4-3-0 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION BEVERLY HEALTHCARE OF AT NORTH OKALOOSA, Petitioner, vs. AHCA NO. 2002006631 DOAH CASE NO. 02-1098 AHCA NO. 2002026751 RENDITION NO.: AHCA-04 AGENCY FOR HEALTH CARE S0C Chas ADMINISTRATION, Respondent. FINAL ORDER This cause was referred to the Division of Administrative Hearings and assigned to an Administrative Law Judge (ALJ) for a formal administrative hearing and the entry of a Recommended Order. The Recommended Order of April 3, 2003, is attached to this Final Order, and incorporated herein by reference except as noted. RULING ON EXCEPTIONS This case concerns a nursing home (Beverly Healthcare of North Okaloosa) that was the subject of two notices of intent to assign conditional licensure status alleging that the nursing home had failed to (1) ensure that the use of restraints for three residents was for treatment of a medical condition, (2) provide adequate supervision to: prevent accidents, (3) notify a resident’s physician of the resident’s change in condition, and (4) develop comprehensive care plans that address patient-specific needs. An administrative complaint was also filed seeking to impose a fine on respondent based on the same stated deficiencies. Petitioner did not file exceptions. The Agency filed an exception to the ALJ’s recommendation that the Agency revise the survey reports by deleting the deficiencies described under Tags F-157, F-221, F-279, F-324, and F-325. The ALJ cites no authority for this proposition. The Agency’s exception is that the Agency has no authority to make such revisions or to alter the Form 2567. This is correct, and, based on a complete review of the record, the exception is granted. However, granting this exception does not change the ALJ’s findings and conclusions regarding the charges made in the notices of intent to assign conditional licensure status and the administrative complaint. While the Agency has no authority on its own to make such changes, there is a procedure by which this can be done through the Centers for Medicare and Medicaid Services (CMS). The Petitioner may request that CMS review the Final Order and supporting documentation. Upon review, CMS may request or approve changes in the federal component of the 2567. If changes are requested or approved by CMS, the Agency will direct the field office to modify the 2567 to reflect the approved changes. Ultimate authority to make these changes rests with CMS. FINDINGS OF FACT The Agency adopts the findings set forth in the Recommended Order, which is attached hereto and incorporated by reference. CONCLUSIONS OF LAW The Agency adopts the conclusions of law set forth in the Recommended Order. IT IS THEREFORE ADJUDGED THAT: The deficiencies described under Tags F-157, F-221, F-279, F-324, and F-325 in this case were not proven by the Agency and the facility’s licensure status for the relevant period is restored to standard. The Petitioner may request that CMS review this Final Order and approve changes to delete the deficiencies set out in the above tags from the Form 2567. DONE and ORDERED this 1d day of je __, 2004, in Tallahassee, Florida. ) ALAN LEVINE, SECRETARY Agency for Health Care Administration NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY, ALONG WITH THE FILING FEE PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. Mail, or by the method indicated, to the persons named below on this /@ day of —\ We , 2004. _ Lealand/L. McCherett; AgencyCterk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 COPIES FURNISHED TO: Diane Cleavinger Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Richard Saliba, Esquire Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 Donna H. Stinson, Esquire Broad & Cassel 215 South Monroe Street, Suite 400 Post Office Box 11300 Tallahassee, Florida 32302 Elizabeth Dudek Deputy Secretary Wendy Adams Facilities Intake

Docket for Case No: 02-000692

Orders for Case No: 02-000692