STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR O \ } 20 & HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2008000655 MUNNE CENTER, INC., 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 MUNNE CENTER, INC. (hereinafter Respondent), pursuant to Section 120.569, and 120.57, Florida Statutes, (2007), and alleges: NATURE OF THE ACTION This is an action to revoke the Respondent’s license to operate an assisted living facility and impose an administrative fine in the amount of nineteen thousand dollars ($19,000.00) and a survey fee of five hundred ($500.00) based upon three (3) State Class I deficiencies and four (4) State Class II deficiencies pursuant to Section 429.19(2)(a) and (b), Florida Statutes (2007). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and Chapters 408, Part II, and 429, Part I, Florida Statutes (2007). 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 regulations, state statutes and rules governing assisted living facilities pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. 4. Respondent operates a 160-bed assisted living facility located at 17250 SW 137 Avenue, Miami, Florida 33177, and is licensed as an assisted living facility with limited nursing services and limited mental health, license number 9446. 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. GENERAL FACTUAL ALLEGATIONS 6. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR #2007013597, #2007013713 and #2007013237) of the Respondent facility. 7. That the Petitioner’s representative toured the Respondent facility and reviewed Respondent’s records and noted the following: a. That the Respondent’s south wing is a secure unit; b. That fifty-one (51) residents reside in the secure unit; c. That of the population, only six (6) of the residents are under the age of fifty-five (55) years; d. That the vast majority of the residents of the secure unit are vulnerable adults who suffer from cognitive impairments such as dementia; e. That on December 6, 2007, the unit was staffed as follows: Three (3) staff members for the 6:30 AM to 2:00 PM shift, three (3) staff members on the 2:00 PM to 10:30 PM shift, and two (2) staff members on the 10:30 PM to 6:30 AM shift; 2 f. That the doorway to the secure unit is a double door requiring the use of a push button to release the lock in order to gain entry, while a coded key pad requires the entry of a code to exit the wing; g. That independent residents of the secure wing are provided the code for the key pad and may enter and exit the secure unit without limitation; h. That on December 6, 18, 19, and 20, 2007, residents were observed to be seated around and near the wing’s nurses station. 8. That the Petitioner’s representative reviewed Respondent’s records regarding resident number one (1) during the survey and noted as follows: a. b. The Residents is a thirty-three (33) years old; The resident was admitted to the Respondent’s secure unit on August 2, 2007; The resident’s diagnoses, as identified on the resident’s health assessment dated August 2, 2007, included Bipolar disorder, psychosis, and impaired cognition; Noted in Respondent’s progress notes for the resident are the following: 1. On August 24, 207, the resident was aggressive and threatening to commit suicide; 2. The resident was admitted to Cedars Hospital and returned from the hospital on August 28, 2007; 3. On September 6, 2007, the resident was not given prescribed evening medications, including psychotropics, due to the resident having returned to the facility drunk while the evening shift was on duty; 4. On September 30, 2007, the resident was aggressive and punched and pushed another female elderly resident, resident number nine (9), down to the floor; 5. That no time of incident is known, but the incident again appears to have occurred during the evening or night shift and staff was not available to intervene. e. That a 45-day discharge notice, dated October 29, 2007, was given to the resident and resident number six (6). 9. That the Petitioner’s representative reviewed the Respondent’s records regarding resident number five (5) during the survey and noted the following: a. The resident is a seventy (70) year old female; b. The resident was admitted to the Respondent on January 28, 2007; c. The resident’s health assessment dated January 24, 2007 reflects resident diagnoses as Alzheimer's d. The resident’s family removed the resident's belongings from the facility on December 7, 2007; e. The resident did not return to the facility following hospitalization for a sexual assault on November 30, 2007. 10. That the Petitioner’s representative interviewed resident number six (6) during the survey who indicated as follows: a. That the resident had had three (3) fights with resident number one (1); b. That the resident did not remember the dates or times of these altercations but indicated that resident number one (1) would come back to the facility drunk late at night and normally got into a fight with other residents; c. That when this occurred, the resident would intervene as staff were often not available or within eye sight; d. That a 45-day discharge notice, dated October 29, 2007, was given to the resident. e. That a fight, on or about November 29, 2007, occurred between the resident and resident number one (1) described as follows: 1. Resident number one (1) returned to the Respondent facility at around midnight with a female visitor; 2. An elderly male resident, whose name is unknown, attempted to speak with the woman; . 3. No staff members were around; 4. Resident number six (6) intervened when resident number one (1) tried to assault the elderly male resident due to the lack of staff to address the threat of resident number one (1). 11. That the Petitioner’s representative interviewed Respondent’s assistant administrator on December 20, 2007 who indicated as follows: a. That Respondent was aware of the third altercation between residents numbered one (1) and six (6); b. That Respondent had not documented the altercation in any record; c. That the Respondent’s sole response was to issue a notice to the residents notifying them that their residencies would be terminated effective n forty-five (45) days. 12. _ That the Petitioner’s representative reviewed Respondent’s records relating to a sexual assault occurring in the Respondent facility on November 30, 2007 and noted the following: a. That a sexual assault of a resident occurred on November 30, 2007 at 8:20 PM in room number 720 — South Wing; Room number 720 — South Wing is in the secure unit of the Respondent facility; A written statement authored by Respondent’s resident care director documented as follows: 1. That residents of the south wing were seated in the lobby while two certified nursing assistants (Hereinafter “CNA”), staff members numbered five (5) and eight (8), were showering a new resident; 2. A third CNA, staff member number seven (7), was taking care of the residents; 3. The Respondent’s supervisor, staff member number four (4), sent the third CNA, the staff member supervising residents, to accommodate the new resident in the resident’s room; 4. This redirection of staff left the lobby of the unit unsupervised; 5. Meanwhile, resident number ten (10) called out for CNAs because the resident found the resident’s roommate, resident number one (1), in the room with a female resident, resident number five (5); 6. The female resident was found undressed from her hips to her feet; 7. When resident number one (1) saw a CNA, he ran to get dressed; 8. The CNA took resident number five (5) out of the room, assisted the resident, and called the administrator who directed staff to call 911 immediately; 9. Resident number one (1) and resident number ten (10) began fighting until law enforcement responded to the call; 10. Once law enforcement arrived at the facility, resident number one (1) was arrested; 11. Resident number five (5) was sent to a hospital and did not return to the Respondent facility. COUNT I 13. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 14. That pursuant to Florida law, in addition to the staffing and care standards of this rule chapter to provide for the welfare of residents in an assisted living facility, a facility holding a limited mental health license must observe resident behavior and functioning in the facility, and record and communicate observations to the resident’s mental health case manager or mental health care provider regarding any significant behavioral or situational changes which may signify the need for a change in the resident’s professional mental health services, supports and services described in the community living support plan, or that the resident is no longer appropriate for residency in the facility. 58A-5.029(3)(c), Florida Administrative Code. 15. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR #2007013597, #2007013713 and #2007013237) of the Respondent facility. 16. That based upon the review of records, observation, and interview, Respondent the facility failed to assure that limited mental health resident behavior and functioning in the facility .was observed to ascertain if any significant behavioral or situational changes which may signify the need for a change in the resident's professional mental health services, supports and services described in the community living support plan; or that the resident is no longer appropriate for residency in the facility and to report such changes to identified persons for three (3) of three (3) limited mental health residents sampled, the same being contrary to law. 17. That the Petitioner alleges and incorporates paragraphs six (6) through twelve (12) as if fully set forth herein. 18. That the Respondent knew or should have known of the behaviors of resident number one (1) which included: a. Repeatedly entering the facility while intoxicated; b. Engaging in violent conflicts and aggressive behavior with resident number six (6); c. Engaging in violent and aggressive behavior with resident number nine (9); d. The failure of the resident to receive prescribed medications as a result of the resident’s intoxication; e. The inability of Respondent’s staff to provide monitoring of the resident sufficient to address and or prevent such behaviors. 19. That the Respondent knew or should have known of the behaviors of resident number six (6) which included repeated violent conflicts with resident number one (1). 20. That the Petitioner’s representative noted, in the review of Respondent’s records regarding residents numbered one (1), six (6), and nine (9), that each was a limited mental health resident yet Respondent failed to obtain or maintain a Community Living Support Plan or Cooperative Agreement as required by law, see, Section 429.075(3)(a), Florida Statutes (2007), Rule 58A-5.029(2)(c), Florida Administrative Code, and as such no active mental health case managers were available for the residents. 21. That the Petitioner’s representative interviewed Respondent’s assistant administrator on December 19, 2007 who indicated an awareness that resident number one (1) required mental health case management and mental health services, but could not explain why the same had not been pursued or provided. 22. That the violent behaviors of resident number one (1), the risk of resident one (1) harming others, the failure to provide prescribed medications, and the inability or unwillingness of Respondent to provide sufficient staff to prevent such behaviors are all significant behavioral or situational changes which may signify the need for a change in the resident's professional mental health services, supports and services described in the community living support plan; or indications that the resident is no longer appropriate for residency in the facility. 23. That the repeated violent conflicts of resident number six (6) with resident number one (1), the risk of harm presented to the resident and others as a result of these conflicts, and the inability or unwillingness of Respondent to provide sufficient staff to prevent such behaviors are all significant behavioral or situational changes which may signify the need for a change in the resident's professional mental health services, supports and services described in the community living support plan; or indications that the resident is no longer appropriate for residency in the facility. 24. — That the assault of resident number nine (9) by resident number one (1), the risk of harm presented to the resident and others as a result of these conflicts, and the inability or unwillingness of Respondent to provide sufficient staff to prevent such behaviors are all significant behavioral or situational changes which may signify the need for a change in the resident's professional mental health services, supports and services described in the community living support plan; or indications that the resident is no longer appropriate for residency in the facility. 25. That Respondent failed to record observed or known behaviors of residents numbered one (1) and six (6) as required by law. 26. That Respondent failed to notify the physician’s of residents numbered one (1), six (6), and nine (9) of the residents’ behavior and functioning as above described to alert to medication or residential adjustments that may be necessary. 27. That the failure to notify required persons is a failure of Respondent to provide the observation and reporting services mandated by law for mental health residents, the same allowing multiple violent conflicts culminating with the sexual assault of an elderly resident without the residents’ mental health providers and or physicians having such information to address such behaviors. 28. That these failures are contrary to the dictates of law and present imminent danger to residents numbered one (1) , six (6), nine (9) and all other residents, staff, and visitors to the Respondent facility. 29. | 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. 30. That the Agency provided Respondent with a mandatory correction date of December 28, 2007. 31. That pursuant to § 429.19(2)(a), Florida Statutes (2007), 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 $5,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to Section 429.19(2)(a), Florida Statutes (2007). COUNT II 32. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 33. 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. R. 58A-5.0182, Florida Administrative Code. 34. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR #2007013597, #2007013713 and #2007013237) of the Respondent facility. 35. That based upon observation, the review of records, and interview, Respondent failed to provide care and services appropriate to the needs of residents accepted for admission to the facility, the same being contrary to the requirements of law. 36. That the Petitioner alleges and incorporates paragraphs six (6) through twelve (12) as if fully set forth herein. 37. - That the Petitioner’s representative interviewed the previous mental health case manager of resident number one (1) on December 20, 2007 who indicated as follows: a. That while the resident was residing at the facility where she was employed, the resident was receiving case management services and psychotherapy three (3) to four (4) times per day five (5) days a week; b. That upon the admission of the resident to Respondent’s facility, the case manager had informed Respondent’s staff that the resident required mental health case management as well as mental health services. 38. That the Petitioner’s representative noted, in the review of Respondent’s records regarding residents numbered one (1) and six (6), that each was a limited mental health resident yet Respondent failed to obtain or maintain a Community Living Support Plan or Cooperative Agreement as required by law, see, Section 429.075(3)(a), Florida Statutes (2007), Rule 58A- 5.029(2)(c), Florida Administrative Code, and as such no active mental health case managers were available for the residents. 39. That the Petitioner’s representative interviewed Respondent’s assistant administrator on December 19, 2007 who confirmed that the Respondent was aware that resident number one (1) required both mental health case management as well as mental health services and could offer no explanation as to why the Respondent had failed to ensure that the same were provided for the resident. | 40. That the Respondent’s failure to ensure that required mental health case management and mental health services appropriate to the needs of its mental health residents, including resident’s one (1) and six (6), places the resident’s at risk and threatens their health and well-being by not ensuring that necessary care and services for mental health conditions are provided and is contrary to law. 41. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 42. That the Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2007). | 43. That the Agency provided Respondent with a mandatory correction date of January 20, 2008. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(b), Florida Statutes (2007). COUNT II 44. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 45. That pursuant to Florida law, facilities shall offer personal supervision, as appropriate for each resident. R. 58A-5.0182(1), Florida Administrative Code. 46. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR #2007013597, #2007013713 and #2007013237) of the Respondent facility. 47. That based upon the review of records, observation, and interview, Respondent the facility failed to provide personal supervision, as appropriate for fifty-one (51) of fifty-one (51) residents of the Respondent’s secure unit, said failures placing residents, staff, and visitors at risk for violence as evidenced by multiple occasions of violence including a physical assault on residents and a sexual assault on a resident, said failures being contrary to law. 48. That the Petitioner alleges and incorporates paragraphs six (6) through twelve (12) as if fully set forth herein. 49. That commencing within two (2) weeks of the admission of resident number one (1), Respondent was aware of the resident’s violent and aggressive behaviors. 50. That within one (1) month of the admission of resident number one (1), Respondent was aware of the resident’s behaviors relating to the use or abuse of alcohol and its effect on the 13 resident’s prescribed medication regime. 51. That Respondent was aware of the aggressive and violent behaviors of resident number one (1) towards other residents. 52. That Respondent was aware that the mental health services requires by resident number one (1) were not being provided to the resident. 53. That Respondent was aware that it had placed resident number one (1) in the facility’s secure unit in which its population consisted primarily of elderly vulnerable adults, most suffering from disease processes which limited their cognitive functioning. 54. That despite the Respondent’s knowledge of these multiple risk factors, Respondent took no action to ensure that resident number one (1) was supervised to a level appropriate to the resident’s behaviors, such deficits in supervision evidenced by: a. Respondent failed to take any action to ensure supervision adequate to prevent or protect resident number one (1) from engaging in violent, aggressive, or intoxicated behaviors, including but not limited to the failure to adjust staffing levels during the resident’s residency to ensure closer supervision of the resident and the resident’s interactions with others; b. Respondent failed to take any action to ensure supervision adequate to prevent or protect other residents from the violent, aggressive, or intoxicated behaviors of resident number one (1), including but not limited to the failure adjust staffing levels during the resident’s residency to ensure closer supervision of the remaining census of the secure unit to ensure that the residents would be protected from the violent and aggressive behaviors of resident number one (1); c. Respondent chose not to document repeated incidents of violent behavior of resident number one (1) or to evaluate and address appropriate interventions; d. Respondent’s only evidenced intervention for the multiple noted and known events of violence, aggressive behavior, and intoxication was to issue a notice that the resident’s residency, along with that of resident number six (6), would end forty-five (45) days following October 29, 2007; e. Respondent chose to tolerate, ignore, or otherwise turn a blind eye to the risks presented by the known behaviors of resident number one (1) while apparently awaiting the passage of time. f. Respondent, with actual knowledge of the behaviors of resident one (1), failed to take any action to relocate the resident to a more appropriate setting including, but not limited to, a different facility with a higher level of supervision an or to an area where the population’s cognitive skills better equip residents, staff, and ‘visitors to address such behaviors. 55. That resident number (1) engaged in multiple violent acts directed at residents including a physical assault on several residents and a sexual assault on one resident. 56. That the Respondent’s actions and inactions, intentional or negligent, constitute the failure to provide an appropriate level of supervision for resident number one (1) and or the remaining resident’s of the secure unit, said failures placing all residents, staff, and visitors at risk of imminent harm. 57. 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 15 deficiency. 58. That the Agency provided Respondent with a mandatory correction date of December 28, 2007 . 59. That pursuant to § 429.19(2)(a), Florida Statutes (2007), 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 $5,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to . Section 429.19(2){a), Florida Statutes (2007). COUNT IV 60. | The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 61. That pursuant to Florida law, 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; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out. R. 58A-5.0182(1)(d), Florida Administrative Code. 62. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR. #2007013597, #2007013713 and #2007013237) of the Respondent facility. 63. That based upon the review of records, observation, and interview, Respondent failed to - contact the resident's health care provider and other appropriate party such as the resident's family, guardian, health care surrogate, or case manager, where the resident exhibits a significant change for one (1) of nine (9) residents reviewed, the same being contrary to law. 64. That the Petitioner alleges and incorporates paragraphs six (6) through twelve (12) as if fully set forth herein. 65. That the Respondent knew or should have known of ongoing assaultive, aggressive, and intoxicated behaviors of resident number one (1) during the resident’s residency. 66. That Respondent documented several of such incidents, including the failure to administer prescribed psychotropic medications on September 6, 2007 due to the resident’s level of intoxication and the physical assault of another resident on September 30, 2007. 67. That Respondent’s continuing knowledge of the significant behavioral changes of resident number one (1) resulted in the Respondent’s decision to issue a notice to the resident that residency would be discontinued. 68. That despite these ongoing incidents of significant changes in behavior and the failure to administer psychotropic medications, Respondent took no action to contact the resident’s physician, responsible persons, or mental health providers. 69. Respondent’s failure to ensure that the resident had mental health support from case management does not abrogate the Respondent’s legal mandate to contact other identified parties where such significant behavioral deficits occur. 70. That the failure to contact required parties where a resident exhibits significant changes places the resident at risk of not receiving services, including but not limited to, alternative placement, additional or altered medication regimes, or focused services such as counseling or alternative supervision, and allows such behaviors to continue endangering the resident. 71. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 72. That the Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2007). 73. That the Agency provided Respondent with a mandatory correction date of January 20, 2008. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(b), Florida Statutes (2007). COUNT V 74. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 75. That pursuant to Florida law, a written record, updated as needed, of any significant changes as defined in 58A-5.0131(33), F.A.C., any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services. R. 58A-5.0182(1), Florida Administrative Code. 76. That a significant change is defined by law as the sudden or major shift in behavior or mood, or a deterioration in health status such as unplanned weight change, stroke, heart condition, or stage 2, 3, or 4 pressure sore. Ordinary day-to-day fluctuations in functioning and behavior, a short-term illness such as a cold, or the gradual deterioration in the ability to carry out the activities of daily living that accompanies the aging process are not considered significant changes. R. 58A-5.0131(33), Florida Administrative Code 77. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR #2007013597, #2007013713 and #2007013237) of the Respondent facility. 18 78. That based upon the review of records and interview, Respondent failed to maintain a written record of significant changes or incidents as required by law. 79. That the Petitioner alleges and incorporates paragraphs six (6) through twelve (12) as if fully set forth herein. 80. That the Respondent failed to document or maintain a record of the sudden and major shifts in behavior of resident number one (1) on a consistent basis. 81. | That Respondent was aware of violent outbursts and assaultive behaviors of resident number one (1) which were not documented. 82. That a record of such behavior is necessary for facility staff and health care providers to effectively evaluate and address the medical and social needs of residents on a consistent basis, the absence of which preventing or hindering the ability of persons responsible for the resident’s well-being, including Respondent, to effectively address and intervene for the protection of the resident and others. 83. That the failure to document such significant changes is contrary to law, results in the failure to identify and address the causative factors of such behaviors, and endangers the well- being of the resident and or others. 84. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 85. That the Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2007). 86. That the Agency provided Respondent with a mandatory correction date of January 20, 2008. 19 WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(b), Florida Statutes (2007). COUNT VI 87. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 88. That pursuant to Florida law, every resident of a facility shall have the right to live in a safe and decent living environment, free from abuse and neglect, and be treated with consideration and respect with due recognition of personal dignity. § 429.028(1), Florida Statutes (2007). 89. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR #2007013597, #2007013713 and #2007013237) of the Respondent facility. 90. That based upon the review of records, observation, and interview, Respondent failed to comply with the Resident's Bill of Rights by the failure to ensure a safe and decent living environment, free from abuse and neglect and failing to ensure that residents are treated with consideration and respect and with due recognition of personal dignity for fifty-one (51) of fifty- one (51) residents on the secure unit and all handicap residents residing in the facility, the same being contrary to law. 91. That the Petitioner alleges and incorporates paragraphs six (6) through twelve (12) as if fully set forth herein. 92. That Respondent knew of the continuing violent, assaultive, and intoxicated behaviors of resident number one (1) commencing soon after the resident’s admission. 20 93. That despite this knowledge, Respondent failed to take any action to ensure that its resident’s resided in a safe and decent living environment, free from actual or potential violent behaviors and assault by resident number one (1) as illustrated by the following: a. Respondent took no action to remove resident number one (1) from the secure unit where most residents were elderly vulnerable adults with disease processes which limited cognitive functions; Respondent took no action to provide supervision of resident number one (1) adequate to ensure that the residents of the secure unit would not be subjected to violent or assaultive behaviors of resident number one (1); Respondent took no action to ensure supervision of other unit residents which would be adequate to ensure that the residents of the secure unit would not be subject to the violent or assaultive behaviors of resident number one (1). 94. That the Respondent knew of the threat to physical well-being of others presented by resident number one (1) as evidenced by its knowledge that resident number one (1) had assaulted resident number nine (9), had engaged in numerous violent conflicts with resident number six (6), had returned to the facility in a state of intoxication, had not received required mental health care and services, and had not received prescribed psychotropic medications. 95. That Respondent’s failure to address the behaviors, violent and intoxicated, deprived the residents of the secure unit of a safe and decent living environment as evidenced by: a. Resident number six (6) being engaged in multiple physical altercations with resident number one (1) as a result of the resident’s intervention to the assaultive behavior of resident number one (1); The physical assault of resident number nine(9); 21 c. d. The physical and or verbal assault of resident number ten (10); The sexual assault of resident number five (5). 96. That the Petitioner’s representatives observed the following during its survey of the Respondent facility: a. That residents utilizing wheelchairs had difficulty moving their wheelchair through the front entrance; Such residents would try to hold the door open while pushing their wheelchair in and out the door; On several occasions during the survey, Petitioner’s personnel had to hold the door open for residents with wheelchair; The door had no buttons or other remote device which would enable wheelchair bound persons to enter or exit through the doorway without simultaneously opening and holding the doorway open during passage; That previous mechanical access buttons had been removed, with the area for the exit button having been tiled over and a trace of the device still evident on the outside of the doorway. 97. That the Petitioner’s representative interviewed Respondent’s assistant administrator and several residents during the survey who indicated that the Respondent’s corporate shareholder/owner had removed the wheelchair access buttons to the doorway and that the assistant administrator had entered the access issue on the facility’s maintenance log. 98. That the Petitioner’s representative interviewed Respondent’s shareholder/owner during the survey who indicated that he had in fact removed the handicap access buttons on the facility doorway and alleged that the same had been done for safety reasons as in the past residents with 22 electric wheelchairs would sometimes go in and out of the doors at a very high speed and he wanted to prevent other residents who were walking in and out of the doors from getting hit and injured. 99. That Respondent’s shareholder/owner mentioned no alternative means considered or attempted to address the safety concern he identified. 100. That Respondent’s removal of handicap access buttons deprived residents who utilized wheelchairs of dignity and due recognition of personal dignity by depriving them of a means whereby they may exercise their independence to gain access in and out of the building as conveniently as possible. 101. That the Petitioner’s representative interviewed several residents, who wish to remain anonymous, during the survey who indicated as follows: a. That Respondent’s-shareholder/owner was verbally abusive; b. That he yelled at them; c. That when they complained, he stated that if they did not like living in the facility, they could leave; d. That although they were not afraid of the owner, they did not like they way he spoke to them; e. That due to the owner's verbal abuse, several residents indicated that they were looking to locate a different assisted living facility to which they could relocate. 102. That the Petitioner’s representative interviewed Respondent’s shareholder/owner during the survey who indicated that he had never verbally abusive with residents, that he had a hearing impairment that resulted in him speaking loudly, and that he had sent out a written apology note to the residents and the residents’ family on this issue. 23 103. That Respondent’s shareholder/owner’s verbal abuse of residents deprived residents of dignity and due recognition of personal dignity, the same being contrary to law. 104. That the above reflects Respondent’s failure to ensure that the rights of residents of the facility are protected. 105. 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. 106. That the Agency provided Respondent with a mandatory correction date of December 28, 2007. 107. That pursuant to § 429.19(2)(a), Florida Statutes (2007), 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 $5,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to Section 429.19(2)(a), Florida Statutes (2007). COUNT VII . 108. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 109. That pursuant to Florida law, Resident records for mental health residents in a facility with a limited mental health license must include the following: A Community Living Support Plan - a. Each mental health resident and the resident’s mental health case manager shall, in 24 consultation with the facility administrator, prepare a plan within 30 days of the resident’s admission to the facility or within 30 days after receiving the appropriate placement assessment under paragraph (c), whichever is later, which: (i) Includes the specific needs of the resident which must be met in order to enable the resident to live in the assisted living facility and the community; (ii) Includes the clinical mental health services to be provided by the mental health care provider to help meet the resident’s needs, and the frequency and duration of such services; (iti) Includes any other services and activities to be provided by or arranged for by the mental health care provider or mental health case manager to meet the resident’s needs, and the frequency and duration of such services and activities; (iv) Includes the obligations of the facility to facilitate and assist the resident in attending appointments and arranging transportation to appointments for the services and activities identified in the plan which have been provided or arranged for by the resident’s mental health care provider or case manager; (v) Includes a description of other services to be provided or arranged by the facility; (vi) Includes a list of factors pertinent to the care, safety, and welfare of the mental health resident and a description of the signs and symptoms particular to the resident that indicate the immediate need for professional mental health services; (vii) Is in writing and signed by the mental health resident, the resident’s mental health case manager, and the ALF administrator or manager and a copy placed in the resident’s file. If the resident refuses to sign the plan, the resident’s mental health case manager shall add a statement that the resident was asked but refused to sign the plan; (viii) Is updated at least annually; (ix) May include the Cooperative Agreement described in subparagraph 4. If included, the mental health care provider must also sign the plan; and (x) Must be available for inspection to those who have a lawful basis for reviewing the document. R. 58A-5.029(2)(c)(3)(a), Florida Administrative Code. Further, a facility that has a limited mental 25 health license must: have a copy of each mental health resident's community living support plan and the cooperative agreement with the mental health care services provider. The support plan and the agreement may be combined. §429.075(3)(a), Florida Statutes (2007). A "Cooperative agreement" means a written statement of understanding between a mental health care provider and the administrator of the assisted living facility with a limited mental health license in which a mental health resident is living. The agreement must specify directions for accessing emergency and after-hours care for the mental health resident. A single cooperative agreement may service all mental health residents who are clients of the same mental health care provider. §429.02(8), Florida Statutes (2007). 110. That on December 20, 2007, the Agency completed three Complaint Surveys (CCR #2007013597, #2007013713 and #2007013237) of the Respondent facility. 111. That based upon observation, the review of records, and interview, Respondent failed to ensure that current community living support plans were timely obtained and maintained for three (3) of three (3) sampled limited health residents, the same being contrary to law. 112. That the Petitioner alleges and incorporates paragraphs six (6) through twelve (12) as if fully set forth herein. 113. That the Petitioner’s representative reviewed respondent’s records and noted the following regarding residents numbered one (1), six (6), and nine (9); a. That all were limited mental health residents who had been in residence in excess of thirty (30) days; b. That the resident’s diagnoses were noted as follows: 1. Resident number one (1) — Bipolar disorder; 2. Resident number six (6) — Paranoid schizophrenia; 26 3. Resident number nine (9) — Schizoaffective disorder, multiple sclerosis, seizure disorder, and axillary cyst. c. That none of the residents had community Living Support Plans as required by law. 114. The failure to have completed and maintain Community Living Support Plans place limited mental health residents at risk as; a. Respondent and its staff cannot identify the specific needs of the resident which must be met in order to enable the resident to live in the assisted living facility and the community; b. That clinical mental health services to be provided by the mental health care provider to help meet the resident’s needs, and the frequency and duration of such services have not been identified or met, including any other services and activities to be provided by or arranged for by the mental health care provider or mental health case manager to meet the resident’s needs; c. That the Respondent’s obligations regarding appointments for services are not identified; d. That other ancillary services to be provided are not identified; e. That a list of factors pertinent to the care, safety, and welfare of the mental health resident and a description of the signs and symptoms particular to the resident that indicate the immediate need for professional mental health services are not identified for Respondent’s staff. 115. That the Respondent’s failure to comply with the requirements of law regarding Community Living Support Plans for its residents resulted in the residents not getting care and 27 services necessary for the resident’s well-being, including but not limited to the assignment of case managers and behavioral assessments for the determination of the resident’s continuing appropriateness for residence in an assisted living facility. 116. That the Petitioner’s representative interviewed Respondent’s assistant administrator on December 19, 2007 who confirmed that the Respondent was aware that resident number one (1) required both mental health case management as well as mental health services and could offer no explanation as to why the Respondent had failed to ensure that the same were provided for the resident. 117. That the Respondent’s failure to ensure that Community Living Support Plans results in the minimum services required by law, including but not limited to the assurance that such residents are evaluated for and receive adequate social and psychiatric support services to maintain the health level necessary to remain in an assisted living facility, not being provided. Respondent’s failure to ensure that such plans are obtained, that staff are trained and educated on the contents of the same, result in the neglect, either intentional or negligent, of the resident’s mental health needs, the same being in violation of law and placing the resident at imminent risk of deterioration of mental health status. 118. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 119. That the Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2007). 120. That the Agency provided Respondent with a mandatory correction date of January 20, 2008. 28 WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(b), Florida Statutes (2007). COUNT VII 121. The Agency re-alleges and incorporates Paragraphs one (1) through five (5) and Counts I through VII as if fully set forth herein. 122. That pursuant to Section 429.19(7), Florida Statutes (2007), in addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one half of a facility’s biennial license and bed fee or $500, to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits conducted under Section 429.28(3)(c), Florida Statues (2007), to verify the correction of the violations. 123. That on or about December 20, 2007, the Agency completed a complaint investigation at the Facility that resulted in violations that were the subject of the complaint to the Agency. 124. That pursuant to Section 429.19(7), Florida Statues (2007), such a finding subjects the Respondent to a survey fee equal to the lesser of one half of the Respondent’s biennial license and bed fee or $500.00. 125. That Respondent is therefore subject to a complaint survey fee of five hundred dollars ($500.00), pursuant to Section 429.19(7), Florida Statutes (2007). WHEREFORE, the Agency intends to impose an additional survey fee of five hundred dollars ($500.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 429.19(7), Florida Statutes (2007). 29 COUNT IX 126. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and the remainder of this Complaint as if fully recited herein. 127. That the Agency may revoke any license issued under Part I of Chapter 429 Florida Statutes (2007) for the citation of one (1) or more cited Class I deficiencies, three (3) or more cited Class II deficiencies, or five (5) or more cited Class III deficiencies that have been cited on a single survey and have not been corrected within the specified time period. Section 429.14(1)(e) Florida Statutes (2007). 128. That the Respondent has been cited with three (3) Class I deficiencies and three (3) Class II deficiencies on an Agency complaint survey completed December 20, 2007. 129. | That based thereon, the Agency seeks the revocation of the Respondent’s licensure. 130. That pursuant to Florida law, in addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest: (b) An intentional or negligent act materially affecting the health or safety of a client of the provider; (c) A violation of this part, authorizing statutes, or applicable rules; or (d) A demonstrated pattern of deficient performance. Section 408.815(1), Florida Statutes (2007) 131. That in addition to the deficient practices cited in this complaint, Respondent was cited for twenty-one (21) Class III deficient practices, said deficiencies summarized as follows: a. That Respondent failed to obtain and maintain documentation from the Department of Children and Families that three (3) of three (3), residents numbered one (1), six (6), and nine (9), sampled mental health residents had been assessed and determined as appropriate for placement in an assisted living facility, 30 the same in violation of Sections 429.075(3)(b) and 429.26(6), Florida Statutes (2007); That Respondent failed to obtain and maintain a cooperative agreement for three (3) of three (3), residents numbered one (1), six (6), and nine (9), sampled mental health residents, the same in violation of Section 429.075(3)(a), Florida Statutes (2007), and Rule 58A-5.029(2)94)(c), Florida Administrative Code; That Respondent failed to ensure that one (1) of ten (10) staff members reviewed had timely completed required training related to mental health residents in violation of Section 429.075(1), Florida Statutes (2007), and Rules 58A- 5.029(3)(d) and 58A-5.0191(8), Florida Administrative Code; That Respondent failed to ensure that a satisfactory annual fire inspection was obtained and maintained in violation of Section 429.41(1)(a)(1)(m), Florida Statutes (2007), and Rule 58A-5.015(1)(a)(3), Florida Administrative Code; That Respondent failed to discharge a resident, resident number nine (9), who no longer met criteria for continuing residence in an assisted living facility due to the resident’s inability to assist with transfer, the same in violation of Rule 58A- 5.0181(5), Florida Administrative Code; That Respondent’s administrator failed in the statutory duty to review residents for their continued appropriateness of placement where a resident, resident number nine (9), who no longer met criteria for continuing residence, was not reviewed by the administrator, the same in violation of Section 429.26(1), Florida Statutes (2007) and Rule 58A-5.0181(4)(d), Florida Administrative Code; That Respondent failed to ensure criminal background information was obtained 31 and maintained for staff who perform personal services for residents for two (2) of ten (10) staff members, staff members numbered five (5) and i ght (8), sampled, the same in violation of Section 429.174(2), Florida Statutes and Rule 58A-5.019(3), Florida Administrative Code; That Respondent failed to ensure that required training on incident recognition and reporting and emergency procedures were timely complete and documented for two (2) of ten (10) staff members, staff members numbered five (5) and eight (8), sampled, the same in violation of Rules 58A-5.0191(2)(b) and (11)(a), Florida Administrative Code; That Respondent failed to ensure that required training on resident rights and recognizing abuse were timely complete and documented for two (2) of ten (10) staff members, staff members numbered five (5) and eight (8), sampled, the same in violation of Rules 58A-5.0191(2)(c) and (11)(a), Florida Administrative Code; That Respondent failed to ensure that required training in resident behavior and needs were timely completed and documented for staff who perform direct care for residents for two (2) of ten (10) staff members, staff members numbered five (5) and eight (8), sampled, the same in violation of Rules 58A-5 .0191(2)(d) and (11){a), Florida Administrative Code; That Respondent failed to ensure that required training in elopement procedures were timely completed and documented for staff for two (2) of ten (10) staff members, staff members numbered five (5) and eight (8), sampled, the same in violation of Rules 58A-5.0191(2)(f) and (11)(a), Florida Administrative Code; That Respondent failed to ensure that the individual responsible for food service 32 accomplished the same in a safe and sanitary manner by the presence of expired food products in the facility, the same in violation of Rule 58A-5.020(1)(b), Florida Administrative Code; That administrator or designee failed to ensure that therapeutic meals were provided as prescribed in the failure to serve a diabetic meal to a resident, resident number eight (8), the same in violation of Rule 58A-5.020(1)(c), Florida Administrative Code; That Respondent failed to date and plan meals at least one (1) week in advance, the same in violation of Rule 58A-5.020(2)(d), Florida Administrative Code; That Respondent failed to ensure that therapeutic meals were served as prescribed in the failure to serve a diabetic meal to a resident, resident number eight (8), the same in violation of Rule 58A-5.020(2)(e), Florida Administrative Code That Respondent failed to ensure repair missing shower heads in five (5) rooms, a hole in the wall of another, and mold in a bathroom, the same in violation of Rule 58A-5.023(1)(b), Florida Administrative Code; That Respondent failed to ensure that windows, doors, appliances, and plumbing was functional and in good working order by removing handicap access for the front door, a broken toilet seat in a room, and broken doors or locks in the facility, the same in violation of Rule 58A-5.023(1)(b), Florida Administrative Code; That Respondent failed to ensure that furniture was in good repair in that a broken dresser and armoire were maintained, the same in violation of Rule 58A- 5.023(1)(b), Florida Administrative Code; That Respondent failed to ensure that each bathroom has a functioning door in the 33 absence of a door knob or lock to the bath of a room, the same in violation of Rule 58A-5.023(5)(b), Florida Administrative Code; That Respondent failed to ensure that required training in HIV/AIDS was timely completed and documented for one (10 of ten (10) staff members, staff member numbered ten (10), sampled, the same in violation of section 429.275(2), Florida Statutes (2007) and Rules 58A-5.0191(3) and (11), and 58A-5.024(2)(a)(1), Florida Administrative Code; That Respondent failed to ensure that licenses or certifications for staff were obtained and maintained one (1) of ten (10) staff members, staff member numbered ten (10), sampled, the same in violation of Rules 58A-5.024(2)(a)(2), Florida Administrative Code; That Respondent failed to maintain proof of staff criminal background screening for two (2) of ten (10) staff members, staff members numbered five (5)-and eight (8), sampled, the same in violation of Section 429.275(2), Florida Statutes (2007) and Rules 58A-5.019(3) and 58A-5.024(2)(a)(3), Florida Administrative Code. That Respondent was fined for deficient performance as evidenced by Administrative Complaints filed February 22, 2007, attached hereto and incorporated herein as Exhibit “A,” June 1, 2007, attached hereto and incorporated herein as Exhibit “B,” January 11, 2008, attached hereto and incorporated herein as Exhibit “C,” and January 14, 2008, attached hereto and incorporated herein as Exhibit “D.” That the contents of this complaint and the deficiencies reference above constitute, individually and collectively, a pattern of deficient performance, or intentional or negligent acts materially affecting the health or safety of a client of the provider; or a violation of this Chapter 34 408, Part I, chapter 429, Part I, or applicable rules; all of which constitute grounds for the revocation of Respondent’s license. WHEREFORE, the Agency intends to revoke the license of the Respondent to operate an assisted living facility in the State of Florida, pursuant to §§ 408.815(1) and 429.14(1)(e) , Florida Statutes (2007). Respectfully submitted this Ze day of January, 2008. unsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 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 Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg 4#3,MS #3, Tallahassee, FL 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 been served by US. Certified Mail, Return Receipt No. 7007 0710 0004 0428 8945 on January TZ, 2 2008 to Ysel R. Hernandez, Administrator/Reg. Agent, Munne Center, Inc. 50 S.W. 137" Avenue, Miami, FL 33177. T 1m, J. Walsh II 35 Copies furnished to: Ysel R. Hernandez Administrator/Reg. Agent Munne Center, Inc. 17250 S.W. 137" Avenue Miami, Florida 33177 U.S. Certified Mail) Robert Emling Field Office Manager Agency for Health Care Admin. 8355 NW 53” Street, 15* Floor Miami, Florida 33166 (U.S. Mail) Thomas J. Walsh, II Agency for Health Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, Florida 33701 (nteroffice) 36 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2007000384 Vv. Return Receipt Requested: 7002 2410 0001 4235 5192 MUNNE CENTER, INC., d/b/a MUNNE CENTER, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Munne Center, Inc. d/b/a Munne Center, Inc. (hereinafter “Munne Center, Inc.”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $500:00 pursuant to Section 429.19, Florida Statutes (2006), for the protection of the public health, safety and welfare pursuant to Section 429.28(3) (c), Florida Statutes (2006). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida EXHIBIT A! Administrative Code. 3. Venue lies in Miami-Dade County, pursuant to Section 120.57, Fla. Stat. and Rule 28-106.207, Florida Administrative Code. 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, Florida Statutes (2006), and Chapter 58A-5, Florida Administrative Code. 5. Munne Center, Inc. operates a 160-bed assisted living facility located at 17250 SW 137°" Avenue, Miami, Florida 33177. Munne Center, Inc. is licensed as an assisted living facility license number AL9446, with an expiration date of September 23, 2007. Munne Center, Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I MUNNE CENTER, INC. FAILED TO ENSURE THAT THERE WAS A WRITTEN ORDER FROM A RESIDENT’S PHYSICIAN FOR A FULL BED RAIL Rule 58A-5.0182(6) (h), Florida Administrative Code (RESIDENT CARE STANDARDS) UNCORRECTED CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the Spot Check conducted on 9/07/06 and based on observation, interview, and record review, the facility failed to have a written order from a resident's physician for a full bed rail for Resident #2. 8. A tour of the facility was conducted on 09/07/06 starting at approximately 9:45 a.m. 9. An observation of resident #1's room revealed a bed with full bed rails installed on both sides of the bed. 10. The Resident Care Coordinator stated, during interview on 09/07/06 at approximately 11:00 a.m., that she/he was not aware the full bed rails were on the bed. 11. Resident #1's record was reviewed on 09/07/06. There was no record of a physician's order for the full bed rails. The facility could not provide any other documentation for the resident needing full bed rails. Correction Date: 10/07/06. 12. A follow-up to Spot Check was conducted on 11/16/06 and based on observation, record review, and staff interview the facility still failed to ensure that there was a written order from the residents’ physician for a full bed rail for Resident #2 and #5. 13. At the time of the re-visit on 11/16/06 at approximately 8:00 a.m. the facility tour revealed sampled resident #2 still had a bed with full bed rails installed on both sides of the bed, and sampled resident #5 had half bed rails installed on both sides of the bed. 14. Clinical record review for sampled resident #2 revealed there still was no record of a physician's order for the full bed rails. The facility still could not provide any other documentation for the resident needing full bed rails. Clinical record review for sampled resident #5 revealed there was no physician's order for the 1/2 bed rails. 15. An interview conducted with the Administrator on 11/16/06 at 4:00 p.m. revealed that he/she was under the impression that. an order for a hospital bed also covered the bedrail, and there was still no physician's order for full or half bed rails. This is an uncorrected deficiency from the 9/07/06 survey. 16. Based on the foregoing, Munne Center, Inc. violated Rule 58A-5.0182(6) (h), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: . A. Make factual and legal findings in favor of the Agency on Count I. c. Assess an administrative fine of $500.00 against Munne Center, Inc. on Count I pursuant to Section 429.19, Florida Statutes. D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2006). Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. Nelson E. Rodney Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52™¢ Terrace Suite 103 Miami, Florida 33166 Copies furnished to: Harold Williams Field Office Manager Agency for Health Care Administration 8355 NW 5374 Street, 1°* Floor Miami, Florida 33166 (Inter-office mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Inter-office Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I. HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Ysel R. Hernandez, Administrator/Registered Agent, Munne Center, Inc., 17250 S.W. 137 Avenue, Miami, Florida 33177 on , 2007. Nelson E. Rodney STATE OF FLORIDA a AGENCY FOR HEALTH CARE ADMINISTRATION”; AGENCY FOR HEALTH CARE “AR ip ADMINISTRATION, Petitioner, AHCA No.: 2007004677 Vv. Return Receipt Requested: 7002 2410 0001 4235 6687 MUNNE CENTER, INC, d/b/a MUNNE CENTER, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Munne Center, Inc. d/b/a Munne Center, Inc. (hereinafter “Munne Center”), pursuant to’ Chapter 429, Part I, and Section 120.60, Florida Statutes, (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $9,026.00 pursuant to Section 429.428, Florida Statutes (2006), for the protection of the public health, safety and welfare and a $500.00 survey fee pursuant to Section 429.19(2) (a), and 429.19(10), Florida Statutes (2006). EXHIBIT BB JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies in Miami-Dade County, pursuant to Section 120.57, Florida Statutes and Rule 28-106.207, Florida Administrative Code. 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, Florida Statutes (2006), and Chapter 58A-5, Florida Administrative Code. 5. Munne Center operates a 160-bed assisted living facility located at 17250 SW 137 Avenue, Miami, Florida 33177. Munne Center is licensed as an assisted living facility license number AL9446, with an expiration date of September 23, 2007. Munne Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I MUNNE CENTER FAILED TO ENSURE REFUNDS WERE MADE ACCURATELY AND TIMELY FOR 3 OF 9 DISCHARGED RESIDENT RECORDS REVIEWED FOR REFUNDS Section 429.24(3) (a), Florida Statutes (RESIDENT RECORDS STANDARDS) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the complaint investigation conducted on 02/26/07 and 02/27/07 and based on record review and interview, the facility failed to ensure that refunds were made accurately and timely for 3 of 9 discharged resident records reviewed for refunds (#13, #17, and #21). 8. Resident #13 was admitted to the facility on 5/14/01 and discharged on 12/19/05, The facility determined that a refund was due in the amount of $1,705.08 on 01/02/06. A check was cut on 01/02/06. Review of bank statement from 01/06 to 2/07 failed to show that the check had cleared. (September and December 2006 statements were not available for review) (a) When contacted on 02/27/07 at approximately 5:00 p.m., the responsible party verified that he had never received a check from the facility for the refund, and had given up on receiving the refund. The treble damage for Resident #13 is $1,705.08 x 3 = $5,115.24 pursuant to Section 429.24(3) (a), Florida Statutes (2006). 9. Resident #17 was admitted to the facility on 9/10/04 and discharged on 12/12/06. The facility cut a check on 12/15/06 which was not cashed. The administrator stated the check was "lost in the mail." A second check was cut in 2/07 after the family complained. This was cashed on 2/13/07. The facility made a refund of $1,468.42 instead of the owed amount of $1,553.06 a difference of $64.64. (a) When asked, the Administrator verified she calculates all refunds on a 30 day month not the per day basis required by Florida Statute 429.24. (b) This refund was late and of an-inaccurate amount. The treble damage for Resident #17 is $1,553 x 3 = $4,659.18 minus the credited payment of $1,468.42 = $3,190.76. 10. Resident #21 was admitted to the facility on 10/18/06 and discharged on 12/23/06. The facility determined that a refund was due. A check was cut for $240.00 on 12/26/06. As the facility had no forwarding address the check remains at the facility on 2/27/07. This resident had paid all bills during the admission from a private bank account the information for which the facility has. No attempt was made by the facility to deposit the refund into this former resident’s account. The treble damage is $240.00 x 3 = $720.00. 18. Based on the foregoing, Munne Center violated Section 429.24(3) (a), Florida Statutes, a deficiency, which carries, in this case, a total assessed fine of $9,026.00. SURVEY FEE Pursuant to Section 429.19(10), Florida statutes, AHCA May assess a survey fee of $500.00 to cover the cost of conducting complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count f. B. Assess an administrative fine of $9,026.00 against Munne Center on Count I for the violations cited above. Cc. Assess a survey fee of $500.00 against Munne Center, pursuant to Sections 429.19(10), and 429.19(2) (a), Florida Statutes (2006). D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2006). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST. FOR 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. Nelson E. Rodney Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52°¢ Terrace Suite 103 Miami, Florida 33166 (305) 499-2165 Copies furnished to: Field Office Manager Agency for Health Care Administration 8355 NW 53°¢ Street, First Floor Miami, Florida 33166 (Inter-office mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Inter-office Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Ysel R. Hernandez, Administrator and Registered Agent, 17250 SW 137° Avenue, Miami, Florida 33177 on , 2007. Nelson E. Rodney 2 a" bf STATE OF FLORIDA On, fy fae AGENCY FOR HEALTH CARE ADMINISTRATION “ap /0 os a) AGENCY FOR HEALTH CARE ADMINISTRATION, Ga ey Petitioner, AHCA No.: 2007010852”) © v. Return Receipt Requested: 7004 2890 0000 5526 1320 MUNNE CENTER, INC., d/b/a MUNNE CENTER, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Munne Center, Inc. d/b/a Munne Center, Inc. (hereinafter “Munne Center, Inc.”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $500.00 pursuant to Section 429.19, Florida Statutes (2006), for the protection of the public health, safety and welfare pursuant to Section 429.28(3)(c), Florida Statutes (2006). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. EXHIBIT L 3. Venue lies in Miami-Dade County, pursuant to Section 120.57, Fla. Stat. and Rule 28-106.207, Florida Administrative 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, Florida Statutes (2006), and Chapter 58A-5, Florida Administrative Code. 5. Munne Center, Inc. operates a 160-bed assisted living facility located at 17250 SW 137%" Avenue, Miami, Florida 33177. Munne Center, Inc. is licensed as an assisted living facility license number AL9446, with an expiration date of September 23, 2007. Munne Center, Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I MUNNE CENTER, INC. FAILED TO OBTAIN A SIGNED CONSENT FROM THE RESIDENT OR RESIDENT’S REPRESENTATIVE FOR THE PLACEMENT OF BED RAILS Rule 58A-5.0182(6) (h), Florida Administrative Code (RESIDENT CARE STANDARDS) REPEATED CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the Spot Check conducted on 9/07/06 and based on observation, interview, and record review, the facility failed to have a written order from a resident's physician for a full bed rail for Resident #1. 8. A tour of the facility was conducted on 09/07/06 starting at approximately 9:45 a.m. 9. An observation of resident #1's room revealed a bed with full bed rails installed on both sides of the bed. 10. The Resident Care Coordinator stated, during interview on 09/07/06 at approximately 11:00 a.m., that she/he was not aware the full bed rails were on the bed. 11. Resident #1's record was reviewed on 09/07/06. There was no record of a physician's order for the full bed rails. The facility could not provide any other documentation for the resident needing full bed rails. 12. During a complaint investigation conducted on 8/01/07, and based on observation, record review and interview, the facility failed to obtain a signed consent from the resident or resident's representative for the placement of bed rails, and limit the use of bed rails to half bed rails for 1 out of 4 sampled residents (Resident #2). 13. A tour of the facility conducted on 08/01/07 at approximately 10:20 AM, revealed that resident #2 had an expandable full bed rails in place at the time of the survey. 14. A resident's record review for resident #2 (admitted 05/18/06) revealed that the resident had a prescription by the physician for bed rails dated 03/15/07; however, the resident/resident's representative did not sign a consent for the use of bed rails. 15. An interview conducted on 08/01/2007, at approximately 3:00 PM, with the Administrator confirmed the findings. This is a repeat deficiency from the Spot Check of 9/07/06. 16. Based on the foregoing, Munne Center, Inc. violated Rule 58A-5.0182(6) (h), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I. Cc. Assess an administrative fine of $500.00 against Munne Center, Inc. on Count I pursuant to Section 429.19, Florida Statutes. dD. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2006). Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. Nelson E. Rodney Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52™¢ Terrace Suite 103 Miami, Florida 33166 Copies furnished to: R. Steve Emling Field Office Manager Agency for Health Care Administration 8355 NW 53° Street, 1%* Floor Miami, Florida 33166 (Inter-office mail) Finance and Accounting Revenue and Management Unit Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Inter-office Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Ysel R. Hernandez, Administrator/Registered Agent, Munne Center, Inc., 17250 S.W. 137° Avenue, Miami, Florida 33177 on , 2007. Nelson E. Rodney 2 &g : ff fy Mp =p STATE OF FLORIDA Byy wb? AGENCY FOR HEALTH CARE ADMINISTRATION ; “yy AGENCY FOR HEALTH CARE ay ADMINISTRATION, M4 Petitioner, AHCA No.: 2007013657 v. Return Receipt Requested: 7002 2410 0001 4235 9633 MUNNE CENTER, INC., d/b/a 7002 2410 0001 4235 9640 MUNNE CENTER, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Munne Center, Inc. d/b/a Munne Center, Inc. (hereinafter “Munne Center, Inc.”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $500.00 pursuant to Section 429.19, Florida Statutes (2006), for the protection of the public health, safety and welfare pursuant to Section 429.28(3)(c), Florida Statutes (2006). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections. 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. EXHIBIT DL 3. Venue lies in Miami-Dade County, pursuant to Section 120.57, Fla. Stat. and Rule 28-106.207, Florida Administrative Code. 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, Florida Statutes (2006), and Chapter 58A-5, Florida Administrative Code. 5. Munne Center, Inc. operates a 160-bed assisted living facility located at 17250 sw 137" Avenue, Miami, Florida 33177. Munne Center, Inc. is licensed as an assisted living facility license number AL9446, with an expiration date of September 23, 2007. Munne Center, Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I MUNNE CENTER, INC. FAILED TO ENSURE THAT SCHEDULED ACTIVITIES WOULD BE AVAILABLE AT LEAST SIX (6) DAYS A WEEK FOR A TOTAL OF NOT LESS THAN TWELVE (12) HOURS PER WEEK Rule 58A-5.0182 (2) (c), Florida Administrative Code (RESIDENT CARE STANDARDS) REPEATED CLASS III VIOLATION 6. AHCA re~alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the biennial survey conducted on 02/26-27/07 and based on observation and interview it was determined that the facility ‘failed to ensure scheduled activities would be available at least six (6) days a week for a total of not less than twelve (12) hours per week. 8. An interview on 2/26/07 at 4:30 p.m. with residents in the activity room, found that Bingo had just occurred. Activities did not occur often, mostly you have to, "make your own activities." One resident stated that she/he had not been out of the facility since her admission six months before. A second resident verified that she/he had lived there over a year and had few activities and no outside activities. 9. A review of the activity log showed that activities were documented 5 days a week at 10 or 10:30 on the South wing and at 2:00 p.m. on the West wing from 12/22/06 to 01/30/07. Of the 28 days activities were documented for the West wing only 17 of 28 were noted as "participated." For the South wing, 19 of 27 days noted were "participated." 10. An observation on 02/26/07 found no activities on the South wing around 10-10:30 a.m. or anytime from 10:30 to ~5:30. An observation of the West wing only found bingo, on 2/26/07. Activities are not provided at a minimum of six days a week for 12 hours a week. 11. During a visit conducted on 10/17/07 and based on observation and interview it was determined that the facility failed to ensure scheduled activities would be available at least six (6) days a week for a total of not less than twelve (12) hours per week. 12. During observation of the West wing on 10/17/07 at 10:00 am, it was revealed that the activity scheduled stated that between the hours of 10 am and 11:30 am the scheduled activity was exercising. However there were not any activities being facilitated at that time. All residents were parked in wheelchairs by the nurses station. 13. During a tour of the South wing on 10/17/07 at 11:00 am it was observed that the activity calendar stated that residents would be taking a walk during the hours of 10 am and 11:30 am. However, there was not any evidence of the scheduled activity being facilitated by staff. Resident were in sitting in the hallways in chairs, or sitting by the nurses station. 14. An interview with the Administrator on 10/17/07 confirmed these findings. The Administrator stated that most of the residents refuse to participate in the scheduled activities. However, there was not any documentation regarding the resident's refusal to participate in the planned activities. This is a repeat deficiency from the 02/26/07 survey. 15. Based on the foregoing, Munne Center, Inc. violated Rule 58A-5.0182(2) (c), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and- legal findings in favor of the Agency on Count I. B. Assess ‘an administrative fine of $500.00 against Munne Center, Inc. on Count I pursuant to Section 429.19, Florida Statutes. c. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2006) . Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, ‘telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. Nelson E. Rodney Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52°° Terrace Suite 103 Miami, Florida 33166 Copies furnished to: Field Office Manager Agency for Health Care Administration’ 8355 NW 53°° Street, 1°* Floor Miami, Florida 33166 (Inter-office mail) Finance and Accounting Revenue and Management Unit Agency for Health Care Administration 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (Inter-office Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Ysel_ R. Hernandez, Administrator Registered Agent, Munne Center, Inc., 17250 S.W. 137° Avenue, Miami, Florida 33177 on , 2007. Nelson E. Rodney SENDER: COMPLETE THLS, SECTION COMPLETE THIS SECTION OPLDELIVERY @ Complete items 1,2, an. 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 card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: different from item 1?’ (1 Yes If YES, enter delivery address below: [No Ysel R. Hernandez Administrator/Reg. Agent Munne Center, Inc. 17250 S.W. 137" Avenue Miami, Florida 33177 3. Service Type © Certified Mat © Express Mail C1 Registered 1D Return Receipt for Merchandise O Insured Mail =O1cop..- 4 4. Restricted Delivery? (Extra Fee): * tome, 7007 O720 BOO4 D428 agus PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

Docket for Case No: 08-001206