STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, e \- God AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Fraes Nos. 2008012403 2008012404 NORTHWEST CARE CENTRE, INC., d/b/a NORTHWEST CARE CENTRE HI, 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 IH (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 twenty thousand dollars ($20,000.00) and assess a survey fee of five hundred dollars ($500.00) based upon one class I violation and two 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 0, 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) Violated The Authorizing Setutes and Applicable Rules For Assisted Living Facilities In Violation Of F.S. 408.815(1)(c) 6. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 7. 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) 1. One or more cited class 1 deficiencies. 2. Three or more cited class II deficiencies. 3. Five or more cited class I] 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). 8. 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). 9. The Agency re-alleges and incorporates by reference Counts II through IV. 10. The Respondent committed an intentional or negligent act materially and/or ’ seriously affecting the health, safety, or welfare of a resident of the facility. 11. The Respondent was cited for one or more cited class I deficiencies. 12. 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 seeks the revocation of the Respondent’s license to operate an assisted living facility. COUNT II (Tag 429 The Respondent Failed To Ensure The Continued Appropriateness Of Its Residents In Violation Of F.A.C. 58A-5.0181(4) 13. | The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 14, Under Florida Jaw, 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). 15. | 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 an 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). 16. | On or about September 9, 2008, the Agency conducted a revisit of a complaint survey of the Respondent and its Facility (CCR 2008009139). 17. Based upon record review and interview, the Administrator failed to monitor the continued appropriateness of resident placements for 1 of 11 residents reviewed (Resident #6), in terms of the Resident being a danger to himself or herself or a danger to other residents in the Facility. 18. Resident #6 had diagnoses of Down's Syndrome and chronic impaired mental retardation and was physically aggressive. 19. The Facility records described Resident #6 as irritable when he or she does not get what he or she wants. 20. Resident #6 has a history of setting fires, and in the past, has set fire to paper in the trash can in the bathroom using a lighter. 21. Resident #6 is a smoker,and has lit a cigarette at a gas station in the past. 22. On September 23, 2008, the Resident was observed with two packs of cigarettes and a lighter. 23. | The House Manager saw this and took the lighter away from the Resident saying that he or she was not supposed to have a cigarette lighter on his or her person. 24, The House Manager also stated that she has awakened in the early morning hours and found Resident #6 outside smoking in the dark, which scared her. 25. The Facility has no staff awake at night to supervise residents who may be up at night, such as this resident, who wakes up’in the middle of the night to smoke. 26. During an interview with the Operations Manager at approximately 8:30 a.m., it was revealed that Resident #6 "never sleeps" and has a "problem with lighters." 27. The Facility records revealed that on June 19, 2008, the staff found Resident #6 naked in bed with his or her roommate. 28. The room was then changed and Resident #6 was assigned a new roommate. 29. The Facility records revealed that there have been violent altercations between Resident #6 and other residents where staff intervened to separate the residents. 30. Per Facility records, on July 3, 2008, Resident #6 hit another resident in the face due to being angry and because he or she had no cigarettes. 31. The propensity for violence, as well as this documented behavior, put the lives and well-being of this Resident and other residents in jeopardy, and demonstrated that Resident #6 was not appropriate for continued assisted living facility placement. 32. The Respondents’ actions and/or inactions constituted a class II violation. 33. 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). 34. | The Agency shall impose an administrative fine for a cited class IT 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 seeks an administrative fine against the Respondent in the amount of five thousand dollars ($5,000.00). _ COUNT IM (Tag 429) The Respondent Failed To Ensure The Continued Appropriateness Of Its Residents In Violation Of F.A.C. 58A-5.0181(4) 35. | The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 36. 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). 37. 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 an 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). 38. On or about October 18, 2008, the Agency conducted a complaint survey of the Respondent and its Facility (CCR 200801 1866). 39, Based upon record review and interview, the Administrator failed to monitor the continued appropriateness of resident placements for 1 of 3 residents reviewed (Resident #1), in that the Resident was identified to be at risk of consuming potentially harmful liquids, and had incidents of drinking dangerous substances. 40. A review of the record of Resident #1 found that he or she had been admitted into the Facility on April 3, 2007. 41. The Resident’s initial health assessment completed on April 19, 2007, identified the Resident's diagnosis of bipolar disorder, mental retardation, and epilepsy. 42. The Resident was assessed as independent in ambulation, toileting, eating, and transferring, and identified the Resident as requiring assistance with bathing and dressing. 43. | Under the category cognitive or behavioral, the Resident’s health assessment documented: "ingestion of non-nutritive liquids, stealing, verbal aggression, aggression to property.” . ' 44. A telephone interview with a family member of the Resident found the Resident had exhibited such behavior while living at home in the community and that staff had been informed of the risk that the Resident would consume inappropriate liquids. 45. According to Facility records, on June 5, 2007, that the Resident consumed a portion of Fabuloso cleanser, which made the Resident ill. 46. After this incident, the staff removed chemical liquids from access by residents. 47. On October 17, 2008, the Resident drank a substantial quantity of mouthwash containing alcohol. 48. During an interview of the Administrator on October 18, 2008, at approximately 10:30 a.m., she stated that the Facility staff had not considered mouthwash to be a potentially hazardous item. . 49. According to a publication in Pediatrics for Parents: “Most parents don't realize that mouthwash can contain more alcohol than beer or wine. Popular brands of mouthwash are 6.6% to 26.9% alcohol. Beers are usually 5% to 7% alcohol, wine is 12% to 14%. ... When swallowed in large quantities, mouthwash can cause seizures, brain damage, and death.” 50. After the event, mouthwash was removed from access by the other residents, the Facility staff was retrained on hazardous liquids which posed risk to residents and the residents were reassessed regarding the potential for ingestion of inappropriate substances. 51. In this case, the privilege of having health care liquids such as mouthwash in their rooms was denied to residents to ensure the safety of one resident. 52. Despite the Resident’s health assessments, given the Resident’s subsequent and continued behavior which alerted the Respondent that the Resident was at risk for self-harm and given the Facility’s practice of allowing other residents to have liquids such as mouthwash in their own rooms, the Resident’s continued placement in the Facility was inappropriate. 53. A tour of the Facility on October 18, 2008, at 10:15 a.m., found no potentially hazardous liquids accessible to residents. , . 54. | No mouthwash was in any resident room or bathroom. 55. The Respondents’ actions and/or inactions constituted a class II violation. 56. 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). 57. 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 secks an administrative fine against the Respondent in the amount of five thousand dollars ($5,000.00). COUNT IV (Tag 701 The Respondent Failed To Provide Appropriate Monitoring, Observation and Supervision Of Its Residents In Violation Of F.A.C. 58A-5.0182 58. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 59. 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. Assisted living facilities shall offer personal supervision, as appropriate for each resident, including the following: (a) Monitor the quantity and quality of resident diets in accordance with Rule 58A-5.020, Florida Administrative Code. (b) Daily observation by designated staff of the activities of the resident while on the premises, and awareness of the general health, safety, and physical and emotional well-being of the individual. (c) General awareness of the resident’s whereabouts. The resident may travel independently in the community. (d) 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. (e) A written record, updated as needed, of any significant changes as defined in 58A-5.0131(33), Florida Administrative Code, any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services. Fla, Admin, Code R. 58A-5.0182(1)(a)-(e). 60. On or about October 18, 2008, the Agency conducted a complaint survey of the Respondent and its Facility (CCR 2008011866). 61. Based upon record review and interview, the Respondent failed to provide appropriate monitoring, observation and supervision for 1 of 3 residents sampled (Resident #1), who was identified as being at risk for consuming harmful liquids, and had prior incidents of drinking dangerous substances which was known to the Facility. 62. The Agency re-alleges and incorporates by reference paragraphs 40 through 46. 63. On October 17, 2008, while at the Facility, the Resident drank a substantial quantity of mouthwash containing alcohol. . 64. As a result, the Resident passed out at the Facility. The Facility had to call 911 and summon emergency medical services for the Resident. 65. The Resident was rushed to a local hospital emergency room by emergency services personnel. 5 66. A review of the local hospital emergency room documentation revealed that the Resident arrived at the emergency room on October 17, 2008, at 9:17 a.m., with the complaint of ingestion and alcohol intoxication. 67. The Resident was unresponsive at the emergency room and placed on a ventilator. 68. Testing in the hospital emergency room documented that the Resident’s blood alcohol level was 0.42. . 69. Additional emergency room documentation revealed that the hospital staff had spoken with the Facility’s DON and that the DON stated that an empty 1.75 liter bottle of mouthwash was found in Resident's room. The mouthwash was 26.9% alcohol by volume. 70. The Resident was treated and stabilized in the hospital and later discharged to his or her family home. 71. During an interview with the Facility Administrator on October 18, 2008, at approximately 10:30 a.m., she stated that the Facility staff had not considered mouthwash to be a potentially hazardous item. 72. The failure of the Facility staff to monitor, observe and supervise the Resident, knowing the Resident’s past behavior of attempting to drink inappropriate liquids while at the Facility, resulted in the Resident being hospitalized. 73. The Respondents’ actions and/or inactions constituted a class I violation. 74. Class "I" 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 present an imminent danger to the residents or guests of the facility or a substantial probability that death or serious physical or emotional harm would result therefrom. The condition or practice constituting a class I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by the Agency, is required for correction. The Agency shall impose an administrative fine for a cited class I violation in an amount not less than $5,000 and not ~ exceeding $10,000 for each violation. A fine may be levied notwithstanding the correction of the violation. § 429.19(2)(a), Fla. Stat. (2008). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of ten thousand dollars ($10,000.00). COUNT V Assessment of Survey Fee 75. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 76. The Agency re-alleges and incorporates by reference Counts III through IV. 77. The Agency received a complaint about the Respondent. 78. In response to the complaint, the Agency conducted a complaint survey of the Respondent and its Facility. 79. Asaresult of the complaint survey, the Respondent was cited for a violation. 80. The basis for the violation alleged in this Administrative Complaint relates to the complaint made against the Respondent and its Facility. 81. | 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). 82. 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 seeks 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 seeks an order that: 1. Makes findings of fact and conclusions of law in favor of the Agency. 2. Revokes the Respondent’s license. 3. Imposes an administrative fine against the Respondent in the total amount of twenty thousand dollars ($20,000.00). 4. Assesses a survey fee against the Respondent in the t of five hundred dollars ($500.00). Respectfully submitted on this 5th day of November, 20; Thomas M. Hoeler, Senior Attorney 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 were served to: Vicky K. Washington, Administrator, Northwest Care Center III, 802 71st Street N.W., Bradenton, Florida 34209, by USY Receipt No. 7007 1490 0001 6979 1519, and Gregory C. on e, 5 Thomas M. Hoeler, Senrof Attorney 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 Copies furnished to: Vicky K. Washington, Administrator Northwest Care Center III 802 71st Street N.W. Bradenton, Florida 34209 (U.S. Certified Mail) Gregory C. Meissner, Esquire Registered Agent Northwest Care Centre, Inc, 1111 3rd Avenue West, Suite 150 Bradenton, Florida 34205 Pamela Anne Thomas, Esquire Holland & Knight, LLP Post Office Drawer 810 Tallahassee, Florida 32302-0810 Thomas M. Hoeler, Senior Attorney Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330 St. Petersburg, Florida 33701 (Interoffice) Kathleen Varga Facility Evaluator Supervisor Agency for Health Care Administration 525 Mirror Lake Drive North, 4th Floor St. Petersburg, Florida 33701 (Interoffice) SENDER: COMPLETg OnLON DELIVERY @ Complete Items 1, 2, an. v. Also compiete item 4 if Restricted Delivery is desired, @ Print your name and address on the reverse COMPLETE THIS SECT! so that we can return the card to you. § Attach this card to the back of the malipisce, ‘or on the front If space permits. 1. Article Addressed to: Vicky Washington, Administrator Northwest Care Center II 802 71st Street, N.W. Bradenton, Florida 34209 : ” Express Mail Ci Registered 2) Return Receipt for Merchandise Ocoo. Ol ves z - tm 700? 1490 o001 £974 1514 ROOFH (2 to¢ PS Form 3811, February 2004 Domestic Return Receipt _. _ 102505-02.81540 U.S. Postal Service: RTIFIED MAIL., RECEIPT Imestic Mail Only; No insurance Coverage Provit For delivery information visit our website at www.usps.coms OFFICIAL USE Cn Retum Recelpt Fee {Endorsement Required) Restricted Delivery Fee (Endorsement Required) | ™ Vicky Washington, Administrator 3) Northwest Care Center IIT Si BO2 7st Street, N.W. - Ss; Bradenton, Florida 34209 . 700? 1490 0002 6979 1514 PS Form 3800, August, 2006 Sée Heverse for Instructions

Docket for Case No: 08-006049