STATE OF FLORIDA “Moy *s yy AGENCY FOR HEALTH CARE ADMINISTRATION / é STATE OF FLORIDA AGENCY FOR Wels Wo, M9 HEALTH CARE ADMINISTRATION, In, vid a s Petitioner, vs. CaseNo. 2006004280 ROBERT BRUCE MACCART, d/b/a PLEASANTVIEW RETIREMENT &( ) & ALF CENTER, D lo - U (p Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency For Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against ROBERT BRUCE MACCART, d/b/a PLEASANTVIEW RETIREMENT & ALF CENTER (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 an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) pursuant to Section 400.419(2)(b), Florida Statutes (2005), based upon the existence of one (1) Class II violation. JURISDICTION AND VENUE 1. 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 and rules governing assisted living facilities pursuant to the Chapter 400, Part II, Florida Statutes, and Chapter 5 8A-5, Florida Administrative Code (2005). 4. Respondent is licensed by the Agency to operate a twenty (20) bed assisted living facility located at 1318 Santa Barbara Blvd., Cape Coral, Florida 33991, having been issued provisional license number 5876, pursuant to Section 400.441(12), Florida Statutes (2005). 5. Respondent was at all times material hereto a licensed assisted facility under the licensing authority of the Agency, and was required to comply with all applicable tules, 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 Rule 58A-5 -0182, Florida Administrative Code (2005), an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility, 8. Pursuant to Rule 58A-5.0182(1)(d), Florida Administrative Code (2005), assisted living facilities shall offer personal supervision, as appropriate for each resident, including contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change, 9. On or about March 7, 2006, the Agency conducted a Change of Ownership (CHOW) survey in conjunction with the Limited Nursing License (LNS) survey of the Respondent’s assisted living facility (hereinafter “Facility”), 10. Based on record review and interview, the Agency determined that the Respondent failed to ensure that it offer personal supervision, as appropriate for each resident, including contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change, in violation of Rule 5 8A-5,0182(1)(d), Florida Administrative Code (2005), and/or failed to provide care and services appropriate to the needs of residents accepted for admission to the Facility, in violation of Rule 58A-5.0182, Florida Administrative Code (2005). 11. Resident #1 was admitted to the Facility on November 2, 2005. 12. Resident #1’s weight upon admission to the Facility was noted as one hundred fifteen (115) pounds. 13. Anentry on January 9, 2006, indicated that Resident #1’s weight had decreased to one hundred eight (108) pounds. 14, The decrease from one hundred fifteen (115) pounds to one hundred eight (108) pounds represents a weight decrease of approximately six percent (6%) for Resident #1. 15. By losing approximately six percent (6%) of his/her body weight over a time period of just over two (2) months, Resident #1 exhibited a significant change. 16. —_ Review of the records for Resident #1 revealed no documentation indicating that the Respondent notified Resident #1’s physician concerning the noted decrease in such resident’s weight during the described time period. 17. Review of the records for Resident #1 revealed no documentation indicating that the Respondent initiated any changes to Resident #1’s dietary regimen in an attempt to help resident maintain or regain his/her weight during the described time period. 18. In an interview conducted during the survey, Facility staff indicated that on approximately March 6, 2006, a Resident #1’s physician ordered a dietary supplement, but that, prior to such date, no interventions regarding Resident #1’s weight loss had been implemented. 19. Record review revealed documentation indicating that Resident #6 weighed one hundred twenty-five (125) pounds on July 15, 2005, 20. Record review revealed documentation indicating that Resident #6 weighed one hundred eighteen (118) pounds on October 3, 2005. 21. Record review revealed documentation indicating that Resident #6 weighed one hundred thirteen (113) pounds on J: anuary 9, 2006. 22. Record review revealed documentation indicating that Resident #6 weighed one hundred twelve (112) pounds on March 6, 2006. 23. The decrease from one hundred twenty-five (125) pounds to one hundred twelve (112) pounds represents a weight decrease of approximately ten percent ( 10%) for Resident #6. 24. —_ By losing approximately ten percent (10%) of his/her body weight over a time period of approximately eight (8) months, Resident # 6 exhibited a significant change. 25. Review of the records for Resident #6 revealed no documentation indicating that Respondent notified Resident #6’s physician concerning the noted decrease in such resident’s weight. 26, Review of the records for Resident #6 revealed no documentation indicating that the Respondent initiated any changes to Resident #6’s dietary regimen in an attempt to help resident maintain or regain his/her weight. 27. In an interview conducted during the survey, Facility staff agreed that, as of the date of the survey, no intervention had been implemented for Resident #6’s weight loss. 28. In an interview conducted during the survey, Facility staff indicated that Facility tesidents are weighed on a quarterly basis. 29. Based upon the above, the Agency determined that the Respondent failed to ensure that it offer personal supervision, as appropriate for each resident, including contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change, in violation of Rule 58A-5.0182(1)(d), Florida Administrative Code (2005), and/or failed to provide care and services appropriate to the needs of residents accepted for admission to the Facility, in violation of Rule 58A-5.0182, Florida Administrative Code (2005). 30. The Agency determined that this deficient practice was related to operation and maintenance of the Facility or to the personal care of Facility residents and directly threatened the health, safety, or security of Facility.residents. Accordingly, the Agency cited the Respondent for a Class II deficiency pursuant to Section 400.419(2)(b), Florida Statutes (2005). 31. The Agency provided Respondent with a mandatory correction date April 7, 2006. 32. Respondent’s failure to ensure that it offer personal supervision, as appropriate for each resident, including contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surro gate, or case manager if the resident exhibits a significant change, in violation of Rule 58A-5.01 82(1)(d), Florida Administrative Code (2005), and/or failure to provide care and services appropriate to the needs of residents accepted for admission to the Facility, in violation of Rule 58A-5 .0182, Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). Respectfully submitted this /27day of October, 2006. LAY ZZ Brian T. Mulligan Fla. Bar. No. 0676543 Senior Attorney Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330L St. Petersburg, Florida 33701 Respondent is notified that it has a tight 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. 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;T. elephone (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 IHEREBY CERTIFY that a true and correct copy of the foregoing has been served by USS. Certified Mail, Return Receipt No. 7004 2510 0005 4049 1338 on October /2 7 2006 to Robert B. Maccart, Owner/Administrator, Pleasantview Retirement & ALF Center, 1318 Santa Barbara Blvd., Cape Coral, FL 33991 and by U.S. Mail to John Gilroy, I, Esq., 1435 E. Piedmont Dr., Suite 100, Tallahassee, FL 32308. Brian T’ Mulligan Senior Attorney Copies furnished to: Robert B. Maccart John Gilroy, III, Esq. Brian T. Mulligan Owner/Administrator 1435 East Piedmont Drive | Senior Attorney Pleasantview Retirement & ALF Ctr. | Suite 100 Agency for Health Care Admin. 1318 Santa Barbara Blvd. Tallahassee, FL 32308 525 Mirror Lake Drive, 330L Cape Coral, FL 33991 (U.S. Mail) St. Petersburg, Florida 33701 (U.S. Certified Mail) (Interoffice) SENDER: COMPLETRAIHIS SECTION A, Signature h t . Cl Agent : x ae aye Addressee” B. Received by (Printed Nama) C: Dats 1 Dell a aren \Ibi lb |Ob: ¥ D. Is delivery address different from Item 1? es If YES, enter delivery address below: 1 No ‘ m™ Complete items 1, & wiid 3. Also complete sh Itam 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 mailpiece, or on the front if space permits. 1. Article Addressed to: Robert B. Mactarl Cone” | Adwunrshroter O'\ case eu ew A id\ g Swute Cavtoave wed. Di Cortiied Mall C1 Express Mall : CO Registered C1 Return Receipt for Merchandise : Cope Covell A- 3zqq, |bessmst Seon 2, Articla Number 7oo4 2510 gOOS5 4044 1358 Blo RD : (Transfer trom serencerewey—————SsS—s—S—SSCS ¢ ) : PS Form 3811, February 2004 Domestic Return Recalpt 402895-02-M-1540 . Service Types

Docket for Case No: 06-004680