STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATIONO4 JUN [¢ PH 4: 9g #38 AGENCY FOR HEALTH CARE ULV iSiLy i ADMINISTRATION, ADMINISTRA: HEARINGS Petitioner, AHCA Case No. 2004002315 vs. BEAUCLERC MANOR HEALTH CARE ASSOCIATES, L.L.C. d/b/a BEAUCLERC op MANOR, by - HY Y Respondent. ADMINISTRATIVE COMPLAINT The AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “A gency”), by and through its undersigned counsel, hereby serves this ADMINISTRA- TIVE COMPLAINT against BEAUCLERC MANOR HEALTH CARE ASSOCIATES, L.L.C. d/b/a BEAUCLERC MANOR (“BEAUCLERC MANOR”), pursuant to Sections 120.569 and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTIONS 1. By and through this Administrative Complaint [AC], AHCA seeks to impose administrative fines upon BEAUCLERC MANOR totaling $6,000. JURISDICTION & VENUE 2. AHCA, and the Division of Administrative Hearings [DOAH], in the event Respondent requests a formal hearing, have jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2003). 3. Venue shall be determined pursuant to Rule 28-106.207, Fla. Admin. Code. PARTIES 4. AHCA is the regulatory agency responsible for licensure of skilled nursing facilities and enforcement of all applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to: (a) the federal Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended); (b) Chapter 400, Part II, Florida Statutes (2003); and (c) Chapter 59A-4, Florida Administrative Code: 5. BEAUCLERC MANOR HEALTH CARE ASSOCIATES, L.L.C. owns and operates a skilled nursing facility in the state of Florida. The facility, BEAUCLERC MANOR [the “Facility,” whenever reference is to the Facility as opposed to the owner/ licensee] is a 120-bed skilled nursing facility located at 9355 San Jose Boulevard, Jacksonville, Florida 32257. BEAUCLERC MANOR is licensed to operate the Facility, having been issued license #SNF1047096. The Facility was at all times material hereto a licensed facility under the licensing authority of AHCA, and was required to comply with all of the above-referenced applicable regulations, statutes and rules. SURVEY OF FEBRUARY 2004 6. On or about February 13, 2004, AHCA conducted a recertification survey at the Facility, evaluated the Facility’s compliance with applicable regulatory laws, and advised the Facility of its determinations as to then-existing deficiencies. 7. The cited deficiencies from the survey included, but were not limited to, two (2) state class III deficiencies. The cited deficiencies are those identified at the time of the survey under so-called “federal tags” F282 and F514. Specifically as to failure to establish and follow a plan of care for each of two residents [Tag F282] 8. By and through the February 2004 survey, AHCA staff observed certain facts, reviewed pertinent records, and interviewed Facility staff and residents, regarding and evidencing the failure to establish and then follow the plan of care for two residents: identified (and known to the Facility by this survey) as Residents #1 and #2. The failure of the facility and its staff to use appropriate professional judgment and to monitor and assure that the care of these residents was in accordance with their plans of care, created possible negative outcomes, as indicated by the following facts: A. Resident #2: 1) The clinical record for Resident #2, includes: a. the resident’s care plan, dated 5/8/03, which reflects both (1) a notation that on 3/13/03 and 4/8/03 the resident was found sitting on the floor at the end of the bed; and (2) a note for a care plan approach that would include a "bed alarm when in bed;” and b. aphysician’s order, dated 12/2/03, that calls for an alarm to be furnished for use by the resident in his/her bed or in a chair. 2) Upon the February 2004 survey, both on the initial tour of the facility on 2/10/04 and then again on 2/12/04, AHCA’s surveyor observed the resident in bed with two side rails up, and no alarm available for the resident’s use. B. Resident #1: 1) The surveyor’s record review of the resident’s care plan on 2/10/04 and 2/11/04 revealed: a. That the resident is care-planned both under potential for weight loss and with regard to self-care. b. That the plan includes the current physician’s order, dated 1/29/04, that specifically orders the resident to have a built up handle spoon and plate guard at all meals. c. That the goals for the Resident specifically include “to maintain ability to feed self thru next review scheduled for 5/4/04.” d. That under “approaches” the care plan states “setup for all meals” including specifically, assuring that the resident uses an adaptive spoon with a plate guard, and also notes that the resident “can feed self” but needs extensive assistance. 2) AHCA’s surveyor observed Resident #1 being fed by a certified nursing assistant during the lunch meal on 2/10/04, with no adaptive spoon with plate guard and with no attempt by the CNA to help the resident feed himself. 3) Upon interview with the certified nursing assistant who was feeding the resident on 2/11/04, AHCA’s surveyor was told by the CNA that the resident “has been fed by staff for at least a year.” 4) During an interview with the occupational therapist on 2/12/04, the therapist stated that he was unaware that Resident #1 was being fed by staff and that he/she was not using the eating equipment ordered by the physician. 5) On 2/12/04 the surveyor observed Resident #1 at breakfast. He/she had three small bowls and attempted to feed himself/herself with a regular straight spoon. After several attempts to get food into his/her mouth, he/she started using his/her hands to feed himself/herself. 9. AHCA provided to Respondent, with the survey report, a mandatory ' correction date of March 15, 2004, within which to correct this deficiency regarding establishing and following a care plan for each resident. Specifically as to required maintenance of clinical records for 10 of 24 Residents [Tag F514 10. Byand through the February 2004 survey, AHCA staff observed certain facts, reviewed pertinent records, and interviewed Facility staff and residents, regarding and evidencing the failure of the Facility to maintain clinical records as required by law as to each resident, in accordance with accepted professional standards and practices, that are complete, accurately documented, readily accessible, and systematically organized, as indicated by the following facts: A. The record review for Resident #12 on 2/11/04 revealed numerous blank areas on the activities of daily living (ADL) sheets not signed by staff. The facility failed to accurately document the resident’s status on the ADL sheets, presenting a less than accurate picture of the resident’s day to day medical status, care and possible needs regarding his/her care. B. Resident #14 receives Depakote 500mg every 8 hours and is monitored for yelling out. Review of the facility documentation revealed no monitoring of this resident on the 7-3 shift for seven days in February. No monitoring was noted on the 3-11 shift for 2/2/04, nor on the 11-7 shift for 2/1, 2/2, and 2/3/04. C. Review of the Monthly Behavior Monitoring Flow sheet for Resident #21, for the five months of September 2003 to January 2004, did not record the resident’s behavior as to targeted behavior that had been documented as having occurred in the past and which required documented monitoring in order to properly reassess and care for this resident. D. Review of the individual clinical records of eight (8) other residents (Residents #'s 3, 4, 7, 8, 9, 13, 20 & 21) revealed as to each that ADL & Behavior Flow Sheets were incompletely documented in the recent past before the survey. E. - Similarly, the Controlled Narcotic Sheet on the Facility’s east wing medication cart, affecting a number of residents, was noted to have five (5) blank spaces for the licensed nurse’s signature. F. Similarly, the Facility’s Incident/Accident Analyst Reports were incomplete. 11. AHCA provided to Respondent, with the survey report, a mandatory correction date of March 15, 2004, within which to correct this deficiency for failure to document and maintain clinical records as required by law. SURVEY OF MARCH 2004 12. On or about March 22, 2004, AHCA conducted a revisit survey at the Facility, evaluated the Facility’s compliance with applicable regulatory laws and advised the Facility of its determinations as to then-existing deficiencies. 13. The cited deficiencies from the survey included, but were not limited to, two (2) state class II deficiencies, identified at the time of the survey under the same “federal tags” F282 and F514 that were the previously referenced and cited as deficiencies from the February 13, 2004 survey. Specifically as to failure to establish and follow a plan of care for each of two residents [Tag F282] 14. By and through the March 2004 survey, AHCA staff observed certain facts, reviewed pertinent records, and interviewed Facility staff and residents, regarding and evidencing the failure of the Facility to establish and then follow the plan of care for two residents: identified (and known to the Facility by this survey) as Residents #2 and #9, The failure of the Facility and its staff in this regard, is indicated by the following facts: A. Resident #2: 1. As previously noted more specifically in paragraph 8.A.1), the care plan for this resident (same resident as the Resident #2 in the February survey), dated 5/8/03, and the physician’s order of 12/02/03, called for the Facility to provide an alarm, for use by this resident whether in bed or in a chair, to request attention from or assistance by the staff. 2. AHCA’s surveyor observed the resident on the revisit survey of 3/22/04, in the dining room, sitting at his/her table in a wheelchair with no chair alarm. B. Resident #9: 1. AHCA’s surveyor reviewed Resident #9’s clinical records, including in particular the care plan for the resident dated 02/27/04 and certain nurses’ notes and skin condition reports, and observed that: a. the resident was at risk for developing skin problems; b. .the Weekly Skin Sweep of 02/24/04 noted as to the resident’s skin condition, only a bruise on the resident’s right leg; c. the care plan of 02/27/04 revealed a Stage IV (very serious) pressure area on the right great toe (pointedly, not documented or noted on the 02/24/04 Weekly Skin Sweep); d. the resident’s care plan thereupon required turning and repositioning the resident every two hours; e. nurse’s notes of 02/24/04 stated that the resident had an open area on the sacrum (also not documented or noted on the 02/24/04 Weekly Skin Sweep); f. nurse’s notes on 02/28/04 state that the “cyst to sacrum open, noted bloody drainage with pus;” g. the Weekly Skin Sweep of 03/04/04 noted the resident as having an open area on the sacrum; h. review of the treatment book indicates that “HCD to cyst area to sacrum” did not begin until 03/11/04; i. review of the entire clinical record reveals that as of the review date (03/22/04), there was nothing in the plan of care to address the cyst area to the sacrum, first noted as being “open” etc. on 02/24/04, nearly a month earlier. 2. An interview with the Wound Care Nurse on 3/22/04 revealed: a. She first had noted the wound on the great toe as being "unstageable” due to a covering of eschar. b. The facility's policy is to treat stage IV pressure sores aggressively, which is the reason for the care plan addressing the Stage [TV wound. c. The care plan approach was to "turn every 2 hrs. while in bed" (but not other specific treatment as well?). d. AHCA’s surveyor personally observed this resident in bed on 3/22/04 at four different times on that day: at 9:47 a.m., at 11:45 a.m., at 12:55 PM and at 1:20 PM. AHCA’s surveyor observed that the resident remained in the same position in bed on his/her back with head and shoulders elevated to ‘almost 90 degrees at each of the four times observed.. e. A review of the Resident #9"s activities of daily living (ADL) sheets and Nutrition/Hydration Care Record for February 2004 for Bed Mobility on the 7-3 and 3-11 shifts revealed that the caregivers failed numerous times from 02/20/04 to 02/27/04 to note whether the resident had been "turned/repositioned/moved in bed". Specifically as to required maintenance of clinical records for 4 of 15 Residents [Tag F514 15. By and through the March 2004 survey, AHCA staff observed certain facts, reviewed pertinent records, and interviewed Facility staff and residents, regarding and evidencing the failure of the Facility to maintain clinical records as required by law as to each resident, in accordance with accepted professional standards and practices, that are complete, accurately documented, readily accessible, and systematically organized, as indicated by the following facts: A. Resident #2: 1, Review of the activities of daily living (ADL) sheets and Nutrition/Hydration Care Record for the period following 2/13/04 through 3/21/04 revealed 96 blanks for February 2004 and 53 blanks for March 2004. The care plan for the resident stated that resident’s food intake under 75% two days in a row were to be reported to the registered dietician. However, on 3/13/04 the resident’s food intake was at 50% and the next day documentation is blank. The intake for 3/15/04 was 50% and it is unknown what the pattern is during that period with the lack of documentation on 3/14/04. Review of the February 2004 medication administration record (MAR) revealed missing documentation for accuchecks and sliding scale insulin administration on 2/29/04 for 11:30 a.m., 4:30 p.m., and 9:00 p.m. Documentation was not completed for administration of four medications, Detrol at 5 p.m. and Lisinopril at 9 p.m. on 2/29/04, Glyburide at 5 p.m., and Vitamin B12 on 7-3 shift (this medication was ordered one time per month) . Diabetic Resource supplement, ordered with meals, was not documented as being given on 2/29/04. Review of the treatment record for February 2004 revealed no documentation for skin barrier cream application on the 7-3 shift on 2/26/04 and the 11-7 shift on 2/25/04. Resident #9: l. The care plan dated 2/27/04 revealed a Stage IV pressure area on the right great toe despite the documentation on the Weekly Skin Sweep of 2/24/04 that notes only a bruise on the right leg. The care plan approaches were to "turn every 2 hrs while in bed". The resident was noted on the Weekly Skin Sweep of 3/4/04 as having an open area on the sacrum. Review of the Resident #9"s activities of daily living (ADL) sheets and Nutrition/Hydration Care Record for February 2004 for Bed Mobility on 7-3 shift revealed that the care giver had failed to note whether the resident had been turned/repositioned/moved in bed" from 2/20-26/04. 5. The 3-11 caregiver failed to document that the resident had been moved from 2/21-23/04 and 2/25-27/04. Cc. Resident #14: l. Documented as being dependent for all care and feeding with diagnoses of Alzheimer's Disease, anorexia, anxiety, and sacral wound. 2. The facility had initiated a care plan for nutrition and identified the resident as having the potential for weight loss due to swallowing problems; however, review of facility’s ADL & Nutrition/Hydration Care Record for February 15-29 and March 1-21, 2004 revealed incomplete documentation for meal consumption for a total of 45 meals as, follows: Breakfast: February 17, 19-29, 2004; March 14-20, 2004 Lunch: February 17, 19-29, 2004; March 14-20, 2004 Dinner: February 26, 2004; March 15, 2004 3. The resident has had a consistent decline in weight totaling 15 Ibs. from 10/28/03 - 114 Ibs. to current weight on 3/17/04 - 99 Ibs. which was not addressed until the date of the revisit on 3/22/04. D. Resident #11: 1.. Documentation reveals that resident receives three medications to promote bowel function and regularity with physician orders to administer two other medications if there are no results. 2. Review of the facility ADL & Nutrition/Hydration Care Record for February and March 2004, which includes toileting/bowel movements, revealed blanks which did not give the attending licensed nurse clear and needed information on the resident's toileting results. COUNT I Fine for Uncorrected Class III Deficiency Related to Establishing and Following a Plan of Care for Each Resident 42 CFR § 483.20, Code of Federal Regulations Rule 59A-4.109(2), Florida Administrative Code §400.022(1)(), Florida Statutes (2003) 16. | AHCA re-alleges and incorporates by reference paragraphs 1 — 15 above as if fully set forth herein. 17. The regulatory provisions of the Code of Federal Regulations [CFR] that are specifically pertinent here, which regulations are applied in Florida pursuant to Rule 59A-4.1288, Florida Administrative Code, include but are not limited to, the following: §483.20 Resident assessment. The facility must conduct initially and periodically a comprehensive, accurate, standardized. reproducible assessment of each resident's functional capacity. (a) Admission orders. At the time each resident is admitted, the facility must have physician orders for the resident's immediate care. (b) Comprehensive assessments. (1) Resident assessment instrument. A facility must make a comprehensive assessment of a resident's needs, using the resident assessment instrument (RAJ) specified by the State. The assessment must include at least the following: x * * (viii) Physical functioning and structural problems. * Ok Ok (x) Disease diagnoses and health conditions. xk OK (xii) Skin condition. ‘ * ke Ok (xvi) Documentation of summary information regarding the additional assessment performed through the resident assessment protocols. * ek OK The assessment process must include direct observation and communication with the resident, as well as communication with licensed and nonlicensed direct care staff members on all shifts. * Ok OK (k) Comprehensive care plans. (1) The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The care plan must describe the following — (i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well- being as required under Sec. 483.25; and * * * (3) The services provided or arranged by the facility must-- (i) Meet professional standards of quality; and (ii) Be provided by qualified persons in accordance with each resident's written plan of care. * * * [Emphasis added.] 18. The regulatory provisions of the Florida Administrative Code that are specifically pertinent here, include but are not limited to, the following: Rule 59A-4.109 Resident Assessment and Care Plan. (2) The facility is responsible to develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The care plan must describe the services that are to be furnished to attain or maintain the resident’ s highest practicable physical, mental and social well-being. * * * [Emphasis added.] ' 19. With enactment of §400.022, Florida Statutes, the Legislature required all Florida skilled nursing facilities to adopt a statement of the ri ghts, and responsibilities, of residents of such facilities and to “assure each resident” as to a number of “Residents’ rights.” The right of residents, as declared in the statute, that is pertinent here reads: §400.022 Residents' rights.-- (1) All licensees of nursing home facilities shall adopt and make public a statement of the rights and responsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement shall assure each resident the following: (1) The right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency. [Emphasis added. 1] 20. The Facility breached its duty and legal obligation under these referenced provisions of law to assess each of its residents’ health care needs, establish a plan of care for each resident, and provide to each resident the adequate and appropriate health care and protective and support services to which each resident is entitled, consistent with each resident’s care plan and with rules adopted by the agency, including in particular referenced Rule 59A-4.109, F.A.C.. 21. The Facility failed to correct the deficiency cited in the first referenced survey (the February 2004 Survey) within the time required, as evidenced by the facts revealed upon the second referenced survey (the March 2004 Survey). 22. The Facility’s said breach and failure to meet its obligations under the law, as alleged herein, is a violation of the referenced regulatory provisions of 42 CFR §483.20, _ Rule S9A-4.109(2), Florida Administrative Code (2003), and §400.022(1)(1), Florida Statutes (2003). Classification of the Nature and Scope of the Violation 23. AHCA is required by §400.23(8), Florida Statutes (2003) to classify each deficiency in terms of its “nature” and “scope.” Because of the nature of the violation here as it relates to the above-referenced residents, and the circumstances surrounding these cited deficiencies, AHCA has classified the nature of this uncorrected violation as a class III, the least serious classification for which a statutory fine may be imposed against a Florida skilled nursing facility. 24. A class III violation is defined by §400.23(8)(c), Florida Statutes (2003), as “those conditions that the agency determines will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident's ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services.” 25. | AHCA classifies the scope of the violation here as isolated, the least serious of the three statutory categories of scope which the statute specifies for purposes of determining the amount of the fine for any particular violation. Amount of Administrative Fine Here 26. AHCA previously cited this Facility for three (3) class II deficiencies, as the result of the annual inspection of the Facility conducted February 10-13, 2004. The Facility has requested a formal hearing concerning these alleged deficiencies (with no DOAH Case Number available as of the date of this Administrative Complaint, in AHCA Case Numbers 2004002164 and 2004002316). 27. Section 400.23(8)(c), Florida Statutes (2003), provides that a class III deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The statute also states that the “fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class [I deficiencies during the last annual inspection or any inspection...” {Emphasis added. ] 28. Under §400.23(8), Florida Statutes (2003), the classification of the nature of these violations as class II and of the scope of the violations as isolated, generally constitutes grounds for the imposition of an administrative fine of $1,000. However, the referenced “doubling” provision of by §400.23(8) requires a $2,000 fine as to this violation, in the event that AHCA’s position is upheld as to the above-referenced 13 citations in the pending DOAH proceeding (or $1,000 in the event the Facility prevails in that proceeding). COUNT HE Fine for Class III Deficiency Related to Failure to Provide Required Maintenance of Clinical Records on Each Resident [42 CFR § 483.75(1)(1) and §400.141(10) & (12), Florida Statutes] 29. AHCA re-alleges and incorporates by reference paragraphs | ~ 15 above, as if fully set forth herein. 30. The regulatory provisions of the Code of Federal Regulations [CFR] that are specifically pertinent here, which regulations are applied in Florida pursuant to Rule 59A-4.1288, Florida Administrative Code, include but are not limited to, the following: [42 CFR} §483.75 Administration. A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. x OK OK (1) Clinical records. (1) The facility must maintain clinical records on each resident in accordance with accepted professional standards and practices that are-- (i) Complete; (ii) Accurately documented; (iii) Readily accessible; and (iv) Systematically organized. * oe * (5) The clinical record must contain-- (i) Sufficient information to identify the resident; (ii) A record of the resident's assessments; (iii) The plan of care and services provided; (iv) The results of any preadmission screening conducted by the State; and (v) Progress notes. 14 31. The regulatory provisions of the Florida Statutes that are specifically pertinent here include, but are not limited to, the following: 32. §400.141 Administration and management of nursing home facilities. Every licensed facility shall comply with all applicable standards and rules of the agency and shall: * * * (10) Keep full records of resident admissions and discharges; medical and general health status, including medical records, personal and social history, and identity and address of next of kin or other persons who may have responsibility for the affairs of the residents; and individual resident care plans including, but not limited to, prescribed services, service frequency and duration, and service goals. The records shall be open to inspection by the agency. * * * ' (21) Maintain in the medical record for each resident a daily chart of certified nursing assistant services provided to the resident. The certified nursing assistant who is caring for the resident must complete this record by the end of his or her shift. This record must indicate assistance with activities of daily living, assistance with eating, and assistance with drinking, and must record each offering of nutrition and hydration for those residents whose plan of care or assessment indicates a risk for malnutrition or dehydration. As alleged herein, the Facility breached its duty and legal obligation under these referenced regulations to maintain complete, accurately documented, readily accessible, and systematically organized clinical records on each resident in accordance with these regulatory laws and with accepted professional standards and practices. 33. The Facility’s said breach and failure is a violation of the referenced regulatory provisions of 42 CFR §483.75(1)(1) and §400.141(10) and (12), Florida Statutes (2003). Classification of the Nature and Scope of the Violation 34. AHCA is required by state law, pursuant to §400.23(8), Florida Statutes (2003), to classify each deficiency, once it is determined to exist, “according to the nature and scope of the deficiency.” That is, if a violation exists, then the classification of that violation must be established both in terms (a) of the nature and (b) of the scope of that violation. 35. As aresult of Respondent’s failure to maintain complete, accurately documented, readily accessible, and systematically organized clinical records on each resident in accordance with the referenced regulatory laws and with accepted professional standards and practices, as alleged above, AHCA classified the nature of this violation as a class III, the least serious of the statutory “classes” of the nature of violations for which a statutory fine may be imposed. 36. A class III violation is defined by §400.23(8)(c), Florida Statutes (2003), as “those conditions that the agency determines will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident's ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services.” 37. | AHCA classified the scope of the uncorrected deficiency here, as patterned. This is a “patterned” violation because, while the deficiency was not found by AHCA to be pervasive, the referenced failures affect more than a limited number both of residents and of Facility staff. Amount of Administrative Fine 38. Section 400.23(8), Florida Statutes (2003), provides that a class III deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The statute also states that 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...” [Emphasis added.] The Facility was previously cited for such deficiencies.. 39. Under §400.23(8), Florida Statutes (2003), the classification of the nature of the violation as class III and of the scope of the violation as patterned, generally constitutes grounds for the imposition of an administrative fine of $2,000. However, the referenced “doubling” provision of by §400.23(8) requires a $4,000 fine as to this violation, in the event AHCA’s position is upheld in the pending challenge as to the previously cited deficiencies (and $2,000 in the event the Facility were to prevail in such proceeding). CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests that the Administrative Law Judge enter a Recommended Order, as follows, that: | 1. The evidence shows by clear and convincing evidence that the Facility violated the referenced regulatory provisions set forth respectively in each of the two counts: Count I and Count II. 2. The lawful classification of the “nature” of each of these proven violations (which proof may be by a preponderance of the evidence) is: 17 as to the proven Count I violation — class III as to the proven Count II violation — class III 3. The lawful classification of the “scope” of each of these proven violations (which proof may be by a preponderance of the evidence) is “isolated” as to Count I and “patterned” as to Count II. 4. Based upon such determinations, the Agency should impose upon the Facility administrative fines in the amount of $2,000 as to Count I and $4,000 as to Count I, for a total of $6,000 in administrative fines. These fine amounts represent a doubling of the standard fines pursuant to §400.23(8), Florida Statutes (2003), which doubling shall be imposed here in this case only upon and subsequent to the separate determination by final order in a pending proceeding for formal hearing regarding the existence of such citations requisite to such doubling. Respectfully submitted this Z ax day of May 2004. Tom R. Moore, Senior Attorney Fla. Bar No. 0097383 Agency for Health Care Administration Building 43, MSC #3 2727 Mahan Drive Tallahassee, FL 32308 (850) 922-5873 (office) (850) 413-9313 (fax) NOTICE The Facility 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 review of the fines sought herein are set out in the attached Election of 18 Rights form and explained in the attached Explanation of Rights form. These forms are ‘not sufficient for a request for a formal hearing. All requests for hearing shall be made to the Agency for Health Care Administration; and delivered to Mr. Lealand McCharen, Agency Clerk, Agency for Health Care Administration, Building #3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308. THE FACILITY IS FURTHER NOTIFIED THAT THE AGENCY MUST RECEIVE A REQUEST FOR HEARING WITHIN 21 DAYS OF RECEIPT OF THIS PLEADING BY THE FACILITY. FAILURE TO COMPLY WILL CONSTITUTE AN ADMISSION OF THE FACTS ALLEGED HEREIN AND RESULT IN ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE ' AHCA, by and through its undersigned counsel, hereby certifies that a true and correct copy of the foregoing Administrative Complaint, a form for an Election of Rights for Administrative Hearing, and a form that is an Explanation of Rights Under Section 120.569, F.S.A., have been furnished by certified mail, return receipt requested, to BEAUCLERC MANOR, 9255 San Jose Blvd., Jacksonville, Florida 32257; and to the Registered Agent, CT Corporation System, 1200 South Pine Island Road, Plantation, FL 33324, on this, the aw? day of May 2004. A courtesy copy of the Administrative Complaint concurrently has been furnished to Donna Stinson, of Broad & Cassell, Counsel for Beauclerc Manor in another case, by fax (850-521-1449). ‘None oon TOM R. MOORE AHCA Senior Attorney 19

Docket for Case No: 04-002144