Qn ey ‘ STATE OF FLORIDA a 4 AGENCY FOR HEALTH CARE ADMINISTRATION,,..9,, “ fy STATE OF FLORIDA, Ky SMS AF AGENCY FOR HEALTH CARE O Ok 20 Taps 7, ADMINISTRATION, ee Petitioner, Case No. 2007006148 Vs. ALS LEASING, INC. d/b/a ALTERRA CLARE BRIDGE OF FORT MYERS, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative _ Complaint against the Respondent, Als Leasing, Inc. d/b/a Alterra Clare Bridge of Fort Myers (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2006), and alleges as follows: NATURE OF THE ACTION This is an action against an assisted living facility to impose an administrative fine in the amount of FIVE THOUSAND FIVE HUNDRED DOLLARS ($5,500.00) and to assess a survey fee in the amount of FIVE HUNDRED DOLLARS ($500.00), for a total of SIX THOUSAND Hy CLARS ($6,000.00), based tipon five Class I Violations and one repeat Class TI violation—~""~~~ JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2006). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42, 120.60 and Chapters 408, Part II, and 429, Part I, Florida Statutes (2006). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable federal and state regulations, statutes and rules governing such facilities. Chapters 408, Part II, and 429, Part I, Florida Statutes (2006), Chapter 58A-5, Florida Administrative Code. The Agency may deny, revoke, or suspend any license issued to an assisted living facility or impose an administrative fine for violations. Sections 408.813, 408.815, and 429.14, Florida Statutes (2006). In addition to any administrative fine imposed, the Agency may assess a survey fee against an assisted living facility to verify the correction of violations. Section 429.19(7), Florida Statutes (2006). 5. The Respondent was issued a license (License Number 8817), by the Agency to operate a 38-bed assisted living facility located at 13565 American Colony Boulevard, Fort’ Myers, Florida 33912, and was at all material times required to comply with the applicable federal and state regulations, statutes and rule governing such facilities. COUNT I The Respondent Failed To Ensure That Services Were Provided Under Their Limited Nursing Service, Extended Congregate Care License Or Through A Home Health Agency In Violation Of Rule 58A-5.0181(4)(b)1., Florida Administrative Code (2006) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through ~ five (5). 7. Pursuant to Florida law, criteria for continued residency in a facility holding a standard, limited nursing services, or limited mental health license shall be the same as the criteria for admission, except as follows; A resident requiring care of a stage two (2) pressure sore may be retained provided that the facility has a Limited Nursing Services license and services are provided pursuant to a plan of care issued by a physician, or the resident contracts directly with a licensed home health agency or a nurse to provide care. Rule 58A-5.0181(4)(b)1., Florida Administrative Code (2006). 8. The Respondent failed to comply with the above referenced provisions of law. 9. On or about April 16, 2007 through April 17, 2007 the Agency conducted a Biennial License Survey with Extended Congregate Care and Limited Nursing Services of the Respondent facility. 10. Based on record review and observation, the facility failed to provide services for two (2) of eight (8) sampled residents, Resident number two (2) and Resident number three (3), under their LNS (Limited Nursing services), ECC (Extended Congregate Care) license or through a home health agency. | 11. On April 16, 2007 at 9:30 am., the facility provided a list of all residents who were receiving services under the LNS and ECC licenses. Resident number two (2) and Resident number three (3) were not listed as receiving services under the LNS or ECC licenses. 12, On April 17, 2007 at 10:45 a.m., the Health Care Coordinator stated that Resident number two (2) was not receiving any services under the LNS or ECC licenses. 13. On April 16, 2007. at 10:45 am., a review of Resident number two’s (2) file revealed that on March 31, 2007 a resident aide reported to a staff nurse that Resident number two (2) had developed a stage II sore. On April 1, 2007 a health care provider had ordered nursing service through a home health service. Notes from the Resident's log showed that the facility treated the wound on April 2, 2007. There was no indication that the home health service was involved in the treatment of the wound. 14. _ A further review on April 16, 2007 of the resident’s records revealed Resident number two (2) was receiving care from a home health agency. On March 13, 2007, the Assisted Living Facility staff was instructed to feed the resident due to advanced dementia/Alzheimer’s disease as Resident number two (2) was unable to manage food/water intake. On March 20, 2007, instructions were received to feed Resident number two (2) 100% of the time. There was no notation in the resident log that Resident number two (2) was receiving 100% feeding. Physicians order dated January 27, 2007 stated "weekly weights" for weight loss. Weight on December, 2006 was 124 pounds - weight on January 1, 2007 was 112 pounds. The Resident's weight record of April 1, 2007 was 118 pounds, a gain of 4 pounds from March 23, 2007. On April 7, 2007, Resident number two’s (2). weight was down to 117 pounds and on April 14, 2007 Resident number two’s (2) weight was down to 116.5 pounds. Notes in Resident number two’s (2) log dated April 15, 2007 stated that Resident number two (2) became unresponsive at lunch and was transported to the hospital. A review of the hospital admittance records showed the admitting diagnosis was dehydration and hypoglycemia. 15. On April 17, 2007, a visit to the hospital where Resident number two (2) was admitted and review of the hospital records revealed that the Resident was still suffering from a stage II sore. This was also documented by the hospital upon admission. 16. Resident number two (2) was given two (2) Liters of Normal Saline, IV and begun an antibiotic course of Rocephin. On evaluation in the emergency room Resident number two (2) was noted to have a stage II pressure sore to the left buttocks. Blood sugar was elevated to 389. 17. On April 16, 2007 at 10:45 a.m., resident records for Resident number three (3) were reviewed. It was discovered that Resident number three (3) was receiving cast care. Resident number three (3) was receiving this service by the facility but was not listed as receiving services under the LNS or ECC license. 18. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which directly threatened the health, safety, or security of the resident and constitutes a Class II deficiency as defined in Section 429.19(2)(b), Florida Statutes (2006). 19. The Agency shall impose an administrative fine for a cited Class II violation in an amount not less than one thousand dollars ($1,000.00) and not exceeding five thousand dollars ($5,000.00) for each violation. A fine shall be levied notwithstanding the correction of the violation. Section 429.19(2)(b), Florida Statutes (2006). 20. The Respondent was given a mandatory correction date of May 17, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00). COUNT The Respondent Failed To Ensure That a Resident Was Appropriate For Continued Placement In Violation Of Rule 58A-5.0181(5), Florida Administrative Code (2006) 21. The Agency re-alleges and incorporates by reference. paragraphs one (1) through five (5). 22. Pursuant to Florida law, if the resident no longer meets the criteria for continued residency, or the facility is unable te to meet the resident’ s needs, as determined by the facility administrator or health care provider, the resident shall be discharged in accordance with Section 429,28(1), Florida Statutes . Rule 58A-5.0181(5) Florida Administrative Code (2006). 23. The Respondent failed to comply with the above referenced provisions of law. 24. On or about April 16, 2007 through April 17, 2007 the Agency conducted a Biennial License Survey with Extended Congregate Care and Limited Nursing Services of the Respondent facility. 25. Based on record review, and interview, the facility failed to meet the needs of two (2) of eight (8) sampled Residents, Residents number two (2) and Resident number three (3). 26. On April 16, 2007 at 10:30 am., resident records for Resident number two (2) were reviewed. A Resident Health Assessment state form 1823 dated June 15, 2006 stated that Resident number two (2) needs total help in all activities of daily living except eating and transferring and the resident needs assistance with these activities. Resident number two (2) was noted to be incontinent and needing total help with all other activities and is not capable of helping with this need. The resident was receiving services under the Extended Congregate Care (ECC) license starting June 7, 2006. On July 7, 2006, the facility requested and the health care provider ordered those services to be discontinued. No updated 1823 form was in Resident number two’s (2) file. 27. During an interview on April 17, 2007 at 9:30 a.m. the Health Care Coordinator stated that Resident number two (2) was not receiving any Extended Congregate Care. 28. On April 16, 2007 at 10:30 am. while reviewing resident records it was discovered that Resident number two (2) was receiving care from a home health agency. On March 13, 2007, the Assisted Living Facility Staff was instructed to feed the resident due to advanced dementia/alzheimer disease as Resident number two (2) was unable to manage food/water intake. On March 20, 2007 instructions were received to feed Resident number two (2) 100% of the time. There was no notation in the resident log that Resident number two (2) was receiving 100% feeding. Resident number two’s (2) weight record of April 1, 2007 was 118 pounds, a gain of 4 pounds from previous weight recorded on March 23, 2007. On April 7, 2007 Resident number two’s (2) weight was down to 117 pounds and on April 14, 2007 Resident number two’s (2 weight was down to 116.5 pounds. 29. A physicians order dated January 27, 2007 stated “weekly weights" for weight loss. Weight on December 2006 was 124 pounds - weight on January 1, 2007 was 112 pounds. 30. Notes in Resident number two’s (2) resident log dated April 15, 2007 stated that Resident number two (2) became unresponsive at lunch and was transported to the hospital. A review of the hospital admittance records showed the admitting diagnosis was, Urinary Tract Infection, dehydration and hypoglycemia. Resident number two (2) was given 2 Liters of Normal Saline, IV and begun an antibiotic course of Rocephin. On evaluation in the emergency room Resident number two (2) was noted to have a stage II pressure sore to the left buttocks. Blood sugar was elevated to 389. 31. On April 17, 2007 at 10:45 a.m., the Health Care Coordinator stated that she was unaware of the orders to provide 100% feeding for Resident number two (2). On April 17, 2007 at 11:15 am. the Executive Director stated that any questions concerning the residents care should be addressed to the Health Care Coordinator. The Executive Director stated that she deals only with the operational aspects of the facility and did not have anything to do with resident care. 32. On April 16, 2007 at 10:45 a.m. resident records for Resident number three (3) were reviewed. It was discovered that.Resident number three (3) was receiving cast care. Resident number three (3) was receiving this service by the facility but was not listed as receiving services under the LNS or ECC license. 33. The Respondent’s deficient practice constituted a Class II violation. 34. Class II violations are those conditions or occurrences related to the operation and maintenance of the facility or to the personal care of residents which the Agency determines directly threaten the physical or emotional health, safety, or security of the facility residents other than Class I violations. Section 429.19(2)(b), Florida Statutes (2006). 35. The Agency shall impose an administrative fine for a cited Class II violation in an amount not less than one thousand dollars ($1,000.00) and not exceeding five thousand dollars ($5,000.00) for each violation. A fine shall be levied notwithstanding the correction of the violation. Section 429,19(2)(b), Florida Statutes (2006). 36. The Respondent was given a mandatory correction date of May 17, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00). COUNT II The Respondent Failed To Ensure That a Resident Was Appropriate For Continued Placement In Violation Of Section 429.26(1), Florida Statutes (2006) And Rule S8A- 5.0181 (4)(d), Florida Administrative Code (2006) 37. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 38. Pursuant to Florida law, the owner or administrator of a facility is responsible for determining the appropriateness of admission of an individual to the facility and for determining the continued appropriateness of residence of an individual in the facility. A determination shall be based upon an aaaeeamneat ar the strengths, neéds; atid preferences of the ‘resident; the care‘and services offered or arranged for by the facility in accordance with facility policy, and any limitations in law or rule related to admission criteria or continued residency for the type of license held by the facility under this part. A resident may not be moved from one facility to another without consultation with and agreement from the resident or, if applicable, the resident's representative or designee or the resident's family, guardian, surrogate, or attorney in fact. In the case of a tesident who has been placed by the department or the Department of Children and Family Services, the administrator must notify the appropriate contact person in the applicable department. Section 429.26(1), Florida Statutes (2006). 39. Pursuant to Florida law, criteria for continued residency in an assisted living facility holding a standard, limited nursing services, or limited mental health license shall be the same as the criteria for admission, except as follows: (a) The resident may be bedridden for up to 7 consecutive days. (b) A resident requiring care of a stage 2 pressure sore may be retained provided that: 1. The facility has a Limited Nursing Services license and services are provided pursuant to a plan of care issued by a physician, or the resident contracts directly with a licensed home health agency or a nurse to provide care; 2. The condition is documented in the resident’s record; and 3. If the resident’s condition fails to improve within 30 days, as documented by a licensed nurse or physician, the resident shall be discharged from the facility. (c) A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the . facility if the following conditions are met: 1. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice which coordinates and ensures the provision of any additional care and services that may be needed; 2. Continued residency is agreeable to the resident and the facility; 3. An interdisciplinary care plan is developed and implemented by a licensed hospice in consultation with the facility. Facility staff may provide any nursing service permitied under the facility’s license and total help with the activities of daily living; and 4. Documentation of the requirements of this paragraph is maintained in the resident’s file. Rule 58A-5.0181(4)(d), Florida Administrative Code (2006). 40. The Respondent failed to comply with the above referenced provisions of law. 41. On or about April 16, 2007 through April 17, 2007 the Agency conducted a Biennial License Survey with Extended Congregate Care and Limited Nursing Services of the Respondent facility. 42, Based on record review, observation, and interview, the facility's administrator failed to monitor the continued appropriateness of placement of one (1) of eight (8) sampled residents, Resident number two (2) in the facility. 43. On April 16, 2007 at 10:30 am. resident records for Resident number two (2) were reviewed. A Resident Health Assessment state form 1823 dated June 15, 2006 stated that Resident number two (2) needs total help in all activities of daily living except eating and transferring and the resident needs assistance with these activities. Resident number two (2) was noted to be incontinent and needing total help. with all other activities and is not capable of helping with this need. Resident number two (2) was receiving services under the Extended | Congregate Care (ECC) license starting June 7, 2006. On July 7, 2006 the facility requested and the health care provider ordered those services to be discontinued. No updated 1823 form was in Resident number two’s (2) file. 44, During an interview on April 17, 2007 at 9:30 a.m. the Health Care Coordinator stated that Resident number two (2) was not receiving any ECC care. 45. On April 16, 2007 at 10:30 am., while reviewing resident records, it was discovered that Resident number two (2) was receiving care fom a home health agency. On March 13, 2007 the Assisted Living Facility Staff was instructed to feed the resident due to advanced dementia/alzheimer disease as Resident number two (2) was unable to manage food/water intake. On March 20, 2007 instructions were received to feed Resident number two (2) 100% of the time. There was no notation in the resident log that Resident number two (2) was 10 receiving 100% feeding. Resident number two’s (2) weight record of April 1, 2007 was 118 pounds, a gain of 4 pounds from previous weight recorded on March 23, 2007. On April 7, 2007 Resident number two’s (2) weight was down to 117 pounds and on April 14, 2007 Resident number two (2) weight was down to 116.5 pounds. | 46. Physicians order dated January 27, 2007 stated “weekly weights" for weight loss. Weight on December 2006 was 124 pounds - weight on January 1, 2007 was 112 pounds. 47. Notes in Resident number two’s (2) resident log dated April 15, 2007 stated that resident became unresponsive at lunch and was transported to the hospital. A review of the hospital admittance records showed the admitting diagnosis was, Urinary Tract Infection, dehydration and hypoglycemia. Resident number two (2) was given 2 Liters of Normal Saline, IV and begun an antibiotic course of Rocephin. On evaluation in the emergency room Resident number two (2) was noted to have a stage II pressure sore to the left buttocks. Blood sugar was elevated to 389. | 48. On April 17, 2007 at 10:45 a.m., the Health Care Coordinator stated that she was unaware of the orders to provide 100% feeding for Resident number two (2). . 49. On April 17, 2007 at 11:15 a.m. the Executive Director stated that any questions concerning the residents care should be addressed to the Health Care Coordinator. The Executive Director stated that she deals only with the operational aspects of the facility and did not have anything to do with resident care. 50, The Respondent’s deficient practice constituted a Class II violation. 51. Class II violations are those conditions or occurrences related to the operation and maintenance of the facility or to the personal care of residents which the Agency determines directly threaten the physical or emotional health, safety, or security of the facility residents other 11 than Class I violations. Section 429.19(2)(b), Florida Statutes (2006). 52. The Agency shall impose an administrative fine for a cited Class II violation in an amount not less than one thousand dollars ($1,000.00) and not exceeding five thousand dollars ($5,000.00) for each violation. A fine shall be levied notwithstanding the correction of the violation. Section 429.19(2)(b), Florida Statutes (2006). 53. The Respondent was given a mandatory correction date of May 17, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00). COUNT IV The Respondent’s Administrator Failed To Ensure The Provision Of Adequate Care In Violation Of Rule 58A-5.019(1), Florida Administrative Code (2006) 34. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 55. Pursuant to Florida law, every facility shall be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff and the provision of adequate care to all residents as required by Part I of Chapter 429, Florida Statutes, and Rule 58A-5 -019(1), Florida Administrative Code (2006). 56. The Respondent failed to comply with the above referenced provisions of law. ~22___On or about April 16, 2007 through April 17, 2007 the Agency conducted a Biennial License Survey with Extended Congregate Care and Limited Nursing Services of the Respondent facility. 58. Based on record review, observation and interview the facility's administrator failed to supervise the provision of adequate care for five (5) of eight (8) sampled residents, 12 Residents number two (2), Resident number three (3), Resident number four (4), Resident number five (5), and Resident number six (6). 59. On April 16, 2007 at 9:30 am., at the entrance interview, a list of all residents receiving Limited Nursing Services (LNS) and Extended Congregate Care (ECC) services was provided. Resident number two (2) was not on that list as receiving ECC services and Resident number three (3) was not on the list for receiving LNS services. 60. On April 16, 2007 at-10:30 a.m., resident records for Resident number two (2) were reviewed. A Resident Health Assessment state form 1823 dated June 15, 2006 stated that Resident number two (2) needs total help in all activities of daily living except eating and transferring and the resident needs assistance with these activities. Resident number two (2) was noted to be incontinent and needing total help with all other activities and is not capable of helping with this need. Resident number two (2) was receiving services under the Extended Congregate Care (ECC) license starting June 7, 2006: On July 7, 2006 the facility requested and the health care provider ordered those services to be discontinued. No updated 1823 form was in Resident number two’s (2) file. 61. During an interview on April 17, 2007 at 9:30 am. the Health Care Coordinator stated that Resident number two (2) was not receiving any ECC care. 62. On April 16, 2007 at 10:30 am. while reviewing resident records it was discovered that Resident number two (2) was receiving care from a home health agency. On March 13, 2007 the Assisted Living Facility Staff was instructed to feed the resident due to advanced dementia/alzheimer disease as Resident number two (2) was unable to manage food/water intake. On March 20, 2007 instructions were received to feed Resident number two (2) 100% of the time. There was no notation in the resident log that Resident number two (2) was receiving 100% feeding. The Resident's weight record of April 1, 2007 was 118 pounds, a gain of 4 pounds from previous weight recorded on March 23, 2007. On April 7, 2007 Resident number two’s (2) weight was down to 117 pounds and on April 14, 2007 Resident number two’s (2) weight was down to 116.5 pounds. 63. Physicians order dated January 27, 2007 stated "weekly weights" for weight loss. Weight on December 2006 was 124 pounds - weight on January 1, 2007 was 112 pounds. 64. Notes in Resident number two’s (2) resident log dated. April 15, 2007 stated that the resident became unresponsive at lunch and was transported to the hospital. A review of the hospital admittance records showed the admitting diagnosis was, Urinary Tract Infection, dehydration and hypoglycemia. Resident number two (2) was given 2 Liters of Normal Saline, TV and begun an antibiotic course of Rocephin. On evaluation in the emergency room Resident number two (2) was noted to have a stage II pressure sore to the left buttocks. Blood sugar was elevated to 389. 65. On April 17, 2007 at 10:45 a.m., the Health Care Coordinator stated that she was unaware of the orders to provide 100% feeding for Resident number two (2). 66. On April 17, 2007 at 11:15 a.m., the Executive Director stated that any questions concerning the residents care should be addressed. to the Health Care Coordinator. The Executive Director stated that she deals only with the operational aspects of the facility and did not have anything to do with resident care. 67. On April 17, 2007 at 9:50 a.m., Resident number five (5) was observed sitting in the dining room with the resident’s breakfast meal still on the table. There was food residue on the floor around Resident number five (5). Resident number five (5) was slumped over with the resident’s head resting on the resident’s knee. This was within view of the facility nursing i station. Several of the Resident Aides walked by Resident number five (5) without inquiring as to the condition of the Resident. The Executive Director walked past the area and failed to take notice of Resident number five (5) or inquire as to the Resident's condition. The Staff nurse stated that Resident number five (5) was asleep. The Resident remained in this position at the table for over one (1) hour of direct observation prior to any facility intervention. The staff validated that Resident number five (5) could self transfer to the resident’s wheelchair but the Resident's wheel chair was behind the half wall that separates the eating area, thereby confining the resident to the chair in the eating area. 68. During an interview on April 17, 2007 at 10:20 am. Resident number five (5) rose up and said, "I was asleep." Resident number five (5) stated he/she was OK and asked if the Surveyor would help him/her into his/her wheel chair. The Surveyor reported the request to the Staff Nurse who instructed one of the resident aides to help Resident number five (5) into the wheelchair. | 69. On April 16, 2007 at 10:30 a.m., resident records revealed that Resident number three (3) was receiving cast care but was still under the Standard Assisted Living Facility services. This care must be provided under the Limited Nursing Services. 70. On April 16, 2007 at 9:30 am., a general tour of the facility discovered medications being kept in Resident number four (4) and Resident number six’s (6) room. Resident number four (4) and Resident number six (6) are being assisted with their medication and per facility's policy their medication must be centrally stored. . 71. The Respondent’s deficient practice constituted a Class II violation. 72. Class II violations are those conditions or occurrences related to the operation and maintenance of the facility or to the personal care of residents which the Agency determines 15 directly threaten the physical or emotional health, safety, or security of the facility residents other than Class I violations. Section 429.19(2)(b), Florida Statutes (2006). ‘73. The Agency shall impose an administrative fine for a cited Class II violation in an amount not less than one thousand dollars ($1,000.00) and not exceeding five thousand dollars ($5,000.00) for each violation. A fine shall be levied notwithstanding the correction of the violation. Section 429,.19(2)(b), Florida Statutes (2006). 74. The Respondent was given a mandatory correction date of May 17, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00). COUNT V The Respondent Failed To Ensure The General Health, Safety, And Physical And Emotional Well-Being Of The Residents In Violation Of Rule 58A-5.0182(1)(b), Florida Administrative Code (2006) 75. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). | 76, Pursuant to Florida law, facilities shall offer personal supervision, as appropriate for each resident, including the following, daily observation by designated staff of the activities of the resident while on the premises, and awareness of the general health, safety, and physical and emotional well-being of the individual. Rule 58A-5.0182(1)(b), Florida Administrative Code (2006). 77. The Respondent failed to comply with the above referenced provisions of law. 78, On or about April 16, 2007 through April 17, 2007 the Agency conducted a Biennial License Survey with Extended Congregate Care and Limited Nursing Services of the Respondent facility. 16 79. Based on record review, observation and interview the facility failed to monitor the general health, safety, and physical and emotional well-being of five (5) of eight (8) residents, Residents number two (2), Resident number three (3), Resident number four (4), Resident number five (5), and Resident number six (6). 80. On April 16, 2007 at 9:30 am., at the entrance interview a list of all residents receiving ECC/LNS services was provided. Resident number two (2) and Resident number three (3) were not on that list. 81. On April 16, 2007 at 10:30 am. resident records for Resident number two (2) were reviewed. A Resident Health Assessment state form 1823 dated June 15, 2006 stated that Resident number two (2) needs total help in all activities of daily living except eating and transferring and needs assistance with these activities. Resident number two (2) was noted to be incontinent and needing total help with all other activities and is not capable of helping with this need. Resident number two (2) was receiving services under the Extended Congregate Care (ECC) license, On July 7, 2006 the facility requested and the health care provider ordered those services to be discontinued. No updated 1823 was found in Resident number two’s (2) file. 82. On April 16, 2007 at 10:30 am., while reviewing resident records, it was discovered that Resident number two (2) was receiving care from a home health care agency. On March 13, 2007 the Assisted Living Facility Staff was instructed to feed the resident due to advanced dementia/alzheimer disease as Resident number two (2) was unable to manage food/water intake. On March 20, 2007 instructions were received to feed Resident number two (2) 100% of the time. There was no notation in the resident log that Resident number two (2) was receiving 100% feeding. Physicians order dated January 27, 2007 stated "weekly weights" for weight loss. Weight on December 2006 was 124 pounds - weight on January 1, 2007 was 112 17 pounds. The Resident's weight record of April 1, 2007 was 118 pounds, a gain of 4 pounds from March 23, 2007. On April 7, 2007 Resident number two’s (2) weight was down to 117 pounds and on April 14, 2007 Resident number two’s (2) weight was down to 116.5 pounds. Notes in Resident number two’s (2) log dated April 15, 2007 stated that Resident number two (2) became unresponsive at lunch and was transported to the hospital. A review of the hospital admittance records shows the admitting diagnosis was dehydration and hypoglycemia. 83. Resident number two (2) was given 2 Liters of Normal Saline, IV and begun an antibiotic course of Rocephin. On evaluation in the emergency room Resident number two (2) was noted to have a stage II pressure sore to the left buttocks. Blood sugar was elevated to 389. 84. During an interview on April 17, 2007 at 9:30 a.m. the Health Care Coordinator stated that Resident number two (2) was not receiving any ECC care. 85. On April 17, 2007 at 10:45 am. the Health Care Coordinator stated that she was unaware of the orders to provide 100% feeding for Resident number two (2). On April 17, 2007 at 11:15 am. the Executive Director stated that any questions concerning the resident's care should be addressed to the Health Care Coordinator. The Executive Director stated that she deals only with the operational aspects of the facility. 86. On April 17, 2007 at 9:50 a.m. Resident number five (5) was observed sitting in the dining room with the resident’s breakfast meal still on the table. There was food residue on the floor around Resident number five (5). Resident number five (5) was slumped over with the Resident’s head resting on the Resident’s knee. This was within view of the facility nursing station. Several of the Resident Aides walked by Resident number five (5) without inquiring as to the condition of the Resident. The Executive Director walked past the area and failed to take notice of the Resident or inquire as to the Resident's condition. The Staff nurse stated that Resident number five (5) was asleep. Resident number five’s (5) wheel chair was behind the half wall that separates the eating area thereby confining the resident to the chair in the eating area. 87. During an interview on April 17, 2007 at 10:20 am., Resident number five (5) rose up and said, "I was asleep." Resident number five (5) stated he/she was OK and asked the Surveyor for help to transfer to his/her wheel chair. The Surveyor reported the request to the Staff Nurse who instructed one of the resident aides to help Resident number five (5) into the wheelchair. 88. On April 16, 2007 at 10:30 am., resident records revealed that Resident number three (3) was receiving cast care but was still under the Standard Assisted Living Facility services. This care must be provided under the Limited Nursing Services. 89. On April 16, 2007 at 9:30 am., a general tour of the facility discovered medications being kept in Resident number four (4) and Resident number six’s (6) room. Resident number four (4) and Resident number six (6) are being assisted with their medication and per facility's policy their medication must be centrally stored. 90. The Respondent’s deficient practice constituted a Class II violation. 91. Class JI violations are those conditions or occurrences related to the operation and maintenance of the facility or to the personal care of residents which the Agency determines directly threaten the physical or emotional health, safety, or security of the facility residents other than Class I violations. Section 429.19(2)(b), Florida Statutes (2006). 92. The Agency shall impose an administrative fine for a cited Class II violation in an amount not less than one thousand dollars ($1,000.00) and not exceeding five thousand dollars ($5,000.00) for each violation. A fine shall be levied notwithstanding the correction of the violation. Section 429.19(2)(b), Florida Statutes (2006). 19 93. The Respondent was given a mandatory correction date of May 17, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00). COUNT VI The Respondent Failed To Ensure Staff Had A Statement From A Health Care Provider Verifying Freedom From Communicable Diseases Including Tuberculosis Within Thirty (30) Days Of Employment In Violation Of Rules 58A-5.019(2)(a), And 58A-5.024(2)(a), Florida Administrative Code (2006) 94. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 95. Pursuant to Florida law, newly hired staff shall have thirty (30) days to submit a statement from a health care provider, based on a examination conducted within the last six months, that the person does not have any signs or symptoms of a communicable disease including tuberculosis. Freedom from tuberculosis must be documented on an annual basis. A person with a positive tuberculosis test must submit a health care provider’s statement that the person does not constitute a risk of communicating tuberculosis. Newly hired staff does not include an employee transferring from one facility to another that is under the same management or ownership, without a break in service. If any staff member is later found to have, or is suspected of having, a communicable disease, he/she shall be removed from duties until the administrator determines that such condition no longer exists. Rule 58A-5.019(2)(a), Florida Administrative Code (2006). Pursuant to Florida law, 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. Rule 58A- 5.024(20(a), Florida Administrative Code (2006). 96. On or about June 15, 2005 the Agency conducted a Biennial License Survey with Extended Congregate Care and Limited Nursing Services of the Respondent’s facility. 97. Based on review of the personnel files and an interview with the Health Care Coordinator, the facility failed to ensure one (1) of five (5) employees reviewed, Employee number five (5) had a statement within thirty (30) days of employment from a health care provider that Employee number five (5) did not have any signs or symptoms of a communicable disease including tuberculosis. , 98. A review of the personnel files on June 15, 2005 revealed a hire date for Employee number five (5) of June 28, 2004. There was no indication that Employee number five (5) had a statement from a health care provider stating no signs or symptoms of a communicable disease including tuberculosis. 99. An interview with the Health Care Coordinator on June 15, 2005 at approximately 5:00 p.m. confirmed the missing information. 100. The Agency determined that the Respondent’s conditions and occurrences were related to the operation and maintenance of the Facility, or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of the Facility residents, other than a Class I or Class II violation. 101. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2006). 102. The Respondent was given a mandatory correction date of July 15, 2005. 103. During a Follow-up Survey conducted on July 25, 2005 the Agency determined that the Respondent had corrected the deficiency. 104. On or about’ April 16, 2007 through April 17, 2007 the Agency conducted a Biennial License Survey with Extended Congregate Care and Limited Nursing Services of the Respondent facility. 105. Based on record review and interview the facility failed to ensure two (2) of eight (8) staff, Employee number five (5) and Employee number seven (7) had a statement from a health care provider of being free from communicable diseases including tuberculosis within thirty (30) days of employment. 106. On April 16, 2007 at 4:30 p.m., employee records were reviewed for statements of freedom from communicable diseases including tuberculosis. Employee number five (5) and Employee number seven (7) had no Statements of being free from communicable diseases including tuberculosis. Employee number five’s (5) hire date was December 14, 2006. Employee number seven’s (7) hire date was January 29, 2007. 107. On April 16, 2007 at 5:30 p.m., the Executive Director stated that she “was unaware that the employees had not provided the statements of being free from communicable disease including tuberculosis. 108. The Agency determined that the Respondent’s conditions and occurrences were related to the operation and maintenance of the Facility, or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of the Facility residents, other than a Class Tor Class II violation. 109. The Agency cited the Respondent for a Class IIT violation in accordance with Section 429.19(2)(c), Florida Statutes (2006). 110. The Respondent’s violation constituted a repeat violation. 111. The Agency shall impose an administrative fine for a cited Class III repeat 22 violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 112. The Agency provided a mandated correction date of May 17, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of FIVE HUNDRED DOLLARS ($500.00). COUNT VII Assessment of Survey Fee 113. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5) and the allegations in Counts I through Count VI. 114. Pursuant to Florida law, in addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one half of the Facility's biennial license and bed fee or five hundred dollars ($500.00), to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits conducted under Section 400.428(3)(c), Florida Statutes, to verify the correction of the violations. Section 429.19(7), Florida Statutes (2006). 115. The Agency conducted a biennial license survey of the Respondent’s facility with respect to the care and services being provided to the residents on or about April 16, 2007 through April 17, 2007 116. Based upon the survey, the Agency found violations that were the subject of the administrative complaint. 117. In this particular instance, the Agency is entitled to assess a survey fee against the Respondent in the amount of FIVE-HUNDRED DOLLARS ($500.00). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to assess a survey fee against the Respondent in the amount of FIVE HUNDRED DOLLARS ($500.00). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to grant the following relief: 1. Enter findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of FIVE THOUSAND FIVE HUNDRED DOLLARS ($5,500.00). 3. Assess a survey fee against the Respondent in the amount of FIVE HUNDRED ‘DOLLARS ($500.00). 4. Order any other relief that the Court deems just and appropriate. 5. Respectfully submitted on this 84 Nay of 0) ec, , 2007. Qinideponr I am Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 NOTICE THE RESPONDENT IS NOTIFIED THAT IT HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. IF THE RESPONDENT WANTS TO HIRE AN ATTORNEY, IT/HE/SHE HAS THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS . MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS FORM. THE RESPONDENT IS FURTHER NOTIFIED IF THE ELECTION OF RIGHTS FORM IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. THE ELECTION OF RIGHTS FORM SHALL BE MADE TO THE AGENCY FOR HEALTH CARE ADMINISTRATION AND DELIVERED TO: AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BUILDING 3, MAIL STOP 3, TALLAHASSEE, FL 32308; TELEPHONE (850) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to: Karen Pratt, Administrator, Als Leasing, Inc. d/b/a Alterra Clare Bridge of Fort Myers, 13565 American Colony Boulevard, Fort Myers, Florida 33912, by U.S. Certified Mail, Retum Receipt No. 7006 2760 0003 1536 6510, and to C. T. Corporation System, Registered Agent for Als Leasing, Inc, d/b/a Alterra Clare Bridge of Fort Myers, 1200 South Pine Island Road, Plantation, Florida 33324, by U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1536 6541, on this 2A of 0 Ce. , 2007. Qed weg» On Alon A Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 Copies furnished to: Karen Pratt, Administrator Als Leasing, Inc. d/b/a Alterra Clare Bridge of Fort Myers 13565 American colony Boulevard Fort Myers, Florida 33912 (U.S. Certified Mail) Andrea M. Lang, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) C. T. Corporation System, Registered Agent for | Kriste J. Mennella Als Leasing, Inc. d/b/a Alterra Clare Bridge of Fort Myers 1200 South Pine Island Road Plantation, Florida 33324 (U.S. Certified Mail) Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 | (Interoffice Mail) 26 : SENDER: ‘COMPLETE THIS SECTION. | Complete items 1,2, and 3. Also complete, : ttem 4 if Restricted Delivery Is desired. 3M. Print your name and address on the reverse : so that we can return the card to you. } Wl Attach this card to the back of the mailplece, i or on the front if space permits. 1, Article Addressed to: 2007006148 Karen Pra tty Administrator | Al terre Clare Bridge of Fort Inge 13 sos Awsricarn Colon; Bovlevart Fort Mya, Etorids ; D. Is delivery address different from item If YES, enter delivery address below:' 3. Service Type CO Certified Mail . (1 Express Malt CI Registered D Return Recelpt for Merchandise 339/2 Diinsured Mall = C.0.0, : : . . 4, Restricted Delivery? (Extra Fee) 0 Yes _ 2 Atole Number eg «= «70h 2760 OOO3 153m Slo ; (Transfer fram service fabe, , PS Form 3811, February 2004 Domestic Return Receipt 4102595-02-M-1540

Docket for Case No: 08-000620