CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 1580 STATE OF FLORIDA WP gs AGENCY FOR HEALTH CARE ADMINISTRATION mht AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, on 474 | Case No. 2002045854 HELEN CRESS d/b/a RAINBOW GUEST, wen rN ita \ Respondent. yan Sit SecA ie) \ / ADMINISTRATIVE COMPLAINT oA COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by sok vs and through the undersigned counsel, and files this Administrative Complaint against Helen Cress d/b/a Rainbow Guest (hereinafter “Respondent”), pursuant to Chapter 400, Part III, and section 120.60, Florida Statutes, and alleges: NATURE OF THE ACTION 1, This is an action to impose (1) administrative fine totaling ONE THOUSAND DOLLARS ($1,000.00) against the Respondent, pursuant to Sections 400.414 and 400.419, Florida Statutes. 2. The Respondent was cited for the deficiency set forth below as a result of a biennial survey conducted on July 15, 2002. JURISDICTION AND VENUE 3. AHCA has jurisdiction over licensure of assisted living facilities (ALFs), pursuant to Chapter 400, Part III, Florida Statutes. 4. Venue is in Pinellas County, Division of Administrative Hearings, pursuant to Sections 120.57 and Florida Administrative Code Rule 28-106.207. Page 1 of 4 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 1580 PARTIES 5. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 400, Part Il, Florida Statutes, and Chapter 58A-5 Fla. Admin. Code. 6. The Respondent is licensed to operate an assisted living facility; license number 6093; certificate number 13275; for 18 licensed beds; effective 10/02/2002 through 05/21/03; located at 827 Burlington Avenue, North, St. Petersburg, Florida 33731. As a licensee under the licensing authority of AHCA, the Respondent was at all relevant times required to comply with all applicable rules and statutes governing assisted living facilities. A license to operate an assisted hving facility is a public trust and a privilege, not an entitlement, pursuant to Section 400.401(3), Florida Statutes. 7. AHCA conducted a biennial state licensure survey on July 15, 2002. AHCA conducted a previous survey in July 2000. COUNT I RESPONDENT FAILED TO ENSURE THAT THE COMMUNITY LIVING SUPPORT PLAN WAS UPDATED ANNUALLY FOR ONE OF TWO LIMITED MENTAL HEALTH RESIDENTS REVIEWED CLASS III DEFICIENCY FLORIDA ADMINISTRATIVE CODE RULE 58A-5.029(2)(c)(3)(a)(vii) 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During the biennial survey conducted on July 15, 2002, AHCA determined that the community living support plan had not been updated annually for one of two limited mental health residents reviewed. The findings include: A. A review of resident records revealed that the latest community living support plan for Resident #] was from April 2000. Page 2 of 4 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 1580 10. Based upon the forgoing, the Respondent violated Fla. Admin. Code R. 58A- 5.029(2)(c)(3)(a)(vii), which requires the Respondent to maintain current records for each mental health resident, including specifically a community living support plan that is updated at least annually. 11.‘ This is a repeat deficiency from the survey conducted in July 2000 in which the Respondent was cited for failure to maintain current records for each mental health resident. 12. The above referenced violation is grounds for the imposition of the administrative fine, pursuant to § 400.414, Fla. Stat. This is a Class III violation subjecting the Respondent to a fine of ONE THOUSAND DOLLARS ($1,000.00), pursuant to § 400.419, Fla. Stat. CLAIM FOR RELIEF WHEREFORE, the Agency requests the following relief: 13. Factual and legal findings in favor of the Agency on Count I, and; 14. Uphold the imposition of the administrative fine totaling ONE THOUSAND DOLLARS ($1,000.00). NOTICE OF RIGHTS Respondent is notified that it has a nght to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. 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, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida, 32308; Attention: Joanna Daniels, Assistant General Counsel RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN Page 3 of 4 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 1580 AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted this 12th day of November 2002. 7 t a — 7 7 oven Lee Joanna Daniels Assistant General Counsel Florida Bar I.D. No. 0118321 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served BY CERTIFIED MAIL Article # 7106 4575 1294 2050 1580 on November _12__, 2002 to: Helen Cress, Administrator Rainbow Guest 827 Burlington Avenue, North St. Petersburg, Florida 33731 Copies furnished to: Wendy Adams Joanna Daniels Agency for Health Care Administration Agency for Health Care Administration 2727 Mahan Drive, MS #3 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 Tallahassee, FL 32308 (Interoffice Mail) (File Copy) 4 £ Zz EE c= JOANNA DANIELS Assistant General Counsel \ JD/sr/gm Page 4 of 4 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: __Helen Cress d/b/a Rainbow Guest Enforcement # 2002045854 ELECTION OF RIGHTS REGARDING ADMINISTRATIVE COMPLAINT PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE (1) 0 I do not dispute the allegations of fact contained in the Administrative Complaint and waive my right to object or to be heard. J understand that by waiving my rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) O J donot dispute and I admit the allegations of fact in the Administrative Complaint, but do wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes (F.S.), at which time, I will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) O Ido dispute the allegations of fact contained in the Administrative Complaint and request a formal hearing, pursuant to Section 120.57(1), F.S., before an Administrative Law Judge appointed by the Division of Administrative Hearings. If you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C.), Section 28- 106.111, Florida Administrative Code (F.A.C.), and must state the material facts you dispute. In order to preserve the right to a hearing, the Election of Rights form, in this matter, must be received by the Agency for Health Care Administration within twenty-one (21) days from the date the Administrative Complaint is received by licensee. If the election of rights form with the selected option is not received by the Agency for Health Care Administration within twenty-one (21) days from the date of the receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought. If you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. 0 Mediation under Section 120.573, Florida Statutes, is not available in this matter. (Please sign and fill in your current address.) Respondent (Licensee) Address: License No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: Joanna Daniels, Assistant General Counsel Office of the General Counsel Building 3 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308 Phone: 850/922-5873; Fax: 850/413-9313 or 850/921-0158 TDD 1/800/955-8771 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES ee RAEI ED (To be used with Election of Rights for Administrative Complaint form — attached) In response to the allegations set forth in the Administrative Complaint issued by the Agency for Health Care Administration (Agency), you must make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint. Please make your election on the attached Election of Rights form and return it fully executed to the address listed on the form. OPTION ONE (1): If you do not dispute the allegations in the Administrative Complaint and waive your right to be heard, you should select Option 1 on the Elections of Rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Administrative Complaint. You will be provided a copy of the final order. OPTION TWO (2): If you do not dispute any material fact alleged in the Administrative Complaint (you admit each of them), you may request an informal hearing pursuant to Section 120.57(2), Florida Statutes, before the Agency. At the informal hearing, you will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Administrative Complaint. For an informal hearing, you should select Option 2 on the Election of Rights form. OPTION THREE (3): If you dispute the allegations set forth in the Administrative Complaint (you do not admit them), you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal hearing, select Option 3 on the Election of Rights form. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.111, Florida Administrative Code (F.A.C.), Section 28-106.201, Florida Administrative Code (F.A.C and must state the material facts you dispute. In order to preserve the right to a hearing, the Election of Rights form, in this matter, must be received by the Agency for Health Care Administration within twenty-one (21) days from the date the Administrative Complaint is received by licensee. If the election of rights form with the selected option is not received by the Agency for Health Care Administration within twenty-one (21) days from the date of the receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought. OMBUDSHAN PaRrAnaA Nterim State Ombudsman DATE: February 27, 2002 ‘ 2 TO: Administrator, Rainbow Guest (ALF) - 3 827 Burlington Avenue No, St Petersburg FL 3370] Az OO ¢ a i FROM: Mid & South Pinellas Long-Term Care Ombudsman Council | beers * o Robert Archer, Chairman RP ” z on om ~~ SUBJECT: Ombudsman inspection of facility See RENE OTSLANA SHAAN ERUN SULT REA GUN ESA HAR OUNESOURNEAMHAHESHECEUEEAEMES¢REEeses An ombudsman conducted an inspection of your facility in accordance with Florida Statute, Chapter 400, Part 1 on 1/23/02. The ombudsman verbally informed you, of the person in charge if you were not present, of his/her findings immediately following the inspection. On the date(s) of the inspection the ombudsman made the following recommendation(s) for improvemgntin the care or services at the facility: tae ee SAE ee Aa ie eee fe As required by ALF Regulation, ensure the Long-Term Care Ombudsman Council brochures are provided to each new resident upon admission. On the date of the inspection, none of these brochures were available. The brochures should be kept on hand at all times to include in the facility's admission packets. A supply was mailed t ur facility on 1/25/02 for your convenience. Please call the Ombudsman Office at : ber and order more when the facility runs low on brochures, _. There were no other areas of concern, All inspections are peer reviewed by the council's Quality Assurance Committee to ensure the ombudsman conducted a quality inspection and thoroughly documented it. The council appreciates your cooperation with the inspection. [fF you have any questions, please contact our office at 588-6912, ce: Agency for Health Care Administration 11351 Ulmerton Road, Suite 100, Largo, FL 33778 Toll-Free 1-888-831-0404 or (727) 588-6912 or SC 513-2707 1 Fax (727) 588-3648 or SC 513-1932 www myflorida.com/ombudsman

Docket for Case No: 02-004791