STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ne STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, >> Petitioner, 2 7 vs. Case No. 2005004486 MAPLEWAY COMMUNITY, INC., O87 Al 4 o Respondent. « / ADMINISTRATIVE COMPLAINT COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ‘D, ADMINISTRATION (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against MAPLEWAY COMMUNITY, INC. (hereinafter “Respondent”), pursuant to §§ 120.569 and 120.57, Fla. Stat. (2004), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of THREE THOUSAND DOLLARS ($3,000.00), pursuant to § 400.419(2)(b), Fla. Stat. (2004), and a monitoring visit survey fee in the amount of ONE HUNDRED SIXTY-ONE AND 50/100 DOLLARS ($161.50), pursuant to §§ 400.419(10) and 400.428(3)(c), Fla. Stat. (2004), based upon the existence of three (3) Class II violations. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and 400.407, Fla. Stat. (2004). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable regulations, rules, and statutes governing assisted living facilities pursuant to Chapter 400, Part IIT, Florida Statutes, and Chapter 58A-5 Florida Administrative Code. 4. Respondent operates a twenty (20) bed assisted living facility located at 475 Maple Way, Safety Harbor, Florida 34695, and is licensed as an assisted living facility (License No. 8504). 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable regulations, rules, and statutes. COUNT 1 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 7. Pursuant to § 400.426(1), Fla. Stat. (2004), the owner or administrator of an assisted living facility is responsible for determining the appropriateness of admission of an individual to the facility and for determining the continued appropriateness of residence of an individual in the facility. A determination shall be based upon an assessment of the strengths, needs, and preferences of the resident, the care and services offered or arranged for by the facility in accordance with facility policy, and any limitations in law or rule related to admission criteria or continued residency for the type of license held by the assisted living facility under Part Il), Chapter 400, Florida Statutes. 8. Pursuant to Fla. Admin. Code R. 58A-5.0181(4)(d), the owner or administrator of an assisted living facility is responsible for monitoring the continued appropriateness of placement of a resident in the facility. 9. Pursuant to § 400.441(1)(k), Fla. Stat. (2004), the use of physical restraints in an assisted living facility is limited to half-bed rails as prescribed and documented by the resident's physician with the consent of the resident or, if applicable, the resident's representative or designee or the resident's surrogate, guardian, or attorney in fact. 10. Pursuant to Fla. Admin. Code R. 58A-5.0182(6)(h), the use of physical restraints in an assisted living facility shall be limited to half-bed rails, and only upon the written order of the resident’s physician. 11. Pursuant to Fla. Admin. Code R. 58A-5.0181(1)(g), one criterion for admission and continued residency of a resident in an assisted living facility is that a resident not be a danger to self or others as determined by a physician, or mental health provider. 12. On or about May 5, 2005, the Agency conducted a biennial licensure survey of the Respondent’s assisted living facility (hereinafter “Facility”), in conjunction with a limited mental health license survey and complaint investigation (CCR# 2005002944). 13. Based on observation, record review and interviews, the Agency determined that the Respondent’s administrator failed to ensure that three (3) of eight (8) sampled residents were appropriately placed in an assisted living facility (Residents #2, #4, #8). Resident #2 14. Review of Resident #2’s August 11, 2004, “Monthly Summary/LRC Report Form,” which was completed by a board certified behavioral analyst, indicated that Resident #2 demonstrated the following behaviors in July 2004: 3 elopements, 2 aggressions to property; and 1 aggression to others. 15. The August 11, 2004, Monthly Summary/LRC Report Form described an incident in which Resident #2 attacked another resident so violently that the other resident required emergency medical attention at a local hospital in August 2004. That incident was described as follows: On August 7" [Resident #2] became enraged at a male staff and tried to attack him, when [he/she] was blocked to the attack [he/she] turned on another male resident and attacked him so voraciously that he needed emergency medical attention at the local hospital. [He/She] bit his arm, scratched his face in several places, and hit him multiple times before [he/she] should be restrained. 911 was called and [Resident #2] was Baker Acted to Morton Plant’s psychiatric unit. This is not the first time that [Resident #2] required police involvement to ger [him/her] under control. One other time police were called and [he/she] attacked two of them and was arrested. 16. | A“Functional Behavioral Assessment” for the time frames of August 30, 2004, through September 28, 2004, indicated that the assessment was conducted “due to the severity of [Resident #2’s] aggression to others.” 17. The Medical/Psychological section of the Functional Behavioral Assessment revealed that, prior to admission to the Facility, Resident #2 had been diagnosed with “Intermittent Explosive Disorder, Impulse Control Disorder, Dysthymic Disorder, Post Traumatic Stress Disorder, and Attention Deficit Disorder.” 18. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that, since the time of the placement at the Facility, Resident #2 has been involved in several incidences of property destruction and physical aggression. One such instance was described in the Functional Behavioral Assessment as follows: During one such episode [Resident #2] became angry because [he/she] was jealous of the attention being shown to another consumer. [He/She] attempted to flip over a large screen TV in the residence and was prevented from doing so by the owner of [the Facility]. [Resident #2's] behavior immediately escalated to the point that [he/she] was trying to destroy property and even hung from the ceiling fan during the episode. [He/She] became aggressive and required [Professional Crisis Management] by four staff members to restrain [him/her]. The police were called and when they arrived they instructed the staff to release [Resident #2] without giving them the benefit of relaying [his/her] history with physical aggression. [Resident #2] attacked one of the police officers and grabbed his crotch, refusing to let go. Other officers used nightsticks to get [Resident #2] off the officer. When they realized that [Resident #2] would not let go, they charged [him/her] and tackled [him/her] to the ground, forcing [him/her] to let go of the officer. [Resident #2] was cuffed and Baker Acted; the officer required medical attention. 19. Professional crisis management (hereinafter “PCM”) is a technique utilized to manage crisis situations such as aggression or property destruction. The “Crisis Intervention” component of PCM is designed to stabilize and contain crisis behaviors by utilizing “physical procedures,” which serve as physical restraints. 20. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment described a different incident, in which Resident #2 became “increasingly upset” after learning that he/she would not be allowed to check out a video because of an unpaid late fine, as follows: The library notified [the Respondent] immediately and requested additional staff to handle the situation. By the time the staff arrived [Resident #2] became physically aggressive and needed to be restrained. The police were called and they arrived along with paramedics. Again the police removed the staff from prone restraint and [Resident #2] aggressed on police. Paramedics brought a gurney and [Resident #2] was put in leather restraints by six policemen and tied to the gurney by paramedics. During the episode, [Resident #2] aggressed on a paramedic and hurt him to the point that he required medical attention. 21. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that, according to Facility staff members, Resident #2 “becomes very upset, (sometimes to the point of aggression) and demands immediate attention when [he/she] sees male/female exchange of affection.” The Functional Behavioral Assessment indicated that the last such episode resulted in Resident #2 injuring a male staff member who attempted to intervene, which resulted in that staff member seeking treatment at a hospital. 22. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that “Although {Resident #2’s| aggressions are fewer and farther between, they remain very intense and almost always result in (him/her] being Baker Acted.” 23. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that the Facility’s administrator (hereinafter “Administrator”) contends that “if proper de-escalation procedures and appropriate prone restraint are used, Baker Acting can be avoided.” 24. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that during his/her violent episodes, Resident #2 “almost always hurts someone badly and/or gets hurt [himsel f/herself].” 25. Under the heading “Behaviors of Concern,” the Functional Behavioral Assessment contains the following entry: Aggression to others (ATO) — [Resident #2] will hit, kick, bite, punch, slap, push, and grab the person [he/she] targets by their genitals. Property destruction (PD) — [Resident #2] will throw things, break things, knock things over i.e. TVs, and otherwise destroy property. This is usually part of a chain that leads to ATO. 26. A “Functional Assessment Interview” indicates that aggressive behavior by Resident #2 “usually occurs in the residence.” 27. The Functional Assessment Interview indicates that “Staff must have support when attempting to intervene with [Resident #2] when [he/she] is physically aggressive. Typically, a number of PCM-trained staff are required and law enforcement has been called on several occasions for extra support.” 28. Despite Resident #2’s repeated history of aggressive physical behavior towards others, and the Respondent’s routine use of prone restraint and/or PCM techniques to physically restrain Resident #2 in such instances, in violation of the prohibition of the use of such physical restraints in an assisted living facility, Resident #2 still resided at the Facility as of the May 5, 2005, survey. 29. Resident #2’s continued admission and residency in the Facility indicates that the Respondent failed to ensure that that resident was appropriately placed in an assisted living facility, in violation of § 400.426(1), Fla. Stat. (2004), and of Fla. Admin. Code R. 58A- 5.0181(4)(d). Resident #4 30. Review of Resident #4’s March 23, 2004, “Summary of Behavioral Analysis Services” indicated that Resident #4 “engages in physical aggression to others, elopement, and asking repetitive questions to others.” In addition, that Summary indicated that Resident #4 “has extreme difficulty walking and uses a wheelchair for long distances. [His/her] elopement places [him/her] at extreme risk and can be easily exploited.” 31. Under the heading “Effect of Services,” the Summary of Behavioral Analysis Services indicates that Resident #4’s “aggression and elopement is down to less than one a month.” 32. Despite Resident #4’s history of aggressive physical behavior towards others and propensity to elope, which places that resident “at extreme risk,” Resident #4 still resided at the Facility as of the May 5, 2005, survey. 33. Resident #4’s continued admission and residency in the Facility indicates that the Respondent failed to ensure that that resident was appropriately placed in an assisted living facility, in violation of § 400.426(1), Fla. Stat. (2004), and of Fla. Admin. Code R. 58A- 5.0181(4)(d). Resident #8 34, Record review of Resident #8's “Behavioral Intervention Plan,” with an implementation date of April 1, 2005, and revision date of April 12, 2005, indicated that resident has diagnoses including mild mental retardation, deafness and autism. 35. According to Resident #8’s Behavioral Intervention Plan: [Resident #8] displays a number of inappropriate behaviors that function as escape responses and to gain access to tangibles and preferred activities. These behaviors include aggression towards others, property destruction, and self abuse. The topography of [his/her] aggressions towards others consists of punching, kicking, pushing/shoving, grabbing, scratching or hitting others using [his/her] fist or open hand. The topography of [his/her] property destruction consists of tearing, throwing, kicking, hitting, or breaking objects that do not belong to [him/her]. 36. Inaddition, Resident #8’s Behavior Intervention Plan indicates that Resident #8’s aggressive behaviors “can be quite intense when the do occur.” Accordingly, Facility staff “has been trained to use Professional Crisis Management (PCM) intervention strategies. Staff members will use prompt de-escalation procedures first and progress to the least restrictive most effective hands-on intervention procedures according to PCM guidelines.” 37. A “Functional Behavioral Assessment” for the time frame of February 1, 2004, through February 28, 2004, indicated that Resident #8 was referred for behavioral services “due to his frequent episodes of physical aggression towards others.” That same report indicates that Resident #8’s “aggressions are usually moderate but at times they may be intense as he has caused injury to others that require medical attention...” 38. A “Behavior Incident Reporting Form.” dated July 16, 2004, indicated that, in an incident of aggression to person, Resident #8 “started yelling and hit the seats and different people. [He/She] hit one consumer in the mouth and caused his lip to bleed.” 39. A “Behavior Incident Reporting Form,” dated August 2, 2004, indicated that, in another incident of aggression to person, Resident #8 punched an individual, who then fell on the floor. That form indicates that Resident #8 aggression was “for no reason.” 40. A “Behavior Incident Reporting Form,” dated August 11, 2004, indicated that Resident #8 engaged in another incident of “aggression to person,” which resulted in Resident #8 being physically restrained by Facility staff. An attachment to that form described the incident as follows: [Resident #8] was interacting with another consumer in a brief conversation on the patio at ADT. When the other consumer decided to offer his hand ina friendly shake, [Resident #8] said nothing and got up to physically throw a punch at the jaw of the consumer. The consumer responded with an equal reaction until staff separated them. 41. A “Behavior Incident Reporting Form,” dated November 17, 2004, indicated that Resident #8 engaged in another incident of “aggression to person.” An attachment to that form indicated that Resident #8 “hit another consumer on the leg.” 42. During the survey on or about May 5, 2005, at approximately 4:15 p.m., while accompanying an Agency surveyor back to the administrative office area of the Facility, Resident #8 placed one hand on each side of the Agency surveyor’s head, jerked the Agency surveyor’s head down, and rubbed his face in the Agency surveyor’s hair. The Agency surveyor was startled and frightened by Resident #8’s actions. 43. Despite Resident #8’s repeated history of aggressive physical behavior towards others, and the Respondent’s routine use of prone restraint and/or PCM techniques to physically restrain Resident #8 in such instances, in violation of the prohibition of the use of such physical restraints in an assisted living facility, Resident #8 still resided at the Facility as of the May 5, 2005, survey. 44. Resident #8’s continued admission and residency in the Facility indicates that the Respondent failed to ensure that that resident was appropriately placed in an assisted living facility, in violation of § 400.426(1), Fla. Stat. (2004), and of Fla. Admin. Code R. 58A- 5.0181(4)(d). 45. Based upon the above, the Agency determined that the Respondent’s Administrator failed to ensure that three (3) of eight (8) sampled residents were appropriately placed in an assisted living facility, in violation of § 400.426(1), Fla. Stat. (2004), and Fla. Admin. Code R. 58A-5.0181(4)(d). 46. The deficient practice described in this count constituted, in part, the basis for an immediate moratorium on admissions, which the Agency imposed upon the Respondent, pursuant to § 400.415, Fla. Stat. (2004), in an emergency order dated May 18, 2005. 47. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of the Facility residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 48. The Agency cited the Respondent for a Class II violation pursuant to § 400.419(2)(b), Fla. Stat. (2004). 49. The Agency provided Respondent with a mandatory correction date of May 17, 2005. 50. Respondent’s failure to ensure that three (3) of eight (8) sampled residents were appropriately placed in an assisted living facility, in violation of § 400.426(1), Fla. Stat. (2004), and Fla. Admin. Code R. 58A-5.0181(4)(d), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND DOLLARS ($1000.00), pursuant to § 400.419(2)(b), Fla. Stat. (2004). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND DOLLARS ($1,000.00) upon Respondent, an assisted living facility in the State of Florida, pursuant to § 400.419(2)(b), Fla. Stat. (2004). COUNT I 51. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 52. Pursuant to Fla. Admin. Code R. 58A-5.0182, an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. 53. On or about May 5, 2005, the Agency conducted a biennial licensure survey of the Respondent’s assisted living facility (hereinafter “Facility”), in conjunction with a limited mental health license survey and complaint investigation (CCR# 2005002944). 54. Based on record review and interview, the Agency determined that the Respondent failed to provide care and services appropriate to the needs of two (2) of eight (8) reviewed residents that were accepted for admission to the Facility (Residents #3 and #6). Resident #3 55. Review of Resident #3's clinical record revealed a practitioner's order, dated April 5, 2005, directing the Facility to “keep a chart of percentage of food eaten at each meal.” 56. Although review of Resident #3's record revealed a list of the food the resident ate each day, there was no chart documenting the percentage of food eaten at each meal. Resident #6 57. Record review revealed that Resident #6 was admitted to the Facility on or about April 16, 2005. 58. Review of Resident #6's clinical record revealed from the "Developmental Disability Support/Plan Update" that Resident #6 had a need for "Nebulizer - breathing treatments” and required “Combivent Inhalation aerosol 14.7g/200 actuations” as needed for treatment of asthma. 59. The Facility’s medication observation record contained no entries concerning any medications or breathing treatments for Resident #6. 60. On or about May 3, 2005, Resident #6 was sent to an emergency room as a result of breathing problems. 61. At the time of the May 5, 2005, survey, Resident #6 remained in the hospital. 62. In an interview conducted on or about May 5, 2005, at approximately 3:45 p.m., the Administrator indicated that he was not aware that Resident #6 required any medication or breathing treatments. 63. Based upon the above, the Agency determined that the Respondent failed to ensure that two (2) of eight (8) sampled residents were provided care and services appropriate to their needs, in violation of Fla. Admin. Code R. 58A-5.0182. 64. The deficient practice described in this count constituted, in part, the basis for an immediate moratorium on admissions, which the Agency imposed upon the Respondent, pursuant to § 400.415, Fla. Stat. (2004), in an emergency order dated May 18, 2005. 65. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of the Facility residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 66. The Agency cited the Respondent for a Class II violation pursuant to § 400.419(2)(b), Fla. Stat. (2004). 67. The Agency provided Respondent with a mandatory correction date of May 19, 2005. 68. Respondent’s failure to ensure that two (2) of eight (8) sampled residents were provided care and services appropriate to their needs, in violation of Fla. Admin. Code R. S8A- 5.0182, as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND DOLLARS ($1000.00), pursuant to § 400.419(2)(b), Fla. Stat. (2004). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND DOLLARS ($1,000.00) upon Respondent, an assisted living facility in the State of Florida, pursuant to § 400,419(2)(b), Fla. Stat. (2004). COUNT II 69. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 70. Pursuant to § 400.428(1) (a) Fla. Stat. (2004), every resident of an assisted living facility shall have the right to live in a safe and decent living environment, free from abuse and neglect. 71. On or about May 5, 2005, the Agency conducted a biennial licensure survey of the Respondent’s assisted living facility (hereinafter “Facility”), in conjunction with a limited mental health license survey and complaint investigation (CCR# 2005002944). 72. Based on record review, interview and observation, the Agency determined that the Respondent failed to provide a safe and decent living environment for residents of the Facility. Resident #2 73. Review of Resident #2’s August 11, 2004, “Monthly Summary/LRC Report Form,” which was completed by a board certified behavioral analyst, indicated that Resident #2 demonstrated the following behaviors in July 2004: 3 elopements, 2 aggressions to property; and 1 aggression to others. 74. The August 11, 2004, Monthly Summary/LRC Report Form described an incident in which Resident #2 attacked another resident so violently that the other resident required emergency medical attention at a local hospital in August 2004. That incident was described as follows: On August 7" [Resident #2] became enraged at a male staff and tried to attack him, when [he/she] was blocked to the attack [he/she] turned on another male resident and attacked him so voraciously that he needed emergency medical attention at the local hospital. [He/She] bit his arm, scratched his face in several places, and hit him multiple times before [he/she] should be restrained. 911 was called and [Resident #2] was Baker Acted to Morton Plant’s psychiatric unit. This is not the first time that [Resident #2] required police involvement to get [him/her] under control. One other time police were called and [he/she] attacked two of them and was arrested. 75. A “Functional Behavioral Assessment” for the time frames of 08/30/04 - 09/28/04 indicated that the assessment was conducted “due to the severity of [Resident #2’s] aggression to others.” 76. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that, since the time of the placement at the Facility, Resident #2 has been involved in several incidences of property destruction and physical aggression. One such instance was described in the Functional Behavioral Assessment as follows: During one such episode [Resident #2] became angry because [he/she] was jealous of the attention being shown to another consumer. [He/She] attempted to flip over a large screen TV in the residence and was prevented from doing so by the owner of [the Facility]. [Resident #2's] behavior immediately escalated to the point that he/she was trying to destroy property and even hung from the ceiling fan during the episode. He/she became aggressive and required [Professional * Crisis Management] by four staff members to restrain [him/her]. The police were called and when they arrived they instructed the staff to release [Resident #2] without giving them the benefit of relaying [his/her] history with physical aggression. [Resident #2] attacked one of the police officers and grabbed his crotch, refusing to let go. Other officers used nightsticks to get [Resident #2] off the officer. When they realized that [Resident #2] would not let go, they charged [him/her] and tackled [him/her] to the ground, forcing [him/her] to let go of the officer. [Resident #2] was cuffed and Baker Acted; the officer required medical attention. 77. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that, according to Facility staff members, Resident #2 “becomes very upset, (sometimes to the point of aggression) and demands immediate attention when [he/she] sees male/female exchange of affection.” The Functional Behavioral Assessment indicated that the last such episode resulted in Resident #2 injuring a male staff member who attempted to intervene, which resulted in that staff member seeking treatment at a hospital. 78. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that “Although [Resident #2’s] aggressions are fewer and farther between, they remain very intense and almost always result in [him/her] being Baker Acted.” 79. Under the heading “Functional Assessment Interviews and Observations Summary,” the Functional Behavioral Assessment indicated that during his/her violent episodes, Resident #2 “almost always hurts someone badly and/or gets hurt [himself/herself].” 80. Under the heading “Behaviors of Concern,” the Functional Behavioral Assessment contains the following entry: Aggression to others (ATO) — [Resident #2] will hit, kick, bite, punch, slap, push, and grab the person [he/she] targets by their genitals. Property destruction (PD) — [Resident #2] will throw things, break things, knock things over i.e. TVs, and otherwise destroy property. This is usually part of a chain that leads to ATO. 81. A “Functional Assessment Interview” indicates that aggressive behavior by Resident #2 “usually occurs in the residence.” 82. As of the May 5, 2005, survey, Resident #2 still resided at the Facility. Resident #3 83. Under the heading “Behaviors of Concern,” a Behavioral Assessment for Resident #3, dated November 10, 2002, noted that that resident engages in physical aggression to others. The entry indicates that Resident #3 “will slap or hit another person.” The entry also indicates that “Intensity is low...Frequency is opportunistic. ..but occurs at least weekly.” 84. Under the heading “Behaviors of Concern,” the Behavioral Assessment for Resident #3 notes that that resident “will push or physically intimidate others...” Resident #4 85. Under the heading “Rationale for Behavior Services,” a Summary of Behavioral Analysis Services for Resident #4, dated March 23, 2004, indicated that that resident “engages in physical aggression to others.” Resident #8 86. Record review of Resident #8's “Behavioral Intervention Plan.” with an implementation date of April 1, 2005, and revision date of April 12, 2005, indicated that resident has diagnoses including mild mental retardation, deafness and autism. 87. According to Resident #8’s Behavioral Intervention Plan: [Resident #8] displays a number of inappropriate behaviors that function as escape responses and to gain access to tangibles and preferred activities. These behaviors include aggression towards others, property destruction, and self abuse. The topography of [his/her] aggressions towards others consists of punching, kicking, pushing/shoving, grabbing, scratching or hitting others using [his/her] fist or open hand. The topography of [his/her] property destruction consists of tearing, throwing, kicking, hitting, or breaking objects that do not belong to [him/her]. 88. A “Functional Behavioral Assessment” for the time frame of February 1, 2004, through February 28, 2004, indicated that Resident #8 was referred for behavioral services “due to his frequent episodes of physical aggression towards others.” That same report indicates that Resident #8’s “aggressions are usually moderate but at times they may be intense as he has caused injury to others that require medical attention...” 89. A “Behavior Incident Reporting Form,” dated July 16, 2004, indicated that, in an incident of aggression to person, Resident #8 “started yelling and hit the seats and different people. [He/She] hit one consumer in the mouth and caused his lip to bleed.” 90. A “Behavior Incident Reporting Form,” dated August 2, 2004, indicated that, in another incident of aggression to person, Resident #8 punched an individual, who then fell on the floor. That form indicates that Resident #8 aggression was “for no reason.” 91. A “Behavior Incident Reporting Form,” dated August 11, 2004, indicated that Resident #8 engaged in another incident of “aggression to person.” An attachment to that form described the incident as follows: 17 [Resident #8] was interacting with another consumer in a brief conversation on the patio at ADT. When the other consumer decided to offer his hand ina friendly shake, [Resident #8] said nothing and got up to physically throw a punch at the jaw of the consumer. The consumer responded with an equal reaction until staff separated them. 92. A “Behavior Incident Reporting Form,” dated November 17, 2004, indicated that Resident #8 engaged in another incident of “aggression to person.” An attachment to that form indicated that Resident #8 “hit another consumer on the leg.” 93. During the survey on or about May 5, 2005, at approximately 4:15 p.m., while accompanying an Agency surveyor back to the administrative office area of the F acility, Resident #8 placed one hand on each side of the Agency surveyor’s head, jerked the Agency surveyor’s head down, and rubbed his face in the Agency surveyor’s hair. The Agency surveyor was startled and frightened by Resident #8’s actions. 94. Continued residency of physically aggressive individuals in the Facility created an unsafe and/or indecent living environment, which was continuous and ongoing for all Facility residents. 95. Based upon the above, the Agency determined that the Respondent failed to provide a safe and decent living environment for residents of the Facility, in violation of § 400.428(1) (a) Fla. Stat. (2004). 96. The deficient practice described in this count constituted, in part, the basis for an immediate moratorium on admissions, which the Agency imposed upon the Respondent, pursuant to § 400.415, Fla. Stat. (2004), in an emergency order dated May 18, 2005. 97. | The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of the Facility residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 98. The Agency cited the Respondent for a Class II violation pursuant to § 400.419(2)(b), Fla. Stat. (2004). 99. The Agency provided Respondent with a mandatory correction date of May 17 2005. 100. Respondent’s failure to provide a safe and decent living environment for residents of the Facility, in violation of § 400.428(1) (a) Fla. Stat. (2004), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND DOLLARS ($1000.00), pursuant to § 400.419(2)(b), Fla. Stat. (2004). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to § 400.419(2)(b), Fla. Stat. (2004). COUNTIV 101. The Agency re-alleges and incorporates paragraphs one (1) through five (5), seven (7) through fifty (50), fifty-two (52) through sixty-eight (68), and seventy (70) through one hundred (100) as if fully set forth herein. 102. Pursuant to § 400.419(10), Fla. Stat. (2004), the Agency may assess a survey fee, in addition to any administrative fines imposed, equal to the lesser of one half of an assisted living facility’s biennial license and bed fee or $500.00, to cover the cost of conducting monitoring visits conducted under § 400.428(3)(c), Fla. Stat. (2004), to verify the correction of the violations. 103. Pursuant to Section § 400.428(3)(c), Fla. Stat. (2004), during any calendar year in which no survey is conducted, the Agency shall conduct at least one monitoring visit of each facility cited in the previous year for a class I or class II violation, or more than three uncorrected class H[ violations. 104. The Respondent has been cited for three (3) Class IT violations, and therefore is subject to the additional monitoring fee. 105. The Facility’s biennial license and bed fee is THREE HUNDRED TWENTY- THREE DOLLARS ($323.00). WHEREFORE, the Agency intends to impose an additional monitoring visit survey fee in the amount of ONE HUNDRED SIXTY-ONE AND 50/100 DOLLARS ($161.50) upon Respondent, an assisted living facility in the State of Florida, pursuant to §§ 400.419(10) and 400.428(3)(c), Fla. Stat. (2004). Respectfully submitted this 2E™iay of June 2005. Brian T. — Preserving the Trust Copyright © 1999-2004 USPS. All Rights Reserved. Terms of Use Privacy Policy | POSTAL INSPECTORS sitemap contactus government services jobs National & Premier Accounts http://trkenfrm1.smi.usps.com/PT SIntemetW eb/InterLabelInquiry.do 07/22/2005

Docket for Case No: 05-002644

Issue Date	Proceedings
Jan. 05, 2006	Final Order filed.
Nov. 22, 2005	Order Closing Files. CASE CLOSED.
Nov. 21, 2005	Joint Motion to Relinquish Jurisdiction filed.
Oct. 21, 2005	Order Granting Continuance and Re-scheduling Hearing (hearing set for November 28 and 29, 2005; 9:30 a.m.; Largo, FL).
Oct. 19, 2005	Joint Motion for Continuance filed.
Sep. 09, 2005	Amended Notice of Hearing (hearing set for October 26 and 27, 2005; 9:30 a.m.; Largo, FL; amended as to additional case and date of hearing).
Sep. 08, 2005	Second Order of Conolidation (Case 05-2878) was added to the consolidated batch.
Aug. 18, 2005	Joint Response to Initial Order and Motion to Consolidate (Case Nos. 05-2882, 05-2644, and 05-2878) filed.
Aug. 09, 2005	Order of Pre-hearing Instructions.
Aug. 09, 2005	Notice of Hearing (hearing set for October 26, 2005; 9:30 a.m.; Largo, FL).
Aug. 09, 2005	Order of Consolidation (consolidated cases are: 05-2624 and 05-2644).
Aug. 05, 2005	Joint Response to Initial Order filed.
Jul. 26, 2005	Initial Order.
Jul. 25, 2005	Administrative Complaint filed.
Jul. 25, 2005	Election of Rights filed.
Jul. 25, 2005	Petition for Formal Administrative Hearing filed.
Jul. 25, 2005	Notice (of Agency referral) filed.