STATE OF FLORIDA a AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, O X- UG 20 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2008006382 WESTWOOD MANOR, 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, WESTWOOD MANOR, (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges: NATURE OF THE ACTION This is an action against an assisted living facility to impose an administrative fine in the amount of FIVE THOUSAND DOLLARS ($5,000.00) based upon eight (8) uncorrected Class III deficiencies. 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 Sections 20.42 and 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2007). 3. Venue lies pursuant to Florida Administrative Code Rule 28-106.207. 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 assisted living facilities. Chapter 408, Part II, and Chapter 429, Part I, Florida Statutes (2007); 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 in the manner provided in Chapter 120, Florida Statutes. Sections 408.813, 408.815, 429.14, Florida Statutes (2007). 5. The Respondent was issued a license by the Agency (License Number 8914) to operate a 30-bed assisted living facility located at 2339 Hoople Street, Fort Myers, Florida 343901, and was at all times material required to comply with the applicable federal and state regulations, statutes and rules for assisted living facilities. COUNT I The Respondent Failed To Ensure A Minimum Of One (1) Hour In-Service Training To Staff Who Provide Direct Care To Residents In Violation Of Rule 58A-5.0191(2)(b), And Rule 58A-5.0191(11)(a), Florida Administrative Code (2007) 6. The Agency realleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, facility administrators or managers shall provide or arrange for the following in-service training to facility staff: Staff who provide direct care to residents must receive a minimum of one (1) hour in-service training within thirty (30) days of employment that covers the following subjects: Reporting major incidents. Reporting adverse incidents. Facility emergency procedures including chain-of-command and staff roles relating to emergency evacuation. Rule 58A-5.0191(2)(b), Florida Administrative Code. Pursuant to Florida law, 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. Rule 58A-5.0191(11)(a), Florida Administrative Code. 8. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 9. Based on record review, the facility failed to ensure staff who provide direct care to residents receive a minimum of one (1) hour in-service training in major and adverse incidents and emergency procedures within thirty (30) days of hire for three (3) of four (4) staff, Staff number five (5), Staff number nine (9), and Staff number eleven (11), employed over thirty (30) days. 10. A review of personnel files found Staff number five (5), Staff number nine (9), and Staff number eleven (11) hired on May 5, 2007, December 21, 2006, and February 3, 2008 respectively, had not received training in major and adverse incidents and emergency procedures within thirty (30) days of hire but all had worked with the residents since hire. 11. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class If deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 12. The Respondent was given a mandatory correction date of April 4, 2008 for this deficient practice. 13. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent’s facility. 14. Based on record review, the facility failed to ensure staff who provide direct care to residents receive a minimum of one (1) hour in-service training in major and adverse incidents and emergency procedures within thirty (30) days of hire for three (3) of four (4) staff, Staff number three (3), Staff number five (5), and Staff number twelve (12), employed over thirty (30) days. 15. A review of personnel files found Staff number three (3), Staff number five (5), and Staff number twelve (12), hired on February 20, 2008, May 5, 2007 and October 30, 2007 respectively, had not received training in major and adverse incidents and emergency procedures within thirty (30) days of hire but all had worked with the residents since hire. 16. This remains an uncorrected deficiency. 17. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class Ill deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 18. The Respondent’s deficiency constituted an uncorrected Class III violation. 19. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 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) pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNT IL The Respondent Failed To Ensure That Three (3) Hours Of In-Service Training Was Provided Within Thirty (30) Days Of Employment To Staff Who Provide Direct Care To Residents In Resident Behaviors And Activities Of Daily Living In Violation Of Rule 58A- 5.0191(2)(d), And Rule 58A-5.0191(11)(a), Florida Administrative Code (2007) 20. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5): 21. Pursuant to Florida law, staff who provide direct care to residents, other than nurses, certified nursing assistants, or home health aides trained in accordance with Rule 59A- 8.0095, Florida Administrative Code, must receive three (3) hours of in-service training within thirty (30) days of employment that covers the following subjects; Resident behavior and needs and providing assistance with the activities of daily living. Rule 58A-5.0191(2)(d), Florida Administrative Code. Pursuant to Florida law, 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. Rule 58A-5.0191(11)(a), Florida Administrative Code. 22. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 23. . Based on record reviews, the facility failed to ensure that all staff who provide direct care to residents receive three (3) hours of in-service training within thirty (30) days of employment in resident behaviors and Activities of Daily Living for two (2) of four (4) staff, Staff number nine (9), and Staff number ten (10), employed over thirty (30) days. 24. A review of personnel records found Staff number nine (9) and Staff number ten (10) hired on December 21, 2006 and February 3, 2008 respectively lacked documentation of training in resident behaviors and/or Activities of Daily Living. 25. An interview with the administrator on March 4, 2008 at 2:30 p.m. verified these staff worked with residents and also verified the training records were not complete. 26. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class Ill deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 27. The Respondent was given a mandatory correction date of April 4, 2008 for this deficient practice. 28. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent’s facility. 29. Based on record reviews and interview, the facility failed to ensure all staff who provide direct care to residents receive three (3) hours of in-service training within thirty (30) days of employment in resident behaviors and Activities of Daily Living for three (3) of four (4) staff, Staff number three (3), Staff number five (5), and Staff number twelve (12), employed over thirty (30) days. 30. A review of personnel records found Staff number three (3), Staff number five (5), and Staff number twelve (12), hired on February 20, 2008, May 5, 2007, and October 30, 2007 respectively lacked documentation of training in resident behaviors and/or Activities of Daily Living. 31. A review of personnel records for new staff employed less than thirty (30) days, found Staff number thirteen (13), Staff number fourteen (14) and Staff number sixteen (16), hired on March 20, 2008, March 19, 2008 and April 1, 2008 respectively had signed in-service forms in their personnel files. 32. Aninterview with Staff number five (5) on April 14, 2008 at 10:51 a.m., and with Staff number sixteen (16) on April 14, 2008 at 10:42 a.m., verified these staff worked with residents and also verified the in-service form was signed only by the staff person and blank for all other information as the training had not occurred. 33. This remains an uncorrected deficiency. 34. | The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 35. | The Respondent’s deficiency constituted an uncorrected Class III violation. 36. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 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) pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNT Ill The Respondent Failed To Provide Observation And Awareness Of The General Health And Safety Of Residents In Violation Of Rule 58A-5.0182(1)(b), Florida Administrative Code (2007) 37. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 38. Pursuant to Florida law, an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. 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. 39. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 40. Based on observation and interview, the facility failed to provide observation and awareness of the general health and safety of the activities of two (2) of four (4) random residents, Resident number five (5), and Resident number six (6), who did not receive timely assistance and for two residents, (2) Resident number five (5) and Resident seven (7), who were wearing two (2) incontinence briefs. 41. An observation on March 4, 2008 at 7:00 a.m. revealed, upon entering the facility, the legs of a resident protruding into the hall with a walker lying on its side at the entrance to Room number two (2). A further observation revealed Resident number five (5) was laying on his/her back on the floor with the walker over his/her legs. 42. | When an employee sitting at a desk was informed of Resident number five (5) being on the floor she stated, "Oh that's just (Resident's name)." "He/she sits on the floor all the time." The employee did not go to check Resident number five (5). Resident number five (5) stated, "Can you get someone to help me?” The employee seated at the desk was again requested to help Resident number five (5) and finally went to check after being told Resident number five (5) was asking for help. 43. When asked for a list of residents and room numbers she stated, "I don't have one, but I think there is one in the administrator's office.". When asked the names of residents and which rooms they were in she said she wasn't sure. A resident standing nearby spoke up and listed the residents with room numbers and she said, "Oh yes, he is right.". "He knows them better." She stated that she had been employed at the facility for two (2) months. 44. An observation in the dining room on March 4, 2008 at approximately 8:00 a.m., revealed someone was yelling for help down the hall to the left of the dining room. One staff person was seated at the desk and another was assisting residents to their seats in the dining room but neither responded to the calls for help. When the person seated at the desk was informed that someone needed assistance she stated, "That's (name)." She pointed to the employee in the dining room and said, "Tell her because I am getting ready to leave." When the employee in the dining room was told of the resident yelling for help she stated, "Oh that's just (name)," and continued guiding residents to their tables. The resident's calls for help were audible in the dining room and desk area. Finally, after being asked to check the resident calling for help a second time, the staff person in the dining room went down the hall to the resident's room where another resident was observed assisting Resident number six (6) who is blind and becomes confused and turned around. 45. An observation of Resident number five (5) on March 4, 2008 at 7:40 a.m. revealed the resident was in the bathroom sitting on the toilet. His/her clothes and incontinent brief were pulled down to his/her ankles. An observation of Resident number five’s (5) skin with a staff person revealed his/her skin was intact and he/she was wearing two (2) incontinent pull up briefs. The briefs were dry. When asked why he/she was wearing two (2) incontinent briefs the staff person stated, "We always put on two." When asked why, she did not answer. 46. An observation of Resident number seven (7) on March 4, 2008 at 9:45 a.m. with a second staff person revealed he/she was wearing two (2) incontinent briefs. His/her skin was intact and the briefs were dry. When asked why the resident was wearing two incontinent briefs she stated, "It's the way we do it." When asked why she said she didn't know. 47. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class Ill deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). | 48. | The Respondent was given a mandatory correction date of April 4,.2008 for this deficient practice. 49. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent’s facility. 50. Based on observation, interview and record review, the facility failed to provide observation and awareness of the general health and safety of one (1) of four (4), Resident number four (4), active sampled residents as evidenced by the resident wandering outside the facility and not being found for an extended period of time, 10 3/4 to 12 hours. 51. An observation on April 14, 2008 at 7:15 a.m., revealed Resident number four (4) is ambulating in the hall by Room number five (5). He/she stated, "I'm fine, just fine" and proceeded to walk into the day room. He/she ambulates independently. A review of the record for Resident number four (4) revealed diagnoses that include, but are not limited to, dementia. The Health Assessment form dated January 9, 2008 documents Resident number four (4) has confusion. A further review reveals Resident number four (4) was appointed a legal guardian on February 22, 2005. . 52. An observation on April 14, 2008 at approximately 7:30 a.m., revealed Resident number four (4) was eating cereal and milk with his/her fingers. A staff person said, "Mama said use a spoon" and Resident number four (4) started using a spoon to eat the cereal. Resident number four (4) was also observed attempting to leave the dining room. A staff person said, "Mama said sit down" and placed him/her back in a sitting position. 53. A review of the clinical record for Resident number four (4) reveals the resident was discovered to be missing from the facility at lunch time on March 14, 2008 and was not found by the police until 10:40 p.m. when he/she was found in a vacant lot. 54. A review of the facility's adverse incidents revealed Resident number four (4) had a previous incident of wandering from the facility. It is documented that he/she had been brought back to the facility on February 2, 2007 by the police after being found at the Salvation Army building. 55. An interview on April 14, 2008 at approximately 9:30 a.m., with a resident care aide revealed that the last time Resident number four (4) was seen on March 14, 2008 was after his/her shower at about 10:30 a.m. 56. An interview with the facility administrator on April 14, 2008 at approximately | 10:00 a.m., revealed the facility had conducted a search when Resident number four (4) was not present for lunch and had called the local police department when the facility was unable to locate Resident number four (4). Resident number four (4) was found in a vacant lot at approximately 10:45 p.m. Resident number four (4) had been out of the facility for at least 10 3/4 hours and possibly as many as 12 hours. 57. This remains an uncorrected deficiency. 58. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 59. The Respondent’s deficiency constituted an uncorrected Class III violation. 60. ‘The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of SEVEN HUNDRED FIFTY DOLLARS ($750.00) pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNTIV The Respondent Failed To Ensure That Dietary Allowances Were Met And Food Was Prepared Using Standardized Recipes In Violation Of Rule 58A-5.020(2)(b), Florida Administrative Code (2007) 61. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 62. Pursuant to Florida law, the recommended dietary allowances shall be met by offering a variety of foods adapted to the food habits, preferences and physical abilities of the residents and prepared by the use of standardized recipes. For facilities with a licensed capacity of sixteen (16) or fewer residents, standardized recipes are not required. Unless a resident chooses to eat less, the recommended dietary allowances to be made available to each resident daily by the facility are as follows: Protein: six (6) ounces or two (2) or more servings; Vegetables: three (3)-five (5) servings; Fruit: two (2)-four (4) or more servings; Bread and starches: six (6)-eleven (11) or more servings; Milk or milk equivalent: two (2) servings; Fats, oils, and sweets: use sparingly; and Water. Rule 58A-5.020(2)(b), Florida Administrative Code. 63. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent's facility. 64. Based on observation, the facility did not ensure that the dietary allowances were met and food was prepared using standardized recipes. 65. Upon arrival at the facility on March 4, 2008 at approximately 7:00 a.m., the cook was observed to begin breakfast preparations. Breakfast included a bowl of oatmeal and one slice of toast, cut and buttered. 66. Once residents voiced requests for additional food, and surveyor inquired as to menu and substitutions, the cook prepared one (1) fried egg and a second buttered slice of toast for each resident. Breakfast was planned to be two (2) ounce sausage patty, eight (8) ounces oatmeal, two (2) slices toast, two (2) teaspoons of butter and two (2) packs of jelly and half of a banana. Breakfast served was eight (8) ounces of oatmeal and one (1) slice of bread until resident and surveyor intervention produced an additional plate of one (1) egg and another slice of toast. The two (2) bananas on hand were cut into quarters (8 sections), and offered to the sixteen (16) residents, seven (7) of whom each took a quarter section. 67. A pot on the stove which contained beef was observed not under heat at 7:00 a.m., when the surveyors arrived. The cook stated the 3:00 p.m.-11:00 p.m. shift had removed the frozen beef from the freezer prior to leaving at 11:00 p.m., and placed it into a pot of water on the stove to cook all night. The 11:00 p.m.-7:00 a.m. staff person had turned off the stove at approximately 5:00-5:30 a.m. when the cook called and requested she do so, thus leaving the cooked meat cooling on the stove until 9:00 am. The meat for lunch was removed from the stove about 9:00 a.m. and put into a new pan with tap water added. This was put back on the stove not under heat. Potatoes were then peeled and placed into a bowl, covered and refrigerated. At approximately 11:00 a.m., the meat was returned to heating. At 11:30 am., after a discussion of the menu, the staff person got the potatoes from the refrigerator, added two cans of carrots and heated the meat, potato & carrot mixture. Just prior to serving, thickening was added, but not allowed to boil and thicken. This was served with a slice of buttered bread, rice, green beans and salad with Italian dressing. When asked for the standardized recipe for the beef stew a search of the facility ensued and no recipes were found. The cook had thrown out the beef broth, added thickening unseasoned to meat which cooked reportedly seven (7) hours then sat on the stove for an additional six (6) hours before reheating. The "stew" had the appearance of meat and vegetables in a watery liquid. 68.. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class II deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 69. The Respondent was given a mandatory correction date of April 4, 2008 for this deficient practice. 70. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent’s facility. 71. Based on observation, the facility did not ensure that the dietary allowances were met and food was prepared using standardized recipes. 72. Upon arrival at the facility on April 14, 2008 at approximately 7:00 a.m., the cook was observed to begin breakfast preparations. Breakfast included a bowl of cereal with banana slices. 73. Once the residents finished eating the cereal, the cook began preparing scrambled eggs and a buttered slice of toast for each resident. Breakfast was planned to be two (2) ounces scrambled eggs, six (6) ounces cold cereal, two (2) slices toast, two (2) teaspoons of butter and two (2) packs of jelly and a half banana. Breakfast served was six (6) ounces cold cereal with sliced bananas, less than two (2) ounces of eggs and one slice of toast. The scrambled eggs were made with twenty-four (24) eggs for fifteen (15) people (Thirty (30) eggs should have been used). One (1) person declined to eat eggs and no alternate protein was provided. 74. At11:16a.m., the cook was observed making bologna sandwiches. A tray with sixteen (16) buns, all with one (1) slice of bologna on each sandwich was observed. The cook stated this was to be the supper meal. The supper meal was planned to be three (3) ounces of steak sandwich on two (2) slices of bread, four (4) ounces tossed salad, one (1) package dressing, eight (8) ounces of vegetable soup, and four (4) ounces of fruit cup. When asked about the portion size, the cook stated, "I always make the sandwiches with one (1) slice of meat, they just pick it apart and waste the rest." "When I worked at (another facility) the residents used to throw away the extra meat.” "I give more to (named 3 residents) (another resident) eats small portions.” None of the sixteen (16) sandwiches were observed to have more than one (1) slice of bologna. The sandwiches were not made following a standardized recipe. 75. During the breakfast meal observation at 7:36 a.m., the cook verified the facility still had not obtained and standardized recipes. However, the owner had ordered a "recipe book" from a bookstore. The owner verified he had a recipe book on order. 76. This remains an uncorrected deficiency. 77. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 78. The Respondent’s deficiency constitutéd an uncorrected Class III violation. 79. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 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) pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNT V The Respondent Failed To Ensure That Resident Rooms Had Dressers Or Chests Designed For The Storage Of Personal Belongings In Violation Of Rule 58A-5.023(4)(e), Florida Administrative Code (2007) 80. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 81. - Pursuant to Florida law, residents shall be given the option of choosing their own roommate or roommates if possible. Pursuant to Section 429.27, Florida Statutes, residents shall be given the option of using his/her own belongings as space permits. Each resident bedroom or sleeping area, where furnishings are supplied by the facility shall, at a minimum, be furnished with the following: A clean, comfortable bed with a mattress no less than thirty-six (36) inches in width and seventy-two (72) inches in length with the top surface of the mattress a comfortable height to assure easy access by the resident; A closet or wardrobe space for the hanging of clothes; A dresser, chest, or other furniture designed for the storage of personal effects; and a table, bedside lamp or floor lamp, waste basket, and comfortable chair shall be provided if requested. Rule 58A-5.023(4)(e), Florida Administrative Code. 82. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 83. Based on observation and interview, the facility failed to ensure that four (4) of eighteen (18) rooms had dressers or chests designed for the storage of personal effects. 84. During a tour of the facility on March 4, 2008 at 7:00 a.m., four (4) rooms were noted to have no dresser or chest: Room number four (4), Room number six (6), Room number eleven (11), and Room number eighteen (18). 85. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class Ill deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 86. The Respondent was given a mandatory correction date of April 4, 2008 for this deficient practice. 87. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent’s facility. 88. Based on observation and interview, the facility failed to ensure that three (3) of eighteen (18) rooms had dressers or chests designed for the storage of personal belongings. 89. During a tour of the facility on April 14, 2008 at 7:00 a.m., Room number eleven (11), Room number fifteen (15), and Room number eighteen (18) were noted to have no dresser or chest. There was only a nightstand in these rooms. 90. One room did not have a dresser, but had a plastic unit with see through drawers. The resident in that room stated he/she liked the plastic drawers because he/she can see what is in there. 91. Aninterview with the administrator on April 14, 2008 at 11:15 a.m. confirmed the rooms did not have chests. The administrator stated he was going to buy some but hasn't yet. 92. - This remains an uncorrected deficiency. 93. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 94. | The Respondent’s deficiency constituted an uncorrected Class III violation. 95. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. 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) pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNT VI The Respondent Failed To Ensure That Personnel Records Contained Verification Of Freedom From Communicable Disease, Including Tuberculosis, In Violation Of Section 429.275(4), Florida Statutes (2007), And Rule 58A-5.024(2)(a), Florida Administrative Code (2007) 96. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 97. Pursuant to Florida law, the department may by rule clarify terms, establish requirements for financial records, accounting procedures, personnel procedures, insurance coverage, and reporting procedures, and specify documentation as necessary to implement the requirements of this section. Section 429.275(4), Florida Statutes (2007). Pursuant to Florida law, the facility shall maintain the following written records in a form, place and system ordinarily employed in good business practice and accessible to Department of Elder Affairs and Agency staff. 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. In addition, records shall contain the following, as applicable, documentation of compliance with all staff training required by Rule 58A-5.0191, Florida Administrative Code. Rule 58A-5.024(2)(a), Florida Administrative Code. 98. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 99. Based on record review, the facility failed to ensure personnel records contained verification of freedom from communicable disease, including tuberculosis, for two (2) of four (4), Staff number nine (9), and Staff number eleven (11), staff employed over thirty (30) days. 100. A review of four (4) personnel records for staff employed over thirty (30) days found Staff number nine’s (9) record lacked any medical documentation. Staff number nine (9) was hired on December 21, 2006 which was well beyond the thirty (30) day time frame. 101. Staff number eleven’s (11) record last had freedom from tuberculosis documented on July 2006. Staff number eleven (11) was hired February 3, 2008. 102. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class Ill deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 103. The Respondent was given a mandatory correction date of April 4, 2008 for this deficient practice. 104. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent's facility. 105. Based on record review, the facility failed to ensure personnel records contained verification of freedom from communicable disease including tuberculosis for one (1) of four (4) staff, Staff number three (3), employed over thirty (30) days. 106. A review of four (4) personnel records for staff employed over thirty (30) days found Staff number three’s (3) record lacked any medical documentation. Staff number three (3) was hired on February 20, 2008, well beyond the thirty (30) day time frame. A tuberculosis form was noted to be negative on February 2008, but was signed by the licensed practical nurse and the health care provider had not completed the remainder of the form. 107. This remains an uncorrected deficiency. 108. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 109. The Respondent’s deficiency constituted an uncorrected Class III violation. 110. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of SEVEN HUNDRED FIFTY DOLLARS ($750.00) pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNT VIL Respondent Failed To Ensure That Newly Hired Staff Had Obtained A Verification Of Freedom From Communicable Disease, Including Tuberculosis, Within Thirty (30) Days Of Employment In Violation Of Rule 58A4-5.019(2)(a), Florida Administrative Code, And Rule 58A-5.024(2)(a)2, Florida Administrative Code 111. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 112. 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. 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. In addition, records shall contain the following, as applicable: Copies of all licenses or certifications for all staff providing services which require licensing or certification. Rule 58A-5 .024(2)(a)2, Florida Administrative Code. 113. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent's facility. 114. Based on record review, the facility failed to ensure personnel records contained verification of freedom from communicable disease including tuberculosis for two (2) of four (4) staff, Staff number nine (9), and Staff number eleven (11), employed over thirty (30) days. 115. A review of four (4) personnel records for staff employed over thirty (30) days found Staff number nine’s (9) record lacked any medical documentation. Staff number nine (9) was hired on December 21, 2006, well beyond the thirty (30) day time frame. 116. Staff number eleven’s (11) record last had freedom from tuberculosis documented on July 2006. Staff number eleven (11) was hired February 3, 2008. 117. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 118. The Respondent was given a mandatory correction date of April 4, 2008 for this deficient practice. 119. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent’s facility. 120. Based on record review, the facility failed to ensure newly hired staff had obtained a verification of freedom from communicable disease including tuberculosis within thirty (30) days of hire for one (1) of four (4) staff, Staff number three (3), employed over thirty (30) days. 121. A review of four (4) personnel records for staff employed over thirty (30) days found Staff number three’s (3) record lacked any medical documentation. Staff number three (3) was hired on February 20, 2008, well beyond the thirty (30) day time frame. A tuberculosis form was noted to be negative on February 2008, but was signed by the licensed practical nurse and the health care provider had not completed the remainder of the form. 122. This remains an uncorrected deficiency. 123. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class Ill deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 124. The Respondent’s deficiency constituted an uncorrected Class III violation. 125. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of SEVEN HUNDRED FIFTY DOLLARS ($750.00) pursuant to Section 429.19(2)(c), Florida Statutes (2007). COUNT VI Respondent Failed To Ensure That Staff Who Are Responsible For Medications Have A Two (2) Hour Medication Course Updated Annually In Violation Of Section 429.256(1)(b)(2), Florida Statutes (2007), Rule 58A-5.0191(5)(c), And Rule 58A- 5.024(2)(a)1, Florida Administrative Code 126. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 127. Pursuant to Florida law, for the purposes of this section, the term "Unlicensed person" means an individual not currently licensed to practice nursing or medicine who is employed by or under contract to an assisted living facility and who has received training with respect to assisting with the self-administration of medication in an assisted living facility as provided under Section 429.52 prior to providing such assistance as described in this section. Residents who are capable of self-administering their own medications without assistance shall be encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed prescription's label or the package directions of an over-the-counter medication, assist a resident whose condition is medically stable with the self-administration of routine, regularly scheduled medications that are intended to be self-administered. Assistance with self-medication by an unlicensed person may occur only upon a documented request by, and the written informed consent of, a resident or the resident's surrogate, guardian, or attorney in fact. For the purposes of this section, self-administered medications include both legend and over-the-counter oral dosage forms, topical dosage forms and topical ophthalmic, otic, and nasal dosage forms including solutions, suspensions, sprays, and inhalers. Section 429.256(1)(b)(2), Florida Statutes (2007). Pursuant to Florida law, unlicensed persons who will be providing assistance with self-administered medications as described in Rule 58A-5.0185 , Florida Administrative Code, must meet the training requirements pursuant to Section 429.52(5), Florida Statutes, prior to assuming this responsibility. Courses provided in fulfillment of this requirement must meet the following criteria: Unlicensed persons, as defined in Section 429.256(1)(b), Florida Statutes, who provide assistance with self-administered medications and have successfully completed the initial four (4) hour training, must obtain, annually, a minimum of two (2) hours of continuing education training on providing assistance with self-administered medications and safe medication practices in an assisted living facility. The two (2) hours of continuing education training shall only be provided by a licensed registered nurse, or a licensed pharmacist. Rule 58A-5.0191(5)(c), Florida Administrative Code. 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. In addition, records shall contain the following, as applicable: Documentation of compliance with all staff training required by 58A-5.0191, Florida Administrative Code. Rule 58A-5.024(2)(a)1, Florida Administrative Code. 128. On or about March 4, 2008 the Agency conducted a Complaint Investigation (CCR# 2008-002655) of the Respondent’s facility. 129. Based on record review and interview, the facility failed to ensure that staff who are responsible for medications have a two (2) hour medication course update annually for three (3) of three (3) staff employed over 365 days, Staff number five (5), Staff number eight (8), and Staff number nine (9). 130. A review of personnel records found Staff number five (5), Staff number eight (8), and Staff number nine (9) lacked documentation of the two (2) hour medication update training, which is required annually, in their files. Staff number five (5) had a course in 2006, lacked one in 2007 and took another in February 2008. Staff number eight (8) had training in February 2007, yet lacked an update before March 2008. Staff number nine (9) had documentation of an update in November 2006 and none since. 131. A review of the work schedule with the administrator verified that Staff number five (5), Staff number eight (8), and Staff number nine (9) were all responsible for medications. 132. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class II deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 133. The Respondent was given a mandatory correction date of April 4, 2008 for this deficient practice. 134. On or about April 14, 2008 the Agency conducted a Follow-Up Survey to the Complaint Investigation (CCR# 2008-002655) of March 4, 2008 of the Respondent’s facility. 135. Based on record review and interview, the facility failed to ensure staff who are responsible for medications have a two (2) hour medication course update annually for four (4) of five (5) staff employed who had the four (4) hour medication course over 365 days prior and who assisted residents with medications, Staff number eight (8), Staff number twelve (12), Staff number fifteen (15), and Staff number sixteen (16). 136. A review of personnel records found Staff number eight (8), Staff number twelve (12), Staff number fifteen (15), and Staff number sixteen (16) lacked documentation of the two (2) hour medication update training, which is required annually, in their files. 137. Staff number eight (8) had training in February 24, 2007, yet lacked an update by April 14, 2008. 138. Staff number twelve (12) had documentation of a four (4) hour course in 2002, yet lacked an update by April 14, 2008. 139. Staff number fifteen (15) had training in September 22, 2004, had an up-date in January 2, 2007, but lacked an up-date since. 140. Staff number sixteen (16) stated she had passed medications for years and had taken the four (4) hour medication course prior. She had documentation of a two (2) hour up- date on January 2, 2007, yet lacked an up-date since. 141. This remains an uncorrected deficiency. 142. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2007). 143. The Respondent’s deficiency constituted an uncorrected Class III violation. 144. The Agency shall impose an administrative fine for a cited Class ITI violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. . WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of SEVEN HUNDRED FIFTY DOLLARS ($750.00) pursuant to Section 429.19(2)(c), Florida Statutes (2007) . 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: 1. Make findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the total amount of FIVE THOUSAND DOLLARS ($5,000.00). 3. Enter any other relief that this Court deems just and appropriate. Respectfully submitted this_A%*™ day of Turn 2008. 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/HE/SHE 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. JHE 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 Election of Rights form were served to: Peter Kramer, Administrator, Westwood Manor Ké Living Facility, 2339 Hoople Street, Fort Myers, Florida 33901, by U. S. Certified Mail, Return ‘ I] HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and ? “Y ay os Pe Receipt No. 7006 2760 0003 1537 3310, on this 2% day of _ S. han , 2008. Oi drwe om. 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: Peter Kramer Andrea M. Lang, Senior Attorney Administrator Agency for Health Care Administration Westwood Manor Office of the General Counsel 2339 Hoople Street 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Fort Myers, Florida 33901 (U.S. Certified Mail) (Interoffice Mail) John F. Gilroy ITI, P.A. Counsel for Respondent 1435 East Piedmont Drive, Suite 215 Tallahassee, Florida 32308 (U.S. Mail) Kriste J. Mennella Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) Otte an oe oS COMPLETE THIS SECTION ON DELIVERY Ss 1 B, Received by ( Printed Name) SENDER: COMPLETE THIS SECTION _ W Complete items 1, 2, and 3. Also complete _. ttem.4 if Restricted Delivery is desired. ' Print your name and address on the reverse _ so that we can return the card to you. . mt Attach this card to the back of the mailpiece, »: C. Date of Delivery or-on the front if space permits. : ———— OR O06TOL D. Is delivery address different from item 17 1 Yes ; 1, Article Addressed to: me If YES, enter delivery address below: £1 No Peter Kramer, Administ tor i . Westword Manor ©2334 Hoople Stree Port ys, Flenda 33490! 3. Service Type CO Certified Mail 1 Express Mall Ci Registered 1 Retum Receipt for Merchandise CD insured Mai 0 6.0.0. 4. Restricted Delivery? (Extra Fee) ~ 2. Article Number «» Cranster trom service labo) 2006 2760 0003 1537 3330 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ;

Docket for Case No: 08-004920