Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: DELTA HEALTH GROUP, INC., D/B/A FOUNTAINHEAD CARE CENTER
Judges: STUART M. LERNER
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: Sep. 02, 2008
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, October 22, 2008.
Latest Update: Dec. 24, 2024
FILED
AHCA
STATE OF FLORIDA AGENCY CLERK
AGENCY FOR HEALTH CARE ADMINISTRATION
MOY FEB HY A 8 yy:
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION,
AHCA No.: 2008008054,
Petitioner, AHCA No.: 2008008055 ©
AHCA No.: 2008008057 <=:
V. AHCA No.: 2008008058
DOAH No.: 08-4349 ~
RENDITION NO.: AHCA-09-
DELTA HEALTH GROUP, INC. d/b/a
FOUNTAINHEAD CARE CENTER,
Respondent.
FINAL ORDER
Having reviewed the amended administrative complaint dated August
11, 2008, attached hereto and incorporated herein (Exhibit 1), and all other
matters of record, the Agency for Health Care Administration (“Agency”) has
entered into a Settlement Agreement (Exhibit 2) with the other party to
these proceedings, and being otherwise well-advised in the premises, finds
and concludes as follows:
ORDERED:
1. The attached Settlement Agreement is approved and adopted as
part of this Final Order, and the parties are directed to comply with the
terms of the Settlement Agreement.
2. Respondent shall pay an administrative fine in the amount of
$4,000.00. The administrative fine is due and payable within thirty (30) days
of the date of rendition of this Order.
3. A check should be made payable to the “Agency for Health Care }
Administration.” The check, along with a reference to these case numbers,
should be sent directly to:
Agency for Health Care Administration
Office of Finance and Accounting
Revenue Management Unit
2727 Mahan Drive, MS #14
Tallahassee, Florida 32308
4. Unpaid fines pursuant to this Order will be subject to statutory
interest and may be collected by all methods legally available.
5. A conditional license is imposed commencing May 15, 2008 and
ending June 19, 2008.
6. Each party shall bear its own costs and attorney’s fees.
7. The above-styled cases are hereby closed.
DONE and ORDERED this _/© day of boratey , 2009,
in Tallahassee, Leon County, Florida.
, Secretary —
ealth Care Administration
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED
‘TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY
OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A
SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH
THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE
AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES.
REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH
THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED
WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.
Copies furnished to:
R. Davis Thomas, Jr.
Representative
Delta Health Group, Inc.
2 North Palafox Street
Pensacola, Florida 32502
(U. S. Mail)
Alba M. Rodriguez, Esq.
Assistant General Counsel
Agency for Health Care
Administration
8350 N. W. 52 Terrace — Suite 103
Miami, Florida 33166
(Interoffice Mail)
Finance & Accounting
Agency for Health Care
Administration
2727 Mahan Drive, MS #14
Tallahassee, Florida 32308
(Interoffice Mail)
Elizabeth Dudek
Deputy Secretary
Agency for Health Care
Administration ;
2727 Mahan Drive, Bldg #1, MS #9
Tallahassee, Florida 32308
(Interoffice Mail)
Jan Mills
Agency for Health Care
Administration
2727 Mahan Drive, Bldg #3, MS #3.
Tallahassee, Florida 32308
(Interoffice Mail)
Stuart M. Lerner
Administrative Law Judge
Division of Administrative Hearings
1230 Apalachee Parkway
Tallahassee, Florida 32399
(U.S. Mail)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of this Final Order was
served on the above-named person(s) and entities by U.S. Mail, or the
method designated, on this the [fF aay of FLruwr
QS
al
Richard J. Shoop
Agency Clerk
Agency for Health Care Administration
2727 Mahan Drive, Building #3
Tallahassee, Florida 32308
(850) 922-5873
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION, AHCA No.: 2008008054
: AHCA No.: 2008008055
Petitioner, AHCA No.: 2008008057
AHCA No.: 2008008058
Vv. Return Receipt Requested:
7004 2890 0000 5525 9969
DELTA HEALTH GROUP, INC. 7004 2890 0000 5525 7507
d/b/a FOUNTAINHEAD CARE
CENTER,
Respondent.
/
AMENDED ADMINISTRATIVE COMPLAINT*
COMES NOW the State of Florida, Agency for Health Care
Administration (hereinafter “AHCA”), by and through the
undersigned counsel, and files this administrative complaint
against Delta Health Group, Inc. d/b/a Fountainhead Care Center
(hereinafter “Fountainhead Care Center”) pursuant to Chapter
400, Part II and Section 120-60, Florida Statutes, (2007)
hereinafter alleges:
NATURE OF THE ACTION
1. This is an action to impose an administrative fine in
the amount of $4,000.00 pursuant to Sections 400.23(8) (b),
Florida Statutes, (2007), [AHCA No.: 2008008054; AHCA No.:
2008008057].
v Amended Administrative Complaint is being issued to correct scrivener's error
in the name of the facility in Count I and Count II. The name should read Fountainhead
Care Center.
EXHIBIT
2. This is an action to impose a conditional licensure
rating pursuant to Section 400.23(7) (b), Florida Statutes
(2007), [AHCA No. 2008008055; AHCA No.: 2008008058].
JURISDICTION AND VENUE
3. This court has jurisdiction pursuant to Section
120.569 and 120.57, Florida Statutes (2007), and Chapter 28-106,
Florida Administrative Code.
4. Venue lies in Miami-Dade County pursuant to- Section
120.57, Florida Statutes (2007), and Rule 28-106.207, Florida
Administrative Code (2007),
PARTIES
5. AHCA is the regulatory authority with regard to
skilled nursing facilities licensure pursuant to Chapter 400,
Part II, Florida Statutes (2007), and Rule 59A-4, Florida
Administrative Code.
6. Fountainhead Care Center operates a 146-bed skilled
nursing facility located at 390 N. EH. 135 Street, North Miami,
Florida 33161. Fountainhead Care Center is licensed as a skilled
nursing facility under license number 1163096. Fountainhead Care
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
FOUNTAINHEAD CARE CENTER FAILED TO ENSURE PHYSICIAN ORDERS WERE
FOLLOWED.
RULE 59A-4.107(5), FLORIDA ADMINISTRATIVE CODE
(FOLLOW PHYSICIAN ORDERS STANDARD)
CLASS III
7. AHCA re-alleges and incorporates (1) through (6) as if
fully set forth herein.
8. Fountainhead Care Center was cited with two (2) Class
Til deficiencies as a result of licensure surveys and life
safety surveys that were conducted on April 7, 2008, April 11,
2008, May 15, 2008, and May 27, 2008.
10. A licensure survey was conducted on April 11, 2008.
Based on observation, interview, and record review, it was
determined that the facility failed to ensure physician orders
were followed, and failed to notify physician when scheduled
Insulin was withheld four days for one, Resident #4140, of 10
residents reviewed for medication regimen. The findings include
the following.
11. Resident #140 was admitted to the facility 2/19/08,
with 2 subsequent hospitalizations for renal failure and wound
care. Resident record review revealed Resident #140 arrived from
the hospital and was admitted on 2/19/08 with diagnoses of, but
not limited to, abnormal lab results, severe Peripheral Vascular
Disease (PVD), gangrene of the lefc foot with Cellulitis and
infection, Hypertension (HTN), Diabetes Mellitus (DM) , and
Coronary Artery Disease (CAD) .
12. Record review revealed a physician order for Novulin N
100u/ml (units per milliliter) 20U subcutaneously (SQ) daily
(qd). Review of the Accucheck Blood Sugars done on: 4/7/08 Blood
Sugars - 88; 4/8/08 - Blood Sugars -85; 4/9/08 - Blood Sugars -
83; ‘and 4/10/08 - Blood Sugars -79. Review of the Medication
Administration Record revealed that the Novulin N 100u/ml was
not given on 4/7/08, 4/8/08, 4/9/08, and 4/10/08.
13. Review of the Physician Orders revealed no order to
hold the insulin for any parameters. .
14. During an interview with the Director of Nursing on
4/10/08 at 8:15 a.m., she stated that the nurse called the
doctor, on 4/9/08 regarding the blood sugar. She agreed there is
no note about the return call from the physician. She agreed
there were no orders to hold the insulin. This was not seen by
the consulting pharmacist, the review for April had not beeen
completed to date and are done monthly.
(1s. During an interview with the staff nurse on 4/10/08 at
10:05 a.m., she stated that the physician was informed of the
low blood sugars this morning and he ordered the Novulin Insulin
to be decreased. Review of the Physican's Order on 4/10/08
revealed an order to decrease insulin to 10 units
subcutaneously (SQ) daily.
i¢. The mandated date of correction was designated as May
i7. A licensure revisit survey was conducted on May 27,
2008. Based on observation, interview, and record review, it was
determined that the facility failed to ensure physician orders
were followed as evidenced by failure to administer Glucagon as
ordered and failure to notify physician when accucheck results
were below ordered parameters for one, Resident #15, of nine
sampled residents scheduled for accuchecks of sixteen total
sampled residents. The findings include the following.
18. Record review for Resident #15 revealed diagnosis to
include, but not limited to, Diabetes Mellitus, Cognitive
Disorder, Right Leg Weakness, Anemia, Hypertension, Mood
Disorder, Glaucoma, Cataracts, Seizure Disorder, Hyperlipidemia,
and Depression.
19. Review of the May 2008 Physician's Order Sheet
revealed orders for Novolin R 100/ml Insulin sliding scale sub-0
150-199=1u, 200-249=3u, 250-299=5u, 300-349=7u, greater than (>)
349=8u. Accuchecks with sliding scale coverage: Accuchecks 2x
daily. Glucose below (<) 70, give Glucagon img intramuscular
(IM), ordered 1/31/08. Call Medical Doctor (MD) if blood sugar
greater than (>) 350 or below (<) 70, ordered 5/7/08.
wn
20. Review of Resident #15's Care Plan, initiated on
1/31/08, and updated on 5/1/08, revealed Diagnosis of Diabetes
Mellitus and at risk for hypo/hyperglycemic reaction. Care Plan
Approach included administering Glucagon as ordered.
21. Review of May 2008 Medication Administration Record
(MAR) for Resident #15 revealed Accucheck result on 5/18/08 at
4:30 p.m., recorded at 68 and initialed by nursing staff. The
Medication Administration Record reflected no’ evidence that the
Glucagon was administered as ordered and no evidence that the
Medical Director was notified per ordered parameters for blood
sugar below (<) 70 as evidenced by absence of staff initials on
the Medication Administration Record.
22. Record review revealed no entry in the licensed
nurse's note section of the medical record and no entry on the
24 hour report dated 5/18/08.
23. Interview on 5/27/08, at 2:30 p.m., with the facility
Director of Nursing Services (DONS) revealed a telephone
conversation with the Licensed Practical Nurse (LPN) who had
been scheduled 5/18/08, who stated that the Glucagon had been
administered. The Director of Nursing Services stated that the
facility had no policy or procedures in place for monitoring
and/or documenting blood sugar or resident's condition following
the administration of Glucagon.
24. Interview via telephone on 5/27/08 az 3:35 p.m. with
the Licensed Practical Nurse confirmed that he/she had worked on
5/18/08. Licensed Practical Nurse stated that she recalled doing
the accucheck for Resident #15 on 5/18/08, and administering the
Glucagon due to low blood sugar results. The Licensed Practical
Nurse stated that the facility protocol following administration
of Glucagon is to recheck the resident's blood sugar and monitor
condition. The Licensed Practical Nurse stated that she checked
“’e blood sugar which was "normal". The Licensed Practical Nurse
scated that as a nurse he/she would normally document the
resident's condition following administration of Glucagon. The
Licensed Practical Nurse was unable to recall recording the
results of the repeat accucheck or documenting Resident 15's
condition in the clinical record.
25. Record review revealed that last entry in the licensed
nurse's notes was dated 5/12/08. The Licensed Practical Nurse
stated that the doctor had not been contacted to report the
blood sugar results, because it was Sunday and Resident #15 had
eaten 100% of his/her dinner. This is an uncorrected deficiency
from the survey of April 11, 2008.
26. Based on the foregoing facts, Fountainhead Care Center
violated Rule 59A-4.107(5), Florida Administrative Code, herein
classified as an isolated uncorrected Class III violation
pursuant to Section 400.23(8), Florida Statutes (2007), which
carries an assessed fine of $1,000.00. This also gives rise to
conditional licensure status pursuant to Section 400.23(7) (b)
4
Florida Statutes (2007).
‘COUNT II
FOUNTAINHEAD CARE CENTER FAILED TO ENSURE THE ACCURACY OF THE
ANNUAL FIRE ALARM CERTIFICATION.
RULE 59A-4.107(5), FLORIDA ADMINISTRATIVE CODE
(LIFE SAFETY CODE STANDARD)
CLASS III
27. AHCA re-alleges and incorporates (1) through (6) as if
fully set forth herein.
28. A Fire Life Safety recertification survey was
conducted on April 7, 2008: Based on a review of documentation
and interview, it was determined that the facility did not
ensure the accuracy of the annual fire alarm certification. The
fire alarm company documentation failed to indicate that all of
the fire alarm devices were inspected and tested; and the fire
alarm company failed to provide completed documentation relating
to the annual certification. The findings include the following.
29. During the Life Safety survey conducted on April 7,
2008, while reviewing the two most recent certifications,
Inspection and Test Report, of the fire alarm systems with the
Administrator between 9:30 a.m. and 12:30 p.m. the following
were revealed:
30. There was a discrepancy in the number of smoke
detectors recorded in each report. The semi-annual Inspection
and Test Report dated December 27, 2006 listed 55 Ton smoke
detectors in the fire alarm system, The annual certification's
Inspection and Test Report, dated June 26, 2007, listed 52 Ion
smoke detectors in the fire alarm system.
31. When -questioned, neither the Administrator nor
Maintenance Director could offer an explanation. A telephone
call was placed to the fire alarm company's service supervisor
at 10:30 a.m. He was not immediately available, and never
returned the call.
32. The Fire Alarm Log Book was. not being kept up to date.
There were no entries between November 11, 2007 and March 4,
2008. The Log Book is a permanent record of ail inspections,
testing and maintenance by fire alarm technicians. Information
required includes the date, name of the technician, what was
done and the results. When a fire alarm technician comes to the
facility, this information must be recorded in the Log Book.
33. Documentation regarding testing the fire alarm panel's
batteries was incomplete. Because the facility does not have an
emergency generator for use in the event of an electrical power
failure, an additional test of the fire alarm panel's secondary
9
power supply, back-up batteries, is required. According to NFPA
72, the National Fire Alarm Code, the back-up batteries must
have sufficient capacity to operate the fire alarm system for 24
hours. At the end of the 24-hour period, the batteries must be
capable of operating all alarm notification devices for 5
minutes. In addition, the back-up batteries must be capable of
supplying power for emergency voice/alarm during a fire or other
evacuation emergency at maximum connected load for 15 minutes.
- . The documentation left at the facility by the fire
alarm company indicated that the batteries test took place on
March 4, 2008; however, the document did not explain what the
"battery load test" entailed.
35. The fire alarm company did not test or verify the
activation of the facility's fire sprinkler system devices
during either certification. Since these devices are connected
to and activate the fire alarm, it is required that when
certifying the fire alarm system the fire alarm company test or
at least verify that ...when a tamper switch is tripped, the
activation is indicated ag a "trouble" or "supervisory" signal
on the fire alarm panel; and ...when ‘a water flow device’
(Inspectors Test Valve) is activated (by being opened to
simulate the flow of water from a single sprinkler head), the
water flow initiates the fire alarm throughout the facility; and
within 90 seconds or less, as required.
10
36. It is required that all devices in the fire alarm
system must be inspected, tested and certified as fully
operational annually. The fire alarm company cannot certify that
a fire alarm system is 100 per cent functional when not all
devices are inspected and tested as required.
37. The mandated date of correction was designated as May
11, 2008. |
38. A revisit Life Safety survey was conducted on May 15,
2008. Based on a review of documentation and interview, it was
determined that the facility did not ensure the accuracy of the
annual fire alarm certification. The fire alarm company
documentation failed to indicate that all of the fire alarm
devices were inspected and tested; and the fire alarm company
failed to provide completed documentation relating to the annual
certification. The findings include the following.
39. During the Life Safety revisit survey conducted on May
15, 2008, the facility was unable to produce documents that the
fire alarm company had explained discrepancy in the number of
smoke detectors recorded in each report, nor the other
discrepancies noted in the Life Safety survey on 04/07/08.
40. The Director of Maintenance stated the facility was
changing alarm companies; unsure when the inspection and testing
of the fire alarm system would be completed.
41. There was a discrepancy in the number of smoke
cetectors recorded in each report. The semi-annual Inspection
and Test Report dated December 27, 2006 listed 55 ION smoke
detectors in the fire alarm system. The ‘annual certification's
Inspection and Test Report, dated June 26, 2007, listed 52 ION
smoke detectors in the fire alarm system.
42. The Fire Alarm Log Book was not being kept up to date.
There were no entries between November 11, 2007 and March 4,
2008. The Log Book is a permanent record of all inspections,
testing and maintenance by fire alarm technicians. Information
required includes the. date, name of the technician, what. was
done and the results. When a fire alarm technician comes to the
facility, this information must be recorded in the Log Book.
43. Documentation regarding testing the fire alarm panel's
batteries was incomplete. Because the facility does not have an
emergency generator for use in the event of an electrical power
failure, an additional test of the fire alarm panel's secondary
power supply, back-up batteries, is required. According to NFPA
72, the National Fire Alarm Code, the back-up batteries must
have sufficient capacity to operate the fire alarm system for 24
hours.
44. The fire alarm company did not test or verify the
activation of the facility's fire sprinkler system devices
during either certification. Since these devices are connected
12
to and activate the fire alarm, it is required that when
certifying the fire alarm system the fire alarm company test or
at least verify that ...when a tamper switch is tripped, the
activation is indicated as a "trouble" or "supervisory" signal
on the fire alarm panel; and ...when a water flow device
(Inspectors Test Valve) is activated (by being opened to
simulate the flow of water from a single sprinkler head), the
water flow initiates the fire alarm throughout the facility; and
within 90 seconds or less, as required.
45. It is required that all devices in the fire alarm
system must be inspected, tested and certified as fully
operational annually. The fire alarm company cannot certify that
a fire alarm system is 100 per cent functional when not all
devices are inspected and tested as required. This is an
uncorrected deficiency from the survey of April 7, 2008.
46. Based on the foregoing facts, Fountainhead Care Center
violated: Rule 59A-4.107(5), Florida Administrative Code, herein
classified as a widespread, uncorrected Class III violation
pursuant to Section 400.23(8), Florida Statutes (2007), which
Carries an assessed fine of $3,000.00. This also gives rise to
conditional licensure status pursuant to Section 400.23(7) (b)
Florida Statutes (2007).
THIS PAGE LEFT BLANK DELIBERATELY
14
DISPLAY OF LICENSE
Pursuant to Section 400.25(7), Florida Statutes (2007),
Fountain head Care Center shall post the license in a prominent
place that is clear and unobstructed public view at or near the
place where residents are being admitted to the facility.
The conditional License is attached hereto as Exhibit “A”
EXHIBIT “A”
Conditional License
License # SNF1163096; Certificate No.:
Effective date: 05/15/2008
Expiration date: 04/30/2010
Standard License
License # SNF1163096; Certificate No.:
Effective date: 07/02/2008
Expiration date: 04/30/2010
15305
15306
PRAYER FOR RELIEP
WHEREFORE, the Petitioner, State of Florida Agency for
Health Care Administration requests the following relief:
1. Make factual and legal findings in favor of the Agency
on Counts I and II.
2. Assess against Fountainhead Care Center an
administrative fine of $4,000.00 for the violations cited above.
3. Assess against Fountainhead Care Center a conditional
license in accordance with Section 400.23(7), Florida Statutes.
4. Assess costs related to the investigation and
“prosecution of this matter, if applicable.
5. Grant such other relief as the court deems is just and
proper.
Respondent is notified that it has a right to request an
administrative hearing pursuant to Sections 120.569 and 120.57,
Florida Statutes (2007). 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 the Agency Clerk, Agency for
Health Care Administration, 2727 Mahan Drive, MS #3,
Tallahassee, Florida 32308.
RESPONDENT IS FURTHER NOTIFIED TEAT FAILURE TO RECEIVE A
REQUEST A EEARING WITHIN TWENTY-ONE (21)
COMPLAINT,
PURSUANT TO THE ATTACHED ELECTION OF RIGHTS,
DAYS OF RECEIPT OF THIS
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,
REPRESENTED BY AN ATTORNEY IN THIS MATTER
YOU HAVE THE RIGHT TO BE
fo
Alba M.
Fla. Bar No.:
a) IY. Relea
Rodriduer toast ‘| 47
t
0880175
Assistant General Counsel
Agency for Health Care
Administration
8350 N.W.
52 Terrace - #103
Miami, Florida 33166
Copies furnished to:
R. Steve Emling
Field Office Manager
Agency for Health Care Administration
8355 N. W. 53%° Street
Miami, Florida 33166
(U.S. Mail)
Long Term Care Program Office
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308
(Interoffice Mail)
Finance and Accounting
Agency for Health Care Administration
2727 Mahan Drive, Mail Stop #14
Tailahassee, 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 Carmen Telot, Administrator, Fountainhead
Care Center, 390 N. E. 135 Street, North Miami, Florida 33161;
Kimberly A. Seith, Registered Agent, 2 North Palafox Street,
Pensacola, Florida 32502 on this jprr day of August, 2008.
oN, ; . a .
Calpe FT). Aadis Baa
Alba M. Rodrifguez’ Esq.(. va
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
RE: Delta Health Group, Inc. d/b/a AHCA No.: 2008008054/AHCA No.: 2008008055
Fountainhead Care Center AHCA No.: 2008008057/AHCA No.: 2008008058
ELECTION OF RIGHTS
This Election of Rights form is attached to a proposed action by the Agency for Health Care
Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of
Intent to Impose a Late Fine or Administrative Complaint.
Your Election of Rights must be returned by mail or by fax within 21 days of the day vou
receive the attached Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine
or Administrative Complaint.
If your Election of Rights with your selected option is not received by AHCA within twenty-
one (21) days from the date you received this notice of proposed action by AHCA, you will have
given up your right to contest the Agency’s proposed action and a final order will be issued.
(Please use this form unless you, your attorney or your representative prefer to reply according to
Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)
PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS:
Agency for Health Care Administration
Attention: Agency Clerk
2727 Mahan Drive, Mail Stop #3
Tallahassee, Florida 32308.
Phone: 850-922-5873 Fax: 850-921-0158.
PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS
OPTION ONE (1) J admit to the allegations of facts and law contained in the Notice
of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to
object and to have a hearing. I understand that by giving up my right to a hearing, a final order
will be issued that adopts the proposed agency action and imposes the penalty, fine or action.
OPTION TWO (2)____—Ss—s«s admit to the allegations of facts contained in the Notice of Intent
to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative
Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2),
Florida Statutes) where I may submit testimony and written evidence to the Agency to show that
the proposed administrative action is too severe or that the fine should be reduced,
OPTION THREE (3) ___I dispute the allegations of fact contained in the Notice of Intent
to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative
Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes)
before an Administrative Law Judge appointed by the Division of Administrative Hearings.
PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a
formal hearing. You also must file a written petition in order to obtain a formal hearing before
the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be
received by the Agency Clerk at the address above within 21 davs of your 1..eipt of this proposed
administrative action. The request for formal hearing must conform to the requirements of Rule 28-
106.2015, Florida Administrative Code, which requires that it contain:
1. Your name, address, and telephone number, and the name, address, and telephone number of
your representative or lawyer, if any.
2. The file number of the proposed action.
3. A statement of when you received notice of the Agency’s proposed action.
4. A-statement of all disputed issues of material fact. If there are none, you must state that there
are none.
Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency
agrees.
License type: (ALF? nursing home? medical equipment? Other type?)
Licensee Name: License number:
Contact person:
Name Title
Address: :
Street and number City Zip Code
Telephone No. Fax No. Email(optional)
Thereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency
for Health Care Administration on behalf of the licensee referred to above.
Signed: . Date: .
Print Name: ; Title:
Late fee/fine/AC
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION,
AHCA No.: 2008008054
Petitioner, AHCA No.: 2008008055
AHCA No.: 2008008057
Vv. AHCA No.: 2008008058
DOAH No.: 08-4349
DELTA HEALTH GROUP, INC. d/b/a
FOUNTAINHEAD CARE CENTER,
Respondent.
SETTLEMENT AGREEMENT
Petitioner, State of Florida, Agency for Health Care
Administration (hereinafter the “Agency”}, through its undersigned
representatives, and Respondent, Delta Health Group, Inc. d/b/a
Fountainhead Care Center (hereinafter “Respondent”), pursuant to
Section 120.57(4), Florida Statutes, each individually, a “party,”
collectively as “parties,” hereby enter into this Settlement
Agreement (“Agreement”) and agree as follows:
WHEREAS, Respondent is a nursing home licensed pursuant to
Chapters 400, Part II, and 408 Part II, Florida Statutes (2007),
Section 20.42, Florida Statutes (2007), and Chapter 59A-4, Florida
Administrative Code; and
WHEREAS, the Agency has jurisdiction by virtue of being the
regulatory and licensing authorit over. Respondent, pursuant to
EXHIBIT
AB
Chapter 400, Part II, Florid ); and
WHEREAS, the Agency served Respondent with an amended
administrative complaint on or about August 14, 2008, notifying
the Respondent of its intent to impose administrative fines in the
amount of $4,000.00 and assign a conditional licensure status
commencing May 15, 2008 and ending July 1, 2008; and
WHEREAS , Respondent requested a formal administrative
proceeding by selecting Option Three (3) on the Election of Rights
form; and
WHEREAS, the parties have negotiated and agreed that the best
interest of all the parties will be served by a settlement of this
proceeding; and
NOW THEREFORE, in consideration of the mutual promises and
recitals herein, the parties intending to be legally bound, agree
as follows:
1. All recitals herein are true and correct and are
expressly incorporated herein.
2. Both parties agree that the “whereas” clauses
incorporated herein are binding findings of the parties.
3. Upon full execution of this Agreement, Respondent agrees
to waive any and all appeals and proceedings to which it may be
entitled including, but not limited to, an informal proceeding
under Subsection 120.57(2), Florida Statutes, a formal proceeding
under Subsection 120.57(1), Florida Statutes, appeals under
Section 120.68, Florida Statutes; and declaratory and all writs of
relief in any court or quasi-court of competent jurisdiction; and
Page 2 of 6
agrees to waive compliance with the form of the Final Order
(findings of fact and conclusions of law) to which it may be
entitled, provided, however, that no agreement herein shall be
deemed a waiver by either party of its right to judicial
enforcement of this Agreement.
4, Upon full execution of this Agreement, Respondent agrees
to pay $4,000.00 in administrative fines to the Agency within
thirty (30) days of the entry of the Final Order. Respondent
accepts the assignment of conditional licensure status commencing
May 15, 2008 and ending June 19, 2008.
5. Venue for any action brought to enforce the terms of
this Agreement or the Final Order entered pursuant hereto shall
lie in Circuit Court in Leon County, Florida.
6. By executing this Agreement, Respondent does not admit
and specifically denies, and the Agency asserts the validity of
the allegations raised in the administrative complaint referenced
herein. No agreement made herein shall preclude the Agency from
imposing a penalty against Respondent for any deficiency/violation
of statute or rule identified in a future survey of Respondent,
which constitutes an “uncorrected” deficiency from surveys
identified in the administrative complaint. The parties agree that
in such an “uncorrected” case, the Respondent reserves the right
to challenge the deficiencies from the surveys identified in the
administrative complaint in an appropriate forum.
Page 3 of 6
7. No agreement made herein shall preclude the Agency from
using the deficiencies from the surveys identified in the
administrative complaint in any decision regarding licensure of
Respondent, including, but not limited to, licensure for limited
mental health, limited nursing services, extended congregate care,
or a demonstrated pattern of deficient performance. The Agency is
not precluded from using the subject events for any purpose within
the jurisdiction of the Agency. Further, Respondent acknowledges
and agrees that this Agreement shall not preclude or estop any
other federal, state, or local agency or office from pursuing any
cause of action or taking any action, even if based on or arising
from, in whole or in part, the facts raised in the administrative
complaint.
8. Upon full execution of this Agreement, the Agency shall
enter a Final Order adopting and incorporating the terms of this
Agreement and closing the above~-styled case.
9. Each party shall bear its own costs and attorney’s fees.
10. This Agreement shall become effective on the date upon
which it is fully executed by all the parties.
ll. Respondent for itself and for its related or resulting
organizations, its successors or transferees, attorneys, heirs,
and executors or administrators, does hereby discharge the State
of Florida, Agency for Health Care Administration, and its agents,
representatives, and attorneys of and from all claims, demands,
actions, causes of action, suits, damages, losses, and expenses,
Page 4 of 6
of any and every nature whatsoever, arising out of or in any way
related to this matter and the Agency’s actions, including, but
not limited to, any claims that were or may be asserted in any
federal or state court or administrative forum, including any
claims arising out of this agreement, by or on behalf of
Respondent or related facilities.
12. This Agreement is binding upon all parties herein and
those identified in paragraph eleven (11) of this Agreement.
13. In the event that Respondent was a Medicaid provider at
the subject time of the occurrences alleged in the complaint
herein, this settlement does not prevent the Agency from seeking
Medicaid overpayments related to the subject issues or from
imposing any sanctions pursuant to Rule 59G-9.070, Florida
Administrative Code.
14. Respondent agrees that if any funds to be paid under
this agreement to the Agency are not paid within thirty-one (31)
days of entry of the Final Order in this matter, the Agency may
deduct the amounts assessed against Respondent in the Final Order,
or any portion thereof, owed by Respondent to the Agency from any
present or future funds owed to Respondent by the Agency, and that
the Agency shall hold’a lien against present and future funds owed
to Respondent by the Agency for said amounts until paid.
15. The undersigned have read and understand this Agreement
and have the authority to bind their respective principals to it.
Page 5 of 6
16. This Agreement contains and incorporates the entire
understandings and agreements of the parties.
17. This Agreement supersedes any prior oral or written
agreements between the parties.
18. This Agreement may not be amended except in writing. Any
attempted assignment of this Agreement shall be void.
19. All parties agree that a facsimile signature suffices
for an original signature.
The following representatives hereby acknowledge that they
are duly authorized to enter into this Agreement.
athe Duden CLA)
Elizabeth Dudek R. Davis Thomas, Jr.
Deputy Aecretary Representative
Division of Health Quality Delta Health Group, Inc.
Assurance. 2 North Palafox Street
Agency for Health Care Pensacola, Florida 32502
Administration
2727 Mahan Drive
Tallahassee, Florida 32308
Dated: Sho [3009 Dated: ie/ialo’
la i f a“
Citas 7. Ko
k Alba M. Rodriguez, Esq.
Acting Generai Counsel Assistant General Counsel
Agency for Health Care Agency for Health Care
Administration Administration
2727 Mahan Drive 8350 N.W. 52 Terrace - #103
Tallahassee, Florida 32308 Miami, Florida 33166
Dated: 2 “o/og Dated: jaf 2 1/2 g
Page 6 of 6
Docket for Case No: 08-004349
Issue Date |
Proceedings |
Feb. 12, 2009 |
Final Order filed.
|
Oct. 22, 2008 |
Order Closing File. CASE CLOSED.
|
Oct. 22, 2008 |
Motion to Relinquish Jurisdiction filed.
|
Sep. 11, 2008 |
Order Directing the Filing of Exhibits.
|
Sep. 11, 2008 |
Order of Pre-hearing Instructions.
|
Sep. 11, 2008 |
Notice of Hearing by Video Teleconference (hearing set for December 1, 2008; 9:00 a.m.; Miami and Tallahassee, FL).
|
Sep. 10, 2008 |
Response to Initial Order filed.
|
Sep. 03, 2008 |
Initial Order.
|
Sep. 02, 2008 |
Amended Administrative Complaint filed.
|
Sep. 02, 2008 |
Request for Formal Administrative Hearing filed.
|
Sep. 02, 2008 |
Notice (of Agency referral) filed.
|