wislon of Administrative Hear a j STATE OF FLORIDA ew ' i} r AGENCY FOR HEALTH CARE ADMINISTRATION pte 1-\U-O7 Petitioner, AHCA No.: 2006008299 Return Receipt Requested: v. 7002 2410 0001 4235 2924 7002 2410 0001 4235 2931 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AJ SUBACHAN II, INC. d/b/a BRIARWOOD or 01-04! | Respondent. 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 A J. Subachan II, Inc. d/b/a Briarwood Manor (hereinafter “Briarwood Manor”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes (2005), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $279,000.00 pursuant to Sections 400.414 and 400.419, Florida _ Statutes (2005), 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 (2005) and Chapter 28-106, Florida Administrative Code (2005). 3. Venue lies in Broward County pursuant to Section 120.57, Florida Statutes (2005), and Rule 28-106.207, Florida Administrative Code (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, Florida Statutes (2005), and Chapter 58A-5 Florida Administrative Code (2005). 4 5. Briarwood Manor operates a 39-bed assisted living facility located at 5621-5631 N. W. 28 Street, lULauderhill, Florida 33313. Briarwood Manor is licensed as an assisted living facility under license number 7478. Briarwood Manor 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 BRIARWOOD MANOR FAILED TO PROVIDE DOCUMENTATION VERIFYING THAT A PRELIMINARY REPORT OF AN ADVERSE INCIDENT WAS SUBMITTED TO AHCA WITHIN ONE BUSINESS DAY AFTER THE OCCURRENCE. SECTION 400.423(3), FLORIDA STATUTES. (FACILITY RECORDS STANDARDS) CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Briarwood Manor was cited with five (5) Class III deficiencies due to surveys that were conducted on March 28, 2006, June 2, 2006, and August 2, 2006. 8. A complaint investigation survey was conducted on March 28, 2006. Based on interview and record review, it was determined that the facility failed to provide documentation verifying that a preliminary report of an adverse incident was submitted to A.H.C.A within one business day after the occurrence. The findings include the following. 9. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle, kicked him/her as well as stomp on his/her chest area. 10. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. 11. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 12. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a bottle. 13. The Office Manager reported that Resident #5 was not readmitted to the facility. During a review of Resident #2 and 5's records, it was revealed that the records lacked documentation in regards to the altercations. The Office Manager reported that a preliminary report of the adverse incident had not been submitted to the A.H.C.A within one business day after the occurrence, as of the day of the complaint investigation. 14. The mandated date of correction was designated as April 27, 2006. 15. A follow-up survey was conducted on June 2, 2006. Based on interview and record review, it was determined that the facility failed to provide documentation verifying that a preliminary report of an adverse incident was submitted to A.H.C.A within one business day after the occurrence. The findings include the following. 16. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. 17. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle, kicked him/her as well as stomp on his/her chest area. Resident #2 reported that other residents heard the altercation and called’ the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the eyebrow. Resident #2 reported that prior to the incident, he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 18. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a bottle. 19. The Office Manager reported that Resident #5 was not readmitted to the facility. During a review of Resident #2 and 5's records, it was revealed that the records lacked documentation in regards to the altercations. The Office Manager reported that a preliminary report of the adverse incident had not been submitted to the A.H.C.A within one business day after the occurrence, as of the day of the complaint investigation conducted on 03/28/06. 20. Upon interview with the Office Manager during the revisit survey, conducted 06/02/06 at approximately 11:00 AM, it was reported that the preliminary report of the aforementioned adverse incident was unavailable for review upon request. This is an uncorrected deficiency from the survey of March 28, 2006. 21. The mandated date of correction Date was designated as July 2, 2006. 22. A follow-up survey was conducted on August 2, 2006. Based on interview and record review, it was determined that the facility failed to provide documentation verifying that a preliminary report of an adverse incident was submitted to A.H.C.A within one business day after the occurrence. The findings include the following. 23. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle, kicked him/her as well as stomp on his/her chest area. 24. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 25. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a bottle. The Office Manager reported that Resident #5 was not readmitted to the facility. During a review of Resident #2 and 5's records, it was revealed that the records lacked documentation in regards to the altercations. 26. The Office Manager reported that a preliminary report of the adverse incident had not been submitted to the A.H.C.A within one business day after the occurrence as of the day of the complaint investigation conducted on 03/28/06. 27. Upon interview with the Office Manager during the revisit survey, conducted 06/02/06 at approximately 11:00 AM, it was reported that the preliminary report of the aforementioned adverse incident was unavailable for review, upon request. 28. During a telephone interview with the Administrator at approximately 2:30 PM, while on-site at the facility during the 2nd revisit survey conducted 08/02/06, it was reported that the original copy of the preliminary report of the aforementioned adverse incident was mailed to the A.H.C.A approximately 1 month ago. However, during a further interview, the Administrator reported that he did not have proof that he mailed the report to the A.H.C.A, nor did he have a copy of the report available for review upon request. This is an uncorrected deficiency from the survey dates of March 28, 2006 and June 2, 2006. 29. Based on the foregoing facts, Briarwood Manor violated Section 400.423(3), Florida Statutes, herein classified as an uncorrected Class III violation, which warrants an assessed fine of $31,000.00 [$1,000.00 x 31 days]. COUNT II BRIARWOOD MANOR FAILED TO ENSURE THAT A FULL REPORT OF AN ADVERSE INCIDENT WAS SUBMITTED TO AHCA WITHIN 15 DAYS AFTER THE OCCURRENCE . SECTION 400.423 (4) FLORIDA STATUTES (FACILITIES RECORDS STANDARDS) CLASS III VIOLATION 30. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 31. A compliant investigation survey was conducted on March 28, 2006. Based on interview and record review, it was determined that the facility failed to ensure that a full report of an adverse incident was submitted to A.H.C.A within 15 days after the occurrence. The findings include the following. 32. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle, kicked him/her as well as stomp on his/her chest area. 33. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. 34. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 35. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was 10 Baker Acted, after self inflicting a wound to his/her wrist with a bottle. 36. The Office Manager reported that. Resident #5 was not readmitted to the facility. During a review of Resident #2 and 5's records, it was revealed that the records lacked documentation in regards to the altercations. 37. The Office Manager reported that a report of the adverse incident had not been submitted to the A.H.C.A within 15 days after the occurrence, as of the day of the complaint investigation. 38. The mandated date of correction was designated as April 27, 2006. 39. A follow-up survey was conducted don June 2, 2006. Based on interview and record review, it was determined that the facility failed to ensure that a full report of an adverse incident was submitted to A.H.C.A within 15 days after the occurrence. The findings “include the following. 40. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 11 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle, kicked him/her as well as stomp on his/her chest area. 41. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. 42. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 43. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a bottle. 44. The Office Manager reported that Resident #5 was not readmitted to the facility. During a review of Resident #2 and 5's records, it was revealed that the records lacked documentation in regards to the altercations. 12 45. The Office Manager reported that a report of the adverse incident had not been submitted to the A.H.C.A within 15 days after the occurrence, as of the day of the complaint investigation. 46. Upon interview with the Office Manager during the revisit survey, conducted 06/02/06 at approximately 11:00 AM, it was reported that a full report of the aforementioned adverse incident was unavailable for review upon request. This is an uncorrected deficiency from the survey of March 28, 2006. 47. A follow-up survey was conducted on August 2, 2006. Based on interview and record review, it was determined that the facility failed to ensure that a full report of an adverse incident was submitted to A.H.C.A within 15 days after the occurrence. The findings include the following. 48. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle, kicked him/her as well as stomp on his/her chest area. 13 49. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 50. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a bottle. 51. The Office Manager reported that Resident #5 was not readmitted to the facility. During a review of Resident #2 and 5's records, it was revealed that the records lacked documentation in regards to the altercations. The Office Manager reported that a report of the adverse incident had not been submitted to the A.H.C.A within 15 days after the occurrence, as of the day of the complaint investigation. 52. Upon interview with the Office Manager during the revisit survey, conducted 06/02/06 at approximately 11:00 AM, it 14 was reported that a full report of the aforementioned adverse incident was unavailable for review, upon request. 53. During a telephone interview with the Administrator at approximately 2:30 PM, while on-site at the facility during the 2nd revisit survey conducted 08/02/06, it was reported that the original copy of the full report of the aforementioned adverse incident was mailed to the A.H.C.A approximately 1 month ago. However, during a further interview, the Administrator reported that he did not have proof that he mailed the report to the A.H.C.A, nor did he have a copy of the report available for review, upon request. This is an uncorrected deficiency from the survey dates of March 28, 2006 and June 2, 2006. 54. Based on the foregoing facts, Briarwood Manor violated Section 400.423(4), Florida Statutes, herein classified as an uncorrected Class III violation, which warrants an assessed fine of $31,000.00 [$1,000.00 x 31 days}. COUNT IIT BRIARWOOD MANOR FAILED TO PROVIDE/MAINTAIN WRITTEN RECORD OF SIGNIFICANT CHANGES AND MAJOR INCIDENTS FOR RESIDENTS. RULE 58A-5.0182(1) (e), FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE STANDARDS) CLASS III VIOLATION 55. AHCA re-alleges and incorporates paragraphs (1) 15 through (5) as if fully set forth herein. 56. A complaint investigation survey was conducted on March 28, 2006. Based on interview and record review, it was determined that the facility failed to provide/maintain written record of significant changes and major incidents for 2 out of 5 residents. The findings include the following. 57. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle and was also kicked and stomped in his/her upper chest area. 58. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the right eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. During a further interview, Resident 16 #2 reported that the Administrator never addressed the issue, even after he was notified. 59. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a broken bottle. 60. The Office Manager reported that Resident #5 was not readmitted to the facility. During a review of Resident #2 and 5's records, it was revealed that the records lacked documentation in regards to the incidents. 61. The Office Manager acknowledged the findings. 62. The mandatory date of correction was designated as April 27, 2006. . 63. A follow-up survey was conducted on June 2, “2006. Based on interview and record review, it was determined that the facility failed to provide/maintain written record of significant changes and major incidents for 2 out of 5 residents. The findings include the following. 64. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. 17 During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle and was also kicked and stomped in his/her upper chest area. 65. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the right eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. During a further interview, Resident #2 xveported that the Administrator never addressed the issue, even after he was notified. 66. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a broken bottle. 67. The Office Manager reported that Resident #5 was not readmitted to the facility. During a review of Residents #2 and #5's records during the original complaint investigation survey 18 conducted on 03/28/06 and during the revisit survey conducted on 06/02/06, it was revealed that the records lacked documentation in regards to the incidents. 68. The Office Manager acknowledged the findings. This is an uncorrected deficiency from the survey of March 28, 2006. 69. The mandatory date of correction was designated as July 2, 2006. 70. A follow-up survey was conducted on August 2, 2006. Based on interview and record review, it was determined that the facility failed to provide/maintain written record of significant changes and major incidents for 2 out of 5 ‘residents. The findings include the following. 71. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review, of Resident #5's record, it was revealed that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle and was also kicked and stomped in his/her upper chest area. 72. Resident #2 reported that other residents heard the altercation and called the police. Resident #2 reported that 19 he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the right eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she felt threatened by Resident #5 due to previous altercations. 73. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 74. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager reported that after the police arrived at the facility during the altercation, Resident #5 was Baker Acted, after self inflicting a wound to his/her wrist with a broken bottle. 75. The Office Manager reported that Resident #5 was not readmitted to the facility. 76. During a review of Resident #2 and 5's records during the original complaint investigation survey conducted on 03/28/06, during the revisit survey conducted on 06/02/06, and the 2nd revisit survey conducted on 08/02/06, it was revealed that the records lacked documentation in regards to the incidents. 20 77. The Office Manager acknowledged the findings. This is an uncorrected deficiency from the survey dates of March 28, 2006 and June 2, 2006. 78. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.0182(1) (e), Florida Administrative Code, herein classified as an uncorrected Class III violation, which warrants an assessed fine of $31,000.00 [$1,000.00 x 31 days]. COUNT IV BRIARWOOD MANOR FAILED TO COMPLY WITH THE RESIDENT BILL OF RIGHTS. SECTION 400.428(1), FLORIDA STATUTES (RESIDENT CARE STANDARDS) CLASS III VIOLATION 79. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 80. A complaint investigation survey was conducted on March 28, 2006. Based on interview and record review, it was determined that the facility failed to comply with the Resident Bill of Rights by failing to prevent resident-to-resident abuse for 1 out of 5 residents. The findings include the following. 81. During a review of Resident #2's record, it was revealed that the resident was admitted to the facility in March 2005. During a review of Resident #5's record, it was revealed 21 that the resident was admitted to the facility on 11/14/05. During an interview with Resident #2 at approximately 10:00 AM, it was reported that approximately 5 and 1/2 weeks, ago, he/she was attacked by his/her roommate, Resident #5. Resident #2 reported that he/she was in the process of writing a letter when Resident #5 hit him/her in the head with a bottle and was also kicked and stomped in his/her upper chest area. Resident #2 reported that other residents heard the altercation and called the police. 82. Resident #2 reported that he/she was transported by EMS, hospitalized, and was treated for fractured ribs and a laceration above the right eyebrow. Resident #2 reported that prior to the incident he/she notified the Administrator that he/she ‘felt threatened by Resident #5 due to previous altercations. During a further interview, Resident #2 reported that the Administrator never addressed the issue, even after he was notified. 83. During an interview with the Office Manager at approximately 10:15 AM, the aforementioned incident was confirmed. The Office Manager acknowledged the findings. 84. The mandatory date of correction was designated as April 27, 2006. 85. A follow-up survey was conducted on June 2, 2006. Based on interview and record review, it was determined that the 22 facility failed to comply with the Resident Bill of Rights for 4 out of 4 residents. The findings include the following. 86. Upon interviews with Resident #'s R1 and R3 on the day of the revisit survey conducted on 06/02/06, at approximately 1:00 PM, it was reported that whenever they take a shower and/or utilize the restroom (especially at night) in the bathroom near rooms 4 and 5 of Building A, they feel very uncomfortable due to the fact that the window is missing a covering for privacy. Resident #'s R1 and R3, both reported that they have observed individuals of the opposite sex "peeking into the bathroom window" as they get undressed. Resident #'s Rl and R3 reported that they have informed the Administrator of the aforementioned situation at least four times within the last 3 months, but nothing has been done about it. 87. Upon observation during a tour of Building A, at approximately 1:15 PM, it was noted that the bathroom window in the multi-resident utilized restroom located near rooms 4 and 5, lacked blinds and/or a covering to ensure that the residents are able to utilize the restroom with privacy and dignity. 88. During an interview with Employee #1 at approximately 1:30 PM, it was reported that 4 residents currently utilize the aforementioned restroom. 23 89. During an interview with the Office Manager during the revisit survey conducted on 06/02/06, at approximately 2:15 PM, the aforementioned incidents were confirmed. 90. The Office Manager acknowledged the findings. This is an uncorrected deficiency from the survey of March 28, 2006. 91. The mandatory date of correction Date was designated as July 2, 2006. 92. A following survey was conducted on August 2, 2006. Based on interview and record review, it was determined that the facility failed to comply with the Resident Bill of Rights for 4 out of 4 residents. The findings include the following. 93. Upon interviews with Resident #'s R1 and R3 on the day of the revisit survey conducted on 06/02/06, at approximately 1:00 PM, it was reported that whenever they take a shower and/or utilize the restroom (especially at night) in the bathroom near rooms 4 and 5 of Building A, they feel very uncomfortable due to the fact that the window is missing a covering for privacy. Resident #'s R1 and R3, both reported that they have observed individuals of the opposite sex "peeking into the bathroom window" as they get undressed. Resident #1 and Resident #3 reported that they have informed the Administrator of the aforementioned situation at least four times within the last 3 months, but nothing has been done about it. 24 94. Upon observation during a tour of Building A, at approximately 1:15 PM on 06/02/06, it was notéd that the bathroom window in the multi-resident utilized restroom located near rooms 4 and 5, lacked blinds and/or a covering to ensure that the residents are able to utilize the restroom with privacy and dignity. 95. During an interview with Employee #1 on 06/02/06, at approximately 1:30 PM, it was reported that 4 residents currently utilize the aforementioned restroom. 96. During an interview with the Office Manager during the revisit survey conducted on 06/02/06, at approximately 2:15 PM, the aforementioned incidents were confirmed. 97. Upon observation during the 2nd revisit survey conducted on 08/02/06, at approximately 2:30 PM, the aforementioned issue with the bathroom window near rooms 4 and 5 remained uncorrected. 98. The Office Manager acknowledged the findings. This is an uncorrected deficiency from the surveys of March 28, 2006 and June 2, 2006. 99. Based on the foregoing facts, Briarwood Manor violated Section 400.428(1), Florida Statutes, herein classified as an uncorrected Class III violation, which warrants an assessed fine of $155,000.00 [$5,000.00 x 31 days]. 25 COUNT V BRIARWOOD MANOR FAILED TO PROVIDE A SAFE AND CLEAN ENVIRONMENT. RULE 58A-5.023(1) (b), FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS III VIOLATION 100. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 101. A complaint investigation survey was conducted from on March 28, 2006. Based on observation and interview, it was determined that the facility failed to provide a safe and clean environment. The findings include the following. 102. During a tour of the facility conducted on 03/28/06 at approximately 10:30 AM accompanied by the Office Manager, the following physical plant issues were observed: 103. Building A: A build-up of old dirt on the walls, in the corners, on the floor, and along the baseboards around the perimeter of the dining room area, was observed. 104. In the bathroom near room #3 it was noted that the wall located next to the sink and toilet was missing multiple pieces of tile. It was also noted that there was a build up of dirt and soap scum in the shower stall. The window located in this bathroom was noted to have a build up of dirt and insect droppings/remains. 26 105. A build-up of old dirt on the walls, in the corners, on the floor, and along the baseboards around the perimeter of the resident common area near room #3, was observed. 106. In the bathroom near room #'s 4, 5, and 6, it was noted that the inside of the medicine cabinet was rusty. The wall tile next to the bathroom sink was bulging and in disrepair. The surveyor observed a build-up of old dirt and grime in the bathtub, on the floor, and the baseboards around the perimeter of the bathroom. 107. In the bathroom of room #6, it was noted that the toilet seat cover was missing. It was noted that there was a build-up of dirt and soap scum in the bathtub as well as peeling paint. The surveyor observed a hole in the wall, as well as multiple missing pieces of tile near the towel rack. The hot and cold control handles were missing on the faucet. 108. Building B: Upon entrance of Building B, it was noted that there was a presence of foul odors. The surveyor observed a build-up of old dirt on the walls, behind the furnishings, in the corners, on the floor and along the baseboards around the perimeter of the resident common area. The paint on the floor was noted to be scuffed and in need of repair. 109. In the hallway leading to room #8, it was noted that the ceiling was bulging and stained due to water damage/leaks. 27 110. In the bathroom near room #8, it was noted that the window blinds were missing. It was noted that the bathroom floor was covered in water. The medicine cabinet was rusty. The wall behind the toilet was in need of repair and paint. 111. In room #9, it was noted that the paint on the floor was scuffed and in need of paint. 112. In the bathroom near room 12, the surveyor observed peeling paint and a build-up of old dirt in the bathtub, in the corners of the walls, and along the floor by the baseboards around the perimeter of the bathroom. It was noted that the tile inside of the shower stall was broken and in need of repair. The shower curtain rod and curtain was observed in disrepair. 113. A hole in the wall near the door of room #13 was observed. 114. In room #15, it was noted that the paint on the floor was scuffed and in need of repairing. The tile around the window . was observed broken with sharp jagged edges. 115. In the bathroom near room #15, it was also noted that there was a build-up of dirt and soap scum in the tub as well as peeling paint. The wall tile surrounding the toilet and tub was observed to be broken and need of repair. The window control handle was inoperable. The medicine cabinet was dirty and rusty. 116. In the bathroom of room #16 and 17, it was noted that the window control handle was inoperable. The medicine cabinet 28 was rusty. It was noted that the cover for the light fixture over the sink was missing. The tile next to the towel rack was broken with sharp jagged edges and in need of repair. 117. In room #17, it was noted that the paint on the floor was scuffed and in need of repair. It was noted that the ceiling was bulging and stained due to water damage. It was also noted that there was a hole in the closet door. 118. During a further observation at approximately 10:45 AM, the facility staff was observed utilizing a dirty mop and a brown filthy-like liquid substance in a bucket, while mopping the floor. 119. Upon interview, at approximately 10:55 AM the Office Manager acknowledged the findings during the tour of the facility. 120. The mandatory date of correction Date was designated as April 27, 2006. 121. A follow-up survey was conducted on June 2, 2006. Based on observation and interview, it was determined that the facility failed to provide a safe and clean environment. The findings include the following. 122. Upon tour of the facility during the revisit survey conducted on 06/02/06 at approximately 1:00 PM, the following physical plant issues were observed: 29 123. Building A: A build-up of old dirt on the walls, in the corners, on the floor, and along the baseboards around the perimeter of the dining room. area, was observed. The furnishings, including the dining room tables and chairs, were observed to be filthy and covered with old food stains and matter. 124. In the bathroom near room #3 it was noted that the wall located next to the sink and toilet was missing multiple pieces of tile. It was also noted that there was a build up of dirt and soap scum in the shower stall. The window located in this bathroom was noted to have a build up of dirt and insect droppings/remains. 125. A build-up of old dirt on the walls, in the corners, en the floor, and along the baseboards around the perimeter of the resident common area near room #3, was observed. 126. In the bathroom near room #'s 4, 5, and 6, the surveyor observed a build-up of old dirt and grime in the shower stall, on the floor, and the baseboards around the perimeter of the bathroom. The hot and cold control handles were missing on the faucet. 127. In the hallway near rooms #'s 4, 5, and 6, it was noted that the a/c vent was damaged and in need of repair. 128. The bedroom door of room #6 was noted to be scuffed up, and the door jam was in need of repair. 30 129. The surveyor observed a build-up of dirt on the walls, behind the furnishings, in the corners, on the floor and along the baseboards around the perimeter of the resident common area of Building A. 130. Building B: Upon entrance of Building B, it was noted that there was a presence of foul odors. The surveyor observed a build-up of dirt on the walls, behind the furnishings, in the corners, on the floor and along the baseboards around the perimeter of the resident common area. The paint on the floor was noted to be scuffed and in need of repair. 131. In the hallway leading to room #8, it was noted that the ceiling was bulging and stained due to water damage/leaks. 132. In the bathroom near room #8, it was noted that the window blinds were missing. It was noted that the bathroom floor was covered in water. The medicine cabinet was rusty. The wall behind the toilet was in need of repair and paint. 133. In room #9, it was noted that the paint on the floor was scuffed and in need of paint. 134. In the bathroom near room 12, the surveyor observed peeling paint and a build-up of old dirt in the bathtub, in the corners of the walls, and along the floor by the baseboards around the perimeter of the bathroom. It was noted that the tile inside of the shower stall was broken and in need of repair. The shower curtain rod and curtain was observed in disrepair. 31 141. A follow-up survey was conducted on August 2, 2006. Based on observation and interview, it was determined that the facility failed to provide a safe and clean environment. The findings include the following. 142. Upon tour of the facility during the revisit survey conducted on 06/02/06 at approximately 1:00 PM and during the 2nd revisit survey conducted on 08/02/06, at approximately 2:30 PM, the following physical plant issues were observed: 143. Building A: A build-up of old dirt and missing paint on the walls, in the corners, on the floor, and along the baseboards around the perimeter of the dining room area, was observed. The furnishings, including the dining room tables and chairs, were observed to be filthy and covered with old food stains and matter. 144. In the bathroom near room #3 it was noted that the wall located next to the sink and toilet was missing multiple pieces of tile. It was also noted that there was a build up of dirt and soap scum in the shower stall. The window located in this bathroom was noted to have a build up of dirt and insect droppings/remains. 145. A build-up of old dirt on the walls, in the corners, on the floor, and along the baseboards around the perimeter of the resident common area near room #3, was observed. 33 146. In the bathroom near room #'s 4, 5, and 6, the surveyor observed a build-up of old dirt and grime in the shower stall, on the floor, and the baseboards around the perimeter of the bathroom. The hot and cold control handles were missing on the faucet. 147. In the hallway near rooms #'s 4, 5, and 6, it was noted that the a/c vent was rusty and damaged and in need of repair. 148. The bedroom door of room #6, was noted to be scuffed up, the door jam and baseboard near the bottom of the door was in need of repair. 149. The surveyor observed a build-up of dirt on the exit door, walls, behind. the furnishings, in the corners, on the floor and along the baseboards around the perimeter of the resident common area of Building A. 150. Building B: Upon entrance of Building B, it was noted that there was a presence of foul odors. The surveyor observed a build-up of dirt on the walls, behind the furnishings, in the corners, on the floor and along the baseboards around the perimeter of the resident common area. The paint on the walls and flooring was noted to be scuffed and in need of repair. i151. In the hallway leading to room #8, it was noted that the ceiling was bulging and stained due to water damage/leaks. 34 152. In the bathroom near room #8, it was noted that the window blinds were missing. The medicine cabinet was rusty. The wall behind the toilet was in need of repair and paint. 153. In room #9, it was noted that the paint on the floor was scuffed and in need of paint. 154. In the bathroom near room 12, the surveyor observed peeling paint and a build-up of old dirt in the bathtub, in the corners of the walls, and along the floor by the baseboards around the perimeter of the bathroom. It was noted that the tile inside of the shower stall was broken and in need of repair. The shower curtain rod and curtain was observed in disrepair. 155. Multiple holes in the walls of room #'s 7, 9, 12, 11, 13, and 17 were observed. 156. The tile around the window of room #15, was observed broken with sharp jagged edges. 157. In the bathroom near room #15, it was also noted that there was a build-up of dirt and soap scum in the tub as well as peeling paint. The wall tile surrounding the toilet and tub was observed to be broken and need of repair. The window control handle was inoperable. The medicine cabinet was dirty and rusty. 158. In the bathroom of room #16 and 17, it was noted that the window control handle was inoperable. The medicine cabinet was rusty. It was noted that the cover for the light fixture over the sink was missing. The tile next to the towel rack was 35 broken with sharp jagged edges and in need of repair. The hot and cold control handles were missing on the faucet. 159. During a further observation at approximately 1:45 PM on the revisit survey conducted on 06/02/06 and during the 2nd revisit survey conducted on 08/02/06, it was noted that the a/c unit was inoperable. 4 Residents, chosen at random, on 06/02/06 and 08/02/06 reported that the a/c unit was inoperable. During with Employee #2 on 06/02/06, at approximately 2:30 PM, it was reported that the a/c unit in Building B "works when it wants to". The Employee declined to give further details. This is an uncorrected deficiency from the survey dates of March 28, 2006 and June 2, 2006. 160. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.023(1) (b), Florida Administrative Code, herein classified as an uncorrected Class III violation, which warrants an assessed fine of $31,000.00 [$1,000.00 x 31 days]. 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 Briarwood Manor on Counts I through V. 36 2. Assess an administrative fine of $279,000.00 against Briarwood Manor on Counts I through V for the violations cited above. 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 (2005). Specific options for administrative action are set out in the attached Election 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 37 THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. fine Geran, ourdes A Naranjo, Esq. Fla. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (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) 38 Florida 33166 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 Andy Subachan, Administrator, Briarwood Manor, 5621-5631 N. W. 28% Street, Lauderhill, Florida 33313; Andrew Subachan, Registered Agent, 380 S. Federal Highway, Dania Beach, Florida 33004 on this Ih ® aay of VOLE , 2006. necite, (hee des A. Naranjo, Esq. 39 U.S. Postal Service.., aa CERTIFIED MAIL... | 3=" : _ z (Domestic Mail Only: No icra . omen 2, and 3. Also complete - aI uw For delivery information visit our we i Prt your nae ares on ho reveaa fy 2 { m OFFIC] ‘A $2 that we can retum the card to you. on :, Date pt Delve u - @ Attach this card tothe back ofthe maliplece, } Es BY OE _ Postage | $ or on the front if space permits. see fom tom 17 ere { a Cortified Feo _ 1, Article Addressed to: : : res oman ONo S cen tt Rector Foe Gmdnour Sudecham ao fh =a Dellvery Feo 380 S. Federal tou, | u Déamia, Poach. F020 Sonny Total Postage & Fees | $ : 8. Service Type [san CiCertiied Met! 12 Express Mail 3 | D Registered O Return Receipt for Merchandise - | — insured Mal O cop. . 7002 e440 ooa1 ae35 2431

Docket for Case No: 07-000411