STATE OF FLORIDA STATE OF FLORIDA, OX S C U ‘4 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Fraes No. 2008010271 NORTHWEST CARE CENTRE, INC., d/b/a NORTHWEST CARE CENTRE III, 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, Northwest Care Centre, Inc., d/b/a Northwest Care Centre III (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2008), and alleges as follows: NATURE OF THE ACTION This is an action against an assisted living facility to revoke its license, impose an administrative fine in the amount fifteen thousand dollars ($15,000.00), and assess a survey fee of five hundred dollars ($500.00) based upon three class II violations. JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.60 and 120.57, Florida Statutes (2008). 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 (2008). 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 state statutes and rules governing such facilities. Ch. 408, Part II, Ch. 429, Part I, Fla. Stat. (2008); 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. (2008). 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. (2008). 5. The Respondent was issued a license by the Agency (License Number 8425) to operate a 16-bed assisted living facility located at 802 71st Street, N.W., Bradenton, Florida 34209, and was at all material times required to comply with the applicable 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 under-takes 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. (2008). 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 I (Revocation of License The Respondent Committed An Intentional Or Negligent Act Materially And/Or Seriously Affecting The Health, Safety, Or Welfare Of A Resident Of The Facility, In Violation Of F.S. 429.14(1)(a) And F.S. 408.815(1)(b) Was Cited By The Agency For Three Or More Class II Deficiencies In Violation Of F.S. 429.14(1)(e) And Violated The Authorizing Statutes and Applicable Rules For Assisted Living Facilities In Violation Of F.S. 408.815(1)(c) 6. Under Florida law, in addition to the requirements of part II of chapter 408, the Agency may deny, revoke, and suspend any license issued under this part and impose an administrative fine in the manner provided in chapter 120 against a licensee of an assisted living facility for a violation of any provision of this part, part II of chapter 408, or applicable rules, or for any of the following actions by a licensee of an assisted living facility, for the actions of any person subject to level 2 background screening under Section 408.809, Florida Statutes, or for the actions of any facility employee: (a) An intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility. ... (e) A citation of any of the following deficiencies as defined in Section 429.19, Florida Statutes: 1. One or more cited class I deficiencies. 2. Three or more cited class II deficiencies. 3. Five or more cited class III deficiencies that have been cited on a single survey and have not been corrected within the times specified. § 429.14(1)(a), (e), Fla. Stat. (2008). 7.° Under Florida law, in addition to the grounds provided in authorizing statutes, grounds that may be used by the Agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest: ... (b) An intentional or negligent act materially affecting the health or safety of a client of the provider. and (c) A violation of the Florida Health Care Licensing Procedures Act, authorizing statutes, or applicable rules. § 408.15(1)(b)-(c), Fla. Stat. (2008). 8. The Agency re-alleges and incorporates by reference Counts II through IV. 9. The Respondent committed an intentional or negligent act materially and/or seriously affecting the health, safety, or welfare of a resident of the facility. 10. | The Respondent was cited by the Agency for three or more class II deficiencies in its complaint survey. 11. The Respondent violated the authorizing statutes and applicable rules for assisted living facilities. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to recommend the revocation of the Respondent’s license to operate an assisted living facility. COUNT Il (Tag 429 The Respondent Failed To Ensure The Continued Appropriateness Of Its Residents In Violation Of F.A.C. 58A-5.0181(4) 12. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 13. Under Florida law, the assisted living facility administrator is responsible for monitoring the continued appropriateness of placement of a resident in the facility. Fla. Admin. Code R. 58A-5.0181(4)(d). 14. Under Florida law, the owner or administrator of a facility is responsible for determining the appropriateness of admission of an individual to the facility and for determining the continued appropriateness of residence of an individual in the facility. A determination shall be based upon an assessment of the strengths, needs, and preferences of the resident, the care and services offered or arranged for by the facility in accordance with facility policy, and any limitations in law or rule related to admission criteria or continued residency for the type of license held by the facility under this part. A resident may not be moved from one facility to another without consultation with and agreement from the resident or, if applicable, the resident's representative or designee or the resident's family, guardian, surrogate, or attorney in fact. In the case of a resident who has been placed by the Department of Elder Affairs or the Department of Children and Family Services, the administrator must notify the appropriate contact person in the applicable department. § 429.26(1), Fla. Stat. (2008). 15. On or about August 1, 2008, the Agency conducted a complaint survey of the Respondent and its Facility (CCR#2008009139). 16. Based upon record review and interview, the Administrator failed to monitor the continued appropriateness of placement of residents for 2 of 4 residents (Residents #1 and #2). 17. A record review on August 1, 2008, revealed that Resident #1 had diagnoses that included Schizophrenia, mental retardation and autism. 18. A staff interview on this date at approximately 1:50 p.m. revealed that Resident #1 was noncommunicative. 19. Resident #1 was a walker and would pace-walk all the time. 20. Resident #1’s mode of communication was to pull on people to get them to walk with him or her. 21. Resident #1’s pulling was so intrusive to some people that the Facility placed a 1:1 staff member/companion with the Resident during the daytime. 22. A record review of Resident #2, who was the roommate of Resident #1, revealed that Resident #2 was diagnosed with Down's Syndrome and chronic impaired mental retardation and was physically aggressive. 23. During a staff interview on this date at approximately 11:00 a.m. it was revealed that Resident #2 was not typically aggressive, but would defend himself or herself if his or her boundaries were violated. 24. Resident #2 had been known to fight, but not initiate fights. 25. Resident #2 was afraid of the Resident #1. 26. . An Adult Protctive Services Investigator from the Department of Children and Families was at the Facility to investigate incidents between the two residents, which resulted in injury to Resident #1. 27. Resident #1’s injuries included two black eyes, bruises on the body and a fracture of the femoral neck of the right femur. 28. A record review revealed that the Adult Protective Services Investigator wrote a letter dated July 15, 2008, to the Facility stating that these two residents should be separated as soon as possible due to their extensive behavior problems. 29. The Adult Protective Services Investigator made clear to the Facility: “These two residents should not be placed in the same room. These two residents should be placed in rooms with no other residents as soon as possible.” 30. Despite this letter, the Facility did not move the residents into separate rooms and did not separate them. 31. On July 29, 2008, at approximately 8:00 a.m., Resident #1 was found dead in his bed. . 32. During an interview with the Administrator on August 1, 2008, at 3:00 p.m., she stated that they had talked about separating Resident #1 from Resident #2, but did not get to it because the Facility did not have any private rooms. 33. They had also considered discharging Resident #1, but had not done so. 34. During an interview with Resident #2 on August 1, 2008, he or she stated that he or she “didn’t want a roommate anymore.” 35. | The Respondents’ actions and/or inactions constituted a class II violation. 36. 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. (2008). 37. 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. (2008). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to recommend an administrative fine against the Respondent in the amount of five thousand dollars ($5,000.00). COUNT Il (Tag 706 The Respondent Failed To Provide Care And Services Appropriate To The Needs Of Residents Accepted For Admission To The Facility And Failed To Contact The Resident’s Health Care Provider When Required In Violation Of F.A.C. 58A-5.0182 38. | The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 39. | Under Florida law, an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. Fla. Admin. Code R. 58A-5.0182. 40. | Under Florida law, assisted living facilities shall offer personal supervision, as appropriate for each resident, including: contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out. Fla. Admin. Code R. 58A-5.0182(1)(d). 41. Under Florid law, “significant change” means a sudden or major shift in behavior or mood, or a deterioration in health status such as unplanned weight change, stroke, heart condition, or stage 2, 3, or 4 pressure sore. Ordinary day-to-day fluctuations in functioning and behavior, a short-term illness such as a cold, or the gradual deterioration in the ability to carry out the activities of daily living that accompanies the aging process are not considered significant changes. Fla. Admin. Code R. 58A-5.0131(33). 42. On or about August 1, 2008, the Agency conducted a complaint survey of the Respondent and its Facility (CCR#2008009139). 43. Based upon interview, the Respondent failed to notify the health care provider of a significant change for 1 of 4 sampled residents (Resident #1). 44. During an interview with the House Manager on August 1, 2008, at 2:00 p.m., she stated that on July 26, 2008, Resident #1 was quieter than usual. 45. The Resident's normal activity was a constant pacing/walking. 46. On July 26, 2008, however, she noted that the Resident was sitting naked and was withdrawn. The Resident did not want to eat. 47. She stated that the Resident appeared yellow and "just out of it.” 48. She stated that she told a co-worker, who notified the Director of Nursing (DON). 49. During an interview with the DON on August 1, 2008, at 2:40 p.m., she denied that she had been told of the change of consciousness and behavior in Resident #1. 50. The Resident’s doctor was not notified of the Resident’s significant changes. 51. There were no progress notes or any information written about the Resident’s significant changes. 52. The Respondents’ actions and/or inactions constituted a class II violation. 53. 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. (2008). 54. | 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. (2008). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to recommend an administrative fine against the Respondent in the amount of five thousand dollars ($5,000.00). COUNT IV (Tag 718) The Respondent Failed To Ensure The Residents’ Right To Live In A Safe And Decent Living Environment, Free From Abuse And Neglect, And To Be Treated With Consideration, Respect And With Due Recognition Of Personal Dignity In Violation Of Section F.S. 429.28(1)(a)-(b) 55. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 56. Under Florida law, no resident of an assisted living facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to live in a safe and decent living environment, free from abuse and neglect and be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy. § 429.28(1)(a)-(b), Fla. Stat. (2008). 57. On or about August 1, 2008, the Agency conducted a complaint survey of the Respondent and its Facility (CCR#2008009139). 58. Based upon record review and interview, the Respondent failed to provide its residents a safe and decent living environment free from abuse and neglect and failed to treat its residents with due recognition of their personal dignity, individuality and the need for privacy, for 1 of 4 residents sampled (Resident #1). 59. A record review revealed that Resident #2 gave Resident #1 a black eye on June 23, 2008, Resident #1's first night of admission. 60. On June 24, 2008, Resident #1 had another black eye and bruises that were evident on his or her body. 61. The Facility staff stated that they had spoken with Facility administration about the incidents, which continued for about one week, with Resident #1 sustaining more bruises on a daily basis. 62. A record review revealed that an Adult Protective Services Investigator from the Department of Children and Families wrote a letter dated July. 15, 2008, to the Facility stating that these two residents should be separated as soon as possible due to their extensive behavior problems. 63. During an interview with the House Manager on August 1, 2008, at approximately 2:00 p.m., she stated that on July 29, 2008, at 6:45 a.m., she went to awaken the Resident's roommate. 64. At that time, Resident #1 looked at the staff member, "just looked at me." 65. She returned at approximately 7:45 a.m. to get Resident #1 and found him or her with froth coming out of his or her mouth. 66. She checked for a pulse and found none. 67. She called 911 and the Administrator. 68. | When questioned as to if she initiated CPR, she confirmed that she did not and said that she just panicked and all she thought of was calling 911 and the Administrator. 69. Resident #1 died in bed. 70. The Respondents’ actions and/or inactions constituted a class II violation. 71. 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. (2008). 72. 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. (2008). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to recommend an administrative fine against the Respondent in the amount of five thousand dollars ($5,000.00). COUNT V Assessment of Survey Fee 73. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 74. The Agency re-alleges and incorporates by reference Counts I through III. 75. The Agency received a complaint about the Respondent. 76. In response to the complaint, the Agency conducted a complaint survey of the . Respondent and its Facility. 77. As aresult of the complaint survey, the Respondent was cited for a violation. 78. The basis for the violation alleged in this Administrative Complaint relates to the complaint made against the Respondent and its Facility. 79. Under Florida law, in addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one half of the 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. (2008). 80. In this particular instance, the Agency is entitled to assess a survey fee against the Respondent in the amount of five-hundred dollars ($500.00). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to recommend 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. Recommend the revocation of the Respondent’s license. 3. Recommend an administrative fine against the Respondent in the total amount of $15,000.00. 4. Recommend a survey fee against the Respondent in the amount of five hundred 12 dollars ($500.00). 5. Order any other relief that the Court deems just and4 Respectfully submitted on this 29th day of Septembe 771 Thomas M. Hoeler, Sechior“Attomey Florida Bar No. 709311 Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 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 was served to: Vicky Washington, Administrator, Northwest Care Center ITI, 802 71st Street, N.W., Bradenton, Florida 34209, by U.S. Certified Mail, Return Receipt No. 7004 1350 0004 2776 0130, and Gregory C. Meissner, Esquire, Registered Agent, Copies furnished to: Florida Bar No. 70931 Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 Vicky Washington, Administrator Northwest Care Center III 802 71st Street, N.W. Bradenton, Florida 34209 (U.S. Certified Mail) Thomas M. Hoeler, Senior Attorney | Agency for Health Care Administration Office of the General Counsel 525 Mirror Lake Drive North, Suite 330 St. Petersburg, Florida 33701 (Interoffice) Gregory C. Meissner, Esquire Registered Agent Northwest Care Centre, Inc. 1111 3rd Avenue West, Suite 150 Bradenton, Florida 34205 (U.S. Mail) Kathleen Varga Facility Evaluator Supervisor Agency for Health Care Administration 525 Mirror Lake Drive North, 4th Floor St. Petersburg, Florida 33701 (nteroffice) A, Florida 34205, by SENDER: COMPLETE Ti ™@ Complete items 1, 2, and 3, Aiso complete item 4 if Restricted Delivery is desired. ~ @ Print your name and address on the reverse so that we can return the card to you. _ @ Attach this card to the back of the mailpiece, ‘or on the front if space permits. : 1. Article Addressed to: i COMPLETE THIS SECTION Qg A. Signature XS B, Received by (Printed Name) . ek Meh roe _| D. Is delivery address different from item 17 (1 Yes If YES, enter delivery address below: 0 No Vicky Washington, Administrator © Northwest Care Center IIT 802 71st Street, N.W. 3. Service Type : Oo Qo Bradenton, Florida 34209 fa Regier’ ral Ralorn Receipt for Merchandise Cl Insured Mail =. C.0.D. : 4. Restricted Delivery? (Extra Fee) C1 Yes aa aoo4 1350 0004 2776 0430__ TH soo Yolo 27 le PS Form 3811, February 2004 Domestic Return Receipt “ 102595-02-M-1540

Docket for Case No: 08-005448