STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 201002003 Return Receipt Requested: v. 7002 2410 0001 4236 3463 7002 2410 0001 4236 3470 SENIOR HOUSING MANAGEMENT PROVIDER LLC d/b/a PALM BEACH ASSISTED LIVING FACILITY, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Senior Housing Management Provider LLC d/b/a Palm Beach Assisted Miving Facility (hereinafter “Palm Beach Assisted Living Facility”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2009), and alleges: NATURE OF THE ACTION . 1. This is an action to impose an administrative fine of $3,200.00 pursuant to Sections 429.14 and .429.19, Florida Statutes (2009), for the protection of public-health, safety and welfare. Filed September 24, 2010 3:01 PM Division of Administrative Hearings. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2009), and Chapter 28-106, Florida Administrative Code (2009). 3. Venue lies pursuant to Section 120.57, Florida Statutes (2009), and Rule 28-106.207, Florida Administrative Code (2009). PARTIES 4. 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 (2009), and. Chapter 58A-5 Florida Administrative Code (2009). 5. Palm Beach Assisted Living Facility operates a 200-bed assisted living facility located at 534 Datura Street, West Palm Beach, Florida 33401. Palm Beach Assisted Living Facility is licensed as an assisted living facility under license number 7617. Palm Beach Assisted Living Facility 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 PALM BEACH ASSISTED LIVING FACILITY FAILED TO COMPLY WITH THE RESIDENT'S BILL OF RIGHTS TO BE TREATED WITH CONSIDERATION AND RESPECT OF PERSONAL DIGNITY. SECTION 429.28(1), FLORIDA STATUTES (RESIDENT CARE STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Palm Beach Assisted Living Facility was cited with three (3) Class II deficiencies as a result of a complaint investigation survey conducted on January 7, 2010. 8. A complaint investigation survey was conducted on January 7, 2020. Based on record review, interview, and observations, it was determined that the facility failed to comply with the Resident's Bill of Rights by failing to ensure all residents residing at the facility are treated with dignity, individuality, and have adequate shelter which provides a safe and decent living environment, for all 134 residents residing at the facility. The facility neglected the appropriate shelter needs of the residents due to significant changes in the weather condition requiring prompt attention. The findings include the following. 9. Research of weather conditions for 01/04/10, 01/05/10 and 01/06/10, revealed the outside weather temperatures were 3 below 65 degrees Fahrenheit during awake and sleeping hours at the facility. (Refer to A1011 & A1012.) 10. The facility is mandated to maintain an inside temperature of 72 degrees Fahrenheit, when the outside temperatures are 65 degrees or lower during wake hours and 68 degrees Fahrenheit during sleeping hours to ensure the safety and well-being of residents. However, during tour of the facility between the hours of 9:15 AM and 1 PM on 01/07/10 with the Administrator, it could not be confirmed that the inside temperature remained within the guidelines, which had the potential to ‘jeopardize the well-being and health of the residents. 11. Random interviews with residents between the hours of 9:15 AM and 1 PM on 01/07/10 revealed the rooms were extremely cold and had been cold the last three nights when the outside temperatures were extremely cold. It was also revealed no source of heat was available in many of the rooms or Dining Area, making it uncomfortable during the night and early morning hours. 12. Based on record review and observations, many of the residents have Limited Mental Health problems and require some form of assistance or supervision with Activities of Daily Living (ADLs). 13. Interview with the Administrator at 11 AM on 1/7/10, revealed it was unknown the facility had central heat on the first floor until this time. It was also revealed the facility did not offer any source of heat for the residents other than random resident rooms provided with space heaters until this date. The Administrator had not provided "heat blowers" for the common areas of the facility on the second and third floors until this date. Furthermore, the facility had not been monitoring temperatures in the facility until this time. This is a repeat deficiency from the survey conducted on October 13, 2009. 14. Based on the foregoing facts, Palm Beach Assisted Living Facility violated Section 429.28(1), Florida Statutes, herein classified as a Class II violation, which warrants an assessed fine of $1,200.00. COUNT IT PALM BEACH ASSISTED LIVING FACILITY FAILED TO ENSURE THAT NO RESIDENT SHALL BE IN ANY INSIDE AREAS THAT ARE BELOW 72 DEGREES . FAHRENHEIT. RULE 58A-5.023(2) (a), FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS II VIOLATION 15. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 16. A complaint investigation survey was conducted on January 7, 2010. Based on observation and interview, it was determined that the facility failed to ensure that no resident shall be in any inside areas of the facility that are below a temperature of 72 degrees Fahrenheit when the outside temperatures are 65 degrees or lower during the day. This has the potential to directly affect the health and safety of the residents of the facility. The findings include the following. 17. During tour of the facility conducted on 01/07/2010 between the hours of 9:15 AM and 1 PM, accompanied by the Administrator, it was noted the outside temperature was below 65 degrees. Review of weather reports for the area of the facility confirmed outside temperatures during the day were below 65 degrees for the past three nights (01/04/10, 01//05/10 and 01/06/10). It was also revealed the facility's census was 134 cresidents. At 9:30 AM, the central air conditioning thermostat in the Dining Room indicated the room was 58 degrees. There was no device available to monitor temperatures throughout the rest of the facility until 12 PM on this date. 18. When the Administrator was interviewed at 10 AM, she was unaware that the facility had central heat available on the first floor. Random residents had been provided space heaters for individual use in their rooms. There was no other heating mechanism available to keep the temperature within regulation guidelines for the resided. 19. At 1 PM, second and third floors where residents the central heat was operating on the first floor and the temperature on the thermostat in the Dining Room registered 62 degrees, still below the -.required minimum temperature of 72 degrees during the day. 20. The following outside temperatures were noted for 01/04/10, 01/05/10 and 01/06/10 (every 2 hours): 01/04/10: Time Temperature ee PM 35 degrees Fahrenheit . 8:05 PM {raster Eee —-—| 10:05 AM 38 degrees Fahrenheit 12:05 AM 44 degrees Fahrenheit 1:05 AM 47 degrees Fahrenheit 3:05 PM Si degrees Fahrenheit 5:05 Pil 50 degrees Fahrenheit 7:05 PM 44 degrees Fahrenheit 9:05 PM 41 degrees Fahrenheit 01/05/10: Time Temperature 6:05 PM 37 degrees Fahrenheit 8:05 PM 32 degrees Fahrenheit 10:05 AM. 34 degrees Fahrenheit 12:05 AM 39 degrees Fahrenheit 1:05 AM 43 degrees Fahrenheit 3:05 PM 40 degrees Fahrenheit 5:05 PM 46 degrees Fahrenheit 7:05 PM 41. degrees Fahrenheit 9:05 PM 37 degrees Fahrenheit 01/06/10: Time Temperature 31 degrees Fahrenheit 8:05 PM 30 degrees Fahrenheit 10:05 AM ‘ degrees Fahrenheit 12:05 AM 43 degrees Fahrenheit 1:05 AM 45 degrees Fahrenheit 3:05 PM 49 degrees Fahrenheit 5:05 PM 49 degrees Fahrenheit 7:05 PM 43 degrees Fahrenheit 9:05 PM 39 degrees Fahrenheit 21. Random interviews with residents between 9:15 AM and 1 PM on 01/07/10 revealed the rooms were extremely cold and had been cold the last two days. It was also revealed only some residents were provided space heaters making it uncomfortable for others during the day. 22. Interview with the Administrator at 11 AM on 1/7/10, revealed the facility had ordered large "heat blowers" to be placed on each hall on the second and third floors. It was also revealed the facility was not aware that central heat was available on the first floor until this time. The facility failed to ensure warm temperatures in all residents' rooms and Dining Area for the safety and well-being of all residents. 23. Based on the foregoing facts, Palm Beach Assisted Living Facility violated Rule 58A~-5.023(2) (a), Florida Administrative Code, herein classified as a Class II violation, which warrants an assessed fine of $1,000.00. COUNT III PALM BEACH ASSISTED LIVING FACILITY FAILED TO ENSURE THAT NO RESIDENTS ARE IN INSIDE AREAS THAT ARE BELOW 68 DEGREES FAHRENHEIT. RULE 58A~5.023(2) (a), FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS II VIOLATION 24. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 25. A complaint investigation survey was conducted on January 7, 2010. Based on observation and interview, it was determined that the facility failed to ensure that no resident shall be in any inside areas of the facility that are below an inside temperature of 68 degrees Fahrenheit, when the outside temperatures are 65 degrees or lower when residents are asleep. This has the potential to directly affect the health and safety of the residents of the facility. The findings include the following. 26. During tour of the facility conducted on 01/07/2010 between the hours of 9:15 AM and 1 PM, accompanied by the Administrator, it was noted the outside temperature was below 65 degrees. Review of weather reports for the area of the facility confirmed outside temperatures during sleeping hours were below 65 degrees for the past three nights (01/04/10, 01//05/10 and 01/06/10) . 27. %It was also revealed the facility's census was 134 residents. At 9:30 AM, the central air conditioning thermostat in the Dining Room indicated the room was 58 degrees. There was no device available to monitor temperatures throughout the rest of the facility until 12 PM on this date. When the Administrator was interviewed at 10 AM, she was unaware that the facility had central heat available on the first floor. Random residents had been provided space heaters for individual use in their rooms. 10 There was no other temperature within regulation heating mechanism available to keep the guidelines for the second and third floors where residents resided. 28. At 1 PM, the. central heat was operating on the first floor and the temperature on the thermostat in the Dining Room registered 62 degrees, still below the required minimum temperature of 68 degrees at night. 29. The following outside temperatures were noted for 01/04/10, 01//05/10 and 01/06/10 (every 2 hours): 01/04/10 Time Temperature [S305 By ar agrees Banremnet 11:05 PM 40 degrees Fahrenheit 12:05 AM 37 degrees Fahrenheit 2:05 AM 36 degrees Fahrenheit 4:05 AM 36 degrees Fahrenheit 01/05/10: Time Temperature 9:05 PM 38 degrees Fahrenheit 11:05 PM 37 degrees Fahrenheit 12:05 AM 40 degrees Fahrenheit 2:05 AM 39 degrees Fahrenheit 1 1 4:05 AM 39 degrees Fahrenheit 01/06/10: Time Temperature 9:05 PM 39 degrees Fahrenheit 11:05 PM 37 degrees Fahrenheit 12:05 AM 37 degrees Fahrenheit 2:05 AM 35 degrees Fahrenheit 4:05 AM 33 degrees Fahrenheit 30. Random interviews with residents between 9:15 AM and 1 PM on 01/07/10 revealed the rooms were extremely cold and had been cold the last three nights. It was also revealed only some residents were provided space heaters, making it uncomfortable for others during the night and early morning hours. 31. Interview with the Administrator at 11 AM on 1/7/10, revealed the facility had ordered large "heat blowers" to be placed on each hall on the second and third floors. It was also revealed the facility was not aware that central heat was available on the first floor until this time. The facility failed to ensure warm temperatures in all residents' rooms and Dining Area for the safety and well-being of all residents at night. 12 32. Based on the foregoing facts, Palm Beach Assisted Living Facility violated Rule S8A~-5.023(2) (a), Florida Administrative Code, herein classified as a Class II violation, which warrants an assessed fine of $1,000.00. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Palm Beach Assisted Living Facility on Counts I through III. 2. Assess an administrative fine of $3,200.00 against Palm Beach Assisted Living Facility on Counts I through III for the violations cited above. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4, 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 (2009). Specific options for . administrative action are set out in the attached Election of Rights. All 13 requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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 tn. Ko Alba M. Rodriguez, Esd. Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) 14 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 Ricki Kaneti, Administrator, Palm Beach Assisted Living Facility, 534 Datura Street, West Palm Beach, Florida 33401; Ricki Kaneti, Registered Agent, 534 Datura Street, West Palm Beach, Florida 33401 on this w3rekday of Oprrt. , 2010. Qhra) Ro Alba M. Rodriguez, Esq. 15 a or PLETE THIS SECTION ON DELIVERY m SENDER: COMPLETE THIS SECTION com , 6 -_ in Signature ee an . os fu & Complete items 1, 2, and 8. Also complete A. Signal f Ch Agent = i A item. 4 If Restricted Delivery Is dedired, esse x ate Baers see ‘ ur name and address on the revers ; _ a —" so that we can return the card to you. B-Regelved by (frinted Name) G. Date of Delivery Q Certitied p , & Attach this card to the back of the mailpiece, x ye { | é bit! AL =] hom ‘00 or on the front if space permits. Dy le delivery address different from item 1? 8 Yes a (roan 1. Article Addressed to: If YES, enter delivery address below: lo Pry gt8strloted Dy a 4: ar nen ih Cine Kandhi u _ . ry _ Hel Postage & Fos PeQrms Petich. Ganarted Susung o ‘ . ees rn 5ay Det, Ditent ~ ” 3. Service Type oe Mal j ; F Qeatdin 32° riiied Mall xpfess Mal Ww aa Pie Pench . fis soa | Pegietered 1 Rethrn Recelpt for Merchandise 11 6.0.0. % nad : C1 Insured Mall A. Restricted Delivery? (Extra Fea) 7002 2410 0004 yeah S43 Domestic Return Recelpt G. umn Cemapey 402895-02-M-1540 (Transfer from service label) PS Form 3811, February 2004 COMPLETE THIS SECTION ON DELIVERY SENDER: COMPLETE THIS SECTION Restiloted Delivery Fe (Endorsement Rooqulted) tuear Paling Penchs Fiend 330i 8. Service Type 1 Certitied Mall +1 Express/Mall ( Registered DD Return Receipt for Merchandise Cl insured Mall C1 C.0.D. cted Delivery? (Extra Fea) 0 ooe 2410 0001 423b 347 . p03 Poms Proek. aasatod (Transfer from service label) PS Form 3811, February 2004 Domestic Return Recelpt G2 wan Cy nya ‘hi BC oO tm in @ Complete items 4, 2, and 3. Also complete A. Signature s item 4 if Restricted Delivery is desired. x 1 Agent F B Print your name and address on the reverse C1 Addresseo so that we can return the card to you. B. Recelved by (Printed Name] Oj Date of Deliver gq ™ Attach this card to the back of the mallpiece, ily | 6 th Y ‘or on the front If space permits, KALA aq , dressed to: D. Is delivery address different from item 1? C1 Yes g it “hee Ad “e to: If YES, enter delivery address below: + No Ret ye ‘ < ap’ a (Endorsement Realeenh : he \ amote . q S24 Cilio iho ot fu mu Q oOo nm 102695-02-M-1540 ~ USPS - Track & Confirm Page | of 1 TAPE. a Track & Confirm Track & Confirm Search Results Label/Receipt Number: 7002 2410 0001 4236 3463 z oC Service(s): Certified Mail™ Track & Confirin Status: Delivered Enter Label/Receipt Number. Your item was delivered at 2:39 PM on April 26, 2010 in WEST PALM . oe - BEACH, FL 33401. ; ‘ . £Go> Notification Options Track & Confirm by email Get current event information or updates for your item sent to you or others by email. { @e>) Site Map Customer Servicg - Forms Gov't Services Careers Privacy Potley TemsotUse Business Customer Gateway ‘ hayetas itn Copyright® 2010 USPS, All Rights Reserved. NoFEARAGLEEO Data FOIA WD eitenahe Pd ncaa kiss http://trkenfrm1 -Smi.usps.com/PTS Internet Web/InterLabellnquiry.do ' 04/27/2010

Docket for Case No: 10-009297