STATE OF FLORIDA . AGENCY FOR HEALTH CARE ADMINISTRATION “& STATE OF FLORIDA, OO¥-Y q| q Be AGENCY FOR HEALTH CARE < ADMINISTRATION, Petitioner, vs. Case No.2008004178 WESTWOOD MANOR, 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, WESTWOOD MANOR, (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 THREE THOUSAND TWO HUNDRED FIFTY DOLLARS ($3,250.00) and to assess a survey fee in the amount of FIVE HUNDRED DOLLARS ($500.00) based upon five (5) repeat Class III violations and one (1) uncorrected Class III 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 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 goveming such facilities. Chapters 408, Part II and 429, Part I, Florida Statutes (2007); Chapter 58A-5, Florida Administrative Code. The Agency may deny, revoke, or suspend any license issued to an assisted living facility or impose an administrative fine for violations. Sections 408.813, 408.815 and 429.14, Florida Statutes (2007). 5. The Respondent was issued a license by the Agency (License Number 8914) to operate a 30-bed assisted living facility located at 2339 Hoople Street, Fort Myers, Florida 343901, and was at all times material required to comply with the applicable federal and state regulations, statutes and rules for assisted living facilities. COUNT I The Respondent Failed To Develop An Elopement Policy And The Procedures To Follow When An Elopement Occurs In Violation Of Section 429.41(3)(a) and (1), Florida Statutes (2007) and Rule 58A-5.024(1)(q), Florida Administrative Code 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, facilities are required to conduct a minimum of two resident elopement prevention and response drills per year. All administrators and direct care staff must participate in the drills which shall include a review of procedures to address resident elopement. Facilities must document the implementation of the drills and ensure that the drills are conducted in a manner consistent with the facility's resident elopement policies and procedures. Section 429.41(3)(a), Florida Statutes (2007). The establishment of specific policies and procedures on resident elopement. Facilities shall conduct a minimum of two resident elopement drills each year. All administrators and direct care staff shall participate in the drills. Facilities shall document the drills. Section 429.41(3)(1), Florida Statutes (2007). Pursuant to Florida law, the 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 resident elopement response policies and procedures and the facility’s documented resident elopement response drills. Rule 58A-5.024(1)(q), Florida Administrative Code. 8. On or about November 15, 2006 the Agency conducted a Biennial Survey of the Respondent’s facility. 9. Based on an interview, the facility failed to conduct any resident elopement drills. 10. On November 15, 2006 at approximately 11:00 a.m. when the administrator was asked for records demonstrating that the required resident elopement drills had been done, he stated, "What's that? We do fire drills but haven't done any elopement drills. How do you do them? 11. The administrator confirmed that the facility has no policy or procedure for elopement drills. He also confirmed that one (1) resident had eloped from the facility two (2) times. 12. The Respondent’s deficient practice related to the operation and maintenance of a facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 13. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 14. The Agency provided the Respondent with a mandatory correction date of December 16, 2006. 15. During a Follow-Up Survey on December 28, 2006 the Agency determined that the Respondent had corrected the deficiency. 16. On or about March 4, 2008 the Agency conducted a Complaint Investigation, (CCR# 2008-002655) of the Respondent’s facility. 17. Based on record review and interviews the facility failed to develop an elopement policy and the procedures to follow when an elopement occurs. 18. During an interview with the administrator on March 4, 2008 at approximately 2:30 p.m., the administrator stated he had not heard of the elopement requirement. The elopement requirement was effective per the Florida Statute in July 2004. The facility had neither developed the elopement policy and procedures nor drilled staff on them. 19. The Respondent’s deficient practice related to the operation and maintenance of a facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 20. This Respondent’s deficient practice constituted a repeat Class III deficiency as provided by law. 21. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 22. The Respondent was given a mandatory correction date of April 8, 2008. 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 HUNDRED DOLLARS ($500.00) pursuant to Sections 400.23(8)(c) and 400.102, Florida Statutes (2007). COUNT I The Respondent Failed To Ensure A Minimum Of Two (2) Resident Elopement Prevention And Response Drills Were Conducted Per Year In Violation Of Section 429.41(3)(a) and (1), Florida Statutes (2007) And Rule 58A-5.0182(8)(c), Florida Administrative Code 23. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). | 24. Pursuant to Florida law, resident elopement requirements: Facilities are required to conduct a minimum of two resident elopement prevention and response drills per year. All administrators and direct care staff must participate in the drills which shall include a review of procedures to address resident elopement. Facilities must document the implementation of the drills and ensure that the drills are conducted in a manner consistent with the facility's resident elopement policies and procedures. Section 429.41(3)(a) and (1), Florida Statutes. Pursuant to Florida law, Facility Resident Elopement Drills. The facility shall conduct resident elopement drills pursuant to Sections 429.41(3)(a) and 429.41(3)(1), Florida Statutes (2007). 25. Onor about November 15, 2006 the Agency conducted a Biennial Survey of the Respondent’s facility. 26. Based on an interview, the facility failed to document that any resident elopement drills had been completed. 27. On November 15, 2006 at approximately 11:00 a.m. when the administrator was asked for records demonstrating that the required resident elopement drills had been done, he stated, "What's that? We do fire drills but haven't done any elopement drills. How do you do them?" 28. The administrator confirmed that the facility has no policy or procedure for elopement drills. He also confirmed that one (1) resident had eloped from the facility two (2) times. 29. The Respondent’s deficient practice related to the operation and maintenance of a facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 30. The Agency cited the Respondent for a Class IIT violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). | 31. The Agency provided the Respondent with a mandatory correction date of December 16, 2006. 32. During a follow-up visit on December 28, 2006 the Agency determined that the Respondent had corrected the deficiency. 33. On or about: March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 34, Based on record review and an interview, the facility failed to ensure all direct care and administrative staff participates in two elopement drills annually for eleven (11) of eleven (11) staff. 35. During an interview with the administrator on March 4, 2008 at approximately 2:30 p.m., the administrator stated he had not heard of the elopement requirement. The elopement requirement was effective per the Florida Statute in July 2004. The facility had neither developed the elopement policy and procedures nor drilled staff on them. 36. The Respondent’s deficient practice related to the operation and maintenance ofa facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 37. This Respondent’s deficient practice constituted a repeat Class III deficiency as provided by law. 38. The Agency shall impose an administrative fine for a cited Class Il violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 39. The Respondent was given a mandatory correction date of April 8, 2008. 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 HUNDRED DOLLARS ($500.00) pursuant to Sections 400.23(8)(c) and 400.102, Florida Statutes (2007). COUNT I The Respondent Failed To Ensure That All Staff Hired After October Of 1998 Had A Level One (1) Background Screening In Violation Of Section 429.174(2), Florida Statutes (2007), And Rule 58A-5.019(3), Florida Administrative Code 40. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 41. Pursuant to Florida law, the person required to be screened has been continuously employed in the same type of occupation for which the person is seeking employment without a breach in service which exceeds 180 days, and proof of compliance with the level one (1) screening requirement which is no more than two (2) years old is provided. Proof of compliance shall be provided directly from one employer or contractor to another, and not from the person screened. Upon request, a copy of screening results shall be provided by the employer retaining documentation of the screening to the person screened. Section 429.174(2), Florida Statutes (2007). Pursuant to Florida law, (a) All staff, who are hired on or after October 1, 1998, to provide personal services to residents, must be screened in accordance with Section 429.174, Florida Statutes, and meet the screening standards of Section 435.03, Florida Statutes. A packet containing background screening forms and instructions may be obtained from the Agency Background Screening Unit, 2727 Mahan Drive, Tallahassee, FL 32308; telephone (850)410- 3400. Within ten (10) days of an individual’s employment, the facility shall submit the following to the Agency Background Screening Unit: 1. A completed Level one (1) Criminal History Request, Agency for Health Care Administration Form 3110-0002, July 2005, which is incorporated by reference and may be obtained in the screening packet referenced in paragraph (3)(a) of this rule; and 2. Acheck to cover the cost of screening. (b) The results of employee screening conducted by the agency shall be maintained in the employee’s personnel file. (c) Staff with the following documentation in their personnel records shall be considered to have met the required screening requirement: 1. A copy of their current professional license, proof that a criminal history screening has been conducted, and an affidavit of current compliance with Section 435.03, Florida Statutes; >. Proof of continuous employment in an occupation which requires Level one (1) screening without a break in employment that exceeds 180 days, and proof that a criminal history screening has been conducted within the previous two (2) years; or 3. Proof of employment with a corporation or business entity or related entity that owns, operates, or manages more than one facility or agency licensed under Chapter 400, Florida Statutes, that conducted Level one (1) screening as a condition of initial or continued employment. Rule 58A-5.019(3), Florida Administrative Code. 42. | Onor about November 15, 2006 the Agency conducted a Biennial Survey of the Respondent's facility. 43. Based upon record review and an interview it was determined that two (2) of seven (7) employee records reviewed did not have verification of background screening, Employee number two (2) and Employee number five (5). 44. Employee number two (2) was hired on April 10, 2006 and Employee number five (5) was hired on September 26, 2006. A review of the employee files on November 15, 2006 at about 3:30 p.m. failed to reveal any background screening clearance or documentation on any exemptions. 45. The assistant administrator was asked if she had documentation of the required screening? The assistant administrator was provided an opportunity to locate the requested information. 46. On November 16, 2006 at about 11:45 a.m. the administrator was informed about various missing personnel documentation to include background screening checks for Employee number two (2) and Employee number five (5). The administrator was provided an opportunity to locate the required documentation. 47. Atabout 4:30 p.m., prior to the exit conference, on November 16, 2006 the administrator was again provided an opportunity to provide the required background screening information. 48. | The Respondent’s deficient practice related to the operation and maintenance ofa facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than class I or class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 49. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 50. The Agency provided the Respondent with a mandatory correction date of December 16, 2006. 51. During a Follow-Up visit on December 28, 2006 the Agency determined that the Respondent had corrected the deficiency. 52. Onor about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 53. Based on record review and staff interview, the facility did not ensure that all personal care staff hired after October of 1998 had a level one (1) background screening for six (6) of eight (8) staff employed over ten (10) days, Staff number three (3), staff number four (4), Staff number six (6), Staff number seven (7), Staff number ten (10) and Staff number eleven (11). 54, A review of personnel files found Staff number three (3), Staff number four (4), and Staff number six (6), were hired on February 20, 2008, February 4, 2008, and February 9, 2008 respectively and had no background screening from Florida Department of Law Enforcement, nor any proof of submission of information to the Agency's Background Screening Unit within ten (10) days of the date the staff member was hired. 10 55. Areview of personnel records for Staff number seven (7), Staff number ten (10) and Staff number eleven (11) who were hired on February 4, 2008, February 9, 2008 and February 3, 2008 respectively and had a screening from Lee County Sheriff Department or Fort Myers Police Department with a time limited check which also was not statewide. 56. Areview of newly hired Staff number one (1) and Staff number two (2) hired on February 25, 2008 and March 3, 2008 also had screenings from Lee County Sheriff Department or Fort Myers Police Department with a time limited check which also was not statewide. 57. Aninterview with the administrator on March 4, 2008 at 2:30 p.m. revealed he was unaware of the need for Florida Department of Law Enforcement check, unaware the checks _ in the files were time limited and County/City limited and did not meet the requirements. 58. The Respondent’s deficient practice related to the operation and maintenance ofa facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 59. This Respondent’s deficient practice constituted a repeat Class III deficiency as provided by law. 60. The Agency shall impose an administrative fine for a cited Class TI violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 61. | The Respondent was given a mandatory correction date of April 4, 2008. 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 HUNDRED DOLLARS ($500.00) pursuant to Sections 400.23(8)(c) and 400.102, Florida il Statutes (2007). COUNT IV _ Respondent Failed To Ensure That All Meal Items Planned Had Appropriate Substitutions Planned And Noted Prior Or During Meal Service In Violation Of Rule 58A- 5.020(2)(d), Florida Administrative Code 62. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 63. Pursuant to Florida law, menus to be served shall be dated and planned at least one week in advance for both regular and therapeutic diets. Residents shall be encouraged to participate in menu planning. Planned menus shall be conspicuously posted or easily available to residents. Regular and therapeutic menus as served, with substitutions noted before or when the meal is served, shall be kept on file in the facility for six (6) months. Rule 58A-5.020(2)(4) Florida Administrative Code. 64. Onor about November 16, 2006 the Agency conducted a Biennial Survey of the Respondent’s facility. 65. Based on observation and review of the facility, posted and printed menu, and staff interview, the facility did not notify the residents of a substitution for the alternate entrée before or when the meal was served. 66. Areview of the facility's printed menu for Wednesday Week 1 listed Mashed Potatoes as the entrée. 67. | Anobservation of the daily menu posted in the Assisted Living Facility dining room at 9:45 a.m. and 12:15 p.m. revealed that mashed potatoes were listed as entrée. 68. During observation of the lunch meal at 12:30 p.m., it was observed that the staff had bought hash brown potato patties to serve as the entrée. A further review of the posted menu at 12:30 p.m. revealed that the staff had not changed the menu to reflect the change in the potatoes. 69. During an interview on November 16, 2006 at 5:00 p.m., when asked for a list of substitutions, the assistant administrator stated, "We don't have one and never have had one. You all were here and I didn't have time to make the mashed potatoes." She then stated, "I will start doing one immediately.” 70. The Respondent’s deficient practice related to the operation and maintenance of a facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class IJ violations, in violation of Section 429.19(2)(c), Florida Statutes(2007). 7h. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). ‘72. The Agency provided the Respondent with a mandatory correction date of December 16, 2006. 73. During a second Follow-Up visit on April 5, 2007 the Agency determined that the Respondent had corrected the deficiency. 74, Onor about August 14, 2007 the Agency conducted a Complaint Investigation (CCR# 2007-008699) of the Respondent’s facility. 75, Based on observation, the facility failed to document the substitutions being made for the noon meal and failed to ensure they were of comparable nutritional value. 76. The noon meal on August 14, 2007 was planned to be: Turkey, stuffing with gravy, buttered corn, tossed salad with dressing, strawberry jello and bread with butter. 77. The noon meal on August 14, 2007 was served to be: Pork roast, white rice, sausage gravy, ted beans, bread with butter, applesauce, and cupcake with vanilla frosting. 13 78. The substitutions were not documented by 12:30 after the meal was concluded. Substitutions failed to ensure the vitamin A in the corn was substituted with another vitamin A food. Applesauce was substituted for the tossed salad, which did not meet the second serving of a vegetable. A frosted cupcake was served for the strawberry jello, but the applesauce made up for the fruit. 79. The Respondent’s deficient practice related to the operation and maintenance ofa facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class I violations, in violation of Section 429,19(2)(c), Florida Statutes (2007). 80. This Respondent’s deficient practice constituted a repeat Class III deficiency as provided by law. 81. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 82. The Respondent was given a mandatory correction date of September 19, 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 SEVEN HUNDRED FIFTY DOLLARS ($750.00) pursuant to Sections 400.23(8)(c) and 400.102, Florida Statutes (2007). COUNT V Respondent Failed To Ensure The Non-Perishable Food Supply Contained The Required Amount Of Food On Hand At All Times In Violation Of Rule 58A-5.020(2)(h), Florida Administrative Code 83. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 14 84. Pursuant to Florida law, a three (3)-day supply of non-perishable food, based on the number of weekly meals the facility has contracted with residents to serve, and shall be on hand at all times. The quantity shall be based on the resident census and not on licensed capacity. The supply shall consist of dry or canned foods that do not require refrigeration and shall be kept in sealed containers which are labeled and dated. The food shall be rotated in accordance with shelf life to ensure safety and palatability. Water sufficient for drinking and food preparation shall also be stored, or the facility shall have a plan for obtaining water in an emergency, with the plan coordinated with and reviewed by the local disaster preparedness authority. Rule 58A- 5.020(2)(h), Florida Administrative Code. 85. Onor about August 14, 2007 the Agency conducted a Complaint Investigation (CCR# 2007-008699) of the Respondent’s facility. 86. Based on observation, the facility failed to maintain a three (3) day emergency food supply. 87. On August 14, 2007 at 10:30 a.m. the food supply was reviewed and the following found: Protein needed 6 oz. x 16 residents x 3 days equals 288 oz. Protein on hand: Tuna 133 oz. Peanut Butter 70 02. total 203 oz. Vegetables needed 12 oz. x 16 residents x 3 days equals 576 02. Vegetables on hand: Red beans 312 oz. Spinach 27 oz. Hominy 15 oz. Tomato Sauce 214 oz. Refried beans 31 oz. total 599 oz. Fruits needed 8 oz. x 16 residents x 3 days equals 384 oz. 15 Fruits on hand: Mandarin oranges: 8 oz. Applesauce 216 oz. Apple butter 28 oz. total 252 02. 88. All non-perishable food on the premise was counted. The protein and fruit were found to be inadequate. The vegetable was only adequate by counting the tomato sauce. One (1) cup of tomato sauce would make a poor vegetable serving in an emergency. Supper had not been made at the time of the food count. 89. The Respondent’s deficient practice related to the operation and maintenance ofa facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 90. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 91. The Agency provided the Respondent with a mandatory correction date of September 14, 2007. 92. Onor about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent facility. 93. Based on observation, the facility failed to ensure the non-perishable food supply contained the required amount of food on hand at all times on March 4, 2008. 94. The facility had a current census of sixteen (16) residents on March 4, 2008. 95. The needed fruit supply was calculated to be 384 ounces. No non-perishable fruit was on hand on the day of the survey. 96. The needed milk supply was calculated to be 96 eight ounce servings. The 16 facility had one box of instant milk (87 servings). The facility used powered milk as their milk supply. 97. The Respondent’s deficient practice related to the operation and maintenance of a facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 98. This Respondent’s deficient practice constituted an uncorrected Class III deficiency as provided by law. 99. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 100. The Respondent was given a mandatory correction date of April 4, 2008. 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 HUNDRED DOLLARS ($500.00) pursuant to Sections 400.23(8)(c) and 400.102, Florida Statutes (2007). COUNT VI ; Respondent Failed To Ensure That Staff Who Are Responsible For Medications Have A Two (2) Hour Medication Course Update Annually In Violation Of Rule 58A-5.0191(5)(c), And Rule 58A-5.024(2)(a)1 Florida Administrative Code 101. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 102. Pursuant to Florida law, unlicensed persons who will be providing assistance with self-administered medications as described in Rule 58A-5.0185, Florida Administrative Code, must receive a minimum of four (4) hours of training prior to assuming this responsibility. 17 Courses provided in fulfillment of this requirement must meet the following criteria: Unlicensed persons, as defined in Section 429.256(1)(b), Florida Statutes, who provide assistance with self- administered medications and have successfully completed the initial four (4) hour training, must obtain, annually, a minimum of two (2) hours of continuing education training on providing assistance with self-administered medications and safe medication practices in an assisted living facility. The two (2) hours of continuing education training shall only be provided by a licensed registered nurse, or a licensed pharmacist. Rule 58A-5.0191(5)(c), Florida Administrative Code. Personnel records for each staff member shall contain, at a minimum, a copy of the original employment application with references furnished and verification of freedom from communicable disease including tuberculosis. In addition, records shall contain the following, as applicable, Documentation of compliance with all staff training required by Rule 58A-5.0191, Florida Administrative Code. Rule 58A-5.024(2)(a)1, Florida Administrative Code. 103. Onor about November 15, 2006 the Agency conducted a Biennial Survey of the Respondent’s facility. 104. Based upon record review and interview it was determined the administrator failed to obtain a minimum of two (2) hours continuing education training on providing assistance with self administered medications and safe medication practices in an Assisted . Living Facility. 105. During a review of the administrator's Employee file on November 16, 2006 at about 9:30 a.m. the surveyor could not find any documentation the administrator obtained a minimum of two (2) hours continuing education training on providing assistance with self administered medications and safe medication practices in an Assisted Living Facility. 106. Inan interview on November 16, 2006 at about 11:45 a.m. the administrator was 18 asked if there was any documentation that he had obtained two (2) hours of continuing education assistance with self administered medications. 107. The administrator was provided an opportunity to provide the surveyor with the required documentation. 108. At about 4:30 p.m. on November 16, 2006, the administrator was again asked if he had any other continuing education documentation for self administered medication continuing education. The administrator indicated he did not have any documentation to provide. 109. The Respondent’s deficient practice related to the operation and maintenance of a facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 110. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 111. The Agency provided the Respondent with a mandatory correction date of December 16, 2006. 112. During a Follow-Up visit on December 28, 2006 the Agency determined that the Respondent had corrected the deficiency. 113. Onor about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 114. Based on record review and interview, the facility failed to ensure that staff who are responsible for medications have a two (2) hour medication course update annually for three (3) of three (3) staff employed over 365 days, Staff number five (5), Staff number eight (8) and 19 Staff number nine (9). 115. A review of personnel records found Staff number five (5), Staff number eight (8) and Staff number nine (9) lacked documentation of the two (2) hour medication update training, which is required annually, in their files. Staff number five (5) had a course in 2006, lacked one in 2007 and took another in February 2008. Staff number eight (8) had training in February 2007, yet lacked an update before March 2008. Staff number nine (9) had documentation of an update in November 2006 and none since. 116. Areview of the work schedule with the administrator verified that Staff number five (5), Staff number eight (8) and Staff number nine (9) were all responsible for medications. 117. The Respondent’s deficient practice related to the operation and maintenance of a facility or to the personal care of residents which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of facility residents, other than Class I or Class II violations, in violation of Section 429.19(2)(c), Florida Statutes (2007). 118. This Respondent’s deficient practice constituted a repeat Class Ill deficiency as provided by law. 119. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 120. The Respondent was given a mandatory correction date of April 4, 2008. 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 HUNDRED DOLLARS ($500.00) pursuant to Sections 400.23(8)(¢) and 400.102, Florida Statutes (2007). 20 COUNT VII Assessment of Survey Fee 121. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5) and the allegations in Count I, Count II, Count III, Count IV, Count V, and Count VI. 122. The Agency received a complaint about the Respondent. 123. In response to the complaint, the Agency conducted a Complaint Survey (CCR# 2008-002655) of the Respondent and its facility on March 4, 2008. 124. Asa result of the Agency’s Complaint Survey, the Respondent was cited for a deficiency for the complaint. 125. The basis for the deficiency alleged in this Administrative Complaint relates to the complaint against the Respondent and its Facility. 126. Pursuant to Section 429.19(10), 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 $500.00, to cover the cost of conducting the initial complaint investigation that resulted in the finding of a violation that was the subject of the complaint, or for monitoring visits conducted under Section 429.28(3)(c), Florida Statutes (2007), to verify the correction of the violations. 127. Inthis case, the Agency is authorized to seek a survey fee of $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: 21 1. Enter findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the total amount of THREE THOUSAND SEVEN HUNDRED FIFTY DOLLARS ($3,750.00). 3. Order any other relief that the Court deems just and appropriate. Respectfully submitted this Q9™ aay of erece _, 2008. CURT Were on. Loy: : Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 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. 22 4, we eS CERTIFICATE OF SERVICE ”, SA "A, I HEREBY CERTIFY that a true and correct copy of the Administra oC Election of Rights form were served to: Peter Kramer, Administrator, Westwood Manor, 2359 ere Hoople Street, Fort Myers, Florida 33901, by U. S. Certified Mail, Return Receipt No. 7006 4760-0003 1537 3143, on this_2**™ day of __ Vu 2008. QnSree WU. Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 Copies furnished to: [ Peter Kramer Andrea M. Lang, Senior Attorney Administrator Agency for Health Care Administration Westwood Manor Office of the General Counsel 2339 Hoople Street 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Fort Myers, Florida 33901 (U.S. Certified Mail) (Interoffice Mail) John F. Gilroy III, P.A. Harold D. Williams Counsel for Respondent Field Office Manager 1435 East Piedmont Drive, Suite 215 Agency for Health Care Administration Tallahassee, Florida 32308 2295 Victoria Avenue, Room 340A (U. S. Mail) Fort Myers, Florida 33901 (Interoffice Mail) I 23 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY B. Received by (Printed Name) D. Is delivery address different from item 1? Yes if YES, enter delivery address below: [I No ™ Complete items 4, 2, and 3, Also complete iter 4 if Restricted Delivery is desired. - Print your name and address on the reverse : | so that we-can return the card to you. - lf Attach this card to the back of the mailpiece, or on the front if space permits. © : 1. Atticle Addressed to: 200 900 % - Peer Kramer, Admin isha Westuaad Manor 2389 Hoople Street (Fart myers, Florid 3390/ C. Date of Delivery 3. Service Type 0 Certified Mall [© Express Mail O Registered 1 Return Receipt for Merchandise C Insured Mail OC.0.D. > 2. Article Number PEP i Trance omsenicolabo) 200 2740 0003 1537 3243 ; PS Form 3811, February 2004 : Domestic Return Receipt 102595-024

Docket for Case No: 08-004919