STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE Certified Article Number ADMINISTRATION, 7106 4575 4294 2050 0750 Petitioner, . SENDERS RECORD ODd-1 ey AHCA CASE NO. 2002049242 Vv. 2002049243 2002049132 LARGO ACLF, LTD., D/B/A THE HOMESTEAD OF LARGO, Respondent. Oc / sé ADMINISTRATIVE COMPLAINT BS: zs oO 2) q * COMES NOW THE AGENCY FOR HEALTH CARE ADMINISTRATIONS, Q (hereinafter referred to as AHCA), by and through its . undersigned counsel, and files this Administrative Complaint against LARGO ACLF, LTD., D/B/A THE HOMESTEAD OF LARGO (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 administrative fines upon Respondent pursuant to Section 400.414, 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, Plorida 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 operates an assisted living facility located at 750 Starkey Road, Largo, Florida 33771. 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 168 beds and having been issued license number 7301. 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. RESPONDENT FAILED TO SUBMIT A PRELIMINARY ADVERSE INCIDENT REPORT FOR A RESIDENT WHO ELOPED ON 8/26/02. Section 400.423(3) Fla.Stat. (2002); and Section 400.414 Fla.Stat. (2002) 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 September 12, 2002, AHCA performed an appraisal visit at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not submit a preliminary report of all adverse incidents within one business day after the occurrence. The findings included an interview with the nurse at approximately 12:00pm and review of adverse incident reports and resident files. Resident #1 had two incidents of elopement on 8/26/02, and9/8/02 for which there was no documentation of an adverse incident reports on the day of the appraisal visit. 9. On or about November 13, 2002, AHCA conducted a follow-up to its appraisal visit at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not submit a preliminary report of all adverse incidents within one business day after the occurrence. The findings included: Based upon an interview with the administrator and review of an adverse incident report during this follow-up visit. Resident #1 had two incidents of elopement on 8/26/02, and 9/8/02. While an adverse incident report had been completed for the incident of 9/8/02, there was no documentation of an adverse incident report for the elopement occurring on 8/26/02. Uncorrected from the visit of 9/12/02 10. Based on the foregoing, Respondent has violated Section 400.423 Florida Statutes (2002), by reason of the fact that Respondent failed to submit a preliminary adverse incident report for a resident who eloped on 8/26/02. 11. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 12. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes of October 12, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT ITI 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. RESPONDENT FAILED TO SUBMIT A 15-DAY REPORT FOR A RESIDENT WHO ELOPED ON 8/26/02. Section 400.423(4) Fla.Stat.(2002); and Section 400.414 Fla.Stat. (2002) 13. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 14. On or about September 12, 2002, AHCA performed an appraisal visit at Respondent’s facility. AHCA cited Respondent based upon the findings below: There was no documentation of a full report of the facility's investigation of two incidents of elopement by resident #1. Review of facility records on the day of the appraisal revealed no documentation of the facility's investigation of incidents of elopement for resident #1 on 8/26/02 and 9/8/02. 15. On or about November 13, 2002, AHCA conducted a follow-up to its appraisal visit at Respondent’s facility. AHCA cited Respondent based upon the findings below: There was no documentation of a full report of the facility's investigation of an incident of elopement by resident #1. Review of facility records on the day of this follow-up visit of 11/13/02 revealed no documentation of the facility's investigation of an incident of elopement for resident #1 on 8/26/02. Uncorrected from the visit of 9/12/02. 16. Based on the foregoing, Respondent has violated Section 400.423(4) Florida Statutes (2002), by reason of the fact that Respondent failed to submit a 15 day report for a resident who eloped on 8/26/02. 17. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1){c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 18. The facility was given a mandated correction date in accordance with Section 400.419(1) (c), Florida Statutes of October 12, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT IIT 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. RESPONDENT FAILED TO PROVIDE ADEQUATE RESIDENT SUPERVISION FOR A RESIDENT WHO ELOPED ON 8/26/02. Rule 58A-5.0182 Fla. Admin. Code (2002); and Section 400.414 Fla.Stat. (2002) 19. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 20. On or about September 12, 2002, AHCA performed an appraisal visit at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not provide personal supervision as appropriate for each resident, based on an interview with the nurse, and review of facility and resident records. An interview with the nurse at approximately 12:00pm revealed that resident #1 had two incidents of elopement on 8/26/02 and 9/8/02. In the first incident, for which there was an incident report, paramedics found the resident lying in a ditch two blocks north of the facility. In the second incident, according to an interview with the nurse at approximately 12:00pm, an alarm went on upstairs, and staff went to look and found resident #1 missing. A second alarm went off downstairs to an outside door, and staff notified the resident's family, who found the resident lying in aditch. An interview with another investigator of the incident revealed that staff did not leave the facility to search for the resident as it was dark out. There was not adequate supervision of the resident to prevent either of the elopements of the resident. 21. On or about November 13, 2002, AHCA conducted a follow-up to its appraisal visit at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not provide personal supervision as appropriate for each resident, based on an interview with the nurse, and review of facility and resident records during the appraisal visit of 9/12/02. On that date an interview with the nurse at approximately 12:00 PM revealed that resident #1 had two incidents of elopement on 8/26/02 and 9/8/02. In the first incident, for which there was an incident report, paramedics found the resident lying in a ditch two blocks north of the facility. In the second incident, according to an interview with the nurse (on 9/12/02 at approximately 12:00 PM) an alarm went on upstairs, and staff went to look and found resident #1 missing. A second alarm went off downstairs to an outside door, and staff notified the resident's family, who found the resident lying in a ditch. An interview with another investigator of the incident (on 9/12/02) revealed that staff did not leave the facility to search for the resident as it was dark out. There was not adequate supervision of the resident to prevent either of the elopements of the resident. During the follow-up visit of 11/13/02 it was determined that documented evidence that the facility had initiated efforts to ensure the above incident did not reoccur was not available. No changes in procedures or staff training had occurred relative to this incident. The administrator during interview on 11/13/02 indicated that in telephone conversation with a corporate nurse, no changes had been made to procedures/policies since this corporate person did not agree with the deficiency. Uncorrected from the visit of 9/12/02 22. Based on the foregoing, Respondent has violated Rule 58A-5.0182 Florida Administrative Code (2002), by reason of the fact that Respondent failed to provide adequate supervision for a resident who eloped on 8/26/02. 23. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 24. The facility was given a mandated correction date in accordance with Section 400.419(1) (c), Florida Statutes of October 12, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT IV 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. RESPONDENT’S STAFF FAILED TO FOLLOW REQUIRED PROCEDURES WITH REGARD TO MEDICATION ADMINISTRATION. Rule 58A-5.0185 Fla.Admin.Code (2002); and Section 400.414 Fla.Stat. (2002) 25. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 26. On or about August 22, 2002, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observations of assistance with medication techniques and medication observation records (MORs) documentation and record review it was determined that staff assisting with self-administration of medications had not followed required procedures to ensure that medications were given as prescribed for 5 of 9 residents sampled. Findings include: On the day of the investigation 08/22/02, based on observation, MOR documentation and record review it was determined that, the steps trained staff are to follow when assisting with medication were not being followed. The following discrepancies were noted: 1, Observation of the medication pass for residents to include # 8 and 9 revealed that centrally stored medication, in its dispensed, properly labeled containers were being opened, the dosage was being placed in another container and this was taken from the medication room to the resident for distribution. 2. Residents # 1, 2 and 7 had notations in the MOR for medications given on a day or at a time when other documentation noted that no medication was available for that resident. For resident # 1 Ocupress 1% eye drops were marked as given on the morning of the investigation 08/22/02, it had not been available for several previous days per MOR documentation and when the medication was requested for verification it was not found. 3. Record review and observation determined that the medications for residents to include # 2 and 8 were being marked as dispensed as they were placed in alternate containers in central storage, not after they had been given. In the case of resident # 8 the morning medications had been poured into an alternate container in the moming, that container had been returned to the medication cart and placed in another resident's drawer and distributed to the resident in the dining room at 11:45. 4. Resident # 1 had medication which was administered in the form of a patch which was to be placed on alternate arms each day. These patches had been documented as not available for three days, on the day of the investigation 08/22/02 the patches were found in the medication cart in a drawer labeled patches with 27 of 30 remaining. When asked about the patch staff indicated it was not in the medication cart drawer labeled for the resident. The patch was applied when brought to the attention of the Director of Nursing (DON). 5. Residents # 1, 2, 7, 8 and 9 had medication unavailable for days in June, July and/or August for staff to distribute. Failure to ensure that medication assistance follows the prescribed steps could result in an adverse effect on the medical well-being of residents, confusion as to what medications taken or not taken and a loss of dignity in the resident not being as involved in the self-administration of medications process as they might otherwise be able. 27. On or about November 13, 2002, AHCA conducted a follow-up to its complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: On the day of this visit (11/13/02) based upon observation and review of the medication observation records for four sampled residents, the facility did not ensure that staff assisting residents with medications followed required procedures in that medications were not available to distribute to one (1) of the four (4) residents. Findings are. The medication observation record (MOR) for resident identified as resident #2 was prescribed Risperdal .Smg. to be given 1 tab at the hour of sleep. The MOR for November, 2002 did not include annotations that the resident received this medication on the evening of 11/12/02. Further, this medication was not available in the medication cart. During interview with the facility nurse, she stated that documentation revealed that the pharmacy (Trellis) had been called for the medication to be refilled on 11/11/02 but the facility had not received the refill as of this date. Uncorrected deficiency from the 8/22/02 visit. 28. Based on the foregoing, Respondent has violated Rule 58A-5.0185 Florida Administrative Code(2002), by reason of the fact that Respondent’s staff failed to follow the required procedures when assisting residents with administration of medication. 29. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 30. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Plorida Statutes of September 22, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT V 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. RESPONDENT FAILED TO PROVIDE VERIFICATION OF AT LEAST ONE STAFF MEMBER, WITH CPR/FIRST AID TRAINING, ON-DUTY AT ALL TIMES. Rule 58A- 5.019 Fla.Admin.Code(2002); and Section 400.414 Fla.Stat. (2002) 31. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 32. On or about September 16, 2002, AHCA performed an annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review, it was determined that the facility had not ensured that at least one staff member was in the facility at all times who was certified in first aid and CPR. Findings include: On the day of the survey 09/16/02, based on record review and an interview with the administrator it was determined that the facility had documentation available showing that only one of eight employees reviewed was certified in first aid and CPR and as a result it could not be ensured that a staff member certified in first aid and CPR was in the facility at all times. 33. On or about November 21, 2002, AHCA conducted a follow-up to its annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review, it was determined that the facility had not ensured that at least one staff member was in the facility at all times who was certified in first aid and CPR. Findings include: On the day of the revisit survey of 11/21/02, based on record review and an interview with the administrator it was determined that the facility did not have documentation on file to verify that nine (9) of ten (10) employees were certified in first aid and CPR. One (1) of the ten (10) employee records only had proof of current valid 1st aid. As a result it could not be assured that there was a staff member certified in first aid and CPR was in the facility at all times. Uncorrected from survey of 9/16/02 34. Based on the foregoing, Respondent has violated Rule 58A-5.0191(2002), by reason of the fact that Respondent failed to provide verification of at least one staff member with CPR/First Aid training, on-duty at all times. 35. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 36. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT VI 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. RESPONDENT FAILED TO ENSURE ALL MEDICATIONS WERE RE-FILLED IN A TIMELY MANNER. Rule 58A-5.0185 Fla.Admin.Code (2002); and Section 400.414 Fla.Stat. (2002) 37. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 38. On or about September 16, 2002, AHCA performed an annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review the facility failed to make a reasonable effort to obtain two medications on one of nine sampled residents (#6). Failure to obtain the | prescribed medication places the resident at risk for deterioration of health. Findings include: Based on record review of the Medication Administration Record, resident #6 did not receive her Colace or her Multivitamin for the period of 9/1/02 through 9/9/02. This is a repeat deficiency from survey of 8/22/02. 39. On or about November 21, 2002, AHCA conducted a follow-up to its annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on review of the medication observation records for four sampled residents on 11/13/02 and interview with the nurse the facility did not ensure that a reasonable effort was made to obtain medications for one of the four residents (#2). Failure to obtain the prescribed medication places the resident at risk for deterioration of health. Findings include: Based on record review of the Medication Observation Record, resident #2 did not receive his Resperdal .Smg. 1 Tab at the hour of sleep on 11/12/02 at 8pm. According to interview with the facility nurse, the medication was ordered from the pharmacy on 11/11/02 but had not been delivered. The nurse stated that facility policy was for medications to be re-ordered seven to ten days prior to running out. The policy had not been followed Repeat deficiency from survey of 8/22/02 and uncorrected from survey of 9/16/02. 40. Based on the foregoing, Respondent has violated Rule 58A-5.0185 Florida Administrative Code (2002), by reason of the fact that Respondent failed to ensure medications were re-filled in a timely manner. 41. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 42. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT VII 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. RESPONDENT FAILED TO MAINTAIN ITS STRUCTURE IN SOUND AND GOOD REPAIR. Rule 58A- 5.023 Fla.Admin.Code (2002); and Section 400.414 Fla.Stat. (2002) 43. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 44. On or about July 17, 2001, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based upon a tour of the facility on the day of this complaint investigation all areas were not maintained in good repair. Areas include but are not limited to the following; 1. Room #214 had multiple small holes in the bathroom wall and the bathroom vent was black with what appeared to be mold/mildew. 2. Room #102 had a large hole in the wall of the bathroom and the air conditioning vent near the bedroom window was black with what appeared to be mold/mildew. 3. The main shower area on the Personal Care Unit was observed to have ceiling damage over the shower, and peeling wall board. 45. On or about September 16, 2002, AHCA conducted a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility's physical structure, including the interior and exterior walls, floors, roof and ceilings were not ensured to be structurally sound and in good repair. Findings include: On the day of the survey 09/16/02, observation revealed that interior and exterior walls, floors, roof and ceilings were not ensured to be structurally sound and in good repair, in examples to include the following: 1. Areas of the outside walls on the south side of the building had holes in the siding and pieces of siding were missing from the wall outside the kitchen. 2. A beam for the roof of the porch on the east side of the building had water damaged or rotting wood. 3. Window screens throughout the facility to include the upstairs and the courtyard were badly worn with some holes. Some screens had been removed to place air conditioners in the windows but it could not be determined if the vents for the old under the window air conditioners had been sealed. 4. The bathroom floor in rooms to include # 220 had badly scraped or stained linoleum and the laundry floors, upstairs southwest was badly worn with tile broken and pieces missing where dirt can accumulate. 5. The ceiling in rooms to include # 232 had water stains. Repeat deficiency from survey of 7/17/01. 46. On or about November 13, 2002, Respondent performed a follow-up to its annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility's physical structure, including the interior and exterior walls, floors, roof and ceilings were not ensured to be structurally sound and in good repair. Findings include: On the day of the re-visit survey 1 1/13/02, observation revealed that interior and exterior walls, floors, roof and ceilings were not ensured to be structurally sound and in good repair, in examples to include the following: 1. Areas of the outside walls on the south side of the building had holes in the siding and pieces of siding were missing from the wall outside the kitchen. During interview with facility staff, the staff person stated that the facility was in process of contracting with a company to do the repairs (the contract for repairs was signed on 9/20/02, although not started yet. The facility did not request an extension of time from the mandated date of correction of 10/16/02. Repeat deficiency from survey of 7/17/01 and uncorrected from survey of 9/16/02. 47. Based on the foregoing, Respondent has violated Rule 58A-5.023 Florida Administrative Code (2002), by reason of the fact that Respondent failed to maintain its structure in good and sound repair. 48. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 49. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT VIII 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. RESPONDENT FAILED TO MAINTAIN ITS FURNISHINGS IN CLEAN AND GOOD REPAIR. Rule 58A-5.023 Fla.Admin.Code (2002); and Section 400.414 Fla.Stat. (2002) 50. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 51. On or about July 17, 2001, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based upon a tour of the facility on the day of this complaint investigation the following furnishing were not maintained in clean and good condition. 1. The plastic dinner ware (glasses and plates) were observed to have chips, scrapes and cracks and therefore, no longer provided a easily cleanable surface. 2. Two wheelchairs observed sitting vacant in hallways were dirty with an accumulation of spills and caked debris on the seats. 3. The tile in the main shower area of the Personal Care Unit was observed to be dirty with a residue build-up. 4. Soiled linen containers were stored in the main shower area of the Personal Care Unit. One of the containers had what appeared to be soiled clothing thrown on top of one of the container covers thereby creating a potential infection control problem. 52. On or about September 16, 2002, AHCA conducted a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not ensure that all furniture and furnishings were clean, functional, free-of-odors, and in good repair. Findings include: On the day of the survey 09/16/02, based on observation it was determined that the facility did not ensure that all furniture and furnishings were clean, functional, free-of-odors, and in good repair. The sheets and spread or blanket on the bed nearest the window in the living room area of room # 220, was urine soaked with an odor of urine from 9:45 am until rechecked at 11:30 am. The mattress was not checked but did not appear to be sealed in waterproof materials. Repeat deficiency from survey of 7/17/01. 53. On or about November 13, 2002, AHCA conducted a follow-up to its survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not ensure that all furniture and furnishings were clean, functional, free-of-odors, and in good repair. Findings include: On the day of the re-visit survey of 11/13/02, based on observation it was determined that the facility did not ensure that all furniture and furnishings were clean, functional, free-of-odors, and in good repair. Although the sheets appeared clean on the bed of room 220, when the sheets were pulled back, a very strong odor of urine appeared to emanate from the mattress. Repeat deficiency from survey of 7/17/01 and uncorrected from the survey of 9/16/02. 54. Based on the foregoing, Respondent has violated Rule 58A-5.023 Florida Administrative Code(2002), by reason of the fact that Respondent failed to maintain its furnishings in clean and good repair. 55. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 56. The facility was given a mandated correction date in accordance with Section 400.419(1) (c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT Ix 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. RESPONDENT'S PERSONNEL RECORDS FAILED TO INCLUDE DOCUMENTATION OF REQUIRED TRAINING. Section 400.423 Fla.Stat.(2002); and Section 400.414 Fla.Stat. (2002) 57. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 58. On or about September 16, 2002, AHCA performed a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility which provides special care for persons with Alzheimer's disease and related disorders, did not ensure that facility staff who have regular contact with or provide direct care to residents with Alzheimer's disease and related disorders, obtained 4 hours of initial training within 3 months of employment. Findings include: On the day of the survey 09/16/02, a review of facility personal records revealed that only two of eight records reviewed had documentation of the required training. 59. On or about November 21, 2002, AHCA conducted a follow-up to its survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility which provides special care for persons with Alzheimer's disease and related disorders, did not ensure that facility staff who have regular contact with or provide direct care to residents with Alzheimer's disease and related disorders, obtained 4 hours of initial training within 3 months of employment. Findings include: On the day of the re-visit survey 11/21/02, a review of facility personnel records revealed that only three of ten records reviewed had documentation of the required training. Uncorrected from survey of 9/16/02 60. Based on the foregoing, Respondent has violated Section 400.4178 Florida Statutes (2002), by reason of the fact that Respondent’s personnel records failed to include documentation of required training. 61. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 62. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT X 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. RESPONDENT FAILED TO MAINTAIN COMPLIANCE WITH ALL REQUIREMENTS OF STANDARD LICENSURE. Section 400.407 Fla.Stat. (2002); and Section 400.414 Fla.Stat. (2002) 63. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 64. On or about September 16, 2002, AHCA performed an extended congregate care survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observation and record review the facility failed to meet the Assisted Living license requirements. Findings include: Based on observation and record review on 9/16/02 the facility failed to meet the requirements of an Assisted Living Facility. Deficiencies cited as a result of 9/16/02 visit. 65. On or about November 21, 2002, AHCA conducted a follow-up to its extended congregate care survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observation and record review the facility failed to meet the Assisted Living license requirements. Findings include: Based on observation and record review on 11/21/02 the facility failed to meet the requirements of an Assisted Living Facility. Deficiencies cited as a result of 9/16/02 survey and the re-visit of 11/21/02. Uncorrected deficiency from the 9/16/02 survey 66. Based on the foregoing, Respondent has violated Section 400.407 Florida Statutes (2002), by reason of the fact that Respondent failed to maintain compliance with all requirements of standard licensure. 67. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 68. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT XI 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. RESPONDENT FAILED TO MAINTAIN DOCUMENTATION OF CONTINUING TRAINING FOR ITS ECC SUPERVISOR. Section 400.4275 Fla.Stat. (2002); and Section 400.414 Fla.Stat. (2002) 69. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 70. On or about September 16, 2002, AHCA performed an extended congregate care survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review the facility failed to provide documentation of continuing education training for the Extended Congregate Care Supervisor. Findings included: The facility failed to provide personnel records of the Extended Congregate Care Supervisor to document continuing education requirements. 71. On or about November 21, 2002, AHCA conducted a follow-up to its extended congregate care survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review on 11/21/02 the facility failed to provide documentation of continuing education training for the Extended Congregate Care Supervisor. Findings included: Record review of interview with the administrator on the date of this re-visit revealed that there was no documentation available at the facility to verify that the Extended Congregate Care supervisor met the required continuing education requirements. The documentation available reflected that the ECC supervisor only attended a core training on 2/26/99. No further training updates verification was available for review. Uncorrected from the survey of 9/16/02. 72. Based on the foregoing, Respondent has violated Section 400.4275 Florida Statutes (2002), by reason of the fact that Respondent failed to maintain documentation of required continuing training for its ECC supervisor. 73. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class TII violation, and pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 74. The facility was given a mandated correction date in accordance with Section 400.419(1) (c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT XII 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. RESPONDENT FAILED TO MAINTAIN DOCUMENTATION OF REQUIRED TRAINING FOR ITS ECC STAFF. Section 400.407 Fla.Stat.(2002); and Section 400.414 Fla.Stat. (2002) 75. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 76. On or about September 16, 2002, AHCA performed an extended congregate care survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review the facility failed to document the training of the Extended Congregate Care staff. Findings included: Based on record review the facility had not provided in-service training or documented any of the required in-service training for its Extended Congregate Care staff. 77. On or about November 21, 2002, AHCA conducted a follow-up to its extended congregate care survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review the facility failed to document the training of the Extended Congregate Care staff. Findings included: Based on record review for ten sampled personnel records on the date of this revisit, the facility had not provided in-service training or documented any of the required in-service training for eight of ten Extended Congregate Care staff. Uncorrected from the survey of 9/16/02. 78. Based on the foregoing, Respondent has violated Section 400.407 Florida Statutes (2002), by reason of the fact that Respondent failed to provide documentation or evidence that its ECC staff had received the required training. 79. The foregoing violation constitutes a Class III violation. Class "III" 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 indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(i)(c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 80. The facility was given a mandated correction date in accordance with Section 400.419(1) (c), Florida Statutes of October 16, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. Dated: January 23, 2003 Agency for Health Care Administration es . pon Senior Attorney Fla. Bar. No. 0174629 NOTICE Respondent, LARGO ACLF, LTD., D/B/A THE HOMESTEAD OF LARGO 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: January 23, 2003 AGENCY FOR HEALTH CARE ADMINISTRATION Jodi > Page, Toye 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 (#71064575129420500750) to The Homestead of Largo, 750 Starkey Road, Largo, Florida 33771, this 23rd day of January, 2003. AGENCY FOR HEALTH CARE ADMINISTRATION 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: 03-001667