STATE OF FLORIDA _AGENCY FOR HEALTH CARE ADMINISTRATION 06 SEP 26 PH 4: Oy STATE OF FLORIDA, At islet GF AGENCY FOR HEALTH CARE ! Wee, " Al VE ADMINISTRATION, ; ARINGS Petitioner, ys. : ; : AHCA Case No.: 2006005938 ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA lp . i) ly ¢{ STERLING HOUSE OF CAPE CORAL, Respondent. ; / ADMINISTRATIVE COMPLAINT COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ‘ADMINISTRATION (“AHICA”),. by and through the undersigned counsel, and. files this Administrative Complaint against ALTERRA HEALTHCARE CORPORATION d/b/a ALTERRA STERLING HOUSE OF CAPE CORAL (“Respondent”) pursuant to Sections 120.569 and 120.57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION This is multi-count action to impose an administrative fine of ONE THOUSAND VIE HUNDRED DOLLARS ($1,500.00) against ALTERRA STERLING HOUSE OF CAPE CORAL pursuant to Sections 400.414, 400.441(1)(a)2.m.; 400.441(1)(b); 400.4178(2)(b); and 400.419(2)(c), Florida Statutes (2005)', and Rules 58A-5.015(1)(a)(3); 58A-5.026(2)(c); 58A- 5.0191(9)(c) and S8A-5.024(2)(a)1., Florida Administrative Code (2006), based. upon three ' §§400.414; 400.441(1)(a)2.m,; 400.441 (1)(b); 400.4178(2)(b); and 400.419(2)(c), Florida Statutes (2005),'were renumbered effective July 1, 2006, as §§429.14; 429.41(1)(a)2.m.; 429.178(2)(b); and 400.19(2)(c) , Florida’ Statutes (2006), respectively. Page 1 of 17 repeat Class m deficiencies cited at a survey on or about May 16, 2006, that were each repeated deficiencies from a previous survey performed on or about April 19-20, 2004. . JURISDICTION AND VENUE 1. This Court has jurisdiction ovér Respondent, pursuant to Sections 120.569 and. 120.57, Florida Statutes (2005). 2. The State of Florida, Agency for Health Care Administration has jurisdiction over the Respondent pursuant to Chapter 400, Part IU, Florida Statutes (2005). ~ 3. Venue shall be determined, pursuant to Chapter 28-106.207, . Florida Administrative Code (2005). PARTIES: 4. The AHCA is the enforcing authority with regard to assisted living facility licensure laws pursuant to Chapter 400, Part If, Florida Statutes (2005) and Rule 58A-5, Florida Administrative Code (2005). . 5. Respondent is a 50-bed facility located at 1416 Country Club Road, Cape Coral, FL 33990. Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part IIL, Florida Statutes (2005), and Chapter 58A-5, Florida Administrative: Code (2005), having been issued license number 9358. | COUNTI THE RESPONDENT FAILED TO HAVE AN ANNUAL FIRE INSPECTION. : VIOLATING Rule 58A-5.015(1)(a)3., Florida Administrative Code (2006) ; §400.441(1)(a)2.m., Florida Statutes (2005) REPEAT CLASS WI DEFICIENCY ? §400.441(1)(a)2.m., Florida Statutes (2005), was renumbered effective July 1, 2006, as §429.41(1)(a)2.m., Florida Statutes (2006). : Page 2 of 17 6. herein, 7. Codes that are AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth The regulatory provisions of the Florida Statutes and Florida Administrative specifically pertinent here include the following: SECTION 400.441(1)(a)2.m, Florida Statutes (2005) 400.441 Rules establishitig standards. (1) It is the intent of the Legislature that rules published and enforced pursuant to this section shall include criteria by which a reasonable and consistent quality of resident care and quality of life may be ensured and the results of such resident care may be demonstrated, Such rules shall also ensure a safe and sanitary environment that is residential! and noninstitutional ‘jn design or nature. It is further intended that reasonable efforts be made to accommodate the needs and preferences of residents to enhance the quality’ of life in a facility. In order to provide safe and sanitary facilities and the highest quality of resident care accommodating the needs and preferences of ~ residents, the department, In consultation with the agency, the Department of Children and Family Services, and the Department of Health, shall adopt rules, policies, and procedures to administer this part, which must include reasonable and fair minimum standards in relation to: : (a) The requirements for and maintenance of facilities, not in conflict with the provisions of chapter 553, relating to plumbing, heating, cooling, lighting, ventilation, living space, and other housing. conditions, which will ensure the health, safety, and comfort of residents and protection from fire hazard, including adequate provisions for fire alarm and other fire protection suitable to the size of the structure. Uniform firesafety standards shall be established and enforced by the State Fire Marshal in cooperation with the agency, the department, and the Department of Health. 2. Firesafety requirements.—... m. Except in cases of life-threatening fire hazards, if an existing facility experiences a change in the evacuation capability, or if the local authority having jurisdiction identifies a construction-type restriction, such that an automatic fire sprinkler system is required, it shall be afforded time for installation as provided in this subparagraph. , Facilities that are fully sprinkled and in compliance with other firesafety standards are not required to conduct more than one of the required fire drills between the’hours of 11 p.m. and 7 a.m., per year. In lieu of the remaining drills, staff responsible for residents during such hours may be required to participate in a mock drill that includes a review of evacuation procedures. Such standards must be included or referenced in the rules adopted by the State Fire Marshal. Pursuant to s. 633.022(1)(b), the State Fire Marshal is the final administrative authority for firesafety standards established and enforced Page 3 of 17 pursuant to this section. All licensed facilities. must have an annual fire inspection conducted by the local fire marshal or authority having jurisdiction. and RULE 58A-5.015(1)(a)3., Florida Administrative Code (2006) 58A-5.015 License Renewal and Conditional Licenses. (1) LICENSE RENEWAL. Every two years, the Agency Central Office shall provide applications for license renewal, either electronically or my mail, to licensees no less than 120 days prior to the expiration of the current license. Applications shall-be postmarked or hand delivered to the Agency a minimum of 90 days prior to the expiration date appearing on the currently held license. Failure to file a timely application shall result in a late fee charged to the facility as described in Section 429,17, F.S. (a) All applicants for renewal ofa license shall submit the following: .... 3. A copy of the annual fire safety inspection conducted by the local authority having jurisdiction over fire safety or the State Fire Marshal. Documentation of a satisfactory fire safety inspection shall be provided at the time of the agency's biennial survey. 8. On April 20, 2004, AHCA conducted a biennial. licensure survey of the Respondent’s facility. The standard that all licensed facilities must have an annual fire ‘inspection conducted by the local fire marshal or authority having jurisdiction was not met as follows: | Based on record review’ the facility failed to have an annual fire inspection. 9. The Respondent was provided a’ mandated correction date of May 21, 2004. 10. That during a re-visit survey conducted June 3, 2004 the Agency determined that the Respondent had corrected the deficiency. 11. AHCA surveyors conducted a survey of the Respondent’s facility on or about - May 16, 2006 the Agency completed a Biennial licensure Survey of the Respondent. The standard that all licensed facilities must have an annual fire inspection conducted by the local fire marshal or authority having jurisdiction was again not met. : 12. On that date, based on facility record review and interview with staff, the facility failed to have annual fire inspections. Page 4 of 17 The findings include: "1. Review of the fire inspection teports for the facility revealed the last inspection the facility had was 03/01/05. 2. Interview with the Administrator on 05/16/06 at approximately 9:30am, revealed she was not aware the inspection was over due. She stated the maintenance director was calling the Fire Department to schedule a visit. 13. The Respondent was provided a mandated correction date of June 16, 2006. 14.‘ The foregoing violations are cited as a repeat deficiency pursuant to Section 400.441 (1}(a)2.m., Florida Statutes (2005), and Rule 58A-5.015(1)(a)3, Florida Administrative Code (2006), which require a copy of the annual fire safety inspection conducted by the local authority having jurisdiction over fire safety or the State Fire Marshal. Documentation of a satisfactory fire safety inspection shall be provided at the time of the agency’s biennial survey. 15. . Said violations constitute the grounds for the imposed repeat deficiency in that it _ indirectly or potentially threatened the physical or emotional health, safety or security of the facility’s residents. . . 16. Pursuant to’ Section 400.419(2)(c), Florida Statutes (2005)*, Class TI violations are subject to an administrative fine of not less than $500 and not exceeding $1,000 for each violation. Therefore, the Agency is authorized to impose a fine in the amount of FIVE HUNDRED DOLLARS ($500) for Count I. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of Count I; 2. Impose a fine in the amount of $500 for the referenced violation; and 3. Enter other legal or equitable relief as this Court may find appropriate. 3 §400.419(2)(c), Florida Statutes (2005), was renumbered effective July 1, 2006, as §429.19(2)(c), Florida Statutes (2006). : Page 5 of 17 COUNT THE RESPONDENT FAILED TO ENSURE THERE WAS AN ANNUAL REVIEW OF 17. herein. 18. Codes that are THE EMERGENCY MANAGEMENT PLAN VIOLATING ; Rule 58A-5.026(2)(c), Florida Administrative Code (2006) §400.441(1)(b), Florida Statutes (2005)* REPEAT CLASS I DEFICIENCY AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth The regulatory provisions of the Florida Statutes and Florida Administrative specifically pertinent here include the following: Section 400.441(1)(b), Florida Statutes (2005) 400.441 Rules establishing standards.-- (1) Itis the intent of the Legislature that rules published and enforced pursuant to this section shall include criteria by which a reasonable and consistent quality of resident care and quality of life may be ensured and the results of such resident care may be demonstrated. Such rules shall also ensure a safe and sanitary environment that is residential and noninstitutional in design or nature. It is further intended that reasonable efforts be made'to accommodate the needs and preferences of residents to enhance the quality of life in a facility. In order to provide safe and sanitary facilities and the highest quality of resident care accommodating the needs and preferences of residents, the department, in consultation with the agency, the Department of Children and Family Services, and the Department of Health, shall adopt rules, policies, and procedures to administer this part, which must include reasonable and fair minimum standards in relation to: .... * §400.441(1)(b), Florida Statutes (2005), was renumbered effective July 1, 2006, as §429.41(1)(b), Florida Statutes (2006). Page 6 of 17 (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 minimum, the rules must provide for plan components that address emergency evacuation transportation; adequate sheltering arrangements; postdisaster activities, including provision of emergency power, food, and water; postdisaster: transportation; 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 review 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 review within 60 days and either approve the plan or advise the facility of necessary revisions. and Rule 58A-5.026(2)(c), Florida Administrative Code (2006) 58A-5.026 Emergency Management. , (2) EMERGENCY PLAN APPROVAL. The plan shall be submitted for review and approval to the county emergency management agency. ‘ (c) The facility shall review its emergency management plan on an annual basis. Any substantive changes must be submitted to the county emergency agency for review and approval. 1. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered substantive revisions for the purposes of this rule. 2. Changes in the identification of specific staff must be submitted to the county - emergency management agency annually as a signed and dated addendum that is * not subject to review and approval. 19. On April 20, 2004, AHCA conducted a biennial licensure survey of the Respondent’s facility., The standard that the facility must review its emergency management plan on an annual basis was not met as follows: Based on a review of the emergency management plan provided by the facility and interview with administrative staff, the facility did not ensure there was an annual review of the emergency plan. The findings include: Page 7 of 17 1. Review of the emergency management book provided by the facility revealed a letter from the county emergency management program indicating their emergency management plan had not been reviewed by the county since August of 2002. The letter further indicated the approval of the plan expired in August of 2003. Administrative staff admitted they had not reviewed the plan until recently and it had been sent out on 4/12/2004 for county review. 20. The Respondent was as provided a mandated correction date of May 21, 2004. 21. That during a re-visit survey conducted June 3,'2004 the Agency determined that the Respondent had corrected the deficiency. 22. . AHCA surveyors conducted a survey of the Respondent’s facility on or about May 16, 2006 the Agency completed a Biennial licensure Survey of the Respondent. The standard that the facility must review its emergency management plan on an annual basis was again not met. . 23, On that date, based upon interview it was determined the facility failed to assure that its emergency management plan is updated on an annual basis. The findings include: At the entrance conference on 5/15/06 at about 9:15 a.m. a surveyor requested from the Executive Director (ED) for documentation that the facility's Comprehensive Emergency Management Plan is updated on an annual basis. The Executive Director informed the surveyor this had not been completed for 2005 and was now in the process for 2006. 24. ' The Respondent was provided a mandated correction date of June 16, 2006. 25. The foregoing violations are cited as a repeat deficiency pursuant to Rule, 58A- 5 026(2)(0), Florida Administrative Code (2005), which requires a facility to review its emergency management plan.on an annual basis. Any substantive changes must be submitted to . the county emergency agency for review and approval. 26. Pursuant to Florida law, the preparation and annual update of a comprehensive emergency management plan. Such standards must be included in the rules adopted by the ‘Page 8 of 17 ° department after consultation with the Department of Community Affairs. At a minimum, the tules must provide for plan components that address emergency evaciation transportation; adequate sheltering arrangements; post-disaster activities, including provision of emergency power, food, and water; post-disaster transportation; 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 review 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 review within 60 days and either approve the plan or advise the facility of necessary revisions. §400.441(1)(b), Florida Statutes (2005). 27. Said violations constitute the grounds for the imposed repeat deficiency in that it ‘indirectly or potentially threatened the physical or emotional health, safety or security of the facility’s residents. 28. Pursuant to Section 400.419(2)(c), Florida Statutes, (2005)°, Class III violations are subject to an administrative fine of not less than $500 and not exceeding $1,000 for each violation. Therefore, the Agency is authorized to impose a fine in the amount of FIVE HUNDRED DOLLARS ($500) for Count II. 5 §400.419(2)(c), Florida Statutes (2005), was renumbered effective July 1, 2006, as §429.19(2)(c), Florida Statutes (2006). : Page 9 of 17 WHEREFORE, AHCA demands the following relief: 1. . Enter factual and legal findings as set forth in the allegations of Count II: 2. Impose a fine in the amount of $500 for the referenced violation; and. ) 3. Enter other legal or equitable relief as this Court may find appropriate. COUNT HI THE RESPONDENT FAILED TO ENSURE THAT DIRECT CARE STAFF . PARTICIPATED IN 4 HOURS OF CONTINUING EDUCATION TRAINING RELATED TO ALZHEDLVIER’S DISEASE ANNUALLY VIOLATING §400.4178(3), Florida Statutes (2005)° Rule 58A-5.0191(9)(c), Florida Administrative Code (2006) Rule 58A-5.024(2)(a)1., Florida Administrative Code (2006) REPEAT CLASS Il DEFICIENCY 29. | AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 30. The regulatory provisions of the Florida Statutes and Florida Administrative Codes that are specifically pertinent here include the following: Section 400.4178(2)(b), Florida Statutes (2005) 400.4178 Special care for persons with Alzheimer's disease or other related disorders.-- .... (2) (b) A direct caregiver who is employed by a facility that provides special care for residents with Alzheimer's disease or other related disorders, and who provides direct care to such residents, must complete the required initial training and’4 additional hours of training developed or approved by the department. The training shall be completed within 9 months after beginning employment and shall satisfy the core training requirements of s. 400.452(2)(g), F.S.. and. : § s400. 4178(2)(b), Florida Statutes (2005), was renumbered effective July 1, 2006, as §429.178(2)(b), Florida Statutes (2006). Page 10 of 17 _ Rule 58A-5.0191(9)(c), Florida Administrative Code (2006) 58A4-5.0191 Staff Training Requirements and Competency Test... (9) ALZHEIMER'S DISEASE AND RELATED DISORDERS (“ADRD”) TRAINING REQUIREMENTS. Facilities which advertise that they provide "special care for persons with ADRD, or who maintain secured areas as described in Rule 58A-5.023, F.A.C., must ensure that facility staff receive the following training... : (c) Facility staff who provide direct care to residents with ADRD must obtain an additional 4 hours of training, entitled “Alzheimer’s Disease and Related Disorders Level II Training,” within 9 months of employment. Facility staff who meet the requirements for ADRD training providers under paragraph (g) of this subsection will be considered as having met this requirement. Alzheimer’s Disease and Related Disorders Level IL Training must address the following subject areas as they apply to these disorders: 1. Behavior management; 2. Assistance with ADLs; 3. Activities for residents; 4, Stress management for the care giver; and 5. Medical information. and Rule 58A-5.024 (2)(a)1., Florida Administrative Code (2006) 58A-5.024 Records. The facility shall maintain the following written records in a form, place and system ordinarily employed in good business practice and accessible to Department of Elder Affairs and Agency staff. .. (2) STAFF RECORDS. (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. In addition as applicable: 1. Documentation of compliance with all staff training required by Rule 58A- 5.0191, F.A.C.; , 31. On April 20, 2004, AHCA conducted a biennial licensure survey of the Respondent’s facility. The standard that the facility must ensure that direct care staff participate in 4 hours of continuing education annually was not met as follows: Based on record review, the facility failed to provide an additional 4 hours of training related to Alzheimer's disease annually for 1 of 5 # 4) employees reviewed. The findings include: Page 11 of 17 Review of the record for employee # 4 reveals a hire date of 10/7/02. Employee # 4 received initial Alzheimer's training on 2/11/03. There was no record of any additional Alzheimer's training. oo . 32. The Respondent was provided a mandated correction date of May 21, 2004. 33. That during a re-visit survey conducted June 3, 2004 the Agency determined that the Respondent had corrected the deficiency.. . 34. AHCA surveyors conducted a survey of the Respondent’s facility on or about : May 16, 2006 the Agency completed a Biennial licensure Survey of the Respondent. The standard that the facility must ensure that direct care staff participate in 4 hours of continuing education annually was again not met. . 35. On that date, based on record review, the facility failed to provide an additional 4 hours of training related to Alzheimer's disease annually for 1 (Employee #3) of 6 employees _ reviewed. The findings include: Review of the record for Employee #3 reveals a hire date of 11/22/04. Employee #3 received initial Alzheimer's training within 3 Months. There was no record of any additional Alzheimer's training. 36. The Respondent was provided a mandated correction date of June 16, 2006. 37. The foregoing violations are cited as a repeat deficiency pursuant to §400.4178(2)(b), Florida Statutes (2005), which requires that a caregiver who is employed by a facility that provides special care for residents with Alzheimer’s disease or other related disorders, and who provides direct care to such residents, must complete the required initial training and 4 additional hours of training developed or approved by the department. The training shall be completed within 9 months after beginning employment and shall satisfy the core training requirements of §400.452(2)(g). Page 12 of 17 38. Pursuant to Florida law, personnel records for each staff meniber shall contain, at a minimum, a copy of the original employment application with references furnished and verification of freedom from communicable disease including tuberculosis. In addition, documentation of compliance with all staff training is required by Rules 58A-5 019196) and 58A-5.024(2)(a), Florida Administrative Code. . | 39. Said violations constitute the grounds for the imposed repeat deficiency in that it indirectly or potentially threatened the physical or emotional health, safety or security of the facility’s residents. 40. Pursuant to Section 400.419(2)(c), Florida Statutes (2005)’, Class III violations are subject to an administrative fine of not less than $500 and not exceeding $1,000 for each violation. Therefore, the Agency is authorized to impose a fine in the amount of FIVE HUNDRED DOLLARS ($500) for Count I. | . WHEREFORE, AHCA demands the following relief: 1, Enter factual and legal findings as set forth in the allegations of Count I; | 2. Impose a fine in the amount of $500 for the referenced violation; and 3. Enter other legal or equitable relief as this Court may find appropriate. CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief 1. Make factual and legal findings in favor of the Agency on Counts T, I and Wy; 2. Impose fines respectively as follows for Counts I, I and Il: Count I: $ 500.00; and Count I: $ 500.00; and 7 §400.419(2)(c), Florida Statutes (2005), was renumbered effective July 1, 2006, as §429.19(2)(c), Florida Statutes (2006). ; : ‘ Page 13 of 17 PLL Bry Count 1: $500.00 few bn LF The total of fines requested to be imposed on all Counts is ONE OE SERA6mPH oh: 04 FIVE HUNDRED DOLLARS ($1,500.00). DNS ish Henin Alive 3. Enter other legal and equitable relief as may be appropriate. . NOTICE ALTERRA HEALTHCARE CORPORATION d/b/a ALTERRA STERLING HOUSE OF CAPE CORAL is hereby notified that it has’a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the attention of: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, Telephone number: (85 9: 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ‘ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER a, Submitted this 22° day of i 2006. Lo Eric R. oS " AHCA — Assi stant General Counsel Fla. Bar No.: 318442 2295 Victoria Ave., Room 346C . Fort Myers, Florida 33901 Office: (239) 338-3203 Fax: (239) 338-2699 Page 14 of 17 CERTIFICATE OF SERVICE I HEREBY CERTIFY that one original Administrative ‘Complaint has been sent via certified mail return receipt requested to Administrator, Alterra Sterling House of Cape Coral, 1416 Country Club Road, Cape Coral, FL 33990 (return receipt #7005 1160 0005 4257 2593), and to CT Corporation System, Registered Agent for Alterrra Healthcare Corporation, 1200 South Pine {sland Road, Plantation, FL 33324 (return receipt # 7005 1160 0005 4257 2609), and to Harold Williams, Field Office Manager, AHICA Field ‘Office, Fort Myers, FL on this o aS day of brsgeD so ee 2& S we eR. Za redemeyer Esquire Page 15 of 17 ‘a ‘Corriplette is1, 2, and 3. Also complete item 4 if ‘Restricted Delivery is desired. @ Print yoiir | name and address on the reverse - 80 that we can return the card.to you, { @ Attach this‘card to the back of the mailpiece, _ or on the front if space permits. OMPLETE THIS SECTION, | oS : 1, Article Addressed to: Adrnini sicodor Aiterre: Stec\i nq house of Cage Corer Hib Coursey Cula 2B, Ca Qe Cotes, EL 22990 . Service Typa O Certified Malt 1 Express Mail ( Registered CI Return Receipt for Merchanc O insured Mail £1. G,0.D. 4, Restricted Delivery? (Extra Fee) O Yes 2. Article Number : ({ranster trom service abe} 7005 LLb0 OO05 425? 2543 Bs For 381 1, February 2004 Domestic Return Recelpt 102505-02-M-

Docket for Case No: 06-003681