OX:d>\ STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. ; Case No. 2008004167 BLC SAND POINT, LLC, a Delaware Limited Liability Company, d/b/a SAND POINT SENIOR LIVING, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“Agency”), by and through the undersigned counsel, and files this Administrative Complaint against BLC SAND POINT, LLC, a/b/a SAND POINT SENIOR LIVING (“Respondent” or “Respondent Facility”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the total sum of six hundred dollars ($600.00) based on one cited uncorrected State Class III deficiency for a fine of five hundred dollars ($500.00) pursuant to Section 429.19(2) (c), Florida Statutes (2007), and one cited uncorrected State Class IV deficiency for a fine of one hundred dollars ($100.00) pursuant to Section 429.19(2)(d), Florida Statutes (2007). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Sections 20.42 and 120.60, and Chapter 429, Part I, and Chapter 408, Part II, 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 state statutes and rules governing assisted living facilities pursuant to Chapter 408, Part II, and Chapter 429, Part I, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. 4. Respondent operates a 70-bed assisted living facility located at 1800 Harrison Street, Titusville, Florida 32780, and is licensed as an assisted living facility, license number 5758, with Limited Nursing Services and Extended Congregate Care licenses. 5. Respondent was at all times material to the allegations of this complaint a licensed facility under the licensing authority of the Agency and was required to comply with all applicable rules and statutes. . COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth in this count. 7. Rule 58A-5.0191(2) (f), Florida Administrative Code, requires: (2) STAFF IN-SERVICE TRAINING. Facility administrators or managers shall provide or arrange for the following in-service training to facility staff: (£) All facility staff shall receive in-service training regarding the facility's resident elopement response policies and procedures within thirty (30) days of employment. 1. All facility staff shall be provided with a copy of the facility's resident elopement response policies and procedures. 2. All facility staff shall demonstrate an understanding and competency in the implementation of the elopement response policies and procedures. 8. Rule 58A-5.0191(11), Florida Administrative Code, requires: (11) TRAINING DOCUMENTATION AND MONITORING. (a) Except as otherwise noted, certificates of any training required by this rule shall be documented in the facility's personnel files which documentation shall include the subject matter of the training program, the trainee's name, the date of attendance, the training provider's name, signature and credentials, professional license number if applicable, and the number of hours of training. (b) Upon successful completion of training pursuant to this rule, the trainee shall be issued a certificate by the training provider as specified in this rule. 9. On January 28, 2008, the Agency conducted a Biennial Survey of the Respondent facility. 9.1. Based on personnel record review and interviews, the facility failed to have documentation that three (3) of four (4) facility staff -- Staff #2, #3 and #4 -- received in-service training regarding the facility’s resident elopement response policies and procedures within thirty (30) days of employment, as required by Rule 58A- 5.0191(2) (£). 9.2. Personnel record review on January 28, 2008, at approximately 4 p.m., revealed that Staff #2 was hired on September 22, 2006, Staff #3 was hired October 6, 2004, and Staff #4 was hired January 18, 2006. 9.3. When the Agency surveyor reviewed the individual personnel records for Staff #2, #3 and #4, the Agency surveyor found no documentation that the staff members had received in-service training regarding the facility's resident elopement response policies and procedures within thirty (30) days of employment. 9.4. When the Agency surveyor interviewed the administrator on January 28, 2008, at approximately 5 PM, the administrator could not locate any documentation that Staff #2, #3, or #4 had taken the required in-service training regarding the facility's response policies and procedures for resident elopement. ~ 10. The Agency determined that the deficient practice of failing to have documentation that facility staff timely received in-service training regarding the facility’s resident elopement response policies and procedures 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. 11. The Agency provided Respondent with a mandatory correction date of February 12, 2008. 12. On March 5, 2008, the Agency conducted a re-visit to the Biennial Survey of the Respondent. 12.1. - Based on personnel record review and interview, the facility still failed to have documentation for one (1) of four (4) facility staff, “Staff #4,” showing that Staff #4 had received in-service training regarding the facility’s resident elopement response policies and procedures. 12.2. Personnel record review on March 5, 2008, at approximately 1:30 p.m., revealed that Staff #4 was hired on January 18, 2006, and was the same Staff #4 as identified during the January 28, 2008, survey. There was still no documentation on file to confirm that Staff #4 had received in-service training regarding the facility’s resident elopement response policies and procedures. 12.3. During an interview with the Agency surveyor on March 5, 2008, at approximately 1:45 PM, the administrator still could not locate documentation that Staff #4 had taken the required in-service elopement training. 13. The Agency determined that the deficient practice of failure to have documentation that all facility staff received in-service training regarding the facility’s resident. elopement response policies and procedures, 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. 14. The failure to document that Staff #4 had received required in-service training regarding the facility’s elopement response policies and procedures being first identified during the Agency’s survey of January 28, 2008, and being uncorrected as of the Agency’s survey of March 5, 2008, this deficiency is “uncorrected” for purposes of Section 429.19(2)(c), Florida Statutes (2007). 15. The Agency provided Respondent with a mandatory correction date of March 20, 2008. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $500.00, or in such amount as this tribunal deems just, against Respondent, an assisted living facility in the State of Florida, pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNT II 16. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth in this count. 17. Sections 429.41(1)(a)3 and (1) (1), Florida Statutes (2007), require: § 429.41. Rules establishing standards 3. Resident elopement requirements.--Facilities are required to conduct a minimum of two resident elopement prevention and response drills per year. All administrators and direct care staff must participate in the drills which shall include a review of procedures to address resident elopement. Facilities must document the implementation of the drills and ensure that the drills are conducted in a manner consistent with the facility's resident elopement policies and procedures. (1) The establishment of specific policies and procedures on resident elopement. Facilities shall conduct a minimum of two resident elopement drills each year. All administrators and direct care staff shall participate in the drills. Facilities shall document the drills. 18. Rule 58A-5.0182(8) (b), Florida Administrative Code, requires: (8) ELOPEMENT STANDARDS (b) Facility Resident Elopement Response Policies and Procedures. The facility shall develop detailed written policies and procedures for responding to a resident elopement. At a minimum, the policies and procedures shall include: 1. An immediate staff search of the facility and premises; 2. The identification of staff responsible for implementing each part of the elopement response policies and procedures, including specific duties and responsibilities; 3. The identification of staff responsible for contacting law enforcement, the resident's family, guardian, health care surrogate, and case manager if the resident is not located pursuant to subparagraph (8) (b)1.; and 4. The continued care of all residents within the facility in the event of an elopement. 19. On January 28, 2008, the Agency conducted a Biennial Survey of the Respondent facility. 19.1. Based on record review and interview, the facility failed to develop written policies and procedures which included all of the required components for responding to a resident elopement. 19.2. Review of the facility’s resident elopement policies and procedures on January 28, 2008, at approximately 11:00 AM, revealed that the facility’s written policies and procedures did not include a policy or procedure for who would provide for the continued care of all residents within the facility in the event of an elopement, as required by Rule 58A-5.0182(8) (b)4, Florida Administrative Code. 19.3. During an interview with the administrator on January 28, 2008, at approximately 5:30 p.m., the administrator told the Agency surveyor that a policy or procedure for who would provide for the continued care of all residents within the facility in the event of an elopement, as required by Rule 58A-5.0182(8) (b)4, Florida Administrative Code, would be added to the resident elopement policies and procedures. 20. The Agency determined that failing to include all of the required components in the written policies and procedures for responding to a resident elopement does not threaten the health, safety, or security of residents of the facility and cited Respondent for a State Class IV deficiency. . 21. The Agency provided Respondent with a mandatory correction date of February 12, 2008. 22. On March 5, 2008, the Agency conducted a re-visit to the Biennial Survey of the Respondent. 22.1. Based on record review and interview, the facility still failed to include all of the required components in the facility’s written policies and procedures for responding to a resident elopement. 22.2. When the Agency surveyor reviewed the facility’s resident elopement policies and procedures on March 5, 2008, at approximately 12:00 p.m., the surveyor found that the facility’s written policies and procedures still did not include a policy or procedure for who would provide for the continued care of all residents within the facility in the event of an elopement, as required by Rule 58A-5.0182(8) (b)4, Florida Administrative Code. 22.3. During an interview with the administrator on March 5, 2008, at approximately 1:45 p.m., the administrator told the Agency surveyor that she thought that the facility’s elopement policies and procedures included a policy or procedure for who would provide for the continued care of all residents within the facility in the event of an elopement, as required by Rule 58A- 5.0182(8) (b)4, Florida Administrative Code. 23. The Agency determined that failing to include all of the required components in the written policies and procedures for responding to a resident elopement does not threaten the health, safety, or security of residents of the facility and cited Respondent for a State Class IV deficiency. 24. The failure to amend the facility’s elopement policies and procedures to include a policy or procedure for who would provide for the continued care of all residents within the facility in the event of an elopement, as required by Rule 58A- 5.0182(8)(b)4, Florida Administrative Code, being first identified during the Agency's survey of January 28, 2008, and being uncorrected as of the Agency’s survey of March 5, 2008, this deficiency is “uncorrected” for purposes of Section 429.19(2)(c), Florida Statutes (2007). 25. The Agency provided Respondent with a mandatory correction date of March 20, 2008. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $100.00, or such amount as this tribunal shall deem just, against Respondent, an assisted living facility 10 in the State of Florida, pursuant to Section 429.19(2)(d), Florida Statutes (2007). es H. Harris, Esq. Bar. No. 817775 Assistant General Counsel Agency for Health Care Administration 525 Mirror Lake Drive, 330H St. Petersburg, FL 33701 727-552-1435 Facsimile: 727-552-1440 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 Administrative Complaint and Election of Rights form have been served by U.S. Certified Mail, Return Receipt No. 7007 1490 0001 6979 2066 on April 2 _, 2008 to Michelle Tersigni, Administrator, 1800 Harrison Street, Titusville, Florida 32780 and by U.S. Certified Mail, Return Receipt No. 7007 1490 0001 6979 2073 to C.T. Corporation System, as Registered Agent for BLC Sand Point, LLC, d/b/a Sand Point Senior Living, 1200 South Pine Island Road, Plantation, Florida 33324 11 COMPLETE THIS SECTIQ sii DELIVERY = Complete items 1, 2, _..4 3. Also complete item 4 if Restricted Delivery is desired. - @ Print your name and address on the reverse ._ So that we can return the card to you. . lM Attach this card to the back of the mailpiece, or on the front if space permits.

Docket for Case No: 08-002631