STATE OF FLORIDA Pg 7) AGENCY FOR HEALTH CARE ADMINISTRATION a fe At 3 AGENCY FOR HEALTH CARE ; ADMINISTRATION, Petitioner, AHCA No.: 2005000387 AHCA No.: 2005000386 v. Return Receipt Requested: 7002 2410 0001 4234 4547 A.D.M.E. INVESTMENT PARTNERS, LTD, 7002 2410 0001 4234 4554 d/b/a OCEANSIDE EXTENDED CARE 7002 2410 0001 4234 4561 CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter referred to as “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against A.D.M.E. Investment Partners, LTD, d/b/a Oceanside Extended Care Center (hereinafter “Oceanside Extended Care Center”), pursuant to Chapter 400, Part II, and Section 120.60, Fla. Stat. (2004), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $5,000.00 pursuant to Section 400.23(8), Fla. Stat. (2004), for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Oceanside Extended Care Center, pursuant to Section 400.23(7) (b), Fla. Stat (2004). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2004), and Chapter 23-106, F.A.C. 4. Venue lies in Miami-Dade County, pursuant to Section 400.121(1)(e), Fla. Stat. (2004), and Rule 28- 106.207, Florida Administrative Code. PARTIES S. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part Il, Fla. Stat., (2004), and Chapter 59A-4 Florida Administrative Code. 6. Oceanside Extended Care Center is a 196-bed skilled nursing facility located at 550 9™ Street, Miami Beach, Florida 33139. Oceanside Extended Care Center is licensed as a skilled nursing facility; license number SNF1171096; certificate number 12194, effective 12/02/2004 through 12/31/2004, and certificate number 12195, effective date 01/01/2005 through 12/31/2005. Oceanside Extended Care Center 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. 7. Because Oceanside Extended Care Center participates in Title XVIII or XIX, it must follow the certification rules and regulations found in Title 42 C.F.R. 483, as incorporated by Rule 59A-4.1288, F.A.C. COUNT I OCEANSIDE EXTENDED CARE CENTER FAILED TO COMPLY WITH ALL REQUIREMENTS OF NFPA 90A, STANDARD FOR THE INSTALLATION OF AIR CONDITIONING AND VENTILATING SYSTEMS Rules 59A-4.130(2), 69A-3.012, Florida Administrative Code; Section 633.022(1) (b), Florida Statutes; NFPA 101: 19.5.2.,19.1.1.1.1, 19.1.1.1.2, 9.2.1 (2000); and NFPA 90A 3-4.7 (1999) {LIFE SAFETY CODE 90-A - MAINTENANCE) UNCORRECTED CLASS III DEFICIENCY 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During the annual Fire & Life Safety survey conducted on 10/20-21/2004 and based on record review air conditioning and vent smoke and fire dampers were not maintained and tested increasing the risk to residents. 10. On the dates of survey October 20 & 2°, 2004, between 8 a.m. and 5 p.m., and during record review on October 21, 2004, the code requirements for testing and maintenance of smoke dampers mechanical operation was requested, no written documentation of damper testing was available or provided. Code reference: NFPA 90A - 3-4.7 Maintenance. 11. At least every 4 years, fusible links (where applicable) shall be removed; all dampers shall be operated to verify that they fully close; the latch, if provided, shall be checked; and moving parts shall be lubricated as necessary. Correction date: November 21, 2004. 12. During the revisit conducted on 12/02/2004 and based on observation, interview and documentation, it was determined that the facility did not comply with all requirements of NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems. In fact, the facility was unaware of the presence of fire dampers within the facility. 13. At the Entrance Conference of the Life Safety survey revisit conducted on December 2, 2004, the Agency was presented with a letter from an air conditioning contractor, as part of the Plan of Correction, attesting to the fact that there were no fire dampers in the building. 14. While touring the facility with the Maintenance Director, Maintenance Assistant and Housekeeping Supervisor, fire dampers were observed within the facility. This surveyor noticed two fire dampers on the 3rd floor above the entrance to the Director of Nursing office. 15. Prior to pointing them out, this surveyor questioned the Maintenance Director about the presence of fire dampers in the building and was assured that there were none in the building. 16. Within the Director of Nursing office was an air conditioning air handler enclosed in a small closet. This closet was constructed as a return air plenum so that return air was drawn back into the room and closet from the atmosphere rather than through air conditioning ducts. To facilitate this return air, grilles were installed above the Director of Nursing office door and in the wall of the air handler closet. Fire dampers were installed in each of the grilles. An additional fire damper was noted in the exhaust of the Soiled Utility Room adjacent to the Director of Nursing office. 17. A fire damper is an Underwriters Laboratories (UL) approved fire protective device. It is positioned at the wall opening and is designed to activate and close when exposed to direct heat or flame. This seals the air conditioning or exhaust opening and prevents smoke and flames from traveling through it. 18. The damper consists of a metal curtain within a frame. The curtain is held open and in place by a small piece of metal called a fusible link. The activaticn occurs when a predetermined level of heat or direct flame contact is reached (usually 50 degrees above ambient heat). This melts the fusible link, releases the metal curtain and seals the opening. 19. In addition to the ones found on the 3rd floor, fire dampers were also discovered on the 4th floor's air handler closet within the Nursing Supervisor office and adjacent Soiled Utility Room and in the 2nd floor Soiled Utility Room. 20. It is required that every fire damper be inspected annually to ensure that there is no impediment to the curtain's ability to close. Every fourth year, the link must be removed and the damper curtain lubricated and operated to verify that they close completely within their frame. This maintenance and testing of each device must be documented. 21. Lack of inspecting and maintaining every fire damper in the facility could result in a damper curtain not closing completely, thus allowing smoke or flames to enter an exit corridor and negating the fire rating of a fire barrier wall. 22. Without a list, lack of knowledge as to just where these devices are could jeopardize the safety of cccupants within the building in a fire emergency. 23. NOTE: The fire dampers seen during the tour are not to be considered as the only ones within the building. A thorough inspection must be made of the air conditioning and exhaust ductwork to ensure that all of the devices are accounted for. 24. According to the facility’s Plan of Correction "the facility does not have fire dampers" and refers to the aforementioned letter from the air conditioning contractor. 25. Based on finding fire dampers within the facility, the corrective action of the Plan of Correction was not met. 26. Based on the foregoing, Oceanside Extended Care Center violated Rules 59A-4.130(2), 69A-3.012, Florida Administrative Code; Section 633.022(1) (b), Florida Statutes; NFPA 101: 19.5.2.,19.1.1.1.1, 19.1.1.1.2, 9.2.1; and NFPA 90A 3-4.7 (1999) , herein classified as an uncorrected Class III deficiency pursuant to Section 400.23(8)(c), Florida Statutes, which carries, in this case, an assessed fine of $2,000.00. This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT IT OCEANSIDE EXTENDED CARE CENTER FAILED TO MAINTAIN OR PROTECT LAUNDRY CHUTES WITHIN THE FACILITY Rules 59A-4.130(2), 69A-3.012, Florida Administrative Code, Section 633.022(1) (b), Florida Statutes; NFPA 101:19.1.1.1.1, 19.1.1.1.2, 19.5.4., 9.5,(2000) and NFPA 82 3-2.2.9 and 3-2.4.1 (1999) {LIFE SAFETY CODE STANDARDS) UNCORRECTED CLASS III VIOLATION 27. BHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 28. During the annual Fire & Life Safety Code survey conducted on 10/20-21/2004 and based on observation tour, and staff interview the facility did not maintain or protect laundry chutes within the facility. 29. On the dates of survey October 20 & 21, 2004, between 8 a.m. and 5 p.m., during the facility tour, it was discovered that the facility had not been maintaining the laundry chute shaft. The dirty linen was piled up and blocking the fusible link protective door from closing in the event of a fire. 30. The lack of proper maintenance and protection of the trash and laundry chutes in this facility would allow the rapid unchecked travel of fire, smoke, and soot throughout the entire building affecting all floors. Correction date: November 21, 2004 31. During the revisit conducted on 12/02/2004 and based on observation and interview, it was determined that the building's laundry (soiled linens) chute was not being maintained to comply with specific requirements of NFPA 101, the Life Safety Code and NFPA 82, Standard on Incinerators and Waste and Linen Handling Systems and Equipment. 32. During the Life Safety survey revisit conducted on December 2, 2004, while touring the facility with the Maintenance Director, Maintenance Assistant and Housekeeping Supervisor the following observations were made: (a) The second floor laundry chute door was observed to be left in the open position; and there was no latching mechanism on the door to ensure that it would remain fastened once the door closed. (b) There was an accumulation of soiled linen bags within the laundry chute at its base on the ground floor, which prevented the laundry chute door from closing completely. 33. These findings mirrored those of the Life Safety surveyor during the annul survey of October 20 and 21, 2004 and which were cited as deficient practices. 34. According to the facility's Plan of Correction "the second floor laundry chute door was replaced and the first floor door was closed." 35. Based on the above, the Plan of Correction was not met. 36. Further observations were made relating to the laundry chute and require corrective actions: (a) In addition to the second floor laundry chute door, the first floor laundry chute door did not have a latching mechanism on the door to ensure it would remain fastened once the door closed. NFPA 82--3-2.4.1 General Access Gravity Waste Chutes. All chute loading doors into a waste chute shall be provided with a self-closing, positive latching frame and gasketed fire door assembly approved for Class B openings and having a fire resistance rating of not less than 1 hour. The doorframe shall be fastened into the chute and the shaft wall. The design and installation shall be such that no part of the frame or door projects into the chute. (b) There was not a fusible link assembly attached to the ground floor laundry chute door. This is required so that, if the chute door was left in the open position and there was a fire in the laundry chute room, the link wound melt and enable the door to close and latch shut. NFPA 82--3-2.2.9 Chute Discharge Doors. Gravity chutes shall be constructed so that the base opening of the chute or shaft, or both, shall be protected by an approved automatic-closing or self-closing 1l-hour fire door suitable for a Class B opening. (c) The first floor corridor door of the laundry chute room did not close and latch shut in five tries. (d) The door to the ground floor laundry chute room did not close and latch shut. (This was repaired during the survey; however, with the accumulation of rust on the door, the repair may only be temporary.) (e) The laundry chute was not being emptied. 37. The initial observation was at 11:30am. At that time, the accumulation of soiled linen bags within the chute at the ground floor was halfway up to the first floor level and was pushing against the ground floor's laundry chute door so that the door could not latch shut completely. A 10 large cart was positioned at the opening of the ground floor chute and the cart was filled with soiled linen bags. 38. When questioned by the surveyor, a staff member indicated that the chute is supposed to be emptied at approximately hourly intervals. 39. A second observation was made at 1:30pm. The laundry cart had not been moved. The laundry chute had not been touched and the laundry chute door was being pushed into an open position by the volume of soiled linen bags behind it. 40. The final observation, at 3:00p.m. found no change in the ground floor laundry room. The cart was still positioned in front of the laundry chute and had not been moved or emptied and the chute door was being push into an cpen position. The surveyor went to the first floor laundry chute room and checked the level within the chute. The accumulation of bags had reached the first floor chute door opening. 41. Based on the foregoing, Oceanside Extended Care Center violated Rules 59A-4.130(2), 69A-3.012, Florida Administrative Code, Section 633.022(1) (b), Florida Statutes; NFPA 101:19.1.1.1.1., 19.1.1.1.2, 19.5.4., 9.5,(2000) and NFPA 82 3-2.2.9 and 3-2.4.1 (1999) , which carries, in this case, an assessed fine of $3,000.00. This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). DISPLAY OF LICENSE Pursuant to Section 400.23(7){e), Florida Statutes, Oceanside Extended Care Center shall post the license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility. The Conditional License is attached hereto as Exhibit wan CLAIM FOR RELIEF 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 Counts I, and II. B. Assess an administrative fine of $5,000.00 against Oceanside Extended Care Center on Counts I, and II. Cc. Assess and assign a conditional license status to Oceanside Extended Care Center in accordance with Section 400.23(7) (b), Florida Statutes. D. 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 12 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, Manchester Building, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Nelson E. Rodney. 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 HYNAL ORDER BY / AGENCY. ; if CM We r ia Lawton-Russell Assistant General Counsel Agency for Health Care Administration Spokane Building, Suite 103 8350 N.W. 52°79 Terrace Miami, Florida 33166 Copies furnished to: Diane Lopez Castillo Field Office Manager Agency for Health Care Administration Manchester Building 6355 N.W. 53™¢ Street Miami, Florida 33166 (U.S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) 14

Docket for Case No: 05-001125