700° WOl0 OO00 9715 38b3 2 o> ff Se oo ty ae i tas, v. 2 od STATE OF FLORIDA on.” by AGENCY FOR HEALTH CARE ADMINISTRATION 494! 75 ny. "39 Heh S775! STATE OF FLORIDA, AGENCY anfhetry Me FOR HEALTH CARE ADMINISTRATION, Petitioner, Ot Uf 5 ( 0 () Vv. ; Case No. 2007006561 ALTERRA HEALTHCARE CORPORATION, D/B/A ALTERRA STERLING HOUSE OF TALLAHASSEE, Respondent. ADMINISTRATIVE COMPLAINT COMES Now the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and -files this Administrative _Complaint against ALTERRA HEALTHCARE CORPORATION, D/B/A ALTERRA STERLING HOUSE OF TALLAHASSEE (hereinafter “Respondent”), pursuant to Chapter 429, Part I, and Sections 120.569, 429.275(2), and 120.57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose a $500.00 administrative fine against the Respondent pursuant to Rules 58A-5.024(2)(a)l and 58A-5.0191(4), Florida . Administrative Code (2006), Sections 20.42 and 429.275(2), Florida Statutes (2006). The imposition of this fine is based on a Class III deficiency pursuant to Section 429.19(2)(c), Florida Statutes (2006). JURISDICTION AND VENUE 2. AHCA has jurisdiction over licensure of assisted living facilities pursuant to Chapter 429, Part I, Florida Statutes and Chapter 58A-5, Florida Administrative Code. 3. Venue lies in Leon County, pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules goveming assisted living facilities pursuant to Chapter 429, Part I and Section 20.42, Florida Statutes, and Chapter 58A-5 Florida Administrative Code. 5. The Respondent is licensed to operate an assisted living facility; license number 9181, effective 10/03/05 through 02/25/08. The Respondent is located at 1780 Hermitage Boulevard, Tallahassee, Florida 32308. The Respondent was at all relevant times required to comply with all applicable rules and statutes goveming assisted living facilities. | COUNT I FAILURE TO MAINTAIN AT LEAST ONE EMPLOYEE IN THE FACILITY AT ALL TIMES WHO WAS CURRENTLY CERTIFIED WITH CPR AND FIRST AID TRAINING, IN CONTRAVENTION OF RULES 58A-5.024(2)(a)1 and 58A- 5.0191(4), FLORIDA ADMINISTRATIVE CODE CLASS Il DEFICIENCY 6 AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Rule 58A-5.0191(4), Florida Administrative Code, requires that a “staff member who has completed courses in First Aid and CPR and holds a currently valid card documenting completion of such courses must be in the facility at all times.” 8. AHCA conducted a survey on or about J; anuary 24, 2007, based on record review and interview the facility failed to maintain staffing 24 hours a day, 7 days a week with at least one staff member that had current CPR and First Aid certifications/training in the facility, A. A review of the staffing schedule was conducted on 01/25/2007. During this review it was noted that the nursing staff members' shifts ended at 11:00 p.m. each night at which time there were several Resident Assistants (RA's)/Direct Care staff members left on duty in the facility by themselves. A further review revealed that on 01/21/2007 and 01/24/2007 the schedule documented that sampled RA/Direct Care staff members (#7 & #8) were the only staff at the facility between 11:00 p.m. and 6:30 a.m. B. A review of sampled staff members #7 and #8 facility training records was conducted on 01/25/2007. During this review it was revealed that neither sampled staff member #7 or #8 had the required current CPR and First Aid Certification/training as required to be left in the facility alone. C, An interview with the facility's Nurse Manager was conducted on 01/25/2007. During this interview the Nurse Manager stated he/she was the only person that made the work schedules for the staff but that the schedules were reviewed and approved by the facility's Administrator. The Nurse Manager also acknowledged that sampled staff members #7 and #8 were the only staff members on duty between 11:00 p.m. and 6:30 a.m. on 01/21/2007 and 01/24/2007. The Nurse Manager also acknowledged that sampled staff members #7 & #8 did not have the required CPR and First Aid certifications, required by regulations, to be left alone at the facility, but that they (sampled staff #7 & #8) were scheduled to take the CPR and First Aid classes in the near future. D. An interview with the facility's Administrator was conducted on 01/25/2007. During this interview the Administrator acknowledged that sampled staff members #7 and #8 did not have the required CPR and First Aid certifications required to be left alone at the facility but allowed this scheduling as sampled staff members #7 and #8 were scheduled to take the classes in a few weeks. 9. The Agency provided a mandated correction date of February 25, 2007. 10. AHCA conducted a follow-up survey on June 2, 2007, based on a schedule review, record review and staff interview, the facility failed to maintain at least one employee in the facility at all times who was currently certified with CPR and first aid training (sample staff employees #1, #2, and #3). A. A review of the work schedule for the 10 pm to 6:30 am shift for February 26th through March 17th was conducted on May 2, 2007. On February 26, March 2, March 3, March 16 and March 17, sample employees #1, #2, and #3 were the only employees to work the 10 pm to 6:30 am shift, A review of the personnel records did not reveal documentation of current certification for CPR and first aid training. 11. Based on the above, AHCA determined that the Respondent violated Rule 58A-5.024(2)(a)1 and 58A-5.0191(4), Florida Administrative Code. 12. AHCA determined that this deficient practice was rélated to the operation and maintenance of the facility or to the personal care of facility residents, and indirectly threatens the physical or emotional health, safety, or security of the facility residents, in violation of Section 429.19 (2)(c), Florida Statutes, 13. The Respondent’s failure to maintain at least one employee in the facility at all times who was currently certified with CPR and first aid training constitutes grounds for the imposition of an administrative fine in the amount of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 429.19(2)(c), Florida Statutes and is a violation of Section 429,275(2), Florida Statutes and Rules 58A-5.024(2)(a)1 and 58A-5.0191(4), Florida Administrative Code. CLAIM FOR RELIEF WHEREFORE, Petitioner, State of Florida, Agency for Health Care Administration, requests the following relief: 1. Make factual and legal findings in favor of AHCA on Count I 2. Assess against Respondent an administrative fine of $500.00 for the violation cited above. 4, Assess costs related to the investigation and prosecution of this matter, if applicable. 6. Grant such other relief as the court deems is just and proper. NOTICE OF RIGHTS 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 form. 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, If you want to hire an attorney, you have the right to be represented by an attorney in this matter. . RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE OR REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. ZAYNAB SALMAN, ESQUIRE Florida Bar LD, No. 0030942 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 / (850) 921-0158 Facsimile CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail (7003 1010 0000 9715 3863) to Owner Alterra HealthCare Corporation, 6737 W. Washington St., Suite 2300, Milwaukee, WI. 53214 " and by U.S. Certified Mail (7000 0520 0024 8388 193 8) to Administrator Jennifer Reyes, 1780 Hermitage Boulevard, Tallahassee, Florida 32308, and to CT Corporation System 1200 South Pine Island Road, Plantation, FL 33324 by U.S. Certified Mail (7000 0520 0024 8388 1600) on this S* Yay of = pakeen \yen , 2007. Copies furnished to: ‘ Zaynab Salman (Interoffice Mail) Barbara Alford Field Office Manager (Interoffice Mail) —> als £ rN AR Zaynab , Esq 666. Ainr *L Lge wos Sd E 3 wy: | : 5 : ES () | 0 & 0) . 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Docket for Case No: 07-004560