STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2007000465 MIRACLE GROUP, INC., 0 7] - D3asw d/b/a PATRICIA HOUSE, 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 MIRACLE GROUP, INC., d/b/a PATRICIA HOUSE (hereinafter “Respondent”), pursuant to §§ 120.569 and 120.57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of $20,000.00, based upon Respondent being cited for two State Class I deficiencies pursuant to § 429.19(2)(a), Florida Statutes (2006). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and 429.07, Florida Statutes (2006). 2. Venue lies pursuant to Florida Administrative 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 429, Part I, Florida Statutes, and Chapter 58A-5 Florida Administrative Code, respectively. 4. Respondent operates a 9-bed assisted living facility located at 1040 Angle Road, Dunedin, Florida 34698, and is licensed as an assisted living facility, under license number 9642. 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. FACTS COMMON TO BOTH COUNTS 6. That on or about December 4, 2006, the Agency conducted an appraisal visit of Respondent's facility. 7. That based on observation, interview, and record review, the Owner and Administrator failed to monitor for the continued appropriateness of placement of residents. This was related to violent behaviors for one current and one past resident (Resident #1 and #2). 8. That the Petitioner’s representative, on December 4, 2006, reviewed the most recently dated health assessment, dated September 19, 2006, of resident number one (1) and noted diagnoses including mental retardation, impaired memory and behavior, and schizoaffective disorder. 9. That the Petitioner’s representative observed and interacted with resident number one (1) during the morning hours of December 4, 2006 and noted the following: a. That at approximately 7:30 a.m., the resident was standing next to the door of the resident’s room; b. That the door of the room had a large semicircular crack in the skin, approximately eight inches (8") around; c. That the resident indicated that the resident was responsible for the damage to the door because "the bad people won't leave me alone;” d. That a similar crack was noted in the office door with the back skin of the office door was separated; e. That at approximately 8:30 a.m., the resident was standing in front of the staff member in charge in the office; f. That the resident complained of the resident’s ear and eye hurting; g. That at approximately 8:34 a.m., the resident was observed becoming more agitated, as evidenced by rapid movements and slamming of the resident’s room door. 10.‘ That the Petitioner’s representative interviewed, on December 4, 2006, the assistant behavioral analyst, a third party provider of mental health services for the resident and not a staff member of Respondent, responsible for the behavioral plan of resident number one (1) at approximately 1:00 p.m. who indicated the following regarding the resident: a. That on December 4, 2006 at approximately 12:30 p.m. the resident displayed socially inappropriate behavior to a visitor; b. That the resident became agitated, ran to the resident’s room, and slammed the door; c. That the behavioral analyst requested that a staff member open the resident's room after slapping sounds were heard; d. That the resident was slapping the resident’s own face and hitting the wall; e. That "Response Blocking" or physically restraining/blocking the resident's hand in order to keep the resident from continued self slapping was required; f. That this resident frequently required this intervention in order to keep the resident from self injury; g. That the behavior of the resident requires intervention of staff; h. That a behavioral analyst would not instruct staff of an assisted living facility to not effect interventions for such behaviors or to merely observe and annotate such behaviors. li. That the Petitioner’s representative observed resident number one (1) during the afternoon hours of December 4, 2006 and noted the following: a. That at approximately 4:28 p.m., the resident was walking rapidly from the resident’s room to the common area saying, "it's time to go home" several times to a behavioral analyst and the Agency’s representative; b. That several other residents were present, one of whom requested that the Agency’s representative remain on site; c. That the resident became more agitated, and at approximately 4:37 p.m. hit the Agency’s representative on the arm; d. That at approximately 4:40 p.m., the resident ran to the resident’s room and slapping sounds were heard emanating from the room; e. That a loud noise was heard; f. That the resident was noted to be hitting an electrical outlet, the cover of which was cracked, and one third of which had fallen off; g. That no intervention to stop the resident’s self destructive behavior were offered or taken by staff. 12. That the Petitioner’s representative reviewed the Respondent’s “Data Collection” sheet for resident number one (1) covering a period of twenty-one (21) days of the month of November, 2006 and noted the following: a. That the resident displayed documented aggression to others forty-three (43) times; b. That the resident displayed documented self-abusive behavior more than three hundred and thirty (330) times; c. That the resident displayed documented self-injurious behavior more than one hundred twenty (120) times; d. That the resident displayed other documented disruptive behaviors such as property destruction, tantrums, inappropriate touching, etc. several hundred times in total; e. That the above documented behaviors occurred in records reviewed for a sample period of less than one (1) calendar month. 13. That the Petitioner’s representative interviewed the Respondent’s staff member in charge on December 4, 2006 who indicated that the damage to the office door was inflicted by resident number one (1) and that such behavior was part of the resident’s frequent behavioral problems. 14, That the Petitioner’s representative interviewed the Respondent’s staff present when resident number one (1) complained of pain in the resident’s ear on December 4, 2006 who indicated that the pain and scab were because the resident was "constantly hitting [self]" and that the facility's response to this was to "just watch and log it - that's what the Behavior Analyst told us to do.” 15. That the Petitioner’s representative interviewed two behavioral analysts on December 4, 2006 who indicated that the severity of behavior of resident number one (1) required frequent physical intervention (restraining the resident's hands by staff members) in order to ensure the resident's safety. 16. That the Petitioner’s representative reviewed the Respondent’s records regarding resident number two (2) on December 4, 2006 and noted the following: a. That the resident was admitted to the facility on August 12, 2006 after having been committed for involuntary mental examination from a sister facility; b. That the resident’s observations record documented the following: i. That on August 13, 2006 at 1:30 p.m., the resident "tries to hit [another resident]. [The other resident] hit [resident number two (2)] back in return;" ii. That on August 13, 2006 an entry of 5:30 p.m. noted "I found [a staff member] in the office with the door locked. When I asked her why she was in the office with the door locked, she said [resident number two (2)] was trying to hit her and was after her. [The resident] also tried to get in the office, when [the resident] couldn't [the resident] kicked the door and punch [sic] a hole in on the door. At 12:30 a.m. [resident number two (2)] tries to go out the door. I talked to [the resident] that [this behavior] is not a good idea. Client screamed and tried to punch me on the face several times...;" iii. That further notes continue for that day indicating that the resident was also hitting self and that on August 14, 2006 the Respondent’s administrator was informed of the preceding incident; iv. That an entry of August 14, 2006 at 9:45 a.m. indicates that the resident reported hallucinations to a staff member and that the resident exhibited agitation; v. That notes of August 15, 2006 of 2:30 a.m. the resident threatened to hit another resident and attempted to hit a staff member several times; vi. That the resident hit the Respondent’s handyman on August 15, 2006; vii. | That the resident threatened to kill a staff member with a knife and a gun on August 16, 2006; c. That there is no indication that mental health professionals or law enforcement were notified by the Respondent regarding the above documented assaultive and threatening behaviors of resident number two (2); d. That Respondent’s records reflect that on August 17, 2006 at 8:45 p.m. the resident began chasing other residents, threatening to kill them, attempting to attack them, and attacking staff; e. That on August 17, 2006, after the above, Respondent contacted the resident’s psychiatrist who directed the resident be involuntarily committed for mental examination. COUNTI 17. That the Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 18 That pursuant to Florida law, an individual must meet minimum criteria to be admitted to a facility holding a standard, limited, or limited mental health license, including, but not limited to, not be a danger to self or others as determined by a physician, or mental health practitioner licensed under Chapter 490 or 491, F.S,. R. 58A-5.0181(1)(g), Florida Administrative Code, and have been determined by the facility administrator to be appropriate for admission to the facility, R. 58A-5.018i(n), Florida Administrative Code. 19 That pursuant to Florida law, the Owner or Administrator is responsible for monitoring the continued appropriateness of placement of a resident in the facility. R. 58A-5.0181(4)(d), Florida Administrative Code. 20 That based upon observation, interview, and the review of records, the Respondent’s Administrator failed to monitor for the continued appropriateness of placement of residents who exhibited violent behaviors as required by law. 21 That the Petitioner re-alleges and incorporates paragraphs seven (7) through seventeen (17) as if fully set forth herein. 22 That resident number one (1) exhibited violent behaviors commencing August 13, 2006. 23 That said behavior continued, presenting a risk to the resident and others on a continuous basis. 24 That there is no indication that the Respondent’s administrator took any action to determine the continued appropriate placement of resident number one (1) in an assisted living facility, including but not limited to a determination as to whether the resident presented a self danger or a danger to others. 25 That the administrator is mandated to determine if a resident continues to meet residency criteria, including but not limited to a resident’s danger to self or others. 26 That Respondent’s failure to determine the continued appropriate placement of resident number one (1) is in violation of law. . 27 That the two behavioral analysts indicated that the severity of behavior of resident number one (1) required frequent physical intervention (restraining the resident's hands by staff members) in order to ensure the resident's safety. 28 That the failure of the administrator to evaluate the intervention needs of resident number one (1), which the facility was unable to provide, made the resident inappropriate for continued placement in an assisted living facility. 29 That Respondent’s failure to determine the continued appropriate placement of resident number one (1) is in violation of law. 30 That on August 13, 2006, resident number two (2) presented a real and present risk to staff and other residents by the resident’s as evidenced by documented violence to another resident and a staff member who found it necessary to lock herself in an office to avoid injury. 31 That on August 15, 2006, resident number two (2) struck a handyman. 32 That on August 16, 2006, resident number two (2) threatened to kill a staff member. 33 That the failure of the administrator to evaluate, or cause to be evaluated, the danger to self and others as exhibited by resident number two (2) and thus the resident’s continued appropriate placement in an assisted living facility is in violation of law. 34 The Agency determined that this deficient practice was related to the operation and maintenance of the facility, or to the personal care of the resident, which the Agency determined ' presented an imminent danger to the resident or a substantial probability that death or serious physical or emotional harm would result therefrom and cited the Respondent for a State Class I deficiency. 35 The Agency provided Respondent with a mandatory correction date of December 11, 2006. 36 That the Respondent has been cited by the Petitioner on previous occasions for the violation of the provisions cited herein. 37 That pursuant to § 429.19(2)(a), Florida Statutes (2006), the Agency is authorized to impose a fine in an amount not less than five thousand dollars ($5,000.00) and not exceeding ten thousand dollars ($10,000.00) for each violation. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $10,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(a) Florida Statutes (2006). COUNT II 38. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 39. That pursuant to Florida law, an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility and offer personal supervision, as appropriate for each resident including, inter alia, 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 R. 58A-5.0182, Florida Administrative Code. 40. That based upon observation, interview and the review of records, the Respondent facility failed to provide, or obtain behavioral and mental health intervention appropriate to for one (1) of seven (7) current residents and one (1) former resident, the same being in violation of law. 41. That the Petitioner re-alleges and incorporates paragraphs seven (7) through seventeen 10 (17) as if fully set forth herein. 42. That the failure of the Respondent to provide or seek interventions to address the self- injurious, disruptive, and aggressive behaviors of resident number one (1) is a failure to provide care and services appropriate to the resident’s needs which resulted in injury to the resident. 43. That the necessity that resident number one (1) be subject to restraint to control behavior is a service that cannot be provided within the scope of Respondent’s licensure. 44. That the failure to provide appropriate services to resident number one (1) is in violation of law. 45. That on August 13, 2006, resident number two (2) presented a real and present risk to staff and other residents by the resident’s as evidenced by documented violence to another resident and a staff member who found it necessary to lock herself in an office to avoid injury. 46. That on August 15, 2006, resident number two (2) struck a handyman. 47. That on August 16, 2006, resident number two (2) threatened to kill a staff member. 48. That the failure of the Respondent to take any action to provide care or services to meet the needs of the resident and the resident’s obvious anti-social and dangerous behaviors to both self and others, including other residents, including but not limited to the failure to notify the resident’s health care provider, family, or law enforcement, is a failure to provide appropriate care and services and is in violation of law. 49. That the Agency determined that this deficient practice was related to the operation and maintenance of the facility, or to the personal care of the resident, which the Agency determined presented an imminent danger to the resident or a substantial probability that death or serious physical or emotional harm would result therefrom and cited the Respondent for a State Class I deficiency. 50. That the Agency provided Respondent with a mandatory correction date of December 11, 2006. 51. That the Respondent has been cited by the Petitioner on previous occasions for the violation of the provisions cited herein. 52. That pursuant to § 429.19(2)(a), Florida Statutes (2006), the Agency is authorized to impose a fine in an amount not less than five thousand dollars ($5,000.00) and not exceeding ten thousand dollars ($10,000.00) for each violation. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $10,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(a) Florida Statutes (2006). Respectfully submitted this day of April 2007. Y Thomas J. Walsh, II, Esquire Fla. Bar:/No. 566365 Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, Florida 33701 (727) 552-1525 (office) (727) 552-1440 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. 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: Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida 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 beén served by USS. Certified Mail, Return Receipt No. 7005 1160 0002 2254 8894 on April 2007 to: Jacqueline K. White, Registered Agent, 600 Bypass Drive, #218, Clearwater, Florida 33764, and by U.S. Mail to: Patricia Richards, Administrator, Patricia House, 1040,Angle Road, Dunedin, Florida 34698. ; he Il, Esquire Tho Copies furnished to: Jacqueline K. White, Reg. Agent Patricia Richards, Administrator Patricia House Patricia House 600 Bypass Drive, #218 1040 Angle Road Clearwater, Florida 33764 Dunedin, Florida 34698 -S. Certified Mail) Kathleen Varga Facility Evaluator Supervisor 525 Mirror Lake Drive, 4" Floor St. Petersburg, Florida 33701 Interoffice) .S. Mail Thomas J. Walsh, II Agency for Health Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, Florida 33701 (interoffice) 13 “GENDER: COMPLETE. THIS.SECTION. ™ Complete itemd,__ <, 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 ; rot fe.the | back poi the mailpiece, 4. or on the fro if spa AK? od by (Printed Name SWeraEs) ae fs 2. Artic re "ber - “ROO eee a 7005 1b OOG2 easy apy 2X

Docket for Case No: 07-002358