STATE OF FLORIDA ym, AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, . Lo Petitioner, AHCA Case Nos.: 2004001055 vs. 2004002678 2004002679 SECURE PLACEMENTS, INC., 2004002889 d/b/a ASSISTED LIVING WITH GRACE, O ~ NGO] Respondent. ~ / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against SECURE PLACEMENTS, INC. d/b/a ASSISTED LIVING WITH GRACE (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION This is an action to impose upon the Respondent an administrative fine in the amount of FOUR THOUSAND FIVE HUNDRED AND 00/100 DOLLARS ($4500.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003), an administrative fine in the amount of ONE HUNDRED AND 00/100 DOLLARS ($100.00) pursuant to § 400.419(2) (d), Fla. Stat. (2003), and a survey fee in the amount of ONE HUNDRED SEVENTY-FIVE AND 00/100 DOLLARS ($175.00) pursuant to § 400.419(10), Fla. Stat. (2003). JURISDICTION AND VENUE 1. This Court has jurisdiction pursuant to §§ 120.569 and 120.57, Fla. Stat. (2003) and Chapter 28-106 Fla. Admin. Code. 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.27. PARTIES 3. The Agency is the enforcing authority with regard to assisted living facility licensure law pursuant to Chapter 400, Part TII, Florida Statutes (2003) and Fla. Admin. Code R. 58A-5. 4. Respondent operates an assisted living facility located at 3713 El Prado Blvd., Tampa, Florida 33629. S. Respondent is, and was at all times material hereto, a licensed facility under Chapter 400, Part III, Florida Statutes (2003), and Chapter 58A-5 Fla. Admin. Code, having keen issued license number 8466. COUNT I 6. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 7. Pursuant to Fla. Admin. Code R. 58A-5.024(1) (d), an assisted living facility is required to maintain, in a form, place and system ordinarily employed in good business practice and accessible to Agency staff, an up-to-date written record of major incidents occurring within the last 2 years. Such record shall contain: a clear description of each incident; the time, place, and names of individuals involved; witnesses; nature of injuries; cause if known; action taken; a description of medical or other services provided; and any steps taken to prevent recurrence. These reports shall be made by the individuals having first hand knowledge of the incidents, including paid staff, volunteer staff, emergency and temporary staff, and student interns. 8. Pursuant to Fla. Admin. Code R. 58A-5.0131(20), “major incident” is defined to include: death of a resident from other than natural causes; determining that a resident is missing; an assault on a resident resulting in an injury; an injury toa resident which requires assessment and treatment by a health care provider; or, any event, such as a fire, natural disaster, or other occurrence that results in the disruption cf the facility’s normal activities. 9. On or about 12/01/03, the Agency conducted a complaint survey (Complaint #2003008239) of the Respondent’s facility (hereinafter “Facility”). 10. Based on record review and interview during the 12/01/03 complaint survey, the Agency determined that the Respondent failed to maintain an up-to-date written record of major incidents, in violation of Fla. Admin. Code R. 58A- 5.024(1) (d). 11. According to information obtained from another state agency, Resident #1 disappeared from the Facility approximately two (2) months prior to the 12/01/03 complaint survey. 22. In a telephone interview conducted during the complaint survey, the Facility owner revealed that Resident #1 was still missing and had not returned to the Facility. 13. Record review revealed no documentation or incident report concerning Resident #1’s elopement. 14. In a telephone interview conducted during the complaint survey, the Facility owner indicated that no written report was created. 15. In an interview conducted during the 12/01/03 survey, facility staff indicated that Resident #11 eloped from the Facility approximately one (1) month prior to the survey. 16. Record review revealed no documentation or incident report concerning Resident #11's elopement. 17. Based on the above, the Agency determined that the Respondent failed to maintain an up-to-date written record of major incidents occurring within the last 2 years, in violation of Fla. Admin. Code R. 58A-5.024(1) (d). 18. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 19. The Agency cited the Respondent for a Class III viotation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 20. The Agency provided a mandated correction date of 01/04/04. 21. On or about 02/23/04, the Agency conducted a follow-up survey to the 12/01/03 complaint survey of the Facility. 22. Based upon record review and interview(s) during the 02/23/04 follow-up survey, the Agency determined that the Respondent failed to maintain an up-to-date record of major incidents, in violation of Fla. Admin. Code R. 58A-5.024(1) (d). 23. On or about 02/23/04, interview with the Facility administrator and acting Facility supervisor revealed that, during the evening of 02/22/04, Resident #1 and Resident #2 became involved in an altercation that required law enforcement to be summoned to the Facility. 24. During an interview conducted on or about 02/23/04, the Facility staff member identified as the supervisor in charge of the Facility during the time of the altercation indicated that Resident #1 was hit in the arm, and that Resident #2 fell and hit his/her head against a cabinet, but did not require first aid and refused to go to the hospital to be examined when asked to do so by Facility staff. 25. During an interview conducted on or about 02/23/04, the Facility staff member identified as the supervisor in charge of the Facility during the time of the altercation indicated that she did not complete a written record to document this major incident. 26. Record review revealed no documentation of: a description of the event, or the event’s time or place; the names of residents involved; any witnesses; the cause of the altercation; any action initiated by Facility staff; or any steps the Facility planned to undertake in order to avoid a recurrence. 27. During an interview, a Facility staff member confirmed that there was no documentation addressing those issues. 28. Based on the above, the Agency determined that the Respondent failed to maintain an up-to-date written record of major incidents occurring within the last 2 years, in violation of Fla. Admin. Code R. 58A-5.024(1) (da). 29. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 30. The Agency cited the Respondent for an uncorrected Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 31. The Agency provided a mandated correction date of 03/23/04. 32. Respondent’s failure to maintain, in a form, place and system ordinarily employed in good business practice and accessible to Agency staff, an up-to-date written record of major incidents occurring within the last 2 years, as set forth in this count, constitutes grounds for the impositicn of an administrative fine in the amount of FIVE HUNDRED DCLLARS ($500.00), pursuant to § 400.419(2)(c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT II 33. AHCA re-alleges and incorporates paragrapks one (1) through five (5) as if fully set forth herein. 34. Pursuant to Fla. Admin. Code R. 58A-5.0182(1) (e), an assisted living facility shall offer personal supervision, as appropriate for each resident, including a written record, updated as needed, of any significant changes in the resident’s normal appearance or state of health, any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services. 35. Pursuant to Pla. Admin. Code R. 58A-5.0131(20), “major incident” is defined to include the death of a resident from other than natural causes, determining that a resident is missing, an assault on a resident resulting in injury, an injury to a resident which requires assessment and treatment by a health care provider, or, any event, such as a fire, natural disaster, or other occurrence that results in the disruption of the facility’s normal activities. 36. On or about 12/01/03, the Agency conducted a complaint survey (Complaint #2003008239) of Respondent’s facility (hereinafter “Facility”). 37. Based on record review and interview during the 12/01/03 complaint survey, the Agency determined that the Respondent failed to maintain a written record, updated as needed, of major incidents, in violation of Fla. Admin. Code R. 58A-5.0182(1) (e). 38. On or about 12/01/03, interview(s) with Facility staff revealed that Resident #11 disappeared from the Facility approximately one month prior to 12/01/03 and never returned. 39. On or about 12/01/03, interview(s) with Facility staff revealed that Resident #11’s disappearance was reported to law enforcement. 40. On or about 12/01/03, review of Resident #11’s record revealed no documentation concerning Resident #11’s disappearance or attempts by the Facility to locate Resident #11. 41. On or about 12/01/03, interview(s) with Facility staff revealed that, approximately two months prior to the date of the survey, Resident #1 disappeared from the Facility and could not be located. 42. On or about 12/01/03, review of Resident #1’s record revealed no documentation concerning Resident #1’s disappearance or any attempts by the Facility to locate Resident #1. 43. Based on the above, the Agency determined that the Respondent failed to maintain a written record, updated as needed, of major incidents, in violation of Fla. Admin. Code R. 58A-5.0182(1) (e). 44. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 45. The Agency cited the Respondent for a Class IIT violation in accordance with § 400.419(2) (c), Fla. Stat. (2003). 46. The Agency provided a mandated correction date of 01/04/04. 47. On or about 02/23/04, the Agency conducted a follow-up survey to the 12/01/03 complaint survey of the Facility. 48. Based on record review and interview during the 02/23/04 follow-up survey, the Agency determined that the Respondent failed to maintain a written record, updated as needed, of major incidents. 49. On or about 02/23/04, interview with the Facility manager revealed that, during the evening of 02/22/04, Resident #1 and Resident #2 became involved in an altercation, a major incident as that term is defined in Fla. Admin. Code R. 58A- 5.0131(20). 50. On or about 02/23/04, record review revealed no . documentation of: a description of the event, or the event’s time or place; the names of residents involved; any witnesses; the cause of the altercation; any action initiated by facility staff; or any steps the facility planned to undertake in order to avoid a recurrence. 51. During interview conducted on or about 02/23/04, the Facility manager confirmed that there was no documentation that addressed those issues. 52. Based on the above, the Agency determined that the Respondent failed to maintain a written record, updated as needed; of major incidents, in violation of Fla. Adrin. Code R. 58A-5.0182(1) (e). 10 53. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indireczly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 54. The Agency cited the Respondent for an uncorrected Class III violation in accordance with § 400.419(2) (c), Fla. Stat. (2003). 55. The Agency provided a mandated correction date of 03/23/04. 56. Respondent’s failure to maintain a written record, updated as needed, of major incidents, as set forth in this counz, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00), pursuant to § 400.419(2) (c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.C0) pursuant to § 400.419(2)(c), Fla. Stat. (2093). COUNT III 57. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 58. Pursuant to Fla. Admin. Code R. 58A-5.0185(6) (b) (1), an assisted living facility shall ensure that centrally stored a1 medications are kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times. 59. Pursuant to Fla. Admin. Code R. 58A-5.0185(6) (b) (2), an assisted living facility shall ensure that refrigerated medications are secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which the refrigerator is located locked. 60. On or about 01/21/04, the Agency conducted a complaint survey (Complaint #2003000239) of Respondent’s facility (hereinafter “Facility”). 61. Based on observation, record review, and interview during the 01/21/04 complaint survey, the Agency determined that the Respondent failed to ensure that all centrally stored medications were kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times. In addition, the Agency determined that the Respondent failed to ensure that refrigerated medications are secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which the refrigerator is located locked. 62. A review of residents’ medications and medication observation record revealed that a physician had prescribed insulin to Resident #3. 12 63. During an interview, Facility staff indicated that the insulin was stored in the refrigerator located in the sitting/television area of the Facility. 64. The refrigerator in which the insulin was stored was unlocked and accessible to all residents in the Facility. 65. Inside the refrigerator, the insulin was stored in an unlocked container. 66. Based on the above, the Agency determined that the Respondent failed to ensure that refrigerated medications are secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which the refrigerator is located locked, in violation of Pla. Admin. Code R. 58A-5.0185(6) (b) (2). 67. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 68. The Agency cited the Respondent for a Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 69. The Agency provided a mandated correction date of 01/21/04. 70. On or about 02/23/04, the Agency conducted a follow-up survey to the 01/21/04 complaint survey of the Facility. 13 71. Based on observation and interview during the 02/23/04 follow-up survey, the Agency determined that the Respondent failed to ensure that all centrally stored medications were kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times. In addition, the Agency determined that the Respondent failed to ensure that refrigerated medications are secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which the refrigerator is located locked. 72. During a Facility tour on or about 02/23/04, an Agency surveyor observed an unlocked refrigerator, located in the sitting room in the northeast side of the Facility, that contained two (2) vials of insulin (Novolin) and syringes in a clear plastic bag. 73. During an interview conducted on or about 02/23/04, the Facility staff indicated that the insulin belonged to a resident who left the Facility approximately one (1) month prior to the 02/23/04 survey. 74. During a Facility tour on or about 02/23/04, an Agency surveyor observed a packet of ferrous sulfate pills lying on top of furniture that was moved to the sitting area while a bedroom was being painted. 14 75. Based on the above, the Agency determined that the Respondent failed to ensure that centrally stored medications are kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times, in violation of Fla. Admin. Code R. 58A-5.0185(6) (b) (1). 716. Based on the above, the Agency determined that the Respondent failed to ensure that refrigerated medications are secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which the refrigerator is located locked, in violation of Fla. Admin. Code R. 58A-5.0185(6) (b) (2). 77. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 78. The Agency cited the Respondent for an uncorrected Class III violation in accordance with § 400.419(2) (c), Fla. Stat. (2003). 79. The Agency provided a mandated correction date of 03/23/04. 80. Respondent’s failure to ensure that all centrally stored medications were kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times, 15 and failure to ensure that refrigerated medications are secured by being kept in a locked container within the refrigerator, by keeping the refrigerator locked, or by keeping the area in which the refrigerator is located locked, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00), pursuant to § 400.419(2)(c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT IV 81. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 82. Pursuant to Fla. Admin. Code R. 58A-5.024(3), an assisted living facility is required to maintain resident records on the premises. 83. On or about 10/20/03, the Agency conducted a complaint survey (Complaint #2003007665) of Respondent’s facility (hereinafter ‘“Facility”). 84. Based on interview(s) during the 10/20/03 complaint survey, the Agency determined that the Respondent failed to maintain resident records on the premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 16 85. During an interview conducted on or about 10/20/03, an Agency surveyor requested to review the records of six (6) residents and was informed by Facility staff that the records of three (3) of those residents (Residents #1, #3, and #7) were unavailable because they were in the possession of the Facility administrator, who was not at the Facility at the time of the interview. 86. Based on the above, the Agency determined that the Respondent failed to maintain all resident records on facility premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 87. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 88. The Agency cited the Respondent for a Class III violation in accordance with § 400.419(2) (c), Fla. Stat. (2003). 89. The Agency provided a mandated correction date of 11/20/03. 90. On or about 12/01/03, the Agency conducted a follow-up survey to the 10/20/03 complaint survey of the Facility. 91. Based on observation and interview during the 12/01/03 follow-up survey, the Agency determined that the Respondent 17 failed to maintain resident records on the premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 92. In an interview conducted on or about 12/01/03 at approximately 10:45 a.m., a Facility staff member indicated that the medical record for Resident #1 was not available for review. 93. Based on the above, the Agency determined that the Respondent failed to maintain all resident records on facility premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 94. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 95. The Agency cited the Respondent for an uncorrected Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 96. The Agency provided a mandated correction date of 01/01/04. 97. Respondent's failure to maintain resident records on the premises, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00), pursuant to § 400.419(2) (c), Fla. Stat. (2003). 18 WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT V 98. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 99. Pursuant to Fla. Admin. Code R. 58A-5.024(3), an assisted living facility is required to maintain resident records on the premises. 100. On or about 10/20/03, the Agency conducted a complaint survey (Complaint #2003007665) of Respondent’s facility (hereinafter “Facility”). 101. Based on interview(s) during the 10/20/03 complaint survey, the Agency determined that the Respondent failed to maintain resident records on the premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 102. During an interview conducted on or about 10/20/03, an Agency surveyor requested to review the records of six (6) residents and was informed by Facility staff that the records of three (3) of those residents (Residents #1, #3, and #7) were unavailable because they were in the possession of the Facility administrator, who was not at the Facility at the time of the interview. 19 103. Based on the above, the Agency determined that the Respondent failed to maintain all resident records on facility premises, in violation of Fla. Admin. Code R. 58A-5.024 (3). 104. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personalcare of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 105. The Agency cited the Respondent for a Class III violation in accordance with § 400.419(2) (c), Fla. Stat. (2003). 106. The Agency provided a mandated correction date of 11/20/03. 107. On or about 12/01/03, the Agency conducted a follow-up survey to the 10/20/03 complaint survey of the Facility. 108. Based on observation and interview during the 12/01/03 follow-up survey, the Agency determined that the Respondent failed to maintain resident records on the premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 109. In an interview conducted on or about 12/(1/03 at approximately 10:45 a.m., a Facility staff member indicated that the medical record for Resident #1 was not available for review. 110. Based on the above, the Agency determined that the Respondent failed to maintain all resident records on facility premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 20 111. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 112. The Agency cited the Respondent for an uncorrected Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 113. The Agency provided a mandated correction date of 01/91/04. 114. On or about 02/23/04, the Agency conducted a second follow-up survey to the 10/20/03 complaint survey of the Facility. 115. Based on record review and interview during the 02/23/04 follow-up survey, the Agency determined that the Respondent failed to maintain resident records on the premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 116. Review of the admission/discharge log during the 02/23/04 survey indicated a census of nine (9) Facility residents. 117. In an interview conducted on or about 02/23/04 at approximately 9:15 a.m., the Facility’s administratcr (hereinafter “Administrator”’) indicated that the resident census 21 of the Facility was actually eleven (11), and that Resident #3 and Resident #7 were not listed on the admission/discharge log. 118. When asked by an Agency surveyor to provide a record for Resident #3, the Administrator indicated that that resident’s record was located at a different facility, even though that resident resided at the (Respondent’s) Facility. 119. When asked by an Agency surveyor to provide a record for Resident #7, the Administrator provided a form entitled “Health and Social Services Assisted Living Authorization,” dated 02/01/04. 120. The Health and Social Services Assisted Living Authorization form for Resident #7 read, in part, as follows: “Authorized to: Secure Placements, INC doing business as Assisted Living with Grace.” 121. During the interview conducted on or about 02/23/04, the Administrator indicated that the Health and Social Services Assisted Living Authorization form for Resident #7 was the only information the Respondent had regarding Resident #7. 122. During record review conducted on or about 02/23/04, the Agency surveyor determined that the Facility was receiving payments for both Resident #3 and Resident #7. 123. Based on the above, the Agency determined that the Respondent failed to maintain all resident records on facility premises, in violation of Fla. Admin. Code R. 58A-5.024(3). 22 124. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 125. The Agency cited the Respondent for a continuing uncorrected Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 126. The Agency provided a mandated correction date of 03/23/04. 127. Respondent’s failure to maintain resident records or the premises, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00), pursuant to § 400.419(2) (c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($509.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT VI 128. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 129. Pursuant to Fla. Admin. Code R. 58A-5.0182(6) (a), a copy of the Resident Bill of Rights, or a summary provided by 23 the long-term care ombudsman council shall be posted in full view in a freely accessible resident area. 130. On or about 10/20/03, the Agency conducted a complaint survey (Complaint #2003007665) of Respondent’s facility (hereinafter “Facility”). 131. Based on observation and interview during the 10/20/03 complaint survey, the Agency determined that the Respondent failed to post a copy of the Resident Bill of Rights, or a summary provided by the long-term care ombudsman council, in full view in a freely accessible resident area. 132. During a tour of the Facility on or about 10/20/03, an Agency surveyor did not observe a copy of the Resident Bill of Rights, or a summary provided by the long-term care ombudsman council, in full view in a freely accessible resident area. 133. In an interview conducted on or about 10/20/03, a Facility staff member indicated that the long-term care ombudsman council was sending Resident Bill of Rights posters and brochures. 134. Based on the above, the Agency determined that the Respondent failed to post a copy of the Resident Bill of Rights, or a summary provided by the long-term care ombudsman council, in full view in a freely accessible resident area, in violation of Fla. Admin. Code R. 58A-5.0182(6) (a). 24 135. The Agency determined that this deficient practice was related to the operation and maintenance of a building or to required reports, forms, or documents that do not have the potential of negatively affecting Facility residents. 136. The Agency cited the Respondent for a Class IV violation in accordance with § 400.419(2)(d), Fla. Stat. (2003). 137. The Agency provided a mandated correction date of 11/20/03. 138. On or about 12/01/03, the Agency conducted a follow-up survey to the 10/20/03 complaint survey of the Facility. 139. Based on observation and interview during the 12/01/03 follow-up survey, the Agency determined that the Respondent failed to post a copy of the Resident Bill of Rights, or a summary provided by the long-term care ombudsman council, in full view in a freely accessible resident area. 140. During a tour of the Facility on or about 12/01/03, an Agency surveyor did not observe a copy of the Resident Bill of Rights, or a summary provided by the long-term care ombudsman council, in full view in a freely accessible resident area. 141. Based on the above, the Agency determined that the Respondent failed to post a copy of the Resident Bill of Rights, or a summary provided by the long-term care ombudsman council, in full view in a freely accessible resident area, in violation of Fla. Admin. Code R. 58A-5.0182(6) (a). 25 142. The Agency determined that this deficient practice was related to the operation and maintenance of a building or to required reports, forms, or documents that do not heéve the potential of negatively affecting Facility residents. 143. The Agency cited the Respondent for an uncorrected Class IV violation in accordance with § 400.419(2) (d), Fla. Stat. (2003). 144. The Agency provided a mandated correction date of 01/01/04. 145. Respondent’s failure to post a copy of the Resident Bill of Rights, or a summary provided by the long-term care ombudsman council, in full view in a freely accessible resident area, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE HUNDRED DOLLARS ($100.00), pursuant to § 400.419(2) (d), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of ONE HUNDRED DOLLARS ($190.00) pursuant to § 400.419(2)(d), Fla. Stat. (2003). COUNT VII 146. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 147. Pursuant to Fla. Admin. Code R. 58A-5.0182(6)(c), the address and telephone number for lodging complaints against a 26 facility or facility staff with the district long-term care ombudsman council, the Advocacy Center for Persons with Disabilities, the Human Rights Advocacy Committee and agency area office, shall be posted in full view in a common area accessible to all residents. 148. On or about 10/20/03, the Agency conducted a complaint survey (Complaint #2003007665) of Respondent's facility (hereinafter “Facility”). 149. Based on observation during the 10/20/03 complaint survey, the Agency determined that the Respondent failed to post, in full view in a common area accessible to all residents, the address and telephone number for lodging complaints against a facility or facility staff with the district long-term care ombudsman council, the Advocacy Center for Persons with Disabilities, the Human Rights Advocacy Committee ard agency area office. 150. During a tour of the Facility on or about 10/20/03, an Agency surveyor did not observe posted anywhere in the Facility the address and telephone number for lodging complaints against a facility or facility staff with the district long-term care ombudsman council, the Advocacy Center for Persons with Disabilities, the Human Rights Advocacy Committee and agency area office. 27 151. Based on the above, the Agency determined that the Respondent failed to post, in full view in a common area accessible to all residents, the address and telephone number for lodging complaints against a facility or facility staff with the district long-term care ombudsman council, the Advocacy Center for Persons with Disabilities, the Human Rights Advocacy Committee and agency area office, in violation of Fla. Admin. Code R. 58A-5.0182(6) (c). 152. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 153. The Agency cited the Respondent for a Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 154. The Agency provided a mandated correction date of 11/20/03. 155. On or about 12/01/03, the Agency conducted a follow-up survey to the 10/20/03 complaint survey of the Facility. 156. Based on observation during the 12/01/03 follow-up survey, the Agency determined that the Respondent failed to post, in full view in a common area accessible to all residents, the address and telephone number for the Advocacy Center for 28 Persons with Disabilities, and the Human Rights Advocacy Committee. 157. During a tour of the Facility on or about 12/01/03, an Agency surveyor did not observe posted anywhere in the Facility the address and telephone number for the Advocacy Ceater for Persons with Disabilities, or the Human Rights Advocacy Committee. 158. Based on the above, the Agency determined that the Respondent failed to post, in full view in a common area accessible to all residents, the address and telephone number for the Advocacy Center for Persons with Disabilities, and the Human Rights Advocacy Committee, in violation of Fla. Admin. Code R. 58A-5.0182(6) (c). 159. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 160. The Agency cited the Respondent for an uncerrected Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 161. The Agency provided a mandated correction date of 01/01/04. 29 162. Respondent’s failure to post, in full view in a common area accessible to all residents, the address and telephone number for lodging complaints against a facility or facility staff with the district long-term care ombudsman council, the Advocacy Center for Persons with Disabilities, the Human Rights Advocacy Committee and agency area office, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DCLLARS ($500.00), pursuant to § 400.419(2)(c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT VIII 163. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 164. Pursuant to Fla. Admin. Code R. 58A-5.023(1) (b), an assisted living facility’s physical structure, including the interior and exterior walls, floors, roof and ceilirgs shall be structurally sound and in good repair. 165. On or about 12/01/03, the Agency conductec a follow-up survey to a 10/20/03 complaint survey of the Responcent’s facility (hereinafter “Facility”). 166. Based on observation during the 12/01/03 survey, the Agency determined that the Respondent failed to ensure that the 30 Facility’s physical structure, including the interior and exterior walls, floors, roof and ceilings were structurally sound and in good repair. 167. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed holes in the walls of Resident #6'S bedroom. 168. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed that a baseboard was removed from one of the walls in Resident #6’s bedroom. 169. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed that walls throughout the Facility were dirty and marred. 170. Based on the above, the Agency determined that the Respondent failed to ensure that the Facility’s physical structure, including the interior and exterior walls, floors, roof and ceilings were structurally sound and in good repair, in violation of Fla. Admin. Code R. 58A-5.023(1) (b). 171. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 172. The Agency cited the Respondent for a Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 31 173. The Agency provided a mandated correction date of 01/01/04. 174. On or about 02/23/04, the Agency conducted a second follow-up survey to the 10/20/03 complaint survey of the Facility. 175. Based on observation during the 02/23/04 survey, the Agency determined that the Respondent failed to ensure that the Facility’s physical structure, including the interior and exterior walls, floors, roof and ceilings were structurally sound and in good repair. 176. During a tour of the Facility on or Agency surveyor observed holes in the wall of bedroom. 177. During a tour of the Facility on or Agency surveyor observed that a baseboard was of the walls in Resident #4’s bedroom. 178. During a tour of the Facility on or Agency surveyor observed that a baseboard was portion of a hallway. 179. During a tour of the Facility on or about 02/23/04, an Resident #4’s about 02/23/04, an removed from one about 02/23/04, an removed from one about 02/23/04, an Agency surveyor observed that walls throughout the Facility were dirty, marred, and scraped. 180. Based on the above, the Agency determined that the Respondent failed to ensure that the Facility’ 32 s physical structure, including the interior and exterior walls, floors, roof and ceilings were structurally sound and in good repair, in violation of Fla. Admin. Code R. 58A-5.023(1) (b). 181. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 182. The Agency cited the Respondent for an uncorrected Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 183. The Agency provided a mandated correction date of 03/23/04. 184. Respondent’s failure to ensure that the Facility’s physical structure, including the interior and exterior walls, floors, roof and ceilings were structurally sound and in good repair, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00), pursuant to § 400.419(2)(c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($590.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT_IX 33 185. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 186. Pursuant to Fla. Admin. Code R. 58A-5.023(1) (b), an assisted living facility’s windows, doors, plumbing, and appliances shall be functional and in good working crder. 187. On or about 10/20/03, the Agency conducted a complaint survey (Complaint #2003007665) of Respondent’s facility (hereinafter “Facility”). 188. Based on observation during the 10/20/03 survey, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order. 189. During a tour of the Facility on or about 10/20/03, an Agency surveyor observed that the glass pane was missing from Resident #3’s bedroom window. 190. During a tour of the Facility on or about 10/20/03, an Agency surveyor observed that the door for one of the resident bedrooms was missing a doorknob. 191. Based on the above, the Agency determined that the Respondent failed to ensure that the Facility’s wincows, doors, plumbing, and appliances were functional and in gooc working order, in violation of Fla. Admin. Code R. 58A-5.023(1) (b). 192. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to 34 the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 193. The Agency cited the Respondent for a Class IIT violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 194. The Agency provided a mandated correction date of 11/15/03. 95. On or about 12/01/03, the Agency conducted a follow-up survey to the 10/20/03 complaint survey of the Facility. 196. Based on observation during the 12/01/03 survey, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order. 197. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed that the door for one of the resident bedrooms was missing a doorknob. 198. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed that Resident #2’s bedroom door was rotting near the bottom. 199. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed windows with bent screens in two resident bedrooms. 35 200. In an interview conducted on or about 12/01/03, a Facility resident stated that the Facility was cold at night and that there was no heat in the Facility. 201. When the Agency surveyor asked Facility staff to turn on che heat to verify the accuracy of the resident’s complaint, the staff indicated that they were unable to do so because a locked box, for which the facility staff did not have a key, protects the thermostat. 202. Based on the above, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order, in violation of Fla. Admin. Code R. 58A-5.023 (1) (b). 203. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 204. The Agency cited the Respondent for an uncorrected Class TII violation in accordance with § 400.419(2) (c), Fla. Stat. (2003). 205. The Agency provided a mandated correction date of 01/01/04. 206. Respondent’s failure to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in 36 good working order, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00), pursuant to § 400.419(2) (c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT X 207. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 208. Pursuant to Fla. Admin. Code R. 58A-5.023(1) (b), an assisted living facility’s windows, doors, plumbing, and appliances shall be functional and in good working order. 209. On or about 10/20/03, the Agency conducted a complaint survey (Complaint #2003007665) of Respondent’s facility (hereinafter “Facility”). 210. Based on observation during the 10/20/03 survey, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order. 211. During a tour of the Facility on or about 10/20/03, an Agency surveyor observed that the glass pane was missing from Resident #3'’s bedroom window. 37 212. During a tour of the Facility on or about 10/20/03, an Agency surveyor observed that the door for one of the resident bedrooms was missing a doorknob. 213. Based on the above, the Agency determined that the Respondent failed to ensure that the Pacility’s windows, doors, plumbing, and appliances were functional and in good working order, in violation of Fla. Admin. Code R. 58A-5.023(1) (b). 214. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 215. The Agency cited the Respondent for a Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 216. The Agency provided a mandated correction date of 11/15/03. 217. On or about 12/01/03, the Agency conducted a follow-up survey to the 10/20/03 complaint survey of the Facility. 218. Based on observation during the 12/01/03 survey, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order. 38 219. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed that the door for one of the resident bedrooms was missing a doorknob. 220. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed that Resident #2's bedroom door was rotting near the bottom. 221. During a tour of the Facility on or about 12/01/03, an Agency surveyor observed windows with bent screens in two resident bedrooms. 222. In an interview conducted on or about 12/01/03, a Facility resident stated that the Facility was cold at night and that there was no heat in the Facility. 223. When the Agency surveyor asked Facility staff to turn on the heat to verify the accuracy of the resident’s complaint, the staff indicated that they were unable to do so because a locked box, for which the facility staff did not have a key, protects the thermostat. 224. Based on the above, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order, in violation of Fla. Admin. Code R. 58A-5.023(1) (b). 225. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the care of Facility residents, and indirectly or potentially 39 threatened the physical or emotional health, safety, or security of Facility residents. 226. The Agency cited the Respondent for an uncorrected Class III violation in accordance with § 400.419(2) (c), Fla. Stat. (2003). 227. The Agency provided a mandated correction date of 01/01/04. 228. On or about 02/23/04, the Agency conducted a second follow-up survey to the 10/20/03 complaint survey of the Facility. 229. Based on observation during the 02/23/04 survey, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order. 230. During a tour of the Facility on or about 02/23/04, an Agency surveyor observed windows with bent screens in two resident bedrooms. 231. Based on the above, the Agency determined that the Respondent failed to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order, in violation of Fla. Admin. Code R. 58A-5.022(1) (b). 232. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or 40 potentially threatened the physical or emotional health, safety, or security of Facility residents. 233. The Agency cited the Respondent for a continuing uncorrected Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 234. The Agency provided a mandated correction date of 03/23/04. 235. Respondent’s failure to ensure that the Facility’s windows, doors, plumbing, and appliances were functional and in good working order, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00), pursuant to § 400.419(2)(c), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent an administrative fine in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to § 400.419(2)(c), Fla. Stat. (2003). COUNT XI 236. AHCA re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 237. Pursuant to § 400.419(10), Fla. Stat. (2003), 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 41 in the finding of a violation that was the subject of the complaint. 238. Pursuant to Fla. Admin. Code R. 58A-5.0182(6) (f), assisted living facility residents may not be required to perform any work in the facility without compensation, except that facility rules or the facility contract may include a requirement that the residents be responsible for cleaning their own sleeping areas or apartments. 239. On or about 10/16/03, the Agency received a complaint regarding the Respondent’s facility (hereinafter “Facility”). 240. The complainant alleged, inter alia, that residents of the Facility were required to perform work at the Facility without receiving compensation for such work. 241. On or about 10/20/03, based upon the complaint received on or about 10/16/03, the Agency conducted a complaint survey (Complaint #2003007665) of Respondent’s Facility. 242. In interviews conducted during the 10/20/03 survey, four (4) residents indicated that Facility staff ordered them to engage in various household duties, including cleaning bathrooms, mopping floors, washing dishes, and performing yard work. 243. The interviewed residents indicated that they received no pay in exchange for performing such duties. 42 244. Based on the above, the Agency determined the Respondent required residents to perform work in the facility witnout compensation, in violation of Fla. Admin. Ccde R. 58A- 5.0182 (6) (f£). 245. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 246. The Agency cited the Respondent for a Class III violation in accordance with § 400.419(2)(c), Fla. Stat. (2003). 247. The Agency provided a mandated correction date of 11/15/03. 248. The Facility’s biennial license and bed fee at the time of this survey was THREE HUNDRED FIFTY AND NO/100 DOLLARS ($350). 249. Based upon the Agency’s initial complaint investigations that resulted in the finding of a violation that was the subject of the complaint, the Respondent is subject to survey fee of ONE HUNDRED SEVENTY-FIVE HUNDRED DOLLARS ($175.00) pursuant to § 400.419(10), Fla. Stat. (2003). WHEREFORE, the Agency intends to impose upon the Respondent a survey fee in the amount of ONE HUNDRED SEVENTY-FIVE HUNDRED DOLLARS ($175.00) pursuant to § 400.419(10), Fla. Stat. (2003). 43 Respectfully submitted this 30” day of June, 2005.