STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY Fi OR HEALTH CARE ADMINISTRATION, Petitioner, O 1 -() ole Case No. 200801 4027 vs, A. & J. OF PALATKA, INC., d/b/a/ ARLINGTON HOUSE ACLF, Respondent, eee ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against ARLINGTON HOUSE ACLF, INC. ,(hercinatter Respondent), pursuant to Section 120.569, and 120.57, Florida Statutes, (2008), and alleges: NATURE OF THE ACTION "This is an action ta revoke the Respondent’s license to operate an assisted living facility (Count III) and impose an administrative fine of ten thousand dollars ($10,000.00) based upon two (2) State Class I deficiencies (Counts I through ID), pursuant to §429.14 (1)(a)(e), 429.19(2)(a), and 429.28, Florida Statutes (2008), JURISDICTION AND VENUE 1 The Agency has jurisdiction pursuant to §§ 20.42, 120.60, 408 Part TT and 429 Part 1, Florida Statutes (2008). 2. Venue lies pursuant 1o Florida Administrative Code R. 28-106,207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living 710/200‘ ~ 20:LL (NOW) 9002-62-330 facilities and enforcement of all applicable state statutes and rules governing assisted living facilities pursuant to Chapter 408 Part IL, Chapter 429, Part I, Florida Statutes (2008), and Chapter 584-5, Florida Administrative Code, respectively. 4. Respondent operates a 150-bed assisted living facility located at 203 S, Moody Road, Palatka, Florida 32117, and is licensed as an assisted living facility, license number 7349, 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNTI 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. That pursuant to Florida law, the Assisted Living Facility shall: 1) provide care and services appropriate to the necds of residents accepted for admission to the facility, 2) offer personal supervision, as appropriate for each resident, including, 3) a general awarencss of the resident’s whereabouts. Florida Administrative Code 58A-5.0182 CX) 8. That on December 3, 2008, the Agency conducted an unannounced Appraisal Survey of the Respondent to determine the facility compliance with Chapier 429, Part 1, Florida Statutes and Chapter 58A-S, Florida Administrative Code. 9. That based on review of the adverse incident reports-and interview the facility failed to ensure that staff provided Resident #1 appropriate supervision to protect the © resident from abuse. Failure to appropriately residents placcs the residents at risk for continued abuse and or psychosocial harm. The findings were as follows: a A review of the facility's adverse incident report dated 11/21 108 revealed that on 11/21/08 Resident #1 filed a complaint against the Acting Administrator PlO/E00 d 20: Ll (NON}8002-62-340 (“M.M.”) for sexual abuse that occurred one weekend in September 2008 at the Acting Administrator's home, b. Review of the medication observation record (MOR) for the month of Scptember 2008 revealed that Resident #1 was out on pass September 11,12 and 13, 2008, which review of a calendar confirmed it was a weekend. Cc. In the interview with the Acting Administrator on 12/3/08 at 12:05 PM, he stated that he does not work on Friday, Saturday or Sundays. “a During the interview with employee #4 on 12/3/08 at 12:45 PM, she stated that Resident #1 called the facility in September 2008 and informed them that he/she would not be at the facility for the weekend because he/she was going to visit his/her brother. Employee #4 stated that she knew Resident #1 did not have a brother, a Continued interview with employee #4 revealed that she did not make an attempt to get more details from the resident or notily the resident's counselor regarding the weekend trip. The employce acknowledged being aware of a prior complaint in June 2008 against the Acting Administrator for sexual assault against Resident #2. f. During an interview with Employee #3 on 12/3/08 at 12:45 pm, she stated that Resident #1 remained in the facility from 11/21/08 -11/23/08 after the Resident had complained of abuse by the Acting Administrator. Continued interview revealed that the staff did not put a plan in place to protect the resident or the other residents from potential abuse after the resident had complained to them about being sexually assaulted by the Acting Administrator. The Acting Administrator was able to enter and leave the facility without restrictions until 12/1/08, when another employee was assigned to remain with the Acting Administrator at all times. PlOs Poo d 20:tl (NOW)8002-62-330 10. That the failure of the Respondent to provided Resident #1, and other residents, appropriate supervision to protect the resident from abuse and the failure to supervise a resident appropriately placed the resident at risk for continued abuse and or psychosocial harm, the same being in violation of law. (Florida Administrative Code Chapter 58A-5) 11. That the Agency determined that this violation constitutes the grounds for the imposition of a Class T violation in that it presents 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. (429.19 (2)(a) Florida Statutes (2008)). Pursuant to the same statutory reference, Section 429.19(2)(a), Florida Statutes (2008), the Agency is authorized to impose a fine in the amount of five thousand dollars ($5,000). 12. That in accordance with 429.19 (2)(a) the Respondent has a correction date within 24 hours, . 13. That the Agency imposed an Emergency Order of Immediate Moratorium On Admissions on the Respondent facility on December 5, 2008, (Case # 2008013584) 14. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $5000.00 against Respondent, an assisted living facility in the State of Florida, for a Class T violation pursuant to § 429.19(2)(a), Florida Statutes (2008), COUNT H 15. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein, 16. That pursuant Florida law, no resident of a facility shall be deprived of any civil or legal rights, benefits, or Privileges guaranteed by law, the Constitution of the State of F lorida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to: Pid/S00 “d 20°1l (NOW)8002-62-130 (a) Live in a safe and decent living environment, free from abuse and neglect. §429,28(1)(a), Florida Statutes (2008). ‘17. That on December 3, 2008, the Agency conducted an unannounced Appraisal Survey of the Respondent facility to determine the facility compliance with Chapter 429, Part 1, Florida Statutes and Chapter 58A-5, Florida Administrative Code. 18. That the Agency determined, based on review of the incident reports, abuse - procedures, and interviews, the facility failed to ensure that the residents were able to live ina safe and decent living environment, free from abuse and neglect and to retain and use personal property. This has a potential for physical, emotional and psychosocial harm, the same being contrary to law. The findings were as follows: . a. During the interview with the actin ig administrator regarding Resident #1 on 12/3/08 at 12:30 pm, he stated that Resident #1 was taking personal items from other residents and keeping them in his/her room, ‘The acting administrator continued to state that he had entered the resident’s room and asked him/her to return the resident ' s items, b. After the acting administrator left the room at 12:45 PM on 12/3/08, Employee #4 stated that the Actin g Administrator did not have the right to enter into resident rooms and force them to return items; she continued to say that residents are always taking from and selling each othcr's property, "it happens all the time". The employce implied that this was a common practice and nothing could be done about it, The surveyor then informed the staff member of the regulations regarding abuse, neglect and exploitation. Further interview with Employee #4 revealed the slafi f was aware that this was the second sexual abuse complaint against the Acting Administrator within a six month time span, pid/900 d 20'tt (NOW) 8002-62-730 G Review of the Assisted Living Facility (ALF) Incident Report dated 11/21/08 revealed that at approximately 11:45 am on 11/21/08 Resident #1 had filed a | sexual abuse complaint against the Acting Administrator, One portion of the form, “steps taken to prevent recurrence;” indicated that the staff would report the abuse to DC+F (Department of Children and Families) and not allow contact between staff member and the resident until the investigation was over. However, there was no plan put in place to protect all other residents that were potentially at risk for sexual abuse from the alleged perpetrator, Purther, there was no indication that this plan to separate Resident #1 and the alleged perpetrator was effectuated. The Acting Administrator was granted full access to the full facility until 12/1/08. d, During the interview with Employee #3 on 12/3/08 at 12:45 PM, she stated that she notified the owner on 11/21/08 of the allegations against the Acting Administrator regarding scxual abuse. The employee continued to state that she had asked the owner what should she do about the acting administrator but she did not receive a response. e. Review of the facility's files revealed there was a policy regarding abuse, but there were no procedures to guide the employecs on the steps that they needed to take . to protect the residents from abusc, neglect and or exploitation, as a result Resident #1 and other residents was left unprotected and unsupervised after having reported being sexually abused. It was not until 12/1/08 that the facility assigned another employee to monitoring the Acting Administrator at all times. £ Interview with an Adult Protection Services (APS) Supervisor on 12/4/08 at 8:50 AM revealed they received an abuse report of another resident alleging inappropriate interactions with the Acting Administrator. PiO/100 4 EO: Ll (NOW)8002-62-330 g. Telephone interview employee #3 on 12/4/08 at 12:44 PM revealed that on the evening of 12/3/08 a resident informed her that during his/her prior admission he/she had inappropriate sexual encounters with the Acting Administrator, at that time the Acting Administrator was a Medication Technician. Further interview revealed that the resident stated that these encounters were the reason he/she left the facility. According to cmployee #3, the resident stated that after he/she returned to the facility, the Acting Administrator asked him/her to accompany him to Manor House (an empty building owned by the facility), Once at Manor House the resident stated that the Acting Administrator asked the resident to perform a sexual act on him and then the Acting Administrator performed one on the resident. 19. That the failure of the Respondent facility to ensure that the residents were able to live in a safe and decent ‘ving environment, free from abuse and neglect and to retain and use personal property is in violation the Resident’s Bill of Rights, the same being in violation of law, 429.28 (1)(a) Florida Statutes (2008). 20. That the Agency determined that this violation constitutes the grounds for the imposition of a Class I violation in that it presents an imminent danger to the residents or pucsts of the facility or a substantial probability that death or serious physical or emotional harm would result therefrom. (429.19 (2)(a) Florida Statutes (2008)). Pursuant to the same statutory reference, Section 429.19(2)(a), Florida Statutes (2008), the Agency is authorized to impose a fine in the amount of five thousand dollars ($5,000). 21. — That in accordance with 429.1 9 (2){a) the Respondent has a correction date within 24 hours. | 22. That the Agency imposed an Emergency Order of Immediate Moratorium On Admissions on the Respondent facility on December 5, 2008. (Case # 2008013584) Ft0/800 “d EO: tt (NOW)8002-62-330 23. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $5000.00 against Respondent, an assisted living facility in the State of Florida, for a Class I violation pursuant to § 429.19(2)(a), Florida Statutes (2008). COUNT II 24, The Agency re-alleges and incorporates paragraphs one (1) through five (5) and the remaining counts of this complaint as if fully set forth herein. 25. That the Agency re-alleges and incorporates Counts 1 and I of this complaint as if fully sct forth herein. 26. That the Agency may revoke any license issued under Part | of Chapter 429 (Assisted Living Facilities) of the Florida Statutcs (2008) for an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the faci lity. Section 429.14 ()(a). 27. That the failure to provide appropriate supervision to protect the residents and the failure to ensure a safe living environment for the residents to live free of abuse are either intentional or negligent acts that seriously affect the health, safety, or welfare of residents, thereby meriting the revocation of the Respondents licensure. 28.. That the Agency may revoke any license issued under Part I of Chapter 429 (Assisted Living Facilities) Florida Statutes (2008) for the citation of one (1) or more cited Class I deficiencies, three (3) or more cited Class II deficiencies, or five (5) or more cited Class IT deficiencies that have been cited on a single survey and have not been corrected within the specified time period. Section 429.14(1)(c) Florida Statutes (2008). 29. That the Respondent has been cited with two (2) State Class I deficiencies on an Agency Monitoring survey of December 3, 2008. 30, WHEREFORE, the Agency intends to revoke the license of the Respondent to 8 PL0/600 d : EO:LL (NOW) 8002-62-330 Operaic an assisted living facility in the State of Florida, pursuant to § 429.14, Florida Statutes (2008). CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Carc Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency on Counts I, I] and I; (B) Recommend administrative fines against Respondent in the amount of $10,000; (five thousand) $5, 000 for Count I, a Class I deficiency and. (five thousand) $5,000 for Count II, a Class I deficiency (C) Revoke the Respondent’s license number 7349 to Operate as. an assisted living facility. | (D) Assess attorney’s fecs and costs; and (E) Grant all other general and equitable relief allowed by law. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights form, All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS” #3, Tallahassee, Florida 32308, (850) 922-5873. If you want to hire an attorney, you have the right to be represented by an attorney in this matter. RESPONDENT IS FURTHER NOTIFIED THAT THE. FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Fto/Ol0-d €0:t1 (NOW) 8002-62-330 ye Respectfully submitted this, 7 day of December, 2008. MaryAlicetH. David ; Florida Bar No. 0831921 Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Phone (850) 922-5873 Fax (850) 921-0158 CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7001 0360 0003 3808 3703 to Tammy Harris, Administrator, 135 Palmetto Road, Satsuma, Florida 32189, and by U.S. Certified Mail, Return Receipt No. 7001 0360 0003 3808 2560 to Tammy Harris, Arlington House ACLF, 203 South Moody Road, Palatka, Florida 32177, and by U.S. Certified Mail, Retum Receipt No. 7001 0360 0003 3808 2577 to Andy Subac Registered Agent, 11606 Hibbs Grove Drive, Cooper City, Florida 33330 on December -? “f , 2008. PlO/ilO d EOtLL (NOW)8002-62-330 Copics furnished to: Tammy Harris Tammy Harris Administrator Arlington House ACLF 135 Palmetto Road 203 South Moody Road Satsuma, Florida 32189 Palatka, Florida 32177 (U.S. Certified Mail) (U.S. Certified Mail) Andy Subachan Kriste Mennella Registered Agent Agency for Health Care Administration 11606 Hibbs Grove Drive 14101 N. Highway 441, Suite 800 Cooper City, Florida 33330 Alachua, Florida 32615 (U.S. Certified Mail) (Unteroffice Mail) Alberta Granger Agency for Health Care Administration Ft. Knox #3 Room 1221A . Tallahassee, Florida 32308 Cnteroffice Mail) : | yu Respectfully submitted this @¥ day of December, 2008 MaryAlice H. David, Esquire il pld/2t0 d EO: LL (NOW }8002-62-330

Docket for Case No: 09-000345