STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ae AHCA NO.: 2004011581" vs. SUNSHINE ACRES NL OS Divo Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through its undersigned counsel, and files this Administrative Complaint against Sunshine Acres pursuant to Fla. Stat. Sections 120.569 and 120.57 (2004), alleging: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Sunshine Acres in the amount of Two Thousand Dollars ($2,000.00) for two class II deficiencies, along with a Two Hundred Fifty-Six Dollar ($256.00) survey fee pursuant to Fla. Stat. Section 400 and Fla. Admin. Code Chapter 58A-5. JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to Fla. Stat. Sections 120.569 and 120.57 (2004). 3. Venue lies in Washington County Florida, pursuant to Fla. Stat. Section 120.57 (2004) and Fla. Admin. Code Chapter 58A-5 (2004). 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Fla. Stat. Section 400, Part III (2004), and Fla. Admin. Code Chapter 58A-5 (2004). 5. Sunshine Acres is a sole proprietor, which owns a 44-bed assisted living facility, located at 2563 River Road, Caryville, Florida. The facility owned by Bruce D. Hall is licensed as an Assisted Living Facility, license #5461, and certificate number 16577, effective May 28, 2004 through May 27, 2006. Sunshine Acres is now and was at all times material hereto, a licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNTI THE RESPONDENT FAILED TO ENSURE CONTACT WAS ATTEMPTED TO THE RESIDENT’S HEALTH CARE PROVIDER FOR A SIGNIFICANT CHANGE, EFFECTING 1 OF 5 SAMPLED RESIDENTS Fla. Admin. Code Section 58A-5.0182(1)(d) (2004) §400.419, Fla. Stat. (2004) 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about December 10, 2004, AHCA conducted a complaint investigation at the Respondent’s facility. AHCA cited the facility based on the findings below, to wit: 1) A clinical record review from Doctors Memorial Hospital dated 12/7/04 revealed resident #1 was emergently admitted to the facility with pneumonia and severe cellulitis in both legs. The physician's and nursing progress notes throughout 12/7/04 revealed the resident was acutely ill and required intubation and mechanical ventilation along with broad spectrum antibiotics. The clinical record also revealed the resident was transport to Bay Medical Center on 12/7/04 at 9:30 PM due to the acuity of her illness. An interview was conducted on 12/9/04 at 8:50 AM with the Director of Nurses at Doctor's Memorial Hospital. She stated she was assisting in the emergency room when resident #1 presented and in her medical opinion the resident had been il! for some while and none of this "could have happened overnight." 2) An interview was conducted on 12/10/04 at 9:45 AM with a staff member of facility. She stated on 12/6/04 and again on 12/7/04, resident #1 was complaining of not feeling well. She stated the resident failed to attend breakfast on 12/7/04 which was very unusual for the resident and when the staff member assisted the resident with her medication on 12/7/04, the resident complained of not feeling well. The staff member stated she was the person responsible for assisting residents with their medication and had informed the owner of the resident's health complaints on 12/6/04. An interview was conducted on 12/10/04 at 9:50 AM with resident #1‘s roommate. She stated the resident #1 had been complaining most of the morning on 12/7/04 of "feeling real bad,” trouble walking, and fluid in her legs. An interview was conducted on 12/10/04 at 9:55 AM. A second staff member stated resident #1 had failed to come to breakfast on 12/7/04 and this was unlike the resident. The second staff member stated she went to check on resident #1 on 12/7/04 at approximately 10:00-10:30 AM, and found resident #1 lying on the floor. 3) A phone interview was conducted on 12/13/04 at 3:59 PM with resident #1's health care provider. She stated she last saw the resident on 10/27/04 for an initial exam and had not been contacted since by the facility related to any resident complaints or changes. 8. The deficiency was cited as a class II violation and AHCA mandated a correction date of January 9, 2005. Class “II” violations are those conditions or practices related to the operation and maintenance of a facility or to the care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of residents, other than class I violations. §400.419(1)(d) Fla. Stat. (2004) 9. The above constitutes a violation of Fla. Admin. Code Section 58A- 5.0182(1)(d)(2004), stating, “Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out.” 10. The violation alleged herein constitutes a class II violation and warrants a fine of $1,000.00. COUNT II THE RESPONDENT FAILED TO COMPLY WITH THE RESIDENT BILL OF RIGHTS AS MANIFESTED BY FAILURE TO TREAT RESIDENTS WITH RESPECT AND ACCESS TO APPROPRIATE HEALTH CARE IN A TIMELY MANNER, EFFECTING 5 OF 5 SAMPLED RESIDENTS Fla, Admin. Code Section 58A-5.0182(1)(d) (2004) §400.419, Fla. Stat. (2004) 11. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 12. On or about December 10, 2004, AHCA conducted a complaint investigation at the Respondent’s facility. AHCA cited the facility based on the findings below, to wit: 1) An unannounced complaint investigation was on 12/10/04. The facility was toured and 4 residents (#2, #3, #4, #5) were interviewed at 10:00 AM. The residents stated the facility's owner is verbally abusive at times and curses frequently. They stated the owner conducts 2-3 hour meetings and will not allow the residents to leave the meetings. The residents stated the owner will yell and curse regarding items such as toilet flushing frequency. They stated the owner "gets out of control" and that his behavior is "scary." Resident #3 stated "lord help us all if he gets mad." An interview was conducted on 12/10/04 at 9:30 AM with a staff member. The staff member stated the owner does curse and yell at the residents. She stated the owner also calls the resident's names and talks bad about the residents in their presence. An interview was conducted on 12/13/04 at 3:59 PM with the healthcare provider for the facility. She stated she visits the resident's at the facility but has been concerned that the facility owner's spouse will not allow her privacy when she speaks to the residents. 2) A clinical record review from Doctors Memorial Hospital dated 12/7/04 revealed resident #1 was emergently admitted to the facility with pneumonia and severe cellulitis in both legs. The physician's and nursing progress notes throughout 12/7/04 revealed the resident was acutely ill and required intubation and mechanical ventilation along with broad spectrum antibiotics. The clinical tecord also revealed the resident was transport to Bay Medical Center on 12/7/04 at 9:30 PM due to the acuity of her illness. An interview was conducted on 12/9/04 at 8:50 AM with the Director of Nurses at Doctor's Memorial Hospital. She stated she was assisting in the emergency room when resident #1 presented and in her medical opinion the resident had been ill for some while and none of this “could have happened overnight." An interview was conducted on 12/10/04 at 9:45 AM with a staff member of facility. She stated on 12/6/04 and again on 12/7/04, resident #1 was complaining of not feeling well. She stated the resident failed to attend breakfast on 12/7/04 which was very unusual for the resident and when the staff member assisted the resident with her medication on 12/7/04, the resident complained of not feeling well. The staff member stated she was the person responsible for assisting residents with their medication and had informed the owner of the resident's health complaints on 12/6/04. An interview was conducted on 12/10/04 at 9:50 AM with resident #1's roommate. She stated the resident #1 had been complaining most of the morning on 12/7/04 of “feeling real bad," trouble walking, and fluid in her legs. An interview was conducted on 12/10/04 at 9:55 AM. A second staff member stated resident #1 had failed to come to breakfast on 12/7/04 and this was unlike the resident. The second staff member stated she went to check on resident #1 on 12/7/04 at approximately 10:00-10:30 AM, and found resident #1 lying on the floor. A phone interview was conducted on 12/13/04 at 3:59 PM with resident #1’s health care provider. She stated she last saw the resident on 10/27/04 for an initial exam and had not been contacted since by the facility related to any resident complaints or changes. 13. The deficiency was cited as a class I violation and AHCA mandated a correction date of January 9, 2005. Class “II” violations are those conditions or practices related to the operation and maintenance of a facility or to the care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of residents, other than class I violations. §400.419(1)(d) Fla. Stat. (2004) 14. The above constitutes a violation of Fla. Admin. Code Section 58A- 5.0182(1)(d)(2004), stating, “Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out.” 15. The violation alleged herein constitutes a class II violation, and warrants a fine of $1,000.00. COUNT I A SURVEY FEE IN THE AMOUNT OF $256.00 IS IMPOSED UPON THE RESPONDENT. § 400.419 (9), Fla. Stat. 16. | AHCA repeats, re-alleges, and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 17. The above cited survey fee is imposed pursuant to, § 400.419(9), Fla. Stat., stating as follows: In addition to any administrative fines imposed, the agency may assess a survey fee, equal to the lesser of one half of the facility's biennial license and bed fee or $500, to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits conducted under s. 400.428(3)(c) to verify the correction of the violations. § 400.419 (9), Fla. Stat. (2004) WHEREFORE, AHCA demands the following relief: 1. Entry of factual and legal findings as set forth in the allegations of this administrative complaint. 2. Imposition of fines in the amount of $2,000.00. 3. Imposition of a survey fee in the amount of $256.00. NOTICE Respondent is notified that she has a right to request an administrative hearing pursuant to Fla. Stat. Section 120.57 (2004). 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, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Agency Clerk. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST 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. Respectfully submitted this A HMiay of Ape] 2005, Leon County, Tallahassee, Florida. Asgistant General Counsel fa. Bar. No. 540129 Counsel for Petitioner Agency for Healthcare Administration 2727 Mahan Drive Bldg. 3, MSC #3 Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 921-0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on Ai vay of April 2005 to: Bruce D. Hall, Sunshine Acres, 2563 River Road, Caryville, Florida 32427. 's L. Rosenthal, Esquire

Docket for Case No: 05-002162