STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, ‘- DI U AGENCY FOR HEALTH CARE a ADMINISTRATION, Petitioner, vs. Case No. 2008002841 BROOKDALE MANAGEMENT OF FLORIDA-PO, LLC, d/b/a ORLANDO MADISON HOUSE, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Brookdale Management of Florida-PO, LLC, d/b/a Orlando Madison House (hereinafter “the Respondent”), pursuant to sections 120.569 and 120.57, Florida Statutes (2007), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine against an assisted living facility in the amount of one thousand dollars ($1,000.00) and asses a survey fee in the amount of five hundred dollars ($500.00) based upon one class II violation. 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 and 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2007). 3. Venue lies pursuant to Florida Administrative Code Rule 28-106.207. PARTIES 4. The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable state statutes and rules governing such facilities. Ch. 408, Part II, Ch. 429, Part I, Fla. Stat. (2007); Ch. 58A-5, Fla. Admin. Code. The Agency may deny, revoke, and suspend any license issued to an assisted living facility and impose an administrative fine for a violation of the Health Care Licensing Procedures Act, the authorizing statutes or applicable rules. §§ 408.813, 408.815, 429.14, 429.19, Fla. Stat. (2007). In addition to licensure denial, revocation or suspension, or any administrative fine imposed, the Agency may assess a survey fee against an assisted living facility. § 429.19(7), Fla. Stat. (2007). 5. The Respondent was issued a license (License Number 9566) by the Agency to operate a 80-bed assisted living facility located at 8001 Pin Oak Drive, Orlando, Florida 32819, and was at all times material times required to comply with the applicable state statutes and rules governing such facilities. “Assisted living facility” means any building or buildings, section or distinct part of a building, private home, boarding home, home for the aged, or other residential facility, whether operated for profit or not, which undertakes through its ownership or manage- ment to provide housing, meals, and one or more personal services for a period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator. § 429.02(5), Fla. Stat. (2007). These residential facilities are intended to be a less costly alternative to the more restrictive, institutional settings for individuals who meet the minimum criteria in order to be admitted to such a facility and do not require 24-hour nursing supervision. Assisted living facilities are regulated in a manner so as to encourage dignity, individuality, and choice for residents, while providing them a reasonable assurance for their health, safety and welfare. Generally, these facilities, through its staff, provide resident supervision, the assistance with personal care and supportive services, as well as the assistance with, or the administration of, medications to residents who require such services. COUNT J (Tag 029) The Respondent Fraudulently Altered, Defaced or Falsified Its Records Regarding Emergency Management In Violation Of F.A.C. 58A-5.024(4)(a) And F.S. 429.49(1) 6. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 7. Under Florida law, it is the intent of the Legislature that rules published and enforced pursuant to this section shall include criteria by which a reasonable and consistent quality of resident care.and quality of life may be ensured and the results of such resident care may be demonstrated. Such rules shall also ensure a safe and sanitary environment that is residential and non-institutional in design or nature. It is further intended that reasonable efforts be made to accommodate the needs and preferences of residents to enhance the quality of life in a facility. The agency, in consultation with the department, may adopt rules to administer the requirements of part II of chapter 408. In order to provide safe and sanitary facilities and the highest quality of resident care accommodating the needs and preferences of residents, the department, in consultation with the agency, the Department of Children and Family Services, and the Department of Health, shall adopt rules, policies, and procedures to administer this part, which must include reasonable and fair minimum standards in relation to: ... The preparation and annual update of a comprehensive emergency management plan. Such standards must be included in the rules adopted by the department after consultation with the Department of Community Affairs. At a minimum, the rules must provide for plan components that address emergency evacuation transportation; adequate sheltering arrangements; post-disaster activities, including provision of emergency power, food, and water; post-disaster transportation; supplies; staffing; emergency equipment; individual identification of residents and transfer of records; communication with families; and responses to family inquiries. The comprehensive emergency management plan is subject to review and approval by the local emergency management agency. During its review, the local emergency management agency shall ensure that the following agencies, at a minimum, are given the opportunity to review the plan: the Department of Elderly Affairs, the Department of Health, the Agency for Health Care Administration, and the Department of Community Affairs. Also, appropriate volunteer organizations must be given the opportunity to review the plan. The local emergency management agency shall complete its review within 60 days and either approve the plan or advise the facility of necessary revisions. § 429.41(1)(b), Fla. Stat. (2007). 8. Under Florida law, each each assisted living facility shall prepare a written comprehensive emergency management plan in accordance with the “Emergency Management Criteria for Assisted Living Facilities,” dated October 1995, which is incorporated by reference. This document is available from the local emergency management agency. The emergency management plan must, at a minimum address the following: (a) Provision for all hazards. (b) Provision for the care of residents remaining in the facility during an emergency including pre- disaster or emergency preparation; protecting the facility; supplies; emergency power; food and water; staffing; and emergency equipment. (c) Provision for the care of residents who must be evacuated from the facility during an emergency including identification of such residents and transfer of resident records; evacuation transportation; sheltering arrangements; supplies; staffing; emergency equipment; and medications. (d) Provision for the care of additional residents who may be evacuated to the facility during an emergency including the identification of such residents, staffing, and supplies. (e) Identification of residents with Alzheimer’s disease and related dementias, and residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation. (f) Identification of and coordination with the local emergency management agency. (g) Arrangement for post-disaster activities including responding to family inquiries, obtaining medical intervention for residents; transportation; and reporting to the county office of emergency management the number of residents who have been relocated and the place of relocation. (h) The identification of staff responsible for implementing each part of the plan. Fla. Admin. Code R. 58A-5.026(1). 9. Under Florida law, the emergency plan shall be submitted for review and approval to the county emergency management agency. Fla. Admin. Code R. 58A-5.026(2). 10. Under Florida law, the assisted living facility shall maintain the following written records in a form, place and system ordinarily employed in good business practice and accessible to Department of Elder Affairs and Agency staff: . . . the facility’s emergency management plan, with documentation of review and approval by the county emergency management agency, as described under Rule 58A-5.026, F.A.C., which shall be located where immediate access by facility staff is assured. Fla. Admin. Code R. 58A-5.024(1)(e). 11. Under Florida law, all assisted living facility records required by this rule chapter shall be available for inspection at all times by staff of the agency, the department, the district long-term care ombudsman council, and the advocacy center for persons with disabilities. Fla. Admin. Code R. 58A-5.024(4)(a). 12. Under Florida law, any person who fraudulently alters, defaces, or falsifies any medical or other record of an assisted living facility, or causes or procures any such offense to be committed, commits a misdemeanor of the second degree, punishable as provided in Section 775.082 or Section 775.083, Florida Statutes (2007). § 429.49(1), Fla. Stat. (2007). 13. On or about May 3, 2007, the Agency conducted a complaint survey of the Respondent and its Facility (CCR# 2007004588). 14. _ Based upon interview and record review, the Respondent fraudulently altered and falsified transportation, pharmacy and water delivery agreements submitted to the Emergency Management Agency with its 2007 Emergency Management Plan when in fact there was no coverage for the delivery of transportation, medications or water in the event of an emergency for the 63 residents residing in the Facility. 15. During an interview on May 2, 2007, at approximately 10:30 am, the Facility's Office Manager stated that there were two disaster agreements that she did not renew in 2007. 16. One agreement was for pharmacy services (Vanguard Advanced Pharmacy Systems) and the other agreement was for disaster evacuation transportation services (Dynamic Tours and Transportation). 17. The Office Manager originally submitted the transportation and pharmacy agreements dated 2006, with the emergency management plan. 18. On April 7, 2007, she received a letter from Emergency Response Planning and Management, Inc. (ERP&M), the plan reviewing agency, requesting updated agreements for the transportation and pharmacy (medication delivery) services. 19. To accommodate that request, the Office Manager confirmed that she deleted the dates, names and signature, from the prior agreements, photocopied them, and then typed in the current dates (January 2, 2007) and the Facility names. 20. The Facility’s Executive Director signed all the falsified/altered agreements (transportation, pharmacy and water) and submitted them as authentic agreements, with the emergency management plans for Orlando Madison House and Orlando Ivy Court. 21. Related to the disaster evacuation transportation agreement with Dynamic Tours and Transportation, the Executive Director stated that there was one original agreement dated 2006, that listed two facilities: Orlando Ivy Court and Orlando Madison House. 22. The Office Manager further indicated that she deleted the names from the agreement, made two copies, and typed in the names of each facility, so as to make it appear as if two agreements were available, and then dated them January 2, 2007. 23. The Office Manager indicated that the original agreement dated 2006 was not available for review. 24.. While at the Facility, an agreement from Dynamic Tours and Transportation arrived in the mail. 25. | The agreement was for Orlando Ivy Court. 26. The Office Manager called the transport company and spoke with the secretary, who stated that the company sent one agreement to the address on the letterhead titled Orlando Madison House 8001 Pin Oak Drive. 27. The Facility needed to submit another letter with the other letterhead Orlando Ivy Court, 8015 Pin Oak Drive. 28. The Facility stated that although it had used different letterheads, the addresses on both letterheads were the same (8015 Pin Oak Drive). 29. The Facility faxed a revised letter, with the correct letterhead and requested an original agreement for Orlando Madison House. 30. The secretary confirmed the authenticity of the agreement and indicated that a _ separate agreement would be sent to Orlando Madison House. 31. On May 3, 2007, at approximately 11:30 am, a telephone call was placed to the Office Manager referencing Page 2 of the letter sent from ERP&M to the Facility and the Agency. 32. Item IV.A.5.c made reference to "D" faithful Transportation. The Office Manager stated that this was an error. 33. It should have read Dynamic Tours and Transportation. 34. Related to the disaster medication delivery agreement with Vanguard Advanced Pharmacy Systems, the Manager stated that she made copies of the 2006 agreement. 35. She deleted the date and the former administrator's name, made two copies, dated them March 7, 2007, typed Orlando Madison House on one and Orlando Ivy Court on the other to make it appear as if two current agreements were in place and available for review. 36. The Office Manager indicated that the original agreement dated 2006 was not available for review. 37. Accurrent agreement dated April 30, 2007, was available for review. 38. The administrative assistant at Vanguard confirmed the authenticity of the April 2007 agreement and indicated that the agreement had been executed by the Chief Executive Officer. 39. Related to the emergency water delivery agreement with Zephyrhills bottled water company, the Office Manager stated that she received one agreement for one year valid through December 2007, that listed one facility- Orlando Ivy Court. 40. She deleted the name, made two copies, and wrote in the name of Orlando Madison House on one copy and Orlando Ivy Ct in the other copy, to make it appear as if there were two separate agreements in place and available for review. 41. The original agreement that listed one facility was not available for review. 42. On May 3, 2007, at approximately 10:50 am, the Office Manager stated that she was desperate, the plan needed to be submitted and her mother had just passed away. 43. She added that it took a long time to get the agreements updated. 44. She started the process in November or December, but did not get it all done. 45. She asked if the Facility was in trouble. 46. The Chief Executive Officer replied "not to focus on what we have done, but how to do it from now on." 1. The Respondent’s actions and/or inactions constituted a class II deficiency. 2. Class II violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the Agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class I violations. § 429.19(2)(b), Fla. Stat. (2007). 47. The Agency shall impose an administrative fine for a cited class II violation in an amount not less than $1,000 and not exceeding $5,000 for each violation. A fine shall be levied notwithstanding the correction of the violation. § 429.19(2)(b), Fla. Stat. (2007). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to impose an administrative fine against the Respondent in the amount of one thousand dollars ($1,000.00). COUNT IV Assessment of Survey Fee 48. | The Agency re-alleges and incorporates by reference paragraphs | through 5. 49. The Agency re-alleges and incorporates by reference Count I. 50. In addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one half of the assisted living 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 Statutes, to verify the correction of the violations. § 429.19(7), Fla. Stat. (2007). 51. The Agency received a complaint about the Respondent. 52. In response to the complaint, the Agency conducted a complaint survey of the Respondent and its Facility. 53. As a result of the complaint survey, the Respondent was cited for the above- referenced violations. 54. The basis for the deficiencies alleged in this Administrative Complaint relates to the complaint made against the Respondent and its Facility. 55. In addition, as a result of the above-stated violations, the Agency is required to conduct monitoring visits to verify the correction of these violations. 56. In this case, the Agency is authorized to seek a survey fee of five hundred dollars ($500.00) from the Respondent. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration respectfully requests the Court to assess a survey fee against the Respondent in the amount of five hundred dollars ($500.00). 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 in the amount of one thousand dollars ($1,000.00). 3. Assess a survey fee in the amount of five hundred dollars ($590.00). 4. Order any other relief that the Court deems just ang apprg ate. Respectfully submitted on this 31st day of March, 2o0 /, cio Thomas M. Hoeler, Florida Bar No. 709311 Agency for Health Care Administration Office of the General Counsel The Sebring Building, Suite 330 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 or Attorney NOTICE The Respondent has the right to request a hearing to be conducted in accordance with Sections 120.569 and 120.57, Florida Statutes, and to be represented by counsel or other qualified representative. Specific options for the administrative action are set out within the attached Election of Rights form. The Respondent is further notified if the Election of Rights form is not received by the Agency for Health Care Administration within twenty-one (21) days of the receipt of this Administrative Complaint, a final order will be entered. The Election of Rights form shall be made to the Agency for Health Care Administration and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form have been served to: Linda Mena, Administrator, Orlando Madison Copies furnished to: Florida Bar No. 709311 Agency for Health Care Administration Office of the General Counsel The Sebring Building, Suite 330 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 Linda Mena, Administrator Orlando Madison House 8001 Pin Oak Drive Orlando, Florida 32819 (U.S. Mail) Joel Libby, Field Office Manager Doris Spivey, Supervisor Agency for Health Care Administration Hurston South Tower 400 W. Robinson St., Suite 309 Orlando, FL 32801 (U.S. Mail) CT Corporation System Registered Agent 1200 South Pine Island Road Plantation, Florida 33324 (U.S. Certified Mail) Thomas M. Hoeler, Senior Attorney Office of the General Counsel Agency for Health Care Administration The Sebring Building, Suite 330D 525 Mirror Lake Drive North St. Petersburg, Florida 33701 (Interoffice) 12 SENDER: COMPLETE SECTION COMPLETE THIS SECTIO; DELIVERY @ Compiete items 1, 2, ana v. 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. 12,0 Sash Pine Tslatect SIViCe Type 5 Sere CE noun facie) F ° : Registered ~ (1 Return Recelpt for Merchandise Ploutation E Clineured wail EPG ‘ i. 3 S32 [a eaticted Deven? eta Fn Ces 2. Article Number 600 2-4 in ‘toms. _ 200? L450 0001 6907 5503 4 / 1 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-W-1540 ;

Docket for Case No: 08-002149