OI-4N95 FILED STATE OF FLORIDA foo Boma AGENCY FOR HEALTH CARE apmrnrsThat ud 9 PH 2: 92 DIVISION 6 ADMINISTRATIVE HEARINGS STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA NO: 07-01-0167-NH vs. ROCKLEDGE NH, LLC, d/b/a ROCKLEDGE HEALTH AND REHABILITATION CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA’), by and through the undersigned counsel, and files this Administrative Complaint against Rockledge NH, LLC, d/b/a Rockledge Health and Rehabilitation Center. {hereinafter “Respondent” ) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of one thousand ($1,000) dollars pursuant to Sections 400.23(8), 400.102 (1) (a), (d), 400.121(1) Florida Statutes. Jurisdiction 2. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 3. Venue lies in Seminole County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28 F.A.C. Parties 4. AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part If, Florida Statutes and Rules 59A-4, Florida Administrative Code. 5. Respondent, Rockledge Health and Rehabilitation Center, is a nursing home located at 587 Barton Blvd., Rockledge, Florida. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A~4, Florida Administrative Code. se COUNT I . RESPONDENT FAILED TO STORE DRUGS AND BIOLOGICALS IN LOCKED COMPARTMENTS. 59A-4.1288, F.A.C. = g by reference J 42° CEFR 483760 (e) (1) CLASS III DEFICIENCY 6. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 7. On or about July 03, 2001, the facility was cited for the deficiency set forth below. This deficiency was previously cited during a survey conducted on or about June 28, 2001, and therefore, constitutes an uncorrected class III deficiency. 8. Based upon the observations of the surveyor, the facility failed to store drugs and biologicals in locked compartments for one of five sampled residents and three random sampled residents. 9. The Respondent was given written notification of the cited deficiency and the time frame for correction. 10. Based on the foregoing, Respondent violated 5S9A-4.1288 F.A.C. adopting by reference 42 CFR 483.60 (e) (1) which requires that in accordance with State and Federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys. This is a repeat class III violation. The Agency is authorized to impose a fine in the amount of $1,000.00 pursuant to Sections 400.23(8)(c), 400.102(1) (a), (d), and 400.121(1) Florida Statutes. WHEREFORE, AHCA intends to impose a fine of one thousand dollars ($1,000) for the violation cited in Count cee CO RC ger rere oe ep wee oe tere I, against the respondent, under Section 400.23(8) (c), Florida Statutes. The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2001). Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the attention of Dennis L. Godfrey, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr., St. Petersburg, Florida, 33701. 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. Respectfully submitted, Michael P. Sasso, Esquire AHCA - Senior Attorney 525 Mirror Lake Drive North Sebring Bldg., Suite 310G St. Petersburg, Florida 3370 (727) 552-1435 I HEREBY CERTIFY that a true copy hereof was sent by U.S. Certified Mail, Return Receipt (Z 170 444 520) Requested, to Ct Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324, Registered Agent for Rockledge NH, L.L.C., on the 30” day of Ockefher, , 2001. Mchal (foo Michael P. Sasso, Esquire Copies furnished to: Long Term Care Section Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Area 7 Office Agency for Health Care Administration 400 W. Robinson Street, Suite $309 Orlando, Florida 33701 Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Wendy Adams Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Administrator Rockledge Health & Rehabilitation 587 Barton Boulevard Rockledge, Florida 33495 1 OeTe i RA ae

Docket for Case No: 01-004493