......--.. ------------------.........-. .,•,,.,.,.,,, , _ ._ llliiilili _
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
Ir,f"-!•,' [ w,'·-L0""'
A l-IC/\
AG E NCY CLERK
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
Petitioner,
S F GROUP INCORPORATED, d/b/a S F WATSON ALF,
Respondent.
zooq Nov - s P 2: ti3
AHCA No: 2009003379
DOAH No: 09-2996
AHCA No: 2009004648
RENDITION NO.: AHCA-09- t II -5-OLC
FINAL ORDER
Having reviewed. the administrative complaints ( #2009003379 dated May 13, 2009, and #2009004648, dated June 15, 2009) attached hereto and incorporated herein (Ex. 1 and 1A), and all other matters of record, the Agency for Health Care Administration ("Agency") has entered into a Settlement Agreement (Ex. 2) with the other party to these proceedings, and being otherwise well-advised ·in the premises, finds and concludes as follows:
The attached Settlement Agreement is approved and adopted as part of this Final Order , and the parties are directed to comply with the terms of the Settlement Agreement.
Respondent shall pay an administrative fine in the amount of
$4,750.00. The administrative fines are due and payable within thirty (30) days of the date of rendition of this Order.
Checks should be made payable to the "Agency for Health Care Administration." The check, along with a reference to these case numbers, should be sent directly to:
Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit
2727 Mahan Drive, MS# 14
Tallahassee, Florida 32308
Filed November 9, 2009 12:04 PM Division of Administrative Hearings.
Unpaid amounts pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available.
Respondent's petition for formal administrative proceedings is hereby dismissed.
Each party shall bear its own costs and attorney's fees.
The above-styled cases are hereby closed.
DONE and ORDERED th is -4-day of---=-- -=------=-- , 2t0r,in Tallahassee, Leon County, Florida.
...&..l.l;i.us o , Secretary
............u._......,ealth Care Administration
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.
Copies furnished to:
Syble F. Watson, Owner
S F Watson Group Incorporated d/b/a S F Watson ALF
2646 Taylor Street
Hollywood, Florida 33020 (U. S. Mail)
Finance & Accounting Agency for Health Care Administration
Revenue Management Unit 2727 Mahan Drive, MS #14
Tallahassee, Florida 32308 (Interoffice Mail)
Tria Lawton-Russell Assistant General Counsel Agency for Health Care Administration
8350 NW 52nd Terrace, 5-103
Miami, Florida 33166 (Interoffice Mail)
June C. McKinney Administrative Law Judge
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060 (U.S. Mail)
Jan Mills
Agency for Health Care Administration
2727 Mahan Drive, Bldg #3, MS #3
Tallahassee, Florida 32308 (Interoffice Mail)
Assisted Living Unit Agency for Health Care Administration
2727 Mahan Drive, MS #30
Tallahassee, Florida 32308 (Interoffice Mail)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of this Final Order was
served on the above-named person(s) and entities by U.S. Mail, or the method designated, on this the day of /½ , 20.QZ'
-
Richard Shoop, Agency Clerk
Agency for Health Care Administration 2727 Mahan Drive, Building #3
Tallahassee, Florida 32308-5403
(850) 922-5873
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTBATION
AGENCY FOR HEALTH CARE ADMINISTRATION,
Petitioner,
v.
SF WATSON GROUP INCORPORATED d/b/a SF WATSON ALF,
Respondent.
I
AHCA No.: 2009003379
Return Receipt Requested:.
7008 0500 0002 0764 7547
7008 0500 0002· 0764 7554
ADMINISTRATIVE COMPLAINT
COMES NOW the Agency for Health Care Administration ("AHCA"), by and through the undersigned counsel, and files this Administrative Complaint against S F Watson Group Incorporated, d/b/a S F Watson ALF (hereinafter "S F Watson ALF"), pursuant to Chapter 429, Part I, and Section 120.60, Florid Statutes, {2008), and alleges:
NATURE OF THE ACTION
This is an action to impose an administrative fine of
$3,500.00 pursuant to Section 429.19, Florida Statutes (2008), for the protection of the public health, safety and welfare pursuant to Section 429.28{3)(c), Florida Statutes (2008).
JURISDICTION AND VENUE
This Court has jurisdiction pursuant to Sections
120.569 and 120.57, Florida Statutes, and ·28-106, Florida Administrative Code.
EXHIBIT
I d.
Venue lies pursuant to Rule 28-106.207, Florida Administrative Code.
P.A.RTIES
AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2008), and Chapter 58A-5, Florida Administrative Code.
S F Watson ALF operates a 4-bed assisted living facility located at 2646 Taylor Street, Hollywood, Florida 33020. S F Watson ALF is licensed as an assisted living facility license number AL10632 with an expiration date of May 9, 2009. S F Watson ALF was at all times material hereto a
.licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes.
COUNT I
SF WATSON ALF FAILED TO ENSURE THAT THEY HAVE DOCUMENTATION AVAILABLE OF A CURRENT ANNUAL FIRE INSPECTION CONDUCTED BY THE LOCAL FIRE MARSHAL
Section 429.41(1) (a)l.m., Florida Statutes (2008), and/or Rule SSA-5.015(1) (a)3., Florida Administrative Code (FACILITY RECORDS STANDARDS)
REPEATED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the full re-licensure survey conducted on 01/11/07 and based on record review and interview, it was
determined that the facility failed to ensure that they have documentation available of a current annual fire inspection conducted by the local fire marshal.
_During the facility records portion of the survey conducted on 01/11/2007 at approximately 10 AM, it was noted that the only available documentation of a facility fire inspection was dated 10/17/2005. The Administrator was interviewed on the day of the survey at approximately 2 PM and after investigation, confirmed the findings.
During the biennial licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide documentation of a current fire inspection conducted by the local authorities on an annual
·basis, as required.
During an interview, conducted on 02/06/09 at approximately 10:00 AM, it was reported that documentation of an annual fire inspection was unavailable for review, as required. The Administrator acknowledged the findings. This is a repeat deficiency from the survey of 01/11/07.
Based on the foregoing, S F Watson ALF violated Section 429.41(1)(a)l.m., Florida Statutes (2008), and/or Rule SBA-5.015(1)(a)3., Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT II
SF WATSON ALF FAILED TO ENSURE THAT THEY CONDUCT A MINIMUM OF TWO RESIDENT ELOPEMENT PREVENTION RESPONSE DRILLS PER YEAR
Sections 429.41(1) (a)3., 429.41(1} (1), Florida Statutes (2008}, and/or Rule 58A-5.182(8) (c), Florida Administrative Code (2008) (FACILITY RECORDS STANDARDS}
REPEATED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the full re-licensure survey conducted on 01/11/07 and based on record review and interview, it was determined that the facility failed to ensure that they conduct a minimum of two resident elopement prevention and response drills per year.
During the facility records portion of the survey conducted on 01/11/2007 at approximately 10 AM, it was noted that there was no documentation made available of any resident elopement prevention and response drills. The Administrator was interviewed on the day of the survey at approximately 2 PM and after investigation, confirmed the findings.
During the biennial survey conducted oh 02/06/09 and based on record review and interview, it was determined that the facility failed to provide documentation of 2 (two) resident elopement prevention and response drills, conducted within the last year.
During a review of the facility's records, it was noted that the the files lacked documentation of 2 (two)
resident elopement prevention and response drill conducted within the last year, as required.
During an interview, conducted on 02/06/09 at approximately 10:00 AM, the Administrator acknowledged the findings. This is a repeat deficiency from the full survey of
01/11/07.
Based on the foregoing, S F Watson ALF violated Sections 429.41(1)(a)3., 429.41(1)(1), Florida Statutes· (2008), and/or Rule 58A-5.0182(8)(c), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT III
SF. WATSON ALF FAILED TO ENSURE THAT ALL STAFF MEMBERS' PERSONNEL RECORDS CONTAIN A COPY OF THE ORIGINAL EMPLOYMENT APPLICATION WITH REFERENCES
Section 429.275(4), Florida Statutes (2008), and/or Rule SSA-5.024(2)(a), Florida Administrative Code (2008)
(STAFF RECORDS STANDARDS) REPEATED CLASS III VIOLATION
AHCA re-alleges and incorporates that paragr·aphs (1)
through (5) as if full set forth herein.
During the full re-licensure survey conducted on 01/11/07 and based on record review and interview, it was determined that the facility failed to ensure that one out of three staff member's personnel record contains a copy of the original employment application with references (employee #2).
. During the Staff Records Standards portion of the survey on 01/11/2007 at approximately 10 AM, it was noted that one employee record reviewed did not have references. The Administrator was interviewed on the day of the survey at approximately 2 PM, and after investigation, confirmed the findings.
During the survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide a copy of the employment application with references for 2 out of 2 sampled employees (Employee #'s 1 and 2).
During an interview with the Administrator on 02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review including documentation of an employment application, with references, for employees #1 and #2, as required. The Administrator acknowledged the findings. This is
a repeat deficiency from the 01/11/07 survey.
Based on the foregoing, S F Watson ALF violated Section 429.275(4), Florida Statutes (2008), and/or Rule 58A- 5.024(2)(a), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of
$500.00.
COUNT IV
SF WATSON ALF FAILED TO PROVIDE A STATEMENT FOR EACH STAFF MEMBER INDICATING THAT HE/SHE DOES HAVE TUBERCULOSIS
Rule SSA-5.019{2} (a), Florida Administrative Code (2008)
{STAFF RECORDS STANDARDS)
REPEATED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the full re-licensure survey conducted on 01/11/07 and based on record review and interview, it was determined that the facility failed to ensure that three out of three staff members are free from tuberculosis, documented on an annual basis (employees #1, #2 and #3).
During the Staff Records portion of the survey conducted on 01/11/2007 at approximately 10 AM, it was noted that one staff record examined (employee #1) does not contain valid documentation of the staff member's current tuberculosis (hereinafter "TB") status. The documentation available has expired. Two staff records examined had no documentation of TB
status (employees #2 and #3). The Administrator was
interviewed on the day of the survey at approximately 2 PM, and after investigation, confirmed the findings.
During the survey conducted on 2/06/09 and based on interview,. it was determined that the facility failed to provide verification of freedom from tuberculosis documented on an annual basis, for two out of two sampled employees (#1 and #2).
During an interview with the Administrator on 02/06/09 at approximately 10: 00 AM, it was reported that the facility's personnel records were not on the premises and
unavailable for review including verification of freedom from tuberculosis documented on an annual basis, for employees #1 and #2, as required. The Administrator acknowledged the findings. This is a repeat deficiency from the 01/11/07
survey.
Based on the foregoing, SF Watson ALF violated Rule 58A-5.019(2) (a), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT V
S F WATSON ALF FAILED TO ENSURE THAT ALL EMPLOYEES RECEIVE HIV AND AIDS TRAINING WITH UPDATES BIENNIALLY
Section 429.275(2), Florida Statutes (2008), and/or Rules 58A- 5.0191(3), 58A-5.024(2) (a)l., and 58A-5.0191(11), Florida
Administrative Code
(STAFF RECORDS STANDARDS)
REPEATED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs· (1) through (5) as if fully set forth herein.
During the full licensure survey. conducted on 01/11/07 and based on record review and interview, it was determined that the facility failed to ensure that all employees receive HIV and AIDS training with updates biennially for one out of three employee records reviewed (Employee #3).
During the Staff Records Standards portion of the survey conducted on 01/11/2007 at appr·oximately 10 AM, it was noted that one employee record reviewed did not contain valid
documentation of update education in HIV/AIDS training. The only documentation made available was dated in 2003.
The Administrator was interviewed on the day of the survey at approximately 2 PM and after investigation, confirmed the findings.
During the full survey conducted on 02/06/09 and based on interview, it was determined that the facility,fa led to provide verification of initial and/or biennial training courses on HIV and AIDS, for two out of two· sampled employees
( # 1 and #2).
During an interview with the Administrator on 02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review including verification of initial and/or biennial training courses on HIV and AIDS, for employees #1 and #2, as required. The Administrator acknowledged the findings. This is a repeat deficiency from the 01/11/07 survey.
Based on the foregoing, S F Watson ALF violated Section 429.275(2), Florida Statutes (2008), and/or Rules 58A- 5.0191(3), 58A-5.024(2)(a)1., and 58A-5.0191(11), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT VI
SF WATSON ALF FAILED TO PROVIDE VERIFICATION OF CURRENT CERTIFICATION IN AN APPROVED FIRST AID AND CPR COURSE FOR SOME EMPLOYEES
Section 429.275(2), Florida Statutes (2008), and/or Rules 58A-5.024(2)(a)l., and SBA-5.0191(4), Florida Administrative Code
(STAFF RECORDS STANDARDS) REPEATED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) and is fully set forth herein.
During the full survey conducted on 01/11/07 and based on record review and interview, it was determined that the facility failed to ensure that personnel records contain documentation of current certification in approved First Aid & CPR courses for two out of three records reviewed (Residents #2 & 3) •
During the Staff Records Standards portion of the survey conducted on 01/11/2007 at approximately 10 AM, it was noted that in two employee records examined (employees #2 & 3), there was no documentation made available of current valid certification in First Aid and CPR. The employees without the current First Aid and CPR documentation are left in charge of the residents. The Administrator was interviewed on the day of the survey at approximately 2 PM and after investigation, confirmed the findings.
During the full survey conducted on 02/06/09 and Based on interview, the facility failed to provide verification
of current certification in an approved First Aid and CPR course for two out of two sampled employees (Employee #'s 1 and 2) •
During an interview with the Administrator on 02/06/09· at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review including verification of current certification in an approved First Aid and CPR for Employee #'s
and 2, as require . The Administrator acknowledged the findings. This is a repeat deficiency from the 01/11/07 survey.
Based on the foregoing, S F Watson ALF violated Section 429.275(2), Florida Statutes (2008), and/or Rules 58A- 5.024(2)(a)l., and 58A-5.0191(4), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT VII
SF WATSON ALF FAILED TO PROVIDE VERIFICATION OF COMPLIANCE WITH BACKGROUND SCREENING REQUIREMENTS FOR SO:t-.'IE EMPLOYEES
Section 429.275(2), Florida Statutes (2008), and/or Rules SSA- 5.019(3), and SBA-5.024(2) (a)3., Florida Administrative Code.
(STAFF RECORDS STANDARDS) REPEATED CLASS III VIOLATION
AHCA re-alleges and incorporates·paragraphs (1) through (5) as if fully set forth herein.
During the full licensure survey conducted on 01/11/07 and based on record review and interview, it was
determined that the facility failed to ensure that all
employees subject to screening requirements background screening documentation for one
have level 1 out of three
applicable staff members' files reviewed (employee #2).
During the Staff Records Standards portion of the survey conducted on 01/11/2007 at approximately 10 AM, it was noted that 1 staff record reviewed did not have appropriate documentation of compliance with level 1 background screening through the Florida Department of Law Enforcement (FDLE). The employee noted without background screening documentation was hired after 10/01/1998. The Administrator was interviewed on the day of the survey at approximately 2 PM and after investigation, confirmed the findings.
During the survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide verification of compliance with the background screening requirements for two out of two sampled employees (Employee #'s 1 and 2).
During an interview with the Administrator on 02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review including verification of compliance with background screening requirements for employees #1 and #2, as required. The Administrator acknowledged the findings. This
is a repeat deficiency from the 01/11/07 survey.
Based on the foregoing, S F Watson ALF violated Section 429.275(2), Florida Statutes (2008), and/or Rules SBA- 5.019(3), and SBA-5.024(2)(a)3., Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00
PRAYER FOR RELIEF
WHEREFORE, the . Petitioner, State of Florida Agency for Health Care Administration requests the following relief:
Make factual and legal findings in favor of the
Agency on Counts I through VII.
Assess an administrative fine of $3,500.00 against S F Watson ALF on Counts I through VII pursuant to Section 429.19, Florida Statutes.
Grant such other relief as this Court dee·ms is just andproper.
Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2008). Specific options for administrative action are set out in·the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency £or Health Care Administration, 2727 Mahan Drive, Mail Stop #3,
Ta1lahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873.
RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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.
IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN
ia on-Russell Assistant General Counsel Agency for Health Care Administration
8350 N. W. 52 Terrace
Suite 103
Miami, Florida 33166
Copies furnished to: Field Office Manager
Agency for Health Care Administration
5050 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (Inter-office mail)
Finance and Accounting Revenue and Management Unit
Agency for Health Care Administration
2727 Mahan Drive, MS #14
Tallahassee, Florida 32308
(Inter-office Mail)
Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive
Tallahassee, Florida 32308
(Interoffice Mail)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Gail Peters, Administrator, S F Watson ALF, 2626 Taylor Street, Hollywood, Florida 33020 and Syble F.
Watson, Registered
FJ.orida 330 0, on
Funston Street, Hollywood,
SENDER: COMPLETE THIS SECTION
Complete Items 1, 2, and 3. Also complete
Item 4 If Restricted Dell\lery Is desired.
Print your name and address on the reverse
so that we can re.turn the card to you.
Attach this card to the back of the mallpiece, or on the front If space permits.
Is delivery address different from Item 17 If YES, enter delivery address below:
2. Article Number
0 Express Mall
□
turnReceipt for Merchandise
C.O.D.
Restricted Delivery? (l=xtra Fee) □Yes
7008 as □□ 0002 0764 75S4
(Transfer from service'
PS Form 3811, February 2004 Domestic Return Receipt 102695·02•M•1540
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
AGENCY FOR HEALTH CARE ADMINISTRATION,
Petitioner,
v.
SF WATSON GROUP INCORPORATED d/b/a SF WATSON ALF,
Respondent.
!
AHCA No.: 2009004648
Return Receipt Requested: 7008 0500 0002 0764 8216
7008 0500 0002 0764 8223
ADMINISTRATIVE COMPLAINT
COMES NOW the Agency for Health Care Administration ( "AHCA"), by and through the undersigned counsel, and files this Administrative Complaint ·against S F Watson Group Incorporated, d/b/a S F Watson ALF (hereinafter "S F Watson ALF") , pursuant to Chapter 4 2 9, Part I, and Section 120. 60, Florida Statutes, (2008), and alleges:
NATURE OF THE ACTION
This is an action to impose an administrative fine of
$6,000.00 pursuant to Section 429.19, Florida Statutes (2008), for the protection of the public heal th, safety and welfare pursuant to Section 429.28 (3) (c), Florida Statutes (2008).
EXHIBIT
l 1ft
JURISDICTION AND VENUE
This Court has jurisdiction pursuant to Sections
120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code.
Venue lies pursuant to Rule 28-106.207, Florida Administrative Code.
PARTIES
AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2008), and Chapter 58A-5, Florida Administrative Code.
S F Watson ALF operates a 4-bed assisted living facility located at 2646 Taylor Street, Hollywood, Florida 33020. S F Watson ALF is licensed as an assisted living facility license number AL10632 with an expiration date of May 9, 2011. S F Watson ALF was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes.
COUNT I
SF WATSON ALF FAILED TO PROVIDE DOCUMENTATION OF RESIDENT ELOPEMENT PREVENTION AND RESPONSE DRILLS, CONDUCTED WITHIN THE LAST YEAR
Sections 429.41(1) (a)3., and 429.41(1)(1), Florida Statutes (2008), and/or Rule SBA-5.0182(8)(c), Florida Administrative Code
(FACILITY RECORDS STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the biennial re-licensure survey conducted on 02/06/09 and based on record review and interview, it was determined that the facility failed to provide documentation of
(two) resident elopement prevention and response drills, conducted within the last year.
During a review of the facility's records, it was noted that the the files lacked documentation of 2 (two) resident elopement prevention and response drills conducted within the last year, as required.
During an interview, conducted on 02/06/09 at approximately 10:00 AM, the Administrator acknowledged the findings. Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on record review and interview, it was determined that the facility failed to provide documentation of 1 (one) out of 2 (two) resident elopement prevention and response drills, conducted within the last year.
During a review of the facility's records, it was noted that the the files lacked documentation of 1 (one) out of
2 (two) resident elopement prevention and response drills conducted within the last year, as required. The only
documentation of an elopement drill that was completed within the last year and available for review was dated 06/11/08.
During an interview, conducted on 03/10/09 at approximately 11:30 AM, the RN/Owner acknowledged the findings. This is an uncorrected deficiency from the 02/06/09 re- licensure survey.
Based on the foregoing, S F Watson ALF violated Sections 429.41(1)(a)3., and 429.41(1)(1), Florida Statutes (2008), and/or Rule 58A-5.0182(8) (c), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT II
SF WATSON ALF FAILED TO PROVIDE DOCUMENTATION OF COMPLETION OF IN-SERVICE TRAINING IN INFECTION CONTROL
Rules SSA-5.0191(2) (a), and SSA-5.0191(11)(a), Florida Administrative Code (2008)
(STAFFING STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
During the re-licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide documentation of completion of in-service training in infection control including universal precautions, and facility sanitation procedures before providing personal care to residents for 1 out of 2 sampled employees (Employee #2) .
Upon interview with the Administrator, conducted on 02/06/09 at approximately 10:00 AM, it was reported that Employee #2 is the designated relief person and is responsible for providing direct care for residents at the facility in the absence of the Administrator.
During a further interview, the Administrator reported that the facility's personnel records were not on the premises and unavailable for review including documentation indicating that Employee #2 received a minimum of 1 hour in service training in infection control, including universal precautions, and facility sanitation procedures before providing personal care to residents. The Administrator acknowledged the findings. Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on interview, it was determined that the facility failed to provide documentation of completion of the required in-service training for 1 out of 3 sampled employees (Employee #3).
Upon interview with the RN/Owner on duty, conducted on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3 is the designated relief person and is responsible for providing direct care for residents residing at the facility in the absence of the Administrator and the RN/Owner.
During a further interview, the RN/Owner reported that Employee #3's personnel record was unavailable for review
including documentation indicating that the employee received a minimum of 1 hour in-service training in the following areas:
Infection control, including universal precautions.
Facility sanitation procedures before providing personal care to residents.
The RN/Owner acknowledged the findings. deficiency from the 02/06/09 re-licensure survey.
Uncorrected
Based on the foregoing, SF Watson ALF violated Rules 58A-5.0191(2)(a), and 58A-5.0191(11)(a), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT III
SF WATSON ALF FAILED.TO PROVIDE DOCUMENTATION OF COMPLETION OF THE REQUIRED IN-SERVICE TRAINING COVERING THE REPORTING OF MAJOR INCIDENTS, ADVERSE INCIDENTS AND EMERGENCY PROCEDURES RELATING EMERGENCY EVACUATION FOR SOME EMPLOYEES
Rules SSA-5.0191(2) (b), and 58A-5.0191(11)(a), Florida Administrative Code (2008)
(STAFFING STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates that paragraphs (1)
through (5) as if fully set forth herein.
During the full re-licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide documentation of completion of the required in-service training for 1 out of 2 sampled employees
(Employee #2).
6
Upon interview with the Administrator, conducted on 02/06/09 at approximately 10:00 AM, it was reported that Employee #2 is the designated relief person and is responsible for providing direct care for residents residing at the facility in the absence of the Administrator. The Administrator confirmed that the employee has held this position for more than 30 days.
During a further interview, the Administrator reported that the facility's personnel records were not on the premises and unavailable for review including documentation indicating that the Employee #2 received in-service training, specifically:
Reporting of major incidents.
Reporting adverse incidents.
Facility emergency procedures including chain of command and staff roles relating to emergency evacuation.
The Administrator acknowledged the findings.
Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on interview, it was determined that the facility failed to provide documentation of completion of the required in-service training for 1 out of 3 sampled employees (Employee #3).
Upon interview with the RN/Owner, conducted on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3 is responsible for providing direct care for
7
residents residing at the facility in the absence of the Administrator and the RN/Owner. It was confirmed that the employee has held this position for more than 30 days.
During a further interview the, RN/Owner reported that Employee #3's personnel record was unavailable for review including documentation indicating that the employee received a minimum of 1 hour in-service training in the following areas:
Reporting of major incidents.
Reporting adverse incidents.
Facility emergency procedures •including chain of command and staff roles relating to emergency evacuation.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from 02/06/09 re-licensure survey.
Based on the foregoing, SF Watson ALF violated Rules 58A-5.0191(2)(b), and 58A-5.0191(11)(a), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.
COUNT IV
SF WATSON ALF FAILED TO PROVIDE DOCUMENTATION THAT ALL EMPLOYEES RECEIVED A MINIMUM OF 1 HOUR IN-SERVICE OF THE CORE TRAINING
Rules SSA-5.019(2) (c), and SSA-5.0191(11)(a), Florida Administrative Code (2008)
(STAFFING STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
8
During the full re-licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide documentation of completion of the required in-service training for 1 out of 2 sampled employees (Employee #2).
Upon interview with the Administrator, conducted on 02/06/09 at approximately 10:00 AM, it was reported that Employee #2 is the designated relief person and is responsible for providing direct care for residents residing at the facility in the absence of the Administrator. The Administrator confirmed that the employee has held this position for more than 30 days.
During a further interview, the Administrator reported that the facility's personnel records were not on the premises and unavailable for review including documentation indicating that the Employee #2 received in-service training, specifically:
Resident rights in an assisted living facility.
I
Recognizing neglect, and exploitation.
and
reporting
resident abuse,
The
Administrator
acknowledged
the findings.
Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on interview, it was determined that the facility failed to
9
provide documentation of completion of the required in-service training for 1 out of 3 sampled employees (Employee #3).
Upon interview with the RN/Owner, conducted on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3 is responsible for providing direct care for residents residing at the facility in the absence of the Administrator and the RN/Owner. It was confirmed that the employee has held this position for more than 30 days.
During a further interview the RN/Owner it was reported that Employee #3's personnel record was unavailable for review including documentation indicating that the employee received a minimum of 1 hour in-service training in the following areas:
Resident rights in an assisted living facility.
Recognizing and reporting resident abuse,
neglect, and exploitation.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the re-licensure survey of 2/06/09.
Based on the foregoing, SF Watson ALF violated Rules SBA-5.0191(2) (c), and SBA-5.0191(11)(a), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00
10
COUNT V
SF WATSON ALF FAILED TO ENSURE THAT ALL EMPLOYEES RECEIVED REQUIRED TRAINING
Rules SBA-5.0191(2) (d), and SBA-5.0191(11)(a), Florida Administrative Code
(STAFFING STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
During the full licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide documentation of completion of the required in-service training on Resident's behavior and needs, and assistance with activities of daily living, for 1 out of 2 sampled employees (Employee #2).
Upon interview with the Administrator, conducted on 02/06/09 at approximately 10:00 AM, it was reported that Employee #2 is the designated relief person and is responsible for providing direct care for residents residing at the facility in the absence of the Administrator. The Administrator confirmed that the employee has held this position for more than 30 days.
During a further interview the Administrator reported that the facility's personnel records were not on the premises and unavailable for review including documentation indicating that the Employee #2 received three hours of in-service training, specifically:
Resident's behavior and needs.
Providing assistance with activities of daily
living.
The Administrator acknowledged the findings.
Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on interview, it was determined that the facility failed to provide documentation of completion of the required in-service training for 1 out of 3 sampled employees (Employee #3).
Upon interview with the RN/Owner, conducted on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3 is responsible for providing direct care for residents residing at the facility in the absence of the Administrator and the RN/Owner. It was confirmed that the employee has held this position for more than 30 days.
During a further interview the RN/Owner it was reported that Employee #3's personnel record was unavailable for review including documentation indicating that the employee received a minimum of 1 hour in-service training in the following areas:
Resident's behavior and needs.
Providing assistance with activities of daily
living.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the 2/06/09 re-licensure survey.
Based on the foregoing, SF Watson ALF violated Rules 58A-5.0191(2) (d), and 58A-5.0191(11)(a), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT VI
SF WATSON ALF FAILED TO PROVIDE ! -SERVICE TRAINING REGARDING RESIDENT ELOPEMENT
Rule SBA-5.0191(2) {f), Florida Administrative Code (STAFFING STANDARDS)
UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) and is fully set forth herein.
During the full re-licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide documentation of completion of in service training regarding the facility's resident elopement response policies and procedures for 1 out of 2 sampled employees (Employee #2).
Upon interview with the Administrator, conducted on 02/06/09 at approximately 10:00 AM, it was reported that Employee #2 is the designated relief person and is responsible for providing direct care for residents residing at the facility in the absence of the Admini trator. The Administrator confirmed that the employee has held this position for more than 30 days.
During a further interview the Administrator reported that the facility's personnel records were not on the premises
and unavailable for review including documentation indicating that the Employee #2 received in-service training regarding the facility's resident elopement response policies and procedures, as required.
The Administrator acknowledged the findings. Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on interview, it was determined that the facility failed to provide documentation of completion of the required in-service training for 1 out of 3 sampled employees (Employee #3).
Upon interview with the RN/Owner, conducted on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3 is responsible for providing direct care for residents residing at the facility in the absence of the Administrator and the RN/Owner. It was confirmed that the employee has held this position for more than 30 days.
During a further interview the RN/Owner it was reported that Employee #3's personnel record was unavailable for review including documentation indicating that the employee received in-service training regarding the facility's resident elopement response policies and procedures, as required.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the re-licensure survey of 02/06/09.
14
Based on the foregoing, SF Watson ALF violated Rule 58A-5.091(2)(f), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT VII
SF WATSON ALF FAILED TO PROVIDE A COPY OF AN EMPLOYMENT APPLICATION WITH REFERENCES FOR SAMPLED EMPLOYEES
Section 429.275(4), Florida Statutes (2008), and/or Rule 58A-5.024(2) (a), Florida Administrative Code
(STAFF RECORDS STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
During the full licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide a copy of an employment application with references for 2 out of 2 sampled employees (Employees #1 and #2).
During an interview with the Administrator on 02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review, including documentation of an employment application with references, for Employees #1 and #2, as required. The Administrator acknowledged the findings. Correction date given 3/04/09.
During the revisit conducted on 3/10/09 and based on
interview, it was determined that the facility failed to
provide copy of employment application with references for 1 out of 3 sampled employees (Employee #3)
During an interview with the RN/Owner on 3/10/09 at approximately 11:30 AM, it was reported that employee #3's personnel record was unavailable for review, including documentation of an employment application, with references, as required.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the 02/06/09 re-licensure survey.
Based on the foregoing, S F Watson ALF violated Section 429.275(4), Florida Statutes (2008), and/or Rule 58A- 5.024(2)(a), Florida Administrative Code, an uncorrected Class· III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT VIII
SF WATSON ALF FAILED TO PROVIDE VERIFICATION OF FREEDOM FROM TUBERCULOSIS DOCUMENTED ON AN ANNUAL BASIS FOR SOME EMPLOYEES
Rule SSA-5.019(2) (a), Florida Administrative Code
(STAFF RECORDS STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
During the full re-licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide verification of freedom from
tuberculosis documented on an annual basis, for 2 out of 2 sampled employees (Employee #'s 1 and 2).
During an interview with the Administrator on 02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review including verification of freedom from
tuberculosis documented on an annual basis, and 2, as required. The Administrator findings. Correction date given 3/04/09.
for Employee #'s 1 acknowledged the
During the revisit conducted on 3/10/09 and based on interview and record review, it was determined that the facility failed to provide verification of freedom from tuberculosis documented on an annual basis, for 2 out of 3 sampled employees (Employee #'s 1 and 3).
During a review of Employee #l's (the Administrator) personnel record, it was revealed that the file lacked current verification of freedom from tuberculosis documented on an annual basis.
During an interview with the RN/Owner on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3's personnel record was unavailable for review including verification of freedom from tuberculosis documented on an annual basis.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the re-licensure survey conducted on 02/06/09.
Based on the foregoing, SF Watson ALF violated Rule 58A-5.019(2)(a), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00
COUNT IX
SF WATSON ALF FAILED TO PROVIDE VERIFICATION OF INITIAL AND/OR BIENNIAL TRAINING COURSES ON HIV AND AIDS FOR SOME EMPLOYEES
Section 429.275(2), Florida Statutes, and/or Rules
SSA-5.0191(3), SSA-5.024(2) {a)l., and SSA-5.0191(11), Florida
Administrative Code
{STAFF RECORDS STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the full re-licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide verification of initial and/or biennial training courses on HIV and AIDS, for 2 out of 2 sampled employees (Employee #'s 1 and 2).
During an interview with the Administrator on 02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review including verification of initial and/or biennial training courses on HIV and AIDS, for Employee #'s 1
and 2, as required. The Administrator acknowledged the findings. Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on record review and interview, it was determined that the facility failed to provide verification of initial and/or biennial training courses on HIV and AIDS, for 2 out of 3 sampled employees (Employee #'s 2 and 3).
During a review of Employee #2's record, it was noted that the file lacked current verification of biennial training on HIV and AIDS, as required.
During an interview with the RN/Owner on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3's personnel record was unavailable for review including verification of initial training on HIV and AIDS, as required.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the 02/06/09 re-licensure survey.
Based on the foregoing, S F Watson ALF violated Section 429.275(2), Florida Statutes (2008), and/or Rules 58A- 58A-5.0191(3), 58A-5.024(2) (a)l., and 58A-5.0191(11), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.
COUNT X
SF WATSON ALF FAILED TO PROVIDE VERIFICATION OF CURRENT CERTIFICATION IN AN APPROVED FIRST AID AND CPR COURSE FOR SOME EMPLOYEES
Section 429.275(2), Florida Statutes, and/or Rules SSA- 5.024(2)(a)l., and SSA-5.0191(4), Florida Administrative Code
(STAFF RECORDS STANDARDS) UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the full re-licensure survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide verification of current certification in an approved First Aid and CPR course for 2 out of 2 sampled employees (Employee #'s 1 and 2).
During an interview with the Administrator on 02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and unavailable for review including verification of current certification in an approved First Aid and CPR for Employee #'s
and 2, as required. The Administrator acknowledged the findings. Correction Date: 03/04/09
During the revisit conducted on 3/10/09 and based on record review and interview, it was determined that the facility failed to provide documentation of valid certification in an approved First Aid and CPR course for 1 out of 3 sampled employees (Employee #3).
Upon interview, conducted on 03/10/09 at approximately 11:30 AM, the RN/Owner reported that Employee #3 is left solely in-charge of the residents during the 7 PM to 7 AM shift, on a daily basis.
During a further interview, the RN/Owner reported that Employee #3's personnel record was unavailable for review including verification of initial training on HIV and AIDS, as required. The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the 02/06/09 full re-licensure survey.
Based on the foregoing, S F Watson ALF violated Section 429.275(2), Florida Statutes (2008), and/or Rules 58A- 5.024(2)(a)l., and 58A-5.0191(4), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.
COUNT XI
SF WATSON ALF FAILED TO PROVIDE VERIFICATION OF COMPLIANCE WITH THE BACKGROUND SCREENING REQUIREMENTS
Section 429.275(2), Florida Statutes, and/or Rules SBA- 5.019(3), and SBA-5.024(2) (a)3., Florida Administrative Code (STAFF RECORDS STANDARDS)
UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the biennial survey conducted on 02/06/09 and based on interview, the facility failed to provide verification of compliance with the background screening requirements for 2 out of 2 sampled employees (Employee #'s 1 and 2).
During an interview with the Administrator on
02/06/09 at approximately 10:00 AM, it was reported that the facility's personnel records were not on the premises and
21
unavailable for review including verification of compliance with background screening requirements for Employee #'s 1 and 2, as required. The Administrator acknowledged the findings. Correction Date: 03/04/09.
During the follow-up conducted on 3/10/09 and based
on interview, it was provide verification
determined that the facility failed to of compliance with the background
screening requirements for 2 out of 3 sampled employees (Employee #'s 1 and 3).
During a review
of. the
Employee #l's (the
Administrator) personnel record, it was noted that the
background screening dated 02/08/08, read "Level 2-FBI-
Reject". During further review of the record and interview with the RN/Owner, it was revealed that the facility lacked verification and/or clarification of compliance with the level
background screening requirements for the Administrator, as required.
During an interview with the RN/Owner on 03/10/09 at approximately 11:30 AM, it was reported that Employee #3's personnel record was not available for review including verification of compliance with the Level 1 background screening requirements for the employee, as required.
The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the biennial survey of 02/06/09.
Based on the foregoing, S F Watson ALF violated Section 429.275(2), Florida Statutes (2008), and/or Rules 58A- 5.019(3), and 58A-5.024(2)(a)3., Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.
COUNT XII
SF WATSON ALF FAILED TO MAINTAIN DOCUMENTATION OF STAFF PARTICIPATION IN RESIDENT ELOPEMENT DRILLS
Rule 58A-5.024(2) (a)S, Florida Administrative Code (STAFF RECORDS STANDARDS)
UNCORRECTED CLASS III VIOLATION
AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
During the biennial survey conducted on 02/06/09 and based on interview, it was determined that the facility failed to provide documentation of all applicable staff participation in resident elopement drills for 2 out of 2 sampled employees (Employee #'s 1 and 2).
Upon interview, conducted on 02/06/09 at approximately 10:00 AM, the Administrator reported that Employee #'s 1 and 2 both provide personal care services for the former residents at the facility.
Upon request, the Administrator reported that documentation confirming that two employees participated in resident elopement drill(s), as required. The Administrator acknowledged the findings. Correction date 3/04/09.
During the follow-up conducted on 3/10/09 and Based on interview, the facility failed to provide documentation of all applicable staff participation in resident elopement drills for 2 out of 3 sampled employees (Employee #'s 1 and 3).
Upon interview, conducted on 03/10/09 at approximately 11:30 AM, the RN/Owner reported that Employee #3 provides personal care services for the residents of the facility.
Upon request, the RN/Owner reported that documentation confirming that Employee #1 (the Administrator) and Employee #3, both participated in resident elopement drill(s), as required. The RN/Owner acknowledged the findings. This is an uncorrected deficiency from the biennial survey of
02/06/09.
Based on the foregoing, SF Watson ALF violated Rule 58A-5.024(2) (a)5.,, Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $500.00.
PRAYER FOR RELIEF
WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief:
Make factual and legal findings in favor of the Agency on Counts I through XII.
Assess an administrative fine of $6,000.00 against S F Watson ALF on Counts I through VII pursuant to Section 429.19, Florida Statutes.
Grant such other relief as this Court deems is just and proper.
Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2008). Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Heal th Care Administration, 2727 Mahan Drive, Mail Stop #3,
Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873.
RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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.
IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER.
Assistant General Counsel Agency for Health Care Administration
8350 N. W. 52nd Terrace
Suite 103
Miami, Florida 33166
Copies furnished to:
Field Office Manager
Agency for Health Care Administration 5050 Linton Boulevard, Suite 500 Delray Beach, Florida 33484
(Inter-office mail)
Finance and Accounting Revenue and Management Unit
Agency for Health Care Administration 2727 Mahan Drive, MS #14
Tallahassee, Florida 32308 (Inter-office Mail)
Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive
Tallahassee, Florida 32308 (Interoffice Mail)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Gail Peters, Administrator, S F Watson ALF, 2626 Taylor Street, Hollywood, Florida 33020 and Syble F.
Watson, Registered
Florida 33020, on
2839 Funston Street, Hollywood,
J<-1,,£r....L-="""'--,, -
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
RE: SF Watson Group Incorporated d/b/a S F Watson ALF
CASE NO: 2009004648
ELECTION OF RIGHTS
This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.
Your Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Administrative Complaint.
If your Election of Rights with your selected option is not received by AHCA within twenty one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency's proposed action and a final order will be issued.
(Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)
PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS:
Agency for Health Care Administration Attention: Agency Clerk
2727 Mahan Drive, Mail Stop #3
Tallahassee, Florida 32308.
Phone: 850-922-5873 Fax: 850-921-0158.
PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS
OPTION ONE (1) I admit to the allegations of facts and law contained in the
Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action.
OPTION TWO (2) I admit to the allegations of facts contained in the Administrative
Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced.
OPTION THREE (3) I dispute the allegations of fact contained in the Administrative
Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.
PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed
administrative action. The request for formal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain:
Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any.
The file number of the proposed action.
A statement of when you received notice of the Agency's proposed action.
A statement of all disputed issues of material fact. If there are none, you must state that there are none.
Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.
License type: (ALF? nursing home? medical equipment? Other type?)
Licensee Name: License number:
Contact person:
Name Title
Address:
Street and number City Zip Code
Telephone No. Fax No. Email(optional) _
Ihereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.
Signed: Date:
Print Name: Title:
Late fee/fine/AC
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
vs.
Petitioner,
AHCA No. 2009003379
DOAH No. 09-2996
AHCA No. 2009004648
SF WATSON GROUP INCORPORATED, d/b/a SF WATSON ALF,
Respondent.
;!
SETTLEMENT AGREEMENT
Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the "Agency"), through its undersigned representatives, and Respondent, SF Watson Group, Incorporated, d/b/a SF Watson ALF (hereinafter "Respondent"), pursuant to Section 120.57(4), Florida Statutes, each individually, a "party," collectively as "parties," hereby enter into this Settlement Agreement ("Agreement") and agree as follows:
WHEREAS, Respondent is an Assisted Living Facility licensed pursuant to Chapter 429, Part I, Florida Statutes, Section 20.42, Florida Statutes, Chapter 408, Part II, Florida Statutes, and Chapter 58A-5, Florida Administrative Code; and
WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to Chapter 429, Part I, Florida Statutes; and
WHEREAS, the Agency served Respondent with two administrative complaints (#2009003379 on or about May 14, 2009, and #2009004648 on or about June 17, 2009)
EXHIBIT
I
notifying the Respondent of its intent to impose administrative fines in the amount of $3,500.00 on #2009003379, and $6,000.00 on #2009004648; and
WHEREAS, Respondent requested a formal administrative proceeding on #2009003379 by selecting Option 3 on the Election of Rights form; and
WHEREAS, the parties have negotiated and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and
NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows:
All recitals herein are true and correct and are expressly incorporated herein.
Both parties agree that the "whereas" clauses incorporated herein are binding findings of the parties.
Upon full execution of this Agreement, Respondent agrees to waive any and all appeals and proceedings to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), Florida Statutes, a formal proceeding under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court of competent jurisdiction; and agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled, provided, however, that no agreement herein shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement.
Upon full execution of this Agreement, Respondent agrees to pay $4,750.00 in administrative fines to the Agency within thirty (30) days of the entry of the Final Order.
Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in Circuit Court in Leon County, Florida.
2
By executing this Agreement, Respondent admits, and the Agency asserts the validity of the allegations raised in the administrative complaint referenced herein. However, no agreement made herein shall preclude the Agency from imposing a penalty against Respondent for any deficiency/violation of statute or rule identified in a future survey of Respondent, which constitutes a "repeat" or "uncorrected" deficiency from surveys identified in the administrative complaint. The parties agree that in such a "repeat" or "uncorrected" case, the deficiencies from the surveys identified in the administrative complaint shall be deemed found without further proof.
No agreement made herein shall preclude the Agency from using the deficiencies from the surveys identified in the administrative complaint in any decision regarding licensure of Respondent, including, but not limited to, licensure for limited mental health, limited nursing services, extended congregate care, or a demonstrated pattern of deficient performance. The Agency is not precluded from using the subject events for any purpose within the jurisdiction of the Agency. Further, Respondent acknowledges and agrees that this Agreement shall not preclude or estop any other federal, state, or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the administrative complaint. This agreement does not prohibit the Agency from taking action regarding Respondent's Medicaid provider status, conditions, requirements or contract.
Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case.
Each party shall bear its own costs and attorney's fees.
This Agreement shall become effective on the date upon which it is fully executed by all the parties.
3
Respondent for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Respondent or related facilities.
This Agreement is binding upon all parties herein and those identified in paragraph eleven (11) of this Agreement.
In the event that Respondent was a Medicaid provider at the subject time of the occurrences alleged in the complaint herein, this settlement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code.
Respondent agrees that if any funds to be paid under this agreement to the Agency are not paid within thirty-one (31) days of entry of the Final Order in this matter, the Agency may deduct the amounts assessed against Respondent in the Final Order, or any portion thereof, owed by Respondent to the Agency from any present or future funds owed to Respondent by the Agency, and that the Agency shall hold a lien against present and future funds owed to Respondent by the Agency for said amounts until paid.
The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. Respondent has the capacity to execute this Agreement. Respondent understands that it has the right to consult with counsel and has knowingly and
4
SEP-23-2009 10!40 AHCA LEGAL DEPARTMENT P.08
freely entered into this Agreement without exercising its tight to consult with counsel Respondent affums that Respondent understands counsel fer the Agency represents solely tic Agenc:y and Agency counsel has not provided legal advice to or influenced Respondent in its decision to enter into this Agreement.
This Agreement contains and incorporates the entire understandings and
agreements of the parties.
This Agreement supersedes any priOT oral or written agreements between the
parties.
This Agreement may not be amended except in writing. Any attempted
assignment of this Agreement shall be void.
AU parties agree that a facsimile signature suffices for an original signature.
The following representatives b.ereby acknowledge that they are duly authorized to enter
-iit
into this Agreement.
, ,s
"Syb atson. Owner
De
Ag Care Administration
272 ' c, Bldg #1
Tallahassee, Flor'
J Sicnio eral Coucscl Florida Bar No. 0079741
Agency for Health Cue Administration 2727 Mahan Driv Mail Stop #3
Tallahassee, Florida.32308
DATED: / 9
S F Watson Group Incorporated dJb/a SF Watson ALF
2646 Taylor Street
HoU .Florida 3
ria Lawton ussell
Assistant General Counsel
Agency for Health Care Administration 8350 NW 52"d Terrace. Suite 103
Miami: Florida. 33166
DATED; {{)-/) -t:) Cj
5
TOTAL P.08
| Issue Date | Proceedings |
|---|---|
| Nov. 09, 2009 | Final Order filed. |
| Sep. 24, 2009 | Order Closing File. CASE CLOSED. |
| Sep. 23, 2009 | Agreed Motion to Relinquish Jurisdiction filed. |
| Jul. 07, 2009 | Order of Pre-hearing Instructions. |
| Jul. 07, 2009 | Notice of Hearing (hearing set for October 6, 2009; 9:00 a.m.; Fort Lauderdale, FL). |
| Jun. 29, 2009 | Notice of Unavailability filed. |
| Jun. 04, 2009 | Agreed Response to Initial Order filed. |
| Jun. 01, 2009 | Initial Order. |
| Jun. 01, 2009 | Administrative Complaint filed. |
| Jun. 01, 2009 | Election of Rights filed. |
| Jun. 01, 2009 | Notice (of Agency referral) filed. |
| Issue Date | Document | Summary |
|---|---|---|
| Nov. 05, 2009 | Agency Final Order |
