STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 0 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2004007475 Return Receipt Requested: Vv. 7003 1680 0006 9825 9509 7003 1680 0006 9825 9516 ALTERRA HEALTHCARE CORPORATION d/b/a 7003 1680 0006 9825 9523 ALTERRA STERLING HOUSE OF STUART, Respondent. a C . cone q q ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Alterra Healthcare Corporation d/b/a Alterra Sterling House of Stuart (hereinafter “Alterra Sterling House of Stuart”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes (2003), and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $3,000.00 pursuant to Sections 400.414 and 400.419, Florida Statutes for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes and Chapter 28-106, Florida Administrative Code. 3. Venue lies in Martin County pursuant to Section 120.57 Florida Statutes and 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. Alterra Sterling House of Stuart operates a 55-bed assisted living facility located at 3401 Aster Lane, Stuart, Florida 34997. Alterra Sterling House of Stuart is licensed as an assisted living facility under license number 8773. Alterra Sterling House of Stuart 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 ALTERRA STERLING HOUSE OF STUART FAILED TO ENSURE THAT THE FACILITY WAS MAINTAINED IN ACCORDANCE WITH PHYSICAL PLANT SAFETY REQUIREMENTS. SECTION 400.419(4), FLORIDA STATUTES RULE 58A-5.023(1) (b), FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Alterra Sterling House of Stuart was cited with one (1) Class III deficiency due to financial monitoring surveys conducted on May 27, 2004 and June 29, 2004. 8. A revisit financial monitoring survey was conducted on May 27, 2004. Observations made during the tour of the facility revealed that the facility did not ensure that it was maintained in accordance with physical plant requirements. The findings include the following: 9. The walls of room # 128 were noted to have food splashed on them in the kitchenette area. In addition, the wall along the resident’s bed and the bed control were soiled with dried on substances. The carpet in the kitchenette area was stained and also had food items present on it. 10. The carpet area in the main dining room was noted to have at least 10 different stained areas. 11. Room #140 was noted to have a strong feces type odor present upon entering it. Upon investigation by the Administrator, it was revealed that this resident who requires total assistance in toileting and dressing had been dressed and changed early that morning and the soiled diaper had just been tossed in a waste basket. The staff member had neglected to properly dispose of this item. 12. The Administrator was present during the tour of the facility and confirmed these observations and findings. This is an uncorrected deficiency from the survey of 3/17/04. 13. The mandated correction date was designated June 26, 2004. 14. A second revisit survey was conducted on June 29, 2004. Observations made during the tour of the facility revealed that the facility still failed to ensure that it was maintained in accordance with physical plant requirements. The findings include the following: 15. The carpet in room 128 had stains in numerous locations and food items were also noted to be stuck to the carpet. The stains and floor condition were substantially unchanged from when it was cited on the previous revisit. 16. A strong urine smell was present in rooms # 124 and #137 as well as a moderate urine smell room # 112. 17. These observations were also witnessed by the staff member who accompanied the surveyor. This is an uncorrected deficiency from the first revisit survey of 5/27/04 4 18. Based on the foregoing facts, Alterra Sterling House of Stuart violated Rule 58A-5.023(1)(b), Florida Administrative Code, herein classified as a Class III violation, which warrants the maximum fine of $1,000.00 per day totaling $3,000.00 pursuant to Section 400.419(4), Florida Statutes due to repeated failure to correct this deficiency. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Alterra Sterling House of Stuart on Count I. 2. Assess an administrative fine of $3,000.00 against Alterra Sterling House of Stuart on Count I for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. 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. 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. Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 305-470-6800 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 &. Tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (U.S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE se I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Judy Bowes, Administrator, Alterra Sterling House of Stuart, 3401 Aster Lane, Stuart, Florida 34997; Alterra Healthcare Corporation, 10000 Innovation Drive, Tax Dept., Milwaukee, Wisconsin 53226; CT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324 on this SH day of Se port , 2004. tied

Docket for Case No: 04-003599