. STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2005006764 ‘ egeipty Requested: fee A Re [5073000 ‘5650 2460 8) 5650212477 Gad Bae Vv. SERENITY GARDEN AT LAUDERHILL, INC. d/b/a SERENITY GARDEN AT LAUDERHILL, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (“AHCA"), by and through 'the undersigned counsel, and files this administrative complaint against Serenity Gardens at Lauderhill, Inc. d/b/a Serenity Garden at Lauderhill, Inc. (hereinafter “Serenity Garden at Lauderhill, Inc.”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, (2004), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the license for an assisted living facility pursuant to Sections 400.414(1) (f£), Section: 400.414(1) (g), Florida Statutes (2004) for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. "This Court has jurisdiction ‘ pursuant to. Sections 120.569 and 120.57 Florida Statutes (2004) and Chapter 28-106, Florida Administrative Code (2004). 3. . Venue lies in Broward County pursuant to Section 120.57 Florida Statutes (2004) and Rule 28-106.207, Florida Administrative Code (2004). PARTIES 4. “BHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules ( . ne governing assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes (2004) and Chapter 58A-5 Florida Administrative Code (2004). 5. Serenity Garden at Lauderhill, Inc. operates a 60-bed assisted living facility located at 5811 N. W. 28th Street, Lauderhill, Florida 33313. Serenity Garden at Lauderhill, Inc. is licensed as an assisted living facility under license number 10176. Serenity Garden at Lauderhill, Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I SERENITY GARDEN AT LAUDERHILL, INC. FAILED TO ENSURE THAT EMPLOYEES WHO DO NOT MEET THE REQUIRED LEVEL 1 SCREENING WERE NOT RETAINED AND THE ADMINISTRATOR OR OWNER OF THE FACILITY DID NOT TAKE ANY ACTION TO REMOVE EMPLOYEES WHO HAD ACCESS TO. THE RESIDENTS AND WHO FAILED TO MEET THE LEVEL 1 BACKGROUND SCREENING CRITERIA SPECIFIED IN SECTION 435.03, FLORIDA STATUTES. SECTION 400.4174(2), FLORIDA STATUTES RULE 58A-5.019(3), FLORIDA ADMINISTRATIVE CODE (STAFF RECORDS STANDARDS) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. A complaint investigation survey was conducted on June 21, 2005. Based on record review and interview with the Administrator on the day of the survey at approximately 1:30 PM., it was determined that the facility did not ensure that employees: who did not meet the required Level I screening were not vretained. It was also determined that the owner or administrator of the facility did not take any action to remove employees who had access to the residents and failed the Level 1 background screening. The findings include the following: 8. During the review four staff records as a result of residents! complaints of being abused by one staff member, the personnel record for this employee revealed that she did not have evidence of a satisfactory FDLE Level I screening. This employee was hired 2/19/05. The facility had. evidence dated 4/27/05 ‘of an unsatisfactory FDLE Level I screening concerning this employee and had received the employee’s criminal history on or about 07/13/05. The facility intentionally continued the employment of this individual despite knowing that this. employee who had "failed to meet the Level 1 background screening standards. had access to the residents. The Administrator stated to the surveyor that the owner reviewed the negative Level 1 background screening report but did not’ take any action to remove the employee and continued to employ this individual who provided direct personal care and medication assistance to these vulnérable residents. As part of her duties, the employee administered medication and narcotics to the residents as reflected in the Medication Observation Records (MOR) 9. Based on the foregoing facts, Serenity Garden at Lauderhill, Inc. violated Section 400.4174(2) Florida Statutes (2004) and Rule 58A-5.019(3), Florida Administrative Code (2004), which warrants revocation of the license pursuant to Section 400.414(1) (£) and (g), Florida Statutes (2004). CLAIM FOR RELIEF WHEREFORE, the Agency requests the, Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Serenity Garden at Lauderhill, Inc. on Count I. 2. Revoke the license of against Serenity Garden at Lauderhill, Inc. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. Grant such other relief as this Court deems is just and proper. ) Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2004). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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. ; urdes A. Naranjo, =” Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 305-470-6800 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 E. Tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (U.S. Mail) Jean ‘Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and _correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Susan Patricia Spaw, Administrator, Serenity Garden at Lauderhill, Inc., 5811 N. W. 28 Street, Lauderhill, Florida 33313; Susan Spaw, 5821 N. W. 28 Street, Lauderhill, Plorida 33313 on this / Aa day of Sot: | 2005. | peruse, GAca Ler Lourdes A. Naranjo, Esq. U COMPLETE THIS SECTION ON DELIVERY THIS SECTION land 3, Also complete blivery is desired. ddress on the reverse the card to you. e back of the mallpiece, Postage D. Is delivery address different fram item 17 0 Yes Cartified Fea If YES, enter delivery address below: No tum Alaciept (Endorsement Hawueey Postmark ~ on a) bh 4 ; Rastrictad Deliv (Endorsement Rogues Toial Postage & Pees . Service Type CO Certified Mail (1 Express Mall 1 Registered CO Return Recelpt for Merchandise evanenn. CJ insured Mait =. 6.0.0, "4. Restricted Delivery? (Extra Fee) CO Yes i TooSipl Te 2 Revers BF label an ath i PS Form 3811, August 2001 Domestic Return Receipt Qa Yun Caps 402595-02-M-1540 THIS SECTION land 3. Also complete blivery Is desired. Address on the reverse the card to you. ‘ e back of the mallplece, 7 CERTIFIED MAIL«: RECEIP’ (Damestic’ Mail Only; No Insurance Coverage Provided)::.- For delivery Information visit our website at i ‘ ft B. Recelved by ( Printed Name) G, Date of Delivery Postage | & D. Is delivery address different from Item 17 OO Yes Canrtified Fe . It YES, enter delivery address below: Na tWeturn Reciapt Fee Pastmark ; (Endorsement Required) Hare i ia Restricted Delivery Fee 3 ) hr 4 (Endorsement Required) Tatal Postage & Fees 3. Service Type O Certified Mai! (1 Express Mui! 0 Registered (CC Return Receipt for Merchandise Cl insured Mail ~=0 C00. [a Ractricted Delivery? (Extra Fee) CO Yes js0 goo0 sh50 2477 ~~ 2noSgp Gtk rr andona ot haus PS Form 3811, August 2001 Domestic Heturn Receipt G a ? 102595-02-M-1540

Docket for Case No: 05-004343