STATE OF FLORIDA ; AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, O1 -U UY ‘On Petitioner, vs. ; Case No. 2007006786 SANDRA CAMPBELL d/b/a LOVE-N-CARE ASSISTED LIVING, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against SANDRA CAMPBELL d/b/a LOVE-N-CARE ASSISTED LIVING (hereinafter Respondent), pursuant to Sections 120.569 and 120.57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION ~ This is an action to impose an administrative fine in the amount of one thousand dollars ($1,000.00) based upon two repeat cited State Class III deficiencies pursuant to § 429.19(2)(c), Florida Statutes (2006). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and 429.07, Florida Statutes (2007). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part II, 429, Part I, Florida Statutes, and Chapter 58A-5 Florida Administrative Code, respectively. 4. Respondent operates an 16-bed assisted living facility located at 5426 18" Street West, Bradenton, Florida 34207, and is licensed as an assisted living facility, license number 10666. 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with ail applicable rules and statutes. COUNTI 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. , 7. That pursuant to Florida law, menus to be served shall be dated and planned at least one week in advance for both regular and therapeutic diets. Residents shall be encouraged to , participate in menu planning. Planned menus shall be conspicuously posted or easily available to residents... R. 58A-5.020(2)(d), Florida Administrative Code. 8. That on November 3, 2006, the Agency conducted a complaint survey of the Respondent facility. . 9. That based upon the review of records and interview, Respondent failed to ensure that planned menus are conspicuously posted or easily available to residents, the same being contrary to law. 10. That the Petitioner’s representative toured the Respondent facility on November 3, 2006 and could not locate any menus available to residents in any public area of the Respondent nN facility. 11. That Petitioner’s representative did locate during tour of the facility a single menu posted in the kitchen area, 12. That Petitioner’s representative interviewed Respondent’s staff member in the kitchen on November 3, 2006 who indicated that resident’s of the Respondent facility are not permitted into the facility’s kitchen area. 1B. That the above reflects Respondent’s failure to ensure that menus are conspicuously posted or easily available to residents, the same being in violation of law. 14, That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a State Class III deficiency. ‘15. That the Agency provided Respondent with a mandatory correction date of December 3, 2006. ) . | 16. That on December 27, 2006, the Petitioner determined that Respondent had corrected the deficient practice. 17, That on May 9, 20076, the Agency conducted a biennial licensure survey of the Respondent facility. 18. That based upon the review of records and interview, Respondent failed to ensure that planned menus are conspicuously posted or easily available to residents, the same being contrary to law. 19. ‘That the Petitioner’s representative toured the Respondent facility on May 9, 2007 and could not locate any menus available to residents in any public area of the Respondent facility. 20. That the Petitioner’s representative interviewed Respondent’s administrator on May 9, 2007, at 12:00 p.m., regarding the posting of or availability of facility menus whereupon she removed some papers from the bulletin board and shuffled through then to find the menu for the day. 21. That the menu presented was in small print and contained several menu cycles. No annotations on the menus indicated what meals would be served when. 22. That the above reflects Respondent’s failure to ensure that menus are conspicuously posted or easily available to residents, the same being in violation of law. 23, That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a State Class III deficiency. 24, That the Agency provided Respondent with a mandatory correction date of June 9, 2007. 25, | That the same constitutes a repeat deficiency as defined by law. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $500.00 against Respondent, an assisted living facility in the State of Florida, pursuant'to § 429.19(2)(c), Florida Statutes (2006). . Count I 26. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 27. That pursuant to Florida law, menus to be served shall be dated and planned at least one week in advance for both regular and therapeutic diets... Regular and therapeutic menus as ' served, with substitutions noted before or when the meal is served, shall be kept on file in the facility for 6 months. R. 58A-5.020(2)(d), Florida Administrative Code. 28. That on November 3, 2006, the Agency conducted a complaint survey of the Respondent facility. 29. That based on observation and interview, Respondent failed to maintain a system or records of recording menu substitutions as required by law. 30. That the Petitioner’s representative reviewed the Respondent’s menu for the noon meal on November 3, 2006 and noted that the menu required the following; a. A four (4) ounce hamburger; b. Bun with tomato c. One slice of cheese; d. Four (4) ounces of three-bean salad; e. One (1) ounce potato chips; f One (1) baked apple; g. One (1) cup milk. 31. . That the Petitioner’s representative observed the meal served for lunch on November 3, 2006 and the following was served: a. Baked beans; b. Tomato soup; c. Fruit cocktail; d. Juice; e. Milk f. Hot dog; g. Sliced tomato. 32. That the Petitioner’s representative interviewed Respondent's dietary aide on November 3, 2006 who reported as follows: . a. That changes were made to the menu; b. That notations of the menu changes had not been annotated; c. That Respondent did not maintain a record of menu changes, substitutions, or alterations. 33. That Respondent elected to substitute nutritional items for approved menus and failed to havea system for or record those substitutions, maintaining the same for a six (6) month period, as required by law. | | 34. That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a State Class III deficiency. 35... That the Agency provided Respondent with a mandatory correction date of December 3, 2006 36. That the Agency determined that Respondent had corrected the deficient practice on December 27, 2006. 37. That on November 3, 2006, the Agency conducted a biennial licensure survey of the Respondent facility. 38. That based on observation and interview, Respondent failed to maintain a system or records of recording menu substitutions as required by law. 39. That the Petitioner’s representative interviewed the Respondent’s administrator on May 9, 2007 who indicated that Respondent did not record or maintain a record of substitutions in menus made as required by law and that any such record could not be provided. 40. That Respondent failed to have a system for or record menu substitutions, maintaining the same for a six (6) month period, as required by law. 41. That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident | . and cited Respondent for a State Class III deficiency. 42. That the Agency provided Respondent with a mandatory correction date of June 9, 2007. 43. That the same constitutes a repeat deficiency as defined by law. . WHEREFORE, the Agency intends to impose an administrative fine in the amount of $500.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(c), Florida Statutes (2006). Respectfully submitted this 6 day of September, 2007. . Walsh II Fla.Bat. No. 566365 Counsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. 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 Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7007 0220 0001 1589 2938 on September _G , 2007 to: Sandra Campbell, Administrator, Sandra Campbell d/b/a Love-N-Care Assisted Living, 5426 | 18" Street West. Bradenton, Florida 34207. Copies furnished to: Sandra Campbell, Administrator Love-N-Care Assisted Living 5426 18" Street West Bradenton, Florida 34207 (USS. Certified Mail) Thomas J. Walsh, IT Agency for Health Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, Florida 33701 (Interoffice) Kathleen Varga Facility Evaluator Supervisor 525 Mirror Lake Drive, 4" Fl. St. Petersburg, Florida 33701 (Interoffice) " @ Complete items 1, 2, anurd. Also complete i item 4.1f Restricted Delivery Is desired. * Mf Print your name and address on the reverse so that we can return the card to you. ™ Attach this card to the back of the mallplece, or‘on the. front if space permits coke “ty Arta Aapreoned to: oe Compe; “Bed ni W-Care. Asst. Livia “700? 0220 0001 1585 2938 | “RS Form n 3811, February 2004 . vege e seme Soe ment et ae antennae at

Docket for Case No: 07-004482