(3.3097 Shaw an bof STATE OF FLORIDA 03 dus AGENCY FOR HEALTH CARE ADMINISTRATION 3 AUS 25 PH 3:59 CLVISs AGENCY FOR HEALTH CARE ADMINIS TRAT Vc ADMINISTRATION, HEARINGS bye, Petitioner, AHCA No.: 2003004916 Return Receipt Requested: v. 7002 2410 0001 4236 8550 7002 2410 0001 4236 8680 HT-BOSTON, INC., d/b/a NORTHPARK, A 7002 2410 0001 4236 8697 CLASSIC RESIDENCE BY HYATT, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against HT-Boston, Inc., d/b/a Northpark, A Classic Residence by Hyatt (hereinafter “Northpark, A Classic Residence by Hyatt”), pursuant to chapter 400, part III, and section 120.60, Florida Statutes, (2002), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $5,000 and $500 survey fee pursuant to Section 400.424 (3) (a), and 400.419(9), Florida Statutes (2002), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes (2002). 3. Venue lays in Broward County, pursuant to Rule 28-106.207, Florida Administrative Code (2002). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 400, Part III, Florida Statutes (2002), and Chapter 58A-5 Florida Administrative Code. 5. Northpark, A Classic Residence by Hyatt Inc. operates a 120-bed assisted living facility located at 2480 North Park Road, Hollywood, Florida 33021. Northpark, A Classic Residence by Hyatt Inc. is licensed as an assisted living facility, license number AL5622; with the expiration date of February 17, 2004. Northpark, A Classic Residence by Hyatt Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I NORTHPARK, A CLASSIC RESIDENCE BY HYATT FAILED TO COMPLY WITH THE RESIDENT BILL OF RIGHTS TO PROVIDE AN ENVIRONMENT FREE OF PHYSICAL AND VERBAL ABUSE 400.428(1), Fla. Stat. {RESIDENT CARE STANDARDS) CLASS I VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the complaint investigation conducted on 6/27/03 and based on interview and record review, the facility failed to comply with the Resident Bill of Rights to provide an environment free from physical and verbal abuse. The findings include: 8. The resident named in the complaint was subjected to a pattern of physical and verbal abuse by a private duty aide. The facility was aware of the abuse and the facility did nothing to immediately remove the aide from service pending investigation after the first incident of abuse was known. The resident was 97 years old at the time of the incidents related below and entered the facility with diagnoses of M.I., GI Bleed and PTCA on the Health Assessment (HA). The HA documents the resident as “confused”. The aide is not an employee of the facility or Senior Health Care. The aide was employed by the family. The aide is under the supervision of the facility. The abuse went on for approximately 2 (two) weeks- March 29, 2003-April 15, 2003- after the first incident and at which time the facility finally removed the aide from service and the facility. 9. On March 29, 2003, an LPN employed by the facility entered the facility dining room and witnessed a private cuty aide (PDA) hitting the resident named in the complaint on the head and shaking the resident's arm. The LPN documents on the Unusual Occurrence Report completed the next day, 03/30/03, and noted in the resident's file at the time of the investigation, "Nurse entered dining room and witnessed PDA striking res. on head with hand, then shaking her arm and telling her to stop taking off bandages." Under the ‘Action Taken' portion of the report, the LPN documents, "Nurse told PDA that striking res. is unacceptable. Nurse made several attempts to report occurrence to SHC, but there was not anybody in cffice." SHC is Senior Health Care, a company that operates out of an office within the facility and provides Home Health Aides for the facility residents. The PDA named in the complaint is not an employee of SHC. The LPN goes on to further document under the ‘Witnesses’ portion of the report, "SHS PDAs in dining room." The names of the witnesses are not noted on the form. According to the Personal Care Director interviewed via the phone on C7/01/03 as part of this investigation, the LPN did not immediately inform the leadership of the facility of the incident nor did the LPN notify the appropriate agencies of the abuse as required. There was no documentation provided by the end of the investigation that the family or the appropriate agencies were notified of the abuse observed by the facility on 03/29/03. A copy of the Unusual Occurrence Report was obtained at the time of the investigation. 10. According to the Adult Protective Services Abuse Report obtained as part of this investigation, approximately 1 (one) week after the initial physical abuse which was observed by the facility, the ALF Administrator witnessed the PDA verbally abuse the resident noted in the complaint. The Administrator overheard the PDA say to the resident, "Put your hands in your lap and shut your mouth.” According to the report, the Administrator gave the PDA a warning that if any other problems occur, the PDA will be escorted out of the building. The APS report goes on to further document that the Administrator informed the APS Investigator that there have been other reports of the PDA being physical with the resident. No documentation of the incident noted above was observed in the resident's file, nor was there any documentation made available by the end of the investigation that the family or the appropriate agencies were notified of the verbal abuse. The cory Administrator was not available at the time of the investigation. During the phone interview with the Personal Care Director noted above, the verbal abuse incident witnessed by the Administrator was confirmed. 11. On 04/15/03, an employee of Senior Health Care overheard the PDA say to the resident named in the complaint, "Put your damn feet up." The SHC employee went to investigate and observed the PDA strike the resident in the face by the nose and mouth 3 (three) times. The employee immediately went to the SHC office and reported the incident to the Manager. The Manager went to facility administration and reported the incident. The PDA was escorted off the property. An interview with the Manager of SHC at the time of the investigation confirmed the incident as described above. 12. Based on the foregoing, Northpark, A Classic Residence by Hyatt violated Chapter 400.428(1), Fla. Stat., a Class I violation, which carries, in this case an assessed fine of $5,000. COUNT II ADDITIONAL FINE UNDER SECTION 400.419(9), Fla. Stat. 20. The Agency, in addition to any administrative fine imposed, may assess a survey fee, equal to the lesser of one half of the facility’s biennial license and bed fee or five hundred dollars ($500) to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint pursuant to Section 400.419(4), Fla. Stat. PRAYER FOR RELIEF WHEREFORE, AHCA requests this Court to orcer the following relief: 1. Make factual and legal findings in favor of the Agency on the Counts I and II. 2. Impose an administrative fine of $5,000 pursuant to sections 400.419(1) (a), Fla. Sta. 3. Impose a survey fee of $500 pursuant to Section 400.419(9), Fla. Stat. 4. Assess costs related to the investigation and prosecution of this matter, if applicable. Respondent is notified that it 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 Flection of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Building #3, Mail Stop #, Tallahassee, Florida 32308, attention Lealand McCharen, Agency Clerk, Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT CF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. elson Rodney ) Assistant General Counsél Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive West Palm Beach, Florida 33407 (U.S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Adult Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) 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 Joan, Berzner, RN, Administrator, Northpark, a Classic Residence by Hyatt, 2480 North Park Road, Hollywood, Florida 33021; HT- Boston, Inc., 200 W. Madison, Suite 4100, Chicago, IL 60606, and to The Prentice-Hall Corporation System, Inc., Registered Agent, 1201 Hays Street, Suite 105, Tallahassee, Florida on this Qyt day of Ley 2003. eKson*‘Rodney

Docket for Case No: 03-003093