03-19-04P%1 2:18 RCV AN Sloane - Lee RIDA : sTaté OF FLO AGENCY FOR HEALTH ‘CARE ADMINISTRATION nites # a 04 APR 20 PY U: 1g AGENCY FOR HEALTH CARE j ADMINISTRATION, Dyi d fr AOMIN : fb wen). Petitioner, AHCA No. : 2004001688 AHCA No.-?: 2004001687 v. Return Receipt Requested: _ 3 /sa/oy 7002 2410 0001 4237 4797 MIAMI DADE COUNTY , PUBLIC 7002 2410 0001 4237 4803 HEALTH TRUST a/b/a PERDUE 7002 2410 0001 4237 4834 MEDICAL CENTER, D Respondent. / ee MAR 22 2004 Office of the County Attorne: Public Health Trust Division” ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health care administration (hereinafter XAHCA") , by and through the undersigned counsel, and files this administrative complaint against Miami Dade County, Public Health Trust d/b/a Perdue Medical Center (hereinafter ‘perdue Medical Center” ) pursuant to Chapter 400, Part II and Section 128-60, Florida Statutes, (2003) hereinafter alleges: NATURE _OF THE ACTIONS 1. This is an action to impose an administrative fine in the amount of $6,000.00 pursuant Lo Sections 400.23(8) (ob), Florida Statutes (AHCA No.+> 2004001687) . 2. Thig ig an action to impose a conditional licensure rating pursuant to Section 400.23(7) (b), Florida Statutes {[AHCA No. 20042001688] . JURISDICTION AND VENUE 3. This court has jurisdiction pursuant to Section 120.569 and 120.57, Florida Statutes and Chapter 28-106, Florida Administrative Code. 4. venue lies in Dade County, pursuant to Section 400.121 Florida Statutes and Chapter 28-106.207, Florida Administrative Code. PARTIES 5. AHCA is the enforcing authority with regard to nursing home licensure pursuant to Chapter 400, Part II, Florida Statutes and Rule 59A-4, Florida Administrative Code. 6. Perdue Medical Center is a nursing home located at 19590 Old Cutler Road, Miami, Florida 33157 and is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I PERDUE MEDICAL CENTER FAILED TO ENSURE THAT EXIT DOORS WERE IMMEDIATELY AVAILABLE AT ALL TIMES. RULE 59A- 4.130, FLORIDA ADMINISTRATIVE CODE and/or NFPA 101i - LIFE SAFETY CODE STANDARD CLASS IIT 7. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 8. During a life safety survey conducted on September 8, 2003, and based upon observation, testing and interview while touring the facility with the maintenance supervisor and housekeeping supervisor, it was determined that not all exit doors were immediately available at all times as is required by law. The findings include the following. 9. While touring the facility between 10:30 A.M. and 12:30 P.M., exit doors were tested for opening. The doors at the end of the East, South, and North wings as well as the door to the loading dock (all being designated as "EBxits") were noted not to open when pressure was applied to the opening mechanism. The door could only be opened by a key, which opened the magnetic lock or by activation of the facility fire alarm. Also, the key required to open the lock was not universally available. Furthermore, the puilding is not fully equipped with sprinklers and these types of locking arrangements are not permitted. According Lo the maintenance supervisor, the locking arrangements were to be upgraded to approved devices with the new alarm/sprinkler system. At this point in time those systems are not operational. This causes exits not to be readily available at all times. 10. The mandated correction date was designated as October 8, 2003. 11. During the follow up life safety survey conducted on October 10, 2003, and based on observation, testing and interview while touring the facility with the maintenance supervisor, it was determined that not all exit doors were immediately available at all times as is required by law. The findings include the following. 12. While touring the facility between 9:30 A.M. and 11:30 A.M., exit doors were tested for opening. The doors at the end of the North wing as well as the door to the loading dock (both _ being designated as "Exits") were noted not to open when | pressure was applied to the opening mechanism. cel th door at the north end of the North nursing unit which was fitted with a 15 second delay latching mechanism would not open when pressure was applied to the panic bar opening device as would be required. {It was necessary to apply pressure to the door itself new" at a height of approximately four to five feet. This should not nblatien be necessary to open the door. This causes the exit door not to be readily available at all times. 13. This is an uncorrected deficiency for the survey conducted on September 8, 2003. 14. Based on the foregoing, Perdue Medical Center violated Rule 59A-4.130, Florida Administrative Code and/or NFPA 101, Life Safety Code standard, herein classified as a Class III violation pursuant to Section 400.23(8), Florida Statutes, which carries, in this case, an assessed fine of $3,000.00. This also gives rise to conditional licensure status pursuant to Section 400.23(7)(b), Florida Statutes. COUNT IIL PERDUE MEDICAL CENTER FAILED TO ENSURE THAT THE TAMPER ALARM FUNCTIONED PROPERLY. RULE 59A-4.130, FLORIDA ADMINISTRATIVE CODE and/or NFPA 101 - LIFE SAFETY CODE STANDARD CLASS III 15. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 16. During a life safety survey conducted on September 8, 2003, and based on observation and monitoring while testing the tamper alarm for operation in the company of the maintenance supervisor and housekeeping supervisor, it was determined that the tampex alarm did not function properly. The findings include the following. 17. During the time when a maintenance worker was observed to move the control valve towards the closed position, the tamper alarm did not sound at the remote annunicator, which is located on the South wing nursing station. This station is the 24 hour a day attended location. This situation could compromise the main sprinkler system water supply and endanger residents’ safety. 18. The mandated correction date was designated as October 8, 2003. 19. During the follow up life safety survey conducted on October 10, 2003 and based on observation and monitoring while testing the tamper alarm for operation, in the company of the maintenance supervisor and his assistant, it could not be determined that the tamper alarm functioned properly. The findings include the following. 20. During the time when a maintenance worker moved the control valve towards the closed position, the tamper alarm did not sound at the remote annunciator, which is located on the South wing nursing station. This station is the 24-hour a day attended location. According to the maintenance supervisor the tamper alarm had been repaired but it did not function under normal circumstances. This situation could compromise the sprinkler system water supply and endanger residents’ safety. Furthermore, while attempting to test the tamper alarm, it was noted that the window on the P.I.V., which shows if the valve is "OPEN" or "SHUT", did not indicate "SHUT" when the handle was moved completely in that direction. 21. This is an uncorrected deficiency from the survey of September 8, 2003. 22. Based on the foregoing, Perdue Medical Center Nursing violated, Rule 51A-4.130, Florida Administrative Code herein classified as a Class III violation pursuant to Section 400.23(8), Florida Statutes, which carries, in this case an assessed fine of $3,000.00 This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statute. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Perdue Medical Center shall post the license in a prominent place that is clear and unobstructed public view at or near the place where residents are being admitted to the facility. The conditional License is attached hereto as Exhibit “A” EXHIBIT “A” Conditional License License # SNF 1435096; Certificate No.: Effective date: 10-10-2003 Expiration date: 05-31-2004 — a RR SS ts Hr TR NF PRAYER FOR RELIEF 4 tPp > ae WHEREFORE, the Petitioner, State of ost Health Care Administration requests the following rel tai 1. Make factual and legal findings in favor of the Agency on Counts I and II. 2. Assess against Perdue Medical Center an administrative fine of $6,000.00 for two (2) Class III violations as cited above. 3. Assess against Perdue Medical Center a conditional license in accordance with Section 400.23(7), Florida Statutes. 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 (2003). 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. Margaret) Julien, Esq. Assigtant Gendral Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Diane Castillo Field Office Manager Agency for Health Care Administration Manchester Building 8350 NW 52 “4 Terrace 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 10 CERTIFICATE OF SERVICE Se RV 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 Reardon, Administrator, Perdue Medical Center, 19590 Old Cutler Road, Miami, Florida 33157; Miami Dade County, Public Health Trust, 2500 N. W. 22 Avenue, Miami, Florida 33142 on this {CH day of Inouk , 2004, Margargt Jul?¥

Docket for Case No: 04-001394