STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Hi) FEB 16 Py ' 52 eye AGENCY FOR HEALTH CARE PVE ge ADMINISTRATION, ADMINISTRA) Hrs HEARINGS — Petitioner, AHCA No.: 2005000001 v. Return Receipt Requested: 7002 2410 0001 4234 3960 HBC ASSOCIATES, LLC, d/b/a 7002 2410 0001 4234 3977 NORTHPARK, A CLASSIC RESIDENCE BY 7002 2410 0001 4234 3984 HYATT, Respondent. ; OS- OD | | ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against HBC Associates, LLC, d/b/a Northpark, a Classic Residence by Hyatt (hereinafter “Northpark, a Classic Residence by Hyatt”), pursuant to Chapter 400, Part III and Section 120.60, Florida Statutes (2004), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $2,000.00 pursuant to Sections 400.414 and 400.419(2) (b), Florida Statutes for the protection of the public health, safety and welfare and $500.00 survey fee pursuant to Section 400.419(10), and 400.428(3) (c), Florida Statutes (2004). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57 Florida Statutes (2004), Chapter 28-106, Florida Administrative Code. 3. Venue lies in Broward County pursuant to Section 120.57, Florida Statutes (2004), 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 (2004), and Chapter 58A-5 Florida Administrative Code. 5. Northpark, a Classic Residence by Hyatt, operates a 120-bed assisted living facility located at 2480 North Park Road, Hollywood, Florida 33021. Northpark, a Classic Residence by Hyatt is licensed as an assisted living facility under license number 5622. Northpark, a Classic Residence by Hyatt 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 NORTHPARK, A CLASSIC RESIDENCE BY HYATT ADMITTED AN INAPPROPRIATE RESIDENT Rule 58A-5.0181(1)(c), Florida Administrative Code (ADMISSIONS CRITERIA STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (S) as if fully set forth herein. 7. During the complaint investigation conducted on 11/24/04 and based on interview and record review the facility admitted an inappropriate resident. 8. During a review of Resident #2's record, it was revealed that the resident was admitted directly into the facility's Memory Support/Alzheimer's care center on 07/22/04. During a review of Resident #2's health assessment dated 05/25/04, it was revealed that the resident was admitted with the diagnosis of Aortic Stenosis and a history of Dementia. During a further review of the Resident's health assessment it was revealed that the resident required "total" help with bathing and dressing, which does not meet the ALF admission criteria. During an interview, the ALF Administrator acknowledged that Resident #2 dia not meet the admission criteria as an appropriate resident due to his/her need for "total" help with bathing and dressing. 9. Based on the foregoing, Northpark, a Classic Residence by Hyatt violated Rule 58A-5.0181(1) (c), Florida Administrative Code, herein classified as a Class II violation, which warrants an assessed fine of $1,000.00. COUNT II NORTHPARK, A CLASSIC RESIDENCE BY HYATT FAILED TO PROVIDE SUFFICIENT CARE AND SERVICES TO MEET THE NEEDS OF A RESIDENT Rule 58A-5.0182, Florida Administrative Code (RESIDENT CARE STANDARDS) CLASS II VIOLATION 10. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 11. During the complaint investigation conducted on 11/24/04 and based on interview and record review, the facility failed to provide sufficient care and services to meet the needs of a resident. 12. During a review of Resident #2's record, it was revealed that the resident was admitted directly into the facility's Memory Support/Alzheimer's care center on 07/22/04. During a review of Resident #2's health assessment dated 05/25/04, it was revealed that the resident was admitted with the diagnosis of Aortic Stenosis and a history of Dementia. Further review of the health assessment revealed that the resident's physician indicated that the resident required "supervision and/or assistance" in his/her Activities of Daily Living, specifically in ambulation, toileting, grooming, and transferring. However, further review of the health assessment revealed that the resident required "total" help with bathing and dressing, which does not meet the ALF admission criteria. During an interview, the ALF Administrator acknowledged that Resident #2 did not meet the admission criteria as an appropriate resident due to his her need for “total” help with bathing and dressing. During a further interview with the ALF Administrator, it was revealed that upon admission, Resident #2 was admitted to the facility from his/her own private home with the accompaniment of two 12-hour private duty aides which were eventually eliminated after 2 months of residency at the facility. Further record review and interview with the ALF Administrator revealed that after admission, facility staff noticed that Resident 42 had a hard time adjusting to the facility and was suffering from a reverse sleep cycle where he/she was up and awake all night and slept all the time during the day. 13. During a further interview with the ALF Administrator, it was reported that the Memory Support/ Alzheimer's care center is equipped with a dining room within the unit where all meals are served for the residents residing in the care center. During a further interview with the ALF Administrator, it was reported that due to Resident #2's reverse sleep cycle, Resident #2 was usually sleeping morning and noon time meals. The ALF Administrator reported that Resident #2's private duty aides and facility staff were responsible for ensuring that Resident #2 consumed his/her meals. However, during a review of Resident #2's weight record, it was revealed that the resident's admitting weight on 07/22/04 was documented as 138 lbs. and on 10/04/04 the resident's weight was documented as 122 lbs. totaling a 16 lb. weight loss in 3 months. During a further interview with the ALF Administrator it was reported that she could not believe that the resident had lost so much weight in such a short period of time without being noticed by the facility's direct care aides and nurses. The ALF Administrator reported that Resident #2's family and physician were notified of the significant weight loss on 10/06/04. The AL Administrator reported that all residents residing in the care center would be weighed on a weekly basis, henceforth. The ALF Administrator also reported that the direct care staff received an in-service on reporting significant changes of residents such as failure to consume meals, weight loss, etc. to ensure that all residents receive necessary care and services as needed. 14. Based on the foregoing, Northpark, a Classic Residence by Hyatt violated Rule 58A-5.0182, Florida Administrative Code, herein classified as a Class II violation, which warrants an assessed fine of $1,000.00. SURVEY FEE Pursuant to Section 400.419(10), Florida Statutes (2004), AHCA may assess a survey fee of $500.00 to cover the cost of conducting monitoring visits conducted under Section 400.428(3) (c), to verify the correction of the violations. 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 Northpark, a Classic Residence by Hyatt on Count I. 2. Assess an administrative fine of $2,000.00 against Northpark, a Classic Residence by Hyatt on Counts I and II, for the violations cited above. 3. Assess a survey fee of $500.00 against Northpark, a Classic Residence by Hyatt, pursuant to Section 400.419(10), and 400.428(3) (c), Florida Statutes (2004). 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 (2004). 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 PENAL DER BY THE AGENCY. Xe Ale n E. Rodney, E&q. Assistant General unsel Agency for Health Care Administration Spokane Bldg., Suite 103 8350 N. W. 52™ Terrace Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 Bast 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 I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Lynn Post, Administrator, Northpark, a Classic Residence by Hyatt, 2480 North Park Road, Hollywood, Florida 33021; 200 West Madison, Suite 3700, Chicago, IL 60606, and to Corporation Service Company, 1201 Hays Street, MT Tallahassee, Florida 32301-2525 on this aU day of Thess, , 2005. Mo be 0,

Docket for Case No: 05-000577