STATE OF FLORIDA CF Oe om, AGENCY FOR HEALTH CARE ADMINISTRATION? y ‘4 Ans, > AGENCY FOR HEALTH CARE Certified Article Number ADMINISTRATION, 7Lb0 3901 4844,2829 2842 Petitioner, SENDERS RECORD Case No. 2002045665 Ceck f caste NOL ZAC VH44 OBZ ZEA O%-0775 vs. JOYCE MCCALLA, d/b/a JOYCE MCCALLA, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against JOYCE MCCALLA, d/b/a JOYCE MCCALLA, hereinafter referred toas “Respondent,” pursuant to Section 120.569, and 120.57, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION... 1. This is an action to impose an administrative fine upon the Respondent, pursuant to Section 400, Part VII, Florida Statutes, (2001). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). | 3. AHCA has jurisdiction over the Respondent pursuant to Chapter 400, Part VII, Florida Statutes (2001). 4, Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2001). PARTIES 5. Pursuant to Chapter 400, Part VII, Florida Statutes, and Rules 58A-14, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living laws and rules. 6. The Respondent is an adult family-care home located at 4116 Latona Avenue, West Palm Beach, Florida 33407. The Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part VII, Florida Statutes (2001), and Chapter 58A-14, Florida Administrative Code (2001), having been issued license number 6905375. COUNT I The Respondent failed to produce its facility’s annual documentation of freedom from communicable diseases and tuberculosis. Fla. Admin. Code R. 58A-14.008(1)(a) (2001) 7. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through six (6) as if fully set forth herein. 8. On or about July 9, 2002, AHCA conducted a survey at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a) The facility did-not ensure that the provider and relief person were certified as. being free from tuberculosis on an annual basis. b) The provider, when requested by the surveyor, was unable to produce any evidence that she and the relief person had been examined and certified as free from tuberculosis during the past year. 9. The Respondent failed to produce its facility’s annual documentation of freedom from communicable diseases and tuberculosis, as required by Fla. Admin. Code R. 58A-14,008(1)(a) (2001). Annual documentation of freedom from communicable diseases and tuberculosis are required, in pertinent part, as follows: (1) MINIMUM STAFF REQUIREMENTS. (a) The provider, all staff, each relief person, and ali adult household members must submit a statement from a health care provider, based on an examination conducted within the last six months, that the person is free from apparent signs and symptoms of communicable diseases including tuberculosis. Freedom from tuberculosis must be documented on an annual basis. Persons witha positive tuberculosis test must submit a physician’s statement that the person does not constitute a risk of communicating tuberculosis...” (Fla. Admin. Code R. 58A- 14.008(1)(a)) 10. The foregoing violation constitutes a Class II] violation. Class III violations are those conditions or practices related to the operation and maintenance of an adult family-care home or to care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of residents, other than class I or II violations. A class III violation is subject to an administrative fine of not less than $100 and not exceeding $250 for each violation. . 11. The Respondent was provided a mandated correction date of 7/11/01. The violation alleged herein constitutes an uncorrected Class III deficiency, and warrants a fine of $250.00. WHEREFORE, AHCA demands the following relief: 1. Enter-factuat and-legal-findings-as-set-forth-in the allegations of this~-- Administrative Complaint. 2. Impose a fine, in the amount of $250.00, against the Respondent. COUNT II The Respondent failed to have relief staff, in sole charge of residents, trained in First Aid and CPR. , Fla. Admin. Code R. 58A-14.008(4)(d) (2001) 12. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through six (6) as if fully set forth herein. 13. Onor about July 10, 2002, AHCA conducted a survey at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: 3 a) The facility did not produce any evidence that the relief person had any First Aid and CPR training. During the interview the provider confirmed that the relief person had not received training in First Aid and CPR. The provider also stated that this was the relief person she had left in sole charge of the residents when the provider had been on vacation from August 20, 2002 through September 3, 2002. b) The provider was scheduled to attend an all day seminar on this date leaving the residents again with this untrained relief person. The surveyor advised the provider that this was not appropriate and the provider then remained at the facility. 14, The Respondent failed to have relief staff, in sole charge of residents, trained in first aid and CPR, as required by Fla. Admin. Code R. 58A-14.008(4)(d) (2001). First Aid and CPR training for relief staff, and any person left in sole charge of residents is required, in pertinent part, as follows: “| ..(4) TRAINING ...(d) The AFCH provider, each relief person, and any person left in sole charge of residents, which may include staff, household members or volunteers, must hold a currently valid card documenting completion of courses in First Aid and CPR. A nurse shall be considered as having met the training requirements for First Aid...” (Fla. Admin. Code R. 58A-14.008(4)(d)) 15. — The foregoing violation constitutes a Class II] violation. Class HI violations are those conditions or practices related to the operation and maintenance of an adult family-care home or to care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of residents, other than class I or II violations. A class III violation is subject to an administrative fine of not less than. $100 and not exceeding. $250. for each violation. - 16. . The Respondent was provided a mandated correction date of 8/8/02. The violation alleged herein constitutes an uncorrected Class III deficiency, and warrants a fine of $250.00. WHEREFORE, AHCA demands the following relief: 1, Enter factual and legal findings as set forth in the allegations of this Administrative Complaint. 2. Impose a fine, in the amount of $250.00, against the Respondent. COUNT I The Respondent failed to have a completed health examination of residents. Fla. Admin. Code R. 58A-14.0061(2) (2001) 17. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through six (6) as if fully set forth herein. 18. Onor about July 10, 2002, AHCA conducted a survey at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a) The facility did not ensure that residents were examined, and DOEA Form 1110 was completed, prior to admission. b) For two (2) of three (3) residents at the facility, the DOEA Form 1110, although present, was not complete. Resident #1’s examination form was not signed and did not have the license number of the examiner. Resident #3’s examination form lacked the required affirmation by the examiner that the needs of the resident could be met at this facility. 19. | The Respondent failed to have a completed health examination of residents, as required by Fla. Admin. Code R. 58A-14.0061(2) (2001). A completed health examination of residents, by the health care provider, is required, in pertinent part, as follows: “...(2) HEALTH ASSESSMENT. Prior to admission to an AFCH, the individual must be examined by the health care provider using the Resident Health Assessment, DOEA Form 1110, February 1999, which is incorporated by reference, and available from the Assisted Livmg Program, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, FL 32399-7000...” (Fla. Admin. Code R. 58A-14.0061(2)) 20. The foregoing violation constitutes a Class III violation. Class III violations are those conditions or practices related to the operation and maintenance of an adult family-care home or to care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of residents, other than class I or I] violations. A class III violation is subject to an administrative fine of not less than $100 and not exceeding $250 for each violation. 21, The Respondent was provided a mandated correction date of 8/8/02. The violation alleged herein constitutes an uncorrected Class III deficiency, and warrants a fine of $250.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of this Administrative Complaint. 2. Impose a fine, in the amount of $250.00, against the Respondent. COUNTIV The Respondent failed to take required remedial training. § 400.6211(4), Fla. Stat. (2001) 22. | AHCA repeats, re-alleges, and incorporates paragraphs one (1) through six (6) as if fully set forth herein. 23. Onor about July 10, 2002, AHCA conducted a survey at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a) The provider had been required to repeat AFCH basic training. b) The provider stated, that due to the absence of local training until the month of December, AFCH basic training had not been repeated and accomplished. The provider has not sought to take this program at other locations where it might be given. c) As evidenced by the provider not correcting the deficiencies of the July 9, 2002 survey and having left the residents from August 20, 2002 through September 3, 2002, under the care of a relief staff member, who did not have First Aid and CPR training, this provider does not have an adequate understanding of the rules and regulations. 19. The Respondent failed to take required remedial training, as required by § 400.6211(4), Fla. Stat. (2001). The education and training for a provider or staff, is required, in pertinent part, as follows: “,,.400.6211 Training and education programs... (4) If the Department of Children and Family Services, the agency, or the department determines that there are problems in an adult family-care home which could be reduced through specific training or education beyond that required under this section, the agency may require the provider or staff to complete such training or education...” (§ 400.6211, Fla. Stat.) 6 20. The foregoing violation constitutes a Class III violation. Class II violations are those conditions or practices related to the operation and maintenance of an adult family-care home or to care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of residents, other than class I or II violations. A class ITI violation is subject to an administrative fine of not less than $100 and not exceeding $250 for each violation. 21. The Respondent was provided a mandated correction date of 8/8/02. The violation alleged herein constitutes an uncorrected Class III deficiency, and warrants a fine of $250.00. WHEREFORE, AHCA demands the following relief: 3. Enter factual and legal findings as set forth in the allegations of this Administrative Complaint. 4. Impose a fine, in the amount of $250.00, against the Respondent. Cc> Submitted on this 10 7” aay of DCL SLE! 2002, on behalf of the Agency for Health Care Administration by, ’ LEED Ze Joanna Daniels, Senior Attomey Fla. Bar. No. 0118321 - Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0070 (office) (850) 413-9313 (fax) STATE OF FLORIDA He ES AGENCY FOR HEALTH CARE ADMIRIgy: TION. v1) Lig. 4 bsp 1 Opa 3 ys, 5 AGENCY FOR HEALTH CARE Wi) remy ADMINISTRATION, HE AST Re ING 6 : Petitioner, vs. Case No. 2002045665 JOYCE MCCALLA, d/b/a JOYCE MCCALLA, Respondent. NOTICE The Respondent, JOYCE MCCALLA, d/b/a JOYCE MCCALLA, is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida, 32308; Attention: Joanna Daniels, Senior Attorney. THE RESPONDENT IS FURTHER NOTIFIED, if the request for hearing is not received by the Agency for Health Care Administration within twenty-one (21) days of receipt of this Administrative Complaint, a Final Order will be entered. Submitted on this.50 A say of SELLE GE. a wa Agency for Health Care Administration by, aa oanna Daniels, Senior Attomey Fla. Bar. No. 0118321 Counsel for Petitioner Agency for Health Care Administration Bidg. 3, MSC#3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0070 (office) (850) 413-9313 (fax) CERTIFICATE OF SERVICE THEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights form, and Election of Rights forms have been sent by U.S. Certified Mail, Return Receipt Requested (return receipt #7160 3901 9844 0829 2841), to Joyce McCalla, d/b/a Joyce McCalla, 4116 Latona Avenue, West Palm Beach, Florida 33407. Submitted on this Rois day of SCP EMIREL 2002, on behalf ofthe Agency for Health Care Administration by, —ee My {Janna Daniels, Senior Catle Fla. Bar. No. 0118321 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0070 (office) (850) 413-9313 (fax)

Docket for Case No: 03-000775