STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. . Case No. 2004011570 CAPITAL HEALTH CARE OS-O8 KO ASSOCIATES, LLC, d/b/a CAPITAL HEALTHCARE CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against CAPITAL HEALTH CARE ASSOCIATES, LLC, d/b/a CAPITAL HEALTHCARE CENTER (“Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2004), and alleges: NATURE OF THE ACTION 1. This is an action against Respondent to impose an administrative fine in the amount of $7,500, pursuant to the various citations, statutes, and rules cited in the count below. 2. In summary, Respondent was cited as follows: November 17, 2004 complaint investigation. Respondent was cited for a Class I violation. Page 1 of 7 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 II, Florida Statutes (2004), and Chapter 59A-4, Florida Administrative Code (2004), AHCA is the licensing and enforcing authority with regard to nursing facility laws and rules. 6. The Respondent is a nursing facility located at 3333 Capital Medical Blvd, Tallahassee, Florida 32308. The Respondent is and was at all times material hereto a licensed nursing facility under Chapter 400, Part Il, Florida Statutes (2004), and Chapter 59A-4, Florida Administrative Code (2004), having been issued license number 1073096. COUNT I (N 069 Respondent failed to self impose an admission moratorium due to the fact that they were below the minimum staffing hours for two consecutive days. § 400.141(15)(d), Fla. Stat. § 400.23(8)(b), Fla. Stat. 7. AHCA re-alleges paragraphs 1-6 above. 8. On November 17, 2004, AHCA conducted a complaint investigation at Respondent’s facility. AHCA cited Respondent for a violation, based on the following findings below: A review of the facility census date sheets for 8/1/04 and 8/2/04 was done on 11/17/04 around 10:30am. The census was 154 residents and 152 residents, which should have had minimum staffing hours of 400.4 and 395.2 hours respectively. However, the actual hours for the facility staffing were below those numbers at 380.00 and 388.60 respectively for those dates. There was no a) Page 2 of 7 evidence that the facility had self imposed a new admission moratorium as required by rule. The facility was short 20.4 CNA hours on 8/01/2004 and short 6.6 CNA hours on 8/2/2004 17/04 around 10:30am she stated she b) In interview with the administrator on 11/ could provide no evidence that the facility had self imposed a moratorium on new admissions following the below staffing days of 8/1/04 and 8/2/04 on 8/3/04 for the next 6 days as required. 9. Respondent failed to self impose an admission moratorium due to the fact that they were below the minimum staffing hours for two consecutive days, as required by Section 400.141(15)(d), Florida Statutes, which provides in pertinent part, as follows: “400.141 Administration and management of nursing home facilities.— Every licensed facility shall comply with all applicable standards and rules of the agency and shall: (15) Submit semiannually to the agency, or more frequently if requested by the agency, information regarding facility staff-to-resident ratios, staff turnover, and staff stability, including information regarding certified nursing assistants, licensed nurses, the director of nursing, and the facility administrator. For purposes of this reporting:...(d) A nursing facility that has failed to comply with state minimum- staffing requirements for 2 consecutive days is prohibited from accepting new admissions until the facility has achieved the minimum-staffing requirements for a period of 6 consecutive days. For the purposes of this paragraph, any person who was a resident of facility and was absent from the facility for the purpose of receiving medical care at a separate location or was on a leave of absence is not considered a new admission. Failure to impose such admissions moratorium constitutes a class I deficiency.” 10. The foregoing violation constitutes a Class II violation, due to the nature of the violation and the gravity of its effect on the residents and warrants a fine of $7,500, to wit: “(b) A class II deficiency is a deficiency that the agency determines has compromised the resident's ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class II deficiency is subject to a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and $7,500 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class Il deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A fine shall be levied notwithstanding the correction of the deficiency.” § 400.23(8)(b), F la. Stat. Page 3 of 7 11. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the 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 $7,500 for the referenced violation; and 3. Impose such other relief as this tribunal may find appropriate. NOTICE Respondent, CAPITAL HEALTH CARE ASSOCIATES, LLC, d/b/a CAPITAL HEALTHCARE CENTER, is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative t out in the attached Election of Rights (one page) and explained in the g shall be made to the action are se attached Explanation of Rights (one page). All requests for hearin; 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. Page 4 of 7 RESPONDENT IS FURTHER NOTIFIED, 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, A FINAL ORDER WILL BE ENTERED. oh Submitted on this_|4 day of EE Arwncg\ —— 2005, Tr ELEM Timothy B. Elliott, Senior Attomey Fla. Bar No. 210536 Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MSC #3 Tallahassee, Florida 32308 Phone: (850) 922-5873 Fax: (850) 921-0158 or 413-9313 CERTIFICATE OF SERVICE | HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights forms have been sent by U.S. Certified Mail, Return Receipt Requested (receipt # 7000 1530 0000 5684 9181) to Capital Healthcare Center, Attention: Administrator, 3333 Capital Medical Blvd, Tallahassee, Florida 32308. _ Submitted on this 14 day of Febnnanes— 2005. Tm hrtt- Timothy B. Elliott, Senior Attomney Agency for Health Care Administration Page 5 of 7 USPS - Track & Confirm Page 1 of 1 Track & Confirm Current Status You entered 7000 1530 0000 5684 9181 Your item was delivered at 2:13 pm on February 15, 2005 in TALLAHASSEE, FL 32308. U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) Postage -| COMPLA. Mal Tf Certified Fee Receipt Fee Required) Re Delivery Fee {End§rsement Required) Total Postage & Fees $ Postmark Here acetate MALE 2 ttlos NB yp ue rn ‘Street, Apt. a or HEA Box LTC es 35 CA pit MEDICA BL1D en See Reverse for Instructions 2000 1530 OOOO 5644 418i COMPLETE THIS SICTION ON NFL VERY Attach this card to the back of na or on the front if space permis, aR DL Article Addressed to: CAPITAL HEALTHCARE CENTER , ATTN: ADMINISTRATOR. 3333 CAPITAL MEDICAL BLVD TALLAHASSEE, FL. 32308 iece, D. 's delivery address different from iter 17? O Yes 'f YES, enter delivery address below. 1.No cone Os O Registered val leturn Recai Merchar 0 Insured Mail Oooo Pt for ndise 2 4. Restricted Delivery? (Extra Fee) CO Yes vl ( oP) 102885-0046-| ip http://trkcnfrm]1.smi.usps.com/netdata-cgi/db2www/cbd 243.d2w/output Track & Confirm Enter label number: lap contact us government services 200401570 2002 USPS. Ali Rights Reserved. Terms of Use Privacy Policy 03/01/2005

Docket for Case No: 05-000880