Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: TLC HOME, INC., D/B/A TLC, III
Judges: MICHAEL M. PARRISH
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: Sep. 23, 2004
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Monday, December 6, 2004.
Latest Update: Dec. 24, 2024
STATE OF FLORIDA 0% 2
AGENCY FOR HEALTH CARE ADMINISTRATION SEp 23 p
MG:
} .
AGENCY FOR HEALTH CARE AnH) VIS iOn « 2)
ADMINISTRATION, He MIST A va
CAP Noe
Petitioner, AHCA No.: 2004004334
Return Receipt Requested:
7002 2410 0001 4237 5954
7002 2410 0001 4237 7484
ve.
T.L.C. HOME, INC. d/b/a TLC III,
Respondent. y- OY - AY (cH
ADMINISTRATIVE COMPLAINT
COMES NOW the Agency for Health Care Administration
(“AHCA”), by and through the undersigned counsel, and files this
administrative complaint against T.L.C. Home, Inc. d/b/a TLC III
(hereinafter “TLC III”), pursuant to Chapter 400, Part III, and
Section 120.60, Florida Statutes, (2003), and alleges:
NATURE OF THE ACTION
1. This is an action to impose an administrative fine of
$6,307.00 [$6,000.00 + $307.00] pursuant to Sections 400.414 and
400.419, Florida Statutes for the protection of the public
health, safety and welfare.
JURISDICTION AND VENUE
2. This Court has jurisdiction pursuant to Sections
120.569 and 120.57 Florida Statutes, Chapter 28-106, Florida
Administrative Code.
3. Venue lies in Dade County pursuant to Section 120.57
Florida Statutes, Rule 28-106.207, Florida Administrative Code.
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 (2003) and Chapter 58A-5 Florida
Administrative Code.
5. TLC III operates a 6-bed assisted living facility
located at 8395 S. W. 112 Street, Miami, Florida 33156. TLC III
is licensed as an assisted living facility under license number
9762. TLC III 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
TLC III FAILED TO MAINTAIN RECORDS ON SITE.
RULE 58A-5.024(4) (a), FLORIDA ADMINISTRATIVE CODE
(FACILITY RECORDS STANDARDS)
CLASS III VIOLATION
6. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
7. TLC III was cited with twelve (12) Class III
deficiencies due to licensure surveys conducted on January 8,
2004 and March 10, 2004.
8. Based on a biennial licensure survey conducted on
January 8, 2004 and based on observation, interview and record
review, it was revealed that the facility did not have personnel
files available for surveyor inspection. The findings are as
follows.
9. A facility tour conducted on January 8, 2004, at 10:00
AM revealed that the facility did not have personnel files on
site available for surveyor inspection. Staff interview with the
caregivers confirmed that there were no personnel files
available for inspection.
10. Record review revealed that there were no records
available for review at the facility. Records had to be obtained
from another facility in order to be reviewed.
11. The mandated correction date was designated as February
8, 2004.
12. Based on a survey conducted on March 10, 2004 and
based on observation, interview, and record review, it was
revealed that the facility still failed to maintain personnel
records on site.
13. Based on the foregoing, TLC III violated Rule 58A-
5.024(4) (a), Florida Administrative Code, herein classified as
an uncorrected Class III violation, which warrants an assessed
fine of $500.00.
COUNT II
TLC III FAILED TO ENSURE THAT DURING TEMPORARY ABSENCE OF THE
ADMINISTRATOR, A STAFF MEMBER WAS DESIGNATED IN WRITING AS BEING
IN CHARGE.
RULE 58A-5.019(4) (a)5, FLORIDA ADMINISTRATIVE CODE
(STAFFING STANDARDS)
CLASS III VIOLATION
14. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
15. Based on a biennial licensure survey conducted on
January 8, 2004 and based on personnel and record review and
staff interview, it was revealed that the administrator did not
ensure that the facility had an employee trained and able to
take charge in case of the absence of the administrator or
manager.
16. The mandated correction date was designated as
February 8, 2004.
17. Based on a follow-up survey conducted on March 10,
2004 and based on personnel and record review, it was revealed
4
that the facility still did not ensure that during temporary
absence of the administrator, a staff member was designated in
writing as being in charge. This is an uncorrected deficiency
from the survey of January 8, 2004.
18. Based on the foregoing, TLC III violated Rule 58A-
5.019(4) (a)5, Florida Administrative Code, herein classified as
an uncorrected Class III violation, which warrants an assessed
fine of $500.00.
COUNT III
TLC III FAILED TO ENSURE THAT THE FACILITY HAS CURRENT CLEARANCE
FROM METRO FIRE DEPARTMENT.
SECTION 400.441(1) (a)1l.m, FLORIDA STATUTES
RULE 58A-5.015(1) (a)3, FLORIDA ADMINISTRATIVE CODE
(FACILITY RECORDS STANDARDS)
CLASS III VIOLATION
19. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
20. Based on a_ biennial licensure survey conducted on
January 8, 2004 and based on record review and interview, it was
revealed that the administrator failed to ensure that the
facility had a current clearance from the Metro Fire Department
for the year of 2003.
21. The mandated correction date was designated as March
10, 2004.
22. Based on a follow-up survey conducted on March 10,
2004 and based on interview and record review, it was revealed
that the facility still did not have a current clearance from
the Metro Dade Fire Department. Documentation revealed that the
facility failed fire inspections on March 12, 2004 and March 15,
2004. This is an uncorrected deficiency from the survey of
January 8, 2004.
23. Based on the foregoing, TLC III violated Section
400.441 (1) (a)l.m, Florida Statutes and Rule 58A-5.015(1) (a) 3,
Florida Administrative Code, herein classified as an uncorrected
Class III violation, which warrants an assessed fine of $500.00.
COUNT IV
TLC III FAILED TO ENSURE THAT AN ADMINISTRATOR, WHO SUPERVISED
MORE THAN ONE FACILITY, APPOINTED IN WRITING A SEPARATE MANAGER
FOR EACH FACILITY.
RULE 58A-5.019(1) (b), FLORIDA ADMINISTRATIVE CODE
(STAFFING STANDARDS )
CLASS III VIOLATION
24. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
25. Based on a _ biennial licensure survey conducted on
January 8, 2004 and based on file and record review and staff
interview, it was revealed that the administrator did not
appoint an employee at the facility as the manager.
26. The administrator did not ensure that the facility had
a manager appointed as required by law when the administrator
supervises 2 other facilities in the area.
27. The mandated correction date was designated an
February 8, 2004.
28. Based on a follow-up survey conducted on March 10,
2004 and based on file and record review and staff interview, it
was revealed that during the follow-up survey, the facility
still failed to ensure that the administrator, (who supervised
more than one facility) appointed in writing a separate manager
for each facility. This is an uncorrected deficiency from the
survey of January 8, 2004.
29. Based on the foregoing, TLC III violated Rule 58A-
5.019(1) (b), Florida Administrative Code, herein classified as
an uncorrected Class III violation, which warrants an assessed
fine of $500.00.
COUNT V
TLC III FAILED TO ENSURE THAT DIRECT CARE STAFF RECEIVED
INFECTION CONTROL TRAINING.
RULE 58A-5.0191(2) (a), FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.0191(10) (e), FLORIDA ADMINISTRATIVE CODE
(STAFFING STANDARDS)
CLASS III VIOLATION
30. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
7
31. Based on a biennial licensure survey conducted on
January 8, 2004 and based on record review and staff interview,
the administrator did not ensure that all members of the staff
were current with the required Infection Control training. Three
out of three employees were not current with their infection
control training.
32 The mandated correction date was designated as
February 8, 2004.
33. Based on a follow-up survey conducted on March 10,
2004 and based on observation, interview and record review, it
was revealed that the facility still failed to ensure that
direct care staff received infection control training. This is
an uncorrected deficiency from the survey of January 8, 2004.
34. Based on the foregoing, TLC III violated Rule 58A-
5.0191 (2) (a), Florida Administrative Code and Rule 58A-
5,0191(10) (e), Florida Administrative Code herein classified as
an uncorrected Class III violation, which warrants an assessed
fine of $500.00.
COUNT VI
TLC III FAILED TO ENSURE THAT THE EMERGENCY MANAGEMENT PLAN WAS
SUBMITTED TO THE OFFICE OF EMERGENCY MANAGEMENT.
SECTION 400.441(1) (b), FLORIDA STATUTES
RULE 58A-5.026(2) (a), FLORIDA ADMINISTRATIVE CODE
(EMERGENCY MANAGEMENT STANDARDS)
CLASS III VIOLATION
35. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
36. Based on a biennial licensure survey conducted on
January 8, 2004 and based on interview and record review, it was
revealed that the facility did not have a current emergency
management plan (within the last 365 days) approved by the
Emergency Management Division available for surveyor to review.
37. Staff interview with the administrator confirmed that
there was no approved plan available for inspection.
38. The mandated correction date was designated as
February 8, 2004.
39. Based on a follow-up survey conducted on March 10,
2004 and based on interview and record review, it was revealed
that the facility still failed to ensure that the emergency
management plan was submitted to the Office of Emergency
Management. This is an uncorrected deficiency from the survey of
January 8, 2004.
40. Based on the foregoing, TLC III violated Section
400.441(1) (b), Florida Statutes and Rule 58A-5.0126(2), Florida
Administrative Code and herein classified as an uncorrected
Class III violation, which warrants an assessed fine of $500.00.
COUNT VII
TLC III FAILED TO ENSURE THAT ALL EMPLOYEE RECORDS CONTAINED
VERIFICATION OF FREEDOM FROM COMMUNICABLE DISEASE.
SECTION 400.4275(4), FLORIDA STATUTES
RULE 58A-5.024(2) (a), FLORIDA ADMINISTRATIVE CODE
(STAFF RECORD STANDARDS)
CLASS III VIOLATION
41. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
42. Based on a licensure survey conducted on January 8,
2004 and based on record review and interview, it was revealed
that the administrator did not ensure the facility maintained
current personnel records containing verification of freedom
from communicable disease including tuberculosis in the
personnel files at the facility. The facts include the
following.
43. Record review and staff interview revealed that none
of the members of the staff were cleared from a doctor to work
at the facility.
44. The mandated correction date was designated as
February 8, 2004.
45. Based on a follow-up survey conducted on March 10,
2004 and based on observation, interview and record review, it
was revealed that the facility still failed to ensure that all
employee records contained verification of freedom from
10
communicable disease. This is an uncorrected deficiency from the
survey of January 8, 2004.
46. Based on the foregoing, TLC III violated Section
400.4275(4), Florida Statutes and Rule 58A-5.024(2) (a), Florida
Administrative Code herein classified as an uncorrected Class
III violation, which warrants an assessed fine of $500.00.
COUNT VIII
TLC III FAILED TO ENSURE THAT ALL EMPLOYEE RECORDS CONTAINED
VERIFICATION OF FREEDOM FROM TUBERCULOSIS.
RULE 58A-5.019(2), FLORIDA ADMINISTRATIVE CODE
(STAFF RECORD STANDARDS)
CLASS III VIOLATION
47. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
48. Based on a biennial licensure survey conducted on
January 8, 2004 and based on record review and interview, it was
revealed that the administrator did not ensure that the facility
maintain current personnel records containing verification of
freedom from communicable disease including tuberculosis in the
personnel files at the facility. The facts include the
following.
49. Facility tour conducted on January 8, 2004 at 10:00
a.m. revealed that no staff members were current with
tuberculosis (TB) screening to work at the facility.
11
50. Record review and staff interview revealed that the
administrator and employees were not cleared with a current TB
screening from a doctor to work at the facility. The mandated
correction date was designated as February 8, 2004.
51. Based on a follow-up survey conducted on March 10,
2004 and based on interview and record review, it was revealed
that the facility still failed to ensure that all employee
records contained verification of freedom from tuberculosis.
52. Based on the foregoing, TLC III violated Rule 58A-
5.019(2) (a), Florida Administrative Code, herein classified as
an uncorrected Class III violation, which warrants an assessed
fine of $500.00.
COUNT IX
TLC III FAILED TO ENSURE THAT ALL EMPLOYEES COMPLETED CONTINUING
EDUCATION COURSE ON HIV/AIDS BIENNIALLY.
SECTION 400.4275(2), FLORIDA STATUTES
RULE 58A-5.0191(3), FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.024(2) (a)1, FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.0191(10), FLORIDA ADMINISTRATIVE CODE
(STAFF RECORDS STANDARDS)
CLASS III VIOLATION
53. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
54, Based on a_ biennial licensure survey conducted on
January 8, 2004 and based on record review and staff interview,
12
it was revealed that the administrator did not ensure that all
members of the staff were current with their HIV training. Three
out of three employees were not current with their required HIV
training. The mandated correction date was designated as
February 8, 2004.
55. Based on a follow-up survey conducted on March 10,
2004 and based on record review and interview, it was revealed
that the facility still failed to ensure that all employees
completed continuing education course on HIV/AIDS biennially.
This is an uncorrected deficiency from the survey of January 8,
2004.
56. Based on the foregoing, TLC III violated Section
400.4275(2), Florida Statutes, Rule 58A-5.0191(3), Florida
Administrative Code, Rule 58A-5.024 (2) (a)1, Florida
Administrative Code, and Rule 58A-5.0191(10), Florida
Administrative Code , herein classified as an uncorrected Class
III violation, which warrants an assessed fine of $500.00.
COUNT X
TLC III FAILED TO ENSURE THAT STAFF THAT PREPARE OR SERVE FOOD
RECEIVED A MINIMUM OF ONE HOUR TRAINING IN SAFE FOOD HANDLING
PRACTICES.
RULE 58A-5.0191(2) (e), FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.020(1) (d), FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.024(2) (a)1, FLORIDA ADMINISTRATIVE CODE
(STAFF RECORDS STANDARDS)
13
CLASS III VIOLATION
57. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
58. Based on a biennial licensure survey conducted on
January 8, 2004 and based on record review and staff interview,
it was revealed that the administrator did not ensure that all
members of the staff, who prepare or serve food, were current
with the food services handling training. Three out of three
employees were not current with required food services handling
training.
59. The mandated corrected date was designated as February
8, 2004.
60. Based on a follow-up survey conducted on March 10,
2004 and based on observation, interview, and record review, it
was revealed that the facility still failed to ensure that
staff, who prepare or serve food, received a minimum of 1 hour
training in safe food handling practices. This is an uncorrected
deficiency from the survey of January 8, 2004.
61. Based on the foregoing, TLC fil violated Rule 58A-
5.0191(2) (e), Florida Administrative Code, Rule S5B8A-5.020(1) (d),
Florida Administrative Code, and Rule 58A-5.024(2) (a)l, Florida
Administrative Code, herein classified as an uncorrected Class
TII violation, which warrants an assessed fine of $500.00.
14
COUNT XI
TLC III FAILED TO ENSURE THAT THE PERSON DESIGNATED AS
SUPERVISING FOOD SERVICE OBTAINS ANNUALLY CONTINUING EDUCATION
IN NUTRITION AND FOOD SERVICES IN AN ALF.
SECTION 400.452(6), FLORIDA STATUTES
RULE 58A-5.0191(6), FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.020(1) (d), FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.024(2) (a)1, FLORIDA ADMINISTRATIVE CODE
(STAFF RECORDS STANDARDS)
CLASS III VIOLATION
62. AHCA’ re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
63. Based on a_ biennial licensure survey conducted on
January 8, 2004 and based on observation, interview, and record
review, it was revealed that the administrator did not have any
members of the staff currently trained in Nutritional In Service
available for surveyor inspection. The facts include the
following.
64. Staff interview with the administrator confirmed that
none of the employees had Nutritional In Service training
certificates available for inspection.
65. Record review revealed that the administrator was
currently trained at the facility.
66. The mandated correction date was designated as
February 8, 2004.
15
67. Based on a follow-up survey conducted on March 10,
2004 and based on observation, interview, and record review, it
was revealed that the facility still failed to ensure that the
person designated as supervising food service obtains annually
continuing education in nutrition and food service in an ALF.
This is an uncorrected deficiency from the survey of January 8,
2004.
68. Based on the foregoing, TLC II! violated Section
400.452(6), Florida Statutes, Rule 58A-5.0191(6), Florida
Administrative Code, Rule 58A-5.020(1) (da), Florida
Administrative Code, Rule 58A-5.024(2) (a)1, Florida
Administrative Code, herein classified as an uncorrected Class
ITI violation, which warrants an assessed fine of $500.00.
COUNT XII
TLC III FAILED TO ENSURE THAT ALL PERSONNEL RECORDS CONTAINED
DOCUMENTATION OF COMPLIANCE WITH LEVEL I BACKGROUND SCREENING.
SECTION 400.4275(2), FLORIDA STATUTES
RULE 58A-5.019(3), FLORIDA ADMINISTRATIVE CODE
RULE 58A-5.024(2) (a)3, FLORIDA ADMINISTRATIVE CODE
(STAFF RECORDS STANDARDS)
CLASS III VIOLATION
69. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
16
70. Based on a_ biennial licensure survey conducted on
January 8, 2004 and based on interview and record review, the
administrator did not have, nor did the administrator ensure
that the facility had maintained the required background
screening clearance for any employees working at the facility.
The facts include the following.
71. Staff interview with the administrator confirmed that
three employees sampled did not have a level 1 background
screening records at the facility available for inspection
during the time of the survey.
72. Record review revealed that there was no level 1
background screening records available for review at the
facility. The mandated correction date is designated as February
8, 2004.
73. Based on a follow-up survey conducted on March 10,
2004 and based on observation, interview and record review, it
was revealed that there were still no background screening
records available for review at the facility. This is an
uncorrected deficiency from the survey of January 8, 2004.
74. Based on the foregoing, TLC III violated Section
400.4275(2), Florida Statutes, Rule 58A-5.019(3), Florida
Administrative Code, and Rule 58A-5.024(2) (a)3, Florida
Administrative Code, herein classified as an uncorrected Class
III violation, which warrants an assessed fine of $500.00.
17
SURVEY FEE
Pursuant to Section 400.419(10), Florida statutes, AHCA may
assess a survey fee of $500.00 to cover the cost of monitoring
visits. A survey fee of $307.00 has been assessed in this case.
CLAIM FOR RELIEF
WHEREFORE, the Agency requests the Court to order the
following relief:
1. Enter a judgment in favor of the Agency for Health
Care Administration against TLC III on Counts I through XII.
2. Assess an administrative fine of $6,000.00 against TLC
III on Counts I through XII for the violations cited above.
3. Assess a survey fee of $307.00 against TLC III
pursuant to Section 400.419(10), Florida Statutes.
4. Assess costs related to the investigation and
prosecution of this matter, if the Court finds costs applicable.
5. 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
18
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 THE FAILURE TO RECEIVE A
REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF
THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED
IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.
Zs
sq.
al Counsel
h Care
Agéncy for
Administratik
8350 N.W. 52 Terrace - #103
Miami, Florida 33166
Copies furnished to:
Diane Castillo
Field Office Manager
Agency for Health Care
Administration
8355 N. W. 53 Street
Miami, Florida 33166
(Interoffice Mail)
Jean Lombardi
Finance and Accounting
Agency for Health Care
Administration
2727 Mahan Drive
Tallahassee, Florida 32308
(Interoffice Mail)
19
Assisted 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 Barbara Clifford, Administrator, TLC III,
8395 S. W. 112 Street, Miami, Florida 33156; Barbara Clifford,
12990 Névada Street, Miami, Florida 33156 on this Osthaay of
, 2004.
20
Docket for Case No: 04-003464
Issue Date |
Proceedings |
Feb. 11, 2005 |
Final Order filed.
|
Dec. 06, 2004 |
Order Closing File. CASE CLOSED.
|
Dec. 06, 2004 |
Agreed Motion to Close File (filed by Petitioner).
|
Nov. 17, 2004 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for January 21, 2005; 9:00 a.m.; Miami, FL).
|
Nov. 12, 2004 |
Motion for Continuance (filed by Petitioner via facsimile).
|
Oct. 04, 2004 |
Notice of Service of Petitioner`s First Set of Request for Admissions, Interrogatories, and Request for Production of Documents (filed via facsimile).
|
Oct. 01, 2004 |
Notice of Hearing (hearing set for December 1, 2004; 9:00 a.m.; Miami, FL).
|
Sep. 30, 2004 |
Response to Initial Order (filed by Petitioner via facsimile).
|
Sep. 24, 2004 |
Initial Order.
|
Sep. 23, 2004 |
Order of Dismissal without Prejudice Pursuant to Sections 120.54 and 120.569, Florida Statues and Rules 28-106.111 and 28-106.201 Florida Administrative Code to Allow for Amendment and Resubmission of Petition filed.
|
Sep. 23, 2004 |
Initiation of Proceedings: 28106.201 filed.
|
Sep. 23, 2004 |
Election of Rights for Administrative Complaint filed.
|
Sep. 23, 2004 |
Administrative Complaint filed.
|
Sep. 13, 2004 |
Notice (of Agency referral) filed.
|