STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2005009711 Return Receipt Requested: Vv. 7002 2410 0001 4234 7555 7002 2410 0001 4234 7562 NEW HORIZON ACLF d/b/a NEW HORIZON, Respondent. / 0) (» -) tp wie, ADMINISTRATIVE COMPLAINT CoMes NOW State of Florida, Agency for Health Care Administration (“AHCA’), by and through the undersigned counsel, and files this administrative complaint against New Horizon ACLF d/b/a New Horizon (hereinafter “New Horizon”) pursuant to Chapter 400, Part IIT, and Section 120.60, Florida Statutes, (2004), and alleges: NATURE OF THE ACTION 1. This ig an action to impose an administrative fine of $6,490.00 [$6,000.00 administrative fine + $490.00 survey fee] pursuant to Sections 400.414 and 400.419, Florida Statutes (2004) for the protection of public health, safety and welfare. ST'd 8Sta@ Té6 @SA NINGY SesO HITYSH ADNSEY pe:6a 9aa2-T2-nr 80:6 900 T@ Inc JURLSDICTION 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 Miami-Dade County pursuant to Section 120.57, Florida Statutes (2004) and Rule 28-106,207, Florida Administrative Code (2004). PARTIES 4a. 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 (2004). 5 New Horizon operates a 39-bed assisted living facility located at 1315 S. &. 9™ Avenue, Hialeah, Florida 33010, New Horizon is licensed as an assisted living facility under license number 713. New Horizon 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. 24T*d S8ST@ 126 ase NINGd FWD HLTWSH ADNG Laie} ee 9age-Tz~Ine 60:6 900¢ 1% Inc COUNT NEW HORIZON FAILED TO PROVIDE DAILY OBSERVATION BY DESIGNATED STAFF OF THE ACTIVITIES OF THE RESIDENTS AND DAILY AWARENESS OF THE GENERAL HEALTH, SAFETY, AND PHYSICAL AND EMOTION WELL BEING OF ALL RESIDENTS. RULE 58A-5.0182(1) (b), FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE STANDARDS) CLASS I VIOLATION é. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. A complaint investigation survey was on Auguet 18, 2005. Based on observation, interview and record review, the facility failed to provide daily observation by designated staff of the activities of the residents while on the premises, and daily awareness of the general health, safety, and physical and emotional well-being of all residents. The findings include the following. a. Record review on 8/18/2008 at 3:15 PM revealed that the facility failed to provide daily observation of resident activities while on the premises, and daily awareness of the general health, safety and physical and emotional well-being of resident #1. Resident record review revealed that resident #1 was Found by staff to be deceased on a/15/05. 9. Interview with staff #1 and #2, on 9/18/05 at 4:00 PM, revealed that resident #1 was found deceased in his bed on 8td 8St@ 126 G58 NING Sav9 HLIWSH ANSE S2:68 98@¢-Te-1 60:6 9002 TZ Int ° ° 8/15/05. The staff stated that the last time they had checked on resident #1 wag 8/13/05. 10. StafE #1 and staff # 2 further stated that staff often "Forgot" to thoroughly check on the status of all the residents on the premises. Staff #2 revealed that staff #3 did not awake resident #1 on Saturday because she "was afraid he would attack her". The staff stated that they do not document daily observations of resident activities while on the premises and daily awareness of the general health, safety and physical and emotional well-being. 41. Review of 8/15/05 Fire Rescue report revealed following: a. “Found 41 y/o male laying on his right side on bed at ALF without movement. Pt. DOA... Pt asystole, stiff and contracted, extremities cold to the touch, blood pooling to the posterior aspect." 12. Review of Medical Examiner's report revealed, "on August 15, 2005, the decedent was found expired in his bed at hia residence in a state of advanced decomposition." Autopsy findings are listed as "moderate putrefactive decomposition." 13, Based on the foregoing facts, New Horizon violated Rule 58A-5.0182(1)(b), Florida Administrative Code (2004), herein classified as a Class I violation, which warrants an assessed fine of $5,000.00. 60d 8914 t26 asa NING’ Sed9 HL ISH ADNSSY Sz:68 -T2- 60:6 9002 Tz Inc 9ag2-T2—-"ne counr_It NEW HORIZON FAILED TO ENSURE THAT THE FACILITY HAD A SATISFACTORY FERE INSPECTION WITHIN THE LAST 365 DAYS. SECTION 400.441(1) (a)i.m, FLORIDA STATUTES RULE 58A-5.015(1) (a)3, FLORIDA ADMINISTRATIVE CODE °« (FACILITY RECORDS STANDARDS) REPEAT CLASS ILL VIOLATION 14. BHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 15. New Horizon was cited with ome (1) Class I deficiency and three (3) Clasa IIT deficiencies due+to surveys that were conducted on September 10, 2003, December 23, 2004 and August 18, 2005. ) 16. A licensure survey was conducted on September 10, 2003. Based on record review and interview, the facility did not ensure that the facility had a satisfactory fire inspection with the last 365 days. The findings include the following. 17. Record review at approximately 1:35 PM revealed that the fire inspection conducted on 08/08/03 was unsatisfactory. Tnterview with the administrator on 09/10/03 at approximately 14:35 PM revealed the re-inspection, conducted on 09/09/03, cleared the facility for operation. Phone interview with a representative of the fire department at 1:40 FM on 09/10/03 revealed that the originally identified fire safety violations d 8STA Tee ace NING Sudo HETWSH AONSOU S2:68 9882-T2-NLe OT:6 = 9002 Te INC had not yet been corrected, and that the facility had not received clearance for re-licensure. 18. The mandated date of correction was designated as October 10, 2003. 19. A complaint investigation survey was conducted on August 18, 2005, Based on observation, interview and record review, it was determined that the facility failed to maintain a current fire inspection report. The findings include the following: 20. Observation during facility tour on 8/18/2005 at 10:20 AM revealed that the facility failed to maintain a current satisfactory fire inspection. 21. Interview conducted with facility staf£ #2, on 6/18/2005 at 10:20 AM, revealed that staff #1, the administrator, failed to post the current fire inspection. Staff #2 vevealed that she did not have access to the main office where the facility records are kept, because staff #1 locked the door upon exiting the facility prior to the survey. 29. Interview conducted with facility staf—f #1, on 8/18/2005 at 3:20 PM, revealed that she could not locate the current fire inspection. Fire Inspector, Raul Almeida, provided staff #1 and the surveyor with his findings from the 9/18/2005 inspection which was unsatisfactory. Te" BStG6 Té6 asa NIWGY SYuD HLTWSH ADNSHY G2 :6a ~Te- 01:6 900z Tz Inc seRe tee 23. Record review of the fire inspection report on 8/18/2005 at 3:20 PM, revealed the following fire safety requirements for the facility: a. (1) A detail(ed) ‘fire alarm' inspection report to be provided as per NFPA -72 indicating no discrepancies (without troubles) . b. (2) A detail(ed) ‘sprinkler system’ inspection report to be provided NFPA 25 ~O84Y Valve to be secured in open position with chain and lock. G. (3) Electrical fire safety electrical wiring and equipment shall be in accordance with NFPA 70 (national electric code) -Covers to be provide(ed) to socket (missing electric bulbs) -Installation must not present an imminent hazard. ad. You have (1) day to contact the Hialeah Fire Prevention Bureau at (305) 883-6900 for a re-ingpection and/or information regarding this notice, Failure to respond may result in the issuance of a SUBPOENA to appear before the CODE ENFORCEMENT BOARD of the City of Hialeah. Plans and permits are required for all work to be done and should be submitted to the Hialeah Building Department. Inspection Denied: R. Almeida August -18-05." ¢4. This is a repeat deficiency from the survey of September 10, 2003. ced 8St@ T2c6 @S8 NIWGY SYUD HLIWSH AONaSY 9c :6 —Te- 01:6 9002 T2 Inc Qa 9e8e-Te-Ne 25. Based on the foregoing facts, New Horizon violated Section 400.441(1) (a)i.m., Florida Statutes (2004) and Rule 58A- 5.015(1) (a)3, Florida Administrative Code (2004), ~ herein classified as a repeat Class IIT violation, which warrants an assessed fine of $500.00. COUNT IIT NEW HORIZON FAILED TO PROPERLY ENSURE THAT FACILITY STAFF HAD THE REQUIRED FIRST ALD TRAINING. RULE 5BA-5,019(4) (a)4, FLORIDA ADMINISTRATIVE CODE (STAFFING STANDARDS) REPEAT CLASS ITI VIOLATION 26. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 27, A complaint investigation survey was conducted on December 23, 2004. Based on observation, interview and record review, 2 of 2 facility staff lacked the required First Aid training. The findings include the following. 28, Facility tour conducted on 12/23/04 at 9:30 AM that facility administrator and staff #1 Jacked training in First Aid. 29. Interview with facility staff revealed that the required First Aid training was not available for review and inspection. £2"d 8St@ té6 BSB NIWGU Sado HLTWSH ADNSEHY 9¢:66 —Te- 01:6 900% TZ INC sabe te NL 30. Record review revealed that the employee file for the Facility administrator and facility staff lacked the required First Aid training. The mandatory date of correction was designated as January 23, 2005. 31, A complaint investigation was conducted on August 18, 2005. Baged on observation, interview and record review revealed that staff #3 did not have the required CPR and First Aid Training, The findings include the following: ‘ 32. Observation of staff records on 8/18/2005 at 3;00 PM revealed that staff #3 did not have proof of the required CPR & First Aid training. 33. Interview conducted with staff #1 and staff #2 revealed that staff #3 was the gtaff person in charge on the weekend. She stated that they will provide her with the training immediately. 34. Record review of staff #3 record on 8/18/2005 at 3:00 pM revealed that staff #3 did not have the requixed CPR and First Aid Training. 35. This is a repeat deficiency from the survey of December 23, 2004. 46. Based on the foregoing facts, New Horizon violated Rule 58A-5.019(4) (a)4, Florida Administrative Code (2004), herein classified as a repeat Class III violation, which warrants an assessed fine of $500.00. 9 berd 8978 126 @cB NIWGY See HIWGSH ADNSoY 92:68 968¢2-Te- TT:6 900¢ Te Inc mee SURVEY FEE Pursuant to Section 400.419(10), Florida Statutes (2004), AHCA may assess a survey fee of $500.00 to cover the cost of monitoring visits. A survey fee of $490.00 has been assessed in this case. 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 New Horizon on Count I through Count IIl. 2. Assess an administrative fine of $6,000.00 against New Horizon on Count I through Count ITI for the violations cated above. 3. Assess a survey fee of $490.00 against New Horizon pursuant to Section 400.419(10), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5. Grant such other relief as this Court deems igs just and proper. 10 Sed 8sT@ 726 ase NIWGY SYWD HLTWSH ANS 4c:68 9aBe-Te-Ane TE:6 900¢ Te Int 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 THER 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. ourdes A. Naranjo, Esq. Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 305-470-6800 Copies furnished to: Harold Williams Field office Manager Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 (Interoffice Mail) Jean Lombardi il 92*d asta 126 ase NIWGY SY09 HLTWSH ASN Bids) 42:60 9age-Te~ TH:6 = 900¢ t2 INC ™ 42°d WLOL 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 Olga Lidia Lazo, Administrator, New Horizon, 1315 5. E. 9 Avenue, Hialeah, Florida 33010; Olga L. Pa Lazo, 139 S. W. 20 Street, Miami, Florida 33175 on this ame) 4 day of 1 urdes A. Naranjo, Eaq. 12 ac*d 8St@ tee @SB NIWdd Sev3 HLTWSH ADNSSY cr:6 9002 Te Inc 20:68 9882-Te-ne

Docket for Case No: 06-002646