(4 300! oD STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2003004536 AHCA No.: 2003004535 v. Return Receipt Requested: 7000 1670 0011 4849 5009 MARATHON MANOR, INC. d/b/a 7000 1670 0011 4849 5016 MARATHON MANOR, 7000 1670 0011 4849 5023 Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or the “Agency”), by and through the undersigned counsel, and files this administrative complaint against Marathon Manor, Inc. d/b/a Marathon Manor (hereinafter “Marathon Manor” or the “facility”), pursuant to 28-106.111, Florida Administrative Code (hereinafter “F.A.C.”) and Chapter 120, Florida Statutes (2002) (hereinafter “Fla. Stat.”), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose and maintain the Agency’s administrative fine in the amount of $7,500.00 pursuant to Sections 400.141(15) (d), 400.23(8) and 400.121, Fla. Stat. [AHCA No.: 2003004535). 2. This is an action to impose and maintain the Agency’s assignment of a conditional licensure rating, pursuant to Sections 400.141(15)(d), 400.23(7) (b), Fla. Stat. [AHCA No. 2003004536]. JURISDICTION AND VENUE 3. This court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat. and Chapter 28-106, F.A.c. 4. venue lies in Monroe County pursuant to Section 120.57 and Section 121(1) (e), Fla. Stat. and Chapter 28-106.207, F.A.C. PARTIES 5. AHCA is the enforcing authority with regard to skilled nursing facilities licensure pursuant to Chapter 400, Part II, Fla. Stat. and Rule 59A-4, F.A.C. 6. Marathon Manor is a skilled nursing facility located at 320 Sombrero Beach Road, Marathon, Florida 33050 and is licensed under Chapter 400, Part II, Fla. Stat. and Chapter S9A- 4, F.A.C. COUNT I MARATHON MANOR FAILED TO IMPOSE A MORATORIUM ON ADMISSIONS WHEN IT FAILED TO MEET STATE MINIMUM-STAFFING REQUIREMENTS FOR TWO OR MORE CONSECUTIVE DAYS. SECTION 400.141 (15) (da), FLORIDA STATUTES (ADMISSIONS MORATORIUM FOR STAFF SHORTAGES) CLASS II DEFICIENCY Te AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 8. During an unannounced licensure and re-certification survey conducted by the Agency from May 12, 2003 through May 15, 2003, and based on interview and record review, the Agency found that Marathon Manor failed to impose a moratorium on admissions despite its failure to meet state minimum-staffing requirements for two or more consecutive days. The findings include the following, to wit: 9. The minimum staffing requirement for certified nursing assistants for the year 2002 was 2.3 hours per resident per day. The staffing records supplied by the facility reflect certified nursing assistant hours of 1.9 on 10/26/02 and 10/27/02. 10. The minimum staffing requirement for certified nursing assistants (CNAs) for the year 2003 is 2.6 hours per resident per day. The staffing records supplied by the facility reflect the following: On 4/19/03 CNA hours were 2.4 per resident per day. On 4/20/03 CNA hours were 2.1 per resident per day. On 4/21/03 CNA hours were On 4/22/03 CNA hours were On 4/25/03 CNA hours were or. 4/26/03 CNA hours were or. 4/27/03 CNA hours were On 4/30/03 CNA hours were On 1/16/03 CNA hours were On 1/17/03 CNA hours were On 1/19/03 CNA hours were On 1/20/03 CNA hours were On 1/21/03 CNA hours were On 1/22/03 CNA hours were On 1/23/03 CNA hours were On 1/24/03 CNA hours were On 1/26/03 CNA hours were On 1/27/03 CNA hours were On 1/29/03 CNA hours were per resident pez day. per resident pez day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. per resident per day. . . NNNNNNHFPNNNNNENNN WY . so 8 6 oe @ 8 . . OAOANNNUUONWHE HON WA HO 11. Review of the admissions for the last three months supplied by the facility reveal admissions of: on 1/25/03 (1), 1/27/03 (1), 1/31/03 (1), 4/21/03 (1), 4/22/03 (2), 4/23/03 (1), 4/24/03 (4), 4/28/03 (1), 4/29/03 (1). 12. Interview with the facility’s director of nurses and administrator on 5/14/03 at approximately 3pm failed to indicate that the facility had adequate nursing staff assigned on the dates indicated above. 13. Section 400.141(15)(d), Florida Statutes, specifically mandates that a failure to impose an admissions moratorium on new admissions constitutes a Class II deficiency. Therefore, based on tke all the foregoing, Marathon Manor violated Section 400.141 (15) (d), Fla. Stat., herein classified as a Class II violation pursuant to Section 400.141(15) (d), and/or 400.23(8), Fla. Stat., which warrants an assessed fine of $7,500.00. This also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b), Fla. Stat. wn DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes, Marathon Manor shall post the license in a prominent place that is clear and unobstructed public view at or near the plece where residents are being admitted to the facility. The conditional License is attached hereto as Exhibit “A” EXHIBIT “A” Conditional License License # SNF 1321096; Certificate No.: Effective date: 05/15/2003 Expiration date: 09/30/2003 PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. Make factual and legal findings in favor of the Agency on Count I. 2. Assess and maintain the Agency’s administrative fine of $7,500.00 against Marathon Manor for one (1) Class II violation, pursuant to Sections 400.141(15) (d), and/or 400.23(8), Fla. Stat. 3. Assess against Marathon Manor a conditional license in accordance with Section 400.23(7), Fla. Stat. 4. Assess costs related to the investigation and prosecution of this matter, if applicable. 5. Grant such other relief as the court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Kathfvyn F. Fenske, Esq. Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 NW 53°° Street Miami, Florida 33166 (305) 499-2165 Copies furnished to: Diane Castillo Field Office Manager Agency for Health Care Administration Manchester Building 8355 NW 53 Street Miami, Florida 33166 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Terry Hilker, Administrator, Marathon Manor, 320 Sombrero Beach’ Road, Marathon, Florida 33050; Marathon Manor, Inc., 11000 Prosperity Farms Road, Suite #100, Palm Beach Gardens, Florida 33410; Theresa B. Cleveland, 11000 Prosperity Farms Road, Suite 100, Palm Beach Gardens, Florida kl - 33410 on this Lr day of , 2003. _—_—— KatYrytF. Fenske, Esq. - 10

Docket for Case No: 03-003091