Sam DEPARTMENT OF HEAIOPH AUS 25. pj1 )>, . BB DEPARTMENT OF HEALTH, ADMIN | 3” . HE Zk zr PETITIONER, o & =- LS vs. CASENUMBER: 99-02071 or LINDA J. BLACKSHEAR, RESPONDENT. ADMINISTRATIVE COMPLAINT COMES NOW, the Petitioner, Department of Health, hereinafter referred to as "Petitioner", and files this Administrative Complaint before the Board of Nursing Home Administrators against LINDA J. BLACKSHEAR, hereinafter referred to as "Respondent", and alleges: 1. Effective July 1, 1997, Petitioner is the state agency charged with regulating the practice of Nursing Home Administration pursuant to Section 20.43, Florida Statutes; Chapter 455, Florida Statutes; and Chapter 468, Florida Statutes. Pursuant to the authority of Section 20.43(3)(g), Florida Statutes, the Petitioner has contracted with the Agency for Health Care Administration to provide consumer complaint, investigative, and prosecutorial services required by the Division of Medical Quality Assurance, councils, or boards as appropriate including the issuance of emergency orders of suspension or restriction. 2. Respondent is, and has been at all time material hereto, a licensed Nursing Home Administrator in the State of Florida, having been issued license number NHA 0002250. 3. | Respondent's last known address is 1865 Raymond Tucker Road, Tallahassee, Florida 32311-8793. . 4. At all times material hereto Respondent was the Nursing Home Administrator at the Wakulla Manor (Manor). EXHIBIT LA YY 5. During or about March 16, 1999 to March 19, 1999, a follow-up survey was conducted at Manor by the Agency for Health Care Administration (AHCA). 6. The March, 1999, survey revealed that Manor was providing substandard care 7. The survey conducted in March, 1999, revealed that Manor failed to inform the appropriate health care designee of changes in the residents health care status on one of the sixteen sampled residents, failed to prohibit neglect on three of sixteen sampled residents, failed to meet the social services needs of sixteen sampled residents, and failed to safely store and prepare food. 8. Agency for Health Care Administration (AHCA) found immediate jeopardy at the follow-up visit of March 16, 1999 through March 19, 1999. 9. In addition, a moratorium on admissions was imposed effective March 19, 1999. 10. As the Manor administrator, Respondent was responsible for implementing appropriate procedures to ensure that the above mentioned deficiencies found in the 1999 survey were corrected. Respondent failed to do so. il. A revisit was conducted at Manor on or about April 26-27, 1999, and it was found out of substantial compliance. COUNT ONE 12. Petitioner realleges and incorporates by reference paragraphs one (1) through eleven (11). 13. Based on the foregoing, Respondent's license to practice nursing home administration is subject to discipline pursuant to Section 468.1755(1)(1), Florida Statutes, for repeatedly acting in a manner inconsistent with the health, safety, or welfare of the patients of the facility in which he or she is the administrator. COUNT TWO 14. Petitioner realleges and incorporates by reference paragraphs one (1) through eleven (11). U- a 15. Based on the foregoing, Respondent's license to practice nursing home administration is subject to discipline pursuant to Section 468.1755(1)(h), Florida Statutes, for negligence, incompetence, or misconduct in the practice of nursing home administration. WHEREFORE, Petitioner respectfully requests that the Board of Nursing Home Administrators enter an order imposing one or more of the following penalties: revocation or suspension of the Respondent's license, restriction of the Respondent's practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, and/or any other relief that the Board deems appropriate. SIGNED this h k day of Dog , 2000. Robert G. Brooks, M.D. Secretary, Department of ancy Snurkowski, Chief Attorney On Behalf of Agency for Health Care Administration COUNSEL FOR PETITIONER: Shannon R. Fleming 3A Senior Attorney DE ; Agency for Health Care Administration PARTMENT Cena Post Office Box 14229 rn . Tallahassee, Florida 32317-4229 CLERK $ehi RM (904) 488-1474 pate Y- //- 2000 PCP: Terry Goodman, Mary Goehring DOM: March 10, 2000 SRF/dja 04/05/2000 3 \

Docket for Case No: 00-003527PL