Division of Administrative Hearings STATE OF FLORIDA AGENCY FOR HEALTH CARE MIN: ITBw - STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA NO: 2002016971 Petitioner, vs. LEE HEALTH CARE ASSOCIATES, LLC, d/b/a LEE CONVALESCENT 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 LEE HEALTH CARE ASSOCIATES, LLC, a/d/a LEE CONVALESCENT CENTER, (hereinafter “Respondent”) and élleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of three thousand five hundred dollars ($3,500) pursuant to (d), 400.1221 (1), and 400.23 (8) (b,c), Sections 400.102(1) (a) and Florida Statutes. 2. The Respondent was cited for the deficiencies set forth below as a result of complaint investigation survey conducted on or about March 7, 2002. JURISDICTION AND VENUE EE AND VENUE 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part fI, Florida Statutes. 4. Venue lies in Lee County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28- 106.207 F.A.C. PARTIES 5. AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules S9A-4, Florida Administrative Code. 6. Respondent is a nursing home located at 2826 Cleveland Avenue, Fort Myers, Florida. ‘The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I RESPONDENT FAILED TO ENSURE THAT A RESTDENT WHO IS FED BY A NASO-GASTRIC OR GASTROSTOMY TUBE RECEIVES THE APPROPRIATE TREATMENT AND SERVICES TO PREVENT ASPIRATION PNEUMONIA, DIARRHEA, VOMI'TING, DEHYDRATION, METABOLIC ABNORMALITIES, AND NASAL-PHARYNGEAL ULCERS AND TO RESTORE, IF POSSIBLE, NORMAL EATING SKILLS VIOLATING RULE 59A-4.1288, Florida Administrative Code AND SECTION 400.022({1) (L), Florida Statute CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. Based on resident record reviews and interviews the Respondent failed to ensure that recommended and ordered tube feeding, nN no decumentation that the medical administration record for Resident #9 and Resident #19 was being followed or indicate that the care and feeding of the residents were being monitored, Purther, nursing notes, meal consumption records, and the medical administration record for both residents were not accurate and complete. i3. The above referenced violation constitutes the grounds for the imposed uncorrected Class III deficiency and for which a fine of one thousand dollars ($1,000) is authorized under Sections 400.022 (3), 490.102 (1) (a,d), 400,121(1), and 400.23(8)(c), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I and Count IT; B. Impose a fine of three thousand five hundred dollars ($3,500) for the violations cited in Count I and Count II, against the respondent under Sections 400.102(1) (a) and (d), 400.121(1), and 400.23(8) (c,b), Florida Statutes; Cc. Attorney’s fees and costs and Dp. All other general and equitable relief allowed by law. NOTICE The Respondent is notified that it has a vight to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). a SS a Ail requests for hearing shall be made to the attention of Michael P. Sasso, 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, Michal {choo — Michael P. Sasso, Esquire AHCA - Senior Attorney $25 Mirror Lake Drive North, St. Petersburg, Florida 33702 I HEREBY CERTIFY that a copy hereof has been furnished to Cc. T. Corporation System, 1200 South Pine Island Road, Plantation, Florida, Return Receipt No. 7001 2510 0007 5976 5162 and to Administrator, Lee Convalescent Center, 2826 Cleveland Avenue, Fort Myers, Florida, Return Receipt No. 7001 2510 0007 5976 5247, by U.S. Certified Mail on amd October 2, 2002. Vhackap fa Michael P. Sasso, Esquire Copies furnished to: C.T. Corporation System Registered Agent for lee Convalescent Center 1200 South Pine Island Road Plantation, FL 33324 (U.S. Certified Mail) Administrator Lee Convalescent Center 2826 Cleveland Avenue Fort Myers, FL 33901-6097 (U.S. Certified Mail) Wendy Adams Agency for Health Care Administration 2727 Mahan Drive, Bldg #3 MS #3 Tallahassee, FL 32308 (Interoffice Mail) Molly McKinstry Long Term Care Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS Code #33 Tallahassee, Florida 32308 (Interoffice Mail) Michael Sasso AHCA ~ Senior Attorney 525 Mirror Lake Drive Suite 330K St. Petersburg, Fl 33701 PAYMENT FORM Agency for Health Care Administration Finance & Accounting P.0. Box 13749 Tallahassee, Florida 32317-3749 Enclosed please find Check No, in the amount of $ . Which represents payment of the Administrative Fine imposed by AHCA. Facility Name AHCA No,

Docket for Case No: 02-004255