CY¥-Uaso STATE OF FLORIDA : AGENCY FOR HEALTH CARE ADMINISTRATION. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Fraes Nos. (fine) 2008006498 (conditional) 2008006500 FL-HIGHLAND PINES, LLC, d/b/a HIGHLAND PINES REHABILITATION CENTER, 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, Fl-Highland Pines, LLC, d/b/a Highland Pines Rehabilitation Center (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges as follows: NATURE OF THE ACTION This is an action against a skilled nursing facility to impose an administrative fine of ten thousand dollars ($10,000.00), assess a six-month survey cycle fine of six thousand dollars ($6,000.00), and assign conditional licensure status beginning on April 24, 2008, and ending on June 3, 2008, based upon one isolated class I deficiency. JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2007). 2. The Agency has jurisdiction over the Respondent pursuant to Section 20.42 and Chapter 120, and Chapter 400, Part I, and Chapter 408, Part II, Florida Statutes (2007). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversees skilled nursing facilities, more commonly referred to as nursing homes, in Florida and enforces the applicable federal regulations and state statutes and rules governing such facilities. Chs. 408, Part II, 400, Part I, Fla. Stat. (2007); and Ch. 59A-4, Fla. Admin. Code. The Agency is authorized to deny an application for licensure, revoke or suspend a license, and impose an administrative fine for a violation of the Health Care Licensing Procedures Act, the authorizing statutes or the applicable tules. §§ 408.813, 408.815, 400.121, 400.23. Fla. Stat. (2007). In addition, the Agency may impose an additional six-month survey cycle fine for certain classes of violations that take place within a specified period of time, assign conditional licensure status, and assess costs related to the investigation and prosecution of this case. §§ 400.19(3), 400.23(7), 400.121(8), Fla. Stat. (2007). 5. The Respondent was issued a license by the Agency (License Number 12280961) to operate a 120-bed skilled nursing facility located at 1111 South Highland Avenue, Clearwater, Florida 32789, and was at all times material times required to comply with the applicable federal and state regulations, statutes and rules governing such facilities. COUNT I (Tag N201) The Respondent Failed to Ensure That Appropriate Care and Services Were Provided To Residents In Violation of F.S. 400.022(1) 6. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 7. Under Florida law, all licensees of nursing homes facilities shall adopt and make , public a statement of the rights and responsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement shall assure each resident . . . the right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recre-ational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency. § 400.022(1), Fla. Stat. (2007). This statement shall assure each resident . . . the right to have privacy in treatment and in caring for personal needs; to close room doors and to have facility personnel knock before entering the room, except in the case of an emergency or unless medically contraindicated; and to security in storing and using personal possessions. Privacy of the resident's body shall be maintained during, but not limited to, toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance. § 400.022(1)(m), Fla. Stat. (2007). This statement shall assure each resident . . . the right to be free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints, except those restraints authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency. In case of an emergency, restraint may be applied only by a qualified licensed nurse who shall set forth in writing the circumstances requiring the use of restraint, and, in the case of use of a chemical restraint, a physician shall be consulted immediately thereafter. Restraints may not be used in lieu of staff supervision or merely for staff convenience, for punishment, or for reasons other than resident protection or safety. § 400.022(1)(o0), Fla. Stat. (2007). 8. On or about April 24, 2008, the Agency conducted an annual health and life safety survey of the Respondent and its Facility. 9. Based upon observation, interview and record review, the Respondent failed to provide adequate and appropriate protective and support services for one resident and failed to fully implement and operationalize its resident abuse policy and procedures as well as comply with Florida law concerning the investigation, reporting and protection of a resident with respect to a possible sexual abuse of the resident (Resident #18). Resident #18 - Clinical Records and Interview 10. Resident #18’s records indicated an admission date of February 18, 2008. 11. A review of the Resident’s April 2008 physician's orders revealed diagnoses that included a cerebral vascular accident, right hip subluxation and senile dementia. 12... A review of the Facility nursing notes from February 18, 2008, to April 21, 2008, revealed that Resident #18 resided in the Facility’s Cedar Point Unit. 13. The nursing notes revealed that Resident was alert and oriented to person and place for the most part, pleasant and cooperative, but sometimes suffered from confusion. 14. _ During an interview with Resident #18 on April 22, 2008, at 12:30 p.m., during lunch, it was revealed that the Resident does not sleep well at the Facility. 15.. The Resident stated that he or she takes a sleeping pill and added that the Facility is “not like home.” 16. A review of the Resident’s April 2008 physician-ordered medication regimen indicated that the Resident took sleep aids: The medication regimen was as follows: a. Lexapro 10 mg daily b. Abilify 5 mg daily c. Aldactone 25 mg daily d. Klor-con (potassium) 20 meq daily e. Digitek 250 mcg daily f. Prednisone 10 mg daily g. Famotidine (Pepcid) 20 mg daily h. Metropolol (Lopressor) 50 mg twice a day i. Docusate Sodium (Colace) 100mg twice a day j. Jantoven (Coumadin) 3 mg daily k. Multivitamin 1 tablet daily 1. Lipitor 20 mg daily m. Artificial tears four times a day n. Restoril 15 mg at bedtime as needed 17. The Resident’s clinical record revealed a nursing note dated April 9, 2008, and timed at 3:00 a.m., stating that the “Resident was yelling out ‘help.’” 18. According to the note, a nurse went to the Resident’s room to inquire about what was going on and the Resident said “I was just raped by a man.” 19. The note further stated that the nurse tried to explain to the Resident that there was no male in the Facility that could have entered the Resident’s room. 20. The Resident’s clinical record revealed a telephone physician's order dated April 9, 2008, untimed, which ordered: “Send to local hospital ER for rape kit evaluation.” 21. Resident #18's laboratory results, dated April 9, 2008, included a complete blood count, chemistry panel and urinalysis that were reviewed with no sign of infection or any other abnormality noted. 22. A review of the Resident’s Medicare 30-day assessment Minimum Data Set (MDS) dated March 24, 2008, indicated that the Resident was assessed by the Facility for short , term/long term memory problems, as having "moderately impaired" daily decision-making skills as well as the presence of "periods of altered perception or awareness of surroundings.” 23. The care plans for Resident #18 were reviewed with respect to mood, cognition, psycho-social, decision-making, behavior and sensory. They included approaches for: a. Potential for side effects of psychoactive medications as related to the use of anti- depressant and anti-psychotic medications related to dementia with psychosis. Dated February 29, 2008. b. Potential for impaired or inappropriate behaviors related to dementia other behaviors restlessness, reduced social interaction, withdrawal from interests and wanders (insomnia not indicated). Resident presents with sensory impairment impacting communication and interaction with others. Dated February 27, 2008. c. Impaired cognition related to dementia, sensory loss, delirium. Dated February 27, 2008. d. Impaired vision. Unable to read small print. Large print with glasses. Dated February 29, 2008. e. Impaired communication. Hearing. Dated February 29, 2008. 24. The last Interdisciplinary Plan of Care Meeting Summary Tool in the records was dated February 29, 2008. 25. A record review revealed a care plan dated April 9, 2008, which stated that the Resident was exhibiting possible signs and symptoms of delirium, as evidenced by his or her taking of Prednisone. 26. The Resident had a current urinary tract infection. 27. The Resident was accusing the staff of raping him or her during the perineal care. 28. This documentation was not part of the care plan reviewed two days earlier on April 21, 2008. 29. _ The Resident's records were silent as to any alleged sexual abuse prior to the nurse's notes of April 9, 2008. Resident Rights Policy And Procedure / Facility Records 30. A review of the Facility's policy and procedure for prevention and reporting suspected resident abuse and/or misappropriation of property, effective January 2006, stated: “The facility has designed and implemented processes, which strive to ensure the prevention and reporting of suspected or alleged resident/patient abuse, neglect, mistreatment.” 31. Implementation and ongoing monitoring consist of the following: Protection: “Provide for the immediate safety of the resident/patient upon identification of suspected abuse, neglect, mistreatment and/or misappropriation of property. . . .” 32. A review of the Facility's Master Daily Staffing Sheet for the 3-11 shift on Tuesday, April 8, 2008, indicated that one male licensed practical nurse (LPN) and eight male certified nurse assistants (CNAs) were assigned to the Cedar Point Unit and Birch Hall Unit during that shift. 33. The male nurses included CNA #8, who was referenced in. an unsubstantiated alleged sexual abuse allegation on March 4, 2008. 34. A review of CNA #8's personnel file revealed that the Facility did not have the Florida Department of Law Enforcement background results on file for CNA #8. 35. The lack of a background screening for this employee was confirmed by the Office Manager on April 24, 2008, at 1:00 p.m. 36. A review of the Facility’s Master Daily Staffing Sheet for the 11-7 shift on Wednesday, April 9, 2008, indicated one male LPN and one male CNA who were assigned to the Birch and Reflections Units during that shift. 37. The next nursing entry was dated April 9, 2008, at 3:48 a.m., and stated that the Resident had placed the call light on. 38. The nurse and CNA #7 entered the Resident’s room. 39. The Resident stated that he or she had been raped. 40. The staff continued to remind the Resident that this was unlikely. 41. The nurse tried to reassure the Resident that he or she was safe. 42. The nurse asked the Resident if he or she would like to go to the hospital or to have an evaluation of her perineal area. The Resident declined. 43. The Resident’s activities of daily living (ADL) were performed with two staff members. 44. Outside of this entry referring to the two staff members performing ADL, there was no other reference to any additional protective measures provided to the Resident. 45. The next nursing entry was dated April 9, 2008, at 4:00 p.m., about thirteen hours after the first entry was made by staff about the allegation of possible sexual abuse. 46. The nursing entry stated that a staff member had placed a call to the Resident’s primary care physician to inform him or her of the Resident’s condition and that the incident had been referred to the Abuse Coordinator and the Administrator. 47. The next nursing entry was dated April 9, 2008, at 7:30 p.m., and stated that an order was received from the primary care physician to send the Resident to the local hospital emergency room. 48. Acall was placed to the local ambulance service and transport arrived. 49. The next nursing entry was dated April 9, 2008, at 11:10 p.m., and stated that the Resident returned to Facility at 11:05 p.m. via stretcher and accompanied by two ambulance attendants. Two staff members were with the Resident at all times. 50. A review of the Facility’s statement worksheet dated April 10, 2008, by LPN #7, who worked the 11-7 shift, stated that the LPN overhead the Resident saying “Help. I was raped.” 51. | The LPN went to the Resident's bedside to find out more about situation. 52. The Resident was noted as having increased confusion and saying that the alleged rape “happened a while ago by a man.” 53. | The LPN, along with a co-worker, was asked by the Resident “are you men?” 54. The LPN explained to the Resident that both of them were females and there was no male employee at the Facility at that time. 55. The staff continued to ask the Resident if he or she wanted any help. 56. The nursing observation of the Resident continued. 57. | Areview of LPN #7's employee record on April 23, 2008, at 11:50 a.m., revealed a Disciplinary Action Report initiated by the Cedar Point Unit Manager dated April 11, 2008, stating that the LPN failed to report a reportable abuse told to her on April 9, 2008. 58. According to the Disciplinary Action Report, the Resident stated to the nurse that he or she had been raped, but that no calls were made to the appropriate department head per Facility policy. 59. LPN #7 acknowledged the Disciplinary Action Report on April 11, 2008, but wrote that when he or she arrived at 10:45 p.m., the Resident was already yelling out. 60. LPN #7 then asked a 3-11 shift nurse about the situation, but did not receive a positive response. 61. This incident was initiated during the 3-11 shift, not during LPN’s 11-7 shift. 62. Attached to the Disciplinary Action Report was a copy of document titled ‘Reportable Incidents, which stated that "abuse" requires an "incident report to be filled out and a phone call made to the Director of Nursing, Risk Manager and/or the Administrator." 63. Despite the statement that was known to the staff that the incident occurred during the 3-11 shift on April 8, 2008, the Resident's record is silent as to any staff response or any intervention on behalf of the Resident during that earlier shift. CNA #4 - Interview 64. A telephone interview was conducted on April 24, 2008, at 11:00 a.m., with CNA #4 who worked the 11-7 shift on April 8-9, 2008. 65. CNA #4 stated that she had just clocked in on April 8, 2008, and had not taken her assignment yet, when she heard Resident #18 “screaming all the way down the hallway” calling out for help and yelling that he or she had been raped. 66. | CNA #4 stated that everyone from the 3-11 shift was still there around the desk. 67. | CNA #4 stated that Resident #18 was upset and she reported the incident to the LPN #7, who also worked the 11-7 shift. 68. She stated that on the day after the incident, the Facility called her into work to write a statement. 69. CNA #4 stated that she was unable to come in during the day and that a blank statement was left for her to fill out. 70. She also stated that she had not been "personally" interviewed by the Facility. 10 LPN #7 - Interview 71. During an interview with the corporate Registered Nurse on April 23, 2008, the nurse stated that LPN #7 would call back for'a telephonic interview, but was "ill" and "upset" with regard to disciplinary action initiated by Facility. 72. During a telephone interview with the LPN #7 on April 24, 2008, at 8:45 a.m., she stated that Resident #18's room was near the nursing station. 73. The Resident was calling out “rape” as she entered the Facility at 10:45 p.m. 74. LPN #7 stated that she observed three nurses from the 3-11 shift standing around the desk as the Resident was yelling that she had been raped. 75. She further stated that the 3-11 shift nurses apparently did not document or report anything. 76. LPN #7 also stated that Resident #18 was not able to visualize and recognize staff without the lights turned on in her room because of her vision. 77. She stated she tried to reassure Resident #18 during the shift. 78. At the end of the shift, LPN #7 wrote a handwritten letter to the Director of Nursing and the Risk Manager regarding Resident #18's alleged sexual abuse. 79. A copy of the handwritten note, dated April 9, 2008, was presented for review by the Administrator. 80. LPN #7 stated that she informed LPN #5 and the Cedar Point Unit Manager at the change of shift about the concerns she had regarding Resident #18's alleged sexual abuse and the nurses who worked the 3-11 shift. LPN #5 - Interview 81. During an interview with LPN #5 on April 24, 2008, at 11:30 a.m., the nurse ) stated that she received the shift change report for the Cedar Point Unit that morning from LPN #7 with the Cedar Point Unit Manager present for the entire shift change report. 82. LPN #5 stated that she did not know who knew about the alleged sexual abuse, but that LPN #7 left communication for two supervisors. 83. A review of LPN #5’s punch detail for April 9, 2008, revealed that the Cedar Point Unit Manager had punched in at 6:30 a.m., LPN #5 had punched in at 6:54 a.m., and LPN #7 had punched out at 7:36 a.m. Continued Interview of Resident #18 and Daughter 84. During an interview with Resident #18 on April 24, 2008, at approximately 9:15 a.m., the Resident stated that he or she remembered that something happened during the night of April 9, 2008, but was unsure if it may have been a dream. 85. He or she also stated that he or she remembered talking to local law enforcement and being seen in the emergency room. 86. During a telephone interview with Resident #18's daughter on April 22, 2008, at 1:15 p.m., it was revealed that the Resident had a stroke and was admitted to the Facility after a hospital admission in December 2007 and a subsequent rehabilitation hospital admission. 87. The daughter stated that the Resident’s Prednisone was reduced to a lower dose and that the Resident has been okay on that dose. 88. She stated that the Resident was taking regular continuous doses of Prednisone for rheumatoid arthritis. 89. The daughter stated that Resident #18 had.never alleged rape before and denied any knowledge of any history of sexual abuse. 90. The daughter also stated that she is concerned about the follow-up care regarding , Resident #18's cataracts and impaired vision. 91. A review of nursing note dated March 30, 2008, at 12:10 p.m., revealed a request faxed to the primary care physician for an appointment to see an ophthalmologist regarding bilateral cataracts. Social Service Director 92. An additional review of Resident #18's clinical record, including social service, revealed that the last documentation was dated April 8, 2008. 93. The clinical records also included physician evaluations by the primary care physician on April 1, 2008, and April 21, 2008, at 2:00 p.m. 94. There was no further information regarding the alleged sexual abuse of Resident #18. 95. During an interview with the Social Service Director on April 21, 2008, at 3:10 p.m., it was revealed that she interviewed Resident #18 on April 9, 2008. 96. The Social Service Director stated that the Resident's account of the incident “Jacked detail” and was “all over the place.” 97. The Social Service Director stated that she had communicated with the Resident’s primary care physician and that the Resident was sent to local hospital emergency room. 98. The Social Service Director stated that Resident #18's daughter was notified and interviewed. 99. The Social Service Director stated that the local police department was notified, but could not remember if the Facility or the local hospital emergency room called the police. 100. The Social Service Director stated that a rape kit had not performed at the local hospital emergency room, but that a full physical was performed and that Resident #18 exhibited 13 “no bruising.” 101. The Social Service Director also stated that the Facility had covered all of its bases based upon Resident #18's “fluctuating cognition.” 102. The Social Service Director had no further information regarding the assignment of any male CNAs to Resident #18. 103. The Social Service Director was also.asked about the social service investigation documentation regarding the alleged sexual abuse on April 9, 2008, because she was unable to give exact notification/interview times during this interview. 104. The Social Service Director stated that she had not entered all of her notes into the clinical record, but that the investigation documentation was available on her desk in her office. 105. On April 21, 2008, at 3:45 p.m., the Social Service Director provided for review one sheet of scratch notes and seven post-it notes referring to multiple social service-conducted interviews, including that of the Resident, staff, abuse registry staff and law enforcement. The “notes included the interview/notification times. 106. A review of the one-page scratch notes, seven post-it notes and social service progress note, along with resident interviews dated April 11, 2008, revealed an interview by the Social Service Director on April 9, 2009, at 10:15, which stated "Not hurt anywhere. Heart hurts. Saw nurse immediately after "Yes-you could say so.'" 107. Another entry on the scratch notes indicated 12:15 and stated: Last night 3/4 in morning. Roommate was sleeping. Someone into room. Appeared to be a man. Can't tell. No words. Roommate asleep. Got to be without clothing on. Was raped. Penetrated. Had no defense. Didn't say anything. Door was open. 1/2 asleep. 108. Another entry on the scratch notes indicated a 3:00 p.m. interview and stated: , Man. Nighttime. Couldn't tell if black or white. Wearing dark outfit. Couldn't see hair. Person was quiet. Didn't hold arms/wrists. Had a hat on. Fedora. 109. The scratch notes also indicated that LPN #7 was a witness. 110. The scratch notes also indicated that a contracted mental health provider was contacted at 12:38 and "abuse" was contacted at 12:45. 111. | The Social Service Director's seven post-it notes indicated: a. The name of a local law enforcement office/telephone number, the local hospital emergency room telephone number and "police department notified by." b. If still alleging, the state examination will occur: Transferring for examination. Local hospital name and “police take care of it." c. 4/10 and 4/11 + law enforcement officer's name. d. 4/10 Met with Resident #18 and daughter. No issues. e. 4/17 Name of abuse registry investigator at 3 pm. - unfounded. f. 11-7 LPN #7 "confirms #s." 112. The social service progress note dated April 11, 2008, contained four resident interviews with Resident #18's roommate and three additional residents. 113. The interviews stated: a. Roommate -- safe - door always open. no problems with abuse or sexual - sleeps hard. | b. Does not hear of problems - more focused on his or her care/treatment - didn't hear anything unusual. c. Nothing unusual - keeps door shut - stays to self — does not like night nurse - but no unsafe feelings. 15 d. Comfortable with the staff - hasn't had recent problems - didn't hear. 114. During a continued interview with the Social Service Director on April 22, 2008, at 11.25 a.m., it was revealed that the 11-7 LPN #7 did not notify the Night Supervisor about the alleged sexual abuse and was written up by the Facility for failing to report Resident #18's alleged sexual abuse on April 9, 2008, which she stated was the Facility's plan of correction. 115. The Social Service Director confirmed that she was first notified of the alleged sexual abuse during the Facility's morning stand-up meeting, that she conducted interviews with Resident #18 at 10:15 a.m. and 12:15 p.m., and that she conducted an additional interview with Resident #18 and the Resident’s daughter at 3:00 p.m. 116. The Social Service Director was questioned about the notification times of the contracted mental health provider and abuse. 117. She stated that the contracted mental health provider was notified before the abuse registry because “only a fax” was required to notify the contracted mental health provider. 118. When asked if the Social Service Director would state that the Facility took "immediate" action with respect to this incident, she stated "no." 119. A review of the facsimile cover letter that accompanied the consultant mental health provider authorization for services for Resident #18, which was completed by the Social Service Director on April 9, 2008, stated that she sent two other referrals a week ago and they have not been done. She asked for a status update. Administrator and Risk Manager - Interviews 120. Interviews were conducted with the Administrator and Risk Manager on April 21, 2008, at 3:25 p.m., with regard to the Facility's investigation of the alleged sexual abuse. 121. The Administrator stated that Resident #18 was newly prescribed Prednisone on 16 , February 18, 2008, and this was considered a significant factor in causing an altered mentation on April 9, 2008. 122. The Administrator stated that Resident #18 had been placed in bed by his or her daughter on April 8, 2008, with an adult brief. 123. She stated that the adult brief was removed by CNA #13, who worked the 3-11 shift, and then disposed of in the garbage. 124. CNA #13 attended an in-service education given by the Administrator on April 10, 2008, about not changing briefs at night. 125. The in-service provided that upon any request by the resident or family, the staff member should inform the Unit Manager or Director of Nursing. 126. A list was to be created of those patients. 127. Acheck of the ADL books for updates should be made on the resident. 128. CNA #13 was the only staff member who attended the in-service. 129. An interview was conducted of the Administrator on April 21, 2008, at 3:45 p.m., regarding the notification of Resident #18's primary care physician on April 9, 2008. 130. The Administrator stated that the Cedar Point Unit Manager initially contacted the wrong primary care physician regarding the alleged sexual abuse. 131. The Administrator had no further information regarding the assignment of a male CNA to Resident #18. 132. During an interview with the Administrator on April 21, 2008, at 4:00 p.m., relating to concerns about Facility documentation of the alleged sexual abuse, which included nursing and social services documentation, the Administrator stated that a full investigation was completed by the Facility. 133. The Administrator was referring to Facility records. 134. A review the Facility records, dated April 9, 2008, at 7:25 p.m., and April 16, 2008, at 6:00 p.m., respectively, revealed a summation sample with questions for a non-reported incident dated April 15, 2008. 135. The Facility records indicated that Resident #18 was unsure if the person was male or female and did not have any details of the incident. 136. The Facility records stated that Resident #18 was started on Prednisone on March 28, 2008, which may have been related to hallucinations and delusions. 137. The Facility records stated that the immediate corrective/protective actions taken were that the CNAs assigned to the Resident’s room were called to come in for an interview and provide written statements, which were still pending. 138. The Facility records stated that interviews were conducted with the CNA staff assigned to care for patient as well. 139. As of April 24, 2008, at 11:00 a.m., however, the Facility had not personally interviewed all of the direct care staff members that were involved in the April 9, 2008, alleged sexual abuse. 140. The Facility records stated that a psychiatric consultation was provided to the Resident and recommendations were made to assess the medication due to the Resident’s history of hallucinations while taking Prednisone. 141. This is a medication that the Resident started taking on March 28, 2008, which may have contributed to increased confusion and hallucinations. 142. The Facility records also stated that the Resident was also taking Remeron, which has a side effect of hallucinations as well. 143. A review of the April 10, 2008, contracted mental health consult, April 9, 2008, local hospital emergency room records and the April 24, 2008, primary care physician note, do not reflect that the Prednisone was associated with, or related to, any psychosis or hallucinations with respect to Resident #18's sexual abuse allegation on April 9, 2008. 144. The Facility records did not reflect that any Facility notification or interview times with the Resident, Resident’s family, abuse registry, local law enforcement and primary care physician. CNA #13 145. During an interview on April 22, 2008, at 3:30 p.m., with CNA #13, who worked the 3-11 shift, the nurse stated that she had no further information regarding the alleged sexual abuse of Resident #18. Policy and Procedure for Abuse 146. The Facility's policy and procedure for Prevention and Reporting: Suspected Resident/Patient Abuse and/or Misappropriation of Property, effective January 2006, stated: "The facility has designed and implemented processes, which strive to ensure the preven-tion and reporting of suspected or alleged resident/patient abuse, neglect, mistreatment,. . . “ 147. The policy and procedure also states that implementation and ongoing monitoring consist of the following: Reporting: 1. Notify the Shift Supervisor immediately if suspected abuse, neglect, mistreatment or misappropriation of property occurs. 2. Report the event to the Director of Nursing and Administrator. 3. Notify the appropriate State agency(s) immediately by fax or telephone after identification of alleged/suspected event. Initiate process according to State- specific regulations: For Florida Only: Abuse Hotline | State AHCA Field Office (One Day) AHCA Agency Facility Data Analysis Unit (One Day) State AHCA Complaint Administration Unit (Five Day) AHCA Agency Facility Data Analysis Unit (Fifteen Day) Note: Person(s) initially identify potential abuse, neglect, mistreatment and/or misappropriation of property may, by State law, be accountable to make initial call. 1. Initiate contact with local law enforcement, immediately, when warranted, as required by State law. 148. The Facility’s mandatory reporting requirement of adult abuse, neglect and/or exploitation, included, but was not limited to nurses, health professionals, staff, social workers, who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused. Said person was required to immediately report such knowledge or suspicion to the hotline on the single statewide toll-free telephone number. 149. The corrective action that was taken or was to be taken according to the Facility records stated that a medication review had occurred and adjustments made to the patient’s regime to better meet his or her needs and reduce the side effects. 20 150. The April 10, 2008, contracted mental health pre-evaluation recommendations were not addressed by the Facility or the primary care physician until April 23, 2008. Cedar Point Unit Manager - Interview 151. During an interview with the Director of Nursing and the Cedar Point Unit Manager on April 21, 2008, at 4:45 p.m., it was revealed that the Cedar Point Unit Manager notified the incorrect primary care physician of the alleged sexual abuse on April 9, 2008. 152. The Cedar Point Unit Manager stated that this error was not noted until the physician's assistant for the incorrect primary care physician arrived at the Facility in "the afternoon.” 153. The Cedar Point Unit Manager also stated that she evaluated Resident #18 on April 9, 2008, and did not find any bruising. 154. The Cedar Point Unit Manager stated that there was no documentation in Resident #18's clinical record to reflect that the incorrect primary care physician had been notified about the alleged sexual abuse or of her evaluation of the Resident. 155. During this interview, the Cedar Point Unit Manager provided a progress note, dated April 9, 2008, which stated that she placed a call to the physician’s assistant for the primary care physician and left message for a return call. 156. The physician’s assistant returned the call, was informed of incident and the need for an examination of the Resident. 157. He stated that he would be in during the late afternoon to see the Resident. 158. After the physician’s assistant arrived, the Facility discovered that it had called the wrong physician. 159. The correct primary care physician was then notified. 21 160. . He stated that he had never handled this type of situation and to send the Resident to the emergency room for an evaluation. 161. The Cedar Point Unit Manager was asked when was this nurse note written and she responded that it was written “today,” April 21, 2008. "Late entry" documentation was not noted. Policy and Procedure for Abuse (Continued) 162. The Facility's policy and procedure for Prevention and Reporting: Suspected Resident/Patient Abuse and/or Misappropriation of Property, effective January 2006, stated that the Facility has designed and implemented processes, which strive to ensure the prevention and reporting of suspected or alleged resident/patient abuse, neglect, and mistreatment. 163. Implementation and ongoing monitoring consist of notifying the Resident’s physician immediately, which was defined as within 24 hours. 164. The time delay with the incorrect primary care physician notification by the Cedar Point Unit Manager was not indicated on the Federal 5-day Report. 165. During the survey on April 22, 2008, at 9:00 a.m., a posting was observed on all units stating that there was a mandatory in-service on abuse and neglect reporting on Tuesday, April 22, 2008 at 2:30 p.m., and Thursday, April 24, 2008, at 2:30 p.m., with the location listed as the nursing office. 166. A review of the Facility's April, 2008, in-service calendar reflected only these two sessions. 167. In order to obtain additional information about the Facility's investigation into the alleged sexual abuse, an interview was conducted with the Administrator on April 22, 2008, at 4:15 p.m. to 5:00 p.m. 22 168. The interview indicated that LPN #7 was written up because there was no immediate notification of the next level up regarding Resident #18's alleged sexual abuse. 169. According to the Administrator, on April 9, 2008, at 9:00 a.m., she reviewed the Facility's 24-hour nursing report and noted the sexual abuse allegation. 170. The Administrator brought the sexual abuse allegation to the scheduled 9:00 a.m. interdisciplinary team meeting with all department heads, which went directly into the scheduled 9:30 a.m. risk management meeting. 171. The Administrator stated that she directed the Social Service Director to interview the Resident, call in the allegation and interview other residents. 172. The Administrator stated that an attempt was made to interview LPN #7, but she was refusing. 173. The Administrator acknowledged that any visual evaluations of Resident #18 during the 11-7, 7-3 and 3-11 nursing shift by the Facility staff were not documented. 174. The Administrator stated that Resident #18's daughter was notified on April 9, 2008, at 10:00 a.m., but this notification was not documented. 175. The Administrator also stated that the state protection agency investigator did not substantiate Resident #18's allegation and that the state protection agency stated that it would call the police if necessary. 176. The Administrator indicated that the local hospital emergency room contacted law enforcement during the emergency room evaluation. 177. During this interview, the Administrator stated that Resident #18's emergency room evaluation for the alleged sexual abuse was pursuant to non-emergent per physician order. 178. The primary care physician's order to send Resident #18 to the emergency room 23 does not reflect that it was non-emergent. 179. The Administrator also stated that because the emergency room transportation for Resident #18 was non-emergent, the Facility had to obtain authorization from Aetna before transportation could be arranged. 180. The Social Service Director stated in notes dated April 9-11 weekly overview late entry that the Resident was sent to a local hospital emergency room per a physician’s order. 181. The Administrator again related that Resident #18's alleged sexual abuse was related to "newly prescribed Prednisone" which caused a "psychosis" on April 9, 2008. 182. The Administrator was notified that upon review of the acute care hospital history and physical dated December 31, 2007, which indicated that Resident #18’s medications included "Prednisone 5 mg 2 x daily" and based on the interview conducted on April 22, 2008, with the Resident’s daughter, Resident #18's Prednisone therapy was not initiated at the Facility. 183. The Administrator stated that the Facility’s investigation concluded there were no resident wanderers that night. 184. Per a Facility provided list of wandering residents on April 23, 2008, 39 residents were identified as wanderers with 26 of them having a Wandergard monitoring device. Resident #18 - Records 185. On April 22, 2008, at 5:05 p.m., Resident # 18 was observed sleeping in bed. 186. An unidentified male CNA was standing next to Resident #18's bed casually talking to the female CNA assigned for a 1:1 observation secondary to a recent fall that Resident #18's roommate had sustained. 187. Based upon review, the contracted mental health provider's pre-evaluation of Resident #18 dated April 10, 2008, listed as tentative diagnosis recommendations and comments: 24 major depression, psychosis, borderline personality disorder. 188. The pre-evaluation made recommendations to the attending physician to consider the following psychotropic medication recommendations: 1. Please increase Lexapro to 20 mg by mouth every morning, 2. Start Aricept 5 mg by mouth every night for 30 days, then increase to 10 mg by mouth every night, 3. Start Namenda Pack then continue with 10 mg by mouth twice a day. 189. A review of Resident #18's clinical record on April 22, 2008, at 5:15 p.m., revealed a nursing note signed by the Risk Manager, dated April 22, 2008, untimed, which stated that the primary care physician was to see the Resident that day, discussed with this writer the fact that he would like to go along with the psychiatrist’s recommendations and the fact that he does not believe there was any evidence of rape. 190. A review of the physician's progress notes on April 22, 2008, at 5:20 p.m., revealed a note dated April 22, 2008, which stated that the physician will go ahead with the psychiatrist’s recommendation that there was no evidence of rape. Assistant Director of Nursing - Interview 191. During an interview with the Assistant Director of Nursing on April 23, 2008, at 11:20 a.m., a copy of the April 22, 2008, 2:30 p.m., sign-in sheet for abuse/neglect training was provided to the Agency surveyor. 192. The Assistant Director of Nursing stated that the 11-7 staff was being trained that night on abuse/neglect reporting. 193. When asked how the 11-7 staff would know about the in-service training for abuse/neglect, the Assistant Director of Nursing stated that it is on the April 2008 in-service education calendar. 25 194. The Assistant Director of Nursing was shown a copy of the April 2008 in-service education calendar and it was acknowledged that there was no abuse/neglect in-service training scheduled for 11-7 shift. 195. The Assistant Director of Nursing then stated that the Director of Nursing conducted the abuse/neglect training this morning. 196. Accopy of the sign in sheet was requested for the training provided by the Director of Nursing, 197. | During an interview the Director of Nursing on April 23, 2008, at 11:25 a.m., it was revealed that she had not provided training in the morning on abuse/neglect, but did provide training on gastrostomy tube medication administration that morning. 198. During an interview with the Assistant Director of Nursing on April 23, 2008, at 11:30 a.m., it was revealed that she would be coming in tonight to train the 11-7 staff on abuse and neglect reporting. 199. When asked how she would train entire 11-7 staff with no observed postings, she said she will make sure, but had no definitive plan. 200. During an interview with the Assistant Director of Nursing on April 24, 2008, at 1:00 p.m., it was revealed that 110 of the Facility's 116 employees had been in-serviced about abuse and neglect reporting. State Advocacy Investigator - Interview 201. During a telephone interview with the state advocacy investigator on April 23, 2008, at 12:30 p.m., she stated that the investigation was closed. 202. - Her investigation included an interview with Resident #18 and his/her daughter. 203. The investigator was not aware that Resident #18 had been taking Prednisone 26 prior to his or her admission to the Facility, but believed, because of Facility interviews, that therapy had been initiated on February 18, 2008. 204. The investigator was not aware that Resident #18 had impaired vision and cataracts. 205. The investigator stated that she was aware that Resident #18 had an evaluation at a local hospital emergency room, but that a rape kit was not performed. 206. The investigator stated that she interviewed LPN #7, who told her that Resident #18 had been screaming out “rape” when she arrived at the Facility prior to the start of her shift. 207. The.investigator also reported that LPN #7 stated there were other nurses around the nurses’ station, who stated that nothing really happened to Resident #18. Statement Worksheet - CNA #4 208. A review of the Statement Worksheet provided by the Facility dated April 10, 2008, by CNA #4 revealed that CNA was walking down the hall going to the Cedar Point Unit to check upon his or her rooms, and while passing a resident’s room, she heard a resident screaming: "Help. I’ve been raped." 209. CNA #4, who worked the 11-7 shift, went straight to the nurse and told her what she heard the Resident say. 210. The two of them went to the room and the nurse asked the Resident if he or she was alright. 211. The Resident said she was raped by a man. 212. The nurse talked to the Resident and determined that she was fine. 213. The Resident did not have a brief on. 214. Every time that the CNA went in there, someone was with him or her. 27 215. The CNA did not put a brief on the Resident for the night. 216. During an interview with the Assistant Director of Nursing on April 23, 2008, at 1:00 p.m., she stated that the Facility attempted to reach CNA #4 for interview, but the nurse stated that she did not have reliable transportation that day. 217. The Facility had not conducted an interview with CNA #4 at this time. Administrator and Vice President - Interviews 218. Interviews were also conducted with the Administrator and Corporate Regional Vice President on April 23, 2008, at 2:00 p.m. 219. They provided additional information for review, including documentation regarding the April 9, 2008, emergency room triage records, nursing and physician evaluations and the law enforcement offense report dated April 9, 2008. 220. The Vice President stated that she felt that the Facility followed its policy and procedure regarding the alleged sexual abuse to the letter. 221. On April 23, 2008, at 12:18 p.m., the Administrator and Vice President provided a Facility summary dated April 23, 2008, which was reviewed for additional information. 222. The summary indicated that the interdisciplinary team met as usual at 9:30 a.m., on April 9, 2008, during which the Director of Nursing opened a letter that had been placed underneath her door. 223. The letter was written from the 11-7 Supervisor LPN #7 and stated that Resident #18 had been raped. 224. According to the summary, the Social Service Director was directed to investigate the details of the allegation, ensure patient safety, and notify the abuse registry. 225. The Cedar Point Unit Manager was informed to immediately notify the Resident’s 28 physician about the incident and request guidance, try to obtain a urine specimen for laboratory review, physically examine the resident for trauma and to ensure a contracted mental health consultation for further counseling/assistance. 226. During an interview with LPN #5, who worked the 7-3 shift, by the Administrator and the Cedar Point Unit Manager regarding the shift change report given by the 11-7 supervisor, LPN #5 stated that she thought that LPN #7 handled the situation and followed the appropriate facility protocols when a resident alleges abuse because LPN #7 received the allegation of abuse. 227. A review of multiple days of the Facility’s Master Daily Staffing Sheet indicated that the 11-7 Supervisor/Nurse was located on the Facility’s Reflections Unit and not the Cedar Point Unit. 228. The summary omitted the 12:15 p.m. resident interview that the Social Service Director’s informal notes indicate. 229. The summary indicated that the Administrator met with the state protection agency investigator and asked if they were going to contact police and they stated that they did not believe that it was necessary at this time. 230. The summary also indicated that the Facility called 911 and the local ambulance company to set the resident up as non-emergency transport. 231. The summary indicated a telephone interview with LPN #7, who stated that she heard yelling out upon arrival at Facility coming from Resident #18’s room at approximately 10:45 p.m., but did not enter the room at time, proceeding to clock in. 232. During a report with a 3-11 nurse, 11-7 LPN #7 questioned the 3-11 nurse as to what was going on with Resident #18. 233. The 3-11 nurse stated nothing unusual. 29 234. The summary stated that interviews were conducted with two 3-11 LPNs and one 3-11 CNA. 235. No interviews were noted with any other 11-7 staff members. 236. The summary also indicated that on April 10, 2008, the Cedar Point Unit Manager questioned LPN #7 why she did not notify administration immediately. 237. She stated that she did not do so because she dismissed what the Resident was alleging. She stated that she did not believe it. 238. The summary stated that on April 10, 2008, the Social Service Director informed the interdisciplinary team of law enforcement, state protection agency, and the local hospital’s conclusion and the dismissal of the incident. 239. The Facility’s written policy, Allegation of Abuse/Neglect or Misappropriation of Property Investigation Worksheet, dated January 2006, provided the following guidance in preparing the Investigation Worksheet. 240. The policy included: Investigation Worksheet: 5. f. Indicate whether statements were obtained from the alleged employee(s). g. Indicate whether statements were obtained from others working at the time of the allegation. h. Indicate whether statements were obtained from cognitively intact residents in the vicinity at the time of the allegation. i. Indicate whether statements were obtained from visitors, family, or others in the vicinity at the time of the allegation. j. Indicate whether statements were obtained from individuals with indirect knowledge of the allegation. k. Summarize the findings based on the allegation. 241. To understand what information the Facility relied upon for the investigation, an interview was held with the Administrator and Risk Manager on April 23, 2008, at 1:00 p.m., regarding how the Facility determined that the Resident’s alleged sexual abuse to be 30 unsubstantiated and not willful. 242. The Administrator stated that based on the state protection agency, the police and hospital findings, the Facility could not determine that this was a willful act. 243. The Administrator was asked why only LPN #7 was disciplined. 244. She stated that everyone involved was verbally counseled regarding abuse/neglect reporting. 245. LPN #7’s Discipline Action Report, dated April 11, 2008, was also reviewed with respect to the nurse’s statement regarding the onset of resident’s alleged sexual abuse. 246. The Administrator stated that LPN #4’s nurse’s statement does not reflect nursing or the Administrator’s information, but acknowledged that the Facility had not yet interviewed CNA #4 regarding her written statement. Law Enforcement Report 247. The police report dated April 9, 2008, for abuse/neglect of aged/disabled call received at 6:22 p.m. was also reviewed. 248. The police report stated that a local hospital emergency room staff member had notified law enforcement dispatch that the emergency room had received Resident #18 via ambulance in relation to a sexual battery. 249. The police report stated that the Resident was sent by the Facility to the local hospital emergency room to be evaluated for potential injury sustained from this allegation. 250. A police officer spoke to the Social Service Director, who informed the officer that no male staff members were working the night shift. Staff had been interviewed. 251. The police officer was also told by the Social Service Director that Resident #18 suffered from dementia, was a previous drug abuse patient, with other medical history. 31 252. The police report stated that Resident #18 was asked if she knew why the police were there to see him or her. 253. The Resident acknowledged that he or she was there about maybe being raped last night. 254. Resident #18 was concerned that something may have happened to him or her and was better off knowing from a doctor if she was ok or if anything had happened to him or her. 255. The Resident was willing to talk. 256. Resident #18 stated that he or she told his or her nurse that he or she had been raped and that some people thought that he or she should get checked at the hospital. 257. Resident #18 said that last night, there was a man who was on top of me, not underneath me, but on top. He never said anything, not a word, but he or she knew what the man wanted. The man was very quiet. The roommate did not wake up. The Resident was not sure what had happened, but thought that he or she may have been raped. The Resident did not think that the man was anyone who lived in the home or a staff member. 258. Resident #18 then said that he or she was certain that it was no one from the home. 259. The police officer repeated the information to make sure that he or she had the facts that the Resident had given were correct. 260. Resident #18 said that the man never said anything to him or her. 261. Resident #18 admitted that she may have some confusion about what happened and did not know if the event was real or if she was dreaming, but she was certain that something strange had happened. 262. The police report continued that the police officer relayed the case thus far and 32 also the lack of abuse investigation end. 263. It was determined that Resident #18 should have a general examination to make sure there was no outward signs of sexual organ injury or any other signs of physical trauma. 264. The emergency room physician completed a general overview examination and stated that the Resident did not have any obvious signs of injury or distress. 265. The emergency room physician did comment on old bruising on the Resident’s thighs, but believed that it was not related to this matter. 266. The police officer stated that she spoke with the Social Service Director on April 10, 2008, who relayed that there was further information about the interviews at the Facility. 267. The police officer and the state protection agency met with CNA #13, who removed Resident #18’s adult diaper. 268. CNA #13 was said to have some masculine qualities that Resident #18 could have mistaken as a male at her bedside. 269. CNA #13 gave a statement to the state protection agency. 270. The police report concluded that the state protection agency discovered that the Resident had a history of psychosis with some dementia and other mental health disorders. 271. A physical examination did not uncover any evidence of sexual assault. 272. Law enforcement and adult protective agency determined that Resident #18 was not sure what occurred. 273. The Resident also acknowledged she could have imagined the incident. 274. The nursing staff that was on duty during the night of the alleged incident was also interviewed by law enforcement. 275. They were able to confirm no one entered or exited the victim’s room that night. 33 Hospital Records 276. A review of the local hospital emergency room documentation from April 9, 2008, including Patient Progress Report at 7:00 p.m., revealed that the Resident was seen by law enforcement. 277. In the Emergency Physician Record - General Adult, timed at 7:00 p.m., the emergency room physician wrote that Resident #18’s chief complaint was that she may have been raped last night. While sleeping at the nursing home, the Resident felt a male-like figure hold/grab her right forearm. The Resident reported that he or she felt that the man was going to rape him or her. The man did not actually grab or touch any other area or touch his or her face or genital area. The Resident stated that it may have been a dream. 278. The emergency room physician indicated that Resident #18 had no similar symptoms previously. 279. The Physical Examination -- General Appearance indicated that the Resident’s abdomen was non-tender, there was no organomegaly, there were normal bowel sounds and there was no distension. 280. It appeared that a rectal examination and/or rape kit were not performed. 281. The emergency room physician also indicated that law enforcement/SAFE team was to evaluate the Resident. 282. The discharge record listed the Resident’s clinical impression as dementia. Employee Records and Other Evidence 283. A random review of employee records revealed a Disciplinary Action Report, dated January 3, 2008, for CNA #10 which stated that CNA #10 failed to report a witnessed incident of abuse. 34 284. The Report stated that "CNA #10 witnessed abuse without notifying a supervisor. This also involved resident to resident and different residents." 285. A review of the "Resident/Patient Concern Report" filed by CNA #10 on January 2, /2008, stated that on several occasions, the CNA witnessed and reported a resident being aggressive on December 30, January 1-2. The CNA’s concern was that the resident will injure another resident or that possibly another resident will injure him. This should have been reported on January 1, as soon as possible, however, there were two agency nurses on duty. 286. During an interview with the law enforcement officer who was assigned to investigate Resident #18’s alleged sexual abuse on April 24, 2008, at 5:30 p.m., the officer stated that she did not know where this case fell through and that from her perspective, the case was a little strange. 287. On April 24, 2008, at 7:25 p.m., the Administrator and Vice President provided eighteen employee statements for additional information for review. 288. Twelve of the statements did not reflect a date when the statements were obtained, three of them reflected that they were obtained on April 23, 2008, and three of them reflected that they were obtained on April 24, 2008. 289. No new additional information was noted from these statements regarding Resident #18’s alleged sexual abuse on April 9, 2008. 290. The Administrator and Vice President were asked whether CNA #4 had been interviewed regarding her statement provided to the Facility on April 10, 2008. The employee had not returned any calls made by the Facility in order to discuss/clarify her statement regarding Resident 18’s alleged sexual abuse. 291. The Respondent’s actions and/or inactions constituted an isolated class I 35 , deficiency. § 400.23)(8)(a), Fla. Stat. (2007). 292. Aclass I deficiency is a deficiency that the agency determines presents a situation in which immediate corrective action is necessary because the facility's noncompliance has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in a facility. The condition or practice constituting a class I violation shall be abated or eliminated immediately, unless a fixed period of time, as determined by the agency, is required for correction. A class I deficiency is subject to a civil penalty of $10,000 for an isolated deficiency, $12,500 for a patterned deficiency, and $15,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class.I or class II deficiencies during the last licensure inspection or any inspection or complaint investigation since the last licensure inspection. A fine must be levied notwithstand- ing the correction of the deficiency. § 400.23)(8)(a), Fla. Stat. (2007). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to impose an administrative fine against the Respondent in the amount of ten thousand dollars ($10,000.00). COUNT II Six-Month Survey Cycle Fine 293. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 294. The Agency re-alleges and incorporates by reference Count I. 295. Under Florida law, the Agency shall every 15 months conduct at least one unannounced inspection to determine compliance by the licensee with statutes, and with rules promulgated under the provisions of those statutes, governing minimum standards of construc- tion, quality and adequacy of care, and rights of residents. The survey shall be conducted every 6 months for the next 2-year period if the facility has been cited for a class I deficiency, has been 36 cited for two or more class II deficiencies arising from separate surveys or investigations within a 60-day period, or has had three or more substantiated complaints within a 6-month period, each resulting in at least one class I or class II deficiency. In addition to any other fees or fines in this part, the Agency shall assess a fine for each facility that is subject to the 6-month survey cycle. The fine for the 2-year period shall be $6,000, one-half to be paid at the completion of each survey. § 400.19(3), Fla. Stat. (2007). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully. requests the Court to impose a six-month survey cycle fine against the Respondent in the amount of six thousand dollars ($6,000.00). COUNT It Assignment of Conditional Licensure Status 296. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 297. The Agency re-alleges and incorporates by reference Count I. 298. Due to the presence of a state class I deficiency that was not corrected within the time established by the Agency, the Respondent was not in substantial compliance at the time of the survey with criteria established under Chapter 400, Part II, Florida Statutes (2007), and the tules adopted by the Agency. 299. The Agency assigned the Respondent conditional licensure status with an action effective date of April 24, 2008. The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference. 300. The Agency later determined that the Respondent had corrected the deficiency and was in substantial compliance with criteria established under Chapter 400, Part II, Florida Statutes (2007), and the rules adopted by the Agency. 301. The Agency issued the Respondent standard licensure status with an action 37 effective date of June 3, 2008. The original certificate for the standard license is attached as Exhibit B and is incorporated by reference. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order assigning conditional licensure status to the Respondent for the period between the assignment of the conditional license and the issuance of the standard license. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief against the Respondent as follows: 1. 2. 6. Make findings of fact and conclusions of law in favor of the Agency. Impose an administrative fine of ten thousand dollars ($10,000.00.). Impose a six-month survey cycle fine of six thousand dollars ($6,000.00). us ae | KAA Thomas M. Hoeler, S Florida Bar No. 709311 Agency for Health Care Administration Office of the General Counsel Sebring Building, Suite 330D 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 or Attorney 38 NOTICE The Respondent has the right to request a hearing to be conducted in accordance with Sections 120.569 and 120.57, Florida Statutes, and to be represented by counsel or other qualified representative. Specific options for the administrative action are set out within 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: Spector, Gadon & Rosen, LLP, Registered Agent, 360 Central Avenue, Suite 1550, St. Petersburg, Florida 33701, by U.9/Certffied Mail, Return Receipt No. 7007 1490 0001 6979 1434, and Mennie Townsend} Alny on this 15th day of August, 2008. Thomas M. Hoeler, Senior Attorney Florida Bar No. 709311 Agency for Health Care Administration Office of the General Counsel Sebring Building, Suite 330D 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 39 Copies furnished to: Spector, Gadon & Rosen, LLP Pat Caufman, Field Office Manager Registered Agent Agency for Health Care Administration 360 Central Avenue, Suite 1550 525 Mirror Lake Drive North, Fourth Floor St. Petersburg, Florida 33701 St. Petersburg, Florida 33701 (Certified U.S. Mail) (nteroffice Mail) Mennie Townsend, Administrator Thomas M. Hoeler, Senior Attorney Highland Pines Rehabilitation Center Office of the General Counsel 1111 South Highland Avenue Agency for Health Care Administration Clearwater, Florida 33756 525 Mirror Lake Drive North, Suite 330D (U.S. Mail) St. Petersburg, Florida 33701 (Interoffice Mail) 40 Exhibit A Original Certificate of Conditional License Al

Docket for Case No: 08-004350