf Rule 58A-5 .0191(2)(a), Florida Administrative Code (2004), or (2) to maintain documentation of compliance with such training requirement and/or to make such documentation available for inspection by the Agency, in violation of Section 400,4275(2), Florida Statutes (2004), and Rule S8A-5.024(4)(a) and (d), Florida Administrative Code (2004). 63. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of F. acility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 64. The Agency cited the Respondent for a continuing uncorrected and/or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 65. The Agency provided a mandated correction date of February 25, 2005. 66. Respondent’s failure: (1) to ensure that facility staff (other than nurses, certified nursing assistants, or certain home health aides) who provide direct care to residents receive a minimum of one (1) hour of in-service training in infection control, including universal precautions and facility sanitation procedures, before providing personal care to residents, in violation of Rule 58A-5.0191(2)(a), Florida Administrative Code (2004), and/or (2) to maintain documentation of compliance with such training requirement and/or to make such documentation available for inspection by the Agency, in violation of Section 400.4275(2), Florida Statutes (2004), and Rule 58A-5.024(4)(a) and (d), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FFVE HUNDRED AND NO/100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT Il 67. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 68. Pursuant to Section 400.417(3), Florida Statutes (2004) and (2005), the Agency shall have access to books, records, and any other financial documents maintained by an assisted living facility to the extent necessary to determine the facility's financial stability. 69. On or about April 27, 2005, the Agency conducted a biennial licensure survey of the Respondent’s assisted living facility (hereinafter “Facility”). 70. During the course of the April 27, 2005, survey, the Respondent failed to grant the Agency adequate access to Facility books, records, and/or other financial documents necessary for the Agency to determine the financial stability of the F. acility, in violation of Section 400.417(3), Florida Statutes (2004). 71. During the April 27, 2005, survey, an Agency surveyor requested that the Facility administrator (hereinafter “Administrator”) provide Facility financial documents demonstrating the Facility’s income (by source) and expenses (by category) for the preceding 12-month period. 72. The Administrator indicated that she did not have access to such documents and contacted the Facility owner (hereinafter “Owner”) by telephone. 73. The Owner subsequently arrived at the Facility and provided the Administrator with a single sheet of handwritten paper that listed the income and expenses for the month of April 2005. 74. The Administrator repeatedly called the Owner in an effort to obtain the income and expenses for the other months that had been requested, but was unsuccessful in obtaining any further financial documentation from the Owner. 75. Based upon the above, the Agency determined that the Respondent failed to grant access to books, records, and any other financial documents necessary for the Agency to determine the facility's financial stability, in violation of Section 400.417(3), Florida Statutes (2004). 76. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or , potentially threatened the physical or emotional health, safety, or security of facility residents. 77. The Agency cited the Respondent for a Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 72. The Agency provided a mandated correction date of May 27, 2005. 79. On or about June 2, 2005, the Agency conducted a revisit to the April 27, 2005, biennial licensure survey of the Facility. 80. During the course of the June 2, 2005, survey, the Respondent failed to grant the Agency adequate access to Facility books, records, and/or other financial documents necessary for the Agency to determine the financial stability of the Facility, in violation of Section 400.417(3), Florida Statutes (2005). 81. During the entrance conference at the June 2, 2005, survey, an Agency surveyor again requested that the Administrator provide Facility financial documents demonstrating the Facility’s income (by source) and expenses (by category) for the preceding 12-month period. 82. In response to such request, the Administrator indicated that the Owner did not grant the Administrator access to such records. Accordingly, the Agency was again denied access to the requested financial documents despite making the Owner, during the April 27, 2005, survey, aware of the Agency’s need to access such documents. 83. Based upon the above, the Agency determined that the Respondent again failed to grant access to books, records, and any other financial documents necessary for the Agency to determine the facility's financial stability, in violation of Section 400.417(3), Florida Statutes (2005). 84. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or . potentially threatened the physical or emotional health, safety, or security of facility residents. 85. The Agency cited the Respondent for a continuing Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2005). 86. | The Agency provided a mandated correction date of July 2, 2005. 87. Respondent's failure to grant access to books, records, and any other financial documents necessary for the Agency to determine the facility's financial stability, in violation of Section 400.417(3), Florida Statutes (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2005). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2005). COUNT IV 88. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 89. Pursuant to Section'400.4275(2), Florida Statutes (2004) and (2005), the administrator or owner of an assisted living facility shall maintain personnel records for each staff member which contains documentation of background screening. 90. Pursuant to Rule 58A-5.019(3)(a), Florida Administrative Code (2004) and (2005), all assisted living facility staff, hired on or after October 1, 1998, to provide personal services to residents, must be screened in accordance with Section 400.4174, Florida Statutes, and meet the screening standards of Section 435.03, Florida Statutes. 91. Pursuant to Section 400.4174(2), Florida Statutes (2004) and (2005), the 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 Section 400.402(17), Florida Statutes, 92. Pursuant to Section 400.402(17), Florida Statutes (2004) and (2005), the term “personal services” is defined as “direct physical assistance with or supervision of the activities of daily living and the self-administration of medication and other similar services which the department may define by rule.” 93. Pursuant to Section 435.03(1), Florida Statutes (2005), all employees required by law to be screened shall be required to undergo background screening as a condition of employment and continued employment. For the purposes of this subsection, level 1 screenings shall include, but not be limited to, employment history checks and statewide criminal correspondence checks through the Florida Department of Law Enforcement, and may include local criminal records checks through local Jaw enforcement agencies. 94, Pursuant to Rule 58A-5.024(2)(a)(3), Florida Administrative Code (2004) and (2005), personnel records shall include documentation of compliance with level one (1) background screening requirements for all assisted living facility staff subject to such screening requirements under Rule 58A-5.019, Florida Administrative Code. 95. On or about April 27, 2005, the Agency conducted a biennial licensure survey of the Respondent’s assisted living facility (hereinafter “Facility”). 96. Based upon record review, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2004) and (2005), and Rule 58A-5.019(3)(a), Florida Administrative Code (2004) and (2005), or (2) failed to maintain results of background Screenings in the personnel file for each employee subject to such requirement, in violation of Section 400.4275(2), Florida Statutes (2004) and (2005), and Rule 58A-5 .024(2)(a)(3), Florida Administrative Code (2004) and (2005). 97. Review of Facility personnel files during the April 27, 2005, survey revealed that the personnel file for a staff member who was hired on November 14, 2004, and who performed personal services at the Facility did not contain any documentation indicating that such employee had undergone a level 1 background screening. 98. Based upon the above, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2004) and (2005), and Rule 58A-5.019(3)(a), Florida Administrative Code (2004) and (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to such requirement, in violation of Section 400.4275(2), Florida Statutes (2004) and (2005), and Rule 58A-5 .024(2)(a)(3), Florida Administrative Code (2004) and (2005). 99. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 100. The Agency cited the Respondent for a Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 101. The Agency provided a mandated correction date of May 27, 2005. 102. Onor about June 2, 2005, the Agency conducted a revisit to the April 27, 2005, biennial licensure survey of the Facility. 103. Based upon record review, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2005), and Rule 58A-5 .019(3)(a), Florida Administrative Code (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to such requirement, in violation of Section 400.4275(2), Florida Statutes (2005), and Rule 58A-5.024(2)(a)(3), Florida Administrative Code (2005). 104. Review of Facility personnel files during the June 2, 2005, survey revealed that the personnel file for a staff member who was hired on November 14, 2004, and who performed personal services at the Facility did not contain any documentation indicating that such employee had undergone a level 1 background screening. 105. Based upon the above, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2005), and Rule 58A-5.019(3)(a), Florida Administrative Code (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to such requirement, in violation of Section 400.4275(2), Florida Statutes (2005), and Rule 58A- 5.024(2)(a)(3), Florida Administrative Code (2005). 106. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 107. The Agency cited the Respondent for an uncorrected Class I violation in accordance with Section 400.419(2)(c), Florida Statutes (2005). 108. The Agency provided a mandated correction date of May 27, 2005 [sic]. The mandated correction date should have been July 2, 2005. 109. Respondent’s continuing failure to either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2005), and Rule 58A-5.019(3)(a), Florida Administrative Code (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to such requirement, in violation of Section 400.4275(2), Florida Statutes (2005), and Rule 5 8A-5.024(2)(a)(3), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/ 100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00) pursuant to Section 400.419(2)(c), Florida Statutes (2005). COUNT V 110. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Eighty-Nine (89) through One Hundred Nine (109) as if fully set forth herein. 111. Onor about August 30, 2005, the Agency conducted a second revisit to the April 27, 2005, biennial licensure survey of the Facility. 112. Based upon record review and interview, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2005), and Rule S8A-5.019(3)a), Florida Administrative Code (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to such Tequirement, in violation of Section 400.4275(2), Florida Statutes (2005), and Rule 58A-5.024(2)(a)(3), Florida Administrative Code (2005). 113. Record review during the August 30, 2005, survey, revealed that the personnel file for Employee #1, who was hired after October 1, 1998, and who provided personal services to Facility residents, contained a Hillsborough County background screening for that employee. 114. Employee #1’s personnel file did not contain employment history checks and statewide criminal correspondence checks through the Florida Department of Law Enforcement as required by Section 435.03(1), Florida Statutes (2005). 115. Based upon the above, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2005), and Rule 58A-5.019(3)(a), Florida Administrative Code (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to sich requirement, in violation of Section 400.4275(2), Florida Statutes (2005), and Rule 58A- 5.024(2)(a)(3), Florida Administrative Code (2005). 116. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 117. The Agency cited the Respondent for a continuing uncorrected Class III violation ‘in accordance with Section 400.419(2)(c), Florida Statutes (2005). . 118. The Agency provided a mandated correction date of September 30, 2005. 119. Pursuant to Section 400.419(3), Florida Statutes (2005), “In determining if a penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 20 120. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2005), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 121. Respondent’s continuing failure to perform required background screenings and/or maintain the results of such screenings in Facility personnel files, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 ($1000.00) pursuant to Section 400.419(2)(c), Florida Statutes (2005). COUNT VI 122. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Eighty-Nine (89) through One Hundred Nine (109) as if fully set forth herein. 123. On or about November 3, 2005, the Agency conducted a third revisit to the April 27, 2005, biennial licensure survey of the Respondent’s assisted living facility (hereinafter “Facility’”). 124. Based upon record review and interview, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screeniiig standards of Section 435.03, Florida Statutes, in violation of Section 400.4174(2), Florida Statutes (2005), and Rule 58A-5.019(3)(a), Florida 21 Administrative Code (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to such requirement, in violation of Section 400.4275(2), Florida Statutes (2005), and Rule 58A-5.024(2)(a)(3), Florida Administrative Code (2005). 125. Record review during the November 3, 2005, survey, revealed that the personnel file for Employee #1, who was hired after October 1, 1998, and who provided personal services to Facility residents, contained a Nationwide American Databank background screening for that employee. 126. Employee #1’s personnel file did not contain employment history checks and statewide criminal correspondence checks through the Florida Department of Law Enforcement as required by Section 435.03(1), Florida Statutes (2005). 127. Based upon the above, the Agency determined that the Respondent failed either: (1) to ensure that all Facility staff hired on or after October 1, 1998, to provide personal services to residents, were screened in accordance with Section 400.4174, Florida Statutes, and met the screening standards of Section 435.03, Florida Statutes, in violation of Section 400.41 74(2), Florida Statutes (2005), and Rule 58A-5.019(3)(a), Florida Administrative Code (2005), or (2) to maintain results of background screenings in the personnel file for each employee subject to such requirement, in violation of Section 400.4275(2), Florida Statutes (2005), and Rule 58A- 5.024(2)(a)(3), Florida Administrative Code (2005). 128. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 129. The Agency cited the Respondent for a Class II violation in accordance with Section 400.419(2)(c), Florida Statutes (2005). 22 130. The Agency provided a mandated correction date of December 3, 2005. 131. Pursuant to Section 400.419(3), Florida Statutes (2005), “In determining ifa penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) = Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 132. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2005), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 133. Respondent’s continuing and/or repeated failure to perform required background screenings and/or maintain the results of such screenings in Facility personnel files, as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND DOLLARS AND NO/100 DOLLARS ($1000.00) pursuant to Section 400.419(2)(c), Florida Statutes (2005). COUNT Vil 134. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 135. Pursuant to Rule 58A~-5.023(1)(b), Florida Administrative Code (2003), (2004) and (2005), an assisted living facility’s physical structure, including the interior and exterior walls, floors, roof and ceilings shall be structurally sound and in good repair. 136. On or about February 26, 2004, the Agency conducted a complaint investi gation (CCR #2004001532) of the Respondent’s assisted living facility (hereinafter “Facility”). 137. Based upon observation during the survey, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2003). 138. Observation of the Main Building of the Facility revealed that: a. The wall plaster was pulled away in the hallway of the living room, exposing metal mesh with sharp edges. b. , The enclosed front porch was missing floor tiles. Cc. A resident bedroom (Room #1) had a hole in the wall beneath the window. d. The bathroom of Room #1 had walls and molding that were damaged. The bathroom shower was deteriorating and moldy. 139. Observation of Annex B of the Facility revealed that: a. There was a hole in the bedroom door for Room #3. b. The bathroom shower was blackened with mold. c. In Bedroom #4, the floor was partially tiled, tiles were broken and missing, there was a hole in the wall, baseboards were missing, and the room was only partially painted. d. A leak existed over a resident bed in a new bedroom recently 24 added in this building. The ceiling was spackled, but not painted. 140. Observation of Annex C of the Facility revealed that: a. In Room #1, an attic door located high on a wali was hanging off its hinges. b. The bathroom was missing floor tiles. The walls were water damaged and had cracks in the corners of the room, appearing as if the walls were not tightly secured. Molding and baseboards were missing and coming off the walls. There was a hole in the shower behind the sink. The shower was badly mildewed. 141. Based upon the above, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2003). 142. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 143. The Agency cited the Respondent for a Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2003). 144. The Agency provided a mandated correction date of March 26, 2004. 145. On or about July 23, 2004, the Agency conducted an Operation Spot Check survey of the Facility. 146. Based upon observation during the survey, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A~-5.023(1)(b), Florida Administrative Code (2004). 147, Observation of the Facility during the July 23, 2004, survey revealed the following: a. The exterior wood on the front of the main house was mildewed 25 and the wood was damaged from moisture. b. The walls of bedrooms and bathrooms in house B and C were dirty, stained and/or marred. c. The walls and moldings of the living room in the main house were dirty, stained, and/or marred. d. The vanity in the bathroom of the women's annex was deteriorating, doors were hanging from the hinges. e. Walls were badly damaged from rot and had holes in them. f. Multiple wires and cables were observed lining doorways to several resident rooms in building C, posing a potential accident hazard. 148. Based upon the above, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 149. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 150. The Agency cited the Respondent for an uncorrected Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 151. The Agency provided a mandated correction date of August 30, 2004. 152, Respondent’s continued failure to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.41 9(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT VIII 153. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and One Hundred Thirty-Five (135) through One Hundred Fifty-Two (152) as if fully set forth herein. 154. On or about November 30, 2004, during a revisit survey, the Agency determined that the Respondent had corrected the previously-described deficient practice that has been incorporated by reference to this Count. 155. On or about January 25, 2005, the Agency conducted a revisit to the February 26, 2004, complaint survey (Complaint #2004001532) of the Facility. 156. Based upon observation during the January 25, 2005, survey, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 157. Observation of Annex C of the Facility during the January 25, 2005, survey revealed that: a. The ceramic tile in the bathroom shower had been painted over in an effort to cover up black mold, which remained visible through the paint. b. Some of the shower tiles were pushed into the wall. c. The walls were water-damaged and had cracks in the comers of the room, appearing as if the walls were not tightly secured. d. Molding/baseboards were missing and coming off the walls. 158. Based upon the above, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule S8A-5.023(1)(b), 27 Florida Administrative Code (2004). 159. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 160. The Agency cited the Respondent for a continuing uncorrected or repeat Class DI violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 161. The Agency provided a mandated correction date of February 25, 2005. 162. Pursuant to Section 400.419(3), Florida Statutes (2004), “In determining if a penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or - serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 163. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2004), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 164. Respondent’s continued failure to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004), as set 28 forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT IX 165. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and One Hundred Thirty-Five (135) through One Hundred Fifty-Two (152) as if fully set forth herein. 166. Onor about April 27, 2005, the Agency conducted a biennial licensure survey of the Facility. 167. Based upon observation during the April 27, 2005, survey, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004), 168. Observation of the Main Building of the Facility revealed that the resident bathroom was missing tiles on the floor and molding on the ceiling. 169. Observation of Annex B of the Facility revealed that: a. The floor tile of all resident rooms were loose, broken, and gaps between them. b. The bathroom floor had brown-stained grout. c. The main hallway floor had chipped/peeling paint. 170. Observation of Annex C of the Facility revealed that: a. The bathroom, which is accessed from the outside only, was observed to have black mildew from water damaged rotting wood along the wall and floor joint near the commode. Additionally, the floor of the bathroom was saturated with water due to the door being left open during rain. b. Floor tiles throughout all resident rooms (C-1, C-2 & C-3) were chipped or improperly laid resulting in gaps between tiles which allowed dirt to accumulate. c. The wall in C-1 was observed to be cracked under the air conditioner unit. The walls were dirty with cobwebs. d. The hall bathroom was observed to have a dirty floor, floor tiles were missing, cracked or had gaps between them. e. The wall in the hall bathroom was cracked behind the toilet and the wall next to the shower. f. The shower in the hall bath was missing tiles. g. Wood was rotting and black along the bottom of the door frame in bedroom C-2., h. The door frame was black from dirt or rotting from water damage in room C-3 and the door paint dirty. i. The bathroom floor had brown-stained grout. j. The main hallway floor had chipped/healing paint. 171. Based upon the above, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 172. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 173. The Agency cited the Respondent for a continuing uncorrected or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 30 174. The Agency provided a mandated correction date of May 27, 2005. 175. Pursuant to Section 400.419(3), Florida Statutes (2004), “In determining if a penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 176. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2004), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 177. Respondent’s continued failure to maintain the Facility’s physical structure in good repair, in violation of Rule S58A~-5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). 31 COUNT X 178. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and One Hundred Thirty-Five (135) through One Hundred Fifty-Two (152) as if fully set forth herein. 179. Onor about June 2, 2005, the Agency conducted a revisit to the April 27, 2005, biennial licensure survey of the Facility. 180. Based upon observation during the June 2, 2005, survey, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 181. Observation of the Main Building of the Facility revealed that the resident bathroom was missing tiles on the floor and molding on the ceiling. 182. Observation of Annex B of the Facility revealed that: a. The floor tile of all resident rooms were loose, broken, and had gaps between them. db. The bathroom floor had brown-stained grout. c. The main hallway floor had chipped/peeling paint. 183. Observation of Annex C of the Facility revealed that: a. The bathroom, which is accessed from the outside only, was observed to have black mildew from water damaged rotting wood along the wall and floor joint near the commode. Additionally, the floor of the bathroom was saturated with water due to the door being left open during rain. b. Floor tiles throughout ali resident rooms (C-1, C-2 & C-3) were chipped or improperly laid resulting in gaps between tiles which allowed dirt to accumulate. c. The wall in C-1 was observed to be cracked under the air conditioner unit. e. The wall in the hall bathroom was cracked behind the toilet and the wall next to the shower. The shower in the hall bath was missing tiles. 184. Based upon the above, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 185. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 186. The Agency cited the Respondent for a continuing uncorrected or repeat Class II violation in accordance with Section 400.419(2)(c), Florida Statutes (2005). 187. The Agency provided a mandated correction date of July 2, 2005. 188. Pursuant to Section 400.419(3), Florida Statutes (2005), “In determining ifa penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) {b) (c) (d) (e) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. Actions taken by the owner or administrator to correct violations. Any previous violations. The financial benefit to the facility of committing or continuing the violation. The licensed capacity of the facility.” 189. In fixing the amount of the fine to be levied pursuant to this count, the Agency 33 considered all factors set forth in Section 400.419(3), Florida Statutes (2005), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 190. Respondent’s continued failure to maintain the Facility’s physical structure in ’ good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). COUNT XI 191. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and One Hundred Thirty-Five (135) through One Hundred Fifty-Two (152) as if fully set forth herein. 192: On or about August 30, 2005, the Agency conducted a second revisit to the April 27, 2005, biennial licensure survey of the Facility. 193. Based upon observation during the August 20, 2005, survey, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 194. Observation of the Main Building of the Facility revealed that: a. The resident bathroom had chipped tile floors. b. The shower had a large amount of soap scum build-up, mildew and dirt. 34 c. A crack was present in the wall. 195. In an interview conducted on or about August 30, 2005, the Facility administrator (hereinafter “Administrator”) indicated that she had attempted to clean the resident bathroom in the Main Building on muitiple occasions by using bleach, but that such technique was ineffective. The Administrator further indicated that she had informed the Facility owner of this problem. 196. Observation of Annex B of the Facility revealed that: a. The floor tiles of all resident rooms were loose, broken, peeling and had gaps between them. b. Room B-3 had window rods and draperies on a diagonal, falling to the floor. In addition, several deep gouges were in the flooring and cigarette butts and tobacco grounds littered the floor. c. The bathroom floor had brown-stained grout and debris. 197. In an interview conducted on or about August 30, 2005, the Administrator indicated that she had repeatedly attempted to clean the resident bathroom in Annex B, but had been unsuccessful in so doing. The Administrator further indicated that she had informed the Facility owner of this problem. 198. Observation of Annex C of the Facility revealed that: a. The exterior bathroom had a small hole in the ceiling and a small hole in the wall from the door knob. b. Floor tiles throughout resident rooms C-1 and C-2 were chipped, peeling and improperly laid, resulting in gaps between tiles which allowed dirt to accumulate and exposing the concrete foundation underneath. c. The wall in C-3 was cracked near the foot of the bed, d. The interior bathroom had dirty grout in the shower. In addition, the tile by the sink/toilet area was chipped and brown stains were on the area where the floor meets the wall. 35 199. Based upon the above, the Agency determined that the Respondent failed to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 200. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 201. The Agency cited the Respondent for a continuing uncorrected or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2005). 202. The Agency provided a mandated correction date of September 30, 2005. 203. Pursuant to Section 400.419(3), Florida Statutes (2005), “In determining if a penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) ‘The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 204, In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2005), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory 36 provisions and the Respondent’s lack of action to correct such violations. 205. Respondent’s continued failure to maintain the Facility’s physical structure in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005), as set: forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). COUNT XII 206. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 207. Pursuant to Rule 58A-5.023(1)(b), Florida Administrative Code (2003) and (2004), peeling paint or wallpaper, missing ceiling or floor tiles, or torn carpeting at an assisted facility shall be repaired or replaced. 208. On or about February 26, 2004, the Agency conducted a complaint investigation (CCR #2004001532) of the Respondent’s assisted living facility (hereinafter “Facility”). 209. Based upon observation during the survey, the Agency determined that the Respondent failed to repair or replace peeling paint, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2003). 210. Observation revealed paint that was scraped and or marred throughout the Facility. In addition, some resident bedrooms were only partially painted. 211. Based upon the above, the Agency determined that the Respondent failed to repair 37 or replace peeling paint, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2003). 212. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 213. The Agency cited the Respondent for a Class III violation in accordance with ; Section 400.419(2)(c), Florida Statutes (2003). 214. The Agency provided a mandated correction date of March 26, 2004. 215. On or about July 23, 2004, the Agency conducted an Operation Spot Check survey of the Facility. 216. Based upon observation during the survey, the Agency determined that the Respondent failed to repair or replace missing and/or broken tiles, in violation of Rule 58A- 5.023(1)(b), Florida Administrative Code (2004). 217, Observation during the July 23, 2004, survey revealed: a. Broken or missing tiles were present in hallways and bedrooms of Annex B and C. b. Room 3 of Annex B had missing and torn floor covering. C. The hail floor of Annex B had broken/torn linoleum tiles. d. Room 1 of Annex C had torn/broken tiles e. Room 3 of Annex C had broken and missing floor tiles. f. Paint was scraped or marred throughout the facility. 218. Based upon the above, the Agency determined that the Respondent failed to repair or replace missing and/or broken tiles, in violation of Rule S8A-5.023(1)(b), Florida Administrative Code (2004). 38 219. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 220. The Agency cited the Respondent for an uncorrected Class II violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 221. The Agency provided a mandated correction date of August 30, 2004. 222. Respondent’s continued failure to repair or replace missing and/or broken tiles, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT XI 223. The Agency re-alleges and incorporates paragraphs One (1) through Five (5) and Two Hundred Seven (207) through Two Hundred Twenty-Two (222) as if fully set forth herein. 224, On or about November 30, 2004, during a revisit survey, the Agency determined that the Respondent had corrected the previously-described deficient practice that has been incorporated by reference to this Count. 225. Onor about January 25, 2005, the Agency conducted a revisit to the February 26, 2004, complaint survey (Complaint #2604001532) of the Facility. 226. Based upon observation during the January 25, 2005, survey, the Agency 39 determined that the Respondent failed to repair or replace peeling paint, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 227. Observation revealed paint that was scraped and or marred throughout the Facility. 228. Based upon the above, the Agency determined that the Respondent failed to repair or replace peeling paint, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 229. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 230. The Agency cited the Respondent for a continuing uncorrected or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 231. The Agency provided a mandated correction date of February 25, 2005. 232. Pursuant to Section 400.419(3), Florida Statutes (2004), “In determining if a penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) — Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 40- 233. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2004), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 234. Respondent’s continued failure to repair or replace peeling paint, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE . THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT XIV 235. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 236. Pursuant to Rule 58A-5.023(1)(b), Florida Administrative Code (2003), (2004), and (2005), windows, doors, plumbing, and appliances at an assisted facility shall be functional and in good working order. 237. On or about February 26, 2004, the Agency conducted a complaint investigation (CCR #2004001532) of the Respondent's assisted living facility (hereinafter “Facility”). 238. Based upon observation during the survey, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5 .023(1)(b), Florida Administrative 41 Code (2003). 239. Observation of the Main Building of the Facility revealed that the ceiling lights in the living room were missing bulbs. 240. Observation of Annex B of the Facility revealed that: a. The ceiling light in Room #3 was missing light bulbs. b. There was no source of heat for the bathroom. c. The shower in the bathroom did not drain. d. In Room #4, wires were hanging loose from the smoke detectors. 241. Observation of Annex C of the Facility revealed that: a. The ceiling lights in Rooms #2 and #3 were missing light bulbs and protective covers. b. Floor fans were dirty. 242. Based upon the above, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A~-5.023(1)(b), Florida Administrative Code (2003). 243. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 244, The Agency cited the Respondent for a Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2003). 245. The Agency provided a mandated correction date of March 26, 2004. 246. On or about July 23, 2004, the Agency conducted an Operation Spot Check survey of the Facility. 247. Based upon observation during the survey, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 248. Observation during the July 23, 2004, survey revealed: a. The vanity of the bathroom in the women's annex was deteriorating, and the sink was pulled from the wall. b. There were gaps around the bedroom door in room #1 of the main house. c. The bathroom window to building C was cracked and in disrepair. d. Ceiling lights were missing light bulbs. 249. Based upon the above, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 250. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 251. The Agency cited the Respondent for an uncorrected Class II violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 252. The Agency provided a mandated correction date of August 30, 2004. 253. Respondent’s continued failure to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A- 5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative 43 fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT XV 254, The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Two Hundred Thirty-Six (236) through Two Hundred Fifty-Three (253) as if fully set forth herein. 255. On or about November 30, 2004, during a revisit survey, the Agency determined that the Respondent had corrected the previously-described deficient practice that has been incorporated by reference to this Count. 256. On or about January 25, 2005, the Agency conducted a revisit to the February 26, 2004, complaint survey (Complaint #2004001532) of the Facility. 257. Based upon observation during the January 25, 2005, survey, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 258. Observation revealed that there was no source of heat in the bathroom of Annex B of the Facility. 259. Observation of Annex C of the Facility revealed that the ceiling lights in Rooms #2 and #3 were missing light bulbs and protective covers. 260. Based upon the above, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 261. The Agency determined that this deficient practice was related to the operation 44 and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 262. The Agency cited the Respondent for a continuing uncorrected or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 263. The Agency provided a mandated correction date of February 25, 2005. 264. Pursuant to Section 400.419(3), Florida Statutes (2004), “In determining ifa . penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions talcen by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 265. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2004), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 266. Respondent’s continued failure to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A- 5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND 45 NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT XVI 267. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Two Hundred Thirty-Six (236) through Two Hundred Fifty-Three (253) as if fully set forth herein. 268. On or about April 27, 2005, the Agency conducted a biennial licensure survey of the Facility. 269. Based upon observation during the April 27, 2005, survey, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5 .023(1)(b), Florida Administrative Code (2004). 270. Observation of the Main Building of the Facility revealed that: a. The screen door to the kitchen had a damaged panel. b. The resident bathroom toilet appeared to be sinking. 271. Observation of Annex C of the Facility revealed that: a. The hall bathroom toilet was running continuously. b. No light switch could be found for Room #3. Aside from the ceiling light fixture, no other source of light was in the room. In an interview conducted during the survey, the resident occupying that room indicated that he/she had been residing in the room for approximately four (4) months and had not been able to locate a switch that would operate the ceiling fixture. 272. Based upon the above, the Agency determined that the Respondent failed to 46 maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 273. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 274, The Agency cited the Respondent for a continuing uncorrected or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 275. The Agency provided a mandated correction date of May 27, 2005. 276. Pursuant to Section 400.419(3), Florida Statutes (2004), “In determining if a penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 277. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2004), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 278. Respondent’s continued failure to maintain all windows, doors, plumbing, and 47 appliances in a functioning state and in good working order, in violation of Rule 58A- 5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to. Section 400.419(2)(c), Florida Statutes (2004). COUNT XVII 279. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Two Hundred Thirty-Six (236) through Two Hundred Fifty-Three (253) as if fully set forth herein. 280. Onor about June 2, 2005, the Agency conducted a revisit to the April 27, 2005, biennial licensure survey of the Facility. 281. Based upon observation during the June 2, 2005, survey, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 282. Observation of the Main Building of the Facility revealed that: a. The screen door to the kitchen had a damaged panel. b. The resident bathroom toilet appeared to be sinking, as it leaned to one side towards the shower. c. The resident bathroom pedestal sink was not secured to the wall and was easily moved if pressure was applied to it. d. The screen door to a resident room was broken with a hanging wood frame and a ripped screen. 48 283. Based upon the above, the Agency determined that the Respondent failed to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 284. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 285. The Agency cited the Respondent for a continuing uncorrected or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2005). 286. The Agency provided a mandated correction date of July 2, 2005. 287. Pursuant to Section 400.419(3), Florida Statutes (2005), “In determining ifa penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 288. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2005), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory 49 provisions and the Respondent’s lack of action to correct such violations. 289. Respondent’s continued failure to maintain all windows, doors, plumbing, and appliances in a functioning state and in good working order, in violation of Rule 58A- 5.023(1)(b), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). _ WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). COUNT XVIII 290. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully set forth herein. 291. Pursuant to Rule 58A-5.023(1)(b), Florida Administrative Code (2003), (2004), and (2005), all furniture and furnishings at an assisted living facility shall be clean, functional, free of odors, and in good repair. 292. Onor about February 26, 2004, the Agency conducted a complaint investigation (CCR #2004001532) of the Respondent’s assisted living facility (hereinafter “Facility”). 293. Based upon observation during the survey, the Agency determined that the Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2003). 294. Observation of the Main Building of the Facility revealed that: a. The floors of Bedroom #1 were dirty and littered with debris. 50 b. The air conditioning unit grill was dirty with dust. 295. Observation of Annex B of the Facility revealed that: a. The sink was loose from the wall in the bathroom and the vanity door was falling off. b. The shower floor and grout were blackened with mildew. 296. Observation of Annex C of the Facility revealed that: a. The floors of the hallway and Rooms #1, #2, and #3 were filthy with debris. b. Floor fans in the resident bedrooms were laden with dust and debris. 297. Based upon the above, the Agency determined that the Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2003). 298. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. ° 299. The Agency cited the Respondent for a Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2003). 300. The Agency provided a mandated correction date of March 26, 2004. 301. On or about July 23, 2004, the Agency conducted an Operation Spot Check survey of the Facility. 302. Based upon observation during the survey, the Agency determined that the ~ Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 31 303. Observation during the July 23, 2004, survey revealed that: a. All bathrooms had mold, dirt and grime build-up throughout. b. The kitchen and dining areas were littered with old food stuff. c. The shower floor in the women’s annex was filthy with a buildup of mold and mildew. d. One resident bedroom in the women's annex had black mildew on the walls from apparent water damage. This room also had a very strong odor. e. Blankets and linens were badly stained or appeared dirty. 304. Based upon the above, the Agency determined that the Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 305. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 306. The Agency cited the Respondent for an uncorrected Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 307. The Agency provided a mandated correction date of August 30, 2004. 308. Respondent’s continued failure to maintain all firniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to 52 Section 400.419(2)(c), Florida Statutes (2004). COUNT XIX 309. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Two Hundred Ninety-One (291) through Three Hundred Eight (308) as if fully set forth herein. 310. Onor about April 27, 2005, the Agency conducted a biennial licensure survey of the Facility. 311. Based upon observation during the April 27, 2005, survey, the Agency determined that the Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 312. Observation of the exterior of the Facility revealed that the wooden bench outside the main house was broken. 313. Observation revealed that the mini blinds on the front door of Annex B of the Facility were bent and broken. 314. Observation of Annex C of the Facility revealed that: a. The hall floor tiles were dirty. b. The floors of Bedrooms #1, #2, and #3 were dirty with an accumulation of debris and a heavy buildup of caked dirt around the perimeters. c. The mini blinds in the hall bathroom were laden with dirt. 315. Based upon the above, the Agency determined that the Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004). 316. The Agency determined that this deficient practice was related to the operation 33 and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents. 317. The Agency cited the Respondent for a continuing uncorrected or repeat Class III violation in accordance with Section 400.419(2)(c), Florida Statutes (2004). 318. The Agency provided a mandated correction date of May 27, 2005. 319. Pursuant to Section 400.419(3), Florida Statutes (2004), “In determining ifa | penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (d) ‘The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 320. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2004), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 321. Respondent’s repeated failure to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2004), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND 34 NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2004). COUNT XxX 322. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Two Hundred Ninety-One (291) through Three Hundred Eight (308) as if fully set forth herein. 323. On or about June 2, 2005, the Agency conducted a revisit to the April 27, 2005, biennial licensure survey of the Facility. 324, Based upon observation during the June 2, 2005, survey, the Agency determined that the Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 325. Observation of the exterior of the Facility revealed that the wooden bench outside the main house had unsecured bars and slats holding the bench together and that such bars and slats were unsecured, bent, or broken. 326. Observation revealed that the mini blinds on the front door of Annex B of the Facility were bent and broken. 327. Based upon the above, the Agency determined that the Respondent failed to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005). 328, The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or 55 potentially threatened the physical or emotional health, safety, or security of facility residents. 329. The Agency cited the Respondent for a continuing uncorrected or repeat Class HI violation in accordance with Section 400.419(2)(c), Florida Statutes (2005). 330. The Agency provided a mandated correction date of July 2, 2005. 331. Pursuant to Section 400.419(3), Florida Statutes (2005), “In determining ifa penalty is to be imposed and in fixing the amount of the fine, the Agency shall consider the following factors: (a) The gravity of the violation, including the probability that death or serious physical or emotional harm to a resident will result or has resulted, the severity of the action or potential harm, and the extent to which the provisions of the applicable laws or rules were violated. (b) Actions taken by the owner or administrator to correct violations. (c) Any previous violations. (4) The financial benefit to the facility of committing or continuing the violation. (e) The licensed capacity of the facility.” 332. In fixing the amount of the fine to be levied pursuant to this count, the Agency considered all factors set forth in Section 400.419(3), Florida Statutes (2005), including, but not limited to, the presence of previous violations of both this and other statutory and regulatory provisions and the Respondent’s lack of action to correct such violations. 333. Respondent’s continued failure to maintain all furniture and furnishings in a clean and functional state, free of odors, and in good repair, in violation of Rule 58A-5.023(1)(b), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an enhanced administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). 56 WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(c), Florida Statutes (2005). Respectfully submitted this gm day of March, 2006. rian Mullig Fla. Bar. No. 0676543 Counsel for Petitioner Agency for Health Care Admin. 525 Mirror Lake Drive, 330L St. Petersburg, FL 33701 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 (two pages) 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 Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. 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. CERTIFICATE OF SERVICE J HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7003 1010 0002 4667 1408 on March_§™ , 2006 to Kevin S. Kladakis, Registered Agent, Clearview Manor, 4008 Sevilla Street, Tampa, FL 33629 and by U.S. Certified Mail, Return Receipt No. 7003 1010 0002 4667 1415 to Rozenia Laster, Administrator, Clearview Manor, 1080 S. Clearview Ave., Tampa, FL 33629. LZ” Be / Brian Mulligan 57 Copies furnished to: Kevin S. Kladakis Registered Agent Clearview Manor 4008 Sevilla Street Tampa, FL 33629 (U.S. Certified Mail) Rozenia Laster Administrator Clearview Manor 1080 S. Clearview Ave. Tampa, FL 33629 (US. Certified Mail) 58 Brian Mulligan. Agency for Health Care Admin. 525 Mirror Lake Drive, 330L St. Petersburg, Florida 33701 (Interoffice) COMPLETE THIS SECTION ON DELIVERY © “ ‘m Complete items 1, 2, ..d 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 mailplece, or on the front if space permits. D. Is delivery address different from item 1? O Yes’ {fF YES, enter delivery address below: No 1. Article Addressed to: Rozenra haste; Rolain: stroctor Clea Nonor 3. Sanice Typ lO%o S. Clearvieus Ave. * “TG , [T Registered 1 Retum Receipt for Merchandise: Arn | Florida, (1 Insured Mall : Z $3429 | 4. Restricted Delivery? (Extra Fee) CO Yes 2, Article Number 2003 1010 o00¢ 4bb? L4i5 ; (Transfer trom s 2 PS Form 3811, February 2004 Domestic Return Recelpt 402595-02-M-154¢

Docket for Case No: 06-001834