STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 4 ofr ; MIS AGENCY FOR HEALTH CARE ie ADMINISTRATION, UNG Petitioner, AHCA No.: 2004007557 v. Return Receipt Requested: 7002 2410 0001 4237 2137 THE GARDENS AT KENDALL THE, d/b/a THE GARDENS AT KENDALL, OU L 26 / | y ve Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against The Gardens at Kendall d/b/a The Gardens at Kendall (hereinafter “The Gardens at Kendall”), 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 $10,000.00 pursuant to Section 400.419, or revocation of license pursuant to Section 400.414(1)(e), Florida Statutes (2003), for the protection of the public health, safety and welfare and $230.50 survey fee pursuant to Section 400.419(10), and 400.428(3)(c), Fla. Stat. (2003) immense JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies in Miami-Dade County, pursuant to Section 120.57, Fla. Stat. and Rule 28-106.207, Plorida 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. The Gardens at Kendall operates a 6-bed assisted living facility located at 8820 Sw 79th Avenue, Miami, Florida 33156. The Gardens at Kendall is licensed as an assisted living facility license number AL9632, with an expiration date of August 15, 2005. The Gardens at Kendall 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 THE GARDENS AT KENDALL FAILED TO PROVIDE AN ENVIRONMENT FREE FROM ABUSE Section 400.428(1), Florida Statutes (RESIDENT CARE STANDARDS) CLASS I VIOLATION 2 ST NAS A RARE PUL Mier tne 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During a complaint investigation conducted on 6/30/2004 and based on new evidence received on 9/08/2004, the facility failed to provide a safe and cGecent living environment, free from abuse and neglect. 8. On 9/08/20004, the Agency was provided with new evidence showing probability that this was an intentional act that lead to the injuries of resident #4. 9. The facility report dated 05/09/2004, revealed that resident #4 was found between 8:30am and 9:00am on the floor of the shower, lying on her left side. The resident was assisted back to her bed and family was notified as per facility’s record and administrator. No documentation in the facility reported that a body assessment was done to check for any bruises or open skin to the resident's body. The administrator stated that she did not contact emergency medical services (EMS) because the resident did not want to go to the hospital. Pertinent medical information on the resident’s demographic data sheet revealed that she has a history of dementia and was not able to make sound decisions. 10. On 05/09/2004 the resident’s family called fire rescue after coming to see the resident later that afternoon at the facility. The fire rescue report revealed that resident #4 was found "in bed, aroused with stimulation but sluggish mentally”. The report also indicetes that the resident had an injured left femur, no apparent Fx (fracture) had no care given, and was overmedicated. The resident was transferred to a local hospital. The facility did not call fire rescue. 11. The resident was seen and admitted into the hospital on 05/09/2004 with a diagnosis of left superficial femoral artery thrombosis with lower leg ischemia. ‘Tre 05/09/2004 Operative report revealed the resident had a contusion with ecchymosis and superficial blistering of the left upper medial thigh. A left femoral thrombectomy was done. The resident’s condition deteriorated. The physician's Operative report States, "It appeared that compression of the artery for a prolonged period had caused the contusion of the medial thigh and thrombosis of the femoral artery." 12. The medical examiner report dated 05/12/2004, revealed that on 05/10/2004 at 6:00am, the resident was placed on a respirator and continued to suffer with acute renal failure. On 05/11/2004, he/she went into cardiac arrest. All advanced cardiac life support efforts were met with negative results. He/she was pronounced dead at 8:15am by the hospital physician. 13. Based on the foregoing, The Gardens at Kendail violated Section 400.428(1), Florida Statutes, a Class JI deficiency, which carries, in this case, an assessed fine of $10,000.00, or revocation of licensure. SURVEY FEE Pursuant to Section 400.419(10), Florida statutes, AHCA may assess a survey fee of $230.50 to cover the cost of conducting complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits. PRAYER FOR RELIEF ER REALE 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 Count I. B. Revoke the license of The Gardens at Kendall on Count I pursuant to Section 400.414(1) (e), Florida Statutes. c. In the alternative to paragraph 8, assess an administrative fine of $10,000.00 against The Gardens at Kendall on Count I violation pursuant to Section 400.419, Florida Statutes. D. Assess a survey fee of $230.50 against The Gardens at Kendall, pursuant to Sections 400.419(10), and 400.428(3) (c), Florida Statutes. E. 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 for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN 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, Tria Lawton-Russell Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52™ Terrace Suite 103 Miami, Florida 33166 Copies furnished to: Diane Lopez Castillo Field Office Manager Agency for Health Care Administration 8355 NW 53** Street, 1%* Floor Miami, Florida 33166 (Inter-office mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Inter-office Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE a ME BR EAVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Mayra del Olmo, Administrator, The Gardens at Splonbes >. 8820 sw 79% Avenue, Miami, Florida 33156 coptomber’> 3 Tria Lawton-Russell

Docket for Case No: 04-003861