Certified Mail Receipt OT J » O (7004 2890 0000 5527 2616) roe > STATE OF FLORIDA ey 4 AGENCY FOR HEALTH CARE ADMINISTRATION ae —_ STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, [es] 0 as ~ Petitioner, © AHCA NO.: 2007012641 vs. CASO, INC. d/b/a PARADISE MANOR II, Respondent. == ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA"), by and through the undersigned counsel, and files this Administrative Complaint against Caso, Inc. d/b/a Paradise Manor II (hereinafter “Paradise Manor II”), pursuant to Section 120.569, and 120.57, Fla. Stat. (2007), alleges: NATURE OF THE ACTION 1. This is an action to impose two (2) administrative fines in the amount of One Thousand Dollars ($1,000.00), against Paradise Manor Il for two (2) uncorrected class II deficiencies, pursuant to Sections 429.19(2\c), 429.52(4), Fla. Stat. (2007) and Sections 58A-5.0181(2)(b), and 58A-5.0191(1\(c), Fla. Admin. Code (2007). JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to 429, Part I and Sections 120.569 and 120.57, Fla. Stat. (2007). 1 EXHIBIT #7 3. Venue lies in Volusia County, Port Orange, Florida, pursuant to Section 120.57 Fla. Stat. (2007); Rule 58A-5, Fla. Admin. Code (2007) and Section 28.106.207, Fla. Stat. (2007). PARTIES 4. AHCA, is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 429, Part I, Fla. Stat. and Rules 58A-5, Fla. Admin. Code (2006). 5, Paradise Manor II is a for-profit corporation, whose 6bed assisted living facility is located at 435 GreenLeaf Square, Port Orange, Florida 32127. Paradise Manor I is licensed as an assisted living facility license # AL9904; certificate number #21283, effective September 1, 2006 through August 31, 2008. Paradise Manor II was at all times material hereto, licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT 1 PARADISE MANOR II FAILED TO ENSURE THAT HEALTH ASSESSMENTS WERE COMPLETED WITHIN 60 DAYS PRIOR TO ADMISSION OR WITHIN 30 DAYS AFTER ADMISSION FOR TWO OF FIVE RESIDENTS REVIEWED. STATE TAG A418-ADMISSIONS CRITERIA STANDARDS Section 429.19(2)(c), Fla. Stat. (2007) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Rule 58A-5.0181(2)(b), Fla. Admin. Code (2007) RESIDENCY CRITERIA AND ADMISSION PROCEDURES 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about September 26, 2007, AHCA conducted a follow-up appraisal visit at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a. On or about July 3, 2007, Paradise Manor II failed to have a medical examination completed within 30 days after admission recorded on the AHCA Form 1823, January 2006 for 1 of 7 residents (Resident #1). A medical examination is crucial for the health of a resident to ensure care and services are provided for the resident as needed. b. During a follow-up survey on or about September 26, 2007, Paradise Manor II failed to ensure that health assessments were completed within 60 days prior to admission or within 30 days after admission for two of five residents reviewed. - The Findings include: A review of records for Residents #2 and #4, revealed that Resident #2 was admitted in October of 2006 and the only health assessment in the record was dated in July of 2007. Resident #4 was admitted in July of 2007 and the health assessment was dated March 22, 2007. The administrator confirmed this information in an interview on September 26, 2007 at 2:15 P.M. Class III Correction Date: 10/26/2007 8. The regulatory provisions of the Fla. Stat. (2007), that are pertinent to this alleged violation read as follows: 429.19 Violations; imposition of administrative fines; grounds. - (2\(c) Class "III" violations are those conditions or occurrerices telated to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class II violations. The agency shall impose an administrative fine for a cited class III violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class [I violation must specify the time within which the violation is required to be corrected. If a class II] violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. toe * 58A-5.0181 Residency Criteria and Admission Procedures. (2)(b) Medical examinations completed after the admission of the resident to the facility must be completed within 30 days of the date of admission and must be recorded on the Resident Health Assessment for Assisted Living Facilities (ALF), AHCA Form 1823, January 2006, which is incorporated by reference. A faxed copy of the completed form is acceptable. A copy of AHCA Form 1823 may be obtained from the Agency Central Office or its website at www.fdhe.state.fl.us/MCH Q/Long_Term_Care/Assisted_living/pdf/AHCA_Form_1823 %_Jan_2006_.pdf. Previous. versions of this form completed up to six (6) months after 7- 30-06 are acceptable. x Ok OF 9. The violation alleged herein constitutes an uncorrected class III deficiency, and warrants a fine of $500.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500.00 COUNT I PARADISE MANOR II FAILED TO ENSURE THAT THE ADMINISTRATOR HAS COMPLETED 12 HOURS OF CONTINUING EDUCATION IN TOPICS RELATED TO ASSISTED LIVING EVERY TWO YEARS. STATE TAG A505-STAFFING STANDARDS Section 429.19(2)(c), Fla. Stat. (2007) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS . Section 429.52(4), Fla. Stat. (2007) Rule 58A-5.0191(1)(c), Fla. Admin. Code (2007) STAFF TRAINING REQUIREMENTS AND COMPETENCY TEST 10. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. ll. On or about September 26, 2007, AHCA conducted a follow-up appraisal visit at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) On or about July 3, 2007, Paradise Manor Il failed to ensure that the administrator has completed 12 hours of continuing education related to Assisted Living every two years. b.) During a follow-up survey on or about September 26, 2007, Paradise Manor Il failed to ensure that the administrator has completed 12 hours of continuing education related to Assisted Living every two years. The Findings include: A review of the administrator's employee record revealed that there was no documentation of continuing education since June of 2005. The administrator in an interview on September 26, 2007 at 1:00 P.M., concurred that 12 hours of continuing education was not completed from June of 2005 through June of 2007. This was previously cited on July 3, 2007 Class II Correction Date: 10/26/2007 12. The regulatory provisions of the Fla. Stat. (2007), that are pertinent to this alleged violation read as follows: 429.19 Violations; imposition of administrative fines; grounds. ~ (2c) Class "IH" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class | or class II violations. The agency shall impose an administrative fine for a cited class III violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class [II violation must specify the time within which the violation is required to be corrected. If a class IL violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. ~*~ ek * 429.52 Staff training and educational programs; core educational requirement.~ (4) Administrators are required to participate in continuing education for a minimum of 12 contact hours every 2 years. 58A-5.0191 Staff Training Requirements and Competency Test. (1)(c) Administrators and managers shall participate in 12 hours of continuing education in topics related to assisted living every 2 years as provided under Section 429.52, FS. * ok O* 13. The violation alleged herein constitutes an uncorrected class III deficiency, and warrants a fine of $500.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500.00 CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. Make factual and legal findings in favor of the Agency on Count’s I, II. 2. Assess against Paradise Manor II an administrative fine in the amount of $1,000.00 for the violation cited above. 3. Grant such other relief as the court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2007). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael O. Mathis, Senior Attorney. RESPONDENT IS FURTHER NOTIFED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL REASULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Florida. Michael O. Mathis Fla. Bar. No. 0325570 Counsel of Petitioner, Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5873 (office) (850) 921-0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served Paradise Manor II, 435 Greenleaf Square, Port Orange, Florida 32127. — haley __ Michael O. Mathis, Esq. saa|ases wdjesey wsNyay Bursn 40s noA yueUL ‘ }dlacay UMay ONSeWOg —_£2Z0-8-66-S65z01 p66) Jequiecag ‘) Lge wos Sd q (uaby 10 aasse. /) aunfeuBis °9 (pred s1 294 ‘ Lavad z Q09y * pure paysenbas si AJUQ) sseippy 8,28Sseppy ‘8 (owen jug) :AG paniaooy *¢ UnLad snod s} ST VNol TA ved | SY Asayaq jo area "2 Leyes. 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Docket for Case No: 07-005730