Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: MERIDIAN PARK VILLAGE LIMITED PARTNERSHIP, D/B/A CLASSIC RESIDENCE BY HYATT AT LAKESIDE VILLAGE
Judges: ROBERT E. MEALE
Agency: Agency for Health Care Administration
Locations: Lantana, Florida
Filed: Jun. 13, 2006
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, June 21, 2006.
Latest Update: Dec. 25, 2024
STATE OF FLORIDA 06 JUN
AGENCY FOR HEALTH CARE ADMINISTRATION 13 py hag
Diy iS] Al RE
AGENCY FOR HEALTH CARE ADM] INSTR SATIY
ADMINISTRATION, HEARINGS YE
Petitioner, AHCA No.: 2005006186
v. Return Receipt Requested:
7002 2410 0001 4234 5711
MERIDIAN PARK VILLAGE LIMITED 7002 2410 0001 4234 5728
PARTNERSHIP, d/b/a CLASSIC RESIDENCE 7002 2410 0001 4234 5735
BY HYATT AT LAKESIDE VILLAGE,
Respondent. , Ole _ 0 f 7
ADMINISTRATIVE COMPLAINT
COMES NOW the Agency for Health Care Administration
(“AHCA”), by and through the undersigned counsel, and files
this Administrative Complaint against Meridian Park Village
Limited Partnership, d/b/a Classic Residence by Hyatt at
Lakeside Village (hereinafter “Classic Residence by Hyatt at
Lakeside Village”), 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 impose an administrative fine
of $1,000 pursuant to Section 400.419, Florida Statutes
(2004), for the protection of the public health, safety and
welfare and $500 survey fee pursuant to Section 400.419(10),
and 400.428(3)(c), Fla. Stat. (2004)
JURISDICTION AND VENUE
2. This Court has jurisdiction pursuant to Sections
120.569 and 120.57, Florida Statutes, and 28-106, Florida
Administrative Code.
3. Venue lies in Palm Beach County, pursuant to Section
120.57, Fla. Stat. and Rule 28-106.207, Florida Administrative
Code.
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, Florida Statutes (2004), and Chapter 58A-5, Florida
Administrative Code.
5. Classic Residence by Hyatt at Lakeside Village
operates a 60-bed assisted living facility located at 2792
Donnelly Drive, Lantana, Florida 33462. Classic Residence by
Hyatt at Lakeside Village is licensed as an assisted living
facility license number AL9045, with an expiration date of
September 14, 2005. Classic Residence by Hyatt at Lakeside
Village 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.
w
COUNT I
CLASSIC RESIDENCE BY HYATT AT LAKESIDE VILLAGE FAILED TO
ENSURE THAT A SAFE ENVIRONMENT WAS BEING MAINTAINED FOR
RESIDENTS
Rule 58A-5.023(1) (a), Florida Administrative Code
(PHYSICAL PLANT S'TANDARDS)
CLASS II VIOLATION
6. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
7. During the Re-licensure Survey conducted on 6/23/05
at approximately 9:30 AM and based upon observations made
during a tour of the facility, the surveyor determined that
the facility did not maintain a safe environment for the
residents.
8. The facility has a locked Alzheimer's unit, which at
the time of this survey had a census of 20 individuals with
severe Dementia and Alzheimer's disease.
9, During a tour of the unit accompanied by the
Administrator the following items were noted as present and
accessible to these residents:
(a) Razors were noted to be present on the
dressers/counters of rooms # 3,17,21,22 and 23.
(b) Room # 14 had a bottle of Ibuprofen, a bottle
of Dulcolax, a tube of Joint Flex Anti-Arthritic cream and a
bottle of Hydrogen Peroxide laying out on the dressers and
counters of this room.
(c) Room # 21 had a package of Imodium, a tube of
A&D ointment, a bottle of Tylenol caplets, another bottle of
Tylenol tablets, a bottle of Iodine, a tube of Ben-Gay
ointment, and a tube of prescription Dovonex ointment laying
out on the room counters/dresser. There were also 3 large
safety pins present on the room dresser.
10. The above noted findings represent a direct threat
to the physical safety and security of the facility residents.
The doors to these rooms on the unit were not locked and
residents may enter any room and have access to these items at
that time.
11. The Administrator during interview, while touring
the unit with the surveyor on the date of this survey
confirmed these findings.
12. Based on the foregoing, Classic Residence by Hyatt
at Lakeside Village violated Rule 58A-5.023(1) (a), Florida
Administrative Code, a Class II deficiency, which carries, in
this case, an assessed fine of $1,000.00.
SURVEY FEE
Pursuant to Section 400.419(10), Florida statutes, AHCA
May assess a survey fee of $500.00 to cover the cost of
conducting complaint investigations that result in the finding
of a violation that was the subject of the complaint or
monitoring visits.
PRAYER FOR RELIEF
WHEREFORE, the Petitioner, State of Florida Agency for
Health Care Administration requests the following relief:
A. Make factual and legal findings in favor of the
Agency on Count I.
B. Assess an administrative fine of 51,000.00
against Classic Residence by Hyatt at Lakeside Village on
Count I for one Class Ir violation.
Cc. Assess a survey fee of $500.00 against Classic
Residence by Hyatt at Lakeside Village, pursuant to Sections
400.419(10), and 400.428(3)(c), Florida Statutes.
D. 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 for
Health Care Administration, 2727 Mahan Drive, Mail Stop #3,
Tallahassee, Florida 32308, attention Agency Clerk, telephone
(850) 922-5873.
"RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A
REQUEST FOR A HEARING WITHIN 21 DHYS OF/ RECEIPT OF THIS
COMPLAINT WILL RESULT IN AN ADMISSIO
THE COMPLAINT AND THE ENTRY OF A FI
Tria Lawton-Russell
Assistant General Counsel
Agency for Health Care
Administration
8350 N. W. 52™ Terrace
Suite 103
Miami,
(305)
Copies furnished to:
Diane Reiland
Field Office Manager
Agency for Health Care Administration
1710 Bast Tiffany Drive, Suite 100
West Palm Beach, Florida 33407
(Inter-office mail)
Jean Lombardi
Finance and Accounting
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308
(Inter-office 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
foregoing has been furnished by U.S. Certified
Florida 33166
copy of the
Mail, Return
Receipt Requested to Winsome McCloud, Administrator, Classic
Residence by Hyatt at Lakeside Village,
2792 Donnelly Drive,
Lantana, Florida 33462; Meridian Park Village Limited
Partnership, 71 South Wacker Drive, Suite 900, Chicago, IL
60606, and to Corporation Service Company, 1201 Hays Street,
DM fA 200¢5
Tallahassee, Florida 32301-2525
ria Lawton-Russell
STATE OF FLORIDA Oy
AGENCY FOR HEALTH CARE ADMINISTRATION & ps "&, fe ion
WY
RE: Meridian Park Village Limited Partnership, d/b/a AHCA 299500 189y
Classic Residence by Hyatt at Lakeside Village ae is ffl
cy oy Lf On
ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT Aeieidiny le
PLEASE SELECT ONLY 1 OF THE 3 OPTIONS
An Explanation of Rights is attached. .
OPTION ONE (1) Respondent does not dispute the allegations of fact contained in
the Administrative Complaint and waives Respondent’s right to object or to be heard.
Respondent understands that by waiving Respondent's rights, a final order will be issued that
adopts the Administrative Complaint and imposes the sanctions sought.
OPTION TWO (2) ___ Respondent does not dispute and Respondent admits the
allegations of fact in the Administrative Complaint, but Respondent does wish to be afforded an
"informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time Respondent
will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty
imposed.
OPTION THREE (3)___—- Respondent does dispute the allegations of fact contained in the
Administrative Complaint and Respondent requests a formal hearing, pursuant to Section
120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of
Administrative Hearings. Respondent’s request for an administrative hearing must conform to
the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the
material facts you dispute.
In order to preserve Respondent’s right to a hearing, Respondent’s original Election of Rights in
this matter must be received by AHCA within twenty-one (21) days from the date Respondent
receives the Administrative Complaint. If the election of rights form with Respondent’s selected
option is not received by AHCA within twenty-one (21) days from the date of the Respondent’s
receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or
violations charged and imposing the penalty sought in the Complaint.
If Respondent is interested in discussing a settlement of this matter with the Agency, please also
mark and check this block. Ervices,
SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT
UNTIL, RESPONDENT RECEIVES A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON
PAYMENT OF ANY FINES.
(Please sign and fill in your current address.)
Respondent (Licensee)
Address:
License. No. and Facility Type: Phone No.
PLEASE RETURN YOUR COMPLETED FORM TO:
- Agency for Health Care Administration, Attention: Agency Clerk, 2727 Mahan Drive, Mail Stop #3,
Tallahassee, Florida 32308. Telephone (850) 922-5873.
STATE OF FLORIDA pe oy
AGENCY FOR HEALTH GARE ADMINISTRATION F Fi
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EXPLANATION OF RIGHTS UNDER SEC. 120. 569, FLORIDA STATUTES 13 Py
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(To be used with Election of Rights for Administrative Complaint form — “att seat ur 6
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In response to the allegations set forth in the Administrative Complaint issuell 59 Rei, balive
Agency for Health Care Administration (“AHCA” or “Agency”), Respondent must make one oP
the following elections within twenty-one (21) days from the date of receipt of the Administrative
Complaint and your Election of Rights in this matter must be received by AHCA within twenty-
one (21) days from the date you receive the Administrative Complaint. Please make your
election of the attached Election of Rights form and return it fully executed to the address listed
on the form.
OPTION 1. If Respondent does not dispute the allegations in the Administrative Complaint
and Respondent elects to waive the right to be heard, Respondent should select OPTION 1 on
the election of rights form. A final order will be entered setting forth the allegations as being
deemed admitted and imposing the penalty sought in the Administrative Complaint. You will be
provided a copy of the final order.
OPTION 2. ‘If Respondent does not dispute any material fact alleged in the Administrative
Complaint (Respondent admits all the material facts alleged in the Administrative Complaint),
Respondent may request an informal hearing pursuant to Section 120.57(2), Florida Statutes
before the Agency. At the informal hearing, Respondent will be given an opportunity to present
both written and oral evidence to reduce the penalty being imposed for the violations set out in the
Compiaint. For an informal hearing, Respondent should select OPTION 2 on the Election of Rights
form.
OPTION 3. If the Respondent disputes the allegations set forth in the Administrative Complaint
(you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida
Statutes. To obtain a formal hearing, Respondent should select OPTION 3 on the Election of
Rights form.
In order to obtain a formal proceeding before the Division of Administrative Hearings under
Section 120.57(1), F.S., Respondent's request for an administrative hearing must conform to
the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state
the material facts disputed. If you select Option 3, mediation may be available in this case
pursuant to Section 120.573, Florida Statutes, if all parties agree to it.
PLEASE CAREFULLY READ THE FOLLOWING PARAGRAPH:
In order to preserve the right to a hearing, Respondent’s original Election of Rights in
this matter must be RECEIVED by AHCA within twenty-one (21) days from the date
Respondent receives the Administrative Complaint. If the election of rights form with
Respondent’s selected option is not received by AHCA within twenty-one (21) days from
the date of Respondent’s receipt of the Administrative Complaint, a final order will be
issued finding the deficiencies and/or violations charged and imposing the penalty
sought in the Complaint.
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Docket for Case No: 06-002047