Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: EMERITUS CORPORATION, D/B/A THE PARK CLUB OF FORT MYERS
Judges: DANIEL MANRY
Agency: Agency for Health Care Administration
Locations: Fort Myers, Florida
Filed: Mar. 04, 2005
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Friday, November 18, 2005.
Latest Update: Dec. 22, 2024
STATE OF FLORIDA :
AGENCY FOR HEALTH CARE ADMINISTRATION *
O5 MAR -t,
AGENCY FOR HEALTH CARE
ADMINISTRATION, F po Sage
Petitioner,
vs. AHCA Case No. 2004006051
EMERITUS CORPORATION,
d/b/a THE PARK CLUB OF a CS) K ;2
FORT MYERS, .) O 4 >
Respondent.
/
ADMINISTRATIVE COMPLAINT
COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION
(“AHCA”) by and through the undersigned counsel, and files this Administrative
Complaint against EMERITUS CORPORATION d/b/a THE PARK CLUB OF FORT
MYERS (“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 an administrative fine in the amount of $2,500
against the Respondent, pursuant to Sections 400.419(1)(c) and 400.419(1)(b), Florida
Statutes (2004); and Rules 58A-5.0181(1)(m)1-3, 58A-5.0182, 58A-5.0182(1)(b), Florida
Administrative Code (2004).
2. Respondent was cited for a Class Tl violation during a complaint
investigation AHCA conducted on or about March 23, 2004. The aforementioned
med a repeat Class IJJ at the Limited Nursing Survey and an appraisal
violation was dee!
visit AHCA completed on June 8, 2004. Respondent was also cited for two Class Il
Page 1 of 13
violations at the Limited Nursing Survey and an appraisal visit AHCA completed on June
8, 2004.
JURISDICTION AND VENUE
3. This tribunal has jurisdiction over Respondent, pursuant to Sections
120.569 and 120.57, Florida Statutes (2004).
4. Venue shall be determined pursuant to Chapter 28-106.207, Florida
Administrative Code (2004).
PARTIES
5. Pursuant to Chapter 400, Part Hl, Florida Statutes (2004), and Chapter
58A-5, Florida Administrative Code (2004), AHCA is the licensing and enforcing
authority with regard to assisted living facility laws and rules.
6. Respondent is an assisted living facility located at 1896 Park Meadows
Drive, Ft. Myers, Florida 33907. Respondent is and was at all times material hereto a
licensed facility under Chapter 400, Part II, Florida Statutes (2004), and Chapter 58A-5,
Florida Administrative Code (2004), having been issued license number 5096.
COUNT 1
Respondent failed to ensure that each resident was appropriate for admission and
continued residency.
§ 400.419(1)(c), Fla. Stat. (2004)
Fla. Admin. Code R. 58A-5.0181(1)(m)1-3 (2004)
7. AHCA re-alleges paragraphs 1-6 above.
8. On or about March 23, 2004, AHCA conducted a complaint investigation
at Respondent’s facility. AHCA cited Respondent for a deficiency, based on the findings
below, to wit:
ew with the complainant on 3/23/04 he/she stated the
a) During an intervi
in the facility to evacuate the residents in
facility does not have enough staff i
a safe and timely manner.
Page 2 of 13
admission and continued residency,
Administrati
During an interview with the local fire marshal on 3/23/04 he/she stated the
facility has a history of unsatisfactory fire safety reports and that he/she is
concemed the facility does not have enough staff to safely evacuate the
residents in the proper amount of time. He/she stated he/she has heard there
is one staff in the facility during the 11:00 PM to 7:00 AM shift. He/she
stated this would not allow the residents to evacuate safely and timely.
During a tour of the facility on 3/23/04 at approximately 10:00 AM it was
revealed that there were four residents in the facility who were in
wheelchairs. Three of the residents were able to get out of the wheelchair
and walk by themselves. One resident, who resides in the memory Lane
(secured unit), was in a wheelchair and required one person assist to get out
of the wheelchair.
A review of the facility's Evacuation Capability worksheet on 3/23/04
revealed the memory lane unit was done on 2/12/04. There were two staff
and 22 residents involved. The level of evacuation capability was rated at
"Impractical" (5.9). During an interview on 3/23/04 the administrator stated
she has been employed at the facility since January 2004.
She stated she was not aware of this evaluation and rating. The facility
staffing schedule showed there were two staff scheduled each day on the 11
PM-7 AM shift for each unit (memory lane and assisted living). The census
for the facility on the day of the survey showed the memory lane has 21
residents and the assisted living has 61 residents. However, the staff at the
facility did not know what time and at what shift this evacuation assessment
occurred.
9. Respondent failed to ensure that each resident was appropriate for
ve Code (2004), which provides, in pertinent part, as follows:
“ggA-5.0181 Residency Criteria and Admission Procedures...(1)
ADMISSION CRITERIA. An individual must meet the following minimum
criteria in order to be admitted to a facility holding a standard, limited nursing or
limited mental health license...(m) Have been determined to be appropriate for
admission to the facility by the facility administrator. The administrator shall
base his/her decision on: 1. An assessment of the strengths, needs, and
preferences of the individual, and the medical examination report required by
Section 400.426, F.S., and subsection (2) of this rule; 2. The facility’s admission
policy, and the services the facility is prepared to provide or arrange for to meet
resident needs; and 3. The ability of the facility to meet the uniform fire safety
standards for assisted living facilities established under Section 400.441, F.S.,
and Chapter 4A-40, F.A.C.”
Page 3 of 13
as required by Rule 58A-5.0181(1)(m)1-3, Florida
10. The foregoing violation constitutes a Class III violation due to the nature
of the violation and the gravity of its probable effect on the residents of the facility, to
wit:
“(c) Class III violations are those conditions or occurrences related to the operation
and maintenance of a facility or to the personal care of residents which the agency
determines indirectly or potentially threaten the physical or emotional health, safety,
or security of facility residents, other than class I or class II violations. A class II
violation is subject to an administrative fine of not less than $500 and not exceeding
$1,000 for each violation...” (§ 400.419(1)(c), Fla. Stat. (2004))
11. On or about June 8, 2004, AHCA completed a Limited Nursing Survey
and an appraisal visit at Respondent’s facility. AHCA cited Respondent for a repeat
deficiency, based on the findings below, to wit:
a) Resident #3 was admitted to the facility on 5/22/04 with the family present
from a sister facility out of the area. The nurse’s admission note of 5/22/04
indicated that he "resists toileting...wears attends. ....alert, disoriented to time
and place. Incontinent of B & B." There was no documentation that he was
evaluated for grooming, bathing, or dressing.
b) Observation of the resident in the dining room of the closed unit on 6/08/04
revealed a resident who was eating independently. He had a bruise across his
face and nose, that appeared to have been recently bleeding because of dried
blood his finger of his left hand and blood drips on his right forearm.
c) Record review of the DOEA 1823 Health Assessment completed on 5/26/04
revealed that he needed total help in bathing, dressing, grooming and was
incontinent of toileting.
d) Interview with the Director of Nursing on 6/08/04 at 3 P.M. revealed that the
resident had fallen on 6/05/08. She stated that at that time she had given the
family a verbal notice that the resident was not appropriate for the facility.
The MOVE OUT form was not signed by the resident or a family member.
12. The foregoing violation constitutes a repeat Class III violation pursuant to
Section 400.419(1)(c), Florida Statutes (2004) (quoted above), due to the nature of the
violation and the gravity of its effect on the residents of the facility, and warrants a fine of
$500.
13. AHCA, in determining the penalty imposed, considered the gravity of the
violation, the probability that death or serious harm will result, the uncorrected actions of
Page 4 of 13
Respondent and its staff, the financial benefit to the facility of committing or continuing
the violation, and the licensed capacity of the facility.
WHEREFORE, AHCA demands the following relief:
1. Enter factual and legal findings as set forth in the allegations of this count;
2. Impose a fine in the amount of $500 for the referenced violation; and
3. Impose such other appropriate relief as this tribunal may find and deem
appropriate.
COUNT
Respondent failed to provide care and services appropriate to the needs of a
resident accepted for admission to the facility for 1 (Resident #2) of 3 active sampled
residents.
§ 400.419(1)(b), Fla. Stat. (2004)
Fla. Admin. Code R. 58A-5.0182 (2004)
14. AHCA re-alleges paragraphs 1-6 above.
15. | On or about June 8, 2004, AHCA completed a Limited Nursing Survey
and an appraisal visit at Respondent’s facility. AHCA cited Respondent for a deficiency,
based on the findings below, to wit:
a) Resident #2 was admitted to the facility on 5/27/04 with diagnosis including
Cirthosis of the liver and Hospice Care.
Interview with the resident in her room on 6/08/04 at 11:45 A.M. revealed
that she was aware of her hospice needs. She stated that at night she has a
hard time breathing, which causes her anxiety. She stated that she has
adjusted to the facility, "Itis like a co-ed soriety.”
Review of the census log revealed that this resident was Independent.
Interview with the DON at 3 P.M. revealed that the staff nurse's had not told
her that the resident needed medication for anxiety due to SOB (shortness of
breath). Discussion with the DON revealed that although she is independent
in all her ADL's, the facility assists the resident with medication
administration. During the interview with staff nurses they said that Hospice
is in charge of the resident.
Review of the Resident Health Assessment dated 5/26/04 indicated the
resident needed help with her medications. It states, "needs meds poured and
given to her."
Page 5 of 13
Review of the resident's clinical record did not contain a care plan that
showed the services that the facility and hospice would provide for care of
the resident.
There was lack of coordination of services for this resident between Hospice
and the facility.
16. Respondent failed to provide care and services appropriate to the needs of
a resident accepted for admission to the facility for 1 (Resident #2) of 3 active sampled
residents, as required by Rule 58A-5.0182, Florida Administrative Code (2004), which
provides in pertinent part, as follows:
“g8A-5.0182 Resident Care Standards. An assisted living facility shall provide
care and services appropriate to the needs of residents accepted for admission to
the facility.”
17. The foregoing violation constitutes a Class II violation, due to the nature
of the violation and the gravity of its effect on the residents of the facility, and warrants a
fine of $1,000, to wit:
“(b) Class “II” violations are those conditions or occurrences related to the operation
and maintenance of a facility or to the personal care of residents which the agency
determines directly threaten the physical or emotional health, safety, or security of
the facility residents, other than class I violations. A class II violation is subject to an
administrative fine in an amount not less than $1,000 and not exceeding $5,000 for
each violation...” (§ 400.419(1)(b), Fla. Stat. (2004))
18. | AHCA, in determining the penalty imposed, considered the gravity of the
violation, the probability that death or serious harm will result, the uncorrected actions of
Respondent and its staff, the financial benefit to the facility of committing or continuing
the violation, and the licensed capacity of the facility.
WHEREFORE, AHCA demands the following relief:
1. Enter factual and legal findings as set forth in the allegations of this count;
2. Impose a fine in the amount of $1,000 for the referenced violation; and
3. Impose such other appropriate relief as this tribunal may find and deem
appropriate.
Page 6 of 13
COUNT Ill
Respondent failed to provide daily observation by staff to ensure awareness of the
general health and well being for 1 (Resident #1) of 3 active sampled residents.
§ 400.419(1)(b), Fla. Stat. (2004)
Fla. Admin. Code R. 58A-5.0182(1)(b) (2004)
19. AHCA re-alleges paragraphs 1-6 above.
20. On or about June 8, 2004, AHCA completed a Limited Nursing Survey
and an appraisal visit at Respondent's facility. AHCA cited Respondent for a deficiency,
based on the findings below, to wit:
a) Resident #1 was admitted to the facility on 10/25/03 with diagnoses
including Diabetes Mellitus, Peripheral Vascular Disease, Hypertension,
Diabetic Neuropathy, Leg Ulcers, and Congestive Heart Failure. The resident
receives Renal Dialysis treatments three times a week.
Review of the Resident Health Assessment dated 3/15/04 indicated the
resident needed help with his/her medications. It further stated the resident
had very poor vision.
On 3/17/04, the resident had a Psychiatric Consult. The consult indicated the
resident had poor insight and judgment and the resident was not competent to
self-administer medication, and suggested supervision. It further indicated
the resident had been making poor food choices, and recommended Risperdal
to be started due to Psychosis.
Observation and interview with the resident on 6/8/04 in his/her room, at
approximately 10:00 A.M. revealed the resident seated in a chair with his/her
right leg elevated on a chair. An open wound was observed on the right lower
leg. There was a large partially filled blister area with clear, yellow and pink
drainage. The area surrounding the open wound was reddened. The resident
stated he/she has had blisters in the past. The resident stated he/she had been
waiting for the nurse to come and put the dressing on the area since 5:00
AM.
Interview with the facility LPN (Licensed Practical Nurse) on 6/8/04 at
approximately 10:30 A.M. revealed the Home Health Agency nurse cared for
the wound. The facility LPN further stated she had not seen the wound.
Interview with the facility RN at approximately 1:50 P.M. revealed she had
seen the wound since it had been noted, but there was no documentation
regarding her observation. When the facility RN was asked if there was any
communication between the Dialysis Center and the facility, the RN
responded there was not.
On 6/3/04 record review revealed a Home Health Agency nurse saw the
resident and the documentation indicated the resident received a treatment to
Page 7 of 13
a Jarge and draining blister on the right lower extremity. The notes further
stated the resident had Iplus edema to both lower extremities, and the
resident had pain in his/her feet.
On 6/5/04 a Home Health Agency nurse saw the resident. The notes
indicated there was slight edema to both lower extremities, and a moderate
amount of clear drainage.
On 6/8/04 a Home Health Agency nurse saw the resident. Interview with the
nurse at approximately 11:30 A.M. following the nurse's assessment of the
wound, revealed the current treatment was not appropriate. The Home Health
Agency nurse contacted the physician and a new order was obtained for a
wound culture, and an antibiotic. The documentation indicated the resident
had pain in her right lower extremity. The Home Health Agency Nurse was
not aware of the resident's visual status, the history of non compliance with
dietary recommendations, psychiatric consult recommendations, or what
services the resident was receiving at the Assisted Living Facility.
21. Respondent failed to provide daily observation by staff to ensure
awareness of the general health and well being for 1 (Resident #1) of 3 active sampled
residents, as required by Rule 58A-5.0182(1)(b), Florida Administrative Code (2004),
which provides in pertinent part, as follows:
“58 A-5,0182 Resident Care Standards. An assisted living facility shall provide
care and services appropriate to the needs of residents accepted for admission to
the facility. (1) SUPERVISION. Facilities shall offer personal supervision, as
appropriate for each resident, including the following...(b) Daily observation by
designated staff of the activities of the resident while on the premises, and
awareness of the general health, safety, and physical and emotional well-being of
the individual.”
22. The foregoing violation constitutes a Class II violation, due to the nature
of the violation and the gravity of its effect on the residents of the facility and warrants a
fine of $1,000, to wit:
“(b) Class “II” violations are those conditions or occurrences related to the operation
and maintenance of a facility or to the personal care of residents which the agency
determines directly threaten the physical or emotional health, safety, or security of
the facility residents, other than class I violations. A class II violation is subject to an
administrative fine in an amount not less than $1,000 and not exceeding $5,000 for
each violation...” (§ 400.419(1)(b), Fla. Stat. (2004))
Page 8 of 13
23. AHCA, in determining the penalty imposed, considered the gravity of the
violation, the probability that death or serious harm will result, the uncorrected actions of
Respondent and its staff, the financial benefit to the facility of committing or continuing
the violation, and the licensed capacity of the facility.
WHEREFORE, AHCA demands the following relief:
1. Enter factual and legal findings as set forth in the allegations of this count;
2. Impose a fine in the amount of $1,000 for the referenced violation; and
3. Impose such other appropriate relief as this tribunal may find and deem
appropriate.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK
Page 9 of 13
NOTICE
Respondent, EMERITUS CORPORATION d/b/a THE PARK CLUB OF FORT
MYERS is notified that she has a right to request an administrative hearing pursuant to
Section 120.569, Florida Statutes. Specific options for administrative action are set out in
the attached Election of Rights (one page) and explained in the attached Explanation of
Rights (one page). 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 Dr., Bldg. 3, MSC 3, Tallahassee, Florida, 32308; Attention: Agency Clerk.
THE RESPONDENT IS FURTHER NOTIFIED THAT IF THE REQUEST FOR
HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE
ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF
THIS ADMINISTRATIVE COMPLAINT, 4A FINAL ORDER WILL BE
ENTERED.
Submitted on this And_ day of Barrer boen 2004.
Tevet lla
Timothy B. tt, Senior Attorney
Fla. Bar No. 210536
Agency for Health Care Administration
2727 Mahan Drive, Bldg. #3, MSC #3
Tallahassee, FL 32308
Phone: (850) 922-5873
Fax: (850) 921-0158 or (850) 413-9313
Page 10 of 13
CERTIFICATE OF SERVICE és &
1 HEREBY CERTIFY that the original Administrative Complaint, rxplanati GAP “4 S
ia Py
Rights form, and Election of Rights forms have been sent by U.S. Certified Mail, Redo 4: ‘3 *)
up
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saa; ee
Receipt Requested (receipt # 7000 1530 0000 5684 9204) to The Park Club of Ft. Myers. Ah #5) SU, Ve
1896 Park Meadows Drive, Ft. Myers, Florida 33907.
Submitted on this nf _ day of __ Verreml-er 2004.
Lally 6 _CLbedlf-
Timoth liott, Senior Attorney
Page 11 of 13
‘USPS - Track & Confirm Page 1 of 1
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Enter Jabel number: -P.
You entered 7000 1530 0000 5684 9204
Your item was delivered at 12:35 pm on November 04, 2004 in FORT
MYERS, FL 33907.
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U.S. Postal Service :
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
| Sent To
PARE Ll LEMOS. [HLM halt
[Street Apt. No.; or P
ME HE MEADONE EME 0. oe
City, State, ZiP> 4
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PS Form 3800, May 2000 See Reverse for Instructions
COMPLETE THIS SECTION ON DELIVERY
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so that we can return the card to you.
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or on the front if space permits.
1. Article Addressed to:
The PAK CLUB OF ET MYERS
ATTENTION ADMINISTRATOR
1296 PARK MEADOWS DRIVE
. 3. $8
ET. MYERS, FLOLIDA 244 07 Certified Mail 1 Express Mail
OO Registered Return Receipt for Merchandise
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(Transfer from service label) i 5 26). 2
PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540
http://trkenfrm1.smi-usps.com/netdata-cgi/db2www/cbd_243.d2w/output 11/16/2004
Docket for Case No: 05-000843
Issue Date |
Proceedings |
Nov. 18, 2005 |
Order Closing Files. CASE CLOSED.
|
Nov. 18, 2005 |
Motion to Relinquish Jurisdiction filed.
|
Nov. 09, 2005 |
Notice of Appearance (filed by E. Bredemeyer).
|
Sep. 15, 2005 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for December 1 and 2, 2005; 9:30 a.m.; Fort Myers, FL).
|
Sep. 14, 2005 |
Joint Motion for Continuance filed.
|
Sep. 09, 2005 |
Notice of Appearance (filed by K. Gieseking).
|
Jul. 20, 2005 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for September 22 and 23, 2005; 9:30 a.m.; Fort Myers, FL).
|
Jul. 18, 2005 |
Unopposed Motion for Continuance filed.
|
May 11, 2005 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for July 22, 2005; 9:30 a.m.; Fort Myers, FL).
|
May 04, 2005 |
Unopposed Motion for Continuance filed.
|
Mar. 23, 2005 |
Notice of Hearing (hearing set for May 13, 2005; 9:30 a.m.; Fort Myers, FL).
|
Mar. 23, 2005 |
Order of Pre-hearing Instructions.
|
Mar. 17, 2005 |
Response to Initial Order (filed by Respondent).
|
Mar. 15, 2005 |
Order of Consolidation (consolidated cases are: 05-0842 and 05-0843).
|
Mar. 07, 2005 |
Initial Order.
|
Mar. 04, 2005 |
Order of Dismissal without Prejudice Pursuant to Sections 120.54 and 120.569, Florida Statutes and Rules 28-106.111 and 28-106.201, Florida Administrative Code to allow for Amendment and Resubmission of Petition filed.
|
Mar. 04, 2005 |
Amended Petition for Formal Administrative Administrative Hearing filed.
|
Mar. 04, 2005 |
Petition for Formal Administrative Hearing filed.
|
Mar. 04, 2005 |
Administrative Complaint filed.
|
Mar. 04, 2005 |
Notice (of Agency referral) filed.
|