1 a : STATE OF FLORIDA ~ . AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs, Case Nos. 2012005448 WATERMAN COMMUNITIES, INC, d/b/a EDGEWATER AT WATERMAN VILLAGE, Respondent, ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by _ and through the undersigned counsel, and files this Administrative Complaint against Waterman Communities, Inc. d/b/a Edgewater at Waterman Village (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2012), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional , commencing Match 29, 2012, and ending April 29, 2012, and impose. an administrative fine in the amount of two thousand five hundred dollars ($2,500.00), based upon Respondent being cited for one Isolated State Class II deficiency. | JURISDICTION AND VENUE 4 1, The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2011). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. ‘PARTIES 3. / The Agency is the regulatory authority responsible for licensure of nursing homes and enforcement of applicable federal regulations, state statutes and rules governing skilled nursing . facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapters 400, Part II, and 408, Part TI, Florida Statutes, and , Chapter 59A-4, Florida Administrative Code. 4. . Respondent operates a one hundred twenty (120) bed nursing home, located at 300 Brookfield Avenue, Mount Dora, Florida 32757 and is-licensed as a skilled nursing facility license number 1138096. 5, ) Respondent was at all times material hereto, a licensed nursing facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutés. ) ' COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. . 7, That pursuant to Florida law, (1) The agency shall require level 2 background screening for personnel as required in s, 408.809(1)(e) pursuant to chapter 435 and s. 408.809. (2) The agency shall, as allowable, reimburse nursing facilities for the cost of conducting © : background screening as required by this section. This reimbursement is not subject to any rate ceilings or payment targets in the Medicaid Reimbursement plan. §400,215, Fla, Stat. (2011). 8. That Florida law provides the following: “Every 5. years following his or her licensure; employment, or entry into a contract in a capacity that under subsection (1) would require level 2 background soreening under chapter 435, each such person must submit to level 2 background rescreening as a condition of retaining such license or continuing in such employment or contrmotaal status. For any such rescreening, the agency shall request the Department of Law Enforcement to forward the person’s fingerprints to the Federal Bureau of Investigation for a national criminal history record check. If the fingerprints of such a person are not retained by the Department of Law Enforcement under s. 943,05(2)(g), the person must file a complete set of fingerprints with the agency and the . agency shall forward the fingerprints. to the Department of Law Enforcement for state processing, and the Department of Law Enforcement shall forward the fingerprints to the Federal — Bureau of Investigation for a national criminal history record check, The fingerprints may be retained by the Department of Law Enforcement under s, 943.05(2)(g). The cost of the state and national criminal history records checks required by level 2 screening may be borne by the licensee or the person fingerprinted. Proof of compliance with level 2 screening standards submitted within the previous 5 years to meet any provider or professional licensure requirements of the agency, the Department of Health, the Agency for Persons with Disabilities, the Department of Children and Family Services, or the Department of Financial Services for an. ‘applicant for a certificate of authority or provisional certificate of authority to operate a continuing care retirement community under chapter 651 satisfies the requirements of this section if the person subject to, screening has not been unemployed for more than 90 days and such proof is accompanied, under penalty of perjury, by an affidavit of compliance with the provisions of chapter 435 and this section using forms provided by the agency” §408.809(2), Florida Statutes Q011). 9, That Florida law provides the following: “‘Level 2 background screening pursuant to chapter 435 must be conducted through the agency on each of the following persons, who are considered employees for the purposes of conducting screening under chapter 435:'(e) Any person, as required by authorizing statutes, seeking employment with a licensee or provider who _ is expected to, or whose responsibilities may require him or her to, provide personal care or services directly to clients or have access to client funds, personal property, or living areas; and any person, as required by authorizing statutes, contracting with a licensee or provider whose responsibilities require him or her to provide: personal care or personal services directly to clients. Evidence of contractor screening may be retained by the contractor’s employer or the , licensee. §408,809(1)(e), Florida Statutes (201 1)... 10.‘ That pursuant to Florida law, an employer may not hire, select, or otherwise allow an employee to have contact with any vulnerable person that would place the employee in a role that requires background screening until the screening process is completed and demonstrates the absence of any grounds for the denial or termination of employment. If the screening process shows any grounds for the denial or termination of employment, the employer may not hire, select, or otherwise allow the employee to have contact with any vulnerable person that would place. the employee in a role that requires background screening unless the employee is granted an exemption for the disqualification by the agency as provided under s. 435.07. §435. .06(2)(a), Florida Statutes (2011). . Hi. That pursuant to Florida law, the employer must terminate the employment of any of its personnel found to be in noncompliance with the minimum standards of this chapter or place the employee in a position for which background screening is not required unless the employee is granted an exemption from disqualification pursuant to s.435.07. §435.06(2)(c), Florida Statutes (2011). . | 12. That pursuant to Florida law, all licensees of nursing home facilities shall adopt and make public a statement of the rights and responsibilities of the residents of such facilities and shall © treat such residents in accordance with the provisions of that statement, The statement shall assure each resident the following ... The right to be free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints, except those restraints authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency... §400.022(1)(0), Florida Statutes (2011). 13.. That Florida law provides the following: “Each nursing home facility shall adopt, implement, and maintain written policies and procedures governing all services provided in the. facility. .:, Each facility shall maintain policies and procedures in the. following areas: (x) ~ Resident’s rights.” Rule 59A~-4,106(2) and (4)(x), Florida Administrative Code. 14, That on March 29, 2012, the Agency completed a re-licensure survey of Respondent's facility. 15, That based ‘upon observation, the review of records and interview, Respondent failed to ensure its staff legally required to undergo criminal background screening were free from disqualifying criminal offenses or otherwise exempted from disqualification prior to employment . in violation of law for one (1) of eleven (11) sampled staff, said failures placing resident’s at increased, illegal, and unnecessary risk of abuse or exploitation, the same being contrary to the requirements of law. ° 16. That Petitioner’s representative reviewed Respondent’s personnel records during the survey and noted as follows related to employee number three (3): a The employee was hired by Respondent on January 15,2012... b. An undated Level 1, or state-wide criminal history background screening, was in the file. on No Level 2 screening, as required for all staff hired after August 1, 2011, was in the employee’s file. 17. That Petitioner's representative interviewed Respondent’s director of nursing regarding employee number three (3) oni March 29, 2012, who indicated as follows: a. The Level 1 criminal history screening in the employee’s file was completed ae a on March 18, 2005, b. The employee was first hired on March 18,:2005. c The employee left the employment of Respondent on August 21, 2011 and was re-employed on January 15, 2012. The employee had been working directly with esidents, d. The employee has been told not to return to employment until a Level II employment screening has been obtained. 18, ‘That the above reflects that employee number three (3) was employed and by Respondent for approximately seven (7) weeks without the facility ensuring a level two (2) background screen has been completed and the employee determined eligible for employment as required by law. 19, That Respondent hired and allowed employee number three (3) to work within the " facility prior to: obtaining Level two (2) Criminal Background Screening results reflecting the staff member to be free from disqualifying events, said actions by Respondent being contrary to the requirements of law. , 20. . That Respondent knew or should have known that its staff member had not successfully undergone required criminal background screening prior to commencing employment. 21. That Respondent has an affirmative duty to prevent persons who have not successfully undergone criminal background screening from being hired by Respondent or having access to facility residents. 22. That the above reflects Respondent’s failure to ensure that its staff had been appropriately determined as clear of disqualifying criminal backgrounds, or otherwise exempted, in violation ~ of Florida law and or Respondent’s policy and procedure, said failures presenting a risk to resident health, safety, or well-being, ee i ee 23. That the Agency determined that these failures compromised the resident’s ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services and cited this deficient practice as an Isolated State Class II deficiency. WHEREFORE, the Agency seeks to impose an administrative fine in the amount of $2,500.00 against Respondent, a ‘skilled nursing facility in the State of Florida, pursuant to § 400. 23(8)(b); Florida Statutes (2011). COUNT II 24. The Agency re-alleges ‘and incorporates paragraphs one (1) through five 6) and Count I of this Complaint as if fully set forth herein. . 25. Based upon Respondent’s cited State Class II deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part IJ of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional " licensure status under § 400.23(7)(a), Florida Statutes (2011). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(7), Florida Statutes (2011) commencing March 29, 2012, and ending April 29, 2012. Respectfully submitted wnisLZ day of February, 2013, i, nas X Walsh MH, Esquire Fla/Baf. No. 566365 Ieenty for Health Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1947 (office) 727.552.1440 (facsimile) DISPLAY OF LICENSE Pursuant to § 400,23(7)(e), Fla. Stat. (2011), Respondent shall post the most current license in a prominent place that is in clear and unobstructed public view, at or near, the place where - residents are being admitted to the facility. ‘Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120,569, Florida Statutes. Respondent 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 to the attention of: The Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 412-3630. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. : ~ CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been,served by USS. Certified Mail, Return Receipt No: 7012 1010 0000 5357 3658 on February “Cb » 2013 to Jeanne Deprada, Administrator, Waterman Communities, Inc. d/b/a Edgewater at Waterman Village, 300 Brookfield Avenue, Mount Dora, Florida 32757 and by U.S, Mail to Richard A, Leigh, Registered agent for Waterman Communities, Inc., 1031 West Morse Boulevard, Suite 350, Winter Park, Florida 32789, Jalsh II, Esquire Copies furnished to: Richard A. Leigh Registered agent for Waterman . Communities, Inc. 1031 West Morse Boulevard Suite 350 , Winter Park, Florida 32789 .S. Mail Jeanne Deprada Administrator Waterman Communities, Inc. d/b/a Edgewater at Waterman Village _| 300 Brookfield Avenue Mount Dora, Florida 32757 (US. Certified Mail) Kriste Mennella . Thomas J. Walsh II, Esquire 4 Field Office Manager Senior Attorney . Agency for Health Care Administration Agency for Health Care Admin. (Interoffice Mail) 525 Mirror Lake Dr., N., #330G : St. Petersburg, Florida 33701 (Interoffice) ee

Docket for Case No: 13-001203