STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No.: 2011000764 Petitioner, Return Receipt Requested: v. 7009 0080 0000 0586 3903 ALL AMERICA ADULT CONGREGATE LIVING FACILITY, INC. d/b/a ALL AMERICA ACLF, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against All America Adult Congregate Living Facility, Inc. d/b/a All America ACLF (hereinafter “All America ACLF”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2010), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,000.00 pursuant to Section 429.19, Florida Statutes (2010) for the protection of the public health, safety and welfare. Filed May 12, 2011 1:40 PM Division of Administrative Hearings JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. 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 (2010), and Chapter 58A-5, Florida Administrative Code. 5, All America ACLF operates a 100-bed assisted living facility located at 808 West 1°* Avenue, Hialeah, Florida 33010. All America ACLF is licensed as an assisted living facility with license number AL7890, with = an expiration date of July 27, 2012. All America ACLF 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 ALL AMERICA ACLF FAILED TO PROVIDE QUALIFIED STAFF FOR RESIDENTS’ SUPERVISION AND SERVICES FOR 7 OUT OF 10 SAMPLED RESIDENTS Rules 58A-5.019(4) (b), and 58A-5.0182 Florida Administrative Code (STAFFING STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During a complaint investigation conducted on 12/01/2010 and based on observation, record review and interview, it was determined that the facility failed to provide qualified staff for resident “supervision and services for the facility residents for 7 out 10 sampled residents (Resident #1, #2, #3, #6, #7, #9, and #10). 8. Clinical Record review on 12/01/2010, at approximately 11:00 AM revealed that: 9. Resident #1 was admitted to the facility on 9/06/2010 and the ‘Health Assessment dated 9/06/2010 indicated that the resident was diagnosed with Depression by the physician. 10. Resident #2. was admitted to the facility on 5/01/2007 and the Health Assessment dated 1/24/2009 indicated that the resident was diagnosed with Schizophrenia. by the physician. 11. Resident #3 was admitted to the facility on 3/10/2010 and the Health Assessment dated 3/22/2010 indicated that the resident was diagnosed with Major Depression by the physician. 12. Resident #6 was admitted to the facility on 9/29/2009 and the Health Assessment dated 10/29/2009 indicated that the resident was diagnosed with Schizophrenia by the physician. 13. Resident #7 was admitted to the facility on 4/13/2007 and the Health Assessment dated 6/09/2009 indicated that the resident was diagnosed with Schizophrenia by the physician. 14. Resident #9 was admitted to the facility on 12/28/2009. and the Health Assessment dated 1/16/2010 indicated that the resident was diagnosed with Schizophrenia by the physician. 15. Resident #10 was admitted to the facility on 11/19/2010 and the Health Assessment dated 1/16/2010, indicated that the resident was diagnosed with Schizophrenia by the physician. 16. The records of residents 1, #2, #3, 46, #7, #9, and #10 document that they are Limited Mental Health residents requiring specially trained staff for supervision and care. 17. During the medication reconciliation on 12/01/2010 at approximately 12:20 PM, the Medication Observation Record for sampled resident #4 revealed that he refused his night medications on 11/28/2010, 11/29/2010 and 11/30/2010. 18. The staffing schedule was reviewed on 12/01/2010 and staff member #4 was scheduled to be alone in the facility from Monday through Friday from 11:00 PM to 7:00 AM. 19.. A record review for staff member #4 documents that he was hired 9/17/2010. There was no documentation available to verify that staff #4 had received specialized training to supervise or provide care for Limited Mental Health Residents. 20. An interview conducted with staff #4 on 12/01/2010, at approximately 11:30 AM revealed that on 11/30/2010 at approximately 9:00 PM he was informed by resident #4 that resident #2 was dressed in women’s clothing and dancing in the room of resident #4. Resident #4 was screaming at resident #2. Staff member #4 stated that he spoke with resident #2 about his/her inappropriate behavior. Staff member #4 stated that at approximately 3:00 AM he was informed that resident #2 and resident #4 were fighting. When he arrived Resident #2 was hitting resident #4 with a 2 x 4 board. Staff member #4 stated that he called the police and the ambulance. Staff member #4 stated that another resident came and grabbed the 2 x 4 from Resident #2. Resident #2 then started to throw stones at people. The police arrived and arrested Resident #2. Resident #4 was transferred to the hospital via ambulance. 21. An interview conducted with the facility Administrator on 12/01/2010 at approximately 1:00 PM, revealed that staff member #4 did not have any specialized training to supervise or provide care to limited mental health residents. The Administrator stated that staff member #4 was hired on 9/17/2010 and did not have time to complete the specialized training given by the Department of Children and Families on supervising and providing care to limited mental health residents. Furthermore, he stated that at the time of the incident staff member #4 was the only staff member on duty. 22. Based on the foregoing, All America ACLF violated Rules 58A-5.019(4) (b), and 58A-5.0182, Florida Administrative Code, a Class II deficiency, which carries, in this case, an assessed fine of $1,000.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State. of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I. B. Assess an administrative fine of $1,000.00 against All America ACLF on Count I, pursuant to Section 429.19, Florida Statutes (2010). Cc. 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 (2010). 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 Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 412-3630. 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. . fa “ Tria Lawton-Ruséell ~! Assistant General Counsel Agency for Health Care Administration 8333 N. W. 53°? Street Suite 300 Miami, Florida 33166 Copies furnished to: Field Office Manager Agency for Health Care Administration 8333 NW 53°¢ Street, Suite 300 Miami, Florida 33166 (Inter-office 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 Pedro Rojas, Administrator, All America ACLF, 8098 “iG 1%* Avenue, s Hialea#, Florida 33010 on x 20 , 11. 4 y ria Lawton-Russell SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY G Dhagent. | A CO) Addressee mpleta ftems. 1/2, and 3, Also complete “lkem:4-If Restrloted Dellvery.ls desired. yur 'hame and.address on the reverse ‘card to the. back of the mallplece, nt if space permits. r dao address below: C1.No 7004 080 booo D58b 3503 \ | PS. Form: 3811, February 2004 Bomestic Return Receipt 102696-02-M-1840

Docket for Case No: 11-002435

Orders for Case No: 11-002435