Certified Mail Receipt (7004 1160 0003 3739 8774) ; STATE OF FLORIDA © AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, a wo ra) Petitioner, AHCA NO: 2005068904 vs. JIMMY & GLORIA GAINEY bia Ho “O71 G : Respondent. _ ADMINISTRATIVE COMPLAINT , COMES NOW the Agency for Health Care Administration (hereinafter “ ‘AHCE *), by and through the undersigned counsel, and files this Administrative Complaint against Jimmy & Gloria d/b/a Gainey’s A.L.F. (hereinafter “Gainey’s A.L.F.”), pursuant to Sections 120.569, and 120.57, Fla. Stat. (2005), and alleges: NATURE OF THE ACTION 1. This is an action to impose six (6) administrative fines for a total of Three Thousand One Hundred Six-One Dollars and Fifty Cents ($3,161.50), based upon six (6) uncorrected Class III deficiencies pursuant to §400.419(2)(c), 400.441(1)(b), 400.4275(4), and 400.4275(2), Fla. Stat. (2005), and Rules 59A-5.0191(2)(c), 58A-5.0191(10)e), 58A- 5.0191(2)(d), 58A-5.026(3)(a), 58A-5.024(2)(a), 58A-5.019(3), 58A-5.024(2)(a)3, and 58A- 5.0191(2)(b), Fla. Admin. Code (2005). JURISDICTION AND VENUE 2 AHCA has jurisdiction pursuant to Chapter 400, Part Tl, Fla. Stat., and Sections 120.569 and 120.57, Fla. Stat. (2005). 3. Venue lies in Washington County, Vernon Pensacola, Florida, pursuant to Section 120.57 Fla. Stat. (2005), Rule 58A-5, Fla. Admin. Code (2005), and Section 28.106.207, Fla. Stat. (2005). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 400, Part III, Fla. Stat. and Rule 58A-5, Florida Administrative Code (2005). 5. Gainey’s A.LF. is a for-profit corporation, whose 16-bed assisted living facility is located at 3328 Hwy 277, Vernon, FL. Gainey's A.L-F. is licensed as an assisted living facility, license # AL8103 certificate number #15354, effective October 08, 2003 through October 07, 2005. Gainey’s A.L.F. was, at all times material hereto, a licensed facility under the licensing authority of AHCA, and was required to comply with all applicable tule and statutes. COUNT I GAINEY’S A.L.F. FAILED TO ENSURE DIRECT CARE STAFF RECEIVE 1 HOUR OF INSERVICE TRAINING IN MAJOR INCIDENTS FOR 4 OF 5 EMPLOYEES (#1, #2, #4, #5); THE FACILITY FAILED TO PROVIDE TRAINING IN EMERGENCY PROCEDURES TO 1 OF 5 EMPLOYEES (EMPLOYEE #5). STATE TAG A513-STAFFING STANDARDS Section 400.419(2)(c), Fla. Stat. (2005) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Section 58A-5.0191(2)(b), Fla. Admin. Code (2005) STAFF TRAINING ~ REQUIREMENTS AND TRAINING FEES bo Section 58A-5.0191(10)(e), Fla. Admin. Code (2005) TRAINING PROVIDER AND - CURRICULUM APPROVAL; TRAINING DOCUMENTATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7, + On or about October 04, 2005, AHCA conducted an unannounced follow- up survey to the biennial survey of July 26, 2005, at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: On or about July 26, 2005, Gainey’s A.L-F, failed to ensure that direct care n the a. staff received a minimum of 1 hour in-service training within 30 days of employment i ~* areas of incident reporting and facility emergency procedures for 5 of 5 sampled employees. b. During an unannounced follow-up survey on or about October 04, 2005, Gainey’s ALF. failed to ensure direct care staff receive 1 hour of in-service training in major incidents for 4 of 5 employees (#1, #2,.#4, #5); the facility failed to provide training in emergency procedures to 1 of 5 employees (Employee #5). 8. The original mandated correction date was 8/26/05. The findings are: 1. A review of the personnel records revealed employees #1, #2, #4, and #5 did not have evidence of training in major incidents. An interview with the Administratotr/Owner on 10/4/05 at 9:40 AM. stated she was unaware of the requirement for training in reporting of major incidents and verified the training of direct care staff has not been completed. 2, A review of the personnel records revealed employee #5 did not have evidence of training in Emergency Procedures. An interview with the Administrator/Owner on 10/4/05 at 9:40 A.M. stated the employee was trained but has no evidence of this training. 9. The regulatory provisions of the Fla. Stat. (2005), that are pertinent to this alleged violation read as follows: ua " 400.419 Violations; imposition of administrative fines; grounds. ~ (2c) Class “HI" violations are those conditions or occurrences related to the ity or to the personal care of residents which tentially threaten the physical or emotional ts, other than class J or class IT violations. operation and maintenance of a facil the agency determines indirectly or po health, safety, or security of facility residen The agency shall impose an administrative fine for a cited class II] violation in an amount not less than $500 and not exceeding $1,000 for each violation..A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class Il violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. Rule 584-5.0191 Staff in-service trainings. ~ residents must receive a minimum of 1 hour . (2)(b) Staff who provide direct care to loyment that covers the following: in-service training within 30 days of emp 1. Reporting major incidents. 2. Facility emergency procedures in roles relating to emergency evacuation. *- * * cluding chain-of command and staff Rule 584-5.0191 Training provider and curriculum approval; training documentation. ~ any training required by this rule. shail be 1 files which documentation shall include the title of the training program, course content, date of attendance, the training provider's name and the training provider's credentials, and number of hours of training. A certificate issued by the department shall provide sufficient documentation of training provided by the department staff. (10)(e) Except as otherwise noted documented in the facility’s personne eo OF 10. The violation alleged herein constitutes an uncorrected class III deficiency and warrants a fine of $500. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500. ®@ ‘ ay @ COUNT IL GAINEY’S A.L.F. FAILED TO PROVIDE 1 HOUR INSERVICE TRAINING IN RESIDENT RIGHTS IN AN ASSISTED LIVING FACILITY FOR 4 OF 5 EMPLOYEES (#1, #2, #4, #5); THE FACILITY FAILED TO PROVIDE 1 HOUR NEGLECT AND EXPLOITATION TO 1 OF 5 EMPLOYEES (EMPLOYEE #5). STATE TAG A514-STAFFING STANDARDS ” Section 400.419(2)(c), Fla. Stat. (2005) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Section 584-5.0191(2)\c), Fla. Admin. Code (2005) (2005) STAFF TRAINING REQUIREMENTS AND TRAINING FEES Section 584-5.0191(10(e), Fla. Admin. Code (2005); TRAINING PROVIDER AND CURRICULUM APPROVAL; TRAINING DOCUMENTATION STANDARDS 11. |. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 12. Onor about October 04, 2005, AHCA conducted an unannounced follow- e Respondent’s facility. AHCA cited up survey to the biennial survey of July 26, 2005, at th the Respondent based on the findings below, to wit: . a. On or about July 26, 2005, Gainey’s A.LF. failed to ensure that a minimum of one hour in-service training within 30 days of employment was conducted in the areas of resident’s rights and recognizing and reporting resident abuse, neglect and exploitation for 5 of 5 sampled employees. b. During an unannounced follow-up survey on ot about October 04, 2005, Gainey'’s A.L-F. failed to provide 1 hour of in-service training in Residents rights in an assisted living facility for 4 of 5 employees (#1, #2, #4, #5); the facility failed to provide 1 hour training in recognizing and reporting resident abuse, neglect and exploitation to 1 of 5 employees (Employee #5). Loi) alleged violation read as follows: “13. The original mandated correction date was 8/26/05. The findings are: 2, #4, and #5 revealed the 1. A review of the personnel record for employee #1, # 1/Owner on lack of training in resident rights. An interview with the Administrato 10/4/05 at 9:45 A.M. stated she was unaware of this requirement and confirmed the training had not been completed. 2, A review of the personnel record for employee #5 revealed the lack of training in recognizing and reporting abuse, neglect, and exploitation. An interview with the Administrator/Owner on 10/ 4/05 at 9:45 AM. confirmed the lack of evidence of "1-hour training in abuse for employee #5, 14. The regulatory provisions of the Fla. Stat: (2005), that are pertinent to this 400.419 Violations; imposition of administrative fines; grounds. ~ (2)(c) Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility orto the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class lor class 11 violations. The agency shall impose an administrative fine for a cited class Il] violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. Rule 58A-5.0191 Staff in-service training. ~ (2\(c) Staff who provide direct care to residents, who have not taken the core training program, shall receive a minimum of 1 hour in-service training within 30 days of employment that covers the followings subjects: 1, Resident rights in an assisted living facility. 2. Recognizing and reporting resident abuse, neglect, and exploitation. Rule 58A-5.0191 Training provider and curriculum approval; training documentation. ~ Except as otherwise noted any training required by this tule shall be onnel files which documentation shall include the (10)(e) documented in the facility’s pers @ " , wt wt oa course content, date of attendance, the training | 's credentials, and number of hours of i department shall provide sufficient title of the training program, provider's name and the training provider’ training. A certificate issued by the documentation of training provided by the department staff. 15. The violation alleged herein constitutes an uncorrected class III deficiency and warrants a'fine of $500: WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set. forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500. COUNT Til . GAINEY’S A.L.F. FAILED TO PROVIDE 3 HOURS OF INSERVICE TRAINING IN RESIDENT BEHAVIOR AND NEEDS FOR 1 OF 5 EMPLOYEES (#1, #2, #4; AND #5); THE FACILITY FAILED TO PROVIDE INSERVICE FOR 1 OF 5 EMPLOYEES . (EMPLOYEE #5) IN PROVIDING ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. : STATE TAG A515-STAFFING STANDARDS Section 400.419(2)c), Fla. Stat. (2005) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Section 58A-5.0191(2)(d), Fla. Admin. Code (2005) (2005) STAFF TRAINING REQUIREMENTS AND TRAINING FEES Section 58A-5.0191(10(e), Fla. Admin. Code (2005), TRAINING PROVIDER AND CURRICULUM APPROVAL; TRAINING DOCUMENTATION STANDARDS 16. AHCArealleges and incorporates paragraphs (1) through (4) as if fully set forth herein. 17. On or about October 04, 2005, AHCA conducted an unannounced follow- up survey to the biennial survey of July 26, 2005, at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: e. 1 © vy wy a. On or- about July 26, 2005, Gainey’s ALF. failed to ensure that a - mminimum of three hours in-service training within 30 days of employment was conducted in the areas of resident behavior and needs and assistance with activities of daily living for 5 of 5 sampled employees. _ b. “During an unannounced follow-up survey on or about October 04, 2005, Gainey’s A.LF. failed to provide 3 hours of in-service training in Resident behavior and needs for 1 of 5 employees (#1, #2, #4, #5); the facility failed to provide in-services for 1 of 5 employees (Employee’#5) in providing assistance with activities of daily living.” 18. The original mandated correction date was 8/26/05. The findings are: 1. A review of the personnel record for employee #1, #2, #4, and #5 revealed a lack of training in resident behavior and needs. An interview with the Administrator/Owner on 10/4/05 at 9:45 A.M. stated she did not have evidence of this training. a 3. A review of the personnel record revealed employee #5 did not have training in Assistance with Activities of Daily living. An interview with the Administrator/Owner on 10/4/05 at 9:45 A.M. stated she did not have evidence of this training. 19, The regulatory provisions of the Fla. Stat. (2005), that are pertinent to this alleged violation read as follows: 400.419 Violations; imposition of administrative fines; grounds. ~ (2)(c) Class "III" violations are those conditions or occurrences related to. the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class I violations. The agency shall impose an administrative fine for a cited class III violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class II] violation must specify the time within which the violation is required to be corrected. If a class II] violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. x oe Rule 58A4-5.0191 Staff in-service training. ~ sidents, other than nurses, CNAs, or home Rule 59A4-8.0095, F.A.C., must received 3 that covers the following (2)(d) Staff who provide direct care to re health aides trained in accordance with hours of in-service training within 30 days of employment subjects: : 1. Resident behavior and needs. 2. Providing assistance with the activities of daily living. Rule 58A-5.0191 Training provider and curriculum approval; training documentation. ~ ed any training required by this rule shall be 4 documentation shall include the date of attendance, the training and number of hours of shall provide sufficient (10)e) Except as otherwise not documented in the facility's personnel files whic title of the training program, course content, provider’s name and the training provider's credentials, training. A certificate issued by the department documentation of training provided by the department staff * * * 20. The violation alleged herein constitutes an uncorrected class II] deficiency and warrants a fine of $500. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500. COUNT IV SURE ALL STAFF RECEIVE TRAINING ON THE MANAGEMENT PLAN 1 OF 5 EMPLOYEES (EMPLOYEE #5). GAINEY’S A.L.F. FAILED TO E “FACILITY’S EMERGENCY STATE TAG A902-EMERGENCY MANAGEMENT Section 400.419(2)(c), Fla. Stat. (2005) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Section 400.441(1)(b), Fla. Stat. (2005), RULES ESTABLISHING STANDARDS Section 58A-5.026(3)(a) 3, Fla. Admin. Code (2005), EMERGENCY MANAGEMENT ‘ e. my ® 21. AHCAre-alleges and incorporates paragraphs (1) through (4) as if fully set u ' ” forth herein. , oan 22. On or about October 04, 2005, AHCA conducted an unannounced follow- up survey to the biennial survey of July 26, 2005, at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a. On or about July 26, 2005, Gainey’s A-LF. failed to train staff regarding duties and responsibilities for implementing the emergency management plan for 5 of 5 employees sampled. b. During an unannounced follow-up survey on or about October 04, 2005, Gainey’s A-L.F. failed to ensure all staff receive training on the facility's emergency management plan for 1 of 5 employees (Employee #5). ‘ 23. The original ‘mandated correction date was 8/26/05. The findings are: 1. A teview of the personnel records revealed employee #5 did not have evidence of training in the facility's Emergency Management Plan. An interview with the Administrator/Owner on 10/4/05 at 9:40 A.M. stated the employee was trained but has no evidence of this training. 24. The regulatory provisions of the Fla. Stat. (2005), that are pertinent to this alleged violation read as follows: 400.419 Violations; imposition of administrative fines; grounds. - (2)(c) Class “III" violations ate those conditions or occurrences related to the nee of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class II violations. The agency shall impose an administrative fine for a cited class II violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class III violation must specify the time within which the violation is required operation and maintena ’ to be corrected. If a class II] violation is corrected within the time specified,-no fine may be imposed, unless it is a repeated offense. * * * 400.441 Rules establishing standards.— : (1)(b) The preparation and annual update of a comprehensive emergency management plan. Such standards must be included in the rules adopted by the department after consultation with the Department of Community Affairs. At a the rules must provide for plan components that address emergency - minimum, ments; postdisaster activities, evacuation transportation; adequate sheltering arrange including provision of emergency power, food, and water; postdisaster -"ansportation; supplies; staffing; emergency equipment; individual identification of residents and transfer of records; communication with families; and responses to family inquiries. The comprehensive emergency management plan is subject to |! .Zeyiew and approval by the local emergency management agency. During its review, the local emergency management agency shall ensure that the following agencies, at a minimum, are given the opportunity to review the plan: the Department of Elderly Affairs, the Department of Health, the Agency for Health Care Administration, and the Department of Community Affairs. Also, appropriate volunteer organizations must be given the opportunity to review the plan. The local emergency management agency shall complete its teview within 60 days and either “approve the plan or advise the facility of necessary revisions. * * * ” Rule 58A-5.026 Emergency Management. - (3)(a) All staff must be trained in their duties and are responsible for implementing the emergency management plan. * * * 25, The violation alleged herein constitutes an uncorrected class III deficiency and warrants a fine of $500. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2 Impose a fine in the amount of $500. v4 @. @ COUNT V * GAINEY’S A.L.F. FAILED TO OBTAIN VERIFICATION FROM COMMUNICABLE DISEASE FOR 3 OF 5 EMPLOYEES (#2, #4, #5); THE FACILITY FAILED TO OBTAIN ‘VERTIFICATION OF FREEDOM FROM TUBERCULOSIS FOR 1 OF 5 1 EMPLYEES (EMPLOYEE #5). STATE TAG A1101STAFF RECORDS STANDARDS Section 400.419(2)\c), Fla. Stat. (2005) VIOLATIONS; IMPOSITION OF ‘ ADMINISTRATIVE FINES; GROUNDS . Section 400.4275(4), Fla. Stat. (2005), BUSINESS PRACTICE; PERSONNEL : RECORDS; LIABILITY INSURANCE Section 58A-5.024(2)a), Fla. Admin. Code (2005), STAFF RECORDS 16. AHCA re-alleges and incorporates paragraphs (1) through (4) astif fully set _ forth herein. -. On or about October 04, 2005, AHCA conducted an unannounced follow- 27. 5, at the Respondent's facility. AHCA cited , : up survey to the biennial.survey of July. 26, 200. the Respondent based on the findings below, to wit: a. On or about July 26, 2005, Gainey’s ALLE. failed to ensure that personnel dom from communicable disease including records contained verification of free tuberculosis for 2 of 5 sampled employees. b. During an unannounced follow-up survey on OF about October 04, 2005, Gainey’s A.L-F. failed to obtain verification from a health care professional of freedom from communicable disease for 3 of 5 employees (#2, #4, #5); the facility failed to obtain on of freedom from tuberculosis for 1 of 5 employees (Employee #5). n date was 8/26/05. verificati 78. The original mandated correctio The findings are: 1. A review of the personnel record revealed a lack of a statement from a health care professional of freedom from communicable disease for employee #2, #4, and #5, An interview with the Administrator/Owner on 10/4/05 at 9:40 AM. stated 12 ’ she did not have a statement of freedom from communicable disease for these employees. 2. . A review of the personnel record for employee #5 revealed a lack of verification of freedom from tuberculosis. An interview with the .. Administrator/Owner on 10/4/05 at 9:40 A.M. stated she did not have a test or ‘ * statement of freedom from tuberculosis for this employee. MH i "29. The regulatory provisions of the Fla. Stat. (2005), that are pertinent to this alleged violation read as follows: "400.419 Violations; imposition of administrative fines; grounds. ~ olations are those conditions or occurrences telated to the enance of a facility or-to the personal care of residents which ' the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class II violations. The agency shall impose an administrative fine for a cited class III violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class ILI violation must specify the time within which the violation is required to be corrected. If a class ILI violation is corrected within the time specified, no fine vcitay be imposed, unless it is a repeated offense. (2c) Class "III" vi v operation and maint ; | : * * ‘ *” ‘2 "490.4275 Business practice; personnel records; liability insurance.— (4) The department may by rule clarify terms, establish requirements for financial records, accounting procedures, personnel procedures, insurance coverage, and reporting procedures, and specify documentation as necessary to implement the requirements of this section. Rule 58A-5.024 Staff Records. - (2)(a) Personnel records for each staff member shall contain, at a-minimum; a copy of the original employment application with references furnished and verification of freedom from communicable disease including tuberculosis. : x * * 30. The violation alleged herein constitutes an uncorrected class III deficiency and warrants a fine of $500. WHEREFORE, AHCA demands the following telief: 13 e. @ vy 1 and findings as set forth in the allegations of this | Ll. Enter - factua ll - administrative complaint. . 2. Impose a fine in the amount of $500. COUNT VI GAINEY’S A.L:F. FAILED TO OBTAIN CURRENT BACKGOUND SCREENING : FOR EMPLOYEE #1 THE CO-OWNER OF THE FACILITY. ’ STATE TAG A1114.STAFF RECORDS STANDARDS Section 400.419(2)(c), Fla. Stat. (2005) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Section 400.4275(2), Fla. Stat. (2005), BUSINESS PRACTICE; PERSONNEL RECORDS; LIABILITY INSURANCE : Fla. Admin. Code (2005), STAFF RECORDS STANDARDS ~ Section 58A-5.019(3), (2)(a) 3, Fla. Admin. Code (2005) RECORDS Section 58A-5.024 31, AHCA realleges and incorporates paragraphs (1) through (4) as if fully ‘set forth herein. 32. - On or about October 04, 2005, AHCA. eonducted an unannounced follow- up survey to the biennial survey of July 26, 2005, at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a. On or about July 26, 2005, Gainey’s ALLE. failed to ensure that a Level 1 background screening was completed for 2 of 6 sampled employees (Employees (#4 & #6). b. During an unannounced follow-up survey on or about October 04, 2005, e #1 the co- Gainey's A.LF. failed to obtain current background screening for employe owner of the facility. 33, The original mandated correction date was 8/26/05. -'' The findings are: 1. Ateview of the personnel file revealed a signed Affidavit dated 8/17/05 which stated the employee #1, the co-owner of the facility, was current on the State of Florida's background screening requirements. An interview with the _, Administrator/Co-owner stated she did not have the date of the actual screening or v|° the results of the screening. She.stated she only needed the Affidavit. She was umsure of the date of the last screening but stated it was when the facility first “opened which is over 5 years ago. She stated when she renewed her licensure . application she was told she needed to rerun her background screening and the employee#1 due to the background screening was over 5 years. She stated she updated her background screening but did not update employee #1's. A review of "the AHCA files revealed the last background screening on file is 2/29/2000, which is over the 5 year requirement Tye 034, The regulatory provisions of the Fla. Stat. (2005), that are pertinent to this alleged violation read as follows: 400.419 Violations; imposition of administrative fines; grounds. ~ (2)(c) Class "III" violations are those conditions or occurrences related to the “operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional as health, safety, or security of facility residents, other than class I or class I] violations. ‘,” ‘~The agency shall impose an administrative fine for a cited class III violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class IH violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. * *” * 400.4275 Business practice; personnel records; liability insurance.— (2) The administrator or owner of a facility shall maintain personnel records for each staff member which contain, at a minimum, documentation of background screening, if applicable, documentation of compliance with all training requirements of this part or applicable rule, and a copy of all licenses or certification held by each staff who performs services for which licensure or certification is required under this part or tule. eo oe * e., r’ Rule 58A-5.019 Staffing Standards. - (3) Backgrounds Screening: " (a) All staff, hired on or after October 01, 1998, to provide personal services to residents must be screened in accordance with Section 400.4174, F.S., and meet the screening standards of Section 435.03, F.S. a packet containing background screening forms and instructions may be obtained from the AHCA Background Screening Unit, 2727 Mahan Drive, Tallahassee, FL. 32308; Telephone (850) 410- 3400.,Within 10 days of the employee’s starting work, the facility shall submit to the AHCA central office: ” 1. A completed Criminal History Check, AHCA Form 3110-0002, June “1998; 2. A-signed Florida Abuse Hotline Information System Background Check, AHCA Form 3110-0003, July 1998; and 3. A check to cover the cost of screening. (b) The results of employee screening conducted by the agency sh: in the employee’s personnel file. (c) Staff with the following documentation in their personnel records shall be considered to have met the required screening requirement: 1. A copy of their current professional license which required Level 1 background screening as a condition of licensing proof that a criminal history and abuse registry check have been conducted, and an affidavit of current compliance with Section 435.03, F.S.; : 2. Proof of continuous employment in an occupation ‘screening without a break in employment that exceeds 180 days, and proof that a criminal history and abuse registry check has been conducted within the previous 2 all be maintained which requires Level 1 years; OT 3. Proof of employment with a corporation or business entity or related that owns, operates, or manages more than one facility or agency licensed entity | 1 screening as a condition of initial under Chapter 400, F.S., that conducted Leve or continued employment. Rule 584-5.024 Staff Records. - tion of compliance with Level 1 background screening for all (2)(a)3 Documenta ule 58A-5.019, F.A.C.. staff subject to screening requirements as required under R x oe The violation alleged herein constitutes an uncorrected class II] deficiency 35. and warrants a fine of $500. "WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 7 2. Impose a fine in the amount of $500. tn ‘ COUNT VII SURVEY FEE IN THE AMOUNT $161.00 PURSUANT TO Section 400.419(10), Fla. Stat. (2005), RIGHT OF ENTRY INSPECTION 36. AHCA realleges and incorporates paragraphs (1) through (5).as if fully set forth herein. 37, The above constitutes a violation of Section 400.419(10), Fla. Stat. (2005), require that in addition to any administrative fines imposed, the agency may assess a survey ‘fee, equal to the lesser of one half of the facility's biennial license and bed fee or $500, to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits conducted under s. 400.428(3)(c) to verify the correction of the violations. 38. The violation alleged herein constitutes one (1) survey fee and warrants a fee of $161.50. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose one (1) survey fee in the amount of $161.50. 17 2. @ wD Respectfully submitted this / Y day of poem fuer 2005, Leon County, Tallahassee, : 4 1 ’ Florida. 1, Michael ©. Mathis Fla. Bar. No. 0325570 Counsel of Petitioner, Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5873 (office). (850) 921-0158 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Fla. Stat. (2005). Specific options for administrative action are set out in : the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page)- .. All requests for hearing shall be made to: the Agency for Health Care Administration, and " delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael O. Mathis, Senior Attorney, Telephone (850) 922-5873. . \ RESPONDENT IS FURTHER NOTIFED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL REASULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE J] HEREBY CERT EY that a true and correct copy of the foregoing has been served by certified mail on LY today of Decent hon , 2005 to Gloria Belinda Gainey, Gainey’s ALF., 3328 Hwy 277, Vernon, FL 32462 NW\yvalntr® Michael O. Mathis, Esq. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY A. Signature | x fe UY , of. J ? Cl Agent baleen =~ O Addressee B, Received by ( Printed Name) CG. Date of Dalivery Belinda Geta La Jhefoe D. Is delivery address different from item 1? 0 Yes If YES, enter delivery address below: O1No 7 Complete items:1, 2,-and 3. Also complete item _4 if Restricted: Delivery is desirad. @ Print your name and.address on the reverse : so that we can return the card to you. @ Attach this card to the back of the mailpiece, or on the front if space permits. ; Articla Adcresseg ps raw Kaety . Gee ‘sf ne | Baw Wwe , Serne nn, ze Zatyor RS: Bedasye ALK. Servicg-Type artified Mail £) Express Malt 1 Registered CQ Return Aecelpt for Merchandise O Insured Mail =O C.0,.0. » Restricted Detivery? (Extra Fea) D Yes 2. Article Number ; (Transter tom Sérvicd label 102585-02-M-1035 Certifiad Fae Caaert € Retum Aeclept Foe pF Here (Endorsement Requirad) Restricted Delivery Fae {Endorsement Required)

Docket for Case No: 06-000791