” — — CERTIFIEO MAIL 7002 2030 0006 4359 5620 AND 7001 0360 0003 3804 3370 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2004006661 Vv. JAMES ELBERT HALL, OWNER/OPERATOR d/b/a HOLMES CREEK ALF, Respondent. ( L 4 | (oO COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administlative Complaint against JAMES ELBERT HALL, OWNER/OPERATOR d/b/a HOLMES GREEK ALF, hereinafter referred to as “Respondent,” pursuant to Sections 120.569, and 120\57, Florida Statutes (2004), and alleges: NATURE OF THE ACTION 1. This is an action to impose revocation of licensure pursuant Sections 400.414(1)(a) and (e)1., Florida Statutes (2004), or an administrative fine|in the amount of five thousand dollars ($5,000); and a complaint survey fee in the amount of two hundred thirty-five dollars ($235) for a total ammount of five thousand two hundred and thirty-five dollars ($5,235) against the Respondent, pursuant to Sections 400.419(1) and (2)(a) andi(10), Florida Statutes (2004). - t.ho A Eyrivet APY Page 1 of $ AHCA Number 2004006661 7 4 loermnen MAIL 7002 2030 0006 4359 5620 i AND 7001 0360 0003 3804 3370 2. The Respondent was cited for deficiencies duringla complaint survey conducted on | or about July 9, 2004. An Emergency Order of Moratorium wds entered on July 14, 2004, based ! upon these findings, pursuant to Section 400.415, Florida Statutes (2004). JURISDICTION AND VENUE 3. The Agency (AHCA) has jurisdiction over the Respondent pursuant to Sections | 120.569 and 120.57, Florida Statutes (2004). | i 4. Venue shall be determined pursuant to Chapter 24-106.207, Florida Administrative Cade (2004). | PARTIES 5. Pursuant to Chapter 400, Part Il, Florida Statites (2004), and Chapter 584-5, Florida Administrative Code (2004), AHCA is the licensing arid enforcing authority with regard to assisted living facility laws and rules. 6. Respondent, James Elbert Hall, Owner/Operdtor d/b/a Holmes Creek ALF (hereinafter “Respondent”), is licensed by the Agency to opdrate a fourteen-bed (14) assisted living facility located at 3732 Roache Avenue, Vernon, Fldrida 32462, having been issued license number 5584. 7. The Respondent is and was at all times matenal|hereto, a licensed assisted living facility governed by Chapter 400, Part III (Sections 400.401 through 400.454), Florida Statutes (2004), and Chapter 584-5, Florida Administrative Code (2004). | | | Page 2 of 9 AHCA Number 2004006661 — {CERTIFIED MAIL 7002 2030 0006 4359 5620 i AND 7001 0360 0003 3804 3370 | i COUNT I FAILURE TO COMPLY WITH THE RESIDENT CARE STANDARDS ENUMERATED IN THE RESIDENT BILL OF RIGHTS - RESPONDENT FAILED TO PROHIBIT THE/MISTREATMENT AND/OR NEGLECT OF RESIDENTS IN }TS FACILITY. Subsection 400.428(1)(a), 400.419(1) aied (2), F.S. CLASS I DEFICIENCY |! | t 8. AHCA re-alleges and incorporates by reference phragraphs (1) through (7) above as if fully set forth herein. 9. The statutory provision applicable to this alleged violation reads as follows: Subsection 400.428, Florida Statutes (2004), Resident bill of rights.-— (1) No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident shall have the right to: (a) Live ina safe and decent living environment, free from abuse and neglect. (b) Be treated with consideration and respect and with due recognition of personal individuality, and need for privacy. | 10. Based on a complaint investigation conducted oniJuly 9, 2004, the facility failed to | ensure that two out of the four sampled residents (residents #11 & #2) were free from verbal and physical abuse from facility agents, other residents, or other third parties. The findings include the following: a. On July 9, 2003, an AHCA surveyor observed that Resident #] had a bruised area approximately 4x8 cm. in the right axilla area, and an abraised area of the skin approximately 1 cm on the left elbow. During an interview with resident #1 on the same date, he/she stated that the owner of the facility caused the injuries on July 8, 2004.! Resident #1 also stated that the owner of the facility “jerked him/her up by his/her hair and under his/her arm and then, pushed him/her to the ground.” Later that day, the resident reported the incident to the case manager at Page 3 of 9 i AHCA Number 2004006661 | — —" CERTIFIED MAIL 7002 2030 0006 4359 5620 AND 7001 0360 0003 3804 3370 the off-facility day treatment center. State Adult Protective $ervices was also notified of this abusive situation. b. An interview with Resident #2, who accompanied resident #1 to the off-facility day treatment on that date, also confirmed the allegations. Resideht #2 also stated the owner of the facility had verbally threatened him/her with a shotgun. Resident #2 stated the owner said to him/her, “I'll shoot you dead.” Jt was not clear when this event transpired. c. Interviews conducted on July 9, 2003 with Residents #3, and #4 corroborated Resident #1’s allegations. Both residents were interviewed separately and described the owner pulling Resident #1 up by the hair on the top of his/her head) and under the arm, and pushing him/her to the ground. d. Interview with the case manager at the off-facilifty day treatment center on July 9, 2004, revealed that Resident #1 was very upset when he/she arrived at the center. Resident #1 was (the owner) beat the hell out of me.” The case manager stated crying and stated, “Mr. Resident #1 showed her the injuries. e. The case manager stated both Resident #1 and H2 requested not to return to the . facility due to their fear. Surrounding facilities were contactkd for alternate placement and a facility in Marianna agreed to admit both Residents No. ] and a 2. f. According to the case manager, the owner of thé facility called and was verbally abusive to the case manager, threatening to not allow any residents at the facility to return to the day treatment center. g. Based upon further investigations by the surveyork, it was also determined that both Resident #1 and Resident #2 have mental health deficits and tlequire particular compassion. In fact, all residents appear to have some degree of mental im deficits requiring similar treatment. Page 4 of 9 AHCA Number 2004006661 —" CERTIFIED MAIL 7002 2030 0006 4359 5620 AND 7001 0360 0003 3804 3370 ‘hb. The Owner/Administrator admitted that the fatts involving the incident with Resident No. 1 occurred, but denied the characterization of this fincident as physical abuse. . 11. Based upon the foregoing, the Respondent failed to ensure the safety and well- being of its residents, in violation of Sections 400.414 and 400.428, Florida Statutes (2004). Based upon the above findings, which allege an intention! hl or negligent act by a facility employee that seriously affects the health, safety, or welfare of a resident, Section 400.414(1)(a), Florida Statutes (2004), supplies grounds fo administrative fine against the Respondent. COUNT JI STATUTORILY AUTHORIZED REVOCATIO LICENSE AS A RESULT OF THE FACILI CITED WITH ONE (1) CLASS I DE. Sections 400.414(1)(a) and(1)(e), Florida ¢ agency action to assess an OF RESPONDENT’S HAVING BEEN CIENCY tatutes (2004) 12. AHCA re-alleges and incorporates by reference paragraphs (1) through (11) above as if fully set forth herein. 13. Based upon the above findings, which allege an injtentional or negligent act by a facility employee that seriously affects the health, safety, or welfare of a vesident, Section 400.414(1)(a), Florida Statutes (2004), supplies grounds for ag| ency action to revoke or fine the Facility’s license. Section 400.419, Florida Statutes (2004), which defines violation classifications and Section 400.414(1), Florida Statutes (2004), AHCA to revoke the license of any assisted living facility that i deficiencies or groups of deficiencies: 1, One or more cited class J deficiencies. 2. Three or more cited class JJ deficiencies. Page 5 of 9 AHCA Number 2004006661 oan further grounds for cited for one of the following ~~ ow CERTIFIED MAIL 7002 2030 0006 4359 5620 AND 7001 0360 0003 3804 3370 _ 3. Five or more cited class [[ deficiencies that have beew cited on a single survey and have not been corrected within the times specified. As noted above, Respondent was cited in the complaint survey on or about July 9, 2004, with one (1) Class I deficiency. 14. Based on the foregoing actions by a facility empldyee that impact the health, safety, or welfare of a resident, this class J violation warrants the revocation of the Facility’s license by AHCA as authorized by Section 400.414(1)(a) and (1)(e)I, Florida Statutes (2004). CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1. Factual and legal findings in favor of the Agency on Cougts J and I; 2. Imposition of the administrative fine in the total amount df $5,000.00 for Count J; 3. Imposition of a complaint survey fee in the amount of $235.00 pursuant to Section 400.419(10), F.S.; or 4. Revocation of the Facility’s license. DISPLAY OF NOTIFICATION OF REVOCATION Pursuant to Section 400.414(7), Florida Statutes (2004), upon the issue of any final order imposing revocation, the Respondent shall post the notification of license revocation at the facility in a location visible to the public. NOTICE Respondent is hereby notified that it has a right to request an administrative hearng pursuant to Sections 120.569 and 120.57, Flonda Statutes (2004). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. (These forms are the|Jast two numbered pages of this Page 6 of 9 AHCA Number 2004006661 ~ — CERTIFIED MAIL 7002 2080 0006 4359 5620 AND 7001 0360 0003 3804 3370 document set.) All requests for a hearing shall be sent to: Apency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Step #3, Tallahassee, FL, 32308. RESPONDENT IS FURTHER NOTIFIED THAT IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT BY RESPONDENT, A FINAL ORDER WILL BE RENDERED BY THE AGENCY FINDING THE DEFICIENCY AND/OR VIOLATION CHARGED AND IMPOSING THE PENALTY SOUGHT IN THE ADMINISTRATIVE COMPLAINT. Respectfully submitted on this ZI day of ilg Requested to: JAMES ELBERT HALL HOLMES CREEK ALF 3732 ROACHE AVE VERNON FL 32462 Certified Article # (checked box below) I 7002 2030 0006 4359 5620 ©7001 0360 0003 3804 3370 on this 29 day of ~ / TE, 2004. Page 7 of 9 AHCA Number 2004006661

Docket for Case No: 04-003160