07.2752 ps STATE OF FLORIDA 07 My 19 =D AGENCY FOR HEALTH CARE ADMINISTRATION 4 yar STATE OF FLORIDA, AGENCY FOR HEALTH Ohi slOM of CARE ADMINISTRATION, “ARNGd Ve Petitioner, AHCA No.: 2007000398 Return Receipt Requested: v. 7002 2410 0001 4235 3211 : 7002 2410 0001 4235 4201 ALL AMERICA ADULT CONGREGATE LIVING FACILITY, INC. d/b/a ALL AMERICA ACLF, 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 All America Adult Congregate Living Facility, Inc. d/b/a All America ACLF (hereinafter “All America ACLF”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,500.00 pursuant to Sections 429.14 and 429.19, Florida Statutes (2006), 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 (2006), and Chapter 28-106, Florida Administrative Code (2006). 3. Venue lies in Miami-Dade County pursuant to Section 120.57, Florida Statutes (2006), and Rule 28-106.207, Florida Administrative Code (2006). 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 429, Part I, Florida Statutes (2006), and Chapter 58A-5 Florida Administrative Code (2006) . 5. All America ACLF operates a 100-bed assisted living facility located at 808 West 1%* Avenue, Hialeah, Florida 33010. All America ACLF is licensed as an assisted living facility under license number 7890. All America ACLF 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 ALL AMERICA ACLF FAILED TO ENSURE THAT MINIMUM STAFFING HOURS WERE MET. RULE 58A-5.019(4) (a)1, FLORIDA ADMINISTRATIVE CODE (STAFFING STANDARDS) CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. All America ACLF was cited with four(4) Class III deficiencies as a result of licensure surveys and complaint investigation surveys that were conducted on February 27, 2006, April 11,2006 and November 20, 2006. 8. A complaint investigation survey was on February 27, 2006. Based on review of the staffing, it was determined that the Administrator failed to ensure that the minimum staffing hours were met. The findings include the following: 9. The documented staffing hours which was not met for the time period February 1, 2006 to February 7™, 2006 with a resident census of 68 residents. The documented staffing was 440 hours and the required staffing was 457 hours weekly. 10. The documented staffing hours were not met. for the time period February 8, 2006 to February 14, 2006. The documented staffing was 442 hours and the required staffing was 457 hours for a census of 68 residents. 11. The documented staffing hours were not met for the time period February 15, 2006 to February 21, 2006. The documented staffing was 440 hours and the required staffing was 457 hours for a census of 68 residents. 12. The projected staffing for February 22, 2006 through February 28, 2006 does not meet the required staffing of 457 hours. The projected staffing is 408 hours. 13. The mandatory date of correction was designated as March 6, 2006. 14. A complaint investigation survey was conducted on November 20, 2006. Based on review of the staffing, it was determined that the administrator failed to ensure that the minimum staffing hours were met. The findings include the following. 15. The documented staffing hours did not show the required hours for the time period November 2, 2006 to November 7, 2006 with a resident census of 48 residents. The documented staffing was 336 hours and the required staffing was 375 hours weekly. 16. The documented staffing hours did not show’ the required hours for the time period November 8, 2006 to November 14, 2006. The documented staffing was 336 hours and the required staffing was 375 hours for a census of 50 residents. This is a repeat deficiency from the survey of February 27, 2006. 17. Based on the foregoing facts, All America ACLF violated Rule 58A-5.019(4)(a)1, Florida Administrative Code, herein classified as a repeat Class III violation, which warrants an assessed fine of $500.00. COUNT II ALL AMERICA ACLF FAILED TO PROVIDE CURRENT COMMUNITY LIVING SUPPORT PLAN FOR RESIDENTS. SECTION 429.075(3) (a), FLORIDA STATUTES SECTION 429.02(8), FLORIDA STATUTES RULE 58A-5.029(2) (c)3.a., FLORIDA ADMINISTRATIVE CODE (COMMUNITY LIVING SUPPORT PLAN STANDARDS) CLASS III VIOLATION 18. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 19. A re-licensure survey was conducted on April 11, 2006. Based on interview and record review, it was determined that facility failed to provide current community living support plan for 3 of 7 residents (resident SAMPLE #1, #3 and #7). The findings include the following. 20. pacility's record review, revealed that the facility failed to provide a current community living support plan for resident #1, (admitted on 7/11/2003), resident #3 (admitted on 7/31/2003), resident #7 (admitted on 3/2/1995). 21. (Interview with the consultant that took place on 4/11/2006 at 3:00 PM, revealed that this is an oversight. 22. The mandatory date of correction was designated as May 11, 2006. 23. A complaint investigation survey was conducted on November 20, 2006. Based on record review and interview the facility failed to ensure that a current Community Living Support Plan from the resident's Mental Health Care Provider was provided for 3 out of 8 sampled residents. (Resident #6, #7 and #8). The findings include the following. 24. Clinical Record review on 11/20/06 at approximately 10:50 AM revealed that the Community Living Support Plan completed within 30 days of admission or within 30 days of receiving the mental health appropriate placement was not provided for Resident #6, #7 and #8, limited mental health residents. 25. Resident #6 was admitted to the facility on 10/18/06. Resident #7 was admitted to the facility on 10/10/06. Resident #8 was admitted to the facility on 10/03/06. 26. An interview conducted with the administrator on 11/20/06 at approximately 11:50 AM revealed that the Community Living Support Plan would be obtained from the residents! Mental Health Care Provider. This is a repeat deficiency from the survey of April 11, 2006. 27. Based on the foregoing facts, All America ACLF violated Section 429.075(3)9a), Florida Statutes, Section 429.02(8), Florida Statutes, and Rule = 58A-5.029(2) (c)3.a., Florida Administrative Code, herein classified as a repeat Class III violation, which warrants an assessed fine of $500.00. COUNT III ALL AMERICA ACLF FAILED TO PROVIDE PROOF OF LIMITED MENTAL HEALTH (LMH) TRAINING FOR STAFF. Section 429.075(1), Florida statutes RULE 58A-5.029(3) (d), FLORIDA ADMINISTRATIVE CODE RULE 58A-5.0191(8), FLORIDA ADMINISTRATIVE CODE (STAFFING STANDARDS) CLASS III VIOLATION 28. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 29. A licensure survey was conducted on April 11, 2006. Based on record review and interview, it was determined that facility failed to provide proof of Limited Mental Health (LMH) training for two out of eight staff (Staff #1 and #8). The findings include the following. 30. The facility's record review on 4/10/06 at approximately 2:00 p.m. revealed that staff #1 (hired on 5/01/05) and staff #9 (hired on 3/19/05), did not have limited mental health training on file. 31. During interview the caregiver on 4/10/06 at approximately 3:45 p.m. stated that staff #1 and #8 had not taken the limited mental health training as required. 32. The mandatory date of correction was designated as May 11, 2006. 33. A complaint investigation survey was conducted on November 20, 2006. Based on record review and interview, it was determined that the facility failed to provide proof of Limited Mental Health (LMH) training for one out of ten staff (Staff #3). The findings include the following. 34. The facility's record review on 11/20/06 at approximately 11:30 AM revealed that Staff #3 (hired on 03/24/06), did not have limited mental health training on file. During interview, the administrator, on 03/24/06 at approximately 12:45 PM, stated that Staff #3 had not taken the limited mental health training as required. 35. Based on the foregoing facts, All America ACLF violated Section 429.075(1), Florida Statutes, Rule 58A- 5.029(3) (d), Florida Administrative Code, and Rule 58A- 5.0191(8), Florida Administrative Code herein classified as a repeat Class III violation, which warrants an assessed fine of $500.00. 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 All America ACLF on Counts I through Iil. 2. Assess an administrative fine of $1,500.00 against All America ACLF on Counts I through III 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 (2006). 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 THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER olrece Y hacen urdes A. Naranjo, Esq. Fla. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Harold Williams Field Office Manager Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 (U.S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) 10 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 Teresita Feal, Administrator, All America ACLF, 808 West 1° Avenue, Hialeah, Florida 33010; Teresita M. Feal, Registered Agent, 410 S. W. 27% Road, Miami, Florida 33129 on this ZY Thoay of / rnc? , 2006. LL) foytde s A. Naranjo, Esq. 11 Fa \ ( THIS U.S. Postal Service: CERTIFIED MAIL, (Domestic Mail Only; No insu 7002 2410 gO01 4235 3211

Docket for Case No: 07-002732