T obed ST. AGENCY FOR HE STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. JEST OPERATING, INC., d/b/a SOMERSET, Respondent. TE OF FLORIDA LTH CARE ADMINISTRATION 094-0144 Case No. 2008003255 ADMINISTRATIVE COMPLAINT COMES NOW the Agency for H alth Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against JEST OPERATING, INC., d/b/a SOMERSET (hereinafter Respondent), pursuant to Section 120.569, and 120.57, Florida Statules, (2007), and alleges: NATL JRE QF THE ACTION This is an action to revoke Respondent's license to operate an assisted living facility in the State of Florida pursuant to §429.14() )(c), Florida Statutes (2007), and to impose an administrative fine of thirteen thousand in hundred dollars ($13,500.00) bascd upon two (2) State Class I deficiencies, iwo (2) State lass 11 deficiencies and thrce (3) State Class III deficiencies pursuant to §429.19(2)(a), (#) and (c), Florida Statutes (2007). 1. ‘The Agency has jurisdiction purs 429, Part I, Florida States (2007). 2. Venue lics pursuant to Florida A nt to §§ 20.42, 120.60, and Chapters 408, Part Il, and ministrative Code R. 28-106.207. 00000-000-000 ONIAIT (HLSISSY LHUSUENOS dOT:TO 2z0z‘LT Nor PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable state statutes and rules governing assisted living facilities pursuant to the Chaptors 408, Part II, and 429, Part 1, Florida Statutes, and Chapter 58A-5, Florida Administrative Code, respectively. 4. Respondent operates a 66-bed assjsted living facility located at 2450 Dora Avenue, Tavares, {'l, 32778, and at all times matetial hereto was licensed as an assisted living facility, license number 7472. 5. Respondent was at all times matetial hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I 6. The Agency re-alleges and incorpjorates paragraphs (1) through (5) as if fully set forth herein. 7. That pursuant to Florida law, every facility shall be under the supervision of an administrator who is responsible for the re and maintenance of the facility including the management of all staff and the provision of adequate care to all residents as required by Part I of Chapter 429, F.S.... Administrators may supervise a maximum of either three assisted living facilities or a combination of housing and health care facilities or agencies on a single campus. However, administrators who supervise ynore than one facility shall appoint in writing a separate “manager™ for each facility who must: 1.|Be at least 21 years old; and 2. Complete the core training requirement pursuant to Rule 58/A-5.0191, F.A.C. Rule S8A-5.019(1)(b), Florida Administrative Code. 8. That pursuant to Florida law, the Lssisted living facility core training requirements established by the department pursuant to Section 429.52, F.S., shall consist of a minimum of 26 z abed 00000-000-000 ONIAIT GaLSISSY LHSHBWOS dOT:TO zZz0z‘LT Nor hours of training plus a competency test. |Administrators and managers must successfully complete the assisted living facility core training requirements within 3 months from the date of becoming a facility administrator or manager. Successful complction of the core training requirements includes passing the competency test. Administrators who have attended core training prior to July 1, 1997, and managers who attended the core training program prior to April 20, 1998, shall not be required to take the competency test. Administrators licensed as nursing home administrators in accordande with Part II of Chapter 468, F.S., are exempt from this requirement. Rule 58A~-5.0191(1)(a)jand (b), Florida Administrative Code. 9. That pursuant to Florida law, every facility shall be under the supervision of an administrator who is responsible for the gperation and maintenance of the facility including the management of all staff and the provision of adequate care to all residents as required by Part [ of Chapter 429, I'.S, The administrators shall: 1. Be at least 21 years of age; and 2. If employed on or after August 15, 1990, have a high schbol diploma or general equivalency diploma (G.E.D.), or have been an operator or administrator, of a licensed assisted living facility in the State of Florida for at least one of the past 3 years in which the facility has met minimum standards. Administrators employed on or after October 30, 1995, must have a high school diploma or G.E.D. Rule 584-5.019(1)(a), Florida Alministrative Code. 10. That on February 25-26, 2008, the Agency conducted an unannounced Biennial Licensure Survey of the Respondent facility 11. That based upon observation, the review of records and interview, Respondent failed to ensure that it was managed by an Administrator who was responsible for the operation and maintenance of the facilily including the management of all staff and the provision of adequate cure to all residents in thal Respondent’s administrator failed to ensure minimum requirements of law were maintained within the facility, gaid administrator having failed to successfully € ebed 00000-000-000 ONIAIT GHISISSY IESHSWOS d0T*T0 220Z‘LT Nor completed a core training which could contribute to the failures noted within the facility. Failure to have an Administrator who has successfully completed training and demonstrated competency therein placed the residents at risk of not leceiving the care and services at the level that which may he required. 12. That review of the facility admission and discharge log revealed a census of seventy- seven (77) residents, 13. That the Petitioner's representative interviewed Respondent's administrator on February 25, 2008 who indicted as follows: a. That the facility censug was actually forty-two (42); b. That she was unaware that she was not aware that she had to keep the admission discharge i current since she took over the facility as Administrator in June 2007. 14. That the Petitioner’s representative toured the Respondent facility during the survey and noted as follows: a. That beds 7A and 7B, located in the locked unit, on February 25, 2008 at 10:40 AM both had installed thereon full length side bed tails, b. Bed 7A did not have ajresident occupying the bed; c. Resident number one | was lying in bed 7B with both full length side rails in the up position; d. Next to the bed of resident number one (1) was a Gerichajr; e, At3:00 PM on Februaty 25, 2008, resident number one (1) was in bed 7B with both full length side rails up in full position; f. No resident was in bed 7A at said time, however one side rail was up and one was down; yp abed 00000-000-000 ONIAIT GHLSISSY LHSHAWNOS dOT?10 2z0z‘LT NOL g. At 1:00 PM on February 26, 2008, resident number one (1) was in bed 7B with both fill length side rails up in full position; h. No resident was in bed|7A at said time, however one side rail was up and one was down. 15. That the Petitioner's reviewed Respondent’s records regarding the resident’s who utilized beds 7A and 7B and could locate no physician's order for the use of full length side rails for the residents nor did the resident's Hospice plins of care mention side rails to be in use by the Hospice staff. 16. That the Petitioner's representative interviewed the Hospice nurse on February 25, 2008 who indicated as follows: a. That she came in mostly every day; b. That she did not stay usually over two hours; c. That facility staff placed the resident in the Gerichair and then puts the resident back to bed affer meals. 17. That the Petitioner's representative reviewed Respondent’s records regarding resident number one (1) and noted as follows: a. That the resident was admitted to the facility on March 24, 2003; b. That the resident was placed on Hospice on June 7, 2004; c. That the resident has "blister like eruptions" in bilateral axilla and buttocks; d. That a treatment was being performed by the facility staff daily of, "Hibiclens wash to bilateral axillajand buttocks” and in parentheses it states, "done by [Certified Nursing Assjstants]”. 18. ‘That the Petitioner’s representative reviewed respondent's Limited Nursing Services (LNS) log and noted that resident numbei one (1) was not listed as receiving limited nursing g ebed 00000-000-000 ONIAIT GULSISSY LHSHHNOS dOT:TO zZz0Zz‘LT Nar services. 19. That the Petitioner's representative interviewed Respondent's Administrator who indicated that she was not aware that Hospice residents should also be on limited nursing services, 20. That the Petitioner’s representative reviewed eight (8) resident contracts during the survey and could locate no written criteriq for a time frame for discharging residents as required by law, 21. That the Petitioner's representative interviewed Respondent’s administrator who indicated that she was unable to produce documentation of discharge criteria and was unaware that the residents are to receive a forty-five (45) day notice prior to discharge or relocation. 22. That the Petitioner’s representative interviewed a random resident, random resident number one (RR1) on February 26, 2008 ht 2:00 PM who indicated that the resident had been requesting a financial statement from the facility since July 2007 and had not been given one t date. 23. ‘That the Petitioner's representative interviewed Respondent’s administrator who indicated that she had not reconciled optional state supplement or medicaid waiver resident's personal spending accounts since June 2007. 24. That the Petitioner’s representative reviewed Respondent's emergency management plan during the survey and noted that it lacked/any evidence of having been submitted to the local emergency management agency. 25. ‘That the Petitioner's representative interviewed Respondent’s administrator who indicated that she was unable to provide documentation that the emergency management plan had becn submitted to the focal emergency management agency. 9 ebed 00000-000-000 ONIAIT CHISISSY LHSUHWOS dIT? 10 2207‘LT Nor 26. ‘That the Petitioner’s representative noted during the initial tour of the facility that a family member of the administrator was residing in resident room number three (3). 27. That the Petitioncr’s representative interviewed Respondent's administrator who indicated that a parent of the administratof is residing in room number three (3) which is a licensed assisted living facility bed of the|facility and the parent is not a resident al the facility. 28. That the Petitioner's records refle¢t that Respondent's administrator had reported to Petitioner’s staff during survey of June 13, 2007 that she was the Respondent’s acting administrator since April 2007. 29. That the Petitioner's representative reviewed the administrator's personnel records and could locate no evidence of the administrator having completed the core competency examination. 30. That the Petitioner’s representalive interviewed Respondent’s administrator on February 25, 2008 who indicated as follows: a. That she had completed the basic core training in June 2007, b. That she has not taken|the competency examination, c. That the facility desigrlee had taken the basic core training, but had not taken the competency test. 31. ‘That Respondent facility has beer| without an administrator who has successfully completed the core training requirements|of law since March 2007. 32. That Respondent's administrator failed to ensure the operation and maintenance of the facility including the management of all staff and the provision of adequate care to all residents as required by law, said failures illustrated by the above and the administrator’s failure to demonstrate competency in the — of law by the failure to complete a core training competency examination. Said failure inflividually and collectively represent a management L ebed 00000-000-000 ONIAIT GHLSISSY LYSWSHOS dIT:TO 2z0z‘LT Nor scheme which systemically fuils to mect the minimum requirements of law. Inclusive of these failures were: a. The use of’ Geri chairs and full bed rails, restraints as defined by law and prohibited; b. The provision of nursing services by non-licensed individuals; c. The failure to place residents requiring nursing services on limited nursing services admissions; d. The failure to inform olsidents or their representatives of financial information; e. The failure to insure that required discharge criteria and processes are contained within resident contracts; f. The failure to maintain accurate admission discharge records; and g. The failure to ensure that emergency management plans have been approved for implementation. 33.‘ That the Agency determined that the above constitutes grounds for the imposition of a Class | deficiency in that it presents an inminent danger to the residents or guests of the facility or a substantial probability that death or serious physical or emotional harm would result therefore. 34. That the Agency cited the Respondent for a Class | violation in accordance with Section 429.19(2)(a), Florida Statutes (2007). WHEREFORE, the Agency intends to impose an administrative fine in the amount of $5,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2){a), Florida Statutes (2007). 9 obed 00000-000-000 ONIAIT GHISISSY LSSHBWOS dIT?10 ¢z02‘LT Nat COUNT 35. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 36. That pursuant to Florida law, the ise of physical restraints shall be limited to half-bed tails, and only upon the written order of the resident's physician, Who shall review the order biannually, and the consent of the resident or the resident’s representative. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance shall not be considered a physital restraint. Rute 58A~5.0182(6)(h), Florida Administrative Code. ...The use of physical restraints is limited to half-bed rails as prescribed and documented by the resident's physician with the consent of the resident or, if applicable, the resident's representative or designcc or the resident's surrogate, guardian, or attorney in fact... Section 429.41 (k), Florida Statutes (2007), 37. That pursuant to Florida law, "Physical restraint" means a device which physically limits, restricts, or deprives an individual of movement or mobility, including, but not limited to, a half also include any device which was not specifically manufactured as a restraint but which has bed rail, a full-bed rail, a geriatric chair, r a posey restraint. The term "physical restraint” shall been allered, arranged, or otherwise used|for this purpose. ‘The term shall not include bandage material used for the purpose of binding @ wound or injury. Section 429.02(17), Florida Statutes (2007). : 38. ‘That on February 25-26, 2008, the Agency conducted an unannounced Biennial Licensure Survey of the Respondent facility. 39. That based upon observation, the review of records, and interview, Respondent failed to ensure that two (2) of eight (8) sampled residents were freé from restraints of bed side-rails and a Gerichair, said use of restraints in violation of law 6 ebed 00000-000-000 SNIAIT CHLSISSY LHSYBWOS dIT:TO 2z0z’LT Nar 40. That the Petitioner's representative toured the Respondent facility during the survey and noted as follows: a. That beds 7A and 78, located in the locked unit, on february 25, 2008 at 10:40 AM both had installed thereon full length side bed rails; b. Bed 7A did not have a resident occupying the bed; c. Resident number one (L) was lying in bed 7B with both full length side rails in the up position; d. Next to the bed of rcsident number one (1) was a Gerichair; c. At3:00 PMon Februsty 25, 2008, resident number one (1) was in bed 7B with both full length sie rails up in full position; {. No resident was in bed! 7A at said time, however one side rail was up and one was down; g. At 1:00 PM on February 26, 2008, resident number onc (1) was in bed 7B with both [ull length t rails up in full position; h. No resident was in bed 7A at said time, however one side rail was up and one was down. 41. That the Petitioner’s reviewed Respondent’s records regarding the resident’s who utilized beds 7A and 7B and could locate no physician's order for the use of full length side rails, no consents fro residents or their representat{ves, or that the resident's Hospice plans of care tacntioned side rails to be i use by the Hospice staff. 42 That the Petitioner’s representative interviewed the Hospice nurse on J’ebruary 25, 2008 who indicated as follows: a. That she came in mosty every day; b. That she did not stay usually over two hours; 1d OT sbed 00000-000-000 ONIAIT GHLSISSY LESUMWOS dTT:TO Zzoz‘LT Nor c. That facility staff placcll the resident in the Cierichair and then puts the resident back to bed after meals. 43. That the Petitioner's representative noted that Respondent had been cited for the use of Gerichairs, lap trays, and lap buddies as ptohibited restraints during a survey of June 13, 2007. 44. That the use of restraints, with limjted exceptions, is prohibited in assisted living facilities. Residents are in imminent al where restraints are utilized without the protections of a physician’s oversight and or where the use of the restraint is not supervised by persons who are trained in the proper use, the associated risks, and appropriately qualified to supervise residents who arc under restraint. Risks of physical injury or death are inherent in the use of restraints and where trained persons are not supervising the application and continuing use of such devices, resident well being is at imminent risk. 45. That the Agency determined that the above constitutes grounds for the imposition of a Class I deficiency in that it presents an imminent danger to the residents or guests of the facilily or a substantial probability that death or serious physical or emotional harm would result therefore. 46. Vhat the Agency cited the Responilent for a Class I violation in accordance with Section 429.19(2)(a), Florida Statutes (2007). WHEREFORE, the Agency intends to impose an administrative fine in the amount of $5,000.00 against Respondent, an el living facility in the State of Florida, pursuant to § 429.19(2)(a), Florida Statutes (2007). COUNT III 47. The Agency re-alleges and incorpprates paragraphs (1) through (5) as if fully set forth herein. IT ebed 00000-000-000 ONIAIT GHLSISSY LYSYMWOS. dTT:TO 7@zoz‘LT Noe 48 That pursuant to Florida law, any facility intending to provide limited nursing services as described in subsection (1) must meet thellicense requirements specified in Section 429.07, F.S., and obtain a license from the Agency in apcordance with Rule 58A-5.014, F.A.C. NURSING SERVICES - A facility with a limited nursing license may provide the following nursing, services in addition to any nursing servicg permitted under a standard license pursuant to Section 429,255, E.S. - (a) Conducting passive rave of motion exercises; (b) Applying ice caps or collars; (c) Applying heat, including dry Heut, hot water bottle, heating pad, aquathermia, moist heat, hot compresses, sitz bath and hot soaks; (d) Cutting the toenails of diabetic residents or residents with a documented circulatory troblem if the written approval of the resident’s health care provider has been obtained; (e) Performing car and eye irrigations; (f) Conducting a urine dipstick test; (g) Replacement of an established self-maintained indwelling urinary catheter, or performance of an intermittent urinary catheterizations; (h) Performing digital stool removal therapies; (i) Applying and changing routine dressings that do not require packing or irrigation, but are for abrasions, skin tears and closed surgical wounds; (j) Care for stage 2 pressure sores. Care for stage 3 or 4 pressure sores are ngt permitted under this rule; (k) Caring for casts, braces and splints. Care for head braces, such as|a halo is not permitted under this rule, (1) Conduct nursing assessments if conducted by a registered nurse or under the direct supervision of a registered nurse; (m) For hospice patient, providing any nursing service permitted within the scope of the nurse’s license including 24-hour nursing supervision; (n) Assisting, applying, caring for and monitoring the application| of anti-embolism stockings or hosiery as prescribed by the health care provider and in accordance with the manufacturers’ guidelines; (0) Administration and regulation of portable oxygen; (p) Applying, caring for and monitoring a transcutaneous electric nerve stimulator (TENS); (q) Catheter, colostomy, ileostomy care and maintenance. Rule 58A-5.031(1), Florida Administrative Code. Zt abed 00000-000-000 ONIAIT GHLSISSY LYSHMWOS dIT:TO 220Z‘T Nor 49. That on February 25-26, 2008, the| Agency conducted an unannounced Biennial Licensure Survey of the Respondent facility. 50. That based upon observation, the review of records, and interview, Respondent failed to provide care and services covered under the facility's Limited Nursing Services (LNS) licensure for resident number one (1) by a nurse, the same being contrary to law. ‘The failure to ensure that qualified persons provide care and services covered under LNS licensure has the potential for a resident's condition to deteriorate withoutjadequale assessment, care, and intervention. Sl. That the Petitioner’s representative observed resident number one (1) during a tour of the facility on February 25, 2008 at 10:30 AM and nated as follows: a. The resident was in bed with full length side rails up; b. A [ospice Registered Nurse was in attendance completing a physical exam; c. There was an oxygen concentrator in the bathroom for this resident; d, There was also a Gerichair on this resident's side of the room. 52. That the Pctitioncr’s representative interviewed the Hospice nurse on I’ebruary 25, 2008 who indicated that she came in mostly every day and did not stay usually over two hours. 53. That the Petitioner’s representative reviewed Respondent’s records regarding resident number one (1) and noted as follows: a. That the resident was admitted to the facility on March 24, 2003; b. That the resident was placed on Hospice care on June 7, 2004; c. That the resident record recites that the resident has "blister like eruptions" in bilateral axilla and buttocks; d. That there is a treatment being performed by the facility staff daily of “[libiclens wash to bildteral axilla and buttocks" and in parentheses it states, “done by [Certified Nursing Assistants}". 13 €T ebed 00000-000-000 ONIAIT (a1SISSY LHSUMWOS dZT:To zZzoz‘LT Nar 54, That the application of a Hibiclets wash, and antibiotic wound cleans} ng. on tle : mL resident's open flesh areas is a nursing service to be provided by licensed perso. el within the parameters of Respondent’s limited nursing services licensure. See, Rule 58A-£.031(1}(i) and it (m), Florida Administrative Code The failure to admit the resident to said services, and to provide nursing care by qualified staff who may assess, treat, and provide nursing interventions, place the resident at risk for deficient or tmiproper care and services, 55. That the Petitioner's representative reviewed respondents Limited Nursing Services (LNS) log and noted that resident numbck one (1) was not listed as receiving limited nursing services, 56, That thé Petitioner’s representative interviewed Respondent's Administrator who indicated that she was not aware that Hogpice residents should also be on limited nursing services. 57. That where nursing services are required to be provided to a resident, said services must be provided by a licensed professional. 58, That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 59. That the Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2007), WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of lorida, pursuant to § 429.19(2)(b), Florida Statutes (2007). 14 v1 obed 00000-000-000 ONIAI' CULSISSY LHSHEWOS dZT?To 7z0z‘LT Nar COUNT IV 60. The Agency re-alleges and incorpdrates paragraphs (1) through (5) as if fully set forth herein. 61. That pursuant to Flotida law, a facjlity administrator shall be in compliance with Level 2 background screening standards pursuant to Section 429.174, FS. Rule 58A-5.019(1)9a)(3), Florida Administrative Code. See also, Section 429.174(1), Florida Statutes (2007). 62. That on February 25-26, 2008, the|Agency conducted an unannounced Biennial Licensure Survey of the Respondent facility. 63. That based upon the review of recprds and interview, Respondent's administrator failed to obtain a complete a level IT background screening, the same being contrary to the provisions of law. 64. That Petitioner’s representative reyiewed the personnel files of Respondent's administrator during the survey and could) locate no evidence of a compicted {evel Hi background screening. 65. That Petitioner’s representative interviewed Respondent's administrator during the survey who indicated that she had bei the request for the Jevel II screening, but had not received results. 66. That the legislature has determined that the public interest in protecting its citizenry from harm requires that persons who have certain convictions be prohibited employment which involves client contact. Inherent therein is the conclusion that the same presents a risk of harm to this vulnerable community. The failure t obtain Level I] criminal background check of the Respondent's administrator places residents at risk that persons in whom their care has been entrusted may be persons who, absent ex¢mption, are prohibited from providing such care and increases the risk that residents may be subject to abuse, neglect, or exploilation. 15 ST ebed 00000-000-000 ONTAIT GHISISSY LESHWOS dzT:TO e2zoz‘Lt Nar 67. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the hehlth, safety, or security of the resident and cited Respondent for a State Class II setae 68. That the Agency cited the Respondent for a Class II violation in accordance with Section 429.19(2)(b), Florida Statutes (2007). WHEREFORE, the Agency intnds to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.39(2)(b), Florida Statutes (2007). COUNT V 69. The Agency re-alleges and incorpprates patagraphs (1) through (5) as if fully set forth herein, 70, ‘That pursuant to Hlorida law, Facifity records shall include... the admission package presented to new or prospective residents|(less the resident's contract) described in Rule 58A- 5.0182, .A.C. Rule 58A-5.024(1)(i), Florida Administralive Code. The facility shal] make available to potential residents a written statement(s) which includes the following information listed below. A copy of the facility resideht contract or facility brochure containing all the required information shall meet this vdone 1. The facility’s residency criteria; 2. The daily, weekly or monthly charge to residg in the facility and the services, supplies, and accommodations provide by the facility for that rate; 3. Personal care services that the facility is prepared to provide to residents and additional costs to the resident, if any; 4. Nursing services that the facility is prepared to provide to tesidents and additional costs to the resident, if any; 5. Food service and the ability of the facility to accommodate special diets; 6. The availability of transportation and additional costs to the resident, if any; 7. Any other special services that are provided by the facility and additional cost ifany; 8. Social and leisure activities generally 16 gt ebed 00000-000-000 ONIATI (HLSISSY IHSHWOS dZT:10 2z0z‘LT Nor offered by the facility; 9. Any services nd the facility does not provide but will arrange for the resident and additional cost, if any; 10, A btatement of facility rules and regulations that residents must follow as described in Rule 58A-5.0182, F.A.C.; 11. A statement of the facility policy concerning Do Not Resuscitate Orders putsuant to Section 429.255, F.S., and Advance Directives pursuant to Chapter 765, F.S.; {2. If the facility also has an extended congregate care program, the ECC program's residency cyteria; and a description of the additional personal, supportive, and nursing services provided|by the program; additional costs; and any limilations, if any, on where ECC residents must vse based on the policies and procedures described in Rule 58A-5.030, F.A.C.; 13. If the facility advertises that it provides special care for persons with Alzheimer’s disease and rclated le ers, a written description of those special services as required under Section 429.177, F.S.; and|14. A copy of the facility’s resident elopement response policies and procedures. Prior to or at the time of admission the resident, responsible parly, guardian, or attomey in fact, if applicable, shal! be provided with the following: 1. A copy of the resident’s contract which meets the requirements of Rule 58A-5.025, ¥.A.C.; 2. A copy of the facility statcment described in paragraph (a) if one has not already been provided; 3. A copy of the resident's bill of rights as required by Rule 58A-5.0182, F.A.C.; and 4. A Long-Term Care Ombudsman Council brochure which includes the telephone number and address of the district council. (c) Documents required by this subsection shall be in Linglish. If the resident is not able to read, or does not understand English and translated documents are not available, the facility must explain its policies to a family member or friend of the resident or another individual who can communicate the information to the resident. Rule 58A-5.0181(3), Florida Administrative Code. Tt. — That on June 13-14, 2007, the Agency conducted two unannounced Complaint Surveys (CCR# 2007005110 & CCR# 2007006044) of the Respondent facility. LT ebed 00000-000-000 SNIAIT GHLSISSY ISSHHWOS dZT:TO zzoz‘Lt Nor QT obed 72. That based upon the review of records and interview, Respondent failed to ensure that the admission package contained the cost of shpplies provided by the facility but not covered in resident's contract rate. 73. That Petitioner’s representative reviewed Respondent’s Admission Package during the survey and noted that it contained a form fontaining the following information: "Somerset has my permission to ppirchase requested or necessary items for (Residents name), Such charges will appear on the ot statement. Name Date Please sign and retum with this months payment.” 74. ‘That absent from the Respondent’ admission package was any documentation regarding the costs of these "necessary items”. 75. That the Petitioner's al interviewed Respondent’s administrator during the survey who confirmed that the Respondent facility does not provide a list of the cost of supplies not covered by the contracted charge, such as gloves, incontinence briefs/pads, and wipes, to residents and or resident representatives, 76. That the failure to list the cost for ts in the residents! contract may result in financial distress if the resident is unable 77. That the Agency determined that pay for the supplies utilized. ig deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a State Class i deficiency. 78. That the Agency cited the sees for a Class I] violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 79, That the Agency provided a mandated correction date of July 14, 2007. 18 00000-000-000 SNIATT GHISISSY LASUSNOS dZT: To ezoz‘LT Nor 80. That during a re-visit survey conducted August 9, 2007 the Agency determined that the Respondent had corrected the deficiency. 81. That on February 25-26, 2008, th Agency conducted an unannounced Biennial Licensure Survey of the Respondent facility. 82. That based upon the review of rechrds and interview, Respondent failed to ensure a complete admission package for prospective and new residents was provided as required by law. 83. That the Petitioner’s representative reviewed Respondent’s admission packet during the survey and noted that the packet failed le, any evidence or information regarding Resident Rights, and The Long Term Care Ombudsman Council information as required by Jaw. 84, That the Petitioner’s representative interviewed Respondent's administrator during the survey who noted that she was not aware the information was not in the admission package. 85, ‘That the failure to have an admisston packet with all required components bas the potential for residents to be uninformed of their rights or how to access help in case of abuse, exploitation, or neglect. 86. That the Agency determined that this deficient practice was related to the personal care of the resident that indircctly or potentially threatened the health, safety, or security of the resident and cited Respondent for a repeat State Cllass II deficiency. 87. That the Agency cited the Respondent for a repeat Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2907). 88. That this constitutes a repeat violation as provided by law. WHEREFORE, the Agency intends to impose an administrative fine in the amount ot five hundred dollars ($500.00), against Respondent, an assisted living facility in the State of Florida, pursuant to Section 429.19(2)(c), Florida Statutes (2007). (9 61 ebed 00000-000-000 ONIAIT GHLSISSY LYSumWOS deT:TO ZzOZ‘LT Nar COUNT VI 89. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 90. That pursuant to Florida law, no resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges cant by law, the Constitution of the State of Florida, or the Constitution of the United States as a fesident of the facility. Every resident ofa facility shall have a right to, inter alia, live in a safe and decent living environment, free from abuse and neglect, and be treated with consideration] and respect and with due recognition of personal dignity, individuality, and the need for privacy. §429.28(1), Florida Statutes (2007). 91. That on June 13-14, 2007, the Agdncy conducted two unannounced Complaint Surveys (CCR# 2007005110 & CCR# 2007006054) of the Respondent facility. 92. That based upon observation, Respondent failed to ensure privacy and dignity were maintained for residents being scen by a im the same being contrary to law. . 93. That the Petitioner's representativp observed the following on June 14, 2007 at 1:15 PM in the Respondent facility: a. That nine (9) facility résidents were in a line along the hallway leading to the open door of the facility’s activity room; b. Within the activity t was a resident, the resident's fect up on a chair being provided foot care by 4 doctor of podiatry; c. The podiatrist was clipping and grinding the resident's tocnails in full view of other residents, staff, and visitors passing in the hallway. 94. That Respondent failed to ensure that resident privacy is protected potentially effecting resident dignity and potentially affecting {he residents’ ability to achieve their highest practical physical, mental, and psychosocial wellb¢ing. 20 oz ebed 00000-000-000 ONTATT CaISISSY LESWHWOS d€T‘TO Zzoz‘iT Nar 95. ‘That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatencd the health, safety, or security af the resident and cited Respondent for a State Class [I|deficiency. 96. ‘That the Agency cited the Respon#ent for a Class II] violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 97. That the Agency provided a mandated correction date of July 14, 2007. 98. That during a re-visit survey condiicted August 9, 2007 the Agency determined that the Respondent had corrected the deficiency. 99, That on February 25-26, 2008, the Agency conducted an unannounced Biennial Licensure Survey of the Respondent facility. 100. That based upon the review of reeprds and interview, Respondent failed to ensure that eight (8) of eight (8) sampled resident contracts contained a 45 day relocation or termination of residency clause, the same being contrary|to law. 101. That the Petitioner's representative reviewed eight (8) resident contracts during the survey and could locate no written criteria for a time frame for discharging residents as tequired by law. 102. That the Petitioner’s Tepresentative interviewed Respondent's administrator who indicated that she was unable to produce documentation of discharge criteria and was unaware that the residents are to receive a forty-five (45) day notice prior to discharge or relocation. 103. That the failure to ensure that vihou receive notice of the statutory time for relocation upon discharge by the facility may place fesidents at risk for discharge absent placement or without sufficient time to permit the resident and or the resident's representative sufficient time to obtain the most appropriate chosen platement option. 104, That the Agency determined that this deficient practice was related to the personal care of 21 Tz obed 00000-000-000 ONIAI'I GHLSISSY LYSWHNOS deT+TO 2z02’LT NAC the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a repeat State Class IH deficiency. 105. That the Agency cited the Respondent for a repeat Class 11] violation in accordance with Section 42.19(2)(c), Florida Statutes (2007). 106. That this constitutes a repeat violation as provided by law. WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against R¢spondent, an assisted living facility in the State of Florida, pursuant to Section 429,19(2)(c), Florida Statutes (2007). COUNT Vil 107. The Agency re-alleges and coma paragraphs (1) through (5) as if fully set forth herein. 108. That pursuant to Florida law, all resident bedrooms shall be for the exclusive use of residents. Live-in staff and their family members shall be provided with sleeping space separate from the sleeping and congregate space i for residents. Rule 58A-5.023(4)(f), Florida Administrative Code. 109. That on September 19, 2007, the Agency conducted two unannounced Complaint Surveys (CCR# 2007010143 & CCR# 2007010146) of the Respondent facility, 110. That based upon observation and interview, Respondent failed to separate the living space of the staff and their family from the living space of the residents, thc same being in violation of law. 111. That Petitioner’s representative toed the Respondent facility on September 19, 2007 from 10:30 AM until 11:30 AM and vad that the administrator's father was sitting at a dining room table drinking coffee 22 zz ebed 00000-000-000 ONTAIT GUISISSY INSHHWOS deT:TO 220Z7LT NAP 112. That the Petitioner's representative interviewed Respondent’s administrator during the survey who indicated as follows: a. That her father docs stay at the facility in room number three (3); bh. That he is one of the ovners of the facility and is therefore staff c. That he has been ill and does need assistance with daily activitics of living, which would make him| an appropriate resident; d. ‘hat his care has been given by the administrator herself rather than staff. 113. That the administrator’s father is npt maintained by the Respondent as a resident of the facility. 114. ‘Uhat the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a State Class III deficiency. 115. That the Agency cited the Respondent for a Class II] violation in accordance with Section 429.19(2)(c), Morida Statutes (2007). 116. That the Agency provided a mandated correction date of October 19, 2007. 117. That during a re-visit survey conducted November 1, 2007 the Agency determined that the Respondent had corrected the vl, 118. That on February 25-26, 2008, the/Agency conducted an unannounced Biennial Licensure Survey of the Respondent facility. 119. That based upon observation and ihterview, Respondent failed to separate the living space of the staff and their family trom th¢ living space of the residents, the same being in violation of law. Jailure to use licensed beds exclusively for residents is not in compliance with state regulatory requirements. €z ebed 00000-000-000 ONIAIT GHLSISSY LUSWHWOS dEeT:TO 72Z0Z‘LT Nor pz ebed 120. 121, indicated that a parcnt of the administrato| That the Petitioner’s representativ: That the Pctitioner’s representative noted during the initial tour of the facility that a family member of the administrator was in in resident room number three (3). interviewed Respondent’s administrator who is residing in room number three (3) which is a licensed assisted living facility bed of thelfacility and the parent is not a resident at the facility and that family members assist the fami] 122. meimbers with needs. ‘That the respondent is utilizing resident space for the care and services to a relative of the administrator, the same potentially depriving residents of the benefits of the facility including, but not limited to, staff meeting resident feeds, scheduled and unscheduled. 123, That the Agency determined that this deficient practice was related to the persoual care of the resident that indirectly or potentially Ce the health, safety, or security of the resident and cited Respondent for a repeat State 124. 125. That this constitutes a repeat viol: Section 429.19(2)(c), Florida Statutes “hes lass II deficiency. ‘That the Agency cited the Responfent for a repeat Class Il] violation in accordance with tion as provided by law. WHEREFORI, the Ageney intenHs to impose an administrative fine in the amount of five hundred dollars ($500.00), against Florida, pursuant to Section 429. 19(2)(c) spondent, an assisted living facility in the State of Florida Statutes (2007). COUNT VII 126. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and the 127. That the Agency may revoke any, remainder of this Complaint as if fully T herein. license issued under Part I of Chapter 429 Florida Statutes (2007) for the citation of one (1 J or more cited Class I deficiencies, three (3) or more cited Class LI deficiencies, or five (5) or fnore cited Class IL deficiencies that have been cited on 24 00000-000-000 ONIAT'T CHLSISSY LASHMWOS deT?TO @20Z‘LT Nor a single survey and have not been ai within the specified time period. Section 429.14(] e) Florida Statutes (2007). 128. That the Respondent has been cited with two (2) Class I deficiencies, two (2) Class fl deficiencies, and three (3) repeat or “| ected Class III deficiencies on an Agency complaint survey completed l’ebruary 26, 2008. 129. That based thereon, the Agency seks the revocation of the Respondent's licensure WHEREFORE, the Agency intends to revoke the Jicense of the Respondent to operate an assisted living facility in the State of Mor(da, pursuant to §§ 408,815(1) and 429.14(1)(c), Florida Statutes (2007). Z Respectfully submitted this “__ day of June, 2008. Counsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FJ. 33701 727.552.1525 Respondent is notified that it has a right fo request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent his the right to retain, and be represented by an attorney in this matter, Specific options for administrative action are sct out in the attached Election of Rights. All requests for hearing shall be made| to the Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg 43,MS #3, Tallahassee, FL 32308;Telepltone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. USS. Certified Mail, Return Receipt No. 4007 1490 0001 6979 0970 on June 2008 to \ Gz obed 00000~-000-000 ONIATI'I (HISISSY LHSHBWOS deT:TO @Z0z‘LT Nor L HEREBY CERTIFY that a truc and correct copy of the foregoing aa by ameea? Elizabeth Heiman, Administrator, se 2450 Dora Avenue, Tavares, *L 32778 Mail to James F. Heiman, Registered Agent, 4520 SW. 624 Court, Miami, FL 33185. \ MP, \ Thémas J, Walsh Tl Senior Attorney Copies furnished to: Elizabeth Heiman, Administrator ——(|[James F. Heiman Somerset Registered Agent 2450 Dora Avenue 4520 S,W. 62™ Court Tavares, Florida 32778 Miami, Florida 33155-5935 (U.S. Certified Mail) (US. Mail) fAnmLopez SS Thomas J. Walsh II ~ Field Office Manager Agency for Health Care Admin. 14101 NW Hwy 441, Suite #800 525 Mirror Lake Drive, 330G Alachua, FL 32615 St. Petersburg, Florida 33701 (U.S. Mail) (Unteroffice) 26 92 ebed 00000-000-000 ONIAI' ASLSISSY INSYSWOS dhT*TO zzOz‘LT Nar

Docket for Case No: 09-000199