STATE OF FLORIDA . AGENCY FOR HEALTH CARE ADMINISTRATION Ale AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, v. ACTS RETIREMENT LIFE COMMUNITIES, INC. d/b/a WILLOWBROOKE COURT AT EDGEWATER POINTE ESTATES, Respondent. foe 09-7? AHCA No.: 2002046497 AHCA No.: 2002045646 Return Receipt Requested: 7000 1670 0011 4845 8325 7000 1670 0011 4845 8332 7000 1670 0011 4845 8349 ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Acts Retirement Life Communities, Inc. d/b/a Willowbrooke Court at Edgewater Pointe Estates, (hereinafter pursuant to Chapter 400, Part II, “Willowbrooke Court”), Florida Statutes (“Fla. Stat.”) and Chapter 59A-4, Florida Administrative Code (“Fla. Admin. Code”) and alleges: NATURE OF THE ACTION 1. This is an action to fine of $16,000.00 pursuant to § (2001), and an action of Notice impose an administrative 400.23(8), Fla. Stat. of Intent to Assign Conditional Licensure Status to Willowbrooke Court at Edgewater Pointe Estates pursuant to § 400.23(7), Pla. Stat. (2001), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part II, Fla. Stat., (2001). 3. Venue lies in Palm Beach County, pursuant to § 400.121 (1) (e), Fla. Stat. And Rule 28.106.207, Fla. Admin. Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Fla. Stat. (2001), and Chapter 59A-4 Fla. Admin. Code. 5. Willowbrooke Court operates a 10l1-bed skilled nursing facility located at 23305 Blue Water Circle, Boca Raton Florida 33433. Willowbrooke Court is licensed as a skilled nursing facility, license number SNF1139096; certificate number 8998 and was at all times material hereto a licensed facility under the licensing authority of AHCA, required to comply with all applicable rules and statutes. COUNT I WILLOWBROOKE COURT AT EDGEWATER POINTE ESTATES FAILED TO PROVIDE ADEQUATE SUPERVISION TO PREVENT ACCIDENTS. TITLE 42 § 483.25, CODE OF FEDERAL REGULATIONS RULE 59A-4.1288, FLA. ADMIN. CODE § 400.022(1)(1) and § 400.23, FLA. STAT. (QUALITY OF CARE) CLASS I 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Based on a complaint investigation conducted on July 12, 2002, AHCA determined that Willowbrooke Court did not ensure that each resident received adequate supervision to prevent accidents, and failed to provide protective and supportive services to one resident (Resident #1). This determination resulted in the citation of a Class I deficiency pursuant to § 400.23(8) (a). 8. Resident #1 was admitted on 01/11/02 with diagnoses of altered mental status and delusional disorder. The resident’s Minimum Date Set (MDS), dated 01/24/02, revealed that he/she was moderately impaired for daily decision-making, could ambulate by self and had no identified wandering behaviors. The MDS dated 04/23/02 assessed resident wandering daily with this behavior not easily altered and as being verbally and physically abusive. The nurse’s notes revealed the resident had a history of wondering during the night as follows: a. 05/06/02, at 3AM, "Resident up and down at night wandering" 05/08/02, at 2. aM, "Resident wandering aimlessly" 05/14/02: "Resident wandering aimlessly at night up and down hallway" 9, The Resident was found missing on 7/2/02 while staff was checking patient doors. He/she had been last seen at 8:30 PM when given a snack and medications. The nurse’s notes documented that the police department was notified at 11:18 pm, arrived at 11:30 PM and was notified at 12:05 AM by security that the resident's body had been found in the lake by the C-building Breeze Way. 10. AHCA determined that there was deficient practice because the main hallway door locking mechanism, as designed, did not adequately prevent a resident wearing a wander guard from leaving the unit unobserved. 11 Interview with the administrator and nursing supervisor and upon observation by AHCA on 7/12/02 revealed that the Lehman Special Care Unit (secured unit) main access/egress door was normally accessible for entering and exiting by any person except when activated by a wander guard device. The nursing supervisor demonstrated with a wonder guard device that when she approached to approximately 10 feet of the main hallway door, the alarm sounded and the door locked. 12. The Administrator and Nursing Supervisors acknowledged that there was "a lot of activity at this door and a lot of visitors entering and exiting. When a resident, inside this unit, wearing a wander guard came within approximately 10 feet of this door, an alarm sounded and the door automatically locked. However, if another person (visitor or staff) opened the door the wonder guard would not lock the door while it was open. 13. On three separate observations during the morning of the survey, 7/12/02, AHCA determined that the nursing Supervisor activated the wander guard alarm while visitors opened the door to enter the unit. The alarm sounded but the door, being opened, did not lock. This would allow any resident wearing a wander guard to exit the unit from this door. 14. AHCA also determined that the staff at the facility could turn the alarm off at the nurses station located at the far end of this hallway and that, "the staff don't have to go up the hallway to check and reset the alarm." AHCA observed that there was an observation camera facing the main hallway door in the ceiling at the end of the hallway nearest the nurse’s station. This hallway was not directly visible from the nurse’s station. Observation of the picture of the hallway on this monitor revealed a view narrowing down to the main hallway door in which objects or persons near the door were difficult to identify. 15. The alarms were being activated unnecessarily and the staff did not even have to physically go the door to check why the alarm was going off. The reason for this was that the door of room 133 opened within the 10-foot space in which a wander guard device sets off the alarm. Interview with the nurse supervisor revealed that the resident that resided in this room who wore a wonder guard device would set off the alarm when entering and exiting his/her room. 16. On the day of the survey, the facility had placed a monitor at the door in question while arrangements were being made to correct the system in place for the wonder guard. The facility nevertheless was cited at a Class I level pursuant to §400.23(8) (a), which provides in pertinent part that “..A fine must be levied notwithstanding the correction of the deficiency”. The facility was cited for a violation of $§400.022(1) (1), which requires that the facility provide protective and supportive services to its residents. The facility must comply with Florida Statutes as part of their licensure requirements. 17. Because Willowbrooke Court at Edgewater Pointe Estates participates in Title XVIII or XIX it must follow certification rules and regulations found in 42 Code of Federal Regulation 483. 18. Willowbrooke was cited for failure to comply with $483.25(h) (1), which requires that the facility remain as free of accidents hazards as is possible. 19. Based on the foregoing, Willowbrooke Court at Edgewater Pointe Estates violated § 483.25(h) (1), Code of Federal Regulations as incorporated by Rule 59A-4,.1288, Florida Administrative Code, $400.022(1) (1), Fla. Stat., herein classified as a Class I violation pursuant to $400.23(8) (a), Fla. Stat., which carries in this case, a fine or $10,000.00 and which gives rise to a conditional rating pursuant to §400.23(7). SURVEY FEE Pursuant to Section 400.419(9), Florida statutes, AHCA may assess a survey fee of $6,000.00 to cover the cost of monitoring visits. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Willowbrooke Court at Edgewater Pointe Estates shall post the license in a prominent place that is clear and unobstructed public view at or near the place where residents are being admitted to the facility. The conditional License is attached hereto as Exhibit NA” CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Willowbrooke Court at Edgewater Pointe Estates on Count I. 2. Assess against Willowbrooke Court at Edgewater Pointe Estates an administrative fine of $10,000.00 on Count I for violation of §§ 400.23 and 400.022(1) (1), Fla. Stat., and § 483.25, Code of Federal Regulations as incorporated by Rule 59A-4.1288, Fla. Admin. Code. 3. Uphold the conditional rating on the license of Willowbrooke Court at Edgewater Pointe Estates pursuant to §400.23(7) 4. Assess against Willowbrooke Court at Edgewater Pointe Estates the total amount due of $16,000 [$10,000.00 on Count I and $6,000.00 for the survey fee]. 5. Assess costs related to the investigation and prosecution of this matter, if applicable 6. Grant such other relief as the court deems is just and proper on Count I. Respondent is notified that it 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 and explained in the attached Explanation of Rights, All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Alba M. Rodriguez. 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. Alba M. Rodriguez Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 E. Tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (U. S. Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) EXHIBIT “A” Conditional License License # SNF 1139096; Certificate No.: Effective date: 07-12-2002 Expiration date: 08-31-2002 a 8998 CERTIFICATE OF SERVICE =e EE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Mary Jill Harden, Administrator, Willowbrooke Court at Edgewater Pointe Estates, 23305 Blue Water Circle, Boca Raton, Florida 33433; Acts Retirement Life Communities, Inc., 375 Morris Road, West Point, PA 19486; Daniel Irwin, Acts, Inc., 6901 S. W. 18 Street - Suite 301, Boca Raton, Florida 33433 on this List day of Or t ofr 2002. Alba ee. at te. ; B ; B

Docket for Case No: 02-004679