2 SEAR se Se AEE REE © EST STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No: 2004002169 Petitioner, Return Receipt Requested On 7002 2410 0001 4237 0768 vs. 7002 2410 0001 4237 0775 7002 2410 0001 4237 0782 INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA, INC., LAUREL POINTE HEALTH AND REHABILITATION, Respondent ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or the “Agency”), by and through undersigned counsel, and files this Administrative Complaint against Integrated Health Services at Central Florida, Inc., a/b/a Laurel Pointe Health and Rehabilitation, (hereinafter “Laurel Pointe Health and Rehabilitation”), pursuant to 28- 106.111, Florida Administrative Code (2003) (hereinafter “FLALC.”), and Chapter 120, Florida Statutes (2003) (hereinafter ‘Fla. Stat.”), and alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine against Laurel Pointe Health and Rehabilitation totaling a ene RC RENE RAE RE A Maremma = tnousand dollars ($10,000.00), pursuant to Sections 400.102, 400.19, and 400.23, Fla. Stat. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 3. venue lies in St. Lucie County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4. AHCA is the enforcing authority with regard to nursing home licensure, pursuant to Chapter 400, Part II, Fla. Stat. and Rule 59A-4 F.A.C. 5. Laurel Pointe Health and Rehabilitation is a nursing home located at 703 S. 29% street, Fort Pierce, Florida 34947, and is licensed under Chapter 400, Part Il, Fla. Stat., and Chapters 59A-4, F.A.C.; license number 11600961 with an expiration date of November 30, 2004. COUNT I LAUREL POINTE HEALTH AND REHABILITATION FAILED TO ALLOW THE HEALTH CARE PROXY TO MAKE A DETERMINATION FOR APPROVAL OF A MEDICAL TREATMENT REQUIRING CONSENT FOR TWO RESIDENTS AND TO PROTECT AND PROMOTE THE INTEREST OF ONE RESIDENT. 42 C.F.R. 483.10(A) (3)&(4), Code of Federal Regulations as incorporated by Rule 59A-4.1288, F.A.C. (EXERCISE OF RIGHTS) UNCORRECTED CLASS III DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. rare A SA SST 9 rn 7. During the xre-certification survey conducted on 01/05-08/2004 and based on record review and interview, it was determined that the facility did not allow the health care proxy to make a determination for approval of a medical treatment requiring consent for two (2) of twenty (20) residents in the survey sample (Residents #13 and #20). 8. Review of the record of Resident # 13 on January 06, 2004, at 2:00 P.M., revealed an influenza immunization informed consent form. The form was signed by the resident on October 24, 2003, and witnessed by a staff member. Signing the form gave permission to the facility to administer an influenza vaccination annually. The form documents that the person signing consent was instructed that as a result of the vaccination, they might experience some side effects. Further review of the resident's record revealed the resident's physician had signed a determination of incapacity on June 10, 2003, which documents the physician's determination that the resident lacks the capacity to give informed consent to make medical decisions. A designation of health care proxy was signed on July 29, 2003, by the resident's family member, and witnessed by staff. The acceptance of health care proxy designation docunents that the proxy accepts the responsibility to act as medical decision maker for the incapacitated resident. There was no documentation in the record that the proxy was informed of the decision to administer the vaccine. In addition, staff had a resident determined to be incapacitated to sign consent to administer a vaccine, which carries a risk of side effects. The unit manager and MDS (Minimum Data Set) coordinator were asked about the validity of having an incompetent resident sign a congent form. It was unable to be explained why this was done. 9. On 01/05/2004, Resident #20's father was interviewed and stated that the resident was on Zoloft (antidepressant) and Seroquel (antiosychotic). The resident's father stated that he was not informed of the initiation of the Seroquel on 12/06/2003 and did not agree with the use of either of the medications. However, he was not able to exercise the resident's right to refuse the use of the medications since he was unaware of their use. He also stated that the only reason he knew the resident was on these psychotropic medications was because he received a billing questionnaire from the Agency for Health Care Administration. The resident's father verified that he was the resident's decision-maker as the resident was unable to understand the medications and his intention was to have the resident taken off of these medications as soon as possible. The resident's clinical record was reviewed and the resident's father had been assigned "Durable Power of Attorney" for health care purposes. On 01/08/2004, a physician's order to discontinue the use of Seroquel was completed and was found in the resident's record. Correction date: February 08, 2004. 10. During the revisit re-certification survey conducted on 02/23/2004 and based upon observation, record review and interview with staff, the facility did not protect and promote the interest of a resident in 1 (Resident #11) of 13 sampled residents. 11. Record review revealed that Resident #11 was on Hospice and did not have the appropriate end stage diagnosis. The medical record diagnosis includes “Fractured femoral left, HTN, type II diabetes, glaucoma, CVA, depression.” 12. The record revealed that this resident is Korean speaking and the only person to speak with her in Korean is the resident’s daughter. The record did not reflect other family or friend visitors. The resident’s daughter is the Health Care Proxy Designee. The record did not reflect a communication board from Hospice nor from the facility. 13. On 01/19/2004 there was a doctor's telephone order, which read, “Hospice consult and admit per daughter's wishes”. Additionally, on 01/20/2004 a History/Physical stated, “Plan: No medication changes at this time. Daughter is refusing any medical care at this time. We will have staff get her to sign a refusal to treat. We will then refer her to Hospice care at that point.” The medical record revealed that the resident was evaluated and admitted to Hospice on 01/19/2004. Moreover, there is a tool that is entitled “Kramofsky Scale” used by the Hospice Registered Nurse dated 01/19/2004 which reflected that the patient was rated “30” which is “Severely disabled; although death was not imminent.” 14, There was a care plan from Hospice of the Treasure Coast beginning 01/19/2004 with minimal updates on 01/23/2004; 02/16/2004 and 02/18/2004. There was one Chaplain’s note (01/10/2004) stating, “Patient was lying in bed, eating her dinner. Patient is alert and I had no communication with her due to language. Patient’s daughter chats with me a little. Patient’s daughter said that there was no Korean Pastors visiting her mother. I said I would try to contact Methodist or Baptist Pastor to visit. I apologized that I did not get ready information on my own----? (SDA) I promised I would bring it next visit.” 15. Information was requested from the facility regarding Hospice rendering care that the facility could not render. Nothing was submitted. Additionally, the Social Service Progress Notes for 02/10/2004 stated ‘Quarterly Note: Daughter nor Hospice representative attended c/p meeting. SSD spoke with the daughter because she was working and could not visit during the day. The daughter was not too pleased with Hospice, did not see that they are doing anything special. Then we began discussing possible d/c to home.”------ The record revealed that this resident who was a vegetarian had lost 6 pounds since November 2003. 16. Observation by two surveyors at approximately 12:15 pm in the dinning room revealed that Resident #11 was trying to get the attention of staff. She was ignored by 2 different certified nursing assistants. She was approached by the surveyor and gestured that she had pain in her chest. The nurse in the dining room was called over and the resident was taken out of the dining room. 17. Interview with staff: Registered Dietitian was asked about the 6 pounds this resident had lost since November 2003 and if there was any additional interventions. Her reply was, “you know, she is terminal.” 18. It is noted in the medical record that this resident was terminal and the reason for the daughter wanting to withhold medical care. There was no evidence in the record that the facility was protecting the resident such as seeing that she receives appropriate treatment and nutrition and to understand motives for discontinuing care. 19. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated 42 C.F.R. 483.10(a) (3)&(4), Code of Federal Regulations, as incorporated by 59A-4.1288 Florida Administrative Code, herein classified as an uncorrected Class III deficiency, pursuant to 400.23(8)(c), Fla. Stat., which carries an assessed fine of $1,000.00. COUNT IT LAUREL POINTE HEALTH AND REHABILITATION FAILED TO PROVIDE SERVICES TO MAINTAIN THE RESIDENTS’ DIGNITY FOR ALL RESIDENTS. 42 C.F.R. 483.15(a), Code of Federal Regulations, as incorporated in 59A-4.1288, F.A.C., and Section 400.022(1)(n), Florida Statutes (QUALITY OF LIFE) UNCORRECTED CLASS III DEFICIENCY 20. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 21. During the Re-certification survey conducted on 01/05-08/2004 and based on observation, interview and record review, the facility failed to provide services to maintain the residents' dignity for 4 of 27 sampled and random residents (Residents #7, #21, #22 and #23). 22. On 1/6/04 at 10 AM, Resident #7 was observed from the hall through a break in the curtain being changed in bed by an aide. The resident's perineal area was in full view from the hall as the aide removed the resident's disposable brief and provided incontinent care. The aide was notified at this time that the resident was exposed to anyone who passed the room and she then fully closed the curtain and the door to the resident's room. 23. On 01/05/2004 at approximately 9:30 AM, Random Resident #21 and Random Resident #22 (both female residents) were observed in wheelchairs in the hall in front of the nurses! station with nearly 1/4 inch hair growth on their chins. 24. On 01/08/2004 at 7:45 AM, Random Resident #23 (female resident) was observed in the hall near the nurses' station with numerous hairs on the resident's chin approximately 1/2 inch long. 25. On 01/07/2004 at 9 AM, Resident #7 was observed fully dressed in his/her room wearing the same shirt that he/she wore the day before. The daughter was interviewed at this time and stated that the resident had clothes but that the clothing was continuously misplaced, sent to central laundry or lost. The DON was notified at this time of the resident's clothing that was taken off during the evening shift not being put in its proper place (family does laundry) . Correction Date: February 8, 2004 26. During the re-visit survey conducted on 02/23/2004 and based upon observation, the facility did not promote care for residents to enhance or maintain each resident’s dignity in observations involving three random residents (Residents #13, 14 and 15). 27. On 02/23/2004 at approximately 12:10 pm Resident #13 was walked into the dining room by a certified nurse assistant. This resident is confused and was in need of assistance in adult living skills including dressing. The resident was wearing a housedress, a wander guard ankle bracelet, a sock on each foot and one slipper on one foot. The resident and the certified nursing assistant were observed to walk over to the dining room table. The certified nursing assistant was asked why the resident had only slipper on. The response was that the other slipper could not be found. At that time a staff person instructed the certified nurse assistant to take the resident back to the room and to get the other slipper. Ten minutes later the certified nurse assistant walked back into the dining room with the resident and both slippers. This is a dignity as well as a safety issue. 28. At approximately 12:20 pm in the dining room, Resident #14 was observed sitting at a dining room table with his name stenciled in large black letters on the back of the shirt. Additionally, there was a hole the size of a quarter in the back of the shirt above the stenciling. 29. At approximately 12:10 pm, Resident #15 was observed sitting at the dining room table with his wife sitting to his left and Resident #14 sitting directly across from him and tables all around with resident eating their lunch with full view of Resident #15. The speech therapist was standing over the resident attempting to show the resident proper eating techniques to use because of his diagnosis and his false teeth. One of the problems was with the teeth; the speech therapist put her fingers (without rubber gloves) into the 10 resident’s mouth trying to find the problem, which was the glue from the false teeth that was sticking the resident’s lips to his guns. The false teeth were put into the resident’s mouth and taken out several times. The speech therapist was also giving the resident's wife instructions while she put her hands in the resident's mouth at a different time. In the meantime, the false teeth were sitting on the table and saliva and food particles were dripping from his mount. The wife wiped the resident’s mouth with a napkin periodically. The speech therapist went from side to side of the resident moving his head and adjusting his position without washing her hands. (a) This went for approximately 10 minutes in full view of the other residents including Resident #14 sitting and eating his lunch directly across the table. The teeth were put back into resident’s mouth and again the speech therapist was instructing the wife in feeding techniques. This was all observed by the surveyor and a facility staff who was standing with the surveyor. At this point, the staff person stopped the speech therapis= and the way in which she was conducting her therapy. The speech therapist then washed her hands at the sink on the other side of the dining room and left. The resident was not afforded privacy in learning feeding techniques while becoming comfortable with his false teeth and working out the problems. Additionally, it was quite obvious 11 that this resident was getting some type of help that was not successful in the presence of other residents while eating their lunch. 30. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated C.F.R. 42, Section 483.15(a), Code of Federal Regulations, as incorporated by 59A-4.1288, F.A.C., herein classified as an uncorrected Class III deficiency, pursuant to 400.23(8)(c), Fla. Stat., which carries an assessed fine of $1,000. COUNT III LAUREL POINTE HEALTH AND REHABILITATION FAILED TO MAINTAIN A CLEAN, SANITARY OR COMFORTABLE ENVIRONMENT FOR ALL RESIDENTS Title 42 Section 483.15(h) (2), Code of Federal Regulations, as incorporated by 59A-4.1288, and/or 59A-4.106(4) (k), F.A.C. (ENVIRONMENT ) UNCORRECTED CLASS III DEFICIENCY 31. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 32. During the Re-certification survey conducted on 01/05-08/2004 and based on surveyor observation and interview with residents and staff, it was determined that staff did not maintain a clean, sanitary, or comfortable environment for residents housed on the A and B wing. 33. During the initial tour on 01/05/2004 beginning approximately 9:30 A.M., random observations of resident restrooms revealed 3 of these restrooms were not maintained in a sanitary manner. The restroom for Room #128 had a dried yellow substance spattered on the majority of the surface of the toilet seat and the surrounding area of the floor. A strong urine odor was also present. The restroom for Room #121 had a brown substance smeared on the toilet seat and the floor area of this restroom was stick? The restroom for Room #110 had a light brown substance streaked down the front of the toilet bowl, base, and the floor area immediately in front of the base of the toilet. 34. On 01/05/2004 at 9:30 AM, an initial tour of the facility was conducted. At this time, the upper 100 hall of the A wind was toured and a pungent urine odor was prevalent throughout the hall. 35. On 01/06/2004 and 01/07/2004 at 9 AM, the upper 200 hall of the B wing also smelled of this urine odor. 36. Tour of the A wing, was conducted on January 05, 2004. Observations made by the surveyor in Room 114 revealed a milky white film on the bathroom sink countertop. In Room 115, chipped, peeling paint was noted behind the head of the beds, as well as brownish stains. Room 113 was observed to have a milky white film on the bathroom sink countertop. Room 117 was observed to have peeling paint and chipped plaster on the wall below the air conditioner unit, as well as scuffmarks. In the room there was also a missing plate for the electric plug. The unit manager was interviewed on January 05, 13 2004, at 10:15 A.M. The findings during tour were explained. Correction date: February 08, 2004. 37. During the re-visit conducted on 02/23/2004 and based on observations and interviews revealed that the facility did not provide housekeeping and maintenance services to maintain a sanitary and orderly interior in 2 residents’ rooms and on 4 medication carts. 38. Based on observation on this date at 11:15 am it was noted that the A-1, A-2, B-1 and B-2 Afromick Medications carts were encrusted and covered with a heavy build up of various unidentifiable matters. This issue was called to the attention of the Nursing Home Administrator immediately following observations of all four-medication carts. Approximately at 3:30pm the Maintenance Director was observed in the common hallway directly across from the Nursing Station 200 spraying the B-2 medication cart with an unknown substance (contained in a spray bottle). The Maintenance director then proceeded to wipe the medication cart with a sponge and unknown solution contained in a bucket. The top of the medication cart and items (spoons, soufflé cups, and 6 ounce drinking cups) on top of the cart were exposed to the unknown fluids the Maintenance Director was using to clean the medication cart. 39. On 02/23/2004 at 9:45 am, in the 100-wing resident shower room, the washbasin top and bowl surfaces were observed 14 to have an accumulation of grey and black particles and soap residue. At that time, this was confirmed by a housekeeper. 40. On 02/23/2004 ay 9:50 am in resident’s room 220, observation revealed a missing molding strip directly under the window’s sill leaving an unpainted strip of wall above the air conditioner. 41. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated Title 42 483.15(h) (2), Code of Federal Regulations, as imcorporated by 59A-4.1288, and 59A- 4.106 (4) (k), F.A.C., herein classified as a patterned uncorrected Class III deficiency, pursuant to 400.23(8)(c), Fla. Stat., which carries an assessed fine of $2,000. COUNT IV LAUREL POINTE HEALTH AND REHABILITATION FAILED TO STORE, PREPARE, DISTRIBUTE AND SERVE FOOD UNDER SANITARY CONDITIONS Title 42 Section 483.35(h) (2), Code of Federal Regulations, as incorporated by 59A-4.1288, F.A.C., and Section 400.141(9), Florida Statutes (DIETARY SERVICES) UNCORRECTED CLASS III DEFICIENCY 42. AHCA re-alleges and incorporates paragraphs (1) through (5) as is fully set forth herein. 43. Based on observation it was determined that the facility failed to store, prepare, distribute, and serve food under sanitary conditions. 15 44. During the Kitchen/Food Service Observation Tour conducted on 01/05/04 at 10 AM, the following sanitation issues were noted: (a) A test of the final rinse temperature of the dish machine was performed 3 times. Each test revealed a temperature of 160 degrees F and did not meet the required minimum temperature of 180 degrees F to ensure proper sanitizing of dishware. The sanitation issue existed for 2 days of the survey. (b) A chemical test of the rag bucket was performed to ensure the required level of sanitizing agent. The test revealed an insufficient amount of sanitizing agent in the bucket. (c) Three - 2 pound containers of yogurt were located within the walk-in refrigerator with an expired date of 10/31/03. (a) The door gasket of the walk-in refrigerator was molded. (e) Numerous 1-gallon containers of salad dressings and condiments were located within the walk-in refrigerator were not labeled with the date of opening. (f) The fan cover of the refrigeration unit located within the walk-in refrigerator was molded. (g) The exterior paint of the Univex bench mixer was peeling directly above the mixing bowl area. (h) Numerous heavily dented cans of soup and juice were located within the food supply pantry. (i) Leftover foods (diced potatoes) dated 12/22/03 were not used within the leftover use policy time of 48 hours. (j) Numerous soiled staff drinking cups were located within food preparation and serving areas. (k) Soiled brooms and dustpans were stored within food preparation areas. (1) A wire food tie was found within the flour container. 45. During tour of the facility on January 06, 2004, at 10:30 A.M., the resident pantry refrigerator was found to contain four (4) salami sandwiches that were undated and unlabeled. The plastic wrap on one of the sandwiches was partially off, and the bread was stale. In addition, there were three (3) Styrofoam and Tupperware-type containers in bags that were not dated or labeled. The unit manager of the A wing was asked who the containers belonged to and it was stated that it was probably staff members food. In addition, the refrigerator was found to have sticky stains on the shelf and dirt. Staff did not store resident's food in the refrigerator under sanitary conditions. 46. On 1/5/04 during the initial tour at 10:08a.m., the surveyor observed an ice chest behind the nurses’ station (200- MSU hall), with the lid partly closed. The surveyor walked over and opened the lid to the ice chest, and observed an ice scoop lying inside on top of the ice. The surveyor left and got another surveyor to observed the scoop in the ice chest, and was again observed by another surveyor. The two surveyors approached the Director of Nursing, regarding the scoop inside the ice chest. This was also observed by the Director of Nursing. 47. On the B-hall (100 hall) at 7:04 a.m. on 1/8/04, the surveyor observed an ice chest on a cart, pushed in the room where the copy machine is kept. The lid to the ice chest was partly closed, and the surveyor opened the lid, and observed a pink, plastic, water pitcher inside the ice chest. The pink pitcher was pushed halfway down into the ice. The surveyor left the ice chest, and went to get the supervisor. The supervisor was brought back to the ice chest, and was shown the pitcher on the inside. The ice-chest was removed by the supervisor. Correction date: February 08, 2004 48. During the revisit to re-certification survey conducted on 02/23/2004 and based upon observation and interview with staff, the facility did not store, distribute and serve food under sanitary conditions. 49. During the tour of the kitchen on 02/23/2004 at approximately 9:30 a.m. it was observed that in the dry storage/pantry that the lids for the thickening powder and the pudding bins were dirty with various color smudges and a build up of unidentifiable dried food products on the ridges of the lids. The lid to the thickening powder did not fit and the surveyor was later told by the Registered Dietitian that it was the wrong lid. The lid that was on the thickening powder bin had the powder scattered on the top. The thickening powder was also on the floor around the bin. Additionally, the bag holding the powder in the bin was not closed leaving it open to dirt and debris falling in the bin, which was not covered properly. 50. During the tour of the kitchen on 02/23/2004 at approximately 9:30 a.m. it was observed that the puree food processor lid was discolored; had deep scratches on the inside and was greasy. The kitchen staff was asked if the processor had been cleaned after breakfast and was told that it had. 51. During three different times in the kitchen, approximately 9:30 a.m., approximately 11:30 a.m. and 2:30 p-m., the large gray rubbish can lid was not on the can properly. It was lying partially off the can. Two different kitchen staffs were observed to put rubbish in-the can; using their bare hands lifting the lid and not replacing it correctly on the can. 52. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated Title 42 Section 483.35(h) (2), Code of Federal Regulations, as incorporated by 59A-4.1288, F.A.C., and Chapter 400.141(9), Florida Statutes herein classified as a widespread uncorrected Class III deficiency, pursuant to 400.23(8)(c), Fla. Stat., which carries an assessed fine of $3,000. COUNT V LAUREL POINTE HEALTH AND REHABILITATION FAILED TO DISPOSE OF GARBAGE AND REFUSE PROPERLY Title 42 Section 483.35(h) (3), Code of Federal Regulations, as incorporated by 59A-4.1288, F.A.C., and Chapter 400.141, Florida Statutes. (DIETARY SERVICES) UNCORRECTED CLASS III DEFICIENCY 53. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 54. During the Re-certification survey conducted on 01/05-08/2004 and based on the Kitchen/Food Service Observation Tour conducted on 01/05/04, the following were noted: (a) The facility dumpster was not equipped with a drain plug that would allow liquids to drain from the concrete pad to a drain that is connected to the public sewage system. (b) The ground area around the dumpster was littered with garbage, trash, and medical supply waste. {c) The lid of the dumpster was wide open and not closed during periods on non-use as required. Correction Date: 02/08/04. 20 55. During the revisit conducted on 02/23/2004 and based upon observation and interview with staff, the facility failed to dispose of garbage and refuse properly. 56. On 02/23/2004 at approximately 9:45 am the area outside of the kitchen was observed. The picnic area that is said to be used by staff had a large rubbish can over on its side. The lid was not on and garbage was out of the can and on the ground. The housekeeper floor tech saw that the surveyor and the Registered Dietitian were observing the garbage. He said that the can gets thrown over by kids that come through the area. He was asked since he is aware of this, why isn’t the can removed to another area or secured so it can’t be thrown over. He stated that he could do something. The director of housekeeping appeared and said that the garbage will now be secured. 57. During this same time, it was observed that a large garbage can filled with garbage directly outside of the kitchen did not have a lid on it. There was very strong, offensive garbage odor coming from the can and permeating into the air around the can. Again, the housekeeper floor tech was asked about the missing lid. He said guesses that he can go get one from the trailer. 58. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated Title 42, Section 483.35(h) (3), Code of Federal Regulations, incorporated by 59A-4.1288, FP.A.C., 21 and Section 400.141(8), Florida Statutes, herein classified as a widespread uncorrected Class III deficiency, pursuant to 400.23(8)(c), Fla. Stat., which carries an assessed fine of $3,000. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, requests the following relief: A. Make factual and legal findings in favor of the Agency on all counts. B. Assess an administrative fine totaling $10,000.00 against Laurel Pointe Health and Rehabilitation for the uncorrected Class III deficiencies in Counts I through V, in accordance with Sections 400.23(8)(c) Fla. Stat. Cc. Award the Agency for Health Care Administration costs related to the investigation and prosecution of the case, in accordance with Section 400.121(1), Fla. Stat., if costs are applicable, and D. Grant such other relief as this 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. 22 All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, attention: Lealand McCharen, Agency Clerk, 2727 Mahan drive, Mail Stop #3, Tallahassee, Florida 32308, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST FOR 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. Respecaful submitted, elson E. Rodney, Es Assistant General Coumsel Agency for Health Care Administration Florida Bar No. 178081 Spokane Building, Suite 103 8350 NW 52nd Terrace Miami, Florida 33166 (305) 499-2165 Copy to: 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 Assisted Living Facilities Program Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 23 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 Thomas L. McDaniel, Administrator, Laurel Pointe Health and Rehabilitation, 703 29™ Street, Fort Pierce, Florida 34947, Integrated Health Services at Central Florida, Inc., 910 Ridgebrook Road, Sparks Glencoe, MD 21152, and to National Corporate Research, LTD, Inc., 103 N. Meridian Street, Tallahassee, Florida 32301-0000 on Apes & , 2004 Neisorf E. Rodney 24

Docket for Case No: 04-001881