LA FVII STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE Division of Administrative Hearings ADMINISTRATION, Petitioner, AHCA CASE NO. 2002034841 . v. GWEN HARRIOTT, ACLF, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW THE AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter referred to as AHCA), by and through its undersigned counsel, and files this Administrative Complaint against Gwen Harriott, ACLF (hereinafter referred to as “Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2001), and alleges the following: Nature of the Action 1. This is an action to impose an administrative fine upon Respondent pursuant to Section 400.419, Florida Statutes. Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4. Venue vests pursuant to Rule 28-106.207, Florida Administrative Code. Parties 5. Pursuant to Chapter 400, Part III, Florida Statutes, and Rules 58A-5, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. Respondent is an assisted living facility located at 5201 Fifth Avenue North, St. Petersburg, Florida 33710. Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code, with 6 beds and having been issued license number 4928. COUNT I RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. THE RESPONDENT FAILED TO ENSURE THAT RESIDENTS SERVING AS PAID OR VOLUNTEER STAFF ARE NOT LEFT SOLELY IN CHARGE OF OTHER RESIDENTS WHILE THE FACILITY ADMINISTRATOR, MANAGER, OR OTHER STAFF ARE ABSENT FROM THE FACILITY. Chapter 58A-5.019 Florida Administrative Code (2001); and Section 400.419 Fla.Stat. (2001) 7. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 8. On or about May 10, 2002, AHCA performed a complaint investigation at Respondent's facility. AHCA cited Respondent based upon the findings below: The administrator did not ensure that residents were not left solely in charge of other residents while the facility administrator or other staff are absent. Findings include, On May 10th, 2002 a visit was made to the facility at approximately 1:30 pm. After this office was notified by the St. Petersburg police department that the administrator of the home had been arrested. Two (2) female residents were in the facility at the time, one elderly female and one younger (approximately 26 years of age). The younger female 2 resident had been left in charge of the home. Representatives from the police department indicated to this office they were told by the administrator that this resident could be left in charge. 9. Based on the foregoing, Respondent has violated Chapter 58A-5.019 Florida Administrative Code (2001) by reason of the fact that Respondent failed to ensure that residents were not left solely in charge of other residents while the facility administrator was absent from the facility. 10. The foregoing violation constitutes a Class II violation. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class I. violations. A Class II violation is subject to an administrative fine in an amount not less than $1,000 and not exceeding $5,000 for each violation. A citation for a Class II violation must specify the time within which the violation is required to be corrected. AHCA is authorized to impose a fine of $5,000. ll. The facility was given a mandated correction date in accordance with Section 400.419(1) (b), Florida Statutes of May 10, 2002. 12. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: be) Make factual and legal findings in favor of AHCA. lon Impose a fine in the amount of $5,000.00. c) Impose and assess a survey fee of $275.00 in addition to the assessed fine. Q Any other general and equitable relief as deemed appropriate. Dated: July 22, 2002 Agency for Health Care Administration Jod . Page, Es e, Senior Attorney Fla. Bar. No. 0174629 NOTICE Respondent, GWEN HARRIOTT ACLF hereby is notified that Respondent has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Jodi C. Page, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. In order to preserve your right to a hearing, your Election of Rights in this matter must be received by AHCA within twenty-one (21) days from the date you receive the Administrative Complaint. If the election of rights form with your selected option is not received by AHCA within twenty-one (21) days from the date of your receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. Dated: July 22, 2002 AGENCY FOR HEALTH CARE ADMINISTRATION Jod . Page, ES e, Senior Attorney Fla. Bar. No. 0174629 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent by Certified Mail (# 7106 4575 1294 2049 8897) to Gwen Harriott ACLF, 5201 Fifth Avenue North, St. Petersburg, Florida 33710, this 224 day of July, 2002. AGENCY FOR HEALTH CARE ADMINISTRATION t Jo Cc. Page, ee Senior Attorney Fla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax)

Docket for Case No: 02-003954