STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION — STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, O lg - 4 a (o 7 vs. Case No. 2006005788 ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA STERLING HOUSE OF SPRING HILL, 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 ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA STERLING HOUSE OF SPRING HILL, (hereinafter Respondent), pursuant to Section 120.569, and 120.57, Fla. Stat., (2005), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of $1,000.00 based upon Respondent being cited with one uncorrected State Class III deficiency, pursuant to §400.419(2}(c) Fla. Stat. (2005). JURISDICTION AND VENUE 1. The Agency h2s jurisdiction pursuant to §§ 20.42, 120.60 and 400.407, Fla. Stat. (2005). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes, and rules governing assisted living facilities pursuant to the Chapter 400, Part DI, Florida Statutes, and Chapter 58A- 5 Fla. Admin. Code, respectively. 4. Respondent operates a 50-bed assisted living facility located at 10440 Palmgren Lane, Spring Hill, Florida 34606, and is licensed as an assisted living facility, license number 9255. 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 (1) through (5) as if fully set forth herein. 7. That pursuant to Florida law, all staff, hired on or after October 1, 1998, who provide personal services to residents, must undergo a background screening as required by law, a copy of which must be maintained in the personnel record of the staff member. Within 10 days of the employee’s starting work, the facility shall submit to AHCA, inter alia, a completed criminal history check. Fla. Admin. Code R. 58A-5.019(3). See also, Section 400.4275(2), Fla. Stat. (2005), R. 58A-5.024(2)(a)(3), Fla. Admin. Code. 8. That on March 1-2, 2006, the Agency conducted a biennial licensure survey including a Limited Nursing Services and an Extended Congregate Care survey of the Respondent. 9. That besed upon the review of personnel records and interview, the Respondent facility failed to ensure that three (3) of four (4) sampled employee records contained documentation of the level 1 background screening. This has a potential to place all residents at risk for abuse. 10. That the Petitioner’s representative reviewed the personnel records for employees numbered one (1), two (2), and four (4) on March 1, 2006 and noted as follows: a. That all three employees provided personal services to the Respondent’s residents; b. That all three employees had been employed by the Respondent for a period in excess of ten (10) days; c. That the personnel files of none of the three employees contained evidence of a level 1 criminal background screening having been conducted on the employee. 11. That the Petitioner’s representative interviewed the Respondent’s administrator on March 1, 2006 who indicated that she was unaware that the documentation reflecting criminal background screenings for employees numbered one (1), two (2), and four (4) were not in the file. 12. That the failure to complete criminal background screenings on employees performing personal services for residents within ten days of employment and or the failure to maintain records of the same is in violation of law. 13. That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a State Class III deficiency. 14. That the Agency provided the Respondent with a mandatory correction date of April 2, 2006. 15. That on May 2, 2006, the Agency completed a re-visit to the biennial licensure survey including a Limited Nursing Services and an Extended Congregate Care survey of the Respondent. 16. That based upon the review of personnel records and interview, the Respondent facility failed to ensure that one (1) of four (4) employee personnel records contained documentation of the level 1 background screening. This has a potential to place all residents at risk for abuse. 17. That the Petitioner’s representative reviewed the personnel records for employees numbered one (1) May 2, 2006 and noted as follows: a. That the employee provided personal services to the Respondent’s residents; b. That the employee had been employed by the Respondent for a period in excess of ten (10) days; c. That the personnel file of the employee contained no evidence of a level 1 criminal background screening having been conducted on the employee. 18. That the Petitioner’s representative interviewed the Respondent’s administrator on May 2, 2006 who indicated that she had not requested a level 1 background screening for employee number one (1) as she thought the employee would resign. 19. That the failure to complete criminal background screenings on employees is mandated for the protection of Florida’s vulnerable population and is not left to the discretion of employers based upon factors unrelated to resident safety such as periods of expected retention. 20. That the failure to complete criminal background screenings on employees performing personal services for residents within ten days of employment and or the failure to maintain records of the same is in violation of law. 21. That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for an uncorrected State Class II deficiency. 22. That the Agency provided the Respondent with a mandatory correction date of May 3, 2006. 23. That the same constitutes an uncorrected Class III deficiency as defined by law, Section 400.419(2)(c) (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 400.419(2)(c), Fla. Stat. (2005). Respectfully submitted this / day of August, 2006. omfas J. Walsh II Fla. Bar. No. 566365 Senior Attorney Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2005). Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to The Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, 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 I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7004 2510 0005 4049 1437 on August _/ __, 2006 to: CT Corporation System, Registered Agent, 1200 South Pine Island Road, Plantation, FL 33324 and by U.S. Mail to Nancy Villani, Administrator, Alterra Sterling House of Spring Hill, 10440 Palmgren Lane, Spring Hill, FL 34608. i 4s J. Walsh II, Esq. / Copies furnished to: CT Corporation System Nancy Villani, Administrator Thomas J. Walsh II, Esq. Registered Agent Alterra Sterling House Spring Hill | Agency for Health Care Admin. 1200 South Pine Island Rd | 10440 Palmgren Lane 525 Mirror Lake Drive, 330G Plantation, FL 33324 Spring Hill, FL 34608 St. Petersburg, FL 33701 (Certified U.S. Mail) (U.S. Mail) (Interoffice) “SENDER: COMPLE TggHiS SECTION °°" COMPLETE THis $EC7 IVER @ Complete items 1, 2, and 3. Also complete item 4 If Restricted Delivery is desired. @ Print your name and address on the reverse so that we can return the card to you. ™@ Attach this card to the back of the maliplece, or on the front if space permits, 1. eC orparadl ree) oe eeol agent ol D \Roo Sats Pine Eslant! Plantation, Fl. 33944 D. Is delivery address different fram item’ If YES, enter delivery address below: CO cantiied Mall ) p oe ela i Eases Ol insured Mail 1 G.0.D. Eien Rest or Mactan, 4. Restricted Dellvary? 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Docket for Case No: 06-003267