Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: WESTWOOD MANOR
Judges: CAROLYN S. HOLIFIELD
Agency: Agency for Health Care Administration
Locations: Fort Myers, Florida
Filed: Nov. 09, 2007
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Friday, April 4, 2008.
Latest Update: Dec. 24, 2024
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
I
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE _.
ADMINISTRATION, O71 ; S| ‘\ a
: Petitioner, ; :
vs. Case No. 2007000273
WESTWOOD MANOR, me
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Respondent. === s Tl
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ADMINISTRATIVE COMPLAINT Ors g i
COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION Ofjeinater
Agency), by and through the undersigned counsel, and files this Administrative Complaint
-against WESTWOOD MANOR (hereinafter Respondent) pursuant to Sections 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 SEVEN THOUSAND
FIVE HUNDRED DOLLARS ($7,500.00), based upon ten (10) uncorrected Class III
deficiencies against the Respondent, pursuant to Sections 429. 19(2)(c),Florida Statutes (2006)
and to assess a survey fee in the amount of FIVE HUNDRED DOLLARS ($500.00).
JURISDICTION AND VENUE
1. The Agency has jurisdiction pursuant to Sections 20,42, 120.60 and 429.07,
Florida Statutes (2006) .
2. Venue lies pursuant to Florida Administrative Code Rule 28-106.207.
Page 1 of 36
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 30-bed assisted living facility located at 2339
Hoople Street, Fort Myers, Florida 33901.: Respondent is and was at all times material
hereto a licensed facility, having been issued license number 8914.
COUNTI
The Respondent Failed To Ensure That All Medication In Its Labeled Container Is Taken
To One (1) Of Three (3) Active Sampled Residents Who Receive Assistance With Self
Administration Of Medications As Evidenced By Staff Removing Three (3) Medications
. From Their Labeled Containers, Placing Them Into A Medication Cup, And Placing The
Cup In The Drawer Of The Medication Cart For One (1) Resident Violating Section
429,256(3)(b), Florida Statutes (2006), And Rule 58A-5.0185(3)(c), Florida Administrative
Code (2006)
5... The Agency re-alleges and incorporates paragraphs (1) through (4) as if fully set
forth herein.
6. Pursuant to Florida law, assistance with self-administration of medication
includes, in the presence of the resident, reading the label, opening the container, removing a
prescribed amount of medication from the container, and closing the container. Section 429.256
(3)(b), Florida Statutes (2006), Staff shall observe the resident take the medication. Any concerns
about the resident’s reaction to the medication shall be reported to the resident’s health care
provider and documented in the resident’s record. Section 429.255, Florida Statutes (2006) and
Rule 58A-5.0185 (3)(c), Florida Administrative Code (2006).
7, On or about August 30, 2006, Agency surveyors conducted a complaint survey of the
Respondent’s facility that resulted in a Class III deficiency. The standard that. the Respondent shall
Page 2 of 36
ensure that all medication in its labeled container is taken to residents who receive assistance with self
administration of medications is not met.
8. Based upon interview it was determined the facility failed to assure that one (1) of four
(4), resident’s, Resident number seven (7), receiving assistance with self administration of medications
received medication in a properly dispensed and labeled container.
9. During a review of Resident number seven’s (7) Health Assessment Form 1823,
Medications, and Medication Observation Record on August 29, 2006 it was noted the resident is
receiving Lantus Insulin 50 units at hour of sleep and 8 units each morning, The resident is also to
check their blood sugar twice a day and cover with Humulin on a sliding scale.
10. . On August 30, 2006 at about 10:23 a.m, a surveyor asks Resident number seven (7) if she
draws up her own Insulin. The resident stated "the facility staff draws up the Insulin.". When asked
which staff drew up the insulin she stated "all of them draw it up.
he In an interview with the Administrator on August 30, 2006 at about 11:30 am. the
administrator, when asked, stated, the resident draws up their own Insulin. When informed, the resident
stated, that facility staff drew up the Insulin. The Administrator stated, that staff assists the residents by
using "the hand over hand" method to assist the residents to draw up the Insulin. The Administrator
was informed that the "hand over hand" method of assistance was not allowed...
12. For this. Class III deficiency, the Agency provided the Respondent a mandated correction
date of September 30, 2006.
. 13. Agency surveyors conducted a Biennial Licensure Survey of the Respondent’s facility on
or about November 15 through November 16, 2006. The standard that the Respondent shall ensure that
all medication in its labeled container is taken to residents who receive assistance with self
administration of medications was again not met.
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14, On that date, based on observations, and staff interview, it was determined that the
facility failed to ensure that all miedication in it’s labeled container is taken to 1 (Resident number ten
(10) of 3 active sampled residents who receive assistance with self administration of medications as
evidenced by staff removing three (3) medications from their labeled containers, placing them into a
medication cup, and placing the cup in the drawer of the medication cart for Resident number ten (10).
15.. Observation on November 15, 2006 at approximately 3:00 p.m., during a medication
review with the Assistant Administrator, a plastic medication cup was found in a drawer in the
medication cart. The medication cup contained three (3) pills. The Assistant Administrator stated that
these were for Resident number ten (10) and had been placed in the cup for 8:00 pm so it would be
easier for whoever was giving the pills.
16. A review of the Resident’s Medication Observation Record revealed Resident number ten
(10) was scheduled to receive Darvocet N-100, Naproxen 220mg and Diovan 80mg at 8:00 p.m.
17... An interview with the Assistant Administrator revealed that she did not know that
; medications could not be prepoured.
18, Such violations constitute the grounds for the imposed Class III deficiency in that it
indirectly or potentially threatened the physical or emotional health, safety or security of the facility’s
residents, other than Class I or Class II violations.
19, Pursuant to Section 400.419(2)(c), Florida Statutes, Class III violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation.
20. ‘For this Class i deficiency, the Agency provided the Respondent a mandated
correction date of December 16, 2006.
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WHEREFORE, the Agency intends to impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($75 0.00) against Respondent, an assisted living facility
_in the State of Florida, pursuant to Section 429.19(2)(c), Florida Statutes (2006). .
COUNT I
The Respondent Failed To Maintain A Daily Up-To-Date Medication Observation
Record For One Of Three Sampled Resident’s Medication Reviews Violating
Rule 58A-5.0185(5)(b), Florida Administrative Code (2006) ;
21, The Agency re-alleges and incorporates paragraphs (1) through (4) above as if
fully set forth herein.
22, Pursuant to Florida law, The facility shall maintain a daily medication observation
record for each resident who receives assistance with self-administration of medications or
medication administration. A Medication Observation Record must: include the name of the
resident and any known allergies the resident may have; the name of the resident’s health care
provider, the health care provider’s telephone number; the name, strength, and directions for use
of each medication; and a chart for recording each time the medication is taken, any missed
dosages, refusals to take medication as prescribed, or medication errors. The’ Medication
Observation Record must be immediately updated each time the medication is offered or
administered. Rule 58A-5.0185(5)(b), Florida Administrative Code (2006).
23. On or about August 30, 2006, Agency surveyors conducted a complaint survey of
the Respondent’s facility that resulted in a Class III deficiency.
24, _ Based upon record review and interview it was determined the facility failed to
maintain an accurate up to date Medication Observation Record for 2 of 4 resident records
reviewed, Residents number four (4) and number nine (9).
Page 5 of 36
25. During a medication review for Resident number four (4) it was observed the
resident had a new order dated August 17, 2006 for Oxycodone 5 mg | tablet every 6 hours as
needed .
26. The Administrator on August 29, 2006 at about 4:00 pm was asked for the
medication and the Medication Observation Record for Resident number four (4). The
medication was available but the medication had not been added to the resident's Medication
Observation Record.
27. Resident number nine (9) was admitted on or about May 8, 2006. The resident's
1823 form had an order for Darvocet N100 1 tablet three times a day as needed.
28. During a medication review on August 29, 2006 at. about 4:00 p.m. a surveyor
was provided with all of the resident's medications except for the Darvocet N100, The surveyor
asked the owner where the Darvocet N100 was.
29. The surveyor reviewed the 1823 form with the owner and showed the owner
where the Darvocet N100 had been included on the May 2006 Medication Observation Record
but was not included on the June, July, or August 2006 Medication Observation Record's,
30. For this Class III deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
31. Agency surveyors conducted a biennial licensure survey of the Respondent’s
facility on or about November 15 through November 16, 2006.
32, This is an uncorrected deficiency from the complaint investigation completed on
August 30, 2006. |
33. Based on record review and staff interview the facility did not maintain a daily
up-to-date Medication Observation Record for one Resident number eleven (11) of three
sampled resident's medication reviews.
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34. An observation on November 15, 2006 at approximately 3:00 p.m., during a
medication review with the Assistant Administrator, a Flovent inhaler labeled for Resident
eleven (11) to receive 2 puffs twice a day was in the medication cart. The Assistant
Administrator confirmed that Resident number eleven (11) had been receiving the medication for
a while. |
35. A review of the resident's Medication Observation Record revealed it did not
include the Flovent inhaler.
36. An interview with the Assistant Administrator revealed that she did not know why
the Flovent was not on the Medication Observation Record because the Resident is receiving the
medication twice a day.
37. Such violations constitute the grounds for the imposed Class III deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations.
38, . Pursuant to Section 400.419(2)(c), Florida Statutes, Class III violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation.
39. For this Class III uncorrected deficiency, the Agency provided the Respondent a
mandatory correction date of December 16, 2006.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted living facility
in the State of Florida, pursuant to Section 429.19(2)(c), Florida Statutes (2006).
Page 7 of 36
COUNT III
Respondent Failed to Ensure that Centrally Stored Medications were Accessible to
Staff Responsible for Filling Pill Organizers, Assisting with Self-Administration or
Administering Medication. Such Staff Must Have Ready Access to Keys to the Medication
Storage Areas at All Times in Violation of Rule 58A-5.0185(6)(b) 3, Florida Administrative
Code (2006)
40, The Agency re-alleges and incorporates paragraphs (1) through (4) above as if
fully set forth herein,
41. Pursuant to Florida law, if facility staff note deviations which could reasonably be
attributed to the improper self-administration of medication, staff shall consult with the resident
concerning any problems the resident may be experiencing with the medications; the need to
permit the facility to aid the resident through the use of a pill organizer, provide assistance with
self-administration of medications, or administer medications if such services are offered by the
facility. The facility shall contact the resident's health care provider when observable health care
changes occur that may be attributed to the resident’s medications, The facility shall document
such contacts in the resident’s records .Rule 58A-5.0185(6)(b)3, Florida Administrative Code
(2006).
42, On or about August 30, 2006, Agency surveyors conducted a complaint survey.of
the Respondent’s facility that resulted in a Class III deficiency.
43, Based upon observation and interview it was determined the facility failed to
assure that staff maintain control of keys to the medication storage cart.
44, On August 29, 2006 from 2:25 p.m. till 3:33 p.m. the keys to the drug storage cart
were left on the top of the drug cart which was parked in front of the nurses’ station. The
administrator was in charge of the medication keys. The administrator was in and out of the area
_ for over an hour. The cart was left open and the keys were unattended.
45, On August 30, 2006 the keys were once again observed to be on top of the
medication drug cart from 10:50 a.m. until about 11:05 am. The Administrator was in and out
Page 8 of 36
of the area working on lunch preparation in the kitchen. The surveyor pointed out to the
Administrator the medication cart was unlocked and the keys were on top of the drug storage cart
unattended.
46. For this Class II deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
47. Agency surveyors conducted a biennial licensure survey of the Respondent's
facility on or about November 15 through November 16, 2006.
48. Based upon observation and interview it was determined the facility failed to
assure that staff maintain control of keys to the medication storage cart.
49. On November 15, 2006 at 8:00 a.m. during the initial tour observation revealed
the keys to the drug storage cart were left on the top of the drug cart which was parked in front of
the nurses station. The assistant administrator was in charge of the medication keys. The
administrator was out of the area for over 15 minutes and the keys were unattended,
50. Such violations constitute the grounds for the imposed Class HI deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class Tor Class I violations.
51. Pursuant to Section 400.419(2)(c), Florida Statutes, Class III violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation.
52. For this Class III uncorrected deficiency, the Agency provided the Respondent
with a mandatory correction date of December 16, 2006.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted living facility
in the State of Florida, pursuant to Section 429,19(2)(c), Florida Statutes (2006).
Page 9 of 36
COUNT IV
Respondent Failed To Provide Scheduled Activities At Least Five (5) Days A
Week For A Total Of Not Less Than Ten (10) Hours Per Week, Not Including Television
Viewing In Violation Of Rule 58A-5.0182(2)(c), Florida Administrative Code (2006)
53. The Agency re-alleges and incorporates paragraphs (1) through (4) as if fully set
forth herein.
54, Pursuant to Florida law, scheduled activities shall be available at least six (6) days
a week for a total of not less than twelve (12) hours per week, Watching television shall not be
considered an activity for the purpose of meeting the twelve (12) hours per week of scheduled
activities unless the television program is a special one-time event of special interest to residents
of the facility. A facility whose residents choose to attend day programs conducted at adult day
care centers, senior centers, mental health centers, or other day programs may count those
attendance hours towards the required twelve (12) hours per week of scheduled activities. An
activities calendar shall be posted in common areas where residents normally congregate. Rule
58A-5.0182(2)(c), Florida Administrative Code (2006).
55, On or about August 30, 2006, Agency surveyors conducted a complaint survey of ,
the Respondent’s facility that resulted in a Class III deficiency.
56. Based upon observations, and resident interviews, it was determined that the
facility failed to ensure that scheduled activities were provided to the residents on a continual
basis at least five days per week for a total of not less than ten hours per week. This is evidenced
by the facility's failure to provide meaningful activities to the residents on a daily basis.
57, During a tour of the facility on August 29, 2006 at about 9:30 a.m. a surveyor
asked residents about the activities program.
58. The following confidential responses were obtained.
. Page 10 of 36
59. A resident at 9:40 a.m. stated there are no activities and the big TV is broken.
60. During an interview at about 9:45 am, the Administrator was asked about the big
TV in the living room.. The Administrator stated it has been broken for about 2 to 3 weeks. The
Administrator was asked ifthe small TV on top of the big TV worked. The administrator stated
this TV worked. However, the remote was missing for this TV since about August 26, 2006 and
the Administrator could not get this TV to work.
61. Two residents were asked, at about 10:00 a.m., about activities. They indicated
there were no activities and the big TV was broken. One stated that the remote control to the
small TV could not be located.
62. A resident, at about 10:55 am, was asked if there were any activities. The
resident stated "who needs activities at our age?" Another resident stated the person who was
supposed to provide some activities was out on leave.
63. A resident, during the noon meal at 12:40 p.m., was asked if there were any
activities, The resident stated there were "no activities."
64, Another resident at about the same time, when asked, stated there were "no
activities". This individual stated that after the surveyor entered the facility a staff member came
by and asked if the resident "wanted to have activities today."
65. A review of the posted activities calendar for August 29, 2006 revealed the
scheduled activity was "story telling". The surveyor did not observe any activities for residents
on August 29, 2006.
66. On August 30, 2006 at about 4:00 p.m. the surveyor and the Administrator
discussed the lack of meaningful activities for residents, The Administrator indicated when he
offers activities no one seems to want to participate.
Page 11 of 36
67. For this Class Ill deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
68. Agency surveyors conducted a biennial licensure survey of the Respondent’s
facility on or about November 15 through November 16, 2006.
69. This is an uncorrected deficiency from the complaint investigation completed on
August 30, 2006.
70. Based upon observations, and resident interviews, it was determined that the
facility failed to ensure that scheduled activities are provided to the residents on a continual basis
at least five days per week for a total of not less than ten hours per week. This is evidenced by
the facility's failure to provide meaningful activities to the residents.
71, During the entrance tour on November 15, 2006 at about 8:00 a.m. two surveyors
observed the monthly activity calendar posted on the wall was dated "October."
72. nan interview with the Administrator and Assistant Administrator on November
15, 2006 at about 9:15 a.m. two surveyors are informed that employee number six (6) is
responsible for the activities program. However, surveyors are informed that employee number
six (6) is out on leave and not on the schedule to work.
73, The surveyors are informed that Employee number two (2) has been substituting
for Employee number six (6) but she is not working due to illness.
74, The surveyors are informed by the Administrator that activities are normally
provided from 10:00 a.m. or 10:30 a.m. through 2:00 p.m. five (5) days a week.
75. In an interview with three (3) residents at 12:00 p.m. on November 15, 2006 a
surveyor asks them about the activity program. The surveyor is informed that there are no
activities and that the activity person is still out.
Page 12 of 36
76. Surveyors observed that no activities were provided to residents on November
15, 2006. |
77. On November 16, 2006 at about 10:00 a.m., a surveyor speaks to a fourth
resident about the activities program. The resident states that "the only activity is changing the
month on the calendar."
78. On November 16, 2006, surveyors are in the facility until around 12:15 p.m.
when they go to lunch. There are no activities during this time period. The surveyors re-enter
the facility around 4:15 p.m, on November 16, 2006 after decision malcing in the Area 8 office
building and see no signs of any resident activities. The monthly activity calendar still reads
"October."
79, Such violations constitute the grounds for the imposed Class III deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations.
80. Pursuant.to Section 400.419(2)(c), Florida Statutes, Class III violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation.
81. For this Class III uncorrected deficiency, the Agency provided the Respondent
with a mandatory correction date of December 16, 2006.
‘WHEREFORE, the Agency intends to impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted living facility
in the State of Florida, pursuant to Section 429.19(2)(c), Florida Statutes (2006).
Page 13 of 36
| COUNT V
Respondent Failed To Ensure Each Staff Member’s Personnel Record Contains A Copy Of
The Original Employment Application With References In Violation of Section 429.275(4),
Florida Statutes(2006) And Rule 58A-5.024(2)(a) Florida Administrative Code (2006)
82. | The Agency re-alleges and incorporates paragraphs (1) through (4) above as if
fully set forth herein. .
83.. Pursuant to Florida law, the Agency may by rule clarify terms, establish
requirements for financial records, accounting procedures, personnel procedures, insurance
coverage, and reporting procedures, and specify documentation as necessary to implement the
requirements of this section. Section 429,275(4), Florida Statutes (2006). Personnel records for
each staff member shall contain, at a minimum, a copy of the original employment application
with references furnished and verification of freedom from communicable disease including
tuberculosis. Rule 58A-5.024(2)(a), Florida Administrative Code (2006).
84. Onor about August 30, 2006, Agency surveyors conducted a complaint survey of
the Respondent’s facility that resulted in a Class III deficiency.
. 85. - Based upon interview it was determined the facility failed to assure that one (1) of
three (3) employees, Employee number three (3), had a personnel record which contained a copy
of the original employment application with references,
86. On August 30, 2006 at about 11:00 am a surveyor asked the administrator for
‘documentation that Employee number three (3) had a personnel record which contained a copy
of the original employment application with references,
87. The Administrator, after review, stated he could not locate the required .
documentation. The surveyor provided the Administrator an opportunity to locate missing
‘documentation. At about 5:00 p.m. on August 30, 2006 the surveyor exited the facility. The
Page 14 of 36
Administrator was informed that if he could locate the missing documentation for Employee
number three (3) to fax them to the office on August 31, 2006.
88... On September 1, 2006 at about 10:50 a.m. the surveyor spoke with the
Administrator. The Administrator stated he could not locate the requested documents,
. 89. For this Class III deficiency, the Agency provided the Respondent a mandated
correction date, of September 30, 2006.
90. . Agency surveyors conducted a biennial licensure survey of the Respondent’s
facility on or about November 15 through November 16, 2006,
91. . This isan uncorrected deficiency from the complaint investigation completed on
August 30, 2006.
92. Based upon record review and interview it was determined the facility failed.to
assure that two (2) of seven (7) employee records, Employees number one (1) and number four
(4), reviewed contained a copy of the original employment application with references.
93, Employee number one (1) was hired on May 1, 2005 and is the Assistant
Administrator. A review of her personnel file on November 15, 2006 at about 3:30 p.m. failed to
_teveal any reference checks. . .
| 94, The Assistant Administrator was provided an opportunity to locate the reference
checks. She stated she was not responsible for making these checks and would not have made
her own reference check. |
95. Employee number four (4) was hired on May 3, 2005. A review of employee
number four’s (4) personnel file on November 15, 2006 at about 3:30 p.m. failed to reveal any
reference checks. The Assistant Administrator was provided an opportunity to locate the
reference checks. She stated she was not responsible for making these checks.
Page 15 of 36
06. On November 16, 2006 at about 11:45 a.m., the administrator was provided an
opportunity to locate the missing reference checks for Employees number one (1) and number
four (4).
97. Atabout 4:30 p.m. on November 16, 2006, the Administrator was asked if he was
able to locate the requested documentation for Employees number one (1) and number four (4).
The Administrator indicated he did not have the requested documentation.
98. Such violations constitute the grounds for the imposed Class III deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations.
99, Pursuant to Section 400.419(2)(c), Florida Statutes, Class IIT violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation.
100. For this Class 1 uncorrected deficiency, the Agency provided the Respondent
with a mandatory correction date of December 16, 2006.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted living facility
in the State of Florida, pursuant to Section 429.19(2)(c), Florida Statutes (2006).
COUNT VI
Respondent Failed To Ensure That Personnel Records Contain Verification Of Freedom
From Communicable Disease Including Tuberculosis In Violation Of Section 429,275(4),
Florida Statutes (2006) And Rule 58A-5.024(2)(a), Florida Administrative Code (2006)
101. The Agency re-alleges and incorporates paragraphs (1) through (4) above as if
fully set forth herein. |
102. Pursuant to Florida law, the Agency may by rule clarify terms, establish
requirements for financial records, accounting procedures, personnel procedures, insurance
Page 16 of 36
coverage, and reporting procedures, and specify documentation as necessary to implement the
requirements of this section. Section 429.275(4), Florida Statutes (2006). Personnel records for
each staff member shall contain, at a minimum, a copy of the original employment application
with references furnished and verification of freedom from communicable disease including
tuberculosis, Rule 58A-5.024(2)(a), Florida Administrative Code (2006).
103, On or about August 30, 2006, Agency surveyors conducted’a complaint survey of
the Respondent's facility that resulted in a Class II deficiency.
_°104. Based upon interview it was determined the facility failed to assure that three (3)
of three (3) employees, Employees number one (1), number two (2), and number three (3) had
verification of freedom from communicable disease including tuberculosis in their personnel
records.
105. On August 30, 2006 at about 11:00 a.m. a surveyor asked the administrator for
documentation that Employees number one (1), number two (2), and number three Q had
verification of freedom from communicable disease including tuberculosis in there personnel
records. :
106. . The Administrator, after review, stated he could not locate the required
documentation. The surveyor provided the Administrator an opportunity to locate missing
documentation, At about 5:00 p.m. on August 30, 2006 the surveyor exited the facility. The
Administrator was informed that if he could locate the missing documentation for Employees
number one (1), number two (2), and number three (3) to fax them to the office on August 31,
2006.
107. On September 1, 2006 at about 10:50 a.m. the surveyor spoke with the
Administrator. The Administrator stated he could not locate the requested documents.
Page 17 of 36
108. For this Class ITI deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
109, Agency surveyors conducted a biennial licensure survey of the Respondent’s
facility on or about November 15 through November 16, 2006.
110, This is an uncorrected deficiency from the complaint investigation completed on
August 30, 2006.
111. Based upon interview it was determined the facility failed to assure that four (4)
of seven (7) employees, Employees number one (1), number two (2), number three (3), and
number seven (7) had verification of freedom from communicable disease including tuberculosis
in their personnel records.
112, Employee number one (1) was hired on May 1, 2005. During a review of
Employee number one’s (1) personnel file for documentation of freedom from Tuberculosis on
November 15, 2006 at about 3:30 p.m. the surveyor observed the only item filled in was the date
the Purified Protein Derivative (PPD) was given. This date was February 9, 2006. The "date
checked" was blank as well as the results. The form was signed on February 16, 2006 by the
Advanced Registered Nurse Practioner.
113. Employee number two (2) was hired on April 10, 2006. During a review of
Employee number two’s (2) personnel file for documentation of freedom from Tuberculosis on
November 15, 2006 at about 3:30 p.m. the surveyor observed the Purified Protein Derivative
(PPD) was given on September 21, 2006. The “date checked" was September 24, 2006. The -
form did not contain any results of the Purified Protein Derivative test.
114. Employee number three (3) was hired on October 28, 2004. During a review of
Employee number three’s (3) personnel file for documentation of freedom from Tuberculosis on
November 15, 2006 at about 3:30 p.m. the surveyor observed the date the Purified Protein
Page 18 of 36
Derivative was given was September 21,2006. The "date checked" was September 24, 2006.
The form did not contain any results of the Purified Protein Derivative test
115... Employee number seven (7) is the Administrator. A review of the Administrator's
personnel file revealed a letter dated February 24, 1998 which stated the Administrator has a
positive Purified Protein Derivative and a chest X-ray does not show active Tuberculosis.
116. On February 4, 2004, an Advanced Registered Nurse Practitioner ordered a chest
X-ray for the Administrator. No results of the chest X-ray are present in the Administrator's file.
117. There are no other Tuberculosis test results in the Administrator's file.
118. -On November 16, 2006 at about 8:35 a.m., Employee number one (1) presented
the surveyor with documents showing that Employees number one (1), number two (2), and
number three (3) are free of Tuberculosis due to negative Purified Protein Derivative’s results.
Refer to A0029 in AHICA State, complaint investigation, CCR# 2006-00986, for additional
information concerning altered PPD test results,
119. On November 16, 2006 at about 11:45 a.m., the administrator was provided an
opportunity to locate documentation that he was free from Tuberculosis.
120. At about 4:30 p.m. on November 16, 2006 the Administrator was asked if he was
able to locate the requested Tuberculosis documentation for himself. The Administrator
indicated he did not have the requested documentation.
121, Such violations constitute the grounds for the imposed Class Il deficiency in that:
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations.
122, Pursuant to Section 400.419(2)(c), Florida Statutes, Class HI violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation.
Page 19 of 36
123. — For this Class III uncorrected deficiency, the Agency provided the Respondent
with a mandatory correction date of December 16, 2006.
WHEREFORE, the Agericy intends to impose an administrative fine in the
amount of SEVEN HUDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted
living facility in the State of Florida, pursuant to Section 429,19(2)(c), Florida Statutes (2006).
f
COUNT VII
Respondent Failed to Provide Documentation That Newly Hired Staff Have Thirty (30)
Days To Submit A Statement From A Health Care Provider, Based On An Examination
Conducted Within The Last Six (6) Months, That The Person Does Not Have Any Signs Or
Symptoms Of A Communicable Disease Including Tuberculosis In Violation Of Rule 58A-
. 5.024(2)(a), Florida Administrative Code (2006)
124, The Agency re-alleges and incorporates paragraphs (1) through (4) above as if
fully set forth herein, .
125, Pursuant to Florida law, newly hired staff shall have 30 days to submit a
statement from a health care provider, based on a examination conducted within the last six
months, that the person does not have any signs or symptoms of a communicable disease
including tuberculosis. Freedom from tuberculosis must be documented on an annual basis. A
person with a positive tuberculosis test must submit a health care provider's statement that the
person does not constitute a risk of communicating tuberculosis. Newly hired staff does not
include an employee transferring from one facility to another that is under the same management
or ownership, without a breal in service. If any staff member is later found to have, or is
suspected of having, a communicable disease, he/she shall be removed from duties until the
administrator determines that such condition no longer exists. Rule 58A~-5.019(2)(a), Florida
‘Administrative Code, Personnel records for each staff member shall contain, at a minimum, a
copy of the original employment application with references furnished and verification of
Page 20 of 36
freedom from communicable disease including tuberculosis, Rule 5 8A-5.024(2)(a), Florida
Administrative Code (2006).
126. On or about August 30, 2006, Agency surveyors conducted a complaint survey of |
“the Respondent's facility that resulted in a Class III deficiency.
127. . Based upon interview and record it was determined the facility failed to assure
that two (2) of three (3) employees, Employee number one (1) and number three (3) submit a
statement from a health care provider, based on an examination conducted within the last six (6)
months, that the person does not have any signs or symptoms of a communicable disease
including tuberculosis within thirty (30) days of hire.
128. Employee number one (1) was hired on May 4, 20006 and Employee number
three (3) was recently hired but the administrator could not tell the surveyor when they were
hired. )
129. The suryeyor could not locate any documentation that Employee number one (1)
had submitted a statement within thirty (30) days of employment that they were free of
communicable disease to include tuberculosis.
130. The surveyor provided the Administrator an opportunity to locate missing
documentation. At about 5:00 pm on August 30, 2006 the surveyor exited the facility. The
Administrator was informed that if he could locate the missing documentation for Employees
number one (1) and number three (3) to fax them to the office on August 31, 2006.
131, On September 1, 2006 at about 10:50 a.m. the surveyor spoke with the
Administrator. The Administrator stated he could not locate the requested documents.
132. For this Class III deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
Page 21 of 36
133, Agency surveyors conducted a biennial licensure survey of the Respondent's
facility on or about November 15 through November 16, 2006.
134, This is an uncorrected deficiency from the complaint investigation completed on
August 30, 2006. .
135. Based upon interview and record it was determined the facility failed to assure
that one (1) of seven (7) employees, Employee number two (2) submit a statement from a
health care provider, based on an examination conducted within the last six months, that the
person does not have any signs or symptoms of a communicable disease including tuberculosis
within thirty (30) days of hire.
136. Employee number two (2) was hired on April 10, 2006. During a review of
Employee number two’s (2) personnel file for documentation of freedom from Tuberculosis on
November 15, 2006 at about 3:30 p.m. the surveyor observed the Purified Protein Derivative was
given on September 21,2006, The "date checked" was September 24, 2006. The form did not
contain any results of the Purified Protein Derivative test.
137, The form was shown to the Assistant Administrator (AA) of the facility, by the
surveyor, and asked what the results were of the Purified Protein Derivative test. Was Employee
number two (2) positive or negative for possible TB? The Assistant Administrator
acknowledged there were no results of the Purified Protein Derivative test documented.
138. On November 16, 2006 at about 8:35 a.m., the Assistant Administrator presented
the surveyor with the same form. At the bottom of the form was "Purified Protein Derivative (-)
on September 24, 2006" and initialed by the Advanced Registered Nurse Practioner (-)
interpreted to mean negative). There was no indication that this was a late. entry.
139. On November 16, 2006 at about 8:35 a.m., the Assistant Administrator presented
the surveyor with a document showing that employee number two (2) is free of TB due to
Page 22 of 36
negative Purified Protein Derivative test results. Refer to A0029 in State Form, complaint
investigation, CCR# 2006-009886, for additional information concerning altered PPD test
results,
140. Such violations constitute the grounds for the imposed Class III deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations,
141. Pursuant to Section 400.419(2)¢c), Florida Statutes, Class III violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation.
142. For this Class III uncorrected deficiency, the Agency provided the Respondent
with a mandatory correction date of December 16, 2006.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted living facility
in the State of Florida, pursuant to Section 429,19(2)(c), Florida Statutes (2006).
| COUNT viII
Respondent Failed To Provide That Freedom From Tuberculosis Must Be Documented On
An Annual Basis. A Person With A False Positive Tuberculosis Test Must Submit A Health
Care Provider’s Statement That The Person Does Not Constitute A Risk Of
Communicating Tuberculosis In Violation Of Rule 58A-5.019(2)(a), Florida Administrative
Code(2006) _
143, The Agency re-alleges and incorporates paragraphs (1) through (4) above as if
fully set forth herein.
144, Pursuant to Florida law, newly hired staff shall have 30 days to submit a
statement from a health care provider, based on a examination conducted within the last six
months, that the person does not have any signs or symptoms of a communicable disease
including tuberculosis. Freedom from tuberculosis must be documented on an annual basis. A
Page 23 of 36
person with a positive tuberculosis test must submit a health care provider’s statement that the
person does not constitute a risk of communicating tuberculosis. Newly hired staff does not
include an employee transferring from one facility to another that is under the same management
or ownership, without a break in service, If any staff member is later found to have, or is
suspected of having, a communicable disease, he/she shall be removed from duties until the
administrator determines that such condition no longer exists. Rule 58A-5.019(2)(a), Florida
Administrative Code (2006),
145. On or about August 30, 2006, Agency surveyors conducted a complaint survey of
the Respondent’s facility that resulted in a Class III deficiency.
146, Based upon record review and interview it was determined the facility failed to.
assure that one (1) of three (3) employees, Employee number two (2) provided documentation
on an annual basis that they were free of tuberculosis.
147, Employee number two (2) was hired on November 1, 2004. During a review of
the employee's personnel file the surveyor could not locate documentation of freedom from
tuberculosis.on an annual basis,
148. The surveyor provided the Administrator an opportunity to locate missing
documentation. At about 5:00 p.m. on August 30 2006 the surveyor exited the facility. The
Administrator was informed that if he could locate the missing documentation for Employees
number two (2) to fax it to the office on August 31, 2006.
149, On September 1, 2006 at about 10:50 am, the surveyor spoke with the
Administrator. The Administrator stated he could not locate the requested documents.
150. For this Class im deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
Page 24 of 36 _
151. Agency surveyors conducted a biennial licensure survey of the Respondent’s
facility on or about November 15 through November 16, 2006.
152. This is an uncorrected deficiency from the complaint investigation completed on
August 30, 2006.
153. Based upon record review and interview it was determined the facility failed to
document that 3 of 7 employee's personnel files, Employees number one () number three (3),
and number seven 1(7) contained documentation of freedom from Tuberculosis (TB) on an
annual basis.
154, Employee number one (1) was hired on May 1, 2005. During a review of
Employee number ones (1) personnel file for documentation of freedom from Tuberculosis on
November 15, 2006 at about 3:30 p.m. the surveyor ‘observed the only item filled in was the date
the Purified Protein Derivative was given. This date was February 9, 2006. The "date checked"
was blank as well as the results. |
155. . Employee number three (3) was hired on October 28, 2004. During a review of
Employee number three’s (3) personnel file for documentation of freedom from Tuberculosis on
November 15, 2006 at about 3:30 p.m. the surveyor observed the date the Purified Protein
Derivative was given was September 21, 2006. The "date checked" was September 24, 2006,
The form did not contain any results of the PPD test,
156. Employee number seven (7) is the Administrator. A review of the Administrator's
personnel file revealed a letter dated February 24, 1998 which stated the Administrator has a
positive Purified Protein Derivative test and a chest X-ray does not show active TB.
157, On February 4, 2004, an Advanced Registered Nurse Practitioner ordered a chest
X-ray for the Administrator. No results of the chest X-ray are present in the Administrator's file,
158. There are no other TB test results in the Administrator's file.
Page 25 of 36
159. -On November 16, 2006 at about 8:35 a.m., the Assistant Administrator presented
the surveyor with documents showing that Employees number one (1) and number three (3) are
free of TB due to negative Purified Protein Derivative tests,
160. ‘ On November 16, 2006 at about 11:45 a.m. the administrator was provided an
opportunity to locate documentation that he was. free from TB. |
161. At about 4:30 p.m. on November 16, 2006 the Administrator was asked if he was
able to locate the requested TB documentation for himself. The Administrator indicated he did
not have the requested documentation.
162. . Such violations constitute the grounds for the imposed Class III deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations.
163. Pursuant to Section 400.419(2)(c), Florida Statutes, Class III violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1, 000, 00 foreach
violation.
164. For this Class III uncorrected deficiency, the Agency provided the Respondent
with a mandatory correction date of December 16, 2006.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted living facility
in the State of Florida, pursuant to Section 429.19(2)(c), Florida Statutes (2006).
Page 26 of 36
COUNT IX
Respondent Failed To Provide That New Facility Staff Must Obtain An Initial Training On
HIV/AIDS Within Thirty (30) Days Of Employment, Unless The New Staff Person
Previously Completed The Initial Training And Has Maintained The Biennial Continuing
Education Requirement. All Facility Employees Must Complete Biennially A Continuing
Education Course On HIV And AIDS In Violation of Section 429.275(2), Florida Statutes
(2006) and Rule 58A-5,0191(3), Rule 58A-5.024(2)(a)1 and Rule 58A-5.0191(11) Florida
Administrative Code (2006)
165, The Agency re-alleges and incorporates paragraphs (1) through (4) above as if
fully set forth herein.
166, Pursuant to Florida law, the administrator or owner of a facility shall maintain
. personnel records for each staff member which contain, at a minimum, documentation of
background screening, if applicable, documentation of compliance with all training requirements
of this part or applicable rule, and a copy of all licenses or certification held by each staff who
performs services for which licensure or certification is required under this part or rule. Section
429.275(2), Florida Statutes (2006). Personnel records for each staff member shal! contain, ata.
minimum, a copy of the original employment application with references furnished and
verification of freedom from communicable disease including tuberculosis. Rule 58A-
5.024(2)(a), Florida Administrative Code (2006). All facility employees must complete
biennially, a continuing education course on HIV and AIDS. New facility staff must obtain an
initial training on HIV/AIDS within thirty (30) days of employment, unless the new staff person
previously completed the initial training and has maintained the biennial continuing education
requirement. Documentation of compliance must be maintained in accordance with subsection
(11) of this rule. Section 381,0035, Florida Statutes (2006) and Rule 58A-5.0191(3), Florida
Administrative Code. Except as otherwise noted, certificates of any training required by this rule
shall be documented in the facility’s personnel files which documentation shall include the
subject matter of the training program, the trainee’s name, the date of attendance, the training
Page 27 of 36
provider’s name, signature and credentials, professional license number if applicable, and the
number of hours of training. Section 429.52, Florida Statutes (2006) and Rule 5 BA-5.0191(1 1),
Florida Administrative Code (2006).
167. On or about August 30, 2006, Agency surveyors conducted a complaint survey of
the Respondent's facility that resulted in a Class III deficiency.
168, Based upon interview it was determined the facility failed to assure that 1 of 3
employees, Employee number three (3) received initial training on HIV/AIDS within thirty (30)
days of employment, unless the new staff person previously completed the initial training and
has maintained the biennial continuing education requirement.
169, On August 30, 2006 at about 11:00 a.m. a surveyor asked the administrator for
documentation that Employee number three (3) had received the required HIV/AIDS training
within thirty (30) days of employment. .
170. The Administrator, after review, stated he could not locate the required.
documentation. The surveyor provided the Administrator an opportunity to locate missing
documentation, At about 5:00 p.m. on August 30, 2006 the surveyor exited the facility. The
Administrator was informed that if he could locate the missing documentation for Employee
number three (3) to fax them to the office on August 31, 2006.
171., On September 1, 2006 at about 10:50 a.m. the surveyor spoke with the
Administrator. The Administrator stated he could not locate the requested documents.
172. For this Class III deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
173. Agency surveyors conducted a biennial licensure survey of the Respondent’s
facility on or about November 15 through November 16, 2006.
Page 28 of 36
- 174. This is an uncorrected deficiency from the complaint investigation completed on
August 30, 2006.
175. Based upon record review and interview it was determined the facility failed to
assure that five (5) of seven (7) new staff, Employees number one (1), number three (3), number
four (4), number five (5), and number six (6) obtain initial training on HIV/AIDS within thirty
(30) days of employment and two (2) of seven (7) staff members, Employees number two (2)
and number seven (7) employed for over two (2) years complete biennially, a continuing
education course on HIV and AIDS. |
176. During an employee record review on November 15, 2006 at about 3:30 pm.a
_ surveyor asked Employee number one (1), the Assistant Administrator (AA) about the training
certificates for HIV/AIDS for Employee number one (1) who was hired on May 1, 2005,
Employee number two (2) who was hired on April 10, 2006, Employee number three (3) who
was hired on October 28, 2004, Employee number four (4) who was hired on May 3, 2005,
employee number five (5) who was hired on September 26, 2006, and Employee number six (6)
who was hired on April 10, 2006,
177, The certificates were either signed by the Assistant Administrator or the
Administrator, The surveyor informed the Assistant Administrator that they were not qualified
to teach HIV/AIDS. The Assistant Administrator indicated she thought since she had attended
Assisted Living Facility Core Training that this qualified her to teach HIV/AIDS, _
178. On November 16, 2006 at about 9:30 a.m., a surveyor was reviewing the
employee file of Employee number seven (7), the Administrator, and could not locate any
training certificates for HIV/AIDS.
Page 29 of 36
179. On November 16, 2006 at about 11:45 a.m., the administrator was provided an
opportunity to locate documentation that hé had received the required HIV/AIDS continuing
education. .
180. At about 4:30 p.m. on November 16, 2006, the Administrator was asked if he was
able to locate the requested HIV/AIDS continuing education documentation for himself. The
Administrator indicated he did not have the requested documentation.
181. Such violations constitute the grounds for the imposed Class III deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations.
182. Pursuant to Section 400.419(2)(c), Florida Statutes, Class III violations are
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation,
183. For this Class II uncorrected deficiency, the Agency provided the Respondent
with a mandatory correction date of December 16, 2006.
WHEREFORE, the Agency intends to i impose an administrative fine in the amount of
SEVEN HUNDRED FIFTY DOLLARS ($750,00) against Respondent, an assisted living Feollity
in the State of Florida, pursuant to Section 429. 19(2)(c), Florida Statutes (2006).
COUNT X ;
Respondent Failed To Ensure That Personnel Records Contain Documentation Of
Compliance With Level One (1) Background Screening For All Statf Subject To Screening
Requirements In Violation Of Section 429. 273(2), Florida Statutes(2006), Rule 58A-
5.019(3), and Rule 58A-024(2)(a) 3, Florida Administrative Code (2006)
184. The Agency re-alleges and incorporates paragraphs (1) through (4) as if fully set
forth herein.
185. Pursuant to Florida law, Personnel records for each staff member shall contain, at
a minimum, a copy of the original employment application with references furnished and
Page 30 of 36
verification of freedom from communicable disease including tuberculosis. Rule 58A-
5.024(2)(a), Florida Administrative Code (2006). The administrator or owner of a facility shal]
maintain personnel records for each staff member which contain, ata Pah documentation
of background screening, if applicable, documentation of compliance with all training
requirements of this part or applicable rule, and a copy of all licenses or certification held by
each staff who performs services for which licensure or certification is required under this part or
rule, Section 429.275(2), Florida Statutes (2006),
186. Onor about August 30, 2006, Agency surveyors conducted a complaint survey of
the Respondent’s facility that resulted in a Class tt deficiency,
187. Based upon interview and record it was determined the facility failed to assure
that two (2) of three (3) employees personnel records, Employees number one (1) and number
three (3) contain documentation of compliance with level one (1) background screening for all
staff subject to screening requirements.
188. . Employee number one (1) was hired on May 4, 2006 and Employee number three
(3) was recently hired’ but the administrator could not tell the surveyor when they were hired.
189, The surveyor could not locate any documentation that Employee number one (1)
had the required level one (1) background screening. There were no personnel records for
Employee number three (3).. The Administrator indicated Employee number three (3) was
recently hired.
190. The surveyor provided the Administrator an opportunity to locate missing
documentation. At about 5:00 p.m. on August 30, 2006 the surveyor exited the facility. The
Administrator was informed that if he could locate the missing documentation for Employees
number one (1) and number three (3) to fax them to the office on August 31, 2006.
Page 31 of 36
191. On September 1, 2006 at about 10:50 a.m. the surveyor spoke with the
Administrator. The Administrator stated he could not locate the requested documents,
192. For this Class III deficiency, the Agency provided the Respondent a mandated
correction date of September 30, 2006.
193. Agency surveyors conducted a biennial licensure survey of the Respondent’s
facility on or about November 15 through November 16, 2006.
194, This is an uncorrected deficiency from the complaint investigation completed on -
August 30, 2006.
195. . Based upon interview and record it was determined the facility failed to assure
that 2 of 7 employees personnel records, Employees number two (2) and number five (5)
contain documentation of compliance with level one (1) background screening for all staff
subject to screening requirements, .
196, . Employee number two (2) was hired on April 10, 2006 and Employee number
five (5) was hired on September 26, 2006, Both employees provide direct care assistance to
residents. During a review of their employee personnel files for compliance level 1 background
screening requirements the surveyor could not locate documentation that Employees number two
(2) and number five (5) had clear background checks.
197. These findings were reviewed with the Assistant Administrator on November 15,
2006 at about 3:30 p.m. The Assistant Administrator was provided an opportunity to locate the
missing documentation.
198. On November 16, 2006 at about 11:45 a.m., the administrator was provided an
opportunity to locate the missing background screening documentation for Employees number
two (2) and number five (5).
Page 32 of 36
199. .At about 4:30 p.m, on November 16, 2006, the Administrator was asked if he was
able to locate the requested background screening documentation for Employees number-two (2)
and number five (5). The Administrator indicated he did not have the requested documentation.
200, Such violations constitute the grounds for the imposed Class III deficiency in that
it indirectly or potentially threatened the physical or emotional health, safety or security of the
facility’s residents, other than Class I or Class II violations.
201. Pursuant to Section 400.419(2)(c), Florida Statutes, Class IIT violations are -
subject to an administrative fine of not less than $500.00 and not exceeding $1,000.00 for each
violation, ,
202. For this Class IIT uncorrected deficiency, the Agency provided the Respondent .
with a mandatory correction date of December 16, 2006. |
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
_ SEVEN HUNDRED FIFTY DOLLARS ($750.00) against Respondent, an assisted living facility
in the State of Florida, pursuant to Section 429,19(2)(c), Florida Statutes (2006).
COUNT XI
(Assessment of Survey Fee)
203. The Agency re-alleges and incorporates by reference paragraphs 1 through 4 and
the allegations in Count I through Count X.
204, The Agency received a complaint about the Respondent.
205. In response to the complaint, the Agency conducted a complaint survey of the
Respondent and its Facility on November 15, 2006.
206. As a result of the Agency’s complaint survey, the Respondent was cited for ten
(10) uncorrected deficiencies for the complaint.
207. The basis for the deficiency alleged in this Administrative Complaint relates to
Page 33 of 36
the complaint against the Respondent and its Facility.
208. Pursuant to Section 429,19(10), Florida Statutes (2006), the Agency is
authorized to, in addition to any administrative fines, assess a survey fee equal to the lesser of
one-half of the facility’s biennial license and bed fee, or $500, to cover the cost of conducting the
initial complaint investigation that resulted in the finding of a violation that was the subject of
the complaint, or for monitoring visits conducted under Section 429,.28(3)(c), Florida Statutes
(2006), to verify the correction of the violations.
209. — In this case, the Agency is authorized to seek a survey fee of $500.00.
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
intends to assess a survey fee against the Respondent in the amount of FIVE HUNDRED -
DOLLARS ($500.00) pursuant to Section 429.19(10), Florida Statutes (2006),
CLAIM FOR RELIEF
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
respectfully requests the Court to enter a final order granting the following relief against the
Respondent as follows:
1. Make findings of fact and conclusions of law in favor of the Agency.
2. Impose an administrative fine against the Respondent in the amount of SEVEN
THOUSAND FIVE HUNDRED DOLLARS ($7,500.00).
3. Assess a survey fee against the Respondent in the amount of FIVE HUNDRED
DOLLARS ($500.00).
Page 34 of 36
4. Order any other relief that this Court deems just and appropriate.
Respectfully submitted this aA day of October, 2007.
Andrea M. Lang, ea Attorney or ae
Florida Bar No. 0364568
Agency for Health Care Administration
Office of the General Counsel .
2295 Victoria Avenue, Room 346C
* Fort Myers, Florida 33901
Telephone: (239) 338-3203
NOTICE
THE RESPONDENT IS NOTIF TED THAT IT/HE/SHE HAS THE RIGHT TO REQUES’ T
AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57,
FLORIDA STATUTES. IF THE RESPONDENT WANTS TO HIRE AN ATT ORNEY,
IT/HE/SHE HAS THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN TIS
MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN
THE aTiACHED ELECTION OF RIGHTS FORM.
THE RESPONDENT IS FURTHER NOTIFIED IF THE ELECTION OF RIGHTS FORM
IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION
WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE
COMPLAINT, A FINAL ORDER WILL BE ENTERED.
THE ELECTION OF RIGHTS FORM SHALL BE. MADE TO THE AGENCY FOR
HEALTH CARE ADMINISTRATION AND DELIVERED TO: AGENCY CLERK,
AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE,
BUILDING 3, MAIL STOP 3, TALLAHASSEE, FL 32308; TELEPHONE (850) 922-5873.
Page 35 of 36
CERTIFICATE OF SERVICE
SEAN Ss
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by
U.S. Certified Mail, Return Receipt No: 7006 0810 0005 8950 3468 on October 4 __, 2007 to:
Peter Kramer, Administrator, Westwood Manor, 2339 Hoople Street, Fort Myers, Florida 33901.
Copies furnished to:
- Andrea M. Lang, Senior Attorney
Florida Bar No.0364568
Agency for Health Care Administration
Office of the General Counsel
2295 Victoria Avenue, Room 346C
Fort Myers, Florida 33901
_ Office: (239) 338-3203
Fax: (239) 338-2699
John F. Gilroy II, P.A.
Counsel for Respondent :
1435 East Piedmont Drive, Suite 215
Tallahassee, Florida 32308
-| (U.S. Mail)
Andrea M, Lang, Senior Attorney
Office of the General Counsel
‘9995 Victoria Avenue, Room 346C.
Fort Myers, Florida 33901
(Interoffice Mail)
Peter Kramer, Administrator
Westwood Manor
2339 Hoople Street
Fort Myers, Florida 33901
(U.S. Certified Mail)
Kriste J. Mennella
Field Office Manager
2295 Victoria Avenue, Room 340A
Fort Myers, Florida 33901
(Interoffice Mail)
Page 36 of 36
Agency for Health Care Administration
Agency for Health Care Administration
i = Complete items'1,2, and 3. Also complete °
item 4 If Restricted Delivery Is desired.
; Mf Print your name and address on the reverse |
so that we.can return.the card to you. !
@ Attach this.card to tha back of the mailplece, :
or on the front if space permits, ES
1. Article Addressed to: oe. TE
Peter ra mes, Adrinssfr for.
| Wes tuned dnaner :
| 2339 Hoaple Street
Fart myers, Florida,
3390/
D, Is delivery address different from ttem1? (1 Yes
If YES, enter delivery address below: .. CJ No
8, Service Type
i Certified Mall “1 Express Mail
GI Registered (2 Return Receipt for Merchandise
1 insured Mall ~=— £1 G.0.D,
4. Restricted Delivery? (Extra Fea)
“7006 paio o005 ‘aq50 34ba |
1PS Form 3811, February 2004 +, Domestic Retum Recelpt
2, Articia Number |
(Transtar from service label) i
102585-02-M-1 S40
Docket for Case No: 07-005152
Issue Date |
Proceedings |
Apr. 04, 2008 |
Order Closing Files. CASE CLOSED.
|
Apr. 02, 2008 |
Joint Motion to Relinquish Jurisdiction filed.
|
Feb. 15, 2008 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for April 23 and 24, 2008; 9:30 a.m.; Fort Myers, FL).
|
Feb. 08, 2008 |
Agreed Motion for Continuance filed.
|
Jan. 29, 2008 |
Amended Notice of Hearing (hearing set for February 19 and 20, 2008; 9:30 a.m.; Fort Myers, FL; amended as to addition of case).
|
Jan. 23, 2008 |
Notice of Service of Agency`s First Set of Interrogatories, Request for Admissions and Request for Production of Documents to Petitioner filed.
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Jan. 22, 2008 |
Order of Consolidation (DOAH Case No. 08-0252 added to consolidated batch).
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Dec. 27, 2007 |
Order of Pre-hearing Instructions.
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Dec. 27, 2007 |
Notice of Hearing (hearing set for February 19 and 20, 2008; 9:30 a.m.; Fort Myers, FL).
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Dec. 26, 2007 |
Order of Consolidation (DOAH Case Nos. 07-5152, 07-5153, and 07-5154).
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Dec. 20, 2007 |
Motion for Continuance filed.
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Nov. 20, 2007 |
(Respondent`s) Response to Initial Order filed.
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Nov. 13, 2007 |
Initial Order.
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Nov. 09, 2007 |
Administrative Complaint filed.
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Nov. 09, 2007 |
Petition for Formal Administrative Proceeding filed.
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Nov. 09, 2007 |
Notice (of Agency referral) filed.
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