Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: PRESBYTERIAN RETIREMENT COMMUNITIES, INC., D/B/A WESTMINSTER TOWERS
Judges: DANIEL M. KILBRIDE
Agency: Agency for Health Care Administration
Locations: Orlando, Florida
Filed: Jul. 31, 2003
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, February 26, 2004.
Latest Update: Dec. 25, 2024
FILE
AGENCY FoR
5
STATE OF FLORIDA DEPUTY Or ISTRATION
AGENCY FOR HEALTH CARE ADMINIST@AION
STATE OF FLORIDA LD el 1 Yog/
AGENCY FOR HEALTH CARE
ADMINISTRATION, DM les S. of
~~ ek 2
Petitioner, AHCA NO. 2003003638 —, Le
2003002543 ©...
v. DOAH NO. 03-2811
03-3315 9° <
PRESBYTERIAN RETIREMENT COMMUNITIES, a
d/b/a WESTMINSTER TOWERS, RENDITION NO.: AHCA-04-0253-S-OLC
Respondent.
FINAL ORDER
Having reviewed the administrative complaint dated August 21, 2003,
attached hereto and incorporated herein (Ex. 1- 2003002543), and the
Notice of Assignment of Conditional Licensure Status served July 14, 2003,
attached hereto and incorporated herein (Ex. 2 - 2003003638) and all other
matters of record, the Agency for Health Care Administration (“Agency”) has
entered into a Stipulation and Settlement Agreement with the parties to
these proceedings, and being otherwise well advised in the premises, finds
and concludes as follows:
The attached Stipulation and Settlement Agreement (Ex. 3), is
approved and adopted as part of this Final Order and the parties are directed
to comply with the terms of the Stipulation and Settlement Agreement.
ORDERED:
1. The attached Stipulation and Settlement Agreement is approved
and adopted as part of this Final Order and the parties are directed to
comply with the terms of the Stipulation and Settlement Agreement.
2. A fine of $7,500.00 is hereby imposed upon the Respondent.
This amount is due and payable within thirty (30) days of the date of
rendition of this Order.
3. Checks should be made payable to the “Agency for Health Care
Administration.” The check, along with a reference to this Case number,
should be sent directly to
Jean Lombardi
Agency for Health Care Administration
Office of Finance and Accounting
2727 Mahan Drive, Mail Stop # 14
Tallahassee, Fl. 32308.
4. Unpaid fines will be subject to statutory interest, and may be collected
by all methods legally available.
5. The conditional license rating will be imposed from March 28, 2003 to
May 7, 2003.
DONE and ORDERED this _/0 day of hay , 2004,
in Tallahassee, Leon County, Florida.
Mary Pat Moore, Interim Secreta
Agency foy Health Care Administration
abt Drute
Leeahey/l. cog
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED
TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY
OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A
SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH
THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE
AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES.
REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH
THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED
WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.
Copies furnished to:
Jonathan S. Grout, Esquire
Goldsmith, Grout & Lewis, P.A.
2180 Park Avenue N., #100
P.O. Box 2011
Winter Park, FL 32790-2011
(U. S. Mail)
Katrina D. Lacy, Esq.
Senior Attorney
Agency for Health Care Administration
525 Mirror Lake Dr. N. #330G
St. Petersburg, FL 33701
(Interoffice Mail)
Jean Lombardi
Finance & Accounting
Agency for Health Care Administration
2727 Mahan Drive Mail Stop Code #14
Tallahassee, Florida 32308
(Interoffice Mail)
Elizabeth Dudek
Deputy Secretary
Agency for Health Care Administration
2727 Mahan Drive Bidg #1 Mail Stop Code #9
Tallahassee, Florida 32308
(Interoffice Mail)
Wendy Adams
Agency for Health Care Administration
2727 Mahan Drive, Bldg #3 MS #3
Tallahassee, FL 32308
(Interoffice Mail)
Daniel M. Kilbride, AU
Division of Admin. Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, FL 32399-3060
(Interoffice Mail)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of this Final Order was
served on the above-named person(s) and entities by U.S. Mail, or the
method designated, on this the (7 day of _7Y a4 / , 2004.
ape sod a Goan Agency Clerk
Agency for Health Care Administration
2727 Mahan Drive, Building #3
Tallahassee, Florida 32308-5403
(850) 921-8177
( EXHIBIT
STATE OF FLORIDA —1
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA,
AGENCY FOR HEALTH
CARE ADMINISTRATION,
Petitioner, AHCA NO: 2003002543
vs.
PRESBYTERIAN RETIREMENT COMMUNITIES, INC.,
d/b/a WESTMINSTER TOWERS,
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 Presbyterian
Retirement Communities, Inc., d/b/a Westminster Towers,
(hereinafter “Respondent”) and alleges:
NATURE OF THE ACTION
1. This is an action to impose an administrative fine in the
amount of thirty-six thousand dollars ($36,000) pursuant to
Sections 400.102(1) (a) and (d), 400.23(8) (a) and (b) and
400.419(3), Florida Statutes (2002).
2. The Respondent was cited for the deficiencies set forth
below as a result of an annual survey conducted on or about March
24-28, 2003.
JURISDICTION AND VENUE
3. The Agency has jurisdiction over the Respondent pursuant
to Chapter 400, Part II, Florida Statutes (2002).
4. Venue lies in Orange County, Division of Administrative
Hearings, pursuant to Section 120.57 Florida Statutes (2002), and
Chapter 28-106.207, Florida Administrative Code (2002).
PARTIES
5. AHCA, is the enforcing authority with regard to nursing
home licensure law pursuant to Chapter 400, Part II, Florida
Statutes (2002) and Rules 59A-4, Florida Administrative Code
(2002).
6. Respondent is a nursing home located at 70 West Lucerne
Circle, Orlando, FL 32801. The facility is licensed under Chapter
400, Part II, Florida Statutes (2002) and Chapter 59A-4, Florida
Administrative Code (2002), having been issued license number
SNF16010961.
COUNT I
RESPONDENT FAILED TO ENSURE THAT EACH RESIDENT RECEIVES ADEQUATE
SUPERVISION AND ASSISTANCE DEVICES TO PREVENT ACCIDENTS.
R.59A-4.1288, Fla. Admin. Code (2002),
ADOPTING BY REFERENCE 42 CFR § 483.25(h) (2) (2002)
CLASS II DEFICIENCY
ISOLATED
7. AHCA re-alleges and incorporates (1) through (6) as if
fully set forth herein.
8. On or about March 24-28 2003, an annual survey was
conducted at Respondent’s facility.
9. Based on observation, record review, and interview,
Respondent failed to provide supervision_and implementation.
procedures to prevent falls/inj e of twenty-four sampled
Findings:
Resident #16 was originally admitted to the facility on January
3, 2002. During the survey, the resident was observed on
multiple days at various times, either lying on the low bed or
sitting in the recliner chair, in his/her room.
During an interview on March 28, 2003 at approximately 9:30 AM,
the Assistant Director of Nursing (ADON) explained that an
investigation is conducted every time a resident has a°~-——
fallt/incident :~ The ADON also stated that therapy conducts a
post fall Screen and recommends appropriate-fall precautions?
Review of the nurses' notes, dated July 30, 2002 through Augus
29, 2002, described a resident who frequently attempted to get ke,
out of bed without assistance. ;
“a
on‘November 16,2002) the resident fell in the facility and [elon
broke his/her right hip. The resident went to the hospital for Qly od
treatment and returned to the facility on November 20, 2002. Spi ]03
Nurse's note, dated January 21, 2003, indicated that the a o3
resident was out of bed and in a recliner chair for most of the 3 Y [P3
shift, and a note at 5 AM indicated: "attempts to get OOB(out
of bed) & recliner; needs to be observed." FG [03
SS ne ne
The-resident continued to be at risk for falls and fell again
of February 4, 2003)at 10:45 PM. According to the fall
investigation,— ident #16 had no injuries and required
assistance to transfer/ambulate. Also, the resident did not
use a bed/chair alarm, nor were restraints used by this
resident. The Post Fall Screen was conducted 3 days later on
February 7, 2003. The therapist indicated that the resident
already has a low bed with floor mats and that Fall Management
was already in place. The therapist did not recommend any new
fall precautions.
Interview with Therapy staff on March 28, 2003 at approximately
9:00 AM, revealed that the resident could ambulate, with hand
held assistance from staff at the time of the fall on February
4, 2003.
The resident fell again on FeSruary 21, 2003) seventeen days
after the last fall. The fall investigation indicated that the
resident was on the floor on his/her right side. The Post Fall
Screen read: "Follow facility protocol for repositioning and
toileting. Measures for injury management are in place and
include low bed with bilateral floor mats."
On February 26, 2003, therapy staff had recommended a Velcro
belt for this resident, but the care plan was not updated with
this new intervention until March 19, 2003.
On’ Fe ry 28, 20 at approximately 7:00 PM, the resident
took off the Velcro belt, stood up and fell. A Post Fall
screen was conducted on March 3, 2003 and therapy staff
xecommended restorative nursing for range of motion &
ambulation.
The resident received two days of r
and 4, 2003, before falling again dn March 4, 10:00 PM.
The resident sustained a laceration above eye and
also to the left side on the nose. The resident was sent to
the emergency room for treatment.
When the resident returned to the facility on March 7, 2003,
there was no evidence that the resident was placed back on
restorative nursing. Interview with ADON and therapy staff on
March 28, 2003 revealed that the staff person in charge of the
restorative nursing program had quit. Therefore, resident #16
was never re-evaluated for restorative nursing. At that time,
there was no evidence of new interventions to prevent falls,
On\Warch 19, 2003 4t 9:20 PM, the resident fell again, this
time $ s/her left hip. The resident was sent to the
hospital for care and treatment and returned to the facility on
March 22, 2003. Two days later, on March 24, 2003, a Post Fall
Screen was conducted. The therapist recommended hip protectors
for the resident.
On March 28, 2003, the last day of the survey, after the
surveyor questioned staff about the hip protectors, the nurse
made a telephone call to inquire about ordering hip protectors
for resident #16. This was four days after the hip protectors
were recommended.
Resident #16 had six falls in the period November 16, 2002
through March 19, 2003, three of which resulted in significant
injury. During this time, there was no evidence that the
facility's interdisciplinary care team assessed & provided a
level of supervision to meet the needs of this resident.
10. The above actions or inactions are a violation of 42 CFR
483.25 (h) (2) (2002), which requires the facility to ensure that each
resident receives adequate supervision and assistance devices to
prevent accidents.
11. Pursuant to Section 400.23(8) (b), Florida Statutes (2002),
the foregoing is an “isolated” class II deficiency and as such, has
compromised the resident’s ability to maintain or reach his or her
highest practicable physical, mental and psychosocial well-being, as
defined by an accurate and comprehensive resident assessment, plan
of care, and provision of services. A class II deficiency is
subject to a civil penalty of $2,500 for an isolated deficiency,
$5,000 for a patterned deficiency, and $7,500 for a widespread
deficiency. The fine amount shall be doubled for each deficiency if
the facility was previously cited for one or more Class I or Class
II deficiencies during the last annual inspection or any inspection
or complaint investigation since the last annual inspection. A fine
shall be levied notwithstanding the correction of the deficiency.
12. Respondent was provided a mandated correction date of
April 21, 2003.
13. A civil penalty is authorized and warranted in the amount
of $2,500, as this violation constitutes an “isolated” Class II
deficiency.
14. During the annual survey of June 30, 2002, Respondent was
cited for Tag F309, an “isolated” class II deficiency. Therefore,
pursuant to Section 400.23(8) (b), Florida Statutes (2002), the fine
amount is doubled to $5,000.
COUNT II
RESPONDENT FAILED TO MAINTAIN SUFFICIENT NURSING STAFF TO PROVIDE
NURSING AND RELATED SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST
PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH
RESIDENT, AS DETERMINED BY RESIDENT ASSESSMENTS AND INDIVIDUAL
PLANS OF CARE.
R.59A-4.1288, Fla. Admin. Code (2002),
ADOPTING BY REFERENCE 42 CFR § 483.30 (2002)
CLASS I DEFICIENCY
PATTERNED
15. AHCA re-alleges and incorporates (1) through (6) as if
fully set forth herein.
16. On or about March 24-28, 2003, an annual survey was
conducted at Respondent’s facility.
17. Based on observations, interviews, and record reviews,
Respondent failed to provide a sufficient staff to ensure that
residents residing on the secured Memory Support Unit, were
supervised and monitored to prevent potential/actual negative
outcomes.
Findings:
During initial tour of the third floor designated Dementia Care
Unit, on March 24, 2003 at approximately 10:00 AM, two sets of
doors were observed to be closed, separating the Memory Support
Unit from the other side of the secured dementia care unit,
where the nurse's station was located. The staff member
identified approximately 25 residents residing on the Memory
Support Unit and the residents were identified to use wander-
guards due to elopement potential. If a resident came within a
few feet of the doors, the doors would automatically lock,
preventing the resident from leaving the unit.
Interview with administrative staff on March 28, 2003 at
approximately 2:30 PM, stated, "The magnetic pads for the
double doors that kept the doors opened, were removed a week
ago".
Observation on March 24, 2003 at approximately 4:25 PM,
Resident #15 was observed on the Memory Support Unit in a
Merri-Walker propelling him/herself around the unit. Another
resident was following Resident #15. A few minutes passed when
Resident #15 became entrapped between a pole in the middle of
the room and a dining room chair. The resident was observed to
become extremely agitated. Resident # 15 was observed in this
situation for approximately five minutes, when another resident
entered the unit ambulating with a walker and was observed to
be agitated with Resident #15 and yelling, "get moving," a
number of times. The only staff member observed on this unit
at this time was a Certified Nursing Assistant (CNA), who was
located in a resident room passing out gowns and pads for
residents for the evening shift. When approached and informed
of the situation occurring on the unit, the CNA looked out the
door of the room he/she was in and stated, "He always does
that," and proceeded to re-enter the room and continued to pass
out evening attire. On the other side of the double closed
doors, a staff member was observed through the door window and
summoned to assist Resident #15. The staff member entered the
unit stating "He lives here," and proceeded to push the
resident out of the Memory Support Unit through the double
doors to the side of the dementia care unit where nursing staff.
were observed.
Interview with a staff member at this time revealed, " The
(memory support unit) unit is not officially opened yet,
tomorrow we will be opening the dining area". Residents were
observed to be living on the Memory Support Unit.
Clinical record review for Resident #15 identified an admission
date of September 1, 2001 with a readmission date of November
14, 2001, status post hip fracture. Diagnoses included
Alzheimer's Disease with Delusional Disorder, Dementia with
Psychosis, Cerebral Vascular Accident, Seizure Disorder, and
Depression. Review of the Minimum Data Set for Resident #15
dated December 13, 2002 and March 14, 2003 revealed the
resident's cognitive skills for daily decision making coded as
three (3), indicating the resident's cognitive abilities as
severely impaired, unable to make decisions with a short and
long term memory deficit. Review of the falls resident
protocol (RAP) dated March 18, 2003, identified the resident
as, "Risk for falls related to several risk factors besides
Dementia. He wanders about unit in Merri-Walker. Impaired
judgment to wait for assistance."
Observation of R #15 on 3/24/03 at approximately 4:25 PM,
identified that the resident was not either supervised or
monitored. A 2/15/03 nurses' note shows, "Nursing to monitor
behaviors."
During interview with administrative staff on March 25, 2003 at
approximately 9:15 PM, staff stated, " I guess we should have
staffed the unit first".
2. During initial tour by a second surveyor, on March 24, 2003
at approximately 9:30A.M., no staff were observed in the third
floor Memory Support Unit. The only staff person that was
seen, other than the staff person touring, was the nurse
passing out medication. There were no other staff identified to
take care of the residents and to monitor the unit. The
residents that were in their rooms were still in bed. Some of
them were asleep and some were awake. After the medications
had been passed out, the nurse exited the Memory Support Unit
to the other side of the closed double doors where the
medications and clinical records for the residents residing on
the Memory Support Unit were located. Staff were observed
giving care and helping residents in the other portion of the
dementia care unit, outside of the Memory Support Unit. All of
the nurses at the time were observed to be on the other side of
the closed double doors, outside of the Memory Support Unit.
During the tour, there were approximately twenty-five residents
on the side of the double doors referred to as the Memory
Support Unit.
During the observation of the noon meal on March 24, 2003 at
11:45 AM, residents left the Memory Support Unit to eat their
meal in the other portion of the dementia care unit, where all
the staff were observed to be located. There were no staff
observed on the Memory Support Unit where residents were
observed to be eating in their rooms with no staff present to
supervise/monitor the residents.
On the second day of the survey, March 25, 2003, during
observation of the Memory Support Unit at 9:00 AM, there was no
staff member located on the Memory Support Unit. Observation
identified a resident having difficulty getting into the
restroom with his/her walker. There were residents still in
bed, but there was no staff member observed to be monitoring
the residents or the unit.
3. During an interview conducted on March 25, 2003 at
approximately 6:30 PM, an Administrative staff member stated
that the intent for the Memory Support Unit was that it would
not be a "locked unit" but rather a "secured unit", meaning
that the staff, public, and other residents would be able to
enter this unit without a code, but residents wearing a wander-
guard bracelet would trigger an alarm system, that would
prevent the doors from opening if they came within a few feet
of the door. Staff further stated that once this system was in
effect, the code system for third floor elevators would be
removed. Staff then stated that the Memory Support Unit was not
actually a separate unit of the third floor, but that the rest
of the resident population would be in rooms outside the
secured doors.
A review of the facility's policy and procedure for the Memory
Support Unit, dated May 30, 2002 and signed by an
8
Administrative staff and the Medical Director, revealed that
the Admission Criteria included the following philosophy
statement for two (2) of the seventeen (17) admission
requirements:
"The Memory Support Unit is a therapeutic residence...a
separate, specialized residence within our facility where the
focus is on "wellness" and success in activities of daily
living. Although there is nursing staff on the unit 24 hours
per day, the focus is not medical in nature."
"Resident must have a primary diagnosis of Dementia Disease
or related untreatable dementia..."
"...Resident must be independent in mobility or be able to
ambulate and transfer with one assist. May be aided by
assistive devices to enable independence."
18. The above actions or inactions are a violation of 42 CFR
483.30(2002) which requires the facility to maintain sufficient
nursing staff to provide nursing and related services to attain or
maintain the highest practicable physical, mental, and psychosocial
well-being of each resident, as determined by resident assessments
and individual plans of care. The above actions or inactions are
also a violation of 42 CFR 483.30(a) (1) &(2) (2002), which requires
the facility to provide services by sufficient numbers of each of
the following types of personnel, on a 24-hour basis, to provide
nursing care to all residents in accordance with resident care
plans: Except when waived under paragraph (c) of this section,
licensed nurses; and other nursing personnel. Additionally, the
facility must designate a licensed nurse to serve as a charge nurse
on each tour of duty.
19. Pursuant to Section 400.23(8) (a), Florida Statutes, the
foregoing is a “patterned” class I deficiency and as such, presents
a situation in which immediate corrective action is necessary
because the facility’s noncompliance has caused, or is likely to
cause, serious injury, harm, impairment, or death to a resident
receiving care in a facility. The condition or practice constituting
a class I violation shall be abated or eliminated immediately,
unless a fixed period of time, as determined by the Agency, is
required for correction.
20. A class I deficiency is subject to a civil penalty of
$10,000 for an isolated deficiency, $12,500 for a patterned
deficiency, and $15,000 for a widespread deficiency. The fine
amount shall be doubled for each deficiency if the facility was
previously cited for one or more Class I or Class II deficiencies
during the last annual inspection or any inspection or complaint
investigation since the last annual inspection. A fine shall be
levied notwithstanding the correction of the deficiency.
21. Respondent was provided a mandated correction date of
March 29, 2003.
22. A civil penalty is authorized and warranted in the amount
of $12,500, as this violation constitutes a “patterned” Class I
deficiency.
23. During the annual survey of June 30, 2002, Respondent was
cited for Tag F309, an “isolated” class II deficiency. Therefore,
pursuant to Section 400.23(8) (a), Florida Statutes (2002), the fine
amount is doubled to $25,000.
24. Pursuant to Section 400.19(3), Florida Statutes
(2002), the agency shall assess a one-time fine, in the amount
of $6,000, for each facility that is subject to the six-month survey
cycle.
CLAIM FOR RELIEF
WHEREFORE, AHCA requests this Court to order the
following relief:
a. Enter actual and legal findings in favor of AHCA;
b. Impose a $36,000 civil penalty against RESPONDENT;
c. Assess costs related to the investigation and
prosecution -of this case pursuant to Section
400.121(10), Florida Statutes (2002); and
d. Grant any other general and equitable relief as
appropriate.
NOTICE
The Respondent is notified that it has a right 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).
All requests for hearing shall be made to the attention of:
Lealand McCharen, Agency Clerk, Agency for Health Care
Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee,
Florida, 32308, (850) 922-5873.
( (
RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE
RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT
IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY
OF A FINAL ORDER BY THE AGENCY.
Respectfully submitted,
Katrina D. Lacy, Esquire
AHCA - Senior Attorney
Fla. Bar No. 0277400
525 Mirror Lake Drive North
St. Petersburg, Florida 33701
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing
has been furnished via U.S. Certified Mail Return Receipt No. 7002
2030 0007 8499 6294 to Robert N. Bianco, Administrator, Westminster
Towers, 70 West Lucerne Circle, Orlando, FL 32801,on the O/s¢ day
of August, 2003.
Katrina D. Lacy, Sodaize
Copies furnished to:
Robert N. Bianco, Administrator
Westminster Towers
70 West Lucerne Circle
Orlando, FL 32801
(U.S. Certified Mail)
Henry T. Keith
Registered Agent for
Westminster Towers
80 W. Lucerne Circle
Orlando, FL 32801
(U.S. Mail)
12
hae_-™
C EXHIBIT
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
TIES, INC.
db/a WESTMINSTER TOWERS Ref. # 2003003638
Cert. # 10260
/ 4{1Je3
Pursuant to and in compliance with s. 400.23(7), Florida Statutes, the Agency for
Health Care Administration (“the Agency”) the Agency surveyed! investigated the above-
identified nursing home facility on OF about March 28, 2003, to make a determination as
to the degree of compliance of the facility with Chapter 400, Part iL, Florida Statutes, and
ay plicable rules for assigning licensure status. The report(s) of that gurvey/investigation
includes the report that constitutes the most recent inspection report that the Agency
evaluated, and upon which the Agency determined its assignment of conditional licensure
status to the facility effective and commencing on or about March 28, 2003. The Agency
evaluated the facility in accordance with the statute and applicable rules and made a
substantial compliance with criteria established under Part II or rules of the Agency. ©
Section 400.23(7) provides that conditional licensure means that a facility is “not in
substantial compliance at the time of the survey” if such non-compliance is tdue to the
presence of one or more class 1 or class Il deficiencies, or class ti deficiencies not
corrected within the time established by the Agency.” The survey(s) pertinent to this
assignment is/are attached hereto. The factual basis for the Agency's evaluation and
determination of licensure status includes, put is not limited to, facts set forth in the
referenced survey! inspection report(s)- This Notice of Assignment constitutes notice of
final Agency action. Bach licensee shall post its license in 2 prominent place that is in
clear and unobstructed public view at or neat the place where residents are peing
admitted to the facility.
The facility has @ right, pursuant to 5.120.569, Florida Statutes, to request an
administrative hearing as to the assignment of conditional licensure status by the Agency:
These specific options are set out in the attached Agency form for “Blection of Rights for
Administrative Hearing Regarding Assignment of Conditional Licensure Status.” This
form may be used to request a hearing, but alone will not serve as 4 legally sufficient
request for a formal hearing. Any request for a hearing must be received within twenty-
one (21) days of the receipt py the facility of this Notice of Assignment of Conditional
Licensure Status.
Long Term Care Unit
Agency for Health Care Administration (03-03)
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES
(To be used with Election of Rights for Assignment of Conditional Licensure Status)
In response to the material facts contained in the Notice of Assignment of Conditional
Licensure Status issued by the Agency for Health Care Administration (“Agency”), please make
one of the following elections on the Election of Rights form and return it fully executed to the
address listed on the form.
OPTION 41. If Respondent. does not dispute the material facts contained in the Notice of
Assignment of Conditional Licensure Status and the related survey/investigation reports(s) (you
consent to the assignment) and elects to waive the right to be heard, Respondent should select
OPTION 1 on the Election of Rights form. The material facts and the related
survey/investigation report(s) attached with the Notice of Assignment of Conditional Licensure
will be deemed admitted. This constitutes notice of final agency action.
OPTION 2. ‘If Respondent does not dispute the material facts contained in the Notice of
Assignment of Conditional Licensure Status and the related survey/investigation reports(s) (you
admit to all of the material facts), Respondent may request an informal hearing pursuant to Section
120.57(2), Florida Statutes before the Agency. At the informal hearing, Respondent will be given
an opportunity to present written and/or oral evidence regarding any lawful basis for the agency to
withdraw the assignment of conditional licensure status. For an informal hearing, Respondent
should select OPTION 2 on the Election of Rights form.
OPTION 3. If the Respondent disputes any material facts as set forth in the Notice of
Assignment of Conditional Licensure Status and the related survey/investigation report(s) (you do
not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes.
To obtain a formal hearing, Respondent should 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., Respondent's request for an administrative hearing must conform to
the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state
the material facts disputed. If you select Option 3, mediation may be available in this case
pursuant to Section 120.573, Florida Statutes, if all parties agree to it.
PLEASE CAREFULLY READ THE FOLLOWING PARAGRAPH:
In order to preserve the right to a hearing, Respondent’s original Election of Rights in
this matter must be RECEIVED by AHCA within twenty-one (21) days from the date
Respondent receives the Notice of Assignment of Conditional Licensure Status.
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
RE: PRESBYTERIAN RETIREMENT CASE NO: 2003003638
COMMUNITIES, INC.
a/b/a WESTMINSTER TOWERS
ELECTION OF RIGHTS
FOR ADMINISTRATIVE HEARING
FOR ADMINISTRATIVE HEARING .
REGARDING ASSIGNMENT OF CONDITIONAL LICENSURE STATUS
PLEASE SELECT ONLY 1 OF THE 3 OPTIONS
An Explanation of Rights is attached.
OPTION ONE (1) __ Respondent does not dispute the material facts contained in the
Notice of Assignment of Conditional Licensure Status and the related survey/investigation
agency action.
OPTION TWO (2) ___ Respondent does not dispute, and admits, the material facts contained
in the Notice of Assignment of Conditional Licensure Status and the related survey/investigation
OPTION THREE (3) ___. Respondent does dispute the material facts contained in the Notice of
Assignment of Conditional Licensure Status and the related survey/investigation reports(s)and
Respondent requests a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an
In order to preserve Respondent’s right to a hearing, Respondent’s original Election of Rights in
this matter must be received by AHCA within twenty-one (21) days from the date Respondent
receives the Notice of Assignment.
Respondent (Licensee)
ooo eee
Address:
License, No. and facility type: Phone No.
ee es
PLEASE RETURN YOUR COMPLETED FORM To:
Attention: Lealand McCharen, Agency Clerk, Agency for Health Care Administration, 2727 Mahan
Drive, Bldg. #3, MS #3, Tallahassee, FL 32308. Telephone Number: (850) 922-5873
FLORIDA AGENCY FOR HEALTH CARE ADMINGTRATION
JEB BUSH, GOVERNOR RHONDA M. MEDOWS, MD, FAAFP, SECRETARY
July 2, 2003
WESTMINSTER TOWERS
70 WEST LUCERNE CIRCLE
ORLANDO, FL 32801
Dear Administrator:
The attached license is being issued for the operation of your facility. Please review it
thoroughly to ensure that all information is correct and consistent with your records. If errors or
omissions are noted, please make corrections on a copy and mail to:
Agency for Health Care Administration
Long Term Care Séttion, Mail Stop #33
2727 Mahan Drive, Building 3
Tallahassee, Florida 32308
License Status Change to Conditional
incerely,
Agency for & Care Administration
Division of Health Quality Assurance
Enclosure
ce: AHCA Area Office 07
Long Term Care Section file
Medicaid Contract Management
Certificate of Need
2727 Mahan Drive Mail Stop #33 Visit AHCA Online at
www fdhe.state fl. us
Tallahassee, FL. 32308
!
"| LICENSE #: SNFI6di0961
State of Florida _
AGENCY FOR HEALTH CARE ADMINISTRATION
DIVISION OF HEALTH QUALITY ASSURANCE
SKILLED NURSING FACILITY.
CONDITIONAL
inistration, authori
licensee is authorized to operate
“WESTMINSTER TOWERS
70 WEST LUCERNE CIRCLE
ORLANDO, FL 32801
TOTAL: 120 BEDS
Sat: 120 BEDS
STATUS CHANGE
ACTION EFFECTIVE DATE: 03/28/2003
‘LICENSE EXPIRATION DATE: 02/29/2004
at
ary, Division of Health Quality Assurance
Po fons
KEVISED: “FESSION ra WD. LIC CBE
we a]o3 , ‘
< ioe RECOMMENDA‘..JN FOR SANCTION - entral Office (FDAU) Use Only
Enf. Complaint #: £203 0d
Case #: "3633
Board Indicator Set (date):
6-Month Cycle in FRAES:
Other ID (opt):
Instructions: Complete this form to impose sanctions by Administrative
Complaint. Attach a copy of the Statement of Deficiencies and other
supporting documents as necessary. Al] RFSs with their supporting
documentation should be sent via interoffice mail to the Central Office
Facility Analysis Data Unit (Mailstop 47) for tracking in FRAES.
Please number pages at bottom of form.
Each survey done (complaint versus recert, etc) must have a separate RFS. However, multiple RFS forms for
surveys completed on or about the same time must be attached together as legal will produce one case /
Administrative Complaint (see Multiple RFS item 12).
1. FIELD OFFICE: 07 2. Facility type: X] Nursing Home [[] Assisted Living Facility [_] Hospital
[_] Home Health Agency [_]Other:
3. Licensee Name: PRESBYTERIAN RETIREMENT COMMUNITIES If unlicensed, check here [_] and
INC
Provide prior licensee name if applicable: 4. Licensed Beds: # 120
5. Facility Name: WESTMINSTER TOWERS. 6. Facility License #.: 16010961
7. Address: 70 WEST LUCERNE CIRCLE 8. City: ORLANDO
9. Date of Visit Resulting in Sanction: 3/28/03 13. Survey Type (check one): .
- XJ Annual [_] Complaint [_] Other
10. FRAES Inspection #: 35956 (_] Follow-up, indicate original survey date:
& Original survey type:
11. Mandated Correction Date: 4/21/03 - F324 (J Annual/ biennial
3)29[03- F3s3 [_] Complaint
12. If Multiple RFS, thisisRFS_ of ___ [_] Other:
[74-Name(s) of Surveyor(s) involved: MARY_ANNE PEARCE, JANE WOODSON, IRENE HAYES-
OLIVERAS LORRAINE HENRY, DOUGLAS METCALFE & MARK FORONDA
a Sanctions Imposed (check a! yy: Cone # 2200300 3638
ines
x} Conditional License ting Home Only) (Check only i the facility is going from a Standard license to a
Conditional license as a result of this survey.)
[1] Moratorium (check if this visit resulted in the imposition of an Immediate Order of Moratorium)
Date of Order: AHCA # on Order: e.g.: 04-01-234 NH)
(] Revocation - Indicate statutory grounds for revocation:
L_] Suspension - Indicate statutory grounds for suspension:
16. Nursing Home 6-Month Survey Cycle
Facility qualifies for 6-month survey cycle (see 400.19, F.S.) for (check all that apply):
x[_] Cited for a Class I deficiency
(_] Cited for two or more Class II deficiencies arising from separate surveys or investigations within a 60-day
period, date of prior Class II:
(Three or more substantiated complaints within a 6 month period, each resulting in at least one Class I or II
deficiencies, dates of two prior complaints: and:
Note to legal: The fine for the 2-year period shall be $6,000, one-half to be paid at the completion of each survey.
EXHIBIT
STATE OF FLORIDA j 3
AGENCY FOR HEALTH CARE ADMINISTRATION
AGENCY FOR HEALTH CARE
ADMINISTRATION,
AHCA Nos.: 2003003638
2003002543
Petitioner, DOAH Nos.: 03-2811
03-3315
vs.
PRESBYTERIAN RETIREMENT COMMUNITIES,
INC., d/b/a WESTMINSTER TOWERS,
Respondent.
/
STIPULATION AND SETTLEMENT AGREEMENT
Petitioner, Agency for Health Care Administration (hereinafter the “Agency") through
their undersigned representatives, and Presbyterian Retirement Communities, Inc., d/b/a
Westminster Towers (““Westminster"), pursuant to Sec. 120.57(4), Florida Statutes (2003), each
individually, a "party", collectively as "parties," hereby enter into this Stipulation and Settlement
Agreement ("Agreement") and agree as follows:
WHEREAS, Westminster is a skilled nursing facility licensed pursuant to Chapter 400
Part II, Florida Statutes (2003), and Rule 59A-4, Florida Administrative Code, (2003); and
WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing
authority over skilled nursing facilities pursuant to Chapter 400, Part II, Florida Statutes; and
WHEREAS, the Agency served Westminster with an Administrative Complaint on
August 23, 2003, notifying the party of its intent to impose a civil penalty for $36,000.00
(AHCA Case No. 2003002543). and
WHEREAS, the Agency served Westminster with a Notice of Assignment of
Conditional Licensure Status on July 14, 2003, imposing a conditional license effective March
28, 2003 through February 29, 2004 (AHCA Case No. 2003003638), and:
TLHI\HEALTHISS664.1
1682330013 DT dma 8/22/02
WHEREAS, Westminster requested a formal administrative hearing, for the fine case, in
a Petition for Formal Administrative Hearing filed by Karen Goldsmith, Esquire and received by
the Agency on September 18, 2003; and
WHEREAS, Westminster requested a formal administrative hearing, for the conditional
license case, in a Petition for Formal Administrative Hearing filed by Karen Goldsmith, Esquire
and received by the Agency on August 6, 2003; and
WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of
this dispute would avoid the expenditure of substantial sums to litigate the dispute; and
WHEREAS, the parties have negotiated and agreed that the best interest of all the parties
will be served by a settlement of this proceeding; and
NOW THEREFORE, in consideration of the mutual promises and recitals herein, the
parties intending to be legally bound, agree as follows:
L. All recitals are true and correct and are expressly incorporated herein.
2. Both parties agree that the "whereas" clauses incorporated herein are binding
findings of the parties.
3. Upon full execution of this Agreement, Westminster agrees to a withdrawal of its
Petition for Formal Administrative Proceedings; agrees to waive any and all appeals and
proceedings; agrees to waive compliance with the form of the Final Order (findings of fact and
conclusions of law) to which it may be entitled including, but not limited to, an informal
proceeding under Subsection 120.57(2), a formal proceeding under Subsection 120.57(1),
appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court
or quasi-court (DOAH) of competent jurisdiction. Provided, however, that no agreement herein,
shall be deemed a waiver by either party of its right to judicial enforcement of this stipulation.
4. The parties agree to the following terms:
TLHI\HEALTHSS664.1
416833/0C13 DT dma 8/22/02
a. Count I-Tag 324 will remain an “Isolated” Class II Deficiency. The fine
amount will be $2,500:
b. Count Il-Tag 353 will be reduced from a “Patterned” Class I Deficiency to a
“Patterned” Class II Deficiency. The fine amount will be $5,000; and
c. The conditional license rating will be imposed upon Westminster from March
28, 2003 to May 7, 2003.
5. Westminster shall pay the Agency Seven Thousand Five Hundred ($7,500.00)
Dollars within thirty days (30) of the rendition of the Final Order in this case.
6. Venue for any action brought to enforce the terms of this Agreement or the Final
Order entered pursuant hereto shall lie in the Circuit Court in Leon County, Florida.
7. Westminster neither admits nor denies the allegations in the Administrative
Complaint. The Agency agrees that it will not impose any further penalty against Westminster
as a result of the survey conducted on March 24-28, 2003. However, no agreement made herein
shal] preclude the Agency from imposing a penalty against Westminster for any
deficiency/violation of statute or rule identified in a future survey of Westminster, which
constitutes a “repeat” deficiency from the survey of March 24-28, 2003.
8. Upon full execution of this Agreement, the Agency shall enter a Final Order
adopting and incorporating the terms of this Agreement and dismissing the above-styled case.
9. Each party shall bear its own costs and attorney fees.
10. This Agreement shall become effective on the date upon which it is fully executed
by all the parties.
11. Westminster, for itself and for its related or resulting organizations, its successors
or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the
Agency for Health Care Administration, and its agents, representatives, and attorneys of and
from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any
and every nature whatsoever, arising out of or in any way related to this matter and the Agency’s
3
TLHTHEALTH55664.4
16833/00 12. DT dma 8/22/02
actions, including, but not limited to, any claims that were or may be asserted in any federal or
state court or administrative forum, including any claims arising out of this agreement, by or on
behalf of Westminster or related facilities.
12. This Agreement is binding upon all parties herein and those identified in the
aforementioned paragraph ten (10) of this Agreement.
13. The undersigned have read and understand this Agreement and have authority to
bind their respective principals to it.
14. This Agreement contains the entire understandings and agreements of the parties.
15. This Agreement supercedes any prior oral or written agreements between the
parties.
16. This Agreement may not be amended except in writing. Any attempted
assignment of this Agreement by Westminster or related facilities, its successor or any resulting
organization, shall be void.
The following representatives hereby acknowledge that they are duly authorized to
enter into this Agreement.
Abed
- Ope PE Lon
Elizabeth Dudek KAREN L. LE Fp, ESQUIRE
Deputy Secretary, GOLDSMITH, GROUT & LEWIS, P.A.
Managed-Care and 2180 Park Avenue North, #100
Health Quality Assurance Post Office Box 2011
Agency for Health Care Administration Winter Park, FL 32790-2011
a e 407/740-0144
DATED: E// LOY
Attorneys for Respondent
Florida Bar No. 274534
DATED: EL 2, Boog
TLHT\HEALTH\S5664.1
168320013 DT dma 8/22/02
Valda Clark Christian
General Counsel
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee FL 32308
DATED: om, Le ‘aL VA
He j £003 03636
AUCH Me 2003 M254
TLH1\HIEALTHISS664 1
168330013 DT dma 8/22/02
Docket for Case No: 03-002811
Issue Date |
Proceedings |
May 18, 2004 |
Final Order filed.
|
Feb. 26, 2004 |
Order Closing File. CASE CLOSED.
|
Feb. 25, 2004 |
Motion to Remand filed.
|
Feb. 24, 2004 |
Motion to Relinquish Jurisdiction (filed by Petitioner via facsimile).
|
Jan. 26, 2004 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for February 26 and 27, 2004; 9:00 a.m.; Orlando, FL).
|
Jan. 26, 2004 |
Motion to Reconsider Order dated January 23, 2004 (filed by Respondent via facsimile).
|
Jan. 23, 2004 |
Second Notice of Additional Witnesses (filed by Respondent via facsimile).
|
Jan. 23, 2004 |
Noticeof Additional Exhibit (filed by Respondent via facsimile).
|
Jan. 23, 2004 |
Notice of Additional Witnesses (filed by Respondent via facsimile).
|
Jan. 23, 2004 |
Order Denying Continuance and Allowing Witness Testimony by Deposition in lieu of Testimony at the Final Hearing.
|
Jan. 20, 2004 |
Notice of Deposition (H. Wiggan, T. Ardines and L Mompoint) filed via facsimile.
|
Jan. 20, 2004 |
Motion to Continue and Reschedule Hearing (filed by Petitioner via facsimile).
|
Jan. 13, 2004 |
Notice of Additional Exhibits (filed by Petitioner via facsimile).
|
Jan. 07, 2004 |
Notice of Additional Witness (filed by Petitioner via facsimile).
|
Dec. 04, 2003 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for January 29 and 30, 2004; 9:00 a.m.; Orlando, FL).
|
Dec. 03, 2003 |
(Joint) Pre-hearing Stipulation filed.
|
Dec. 02, 2003 |
Agreed Upon Motion to Continue and Reschedule Hearing (filed by Respondent via facsimile).
|
Nov. 25, 2003 |
Amended Notice of Video Teleconference (hearing scheduled for December 10, 2003; 9:00 a.m.; Orlando and Tallahassee, FL, amended as to type of hearing and location).
|
Nov. 06, 2003 |
Response to Request to Produce (filed by Respondent via facsimile).
|
Nov. 06, 2003 |
Response to First Set of Request for Admissions (filed by J. Grout via facsimile).
|
Oct. 07, 2003 |
Petitioner`s First Set of Request for Admissions, Interrogatories, and Request for Production of Documents (filed via facsimile).
|
Oct. 01, 2003 |
Order of Pre-hearing Instructions.
|
Oct. 01, 2003 |
Notice of Hearing (hearing set for December 10, 2003; 9:00 a.m.; Orlando, FL).
|
Sep. 26, 2003 |
Order of Consolidation. (consolidated cases are: 03-002811, 03-003315)
|
Sep. 24, 2003 |
Motion to Consolidate (Cases requested to be consolidated 03-2811 and 03-3315) filed by Respondent via facsimile.
|
Sep. 23, 2003 |
Order Granting Continuance and Placing Case in Abeyance (parties to advise status by November 3, 2003).
|
Sep. 19, 2003 |
Motion for Continuance (filed by Respondent via facsimile).
|
Sep. 19, 2003 |
Agreed Upon Motion for Abeyance (filed by Petitioner via facsimile).
|
Aug. 11, 2003 |
Order of Pre-hearing Instructions.
|
Aug. 11, 2003 |
Notice of Hearing (hearing set for October 7, 2003; 9:00 a.m.; Orlando, FL).
|
Aug. 11, 2003 |
Petitioner`s Response to Initial Order (filed via facsimile).
|
Aug. 08, 2003 |
Response to Initial Order (filed by Respondent via facsimile).
|
Aug. 01, 2003 |
Initial Order.
|
Jul. 31, 2003 |
Letter to Westminster Towers from J. Kemp, Agency for Health Case Administration, attaching Conditional License and Recommendation for Sanction filed.
|
Jul. 31, 2003 |
Explaination of Rights under Section 120.569, Florida Statutes filed.
|
Jul. 31, 2003 |
Election of Rights for Administrative Hearing Regarding Assignment of Conditional Licensure Status filed.
|
Jul. 31, 2003 |
Notice of Assignment of Conditional Licensure Status filed.
|
Jul. 31, 2003 |
Petition for Formal Administrative Hearing filed by K Goldsmith, Esquire.
|
Jul. 31, 2003 |
Notice (of Agency referral) filed.
|