STATE OF FLORIDA i EP AGENCY FOR HEALTH CARE ADMINISTRATION gg p cr me Fel 8 PH be yy STATE OF FLORIDA, soe, AGENCY FOR HEALTH CARE _ Wt ADMINISTRATION, 0 lo . Uf [ (65 Petitioner, vs. AHCA Nos. 2006001876 (Fine) 2006007964 (Conditional License) FSL-PANAMA CITY, L.L.C., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through undersigned counsel, and files this administrative complaint against FSL-PANAMA CITY, L.L.C., (hereinafter “Respondent”), pursuant to Chapter 400, Part II, and Sections 120.569 and 120.57, Florida Statutes (2006). NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $30,000 and a survey fee in the amount of $6,000, based upon Respondent being cited for two widespread Class I deficiencies, pursuant to Section 400.102(1)(a), Florida Statutes (2006), and Rule 59A-4.130, Florida Administrative Code (2006) (AHCA No. 2006001876). Additionally, this is an action to impose a conditional licensure rating from August 22, 2006, through August 29, 2006, pursuant to Section 400.23(7)(b), Florida Statutes (2006) (AHCA No. 2006007964). JURISDICTION AND VENUE 2. The Agency has jurisdiction pursuant to Sections 120.569, 120.57, 120.60, and 400.062, Florida Statutes (2006). 3. Venue lies in Bay County, pursuant to Rule 28-106.207, Florida Administrative Code (2006). PARTIES 4, The Agency is the enforcing authority with regard to skilled nursing facilities licensure pursuant to Chapter 400, Part I, Florida Statutes (2006), and Chapter 59A-4, Florida Administrative Code. 5. Respondent operates a skilled nursing facility located at 2100 Jenks Avenue, Panama City, Florida 32405, having been issued license number 1366095. Respondent was at all times material hereto a licensed nursing facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. ) COUNT I RESPONDENT COMMITTED AN INTENTIONAL OR NEGLIGENT ACT THAT FAILED TO PROTECT THE HEALTH OR SAFETY OF RESIDENTS OF THE FACILITY SECTION 400.102(1)(a), FLORIDA STATUTES (2006) WIDESPREAD CLASS I DEFICIENCY 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. That on or about August 22, 2006, in response to a complaint, the Agency conducted a survey at Respondent’s facility. 8. That through interviews with the Respondent’s Administrator (“Administrator”), and observation and inspection of the facility premises, the following was noted: a. An interview with the Administrator at approximately 9:30 a.m. revealed that the automatic sprinkler system, specifically the dry pipe portion of the system that services approximately 90% of the facility, has not been operational since ie) approximately April of 2006. An Agency surveyor inspected the fire sprinkler riser room, where two water sprinkler supply valves were shut. These two valves control two dry pipe sprinkler systems that were inoperative at the time of the survey. A dry pipe system is a sprinkler system whereby pipes in the attic area are filled with air as opposed to water so they do not freeze when the temperature drops below 32 degrees Fahrenheit. If a fire were to cause the temperature inside to reach 165 degrees Fahrenheit, the sprinklers would activate, releasing water into the combustible truss attic space. One dry pipe system covers the attic space above all of the resident rooms, nurses’ stations, and common areas, while the second dry pipe system covers the attic space above support areas, the conference room, and the physical and occupational therapy areas. Further observation revealed that not only were the water supply valves to both dry pipe systems shut off, but that both systems had leaks and showed evidence of previous attempts at repair. A subsequent interview with the Facility Administrator at approximately 11:00 a.m. confirmed the Agency findings. In addition, the Administrator revealed that although both dry pipe systems had been inoperative for some time, and although she alleged that she had asked the nursing supervisor to provide a fire watch, no fire watch had been initiated at the facility, no local fire authorities had been notified, and no residents had been evacuated. Moreover, the Administrator seemed unaware of the requirements of a fire watch. The deficient practice described in this count constituted, in part, the basis for an Emergency Order of Immediate Moratorium on Admissions, which the Agency imposed upon the Respondent on or about August 25, 2006, pursuant to Section 400.121(5)(a), Florida Statutes (2006). g. It was not until after the Agency survey on August 22, 2006 that a fire watch was initiated and local fire authorities were notified. The dry pipe sprinkler systems were not repaired until the Agency served the Facility with an Emergency Order of Immediate Moratorium on Admissions on August 25, 2006. 9. The above constitutes a violation of Section 400.102(1)(a), Florida Statutes (2006), which states that an intentional or negligent act that materially affects the health or safety of residents of the Facility shall be grounds for action by the Agency against the Facility. Having an inoperative dry pipe sprinkler system for months, without taking steps to repair the system, instituting a fire watch, notifying local fire authorities, or evacuating residents, is an intentional or negligent act that materially affects the health or safety of Facility residents. 10. The above constitutes a widespread class I deficiency, for which a fine of $15,000 is authorized pursuant to Section 400.23(8)(a), Florida Statutes (2006). 11. The deficiency is widespread as defined in Section 400.23(8), Florida Statutes (2006), since the lack of a working dry pipe sprinkler system is a pervasive failure or represents systemic failure that has affected or has the potential to affect a large portion of the Facility’s residents. The deficiency is class I as defined in Section 400.23(8)(a), Florida Statutes (2006), since it presented a situation where immediate corrective action was necessary because the lack of a working dry pipe sprinkler system is likely to cause serious injury, harm, impairment, or death to residents of the Facility. Moreover, the fine must be levied notwithstanding the correction of the deficiency. See Section 400.23(8)(a), Florida Statutes (2006). COUNT II RESPONDENT’S FACILITY ADMINISTRATOR FAILED TO USE RESOURCES OR TAKE STEPS TO ENSURE THAT FIRE PREVENTION AND PROTECTION WAS IN PLACE TO PROTECT RESIDENTS, EMPLOYEES, AND VISITORS RULE 59A-4.130, FLORIDA ADMINISTRATIVE CODE (2006) WIDESPREAD CLASS I DEFICIENCY 12. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 13. That on or about August 22, 2006, in response to a complaint, the Agency conducted a survey at Respondent’s facility. 14. That through interviews with the Respondent’s Administrator (“Administrator”), and observation and inspection of the facility premises, the following was noted: a. An interview with the Administrator at approximately 9:30 a.m. revealed that the automatic sprinkler system, specifically the dry pipe portion of the system that services approximately 90% of the facility, has not been operational since approximately April of 2006. b. An Agency surveyor inspected the fire sprinkler riser room, where two water __sprinkler_supply..valves..were.shut... These two valves control two dry pipe sprinkler systems that were inoperative at the time of the survey. c. A dry pipe system is a sprinkler system whereby pipes in the attic area are filled with air as opposed to water so they do not freeze when the temperature drops below 32 degrees Fahrenheit. If a fire were to cause the temperature inside to reach 165 degrees Fahrenheit, the sprinklers would activate, releasing water into the combustible truss attic space. One dry pipe system covers the attic space above all of the resident rooms, nurses’ stations, and common areas, while the second dry pipe system covers the attic space above support areas, the conference room, and the physical and occupational therapy areas. Further observation revealed that not only were the water supply valves to both dry pipe systems shut off, but that both systems had leaks and showed evidence of previous attempts at repair. A subsequent interview with the Facility Administrator at approximately 11:00 a.m. confirmed the Agency findings. In addition, the Administrator revealed that although both dry pipe systems had been inoperative for some time, and although she alleged that she had asked the nursing supervisor to provide a fire watch, no fire watch had been initiated at the facility, no local fire authorities had been notified, and no residents had been evacuated. Moreover, the Administrator seemed unaware of the requirements of a fire watch. | The deficient practice described in this count constituted, in part, the basis for an Emergency Order of Immediate Moratorium on Admissions, which the Agency imposed upon the Respondent on or about August 25, 2006, pursuant to Section ..400.121(5)(a), Florida Statutes, (2006). It was not until after the Agency survey on August 22, 2006 that a fire watch was initiated and local fire authorities were notified. The dry pipe sprinkler systems were not repaired until the Agency served the Facility with an Emergency Order of Immediate Moratorium on Admissions on August 25, 2006. 15. The above constitutes a violation of Rule 59A-4.130(2), Florida Administrative Code (2006), which states that fire prevention, fire protection, and life safety practices shail be the responsibility of the Facility Administrator. In this case, although Respondent’s Administrator knew that the dry pipe sprinkler system was inoperative for months, she either ignored, neglected, or was simply ignorant of the responsibilities under Rule 59A-4.130, Florida Administrative Code (2006), to ensure that fire prevention and protection practices were in place. 16. The above constitutes a widespread class I deficiency, for which a fine of $15,000 is authorized pursuant to Section 400.23(8)(a), Florida Statutes (2006). 17. The deficiency is widespread as defined in Section 400.23(8), Florida Statutes (2006), since the abandonment of responsibility for fire prevention and protection practices by the Facility and its Administrator is a pervasive failure or represents systemic failure that has affected or has the potential to affect a large portion of the Facility’s residents. The deficiency is class I as defined in Section 400.23(8)(a), Florida Statutes (2006), since it presented a situation where immediate corrective action was necessary, but was not taken, because the lack of operational fire prevention and protection systems is likely to cause serious injury, harm, impairment, or death to residents of the Facility. Moreover, the fine must be levied notwithstanding the correction of the deficiency. See Section 400.23(8)(a), Florida Statutes (2006), COUNT II DUE TO THE TWO CITED CLASS I DEFICIENCIES, IMPOSITION OF A CONDITIONAL LICENSE, SURVEY FEE, AND SIX MONTH SURVEY CYCLE FOR A PERIOD OF TWO YEARS IS WARRANTED SECTIONS 400.19(3) AND 400.23(7)(b), FLORIDA STATUTES (2006) 18. The Agency re-alleges and incorporates paragraphs (1) through (17) as if fully set forth herein. 19. Based upon Respondent’s two cited State Class I deficiencies, it was not in substantial compliance at the time of the survey with criteria established under Part I of Florida Statute 400, or with rules adopted by the Agency, a violation subjecting it to assignment of conditional licensure status pursuant to Section 400.23(7)(b), Florida Statutes (2006). 20. Due to the presence of two Class I deficiencies, a conditional license certificate number 13707 was issued to Respondent with an effective date of August 22, 2006. After the Emergency Order of Immediate Moratorium on Admissions was issued on August 25, 2006, the Class I deficiencies were corrected. The Moratorium was lifted on August 29, 2006, and a standard license certificate number 13708 was issued on that date as well. 21. Respondent has been cited for two State Class I deficiencies and therefore is subject to a six (6) month survey cycle for a period of two years and a survey fee of $6,000 pursuant to Section 400.19(3), Florida Statutes (2006). CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency on Count I and Count I, (B) Recommend administrative fines against Respondent in the amount of $15,000 for Count I, $15,000 for Count I, and $6000 as a survey fee pursuant to Section 400.19(3), Florida Statutes (2006), for a total of $36,000; (C) Assess attorney’s fees and costs; and (D) Grant all other general and equitable relief allowed by law. 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 form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308, (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. Respectfully submitted this }: “day of September, 2006. Lorraine M. Novak, Esquire Fla. Bar. No. 0023851 Agency for Health Care Admin. 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 850.922.5873 (office) 850.921.0158 (fax) 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 0000 9716 1721 to: Registered Agent Spector, Gadon, and Rosen, LLP, 360 Central Avenue, Suite 1550, Saint Petersburg, Florida 33701, and U.S. Certified Mail, Retum Receipt No. 7003 1010 0000 9716 1752 to: Facility nh istrator Ruth Bentley, 2100 Jenks Avenue, Panama City, Florida 32405, on September , 2006 to: orraine M. Novak, Esquire Copies fumished to: Barbara Alford. Field Office Manager Agency for Health Care Administration (Interoffice Mail) 10

Docket for Case No: 06-004165