STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2012000134 Return Receipt Requested: v. 7009 0080 0000 0586 2494 DORA HOME CARE INC. d/b/a DORA HOME CARE INC., 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 Dora Home Care Inc. d/b/a Dora Home Care Inc. (hereinafter “Dora Home Care Inc.” or “ALF” or “Respondent”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2011), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the assisted living facility license [License No.: 10723] pursuant to section 429.14(1)(e), Florida Statutes and to impose an administrative fine of $20,500.00 pursuant to section 429.19, Florida Statutes (2011), for the protection of public health, safety and welfare and to impose a survey fee in the amount of $366.00 pursuant to Section 429.19(2) (c) and 429.19(7), Florida Statutes (2012). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2011), and Chapter 28-106, Florida Administrative Code (2011). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2011). 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 (2011), and Chapter 58A-5 Florida Administrative Code (2011). 5. Dora Home Care Inc. operates a 6-bed assisted living facility. located at 260 East 61 Street, Hialeah, Florida 33013. Dora Home Care Inc. is licensed as an assisted living facility under license number 10723. Dora Home Care Inc. 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. 6. In response to a complaint, a Survey was conducted by Agency personnel on Respondent’s Assisted Living Facility on December 8, 2011. 7. During the survey, AHCA personnel found deficient practice, ..which included (two) 2 Class I violations and- an unclassified violation at Respondent’s Assisted Living Facility. . COUNT TIT DORA HOME CARE INC. ADMITTED A RESIDENT TO ITS ASSISTED LIVING FACILITY WITHOUT INFORMATION ABOUT THE RESIDENT’S MEDICAL NEEDS AND KNOWING THE RESIDENT DID NOT MEET ADMISSION CRITERIA RULE 58A~-5.0181(1) (e), (£), (1), (m) and (n) (1), FLORIDA ADMINISTRATIVE CODE CLASS I VIOLATION 8, AHCA re-alleges and incorporates paragraphs one (1) through seven (7) as if fully set forth herein. DEFICIENT PRACTICE FOR COUNT I 9. Respondent’s Administrator admitted Resident #3 to its facility on 10/20/2011. . 10. The Administrator is the person responsible for determining whether an individual is appropriate for admission to an ALF. In this case, the Administrator admitted the Resident with no information regarding his medical and physical “needs”. The Resident was a 97 years old in need of skilled nursing care. Rule 58A-5.0181(1) (n) (1), F.A.C. ll. The Administrator was aware that the Resident did not meet Residency Criteria for an ALF as follows: 12, Respondent’s administrator was aware Resident #3 had been .discharged by his family against medical advice, from a skilled nursing facility, where he was receiving 24 hour nursing supervision, In order to meet residency criteria for an ALF an individual can “not require 24-hour nursing supervision”. (Rule 58A-5.0181(1) (1), F.A.C. 13. Resident #3 had been hospitalized at Mercy’s Hospital on or about 10/15/11. The Resident’s discharge orders from the hospital indicated that the Resident was being discharged to a skilled nursing facility and was to continue as outpatient follow-up to the hospital. 14. An entry on the ALF’s Observation Log dated 10/20/11 at 7:40 pm, signed by the Administrator/owner reflected the following: “Received Resident #3 from (name of nursing home) Family members discharge from (name of nursing home) under own risk, no medication, no Dr. Order, no information, ____ (Resident #3) health condition poor...” 15. On the day of the complaint survey, 12/8/2011 at 12:52 p.m., the Administrator reiterated to AHCA personnel what was written on the Observation Log, and that resident #3 was admitted to the assisted living facility on 10/20/2011 after the family discharged the resident from a nursing home "at their own risk". There were no medication orders or any other information from the nursing home. 16. The Administrator knew Resident #3 had been discharged 17. Resident 43 hospital admission diagnoses on ©r about 10/5/11, approximately 15 days before the assisted living facility admission occurred were: Aspiration Syndrome with bilateral pneumonia, dementia, Coronary artery disease, history of permanent pacemaker, diabetes mellitus type 2, Severe functional decline, benign Prostatic hypertrophy, Status post rhabdomyolysis. The Resident was discharged from the hospital rehabilitation services. (Rule 58A-5.0181 (m), P.A.C., Provides that in Order to be admitted to an ALF the individual must “not require Skilled rehabilitative Services as described in Rule 59G-4,290,” (Rule 99G-290(2) (e), F.A.C., defines skilled rehabilitative Services) , 19, Resident 43 had orders at the nursing home for Swallowing (diagnosis Dysphasia) , Resident #3 had a medical history of Aspiration Pneumonia. 20. The Administrator knew or should have known that in order to admit an individual to an assisted living facility, the facility must be able to meet any special dietary needs the resident may have. Rule 58A-5.0181(1) (£), F.A.C. 21. An entry on the ALF’s Observation Log dated 10/10/11 at 7:40 pm, signed by the Administrator for Resident #3 states as follows: “,..ALF Administ (sic) had a meeting with staff to explain health and about food (Puree and thickener in food)...” 22. The Administrator had no information or doctor orders regarding the consistency the food Resident #3 was supposed to have or whether thickener was to be added to the food and liquids and in what amounts. The Resident had been scheduled to have a swallowing test at the Nursing Home but had been discharged before it was completed. The Administrator, aware the Resident had problems swallowing, but not knowing the extent of those problems, provided “instructions” to the ALF staff to provide pureed food and use thickener on the Resident’s food. 23. The Administrator knew or should have known that the Rules that govern ALFs provide that in order for an individual to be admitted to an ALF he must “be capable of taking his/her own medication with assistance from staff if necessary”. Rule 58A~5.0181(1) (e), F.A.C. The Administrator knew that Resident #3 was not able to take his own medication. Despite this, the Administrator admitted Resident #3 to the ALF. 24, On 12/8/2011 at 1:04 p.m., the administrator told agency personnel that Resident #3 was not taking his own medication but that the medications were being crushed by ALF personnel, placed into yogurt then fed to the resident. Crushing of medication is not included as assistance with self- administration pursuant to Section 429.256(4) (a), Florida Statutes. The Administrator had no Doctor's orders or instructions regarding the crushing of the medications. CLASSIFICATION OF THE VIOLATION ERATION 25. As required by the general provisions of the health care licensing statute (Sec. 408.813(2), Fla. Stat.) which states that violations “shall be classified according to the nature of the violation and the gravity of its probable effect on clients”, AHCA classified the deficient practice subject of Count I as a Class I violation pursuant to Section 408 (813) (2) (a), Fla. Stat. 26. AHCA determined that the occurrences and conditions subject of Count I presented an imminent danger to the resident or a substantial probability that death or serious physical or emotional harm would result therefrom. 27. Respondent admitted Resident #3 to its ALF despite knowing that the Resident’s health was poor and having no information about the current medications the resident was taking, what doctor’s instructions, rehabilitation order, treatment orders and other pertinent information that was necessary to meet the Resident’s needs. 28. The occurrences related to the operation of the facility in regards to admitting Resident #3 to the facility without any knowledge of the Resident’s medical and physical needs presented an imminent danger to the Resident and/or a substantial probability that death or serious physical or emotional harm would result therefrom. AMOUNT OF THE FINE 29. Pursuant to Chapter 429, Part I, the authorizing statute for assisted living facilities and more specifically Sec. 429.19(2) (a), Fla. Stat. which provides that a class I violation carries a fine of not less than $5,000 and not exceeding $10,000, AHCA imposed a fine of $10,000, for the violation subject of Count I, 30. AHCA took into consideration the factors outlined in Sec. 429.19(3). The higher amount for the fine was established based on the gravity of the violation including the probability that death or serious physical or emotional harm to the Resident could result because of the facility’s actions. Also, AHCA considered the financial benefit to the facility of committing or continuing the violation by admitting a resident that did not meet’ residency criteria and for whom the facility had no information or current medications for. 31. Based on the foregoing facts, Dora Home Care Inc. violated Rule 58A-5.0181(1) (e), (£) (m) and (1), Fla. Admin. Code, herein classified as a Class I violation pursuant to Section 408.813(2) (a), Florida Statutes, which warrants an assessed fine of $10,000.00, pursuant to Sections 429.19(2) (a), and 429.19(3), Florida Statutes and which gives rise to the revocation of the assisted living facility license pursuant to Section 429.14(1)(e), Florida Statutes. COUNT II DORA HOME CARE INC. FAILED TO PROVIDE CARE AND SERVICES TO MEET THE NEEDS OF A RESIDENT RULE 58A-5.0182(1), FLORIDA ADMINISTRATIVE CODE CLASS I VIOLATION 32. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 33, Rule 58A-5.0182 provides that: “An assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. 34. Pursuant to a complaint survey that took place on December 8, 2011, the Agency determined that Respondent failed to provide care and services appropriate to the needs of a resident (Resident #3). 35. Respondent failed to provide current medications to the Resident. Respondent had no information regarding the current medication the Resident was supposed to be taking. On the date of the survey, the Administrator told AHCA personnel that Resident #3's family provided old medication bottles that were in resident #3's apartment from before he was admitted to the hospital. 36. Respondent kept a Medication Observation Record (MOR) for Resident #3 during the time the Resident was at the ALF. The following medications were listed as medications being administered to the resident: Avodart .50 (mg) (8 a.m.); Omeprazole 20 mg (8 a.m.); Glyburide 2.5 mg (8 a.m.); and, Meclizine 25 mg (8 p.m.). Respondent, however, was not able to produce prescriptions, medication bottles or bingo cards for the medications. Therefore it is unknown if these were the medications that the Resident was actually being administered. 10 37. The Administrator had no knowledge regarding the resident’s current medical conditions and what medications the resident had been recently prescribed. 38. During the time the Resident was at the facility no sleeping medication was made available to him. The Resident was having serious trouble sleeping at night. He screamed loudly at night keeping the staff awake and disturbing the other residents at the facility. 39. The Resident's Observation Log had an entry dated 10/22/2011, documenting that staff informed the facility's administrator that resident #3 wasn't sleeping. The facility's administrator ordered staff to monitor resident #3 during the night time to prevent falls. Resident #3, a 97 year old individual with complex medical: problems was not provided medication for sleeping during the time he resided at Respondent’ s assisted living facility. The Resident resided at the facility from 10/20/11 through 10/25/11 when he passed away. The Resident’s record reflected that as of 10/24/2011, a medical doctor had still not seen the resident. 40. The Resident’s record reflected that on 10/24/2011, the Administrator contacted Resident #3's granddaughter and informed her that the resident was not sleeping and that the doctor would visit resident #3 that week. The administrator also documented 11 41, Resident #3 had bruises on both arms and his right foot was Swollen and bruised. Resident #3 had wound care orders at the nursing home dated 10/18/2011. Respondent admitted the Resident to his assisted living facility, aware of the bruises and Swelling and without knowing of any current doctor's or treatment orders. 42, Resident #3 had been scheduled to have a swallowing test at the Nursing Home but had been discharged before it was completed. At the time of admission and Stay, the resident needed a pureed diet because of his medical history with Aspiration Pneumonia. Respondent had no information or doctor orders regarding the consistency the food Resident #3 was Supposed to have or whether thickener was to be added to the food and liquids in what amounts. Despite this, Respondent made arrangements for the Residents food to be pureed, Respondent also used thickener without knowing the amounts that needed to be used for the Resident. 43, The Resident had orders for rehabilitation services 5 problems that he was having with swallowing (diagnosis Dysphasia) . Once admitted to Respondent’ s assisted living facility the rehab services Stopped. 12 44. On 10/25/2011, sometime after 7:45 p.m., resident #3 was found not breathing by staff during her medication rounds. Emergency response was called and resident #3 was pronounced dead at 8:10 p.m. 45, On the day of the investigation, 12/12/2011 at 9:18 a.m., the physician's office listed on the resident's demographical sheet was contacted by telephone. The office stated that the resident was not a patient for the physician. Resident #3 was not seen by a doctor during the time he resided at the ALF. At the very least, the Administrator could have contacted the Resident’s primary physician to obtain information and assistance but failed to do so. CLASSIFICATION 46. As required by the general provisions of the health care licensing statute (Sec. 408.813(2), Fla. Stat.) which states that violations “shall be classified according to the nature of the violation and the gravity of its probable effect on clients”, AHCA classified the deficient practice subject of Count II as a Class I violation pursuant to Section 408 (813) (2) (a), Fla. Stat. 47. AHCA determined that the occurrences and conditions subject of Count II presented an imminent danger to the resident or a substantial probability that death or serious physical or 13 emotional harm would result therefrom. 48. Respondent failed to provide the care and services that Resident #3 needed at the time of admission to the assisted living facility and during the resident’s stay there. 49, AHCA determined. that the failure to provide the care and services that Resident #3 needed placed him at imminent danger or a substantial probability that death or serious physical or emotional harm would result therefrom. AMOUNT OF THE FINE 50. Pursuant to Chapter 429, Part I, the authorizing statute for assisted living facility and more specifically Sec, 429.19(2) (a), Fla. Stat. which provides that a class I violation carries a fine of not less than $5,000 and not exceeding $10,000, AHCA imposed a fine of $10,000, for the violation. Sl. AHCA took into consideration the factors outlined ‘in Sec. 429.19(3). “the higher amount was established based on the gravity of the violation, including the probability that death or serious physical or emotional harm to the Resident could result because of the facility’s actions. Also, AHCA considered the financial benefit to the facility of committing or continuing the violation by admitting and keeping a resident that did not meet residency criteria and for whom the facility had no information or current medications for. 14 52. Based on the foregoing facts, Dora Home Care Inc. violated Rule 58A-5.0182, Florida Administrative Code, herein classified as a Class I violation pursuant to Section 408.813(2) (a), Florida Statutes, which warrants an assessed fine of $10,000.00, pursuant to Section 429.19(2) (a), Florida Statutes and which gives rise to the revocation of the assisted living facility license pursuant to Section 429.14(1) (e), Florida Statutes. COUNT IIT DORA HOME CARE INC. EXCEEDED LICENSED CAPACITY RULE 59A-35.040(1)-(3), FLORIDA ADMINISTRATIVE CODE SECTION 408.813. (3(c), FLORIDA STATUTES UNCLASSIFIED VIOLATION 53. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 54. A complaint survey was conducted on December 8, 2011. Based on record review and interview, it was determined that the assisted living facility failed to comply with its licensed capacity and/or failed to submit to the Agency 60 to 120 days in advance a request to modify the licensed capacity. The facility exceeded the licensed capacity of 6 residents for the months of July, August, September, October, and November. The findings include the following. 15 55. Record review found the following: a. Resident #1 was admitted to the facility on 11/4/2010 and discharged 11/19/2011. b. Resident #2 was admitted to the facility on 7/28/2011 and discharged 9/15/2011. c. Resident #3 was admitted to the facility on 10/20/2011 and passed away on 10/25/2011. d. Resident #4 was admitted to the facility on 9/1/2010 went to the hospital 10/12/2011 and returned from the hospital on 10/18/2011. e. Resident #5 and #6 (husband and wife) were admitted to the facility on 12/26/2009. f. Resident #7 was admitted to the facility on 2/8/2011. g. Resident #8 was admitted to the facility on 7/1/2011. h. Resident #9 was admitted to the facility on 12/15/2006 and discharged on 11/25/2011. 1. Resident #10 was admitted to the facility on 6/2/2008. 56. The facility's admission and discharge log plus the facility's medication observation records revealed that the facility had a history of being over its licensed capacity of 6 residents. 16 57. For the months July, August, and September (2011) the facility had nine residents (#1, #2, #4, #5, #6, #7, #8, #9, #10) instead of its licensed capacity of 6 residents. 58. For the month of October (2011) the facility again had nine residents (#1, #3, #4, #5, #6, #7, #8, #9, #10) instead of its licensed capacity of 6 residents. 59. For the month of November (2011) the facility had eight residents (#1, #4, #5, #6, #7, #8, #9, #10) instead of its licensed capacity of 6 residents, 60. The findings were reviewed with the administrator on 12/8/2011 at 12:45 p-m., who acknowledged that the facility was over capacity for several months. 61. Based on the foregoing facts, Dora Home Care Inc. violated Rule 59A-35.040(1) and (2), Florida Administrative Code, which “warrants an assessed fine of $500.00 pursuant to 59A-35.040(3), Florida Administrative Code and Section 408.813(3) (c), Florida Statutes. SURVEY FEE Pursuant to Section 429.19(7), Florida Statues (2012), AHCA may assess a survey fee in the amount of $366.00 to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits. 17 CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: i. Enter a judgment in favor of the Agency for Health Care Administration against Dora Home Care Inc. on Counts I through TII. 2. Revoke Respondent’s assisted living facility license [License No.: 10723] and assess an administrative fine of $20,500.00 against Dora Home Care Inc. on Counts I through III for the violations cited above. 3. Assess a survey fee of $366.00 against Dora Home Care Inc. on Counts I through III for the violations cited above. 4. 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 (2011). Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency Clerk, Agency for 18 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 BR REPRESENTED BY AN ATTORNEY IN THIS MATTER Alba M, Rodrtgue Esqf. Oe Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8333 N.W. 537* Street Suite 300 Miami, Florida 33166 Tel. (305)718-5911 Fax (305) 718-5960 alba. rodriguez@ahca.myflorida.com Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 8333 N. W. 53° Street - Suite 300 Miami, Florida 33166 (Interoffice Mail) 19 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has beén furnished by U.S. Certified Mail, Return Receipt Requested to Eduardo Perez, Administrator, Dora Home Care Inc., 260 East 61 Street, Hialeah, Florida 33013 on this 2O ™ day of Jantiary, 2013. QLbe , acento, Alba M. 2th. Radi y 20 ~ U.S. Postat Service w. CERTIFIED: MAILu: RECEIPT ee ero /,(Bomestic'Mail Only;.No Insurance Coverage Provided) For delivery information visit our website at www.usps.come ; OFFICIAL USE Postage Certilied Fee K Rotuin Recelpt Fee Postma (Gifdorsement Required) esttioted Delivery Fee (Endorsament Required) 7009 g080 0000 6586 euAitt BS Folin 9800, August 2006 COMPLETE THIS SECTION ON DELIVERY

Docket for Case No: 13-000840

Orders for Case No: 13-000840