STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA No.: 2018003908 File No.: 11953384 COURTYARD MANOR RETIREMENT License No.: 5947 LIVING, INC., Provider Type: Assisted Living Facility Respondent. / ADMINISTRATIVE COMPLAINT Petitioner, State of Florida, Agency for Health Care Administration (“the Agency”), by and through its undersigned counsel, hereby files this Administrative Complaint against Respondent, Courtyard Manor Retirement Living, Inc. (“the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes, and alleges as follows: NATURE OF THE ACTION This is an action against an assisted living facility seeking the revocation of its license and the imposition of $40,500.00 in administrative fines based on four Class I violations and one Unclassified violation. PARTIES 1. The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida. Ch. 408, Part II, and Ch. 429, Part I, Fla. Stat. (2017); 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. §§ 408.812, 408.813, 408.815, 429.14, 429.19, Fla. Stat. (2017). 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. (2017). Zi Respondent was issued a license by the Agency to operate this assisted living facility (“the Facility”) located at 140 West 28th Street, Hialeah, Florida 33010, and was at all times material required to comply with the applicable state statutes and rules governing such facilities. 3. On February 28, 2018, the Agency issued an Emergency Suspension Order effective immediately, on Respondent. As a license holder, Respondent is a “licensee” as defined by Florida law. § 408.803(9), Fla. Stat. (2017). COUNT I Arrangement of Care 4, Under Florida law: (3) ARRANGEMENT FOR HEALTH CARE. In order to facilitate resident access to health care as needed, the facility must: (a) Assist residents in making appointments and remind residents about scheduled appointments for medical, dental, nursing, or mental health services. (b) Provide transportation to needed medical, dental, nursing or mental health services, or arrange for transportation through family and friends, volunteers, taxi cabs, public buses, and agencies providing transportation. (c) The facility may not require residents to receive services from a particular health care provider. Rule 58A-5.0182(3), F.A.C., (2018). Survey Findings 5. On or about February 19 through March 7, 2018 the Agency conducted a survey of Respondent’s Facility. 6. Based on interview, record review, and interviews, the Agency determined that Respondent failed to assist six residents with arrangements for health care services (Residents #2, #16, #21, #23, #25, and #33). Resident #21 7. On or about February 20, 2018, the Agency reviewed Resident #21’s records. 8. Resident #21’s health assessment (“1823”) record showed a date of completion of May 2, 2017 with the following information: a. é. f. diagnoses of: left above the knee amputation, gastritis, peripheral atrial disease, hyperlipidemia, SCPT (Schizophrenia Chronic Paranoid Type), CAD (Coronary Artery Disease), HBP (High Blood Pressure), DM type 2 (Diabetes Mellitus Type 2), Constipation, COPD (Chronic Obstructive Pulmonary Disease), Parkinson. Cognitive or behavioral status: depressed and anxiety disorder. Nursing/treatment/therapy service requirements were as follows: supervise medications. Special precautions: Fall precautions. Resident #21 was independent for ambulation, eating, toileting, and transferring, needed supervision for self-care and assistance for bathing and dressing. Resident #21 had a regular diet. Resident #21 needed assistance with self-administration of medication. 9: The Agency then reviewed hospital records of Resident #21. 10. The records showed Resident #21 was first admitted to a hospital from November 12, 2017 to November 15, 2017. The discharge summary showed that the resident arrived to emergency rooms complaining of shortness of breath and abnormal breathing. 11. Resident #21 was diagnosed with acute congestive heart failure, anemia, chronic obstructive pulmonary disease exacerbation, hypoxia, leukocytosis, renal insufficiency, acute respiratory distress, and was admitted to the Intensive Care Unit (“ICU”) due to acute respiratory distress with some status post lactic acidosis, sepsis and hypotension. 12. Resident #21 was subsequently discharged from the hospital and instructed to follow up with a cardiologist and/or a pulmonologist; follow up with the resident’s primary care doctor within 2-3 days; contact a home health care for physical therapy and evaluation; Have Registered Nurse RN monitoring; and receive Activities of Daily Living services. 13. Agency review of Resident #21’s record failed to find documentation that the resident received follow up care with cardiologist, pulmonclogist, primary care physician, home health care, or nurse monitoring and Activities of Daily Living (“ADL”) services. 14. The Agency then reviewed Resident #21’s medical records dated December 18, 2017, which documented the resident’s blood sugar level was 28 mg/dl. Resident #21 was admitted to a hospital from December 18, 2017 until December 20, 2017. 15. Resident #21 was diagnosis with severe diabetic hypoglycemia. 16, Resident #21's discharge papers from this hospital visit revealed instructions that the resident must follow up with a primary care physician within one week. 17. The Agency then reviewed Resident #21’s medical records dated December 26, 2017. Resident #21 was again admitted to a hospital on December 26, 2017 and discharged on December 27, 2017. Resident #21 arrived with difficulty breathing. 18. —- Resident was given results of gastrocnteritis and pneumonia, 19, The Agency reviewed Resident #21’s discharge papers from this third hospital visit, which revealed a diagnosis of bacterial pneumonia and gastroenteritis with instructions that the resident must follow up with a primary care physician within one week and that the resident must follow an at-home diabetic dict. 20. The Agency then reviewed Resident #21’s medical records from a fourth hospital visit. 21. Resident #21's ambulance record showed that on January 7, 2018 the resident's blood sugar level was 49 mg/dl. 22. Resident #21’s hospital record revealed the resident was admitted to a hospital on January 7, 2018 and discharge on January 11, 2018. 23. The discharge summary from this fourth visit showed a final diagnosis of: chronic obstructive pulmonary disease, with acute lower respiratory infection; pneumonia; acute kidney failure; type 2 diabetes with hypoglycemia without coma; type 2 diabetes with diabetic chronic kidney disease; chronic obstructive pulmonary disease exacerbation; hypo-osmolality and hyponatremia; hypertensive chronic kidney disease stage I through stage IV; and chronic kidney disease. 24. During this visit, Resident #21 was admitted to the ICU due to acute respiratory distress with some status post lactic acidosis, sepsis and hypoxemic non-ventilator-dependent respiratory failure with suspicion for systemic inflammatory response syndrome, pneumonia, leukocytosis, microcytic anemia, lactic acidosis, acute renal failure, mild hyponatremia, obesity, and history of hypertension, peripheral vascular disease, hypercholesterolemia, coronary artery disease, and chronic obstructive pulmonary disease. 25. The Agency reviewed Resident #21’s discharge instructions from the January 7 admission and found that the resident must: follow up with a PCP within 2-3 days; follow- up with a home health care service for physical therapy; and follow up with a Registered Nurse for monitoring. 26. The Agency then reviewed Resident #21’s medical records from a fifth hospital visit. 27. Review of Resident #21's hospital record revealed that the resident was admitted on January 24, 2018 and discharge on January 28, 2018. Admission diagnoses were hypoglycemia and leukocytosis. 28. Review of Resident #21's discharge papers revealed discharge diagnoses of hypoglycemia and leukocytosis. 29. Resident #21’s discharge instructions from the January 24, 2018 hospital visit showed: follow up with PCP within 2-3 days and follow up with home health care for nurse monitoring. 30. The Agency then reviewed Resident #21’s medical records from a sixth hospital visit. Si. Review of Resident #21's ambulance record showed that on February 17, 2018 the resident had a blood sugar level of 42 mg/dl. 32. Review of Resident #21's hospital record revealed that the resident was admitted to a hospital on February 18, and discharged on February 20, 2018 with diagnoses of Chronic Obstructive Pulmonary Disease and Hypoglycemia. 33. The resident’s discharged instructions for the February 18, 2018 visit was to begin a cardiac diet- ADA (diabetic) 1800 kcal (calories); and follow up with a cardiologist, a (gastroenterologist, and an endocrinologist as soon as possible. 34. | The Agency was only able to find one note related to a follow up with a primary care physician for Resident #21. 35. The shift report of 3 — 11 P.M. for January 31, 2018, claimed the primary care physician was in Respondent’s Facility and showed that the doctor “passed by.” 36. On or about February 20, 2018, the Agency reviewed Resident #21’s progress notes, which revealed the following: a. 12/07/17- Resident observed to be having hallucinations b. 12/12/17- Resident returned from hospital with discharged paper and scripts sent to pharmacy. c. 12/18/17- A resident went to the office and informed that a resident sat outside a room was drooling. Staff found resident sat drooling and unresponsive. Staff called 911 and transferred to hospital. d. 12/20/17 - Resident #21 returned from hospital with discharged paper but no scripts. e. 12/26/17- Resident #21 complained of not feeling well. Resident had shortness of breath. (Doctor) was called to evaluate the resident. Resident transferred to hospital. f. 12/27/17- resident returned from hospital with discharged paper and scripts sent to pharmacy. g. 01/07/18- night shift reported to morning shift that during round at 6 am saw that Resident was unresponsive. Staff called 911 and transferred resident to hospital at 5:30 AM. h. 01/11/18 - Resident returned from hospital with discharged paper but no scripts. i. 01/24/18- Resident's roommate went to the office and informed that resident was screaming and making many hand movements. Staff found resident lying in bed screaming but staff was not able to understand. Rescue was called and transferred to hospital. Friend was notified. j. 01/28/18- Resident returned from hospital and brought discharge papers. k. 01/31/18 - Resident started to receive home health service for blood sugar monitoring. i 02/11/18- It did not show that Resident saw the Primary Care Physician. m. 02/17/18 at 3:50 PM- Resident's roommate went to staff and said that Resident #21 was not acting right. Staff went to the room and saw Resident #21 foaming from mouth and unresponsive. Staff called 911 and rescue took resident to the hospital. 37. On or about February 20, 2018, the Agency interviewed Respondent’s Administrator. 38. The Administrator stated, “if it is not documented I don't know” about changes in Resident #21 prior to the January 7, 2018 hospitalization. 39. The Administrator also revealed that the resident began to receive home health services for blood sugar monitoring but insurance approved twice a week. 40. The Administrator then stated that when Resident #21 was sent to the hospital, the Facility informed the doctor, and asked the doctor to follow up. The Administrator stated the Facility’s supervisor (Staff F) was responsible to review the record, do the changes, and follow up. The supervisor was responsible to inform the doctor as well. 41. | The Administrator continued to state that the supervisor was new, and said Staff F “missed it.” Resident #2 42. On or about February 20, 2018, the Agency reviewed Resident #2’s 1823 completed on April 5, 2017. 43. Resident #2’s 1823 showed the following: a. a medical history and diagnoses of Chronic Obstructive Pulmonary Disease and Schizophrenia Chronic Paranoid Type. b. Physical or sensory limitations: ambulates with a cane. c. Cognitive or behavioral status: none. d. Resident was independent for all activities of daily living except for self- care that needed supervision. e. Resident needed assistance with self-administration of medications. 44. Onor about February 19, 2018, the Agency interviewed Staff B. Staff B described Resident #2 as very independent and he/she does not have any family members. Staff B also said Resident #2 has no wounds, and walks just fine. 45. | Onor about February 19, 2018, the Agency interviewed Resident #2. Resident #2 stated his/her toe hurts and has secretions/pus coming out of the toe for a month. Resident #2 stated he/she had told five people about the toe’s condition and that it is getting worse. 46. Resident #2 stated he/she cannot walk and it hurts when her/his foot is put down on the floor. 47. Resident#2 continued to state that he/she went to the doctor who made some cut in the toe, but the condition was worse after the visit. The resident said he/she did not see any doctor recently. Resident #2 stated he/she has not received antibiotic. 48. Resident #2 finally stated the toe hurt when he/she walked, slept, or pressed the toe. 49. On or about February 19, 2018, the Agency surveyor observed Resident #2’s toe. Resident #2 pressed the right great toe and it drained, however, the surveyor was unable to see the color of the drainage. 50. The Agency surveyor also observed that Resident #2's right great toe had a yellowish or cream color growing around the nail area. Si. On or about February 19, 2018, the Ayency interviewed Respondent's Administrator. The Administrator stated that she was unaware of Resident #2’s condition on his/her toe. $2. The Administrator then stated that Resident #2 saw a podiatrist already, but she will call the podiatrist again to see Resident #2. 53. The Administrator later revealed that Resident #2 saw the podiatrist last month, but the Facility did not have any report about that visit. The Administrator explained that the doctors did not give any report to the Facility. $4. The Administrator also said that Resident #2 already had an appoimtment for the next day with the podiatrist. The Administrator stated that Resident #2 started complaining about his/her toc onc week ago (from the date of the interview). 55. | Onor about February 19, 2018, the Agency interviewed the podiatrist’s office for Resident #2. 56. The podiatrist’s office representative stated that the Facility scheduled Resident #2's appointment today (02/19/18) for the following day (02/20/2018). The podiatrist’s office representative then stated the most recent time Resident #2 was seen by the podiatrist’s office was on September 28, 2017. 57. Oner about February 20, 2018 the Agency interviewed a Licensed Practical Nurse (“LPN”) from the home health agency that provided wound care to Resident #2. The LPN revealed that last time the resident received wound care was at the end of October 2017. 58. | Onor about February 20, 2018, the Agency reviewed Resident #2’s communication log for home health care. The log revealed that Resident #2 received wound care from October 6, 2017 to October 28, 2017. The last entry stated the resident’s wound healed and the resident was discharged. 59. | The Agency also reviewed the Facility's progress note for Resident #2. Those notes showed: a. 09/28/17- Resident went to podiatry because nail of right toe hurt and returned with a script (Prescription) for home health for a few days and they removed part of the nail. b. 10/04/17- Resident had a toenail removed a couple of days ago but was doing just fine. c. 11/04/17- Resident's toenail was much better and almost fully Tecovered. d. 12/06/17- Resident's toenail was fully recovered 60. Review of Resident #2's record revealed that there was a doctor’s order dated September 18, 2017, requesting home health care to clean the resident’s wound with normal saline and apply to area triple antibiotic for 10 days. 61. The Agency then reviewed the Facility’s shift reports. The shift report for February 16, 2018, 3 p.m. — 11p.m. stated Resident #2 complained of pain on his/her toenail; then the February 17, 2018, 7 a.m. —3 p.m., shift report stated Resident #2 was complaining of pain in his toe and staff called podiatry. 62. The Agency also reviewed Resident #2’s hospital records. The hospital records revealed Resident #2 was admitted to a hospital on February 19, 2018. The Resident complaint was an abscess in the first toe of his left foot. At the physical exam, it was noted that Resident #2 had pain and drainage under the left big toe. Resident was alert, awake, and oriented to person, time and place. The resident’s admission diagnoses were a left big toe infection, osteomyelitis, and 10 peripheral vascular disease. Resident #2 started receiving intravenous antibiotic every eight hours and a topical antibiotic once a day. 63. Further record review showed that previously, Resident #2 was admitted to a hospital on January 7, 2018 and discharged on January 10, 2018. 64. Resident #2 was received at the hospital with abdominal pain and admission diagnoses were abdominal aortic aneurism and abdominal pain. Resident #2 also had diagnoses of cholelithiasis, COPD (Chronic Obstructive Pulmonary Disease), and an enlarged prostate gland. ACT scan of the abdomen and pelvis showed “significant aneurysmal dilatation of the aorta which needs follow up to rule out any worsening or residual complication because of patient's increased risk of risk for perforation. Dissection cannot be rule out on the non-contrast study.” 65. Resident #2’s hospital record revealed that there were discharge instructions from the January 7, 2018 hospitalization. The instructions required the resident to follow up with primary care physician (“PCP”) within 5-7 days. 66. The Agency was not able to find documentation that Resident #2 received follow up care from the PCP. 67. On or about February 20, 2018, the Agency interviewed Respondent’s Administrator again. The Administrator stated that there was no documentation that a doctor saw Resident #2. The Administrator further stated that Facility staff called the doctor, who recommended to check the resident’s blood pressure and ensure that it was under regular parameters. 68. The Agency’s review of personnel files showed that none of the staff were licensed health care providers. 11 Resident #25 69. The Agency reviewed Resident #25’s 1823 dated August 5, 2017, which showed the following: a. medical history and diagnoses of: Diabetes Mellitus Type 2, hypertensive-heart disease, schizophrenia. b. Physical or sensory: paresthesia, less vision right eye. c. Resident was independent for ambulation, eating, toileting and transferring but needed supervision for bathing, dressing, and self-care. d. Resident needed assistance with self-administration of medication. 70. Further Agency review Resident #25’s record revealed hospital discharge records, which stated that Resident #25 was hospitalized from January 12, 2018 until January 13, 2018 for a pubic rami fracture. 71. The Hospital records stated that Resident #25 arrived with left hip pain. An X-ray of Left hip showed possible non-displaced fracture of inferior left pubic ramus. A Pelvic CT scan was done and showed acute, comminuted, non-displaced fractured of left medial inferior pubic ramus; as well as an acute, non-displaced fractures of acetabulum with articular extension. 72. The Agency then reviewed the progress notes for Resident #25. The notes revealed that Resident #25 returned from the hospital on January 13, 2018, and continued to complain of pain, so staff documented that they gave Resident #25 a wheelchair. 73. There was no documentation that a wheelchair was prescribed for the resident by a doctor. 74. | There was no documentation that the resident received follow-up care with a primary care physician. 75. | Onor about February 22, 2018, the Agency interviewed Resident #25’s roommate, Resident #23. 76. Resident # 23, stated that he found Resident # 25 on the floor on January 11, 2018 12 during the night. Resident #23 says he/she went to the staff office, but none of the staff on duty spoke English, so he pantomimed what he/she was trying to tell the staff. Resident #23 stated he/she did not understand the Staff's response, but they seemed upset. 77. Subsequently, Resident #23 stated he/she went to find some other residents to help pick Resident #25 up from the floor. Resident #33 78. On or about February 22, 2018 the Agency reviewed Resident #33’s 1823 dated May 1, 2017, which revealed the following: a. medical history and diagnoses of: DVA (Developmental Venous Anomaly), CAD (Coronary Artery Disease), PVD (Peripheral Vascular Disease), Obese, IDDM (Insulin Dependent Diabetes Mellitus), Insomnia. Imbalance, using a 4 point walker. Home Health service for insulin administration. b. Resident was independent for all activities of daily living except: self- care. c. Special diet: regular, no added salt, low salt/ low cholesterol. d. Resident received assistance with self-administration of medications. 79. | Onor about February 22, 2018, the Agency reviewed Resident #33’s Medication Observation Record (“MOR”). The MOR revealed that on February 5, 6, 8, 9, 12, 15, 17, 18, 20, and 21, 2018, Resident # 33 refused Latuda 20 mg (antipsychotic medicine). Resident #33 also refused Trazadone (sedative and antidepressant) 50 mg on February 4, 5, 6, 8, 12, 15, 17, 18, and 20, 2018. Resident #33 refused Quetiapine (antipsychotic medicine) on February 18, 20, and 21, 2018. 80. The Agency interviewed Respondent’s Administrator on February 22, 2018. The Administrator stated that Staff should be calling the residents doctor about the refusals, and documenting the refusals in the progress notes. 81. | Onorabout February 22, 2018, the Agency reviewed Resident #33’s progress notes 13 and there was no documentation of the medication refusals or of any intervention or coordination with health care providers. 82. The Agency also reviewed Resident #33's Hospital Record, which revealed that the resident was admitted to a hospital on January 12, 2018 and discharged on January 13, 2018. 83. | The record stated Resident #33 arrived with left hip pain. An X-ray of Resident #33’s left hip showed possible non-displaced fracture of inferior left pubic ramus. A pelvic CT scan done on January 13 showed an acute, comminuted, non-displaced fractured of left medial inferior pubic ramus, and acute, non-displaced fractures of acetabulum with articular extension. 84. No follow up with a medical provider was found in facility records. Resident #23 85. The Agency reviewed Resident #23’s hospital records, which revealed Resident #23 was sent to a hospital on January 12, 2018 after an assault by another resident. Resident #23’s eye was bleeding and he/she was treated for an eye injury and fitted with an eye patch. 86. | The Agency could not find documentation that a follow-up with a medical provider was performed for Resident #23. Resident #16 87. | The Agency reviewed an incident report for Resident #16 that stated the resident was hospitalized for a month and three days before returning to the hospital. 88. The incident report stated that on October 25, 2017, the resident’s roommate advised staff that Resident #16 had fallen in his room. The report stated Facility’s staff found the resident already on his feet on top of his bed. Resident #16 reported he/she was feeling ok and refused to go to the hospital. 89. The Report continued to state that on October 26, 2017, Resident #16 complained 14 having pain on his/her left side. The resident’s primary care physician was advised and, per doctor’s orders, Resident #16 was sent to the hospital. 90. On November 29, 2017, Resident #16 returned to the Facility, 91. On or about February 19, 2018, the Agency interviewed Resident #16 who stated he/she had fractured his/her hip. 92. Resident #16 further stated he/she does not receive physical therapy to help with the resident’s ability to walk again. Resident #16 stated that he/she has to use a wheelchair now after the fall, when he/she used to be able to walk with the assistance of a cane. 93. Resident #16 further described the medical appointments as a joke, and stated the doctors do not come to the facility monthly as planned; instead, the resident said the doctors come when they want to come. Resident #16 finally stated the Facility told him/her that insurance does net want to cover the therapy for his/her hip injury, and the Facility docs not provide therapy. 94. On or about February 22, 2018, the Agency interviewed Respondent’s Administrator. Thc Administrator stated that Resident #16 was hospitalized for a fall and had surgery for a broken hip. The Administrator also stated that she had no documentation and/or written information of the resident’s broken hip. 95, The Administrator further stated that Resident #16 is not walking with the assistance of the cane because he/she is afraid and is refusing to walk. The Administrator reported Resident #16’s doctors have stated the resident is doing well, but that she has no documentation that reflected Resident #16 could walk or is doing well. 96. Based on the above mentioned actions and inactions, the Agency cited Respondent with a Class 1 deficiency. Remedy 97. Under Florida law, in addition to the requirements of part II of chapter 408, the agency shall impose an administrative fine in the manner provided in chapter 120 for the violation of any provision of this part, part II of chapter 408, and applicable rules by an assisted living facility, for the actions of any person subject to level 2 background screening under section 408.809, for the actions of any facility employee, or for an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility. § 429.19(1), Fla. Stat. (2017). 98. Under Florida law, class I violations are defined in section 408.813. 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. § 429.19(2)(a), Fla. Stat. (2017). 99. Under Florida law, class “I” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines present an imminent danger to the clients of the provider 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 as provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation. § 408.813(2)(a), Fla. Stat. (2017). WHEREFORE, Petitioner, State of Florida, Agency for Health Care Administration, seeks an administrative fine against the Respondent in the amount of $10,000.00. COUNT I Resident Rights 100. Under Florida law, in pertinent part: (1) 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 Florida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to: (a) Live in a safe and decent living environment, free from abuse and neglect. (b) Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy. (c) Retain and use his or her own clothes and other personal property in his or her immediate living quarters, so as to maintain individuality and personal dignity, except when the facility can demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other residents. * * * (j) Access to adequate and appropriate health care consistent with established and recognized standards within the community. (k) At least 45 days’ notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a physician to require an emergency relocation to a facility providing a more skilled level of care or the resident engages in a pattern of conduct that is harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days' notice of a nonemergency relocation or residency termination. Reasons for relocation shall be set forth in writing. In order for a facility to terminate the residency of an individual without notice as provided herein, the facility shall show good cause in a court of competent jurisdiction. (1) Present grievances and recommend changes in policies, procedures, and services to the staff of the facility, governing officials, or any other person without restraint, interference, coercion, discrimination, or reprisal. Each facility shall establish a grievance procedure to facilitate the residents’ exercise of this right. This right includes access to ombudsman volunteers and advocates and the right to be a member of, to be active in, and to associate either advocacy or special interest groups. § 429.28(1), Fla. Stat. (2017). 101. Under Florida law, in pertinent part: 58A-5.0182 Resident Care Standards. An assisted living facility must provide care and services appropriate to the needs of residents accepted for admission to the 17 facility. * * * (6) RESIDENT RIGHTS AND FACILITY PROCEDURES. (a) A copy of the Resident Bill of Rights as described in Section 429.28, F.S., or a summary provided by the Long-Term Care Ombudsman Program must be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to Rule 58A-5.0181, F.A.C. (b) In accordance with Section 429.28, F.S., the facility must have a written grievance procedure for receiving and responding to resident complaints, and for residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint. * * * (g) In addition to the requirements of Section 429.41(1)(k), F.S., the use of physical restraints by a facility must be reviewed by the resident 's physician annually. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint Fla. Admin. Code R. 58A-5.0182(6). Survey Findings 102. The Agency re-alleges and incorporates by reference the survey findings in Count 103. On or about February 19 through March 7, 2018, the Agency conducted a survey of Respondent’s Facility. 104. Based upon observation, record review and interview, the Agency determined that Respondent’s Facility failed to provide a safe and decent living environment free from neglect for 2 residents (Residents #20 and #25), the Facility failed to provide 45 days’ notice of a relocation or termination of residency for 1 resident (Resident #28), the Facility prevented one resident from exiting his/her bed unassisted by staff (Resident #1), and the Facility failed to use privacy screens in rooms where residents had bedside urinals. 18 Resident #20 105. The Agency reviewed Facility records, which showed that Resident #20 died on December 9, 2017. 106. On or about February 19, 2018, the Agency interviewed Respondent’s employee, Staff C. 107. Staff C stated that on December 9, 2017, she found Resident #20 in his bed, unresponsive to verbal commands. Staff C said she immediately began to conduct CPR on Resident #20. She stated she did not check for breathing or pulse, and only performed one cycle of 30 compressions to Resident #20. 108. Staff C then stated she stopped CPR, and contacted 911 using her personal cell phone. Staff C stated that the Emergency Medical Services (“EMS”) operator told her to either continue chest compressions or use the Automatic External Defibrillator (“AED”). Staff C informed the EMS operator to hurry because the resident was becoming cold. Staff C left Resident #21 alone and went to next building for the defibrillator. She stated that she did neither further compressions nor use the defibrillator because by the time she was about to go and get the AED, EMS had arrived. She stated it took around ten (10) minutes for EMS to arrive. After Staff C got off the phone with 911, she yelled out for help and instructed another employee to wait for the ambulance in the front of the facility. 109. Staff C later stated she worked from 7 am to 3 PM on December 9, 2017. She that residents usually went to the nurse's station to take the medicines, but Resident #20 was the only one who missed medicine that day. Staff C said she then went to Resident #20's room to check on the resident. Staff C said she talked to and moved the resident but he/she was unresponsive. 110. The Agency reviewed the Facility’s policy and procedures regarding CPR showed 19 that staff were to perform CPR on unresponsive residents, and continue until EMS members arrived. 111. On or about February 20, 2018, the Agency surveyor observed that the Facility’s AED was in the nurse’s station and it had a label of expiration date of 04/2013 for the pads. 112. Onor about February 20, 2018, the Agency reviewed Staff C's records. The records showed a completed First Aid, Cardio Pulmonary Resuscitation and Automatic External Defibrillator training on April 11, 2017. 113, Onor about February 20, 2018, the Agency interviewed Respondent’s CPR trainer who provides training to the Facility staff. 114. The CPR trainer revealed that trained staff should give CPR to a victim if the victim has shallow breathing, no pulse or weak pulse. The staff should ensure that victim did not have Do Not Resuscitate Order. The CPR trainer stated that the American Heart Association promoted the circulation as the most important aspect. She further stated the victim needed to be in a flat position or with a flat object in the back. The staff giving CPR needed to do 100-120 compressions per minute, and never leave the victim alone. If the staff member is unable to call for help, he/she should simultaneously call 911. Finally, the CPR trainer stated the staff should give two breaths every 30 compressions. 115. On or about February 20, 2018 the Agency interviewed the Facility’s direct-care employce, Staff N. Staff N revealed that she did not have CPR training but she was scheduled for the class next Wednesday. 116. The Agency then interviewed the Facility’s direct-care employee, Staff L about CPR procedure. Staff L revealed that she worked in the facility for five years and had CPR training. Staff L said she should give CPR to someone who is unresponsive, not breathing, or does not have 20 good color. Staff L stated she will give 5 breaths and 20 compressions and then someone else will come over and continue. If not alone, Staff L stated she needed to continue the CPR. 117. The Agency then interviewed the Facility’s direct-care employee, Staff O about CPR procedure. Staff O revealed that she had received CPR training. Staff O stated that she thought she should give CPR to someone with respiratory problems, but she did not remember how. 118. The Agency finally interviewed the Facility’s direct-care employee, Staff C about CPR procedure. Staff C revealed she had CPR training. Staff C said she should give CPR to someone who was not responsive, put the victim in the most comfortable position, then check for respiration and pulse. Staff C said she would give 30 compressions and 1 breath; if the victim gave no reaction, she would call 911. Residents #23 & #25 119. On or about February 22, 2018, the Agency interviewed Resident #23. Resident #23 stated that he/she found Resident #25 on the floor during the night on January 11, 2018. Resident #23 says he/she went to the staff office, but none of the staff on duty spoke English, so he pantomimed what he was trying to tell them. Resident #23 didn’t know what the staff were saying in response, but they seemed upset. 120. Resident #23 went to find some other residents to help pick Resident # 25 up from the floor after leaving the staff office. 121. Onor about February 19, 2018 the Agency interviewed Staff J. Staff J revealed that she did not speak English, only Spanish. 122. Then the Agency interviewed Staff K. Staff K admitted he/she did not speak English, only Spanish. 123. Then the Agency interviewed Staff B. Staff B admitted he/she did not speak 21 English, only Spanish. 124. Then the Agency interviewed Staff D. Staff D admitted he/she did not speak English, only Spanish. 125. On or about February 19, 2018 the Agency interviewed Resident’s #44, #23, and #24, All three resident’s stated the only problem they have at the Facility is the employees do not speak English, 126. Additionally, Resident #23 and Resident #25 were involved in a physical altercation that resulted in an injury to Resident #23°s eye, which required a hospitalization. 127. While Resident #23*s roommate, Resident #25, was moved to another room after Resident #23’s hospitalization; there was no documentation of Resident #23 receiving assistance regarding the assault, nor any documentation that Facility staff investigated the dispute. Resident #28 128. The Agency reviewed facility records and found that Resident #28 was moved to another facility without receiving a 45-day notice. 129. Onorabout February 19, 2018, the Agency reviewed Resident #28’s records, which revealed an admission date was of August 10, 2017, and an 1823 form dated December 27, 2017 that denoted Resident #28 met the criteria to live in the facility. 130, On or about February 19, 2018 the Agency reviewed the Facility’s observation log, which revealed that on February 14, 2018 Facility staff was informed Resident #28 fell from his/her bed at 6:00 am. Subsequently, on February 15, 2018, Resident #28 was discharged from the Facility to a hospital. 131. At the time of this hospital admission, the observation log further revealed that Resident #28 was moved to another facility because it was a small facility, which could provide 22 the resident more attention. Resident #28 took all of his/her belongings and all of his/her medications. The Administrator was notified. 132. The Agency did not find any documentation of a 45-days’ discharge notice in Resident #28’s file. The Agency did not find any documentation of doctor’s notes that indicated a higher level of care was needed for Resident #28. Resident #1 133. On or about February 19, 2018 the Agency surveyors observed Resident #1 in bed with a wheelchair against the bed. The wheelchair blocked Resident #1 from getting out of bed. 134, On or about February 19, 2018, the Agency interviewed Respondent’s employee Staff E. Staff E stated that he/she placed the wheelchair against Resident #1’s bed because the resident could not come out of bed by his/herself. Staff E further stated the wheelchair is how the Facility prevented Resident #1 from falling. 135. On or about February 22, 2018, the agency interviewed Respondent’s Administrator. The Administrator stated that Resident #1 did not have half-bed rails, and the Facility did not have a fall management plan implemented for those residents who needed it. Resident Privacy 136. On or about February 19, 2018, the Agency surveyors observed bedside urinals with urine in rooms #2, #12, #15, #17, #18, #19, #20, #23, #24, and #29. There were no privacy screens in place in any of the rooms. 137. On or about February 22, 2018, the Agency interviewed Respondent’s Administrator. The Administrator stated that there were no privacy screens in the resident’s rooms. 138. On or about February 19, 2018, the Agency interviewed Resident #8. Resident #8, stated that he does not have a privacy screen to use the portable urinal in the resident’s room. 23 Remedy 139. Under Florida law, in addition to the requirements of part II of chapter 408, the agency shal] impose an administrative fine in the manner provided in chapter 120 for the violation of any provision of this part, part II of chapter 408, and applicable rules by an assisted living facility, for the actions of any person subject to level 2 background screening under section 408.809, for the actions of any facility employee, or for an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility. § 429.19(1), Fla. Stat. (2017). 140. Under Florida law, class I violations are defined in section 408.813. 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. § 429.19(2){a), Fla. Stat. (2017). 141. Under Florida law, class “I” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines present an imminent danger to the clients of the provider 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 as provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation. § 408.813(2)(a), Fla. Stat. (2017). WHEREFORE, Petitioner, State of Florida, Agency for Health Care Administration, seeks an administrative fine against Respondent in the amount of $10,000.00. COUNT Ii Staffing Standards - Administrator 142. Under Florida law, if, during the period for which a license is issued, the owner changes administrators, the owner must notify the agency of the change within 10 days and provide 24 documentation within 90 days that the new administrator has completed the applicable core educational requirements under s. 429.52. § 429.176, Fla. Stat. (2017). 143, Pursuant to Florida law: (1) ADMINISTRATORS. Every facility must be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff and the provision of appropriate care to all residents as required by Part II, Chapter 408, F.S., Part I, Chapter 429, F.S., Rule Chapter 59A-35, F.A.C., and this rule chapter. * * * (c) Administrators may supervise a maximum of either three assisted living facilities or a group of facilities on a single campus providing housing and health care Administrators who supervise more than one facility must appoint in writing a separate manager for each facility. However, an administrator supervising a maximum of three assisted living facilities, each licensed for 16 or fewer beds and all within a 15 mile radius of each other, is only required to appoint two managers to assist in the operation and maintenance of those facilities. (d) An individual serving as a manager must satisfy the same qualifications, background screening, core training and competency test requirements, and continuing education requirements of an administrator pursuant to paragraph (1)(a) of this rule. Managers who attended the core training program prior to July 1, 1997, are not required to take the competency test unless specified elsewhere in this rule. In addition, a manager may not serve as a manager of more than a single facility, except as provided in paragraph (1)(c) of this rule, and may not simultaneously serve as an administrator of any other facility. Fla. Admin. Code R. 58A-5.019(1), F.A.C. (2018). Survey Findings 144. The Agency re-alleges and incorporates by reference the survey findings in Count land II. 145. On or about February 19 through March 7, 2018, the Agency conduced a survey of Respondent’s Facility. 146. Based upon observation, record review and interview, the Agency determined that 25 Respondent’s Facility failed to have the supervision of an Administrator who ensured the management of all staff and the provision of appropriate care to all residents. 147. On or about February 19, 2018, the Agency reviewed Respondent Facility’s policies and procedures regarding administration of CPR. The policy showed that staff were to perform CPR on unresponsive residents, and continue until EMS arrived. 148. Agency interviews found five Facility staff members on duty during the day shift on February 19, 2018 were not capable of performing CPR procedures correctly. Two of the staff members stated they were not trained on how to perform CPR, and the other three staff members described an incorrect procedure, which included massaging the victim’s chest. All five staff members were employed in direct-care positions with residents. 149. Between the dates of February 19 and February 22, 2018, the Administrator took no corrective action regarding the staff's inability to perform CPR. 150. On or about February 22, 2018, the Agency interviewed Respondent’s Administrator about the staffs ability to perform CPR. 151. The Administrator said that she had spoken with all of the staff and they knew how to do CPR, and that a retraining would be provided to all staff on February 27, 2018. The Administrator subsequently stated that she would find a trainer to come in and provide updated training to one staff person on each shift from the 22nd until the 27th, and that the entire staff would be retrained on February 27, 2018. 152. The Agency found no documentation that the Administrator had attempted retraining or other interventions to ensure that unresponsive residents would be provided with CPR before February 22, 2018. 153. On or about February 20, 2018, the Agency observed he Facility’s Automatic 26 External Defibrillator (“AED”) with a labeled expiration date of April 2013 on the pads. 154. When interviewed by the Agency, the Administrator stated the battery had never becn replaced on the AED, despite the recommendation to replace the battery annually. 155. On or about February 20, 2018, the Agency further interviewed the Administrator about Do Not Resuscitate Orders (“DNROs”). The Administrator stated that none of the 80 residents in the Facility had DNROs. 156. Four staff members interviewed by the Agency also stated no residents had DNROS, ad fifth staff member did not know what a DNRO was. 157. Agency record review of the Facility’s residents found that two residents had DNROs in their medical files. 158. In later interviews, the Administrator stated that the Facility’s policy was to identify residents who had a DNRO on admission, and that all staff were informed when residents had such a DNRO on file. 159, The Administrator offered no explanation as to why she didn't know there were two residents who had a DNRO on file in the Facility. 160. The Administrator also did not know about Resident #2’s toe wound, which required hospitalization during the survey. 161. Residents #2, #16, #21, #23, and #25 had no documentation that they received follow-up care after hospitalizations, nor any documentation that the Facility staff assisted them with follow-up care with a primary care physician, despite hospital discharge recommendations. 162. The Facility had no documentation on Resident #16’s hip injury, surgery, or recovery, 163. Resident #21 was hospitalized six times in the last four months prior to the survey, 27 three of the six hospitalizations were for low blood sugar level. There was no documentation that Resident #21 received follow-up care with a physician after any of the hospitalizations. 164. In an interview on or about February 20, 2018 Respondent’s Administrator stated the Facility sent Resident #21 to the hospital, informed his/her doctor, and asked the doctor to follow up. However, a Supervisor (Staff F) was responsible to review the resident’s record, inform the resident’s doctor, and do any changes and follow up. 165. Ina further interview, the Administrator revealed that Staff F was new and “missed it.” 166. Resident #25 reportedly assaulted his/her roommate, Resident #23, which required a hospitalization. The Facility moved Resident #25 from the room, but there was no documentation of Resident #23 receiving assistance regarding the assault or any follow-up investigation of the dispute completed or directed by the Administrator. 167. Agency review of Resident #33’s Medication Observation Record “MOR” revealed multiple refusals to take his/her medication for three different medications. In an interview on February 22, 2018 Respondent’s Administrator stated that Staff should be calling the doctor and documenting the refusals in the progress notes. 168. Agency review of Resident #33’s progress notes showed that there was no documentation of the medication refusals or of any intervention or coordination with health care providers. 169. Accordingly, the Agency cited Respondent with a Class I deficiency. Remedy 170. Under Florida law, in addition to the requirements of part Il of chapter 408, the agency shall impose an administrative fine in the manner provided in chapter 120 for the violation 28 of any provision of this part, part Il of chapter 408, and applicable rules by an assisted living facility, for the actions of any person subject to level 2 background screening under section 408.809, for the actions of any facility employee, or for an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility. § 429.19(1), Fla. Stat. (2017). 171. Under Florida law, class I violations are defined in section 408.813. 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. § 429.19(2)(a), Fla. Stat. (2017). 172. Under Florida law, class “I” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines present an imminent danger to the clients of the provider 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 as provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation. § 408.813(2)(a), Fla. Stat. (2017). WHEREFORE, Petitioner, State of Florida, Agency for Health Care Administration, seeks an administrative fine against the Respondent in the amount of $10,000.00. COUNT IV Staffing Standards - Staff 173. Under Florida law, in pertinent part: (2) STAFF * * * (b) Staff must be qualified to perform their assigned duties consistent with their level of education, training, preparation, and experience. Staff providing services requiring licensing or certification must be appropriately licensed or certified. All staff must exercise their responsibilities, consistent with their qualifications, to observe residents, to document observations on 29 the appropriate resident’s record, and to report the observations to the resident’s health care provider in accordance with this rule chapter. (c) All staff must comply with the training requirements of Rule 58A- 5.0191, F.A.C. (d) An assisted living facility contracting to provide services to residents must ensure that individuals providing services are qualified to perform their assigned duties in accordance with this rule chapter. The contract between the facility and the staffing agency or contractor must specifically describe the services the staffing agency or contractor will provide to residents. Rule 58A-5.019(2), F.A.C., (2018). Survey Findings 174. The Agency re-alleges and incorporates by reference the findings in Count I and Count II of this complaint. 175. On or about February 28 through March 7, 2018, the Agency conducted a survey of Respondent’s Facility. 176. Based on observation, interview, and record review, the Agency determined Respondent’s Facility failed to ensure that individuals providing services and care to residents were qualified to perform their assigned duties. 177. On or about February 19, 2018, the Agency reviewed the Facility’s policies and procedures regarding the administration of CPR. The policy indicated that staff were to perform CPR on unresponsive residents, and continue until EMS (Emergency Medical Services) arrived. The policy further stated: “1. Incase a resident is found unresponsive, the staff member will contact 911 and provide resident with CPR until rescue personnel arrives at facility. 2. The Administrator, if not present at the time should be immediately contacted as well. 3. The paramedics will determine if resident is in need of acute care, or if resident has in fact expired. 4. In the event that paramedics determine and officially declare the resident as having expired, they should contact the local police department who will fill a report. 5. The police department will notify the resident's responsible party, 30 representative (sponsor) or emergency contact, and physician. 6. The Administrator will also contact all parties involved to confirm information and arrange for a convenient time for resident's belongings to be retrieved from facility.” 178. A review of the personnel record for Staff C showed a currently valid First Aid/CPR/AED (Automated Electronic Defibrillator) training completed on April 11, 2017. 179. Staff C, found Resident #20 unresponsive on December 9, 2017. Staff C did not check for a pulse or breathing for Resident #20, and only performed CPR for 30 compressions before calling 911. Staff C did not continue compressions until EMS arrived, nor did Staff C use an AED on the resident. 180. On or about February 20, 2018, the Agency interviewed Respondent’s direct-care employees Staff L, Staff O, and Staff C about the administration of CPR. All three staff members responded with different methods of administering CPR to an unresponsive resident. All three staff members responded with an incorrect method of providing CPR to an unresponsive resident. All three staff members had current documentation of being trained in CPR/First Aid. 181. Additionally, Staff N, a direct-care employee of the Facility, stated that she was not trained in administering CPR. 182. Accordingly, the Agency cited Respondent with a Class I violation. Remedy 183. Under Florida law, in addition to the requirements of part II of chapter 408, the agency shall impose an administrative fine in the manner provided in chapter 120 for the violation of any provision of this part, part II of chapter 408, and applicable rules by an assisted living facility, for the actions of any person subject to level 2 background screening under section 408.809, for the actions of any facility employee, or for an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility. § 429.19(1), Fla. Stat. (2017). 31 184. Under Florida law, class I violations are defined in section 408.813. 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. § 429.19(2)(a), Fla. Stat. (2017). 185. Under Florida law, class “I” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines present an imminent danger to the clients of the provider 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 as provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation. § 408.813(2)(a), Fla. Stat. (2017). WHEREFORE, Petitioner State of Florida, Agency for Health Care Administration, seeks an administrative fine against Respondent in the amount of $10,000.00. COUNT V Background Screening Attestation 186. Pursuant to Florida law, in pertinent part: (2) 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 screening 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 contractual 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 unless the person’s fingerprints are enrolled in the Federal Bureau of Investigation’s national retained print arrest notification program. If the fingerprints of such a person are not retained by the Department of Law Enforcement under s. 943.05(2)(g) and (h), the person must submit fingerprints electronically to the Department of Law Enforcement for state processing, and the Department of Law Enforcement shall forward 32 the fingerprints to the Federal Bureau of Investigation for a national criminal history record check. The fingerprints shall be retained by the Department of Law Enforcement under s. 943.05(2)(g) and (h) and enrolled in the national retained print arrest notification program when the Department of Law Enforcement begins participation in the program. 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. Until a specified agency is fully implemented in the clearinghouse created under s. 435.12, the agency may accept as satisfying the requirements of this section 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 Department of Elderly Affairs, the Agency for Persons with Disabilities, the Department of Children and Families, 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, provided that: ...(c) Such proof is accompanied, under penalty of perjury, by an attestation of compliance with chapter 435 and this section using forms provided by the agency § 408.809(2)(c), Fla. Stat., (2017). Survey Findings 187. On or about February 19 through March 7, 2018, the Agency conducted a survey of Respondent’s Facility. 188. Based on record review and interview, the Agency determined that Respondent’s Facility failed to ensure that three staff members had a copy of the attestation of compliance with Level 2 background screening requirements. 189. Onor about February 19, 2018, the Agency reviewed Respondent’s staff member’s employee files. 190. The review found that Staff E, Staff G, and Staff H did not have a signed copy of the attestation of compliance with the background screening requirements in their files. 191. On or about February 20, 2018, the Agency interviewed Staff B, who confirmed 33 that the three staff members did not have attestations on file at the Facility. Staff B did not explain the missing attestations. Remedy 192. Pursuant to 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 for a violation of any provision of Part I or Chapter 429, Part Il of Chapter 408, or applicable rules. § 429.14(1)(f), Fla. Stat. (2017). 193. Under Florida law, the Agency may impose an administrative fine for a violation that is not designated as a class I, class II, class III, or class IV violation. Unless otherwise specified by law, the amount of the fine may not exceed $500 for each violation. Unclassified violations include: (b) violating any provision of this part, authorizing statutes, or applicable rules. § 408.813(3)(b), Fla. Stat. (2017). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to impose an administrative fine of $500.00 against Respondent. COUNT Vi License Revocation 194. The Agency re-alleges and incorporates by reference Counts I, II, III, and IV. 195. 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: ... (6) An intentional or negligent act materially affecting the health or safety of a client of the provider. (c) A violation of this part, authorizing statutes, or applicable rules. § 408.815(1)(b), (c), Fla. Stat. (2017). 196. Under Florida law, in addition to the requirements of part II of chapter 408, the 34 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 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, any person subject to level 2 background screening under s. 408.809, or any facility staff: (a) an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility ... (e) A citation for any of the following violations as specified in s. 429.19: 1.One or more cited class I violations. § 429.14(1)(a), (e), Fla. Stat., (2017). 197. Pursuant to Florida law, the Agency shall deny or revoke the license of an assisted living facility if: ... (b) The facility is cited for two or more Class I violations arising from unrelated circumstances during the same survey or investigation. § 429.14(4)(b), Fla. Stat., (2017). 198. Respondent’s actions and/or inactions constituted multiple intentional or negligent acts that seriously and/or materially affected the health, safety or welfare of one or more of the residents of the Facility. 199. Respondent’s actions and/or inactions constituted four separate Class I violations. 200. Respondent’s actions and/or inactions constituted two or more Class I violations arising from unrelated circumstances during the same survey. 201. Respondent’s actions and/or inactions constituted a violation of this Chapter 408, Part II, the authorizing statutes, or the applicable rules. 202. Respondent’s actions and/or inactions constituted an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to revoke the Respondent’s license to operate an assisted living facility. 35 CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to enter a final order that: 1. Makes findings of fact and conclusions of law as set forth above. 2; Grants the relief set forth above. Respectfully submitted on this 19th day of March, 2018. . Ce at Cana Andrew B. Thornquést, Assistant General Counsel Florida Bar No. 0104832 The Sebring Building Agency for Health Care Administration 525 Mirror Lake Drive N., Suite #330 St. Petersburg, Florida 33701 Telephone: 727-552-1942 Facsimile: 727-552-1440 andrew.thornquest@ahca.myflorida.com NOTICE OF RIGHTS Pursuant to Section 120.569, F.S., any party has the right to request an administrative hearing by filing a request with the Agency Clerk. In order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), F.S., however, a party must file a request for an administrative hearing that complies with the requirements of Rule 28- 106.2015, Florida Administrative Code. Specific options for administrative action are set out in the attached Election of Rights form. The Election of Rights form or request for hearing must be filed with the Agency Clerk for the Agency for Health Care Administration within 21 days of the day the Administrative Complaint was received. If the Election of Rights form or request for hearing is not timely received by the Agency Clerk by 5:00 p.m. Eastern Time on the 21st day, the right to a hearing will be waived. A copy of the Election of Rights form or request for hearing must also be sent to the attorney who issued the Administrative Complaint at his or her address. The Election of Rights form shall be addressed to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 412-3630, Facsimile (850) 921-0158. 36 Any party who appears in any agency proceeding has the right, at his or her own expense, to be accompanied, represented, and advised by counsel or other qualified representative. Mediation under Section 120.573, F.S., is available if the Agency agrees, and if available, the pursuit of mediation will not adversely affect the right to administrative proceedings in the event mediation does not result in a settlement. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form have been served to the below named persons at the address stated by the method designated on this 19th day of March, 2018. Andrew B. Thornquest, Senioy Attorney Florida Bar No. 104832 Office of the General Counsel Agency for Health Care Administration The Sebring Building 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1942 Facsimile: (727) 552-1940 Andrew. Thomquest@ahca.myflorida.com Administrator Peter A. Lewis, Esquire Courtyard Manor Retirement Living, Inc. Law Offices of Peter A. Lewis, P.L. 140 West 28th Street 3023 N. Shannon Lakes Drive, Suite 101 Hialeah, Florida 33010 Tallahassee, Florida 32309 (Certified Mail- ) (Electronic Mail) 37 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re: Courtyard Manor Retirement Living, Inc. AHCA No. 2018003908 ELECTION OF RIGHTS This Election of Rights form is attached to an Administrative Complaint. The Election of Rights form may be returned by mail or by facsimile transmission, but must be filed with the Agency Clerk within 21 days by 5:00 p.m., Eastern Time, of the day that you received the Administrative Complaint. If your Election of Rights form with your selected option (or request for hearing) is not timely received by the Agency Clerk, the right to an administrative hearing to contest the proposed agency action will be waived and an adverse Final Order will be issued. In addition, please send a copy of this form to the attorney of record who issued the Administrative Complaint. (Please use this form unless you, your attorney or your qualified representative prefer to reply according to Chapter120, Florida Statutes, and Chapter 28, Florida Administrative Code.) The address for the Agency Clerk is: Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop #3 Tallahassee, Florida 32308 Telephone: 850-412-3630 Facsimile: 850-921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) I waive the right to a hearing to contest the allegations of fact and conclusions of law contained in the Administrative Complaint. | understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the fine, sanction or other agency action. OPTION TWO (2) I admit the allegations of fact contained in the Administrative Complaint, but I wish to be heard at an informal hearing (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine, sanction or other agency action should be reduced. OPTION THREE (3) I dispute the allegations of fact contained in the Administrative Complaint and request a formal hearing (pursuant to Section 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be 38 received by the Agency Clerk at the address above within 21 days of your receipt of this proposed agency action. The request for formal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain: 1. The name, address, telephone number, and facsimile number (if any) of the Respondent. 2. The name, address, telephone number and facsimile number of the attorney or qualified representative of the Respondent (if any) upon whom service of pleadings and other papers shall be made. 3. A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. 4. A statement of when the respondent received notice of the administrative complaint. 5. A statement including the file number to the administrative complaint. Licensee Name: Contact Person: Title: Address: Number and Street City Zip Code Telephone No. Fax No. E-Mail (Optional) Ihereby certify that I am duly authorized to submit this Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name: Title: 39

Docket for Case No: 18-002147