Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: ENCORE SENIOR VILLAGE III, LLC, D/B/A ENCORE SENIOR VILLAGE AT FORT MYERS
Judges: DANIEL M. KILBRIDE
Agency: Agency for Health Care Administration
Locations: Fort Myers, Florida
Filed: Mar. 26, 2008
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, September 18, 2008.
Latest Update: Dec. 23, 2024
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
a
STATE OF FLORIDA, (KON
AGENCY FOR HEALTH CARE O¥-15
ADMINISTRATION,
Petitioner,
v. Case No. 2007012256
ENCORE SENIOR LIVING III, LLC,
d/b/a ENCORE SENIOR VILLAGE AT FORT MYERS,
Respondent.
/
ADMINISTRATIVE COMPLAINT
COMES NOW the Petitioner, STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION (hereinafter “the Agency”), by and through the undersigned counsel, and
files this administrative complaint against the Respondent, ENCORE SENIOR LIVING IU,
LLC, d/b/a ENCORE SENIOR VILLAGE AT FORT MYERS (hereinafter “the Respondent”),
pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges:
NATURE OF THE ACTION
This is an action against an assisted living facility to impose an administrative fine in the
amount of TWENTY THOUSAND DOLLARS ($20,000.00) based upon four Class I
deficiencies, pursuant to Section 429.19(2)(a) Florida Statutes (2007), and to assess a survey fee
in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to Section 429.19(7), Florida
Statutes (2007), for a total sum of TWENTY THOUSAND FIVE HUNDRED DOLLARS
($20,500.00).
JURISDICTION AND VENUE
1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569
and 120.57, Florida Statutes (2007).
2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42,
120.60 and Chapters 408, Part II, and 429, Part J, Florida Statutes (2007).
3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code.
PARTIES
4. The Agency is the licensing and regulatory authority that oversees assisted living
facilities in Florida and enforces the applicable federal and state regulations, statutes and rules
governing such facilities, Chapters 408, Part II, and 429, Part I, Florida Statutes (2007), Chapter
58A-5, Florida Administrative Code (2007). The Agency may deny, revoke, or suspend any
license issued to an assisted living facility, or impose an administrative fine in the manner
provided in Chapter 120, Florida Statutes (2007), Sections 408.815 and 429.14, Florida Statutes
(2007).
5. The Respondent was issued a license by the Agency (License Number 9346) to
operate a seventy (70) bed assisted living facility located at 9461 Healthpark Circle, Fort Myers,
Florida 33908, and was at all times material required to comply with the applicable federal and
state regulations, statutes and rules governing assisted living facilities.
COUNT I
The Respondent Failed To Discharge Residents Who Did Not Meet The Criteria For
Continued Residency, Or Was Unable To Meet The Resident’s Needs, As Determined By
The Facility Administrator Or Health Care Provider, In Accordance With Section
429.28(1), Florida Statutes In Violation Of Rule 58A-5.0181(5) Florida Administrative
Code
6. The Agency re-alleges and incorporates by reference paragraphs one (1) through
five (5).
7. Pursuant to Florida law, if the resident no longer meets the criteria for continued
residency, or the facility is unable to meet the resident’s needs, as determined by the facility
administrator or health care provider, the resident shall be discharged in accordance with Section
429.28(1), Florida Statutes. Rule 58A-5.0181(5), Florida Administrative Code (2007).
8. On or about October 16, 2007 through October 18, 2007, the Agency conducted a
Complaint Investigation Survey (CCR #2007-011580) of the Respondents facility.
9. Based on observation, record review, and interview, the facility failed to ensure
four (4) of twelve (12) residents sampled continued to maintain residency even though the
residents do not meet the criteria for continued stay as the facility is unable to meet resident
needs. Resident number three (3) had multiple falls. The facility recognized and documented
the residents’ inability to function without one-to-one care, yet failed to provide the care needed,
or discharge the resident resulting in imminent danger and hospitalization of this. resident.
Resident number five (5), Resident number six (6) and Resident number eleven (11) were unable
to assist with transfer, yet were not discharged.
10. Resident number three (3) had ten (10) falls from September 4, 2007 to October
14, 2007 resulting in hospitalization for severe head trauma on October 15, 2007. The facility
recognized the need for one-to-one staffing on October 12, 2007 yet failed to implement the
staffing. Falls on October 13, 2007 and October 14, 2007 caused severe damage to Resident
number three’s (3) head, face and neck.
11. Resident number three (3) was admitted to the facility on January 4, 2007. A
review of the latest 1823 Health Assessment from June 7, 2007 indicated diagnoses of
Alzheimer's, advanced middle dementia phase; multifactorial gait disorder; and depression.
12. A review on October 16, 2007, of the physician assessed level of care on the June
7, 2007 Health Assessment indicated this 83 year old resident "needs assistance with ambulation,
bathing, dressing, grooming, and transfer.” Resident number three (3) is incontinent. The review
of current medications on that same day listed twelve (12) oral medications, and two eye drops,
given through medication assistance mode. Eating required supervision.
13. | Areview of medical records and the 2007 Incident report log on October 16, 2007
revealed Resident number three (3) had multiple falls on September 4, 2007; September 6, 2007;
September 7, 2007; September 12, 2007; September 16, 2007 and September 18, 2007. After
these six (6) falls, the physician's physical therapy request for evaluation and treatment was,
placed on September 19, 2007 and therapy was started. A high back wheelchair with anti-tippers
was delivered to Resident number three (3) on Sept 28, 2007. There was a fall documented on
September 22, 2007, followed by another on October 1, 2007. After the October 1, 2007 fall,
Resident number three (3) complained of "pain all over" and was sent to the Emergency Room
for evaluation. Resident notes for that day reveal Resident number three (3) was sent to a local
Emergency Room for a full body x-ray and retumed to the facility at 11:30 am. Resident
number three (3) was started on medication for a Urinary Tract Infection diagnosed while in the
Emergency Room on October 1, 2007.
14. A review of the resident notes for October 12, 2007 at 12:45 p.m. indicated a
meeting between the Program Director/Director of Nursing, and the spouse, who is Resident
number three’s (3) Power of Attorney. The resident notes document the Program Director/
Director of Nursing explained to the spouse the.resident may need alternate care in a skilled
facility or a private sitter. The meeting notes quote the spouse as saying, "We will discuss this
when I recover from pending surgery.”
15. Resident number three (3) fell again at 4:00 am. the morning of October 13,
2007, followed by another fall on October 14, 2007 at 6:40 am. These falls resulted in severe
head trauma with bleeding and finally hospitalization on October 15, 2007.
16. For each of the falls which occurred between Sept 4, 2007 and October 14, 2007,
the Resident Notes and incident report documentation indicate the physician and Resident
number three’s (3) spouse were contacted.
17. In an interview with the Director of Nursing on October 16, 2007 at 3:30 p.m., the
Director of Nursing stated she had asked to speak to Resident number three’s (3) spouse because,
"T felt that we could not take care of her anymore, with all the falls she was having." When the
Director of Nursing was asked if the Administrator was aware of the content of this conversation
with the spouse on October 16, 2007, she answered "yes." This information was verified again
during an October 17, 2007 interview at 3:00 p.m. When asked why the facility had not either
discharged Resident number three (3) or provided one-on-one care, the Director of Nursing
stated, "It is not a service Encore offers."
18. An interview with the Administrator on October 17, 2007 at 3:45 p.m. verified the
administrator had been told about the discussion between Resident number three’s (3) spouse
and the Director of Nursing, and the administrator had acknowledged the spouse's desire to re-
visit the issue after the spouse's hospitalization. The administrator repeatedly verified that one-
on-one service was not provided by this assisted living facility, only fifteen (15) minute checks
are maximum supervision available. He also verified the fifteen (15) minute checks were not
authorized or provided until after the October 14, 2007 fall.
19. A record review on October 16, 2007, revealed Resident number three (3) was
taken by Emergency Medical Services to a local hospital on October 15, 2007 at 8:35 a.m.
20. On October 16, 2007, a review of the Emergency Encounter Document from the
hospital Emergency Room at 9:18 am. on October 15, 2007, revealed intravenous fluid was
started at 10:10 a.m. and the neurological exam documented, "disorientation, slurred speech and
anxious behavior, as well as indicators of abuse/neglect.” The documentation stated there were
"contusions in various stages of healing, and delay of days before seeking treatment." The
nursing care plan focused on pain; skin integrity; impaired physical mobility, and impaired
mental status. There was a social service and case manager referral documented.
21. The Emergency Room physician's exam on October 15, 2007 documented an
elevated blood pressure (172/55), a pulse of 105, swelling on the right side of the forehead,
extensive bruising involving the face and both eyes, mucous membranes very dry (sign of
dehydration), mild swelling and extensive bruising of the neck, extensive bruising of the upper
chest and numerous skin tears. The Emergency Room physician's report revealed no fractures,
and presence of an elevated white cell count and red cells in the urine, indicating a urinary tract
infection. The resident's Prothrombin time was elevated at 15, with an International
Normalization Ratio of 1.15. There was an elevated Blood Urea Nitrogen of 33 and a creatinine
of 1.6, and a low hemoglobin level of 9.6. No fractures were identified and an x-ray of the head
was “unremarkable.”
22. Resident number three (3) was admitted to the hospital with diagnoses of frequent
falls, dehydration, renal insufficiency, and Alzheimer's. Resident number three’s (3) admission
history and physical notes by the physician on October 15, 2007, reviewed by surveyor on
October 16, 2007, documented a large hematoma on the right forehead, no evidence of any
subdural hematoma, and documentation of metastatic lesions in the area of Resident number
three’s (3) thoracic spine.
23. An observation of Resident number three (3) in the resident's hospital room at
10:00 a.m. on October 16, 2007 found the resident was in bed receiving intravenous fluid. There
was a large hematoma on the right side of his/her forehead. He/She had multiple bruises of
varying dark and light purple, green and yellow colors on his/her face, neck, shoulder, chest, and
back. There was a large bruise and swelling of the left knee area and an abrasion area on his/her
left leg. The bruising across his/her neck was a swatch about 1 and a half to 2 inches wide.
There were several skin tears over the body and a small, open (Stage II) pressure ulcer above the
coccyx area. Resident number three (3) was able to answer "no" (somewhat blurred) that he/she
did not have pain. His/Her eyes were swollen, but he/she could open them slightly and seemed
to be visually aware of the persons in his/her room. He/She appeared to be anxious and resisted
slightly when he/she was moved on his/her side by the hospital staff to allow an inspection of
his/her back.
| 24. On October 17, 2007 at 4:30 p.m., Resident number five (5) was observed lying in
bed. He/She did not respond to questions or commands. The Certified Nursing Assistant stated
Resident number five (5) is not consistent with assisting with his/her activities of daily living for
transfer, dressing or toileting. There are days when the resident even needs to be fed.
25. On October 17, 2007 at 4:40 p.m., Resident number six (6) was observed lying on
the floor in his/her room. His/Her mattress is on the floor. He/She was on the floor with his/her
knees bent, his/her pants were below his/her knees and his/her brief exposed. Staff picked
him/her up and placed him/her on the mattress and stated his/her brief needed to be changed.
Once Resident number six’s (6) brief was changed by the staff and his/her pants pulled up he/she
was assisted to the wheel chair. Resident number six (6) did not follow commends to stand
straight (place his/her feet flat on the floor) to privet into the wheel chair. His/Her knees
remained bent with the staff holding him/her under his/her arms and lifted and placed the
Resident in the wheel chair. Resident number six (6) was observed to be unable to assist with
transfer.
26. On October 18, 2007 at 9:40 a.m., interview with staff revealed Resident number
eleven (11) required total care with his/her activities of daily living for transfer, toileting or
dressing.
27. The Respondent’s deficient practice constituted a Class I violation in that it
related to the operation and maintenance of a facility or to the personal care of residents which
presented an imminent danger to the residents or guests of the facility or a substantial probability —
that death or serious physical or emotional harm would result therefrom.
28. Pursuant to Section 429.19(2)(a), Florida Statutes (2007), the Agency shall
impose an administrative fine for a Class I violation in an amount not less than five thousand
dollars ($5,000.00) and not exceeding ten thousand dollars ($10,000.00) for each violation. An
administrative fine may be levied notwithstanding the correction of the violation.
29. The Agency provided the Respondent with a mandatory correction date of
November 1, 2007.
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
intends to impose an administrative fine against the Respondent in the amount of FIVE
THOUSAND DOLLARS ($5,000.00) pursuant to Section 429.19(2)(a), Florida Statutes (2007).
COUNT II
The Respondent Failed To Provide Enough Qualified Staff To Provide Resident
Supervision And Arrange Services For Resident Scheduled And Unscheduled Needs And
Care In Violation Of Rule 58A-5.019(4)(b), Florida Administrative Code
30. The Agency re-alleges and incorporates by reference paragraphs one (1) through
five (5).
31. Pursuant to Florida law, notwithstanding the minimum staffing requirements
specified in paragraph (a) of Rule 58A-5.019, Florida Administrative Code, all facilities,
including those composed of apartments, shall have enough qualified staff to provide resident
supervision, and to provide or arrange for resident services in accordance with the residents
scheduled and unscheduled service needs, resident contracts, and resident care standards as
described in Rule 58A-5.0182, Florida Administrative Code. Rule 58A~-5.019(4)(b), Florida
Administrative Code.
32. On or about October 16, 2007 through October 18, 2007, the Agency conducted a
Complaint Investigation Survey (CCR #2007-011580) of the Respondent’s facility.
33. Based on record review and interview, the facility failed to provide enough
qualified staff to provide resident supervision and arrange services for resident scheduled and
unscheduled needs and care in one (1) of four (4) residents sampled, Resident number three (3),
placing the resident in imminent danger resulting in multiple falls and severe head trauma with
hospitalization.
34. Resident number three (3) had ten (10) falls from September 4, 2007 to October
14, 2007 resulting in hospitalization for severe head trauma on October 15, 2007. The facility
recognized the need for one-to-one staffing on October 12, 2007, yet failed to implement the
staffing. Falls on October 13, 2007 and October 14, 2007 caused severe damage to Resident
number three’s (3) head, face and neck.
35. All nights 11 p.m.-7 a.m. shift: One (1) Quality of Life Specialist functions as the
night supervisor and circulates throughout five (5) cottages. One (1) Quality of Life Specialist
staff person functions as a caregiver in each cottage.
36. Weekday evening 3 p.m-11 p.m. shift: One (1) Licensed Practical Nurse 3 p.m.-
11 p.m. supervisor circulates throughout five (5) cottages. One (1) Quality of Life Specialist
functions as a caregiver in each cottage. One (1) Quality of Life Leader functions as a caregiver
in each cottage.
37. Weekend evening 3 p.m.-11 p.m. shift: One (1) Quality of Life Leader functions
as the evening supervisor, circulates through five (5) cottages and works 7:00 p.m. to 7:00 a.m.
A Certified Nursing Assistant covers half evenings and half nights. One (1) Medical Technician
also assists as a caregiver in each cottage. One (1) Quality of Life Specialist functions as a
caregiver in each cottage. One (1) Quality of Life Specialist who works from 4:00 p.m. to 8:00
p.m. functions as a caregiver in each cottage.
38. Week days 7 a.m. - 3 p.m. shift: One (1) Licensed Practical Nurse 7 a.m. - 3 p.m.
- supervisor circulates throughout five (5) cottages, works 7:00 a.m. to 7:00 p.m. and covers half
of days and half of evenings. One (1) Quality of Life Specialist functions as a caregiver in each
cottage. One (1) Quality of Life Leader functions as a caregiver in each cottage. One (1)
Licensed Practical Nurse works with physicians and hospice.
39. | Weekend day 7 a.m. —3 p.m. shift: One (1) Licensed Practical Nurse 7 a.m. ~ 3
p.m. supervisor circulates throughout five (5) cottages, works 7:00 a.m. to 7:00 p.m. and covers
half of days and half of evenings. One (1) Quality of Life Leader functions as a caregiver in each
cottage. One (1) Quality of Life Specialist functions as a caregiver in each cottage. One (1)
Quality of Life Specialist who works 12:00 p.m. to 4:00 p.m. functions as a caregiver.
40. Resident number three (3) had a fall at 4:00 a.m. on Saturday October 13, 2007.
Facility notes document the resident was very confused the rest of the day, crying a lot, anxious,
serious bruising throughout the body and a large hematoma on the head. When interviewed on
October 17, 2007 at 2:35 p.m., Staff number fifteen (15) stated Resident number three (3) was so
anxious she could not even give a shower; instead, she gave a bed bath to try to calm Resident
number three (3) down. The spouse visited from 9:00 a.m. to around 5:00 p.m. that day. When
interviewed on October 17, 2007 at 11:30 a.m., Staff number three (3) stated, "The resident kept
trying to get up from the sofa, and staff had to constantly sit with the resident to prevent more
falls." When interviewed on October 17, 2007 Staff number three (3) and Staff number fifteen
(15) both agreed a staff person was required to continuously watch Resident number three (3)
when the spouse was not present to protect him/her from other injury. Further staff took turns
with Resident number three (3), but the unscheduled needs of Resident number three (3) created
a stress on the staff's time in that they had to care for other residents.
41. Nights only had one caregiver in the unit except when the circulating supervisor
10
came to assist. The supervisor on nights is not a licensed nurse.
42. Resident number three (3) fell again at 6:40 a.m. on Sunday, October 14, 2007.
Interviews with staff verified Resident number three (3) was even more confused and agitated on
Sunday than on Saturday, October 13, 2007 and continued to be extremely anxious, was crying a
lot, repeatedly tried to get out of the wheelchair, and required constant monitoring. The bruises
were increasing. One nursing assistant, Staff number thirteen (13), indicated Resident number
three (3) would get even more agitated when the spouse was not there.
43. . When called on October 13, 2007 at 4:30 a.m., the on-call nurse for the weekend
did not pick up the phone and did not come to the facility to assess the need for outside
emergency evaluation. This on-call nurse was re-called at 7:30 a.m. and spoke to the 7:00 a.m.-
7:00 p.m. nurse who was instructed to do neurological checks every two hours and apply ice.
Neurological checks were only documented as being done October 13, 2007 at 7:30 a.m., 9:30
am. and 11:30 am. The 7:00 am. to 7:00 p.m. nurse did not send the resident out for
emergency evaluation, did not continue the neurological checks as instructed and did not make
arrangements to provide an extra staff person to do one-on-one with a physically, cognitively,
and psychologically demanding resident whose unscheduled needs created burdens on the
weekend staffing on the unit.
44. Fifteen minute checks were not started by the facility staff until after the second
fall on October 14, 2007 at 7:00 a.m. Although cottage staff recognized the need for constant
supervision and stayed with Resident number three (3) on and off as much as possible during the
day shift on October 13, 2007, Resident number three (3) was not sent to the hospital for
evaluation until October 15, 2007 at 8:35 a.m. when the Monday nurse called 911.
45. On October 17, 2007 at 3:00 p.m., the Program Director/ Director of Nursing
stated, "It is not Encore's policy to provide one-on-one."
ul
46. Ina meeting at 5:00 p.m. on October 17, 2007 with the facility administrator and
a Regional Corporate Consultant, the Corporate Consultant stated, "One-on-one is a corporate
policy. I guess for every facility in Florida except the Ft. Myers facility."
47. The Respondent’s deficient practice constituted a Class I violation in that it
related to the operation and maintenance of a facility or to the personal care of residents which
presented an imminent danger to the residents or guests of the facility or a substantial probability
that death or serious physical or emotional harm would result therefrom.
48. Pursuant to Section 429.19(2)(a), Florida Statutes (2007), the Agency shall
impose an administrative fine for a Class I violation in an amount not less than five thousand
dollars ($5,000.00) and not exceeding ten thousand dollars ($10,000.00) for each violation. An
administrative fine may be levied notwithstanding the correction of the violation.
49. The Agency provided the Respondent with a mandatory correction date of
November 1, 2007.
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
intends to impose an administrative fine against the Respondent in the amount of FIVE
THOUSAND DOLLARS ($5,000.00) pursuant to Section 429.19(2)(a), Florida Statutes (2007).
COUNT UT
The Respondent Failed To Provide Care And Services Appropriate To The Needs Of
Residents Accepted For Admission To The Facility In Violation Of Rule
58A-5.0182, Florida Administrative Code
50. The Agency re-alleges and incorporates by reference paragraphs one (1) through
five (5).
51. 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. Rule 58A-5.0182
Florida Administrative Code.
12
52. Onor about October 16, 2007 through October 18, 2007, the Agency conducted a
Complaint Investigation Survey (CCR #2007-011580) of the Respondent’s facility.
53. Based on observations, record review, and interviews, the facility failed to
provide care and services appropriate to meet the needs of one (1) out of twelve (12) residents
sampled, Resident number three (3). Lack of one-to-one care identified on October 12, 2007
resulted in imminent danger, severe head trauma and hospitalization to Resident number three
(3).
54. During the weekend of October 12, 2007 through October 15, 2007, Resident
number three (3), who was located in Cottage number one (1) had two serious falls. The first fall
occurred on October 13, 2007 at 4:00 a.m., and the second on October 13, 2007 at 6:45 a.m.
These two falls followed a series of eight other falls since September 4, 2007 and resulted in
severe head trauma and hospitalization.
55. The last 1823 assessment was completed on June 7, 2007 prior to the start of the
resident’s declining status based on falls. Interviews with thirteen (13) staff members who
worked in Cottage number one (1) during the weekend of October 13, 2007 through October 15,
2007 indicate Resident number three (3) is very unsteady on his/her feet and has a difficult time
even staying in the wheelchair without someone to be in constant observation. Resident number
three’s (3) Alzheimer's is classified as in the middle stage. Resident number three (3) has a gait
disturbance which is interfering with the ability to safely walk around the unit and falls are also
now occurring when getting out of bed. The records indicate a new, high back wheelchair was
obtained on September 28, 2007.
56. A review of the resident notes for October 12, 2007 at 12:45 p.m. indicates a
meeting between the Program Director/ Director of Nursing, and the spouse who is Resident
number three’s (3) Power of Attorney. The resident notes document the Program Director/
Director of Nursing explained to the spouse that Resident number three (3) may need alternate
care in a skilled facility or a private sitter. The meeting notes quote the spouse as saying, "We
will discuss this when I recover from pending surgery."
57. In an interview with the Director of Nursing on October 16, 2007 at 3:30 p.m., the
Director of Nursing stated she had asked to speak to Resident number three’s (3) spouse because,
"T felt that we could not take care of him/her anymore, with all the falls he/she was having."
When the Director of Nursing was asked if the Administrator was aware of the content of this
conversation with the spouse on October 16, 2007, she answered "yes." This information was
verified again during an October 17, 2007 interview at 3:00 p.m. When asked why the facility
had not either discharged Resident number three (3) or provided one-on-one care, the Director of
Nursing stated, "It is not a service Encore offers."
58. An interview with the Administrator on October 17, 2007 at 3:45 p.m. verified the
Administrator had been told about the discussion between Resident number three’s (3) spouse
and the Director of Nursing, and the Administrator had acknowledged the spouse's desire to re-
visit the issue after the spouse's hospitalization. The Administrator repeatedly verified that one-
on-one service was not provided by this assisted living facility and that only fifteen (15) minute
checks are the maximum supervision available. He also verified the fifteen (15) minute checks
were not authorized or provided until after the October 14, 2007 fall.
59. A record review indicates Resident number three (3) started Physical Therapy on
September 19, 2007, but no records are available in Resident number three’s (3) record to review
the evaluation of the therapy services in terms of meeting goal.
60. A review of Resident number three’s (3) records on October 16, 2007 reveal the
resident has had a urinary tract infection since September 4, 2007. The Medication Observation
Record reveals Resident number three (3) was placed on Bactrim starting October 10, 2007 after
a diagnosis was made during an Emergency Room visit on October 1, 2007. Resident number
three (3) is incontinent, but the incontinence is not new.
61. | When Resident number three’s (3) back was observed in the hospital room, there
was a Stage 2 Pressure ulcer noted on the area above the coccyx. When the nurses and
caregivers from Cottage number one (1) were asked about the presence of an open area during
the interviews, no one was aware of one. They did say they were using barrier creme because
they had seen a reddened area in that spot.
62. During an interview with Resident number three’s (3) physician on October 17,
2007, the physician stated she was "not even sure that the facility is prepared to care for the
resident as the resident continues with all these falls.”
63. The Respondent’s deficient practice constituted a Class I violation in that it
related to the operation and maintenance of a facility or to the personal care of residents which
presented an imminent danger to the residents or guests of the facility or a substantial probability
that death or serious physical or emotional harm would result therefrom.
64. Pursuant to Section 429.19(2)(a), Florida Statutes (2007), the Agency shall
impose an administrative fine for a Class I violation in an amount not less than five thousand
dollars ($5,000.00) and not exceeding ten thousand dollars ($10,000.00) for each violation. An
administrative fine may be levied notwithstanding the correction of the violation.
65. The Agency provided the Respondent with a mandatory correction date of
November 1, 2007.
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
intends to impose an administrative fine against the Respondent in the amount of FIVE
THOUSAND DOLLARS ($5,000.00) pursuant to Section 429.19(2)(a), Florida Statutes (2007).
COUNT IV
The Respondent Failed To Comply With The Resident’s Bill Of Rights
In Violation Of Section 429.28(1), Florida Statutes (2007)
66. The Agency re-alleges and incorporates by reference paragraphs one (1) through
five (5).
67. Pursuant to Florida law, no resident of a facility shall be deprived of any civil or
legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or
the Constitution of the United States as a resident of a facility. Section 429.28(1), Florida
Statutes (2007).
68. Onor about October 16, 2007 through October 18, 2007, the Agency conducted a
Complaint Investigation Survey (CCR#2007-011580) of the Respondent’s facility.
69. Based on observation, record review, and interviews, the facility failed to comply
with the Resident Bill of Rights as related to the right to have a safe and decent living
environment free from neglect and access to adequate and appropriate health care consistent with
established and recognized community standards for one (1) out of twelve (12) residents
sampled, Resident number three (3), which resulted in imminent danger, severe head trauma, and
hospitalization.
70. Resident number three (3) had ten (10) falls from September 4, 2007 to October
14, 2007 resulting in hospitalization for severe head trauma on October 15, 2007. The facility
recognized the need for one-to-one staffing on October 12, 2007, yet failed to implement the
staffing. Falls on October 13, 2007 and October 14, 2007 caused severe damage to Resident
number three’s (3) head, face and neck.
71. Resident number three (3) was admitted to the facility on January 4, 2007. The
resident resided in Cottage number one (1), a cottage designated to house those residents the
facility considers to be least independent in terms of functional mobility, most advanced in terms
16
of cognitive decline, and most dependent on caregivers for safety and daily oversight needs. A
review of the census in Cottage number one (1) was twelve (12) from 7:00 a.m. on October 12,
2007 through 8:35 a.m. on October 15, 2007. Supervisor staffing for the nights of the falls did
not indicate the supervisors were nurses who were licensed to assess residents for care and
service needs and on October 13, 2007 the supervisor was a Certified Nursing Assistant unable
to reach a nurse on call.
72. A teview of the resident's notes from September 4, 2007 through October 16,
2007, reveals a pattern of falls, ten (10) since September 4, 2007.
73. In Resident notes examined on October 16, 2007, the 4:00 a.m. resident notes
from October 13, 2007, indicate Resident number three (3) was "found on the floor in bedroom
beside bed during 4:00 a.m. rounds." The notes reveal a "reopened" skin tear on the left arm,
bruising on multiple areas of the body, bruising in right upper forehead with redness on right side
of face, and a skin tear on the right side of forehead. The note also documents Resident number
three’s (3) spouse, when called about the fall, told Employee number two (2) that "(spouse) did
not think that it was necessary to send the resident out."
74. On October 17, 2007 at 12:10 p.m., an interview was held with Employee number
two (2), a Certified Nursing Assistant night supervisor. Employee number two (2) worked 11:00
p.m. through 7:00 a.m. on Friday night and 7:00 p.m. to 7:00 a.m. on Saturday night. The staff,
an on-site supervisor in charge of five cottages at the time of the October 13, 2007 fall, indicated
the nursing assistant called her at 4:00 a.m. on October 13, 2007 to request the supervisor come
to Cottage number one (1) to help get Resident number three (3) back to bed after a fall. The
supervisor stated when she arrived she discovered the upper part of Resident number three’s (3)
head was under the bed and "the resident was scootching to try to get out from under the bed."
The supervisor stated she helped the nursing assistant rotate Resident number three’s (3) head
and body to maneuver the resident under the bedframe, to free Resident number three (3) from
under the bed. The supervisor stated after Resident number three (3) was off the floor, Resident
number three (3) would not stay in bed and was upset, so the decision was made to put Resident
number three (3) in the wheelchair, saying, "we tried repeatedly to help keep the resident in her
chair so the resident would not fall again." The incident report documentation reviewed on
October 16, 2007, indicates the on-call licensed nurse, physician and resident's spouse were
called. When asked if she or the nursing assistant put any ice on the area, she said "no."
75. During an interview with Employee number six (6) at 2:00 p.m. on October 17,
2007, she stated she worked Friday night 11:00 p.m. to 7:00 am. She stated, "they sent the
resident out before when the resident fell the beginning of October, but they did not do that this
time."
76. During an interview at 12:00 p.m. on October 17, 2007, Employee number ten
(10), a Licensed Practical Nurse, identified herself as the administrative on-call nurse for the
entire weekend from Friday evening, October 12, 2007 to Monday morning, October 15, 2007.
Employee number ten (10) stated, "I did not hear my cell phone ring when they called at 4:30
am., but I did answer when they recalled at 7:15 am.” Employee number ten (10) stated she
instructed the licensed nurse, Employee number one (1), on at that time to, "do neuro checks
every two (2) hours and apply ice to what they described as a bump on the head." Employee
number ten (10) stated they had recently started to put Resident number three (3) to bed later, so
Resident number three (3) would not try to get up as much during the night. When asked if she
came in to check on Resident number three (3) at any time on October 13, 2007, she answered
"no, but I did call in three times and they told me the resident kept trying to get up out of the
chair."
77. During an interview on October 17, 2007, Employee number one (1), a Licensed
Practical Nurse, identified herself as the nurse working from 7:00 a.m. to 7:00 p.m. on October
13, 2007. The nurse stated she completed and documented an assessment on Resident number
three (3), who was in a wheelchair, at 7:20 am. This assessment was three (3) hours and twenty
(20) minutes after the night shift fall and the first completed by a licensed nurse since Resident
number three (3) was found with his/her head under the bed. Employee number one (1) stated
she, "started an observation sheet and put it in the chart.". Employee number one (1) reported
that because Resident number three (3) was trying to get out of the chair all morning, she put
Resident number three (3) on the sofa, with legs up for most of the day. She stated, "The
resident's husband came in around 11:00 a.m., and the resident still kept trying to get up from the
sofa" and "before the husband came and after he left at 5:00 p.m., we all had to take turns sitting
with her from time to time." Employee number one (1) stated, "The resident's pulse went down
throughout the day", "she was fussing at her husband all day","she didn't eat that well" and "she
went to bed around 7:00 p.m."
78. The Neurological Observation Record is facility form #NUR00013 (dated April
19, 2004) which is by facility policy to be completed for three (3) days following a fall. A
review of the Neurological Observation Record for Resident number three (3) at 12:45 p.m. on
October 17, 2007, confirmed the resident's Neurological checks were completed on October 13,
2007 at 7:30 am., 9:30 am., and 11:30 a.m. Resident number three’s (3) blood pressure was
183/86 and pulse 98 at 7:30 am.; blood pressure was 147/74 and pulse 87 at 9:30 am., and
blood pressure was 151/68 and pulse 81 at 11:30 a.m. Resident number three (3) was listed on
each of the three checks as having pupils that were equal and reacting to light; speech clear;
following commands and responding to voice and light touch. There were no other entries for
Neurological Observation recording on Resident number three’s (3) record. There are no
initials/signatures on the entries to identify the name and credentials of the staff person(s)
entering information on the form for the three times the checks were completed on October 13,
2007. Each form has room for only three entries.
79, After review on October 17, 2007 at 12:45 p.m., of Resident number three’s (3)
Neurological Observation Records for the remainder of the weekend, the Director of Nursing
confirmed she was, "unable to locate any other of the sheets.”
80. | Employee number thirteen (13), a Nursing Assistant working from 12:00 p.m. to
8:00 p.m. on October 13, 2007, stated on October 18, 2007 "the resident was acting fine on
Saturday." She related that she saw "bruising" on Resident number three’s (3) face and Resident
number three’s (3) right eye was closed.
81. Employee number eight (8) stated on October 17, 2007, she worked from 7:00
a.m. on Saturday and 7:00 p.m. to 11:00 p.m. on Sunday. She stated on Saturday October 13,
2007, "I saw the bruising on the right side of her face on Saturday evening and there was blood
on her face, like the face had been scraped." She stated "she was so confused I couldn't even
give her a shower; I had to give her a bed bath."
82. Employee number seven (7), a caregiver on Saturday October 13, 2007, stated on
October 17, 2007, "I just saw the bruising on her face and neck on Saturday evening, but it
looked to me like the resident was having a problem with vision. The resident was reaching at
things, like she couldn't see things." Employee number seven (7) also commented "the husband
uses a gate belt when he gets her up."
83. There were no resident notes documented after the 7:00 a.m. entry on October 13,
2007, until a second fall is recorded on October 14, 2007 at 6:40 a.m.
84. Employee number two (2) was again on night duty on October 13, 2007. The
Resident notes stated some of the previous skin tears had reopened, and Resident number three
(3) complained of "minor discomfort in the right shoulder." The Notes continued to say the
20
nurse on-call, the physician and Resident number three’s (3) spouse were notified and the
resident was "monitored" the rest of the shift.
85. During an interview on October 17, 2007 with Employee number two (2), the
unlicensed night supervisor, she stated Resident number three (3) was again caught under the
bed, and she and the nursing assistant had to get Resident number three (3) out and help Resident
number three (3) to the wheelchair. She stated "the resident's bottom lip was bleeding, skin tears
were opened, there was more redness to the face, and I saw a bruise on the right shoulder."
"When I left the resident was at the table eating.”
86. A resident notes written documentation, entered at 7:00 a.m. on October 14, 2007,
by the on-coming shift Licensed Practical Nurse, Employee number one (1), identified Resident
number three (3) as “agitated, kept trying to get out of the wheelchair.” She wrote the "staff
instructed to start 15 minute checks.”
87. In an interview with Employee number one (1) on October 17, 2007, the nurse
stated "The resident was very agitated all day. She was trying to get up more. { even brought
her into the nurse’s station with me. Her agitation started to get real bad at lunch.”
88. An interview with Employee number thirteen (13), a nursing assistant working
12:00 p.m. to 8:00 p.m. on October 14, 2007, stated during an interview on October 18, 2007 at
3:00 p.m., that "right after lunch on Sunday she was not ok. She was agitated and there is no
way anyone could say she was not in pain with the bruising she had.” "I asked the nurse to give
her something for the pain and was told there was nothing ordered." "I never saw bruising
wrapped around the neck. I saw bruising on the neck, but it was on the right side." She went on
to say "I have been working here 6 weeks and I never saw her act like the way she did on
Sunday." She stated "myself and another aide put ice on her bruises on her face."
89. | Employee number eight (8), a Certified Nursing Assistant working from 7:00 p.m.
21
to 11:00 p.m. on October 14, 2007, stated during an interview on October 17, 2007 that "the
resident was more confused. She had bruises on the neck, shoulder, ankle, and upper chest on
October 14, 2007 “and "both eyes were swollen. The resident's bruise on her neck extended
down to her chest." She stated she told the nurse she thought Resident number three (3) was in
pain, and said she sat with Resident number three (3) from 7:00 p.m. to 11:00 p.m., doing one-
on-one with the resident.
90. | Employee number five (5) stated during an interview on October 17, 2007, that
"The resident looked like she was in pain on Sunday.”
91. . In-an interview with Employee number three (3) on October 17, 2007 at 12:45
p.m., the resident's physician, she stated, "I got called about both falls over the weekend, but they
did not tell me the extent of the bruising. I was not aware of the severity of the bruising until I
saw her in the Emergency Room on October 15, 2007." She stated she "was surprised when
(she) saw the resident in the hospital ER, because the bruising was a lot worse than they told me
over the telephone.” Resident number three’s (3) physician stated she "was never told about the
hematoma during the calls I received."
92. | When interviewed on October 17, 2007 at 12:40 p.m., related to what constituted
a"15 minute check", the Program Director stated "it means the staff looks at the resident every
15 minutes just to make sure they are safe and where they are supposed to be." When shown the
check sheet which had been used for Resident number three (3) from 7:00 a.m. on October 14,
2007 through to 8:30 a.m. on October 15, 2007 when Resident number three (3) was taken to the
hospital, the Program Director stated, "This is an elopement sheet. They did the wrong form.
They should have done the Neuro Check Sheet.”
93. A Behavior Monitor sheet (NURO0018 date April 29, 2004) was started. Two
documentations were entered for October 14, 2007: Crying/weeping and uncooperative was
22
documented for the 7 a.m. -3 p.m. shift on that day. Uncooperative, crying/weeping, scratching,
unsteady gait, and tremors were documented for the 3 p.m. -11 p.m. shift. There were no entries
after that date and time. At the top of the form, directions state: "When an atypical behavior
occurs, initiate use of this form using the Red Flag System. Use this form for one week. Fill in
each section each shift. Nurse to review this form regularly and provide appropriate resident care
interventions.”
94. The Licensed Practical Nurse who worked 7:00 a.m. to 7:00 p.m. on October 14,
2007, noted she called Resident number three’s (3) physician and got an order to put Resident
number three’s (3) bed on the floor.
95. An interview on October 17, 2007 with Employee number eleven (11), a nursing
assistant, stated "I worked last on Wednesday, October 10, 2007 and when I left Resident
number three (3) was in perfect condition. When I came on to work at 7:00 p.m. on October 14,
2007, I did not even recognize her. Her face was swollen and I questioned the nurse about pain.
Both her eyes were swollen and there was a bruise on her neck and her knee cap was swollen.
She slept all of Sunday night." "When the day nurse came on Monday we conferred and decided
to just call the Emergency Medical Services to get her checked." Employee number eleven’s
(11) notes from Sunday evening described Resident number three (3) as “very badly bruised."
"The resident had a huge bump on her forehead, both eyes were swollen shut, there was a bruise
around the resident's neck, and both knees were swollen" and also "the resident was not sent out
to the hospital for further observation because her husband refused to let the resident go out.”
Employee number eleven’s (11) notes for the rest of the night state "resident appeared to be
sleeping throughout the night, and caregiver and night supervisor kept'a close watch on the
resident." “Resident stayed in bed the entire night and appeared to be peacefully sleeping."
96. During an interview on October 17, 2007 with the weekend on-call nurse,
23
Employee number ten (10), she stated when the staff called her on Sunday morning after the
second fall, "they told me she had a split lip and a little bit of swelling.” "I told them to get an
order for the bed and mattress on the floor, do behavior monitoring, and do 15 minute checks."
Employee number ten (10) stated "Our policy here is they have a right to fall and we just have to
redirect." She indicated she did not go in to check Resident number three (3) "at any time over
the weekend."
97. On October 15, 2007, the resident notes documentation indicates an entry by the
nurse, Employee number nine (9), who had not seen Resident number three (3) since her last
shift ended at 3:30 p.m. on October 12, 2007. In an interview on October 17, 2007 at 2:50 p.m.,
on Friday when she left, "the resident was her normal, confused self." The Monday morning
9:00 a.m. entry indicates "assessment of the resident noted a large swelling to right side of head
with purplish discoloration noted." "The resident's left side looks almost flattened while right
side has large purple swelling area with small serosanguinous drainage.” The entry noted both
eyes shut with purple discoloration to both eyes. Both eyes were checked with a penlight and
blood was noted in both eyes. Purple color bruising was noted to the face, neck, and chest.
Further assessment revealed swelling to the left knee cap and a small scrape to the left leg. The
Administrator was notified at 8:15 a.m., who came and looked at Resident number three (3) and
agreed that the resident should be sent to the Emergency Room for further evaluation.
Emergency Medical Services was called at 8:30 a.m. and arrived at 8:35 a.m. and took Resident
number three (3) to the Emergency Room.
. 98. During an interview on October 16, 2007 at 5:00 p.m., the Administrator stated
“that October 15, 2007 was the first that I saw her." "I was in the facility on Saturday morning,
October 13, 2007 but I was told she would be ok."
99. Acopy of a written attestation from Employee number three (3), dated on October
24
16, 2007, was reviewed at 8:45 a.m. on October 18, 2007 by the Program Director/Director of
Nursing. Employee number three (3) in the written attestation indicated on October 13, 2007
after the first of two weekend falls, "in my professional opinion the resident didn't need to go to
the hospital." "Later I went to the office of the Administrator and advised him of the situation."
"T assured him if anything changed with the resident (like vitals or behavior), I would send her
out.”
100. The Respondent’s deficient practice constituted a Class I violation in that it
related to the operation and maintenance of a facility or to the personal care of residents which
presented an imminent danger to the residents or guests of the facility or a substantial probability
that death or serious physical or emotional harm would result therefrom.
101. Pursuant to Section 429.19(2)(a), Florida Statutes (2007), the Agency shall
impose an administrative fine for a Class 1 violation in an amount not less than five thousand
dollars ($5,000.00) and not exceeding ten thousand dollars ($10,000.00) for each violation. An
administrative fine may be levied notwithstanding the correction of the violation.
102. The Agency provided the Respondent with a mandatory correction date of
November 1, 2007.
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
intends to impose an administrative fine against the Respondent in the amount of FIVE
THOUSAND DOLLARS ($5,000.00) pursuant to Section 429.19(2)(a), Florida Statutes (2007).
COUNT V
Assessment of Survey Fee
103. The Agency re-alleges and incorporates paragraphs one (1) through one hundred
three (103) as if fully set forth herein.
104. The Agency conducted a Complaint Investigation Survey (CCR #2007-011580)
25
on October 16, 2007 through October 18, 2007.
105. As a result of the Agency’s Complaint Investigation Survey (CCR #2007-
011580), the Respondent was cited for four (4) Class I deficiencies.
106. Pursuant to Section 429.19(7), Florida Statutes (2007), the Agency is authorized
to, in addition to any administrative fines, assess a survey fee equal to the lesser of one-half of
the facility’s biennial license and bed fee, or five hundred dollars ($500.00), 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 for monitoring visits conducted under 429.28(3)(c), Florida Statutes
(2007), to verify the correction of the violations.
107. In this case, the Agency is authorized to seek a survey fee in the amount of FIVE
HUNDRED DOLLARS ($500.00).
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration
intends to assess a survey fee against the Respondent in the amount of FIVE HUNDRED
DOLLARS ($500.00), pursuant to Section 429.19(7), Florida Statutes (2007).
_ CLAIM FOR RELIEF
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
respectfully requests the Court to grant the following relief:
1. Enter findings of fact and conclusions of law in favor of the Agency.
2. Impose an administrative fine against the Respondent in the amount of TWENTY
THOUSAND DOLLARS ($20,000.00).
3. Assess a survey fee against the Respondent in the amount of FIVE HUNDRED
DOLLARS ($500.00).
26
4. Order any other relief that this Court deems just and appropriate.
Respectfully submitted this g@Ad, day of FaLeLiailfe , 2008.
Yonorley J aie Senior Attorney
Florida Bar No. 0355712
Agency for Health Care Administration
Office of the General Counsel
2295 Victoria Avenue, Room 346C
Fort Myers, Florida 33901
Telephone: (239) 338-3203
NOTICE
RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN
ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57,
FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT
IT/HE/SHE 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 AND DELIVERED TO THE
ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE
ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA
32308; TELEPHONE (850) 922-5873.
THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING
IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION
WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE
COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY.
27
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election
of Rights form has been served to: Randy Reben, Administrator, Encore Senior Living III, LLC
d/b/a Encore Senior Village at Fort Myers, 9461 HealthPark Circle, Fort Myers, Florida 33908,
by U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1536 6558, and Corporation Service
Company, Registered Agent for Encore Senior Living III, LLC d/b/a Encore Senior Village at
Fort Myers, 1201 Hays Street, Tallahassee, Florida 32301, by U.S. Certified Mail, Return
Receipt No. 7006 2760 0003 1536 6565, on this ash of FebAtLlaty. : , 2008.
Lard Baley ton Senior Attorney
Florida Bar No. 0355712
Agency for Health Care Administration
Office of the General Counsel
2295 Victoria Avenue, Room 346C
Fort Myers, Florida 33901
Telephone: (239) 338-3203
28
Copies furnished to:
Randy Reben, Administrator
Encore Senior Living HI, LLC
d/b/a Encore Senior Village at Fort Myers
9461 HealthPark Circle
Fort Myers, Florida 33908
(US. Certified Mail)
Mary Daley Jacobs, Senior Attorney
Agency for Health Care Administration
Office of the General Counsel
2295 Victoria Avenue, Room 346C
Fort Myers, Florida 33901
(Interoffice Mail)
Corporation Service Company, Registered Agent
for Encore Senior Living II], LLC
d/b/a/ Encore Senior Village at Fort Myers
1201 Hays Street
Tallahassee, Florida 32301
(U.S. Certified Mail)
Kriste Mennella
Field Office Manager
Agency for Health Care Administration
2295 Victoria Avenue, Room 340A
Fort Myers, Florida 33901
(Interoffice Mail)
29
eo ° ~ - a . ° 3
SENDER: COMPLETE THIS SECTION } COMPLETE THIS SECTION ON DELIVERY
. ®@ Complete items 1, 2, and 3. Also complete —
"item 4 if Restricted Delivery is desired. =
1 ll Print your name and address on the reverse
i 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 il Aateeed a: 20077772 78 ©
: Kandy Reben, Ad wna strater
Encore Senior Village
T4460 flea (4h Park Circle
[Fort Myses, Flevids«
B. Received by { Printed Name) . Dg n
CH A A]
D. Is delivery address different from item 1? 0 Yes
if YES, enter delivery address below: ONo
3. Service Type
CO Certified Mall ©) Express Mail
C Registered 1 Return Receipt for Merchandise
Ci insured Mail . (1.0.0.
4. Restricted Delivery? (Extra Fee)
_ 2 Article Number 700b 2?b0 0003 153b 6558
: (Transfer from service label) F
S060 9000 89082) :—: ee_——
: PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Docket for Case No: 08-001505
Issue Date |
Proceedings |
Oct. 08, 2008 |
Final Order filed.
|
Sep. 18, 2008 |
Order Closing File. CASE CLOSED.
|
Sep. 17, 2008 |
Joint Motion to Relinquish Jurisdiction filed.
|
Sep. 02, 2008 |
Notice of Taking Depositions filed.
|
Sep. 02, 2008 |
Notice of Service of Agency`s Answers to Respondent`s Second Interrogatories filed.
|
Aug. 27, 2008 |
Amended Notice of Taking Deposition filed.
|
Aug. 21, 2008 |
Notice of Taking Deposition filed.
|
Aug. 06, 2008 |
Amended Notice of Hearing (hearing set for September 23 through 25, 2008; 9:00 a.m.; Fort Myers, FL; amended as to Room).
|
Aug. 04, 2008 |
Notice of Withdrawal of Agency`s Motion to Compel Discovery filed.
|
Aug. 01, 2008 |
Notice of Service of Encore Senior Village III, LLC d/b/a Encore Senior Village at Fort Myers` Second Interrogatories to Agency for Health Care Administration filed.
|
Jul. 31, 2008 |
Agency`s Motion to Compel Discovery filed.
|
Jul. 31, 2008 |
Respondent Encore`s Amended Answers to AHCA`s First Set of Interrogatories filed.
|
Jul. 31, 2008 |
Notice of Filing filed.
|
Jul. 31, 2008 |
Petitioner`s First Set of Request for Admissions, First Set of Interrogatories, and Request to Produce filed.
|
Jul. 31, 2008 |
Notice of Filing filed.
|
Jul. 25, 2008 |
Notice of Service of Agency`s Answers to Respondent`s First Interrogatories filed.
|
Jul. 24, 2008 |
Notice of Service of Agency`s Response to Respondent`s First Request for Production of Documents filed.
|
Jul. 01, 2008 |
Notice of Serving Respondent Encore`s Amended Answers to AHCA`s First Set of Interrogatories filed.
|
Jun. 30, 2008 |
Encore Senior Village III, LLC d/b/a Encore Senior Village at Fort Myers First Interrogatories to Agency for Health Care Administration filed.
|
Jun. 30, 2008 |
Encore Senior Village III, LLC d/b/a Encore Senior Village at Fort Myers First Request for Production of Documents to the Agency for Health Care Administration filed.
|
Jun. 26, 2008 |
Respondent, Encore`s Responses to AHCA`s First Request for Admissions filed.
|
Jun. 26, 2008 |
Respondent, Encore`s Response to AHCA`s First Request for Production of Documents filed.
|
Jun. 26, 2008 |
Notice of Serving Respondent Encore`s Answers to AHCA`s First Set of Interrogatories filed.
|
May 15, 2008 |
Notice of Service of Agency`s First Set of Interrogatories, Request for Admissions and Request for Production of Documents to Respondent filed.
|
May 08, 2008 |
Order of Pre-hearing Instructions.
|
May 08, 2008 |
Notice of Hearing (hearing set for September 23 through 25, 2008; 9:00 a.m.; Fort Myers, FL).
|
May 02, 2008 |
Agreed Status Report and Request for Hearing filed.
|
Apr. 04, 2008 |
Order Placing Case in Abeyance (parties to advise status by May 3, 2008).
|
Apr. 03, 2008 |
Joint Motion for Extension of Time to Respond to Initial Order filed.
|
Mar. 27, 2008 |
Initial Order.
|
Mar. 26, 2008 |
Administrative Complaint filed.
|
Mar. 26, 2008 |
Petition for Formal Administrative Proceeding filed.
|
Mar. 26, 2008 |
Notice (of Agency referral) filed.
|