hid.. STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, VERSA Nos. 2012007505 vs. ; and 2012009335 FLORIDA CARING HANDS CORPORATION d/b/a APPLE HOUSE II, Respondent . / -ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (the “Agency”) and files this administrative complaint against Florida Caring Hands Corporation d/b/a Apple House II (“Respondent” or “Respondent Facility”), pursuant to §§ 120,569, and 120.57, Fla. Stat., and alleges: NATURE OF THE ACTION ‘This is an action to impose an administrative fine in the amount of six thousand dollars ($6,000.00) and survey fees of one thousand dollars ($1,000.00), or such other relief as this tribunal may determine, based upon the Respondent’s being cited for four (4) Class II violations during two successive Agency surveys, pursuant to Chapter 408, Part II, and Chapter 429, Part 1, Fla. stat., and Chapter 58A-5, Fla. Admin. Code. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Sections Page 1 of 21 bee 20.42, 120.60, and 429.07, and Chapter 408, Part II, Florida Statutes. 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES ) 3. The Agency is the regulatory authority responsible for licensing assisted living facilities and enforcing all applicable state statutes and rules governing assisted living facilities, pursuant to Chapter 408, Part II, and Chapter 429, Part I, Florida Statutes, and Chapter 58A~5, Florida Administrative Code. 4, Respondent operates a 26-bed assisted living facility located at 2301 South Highway 17, Crescent City, Florida 32112, and is licensed as an assisted living facility, license number 9265, with extended congregate care designation. 5, At all times material to the allegations of this administrative complaint, Respondent was a Licensed facility: under the licensing authority of the Agency and was required to comply with all applicable rules and statutes. COUNT I A25 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth in this count. 7. Rule 58A-5.0182, Florida Administrative Code, requires: “BA-5.0182 Resident Care Standards. Page 2 of 21 An assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. (1) SUPERVISION. Facilities shall offer personal supervision, as appropriate for each resident, including the following: : (a) Monitor the quantity and quality of resident diets in accordance with Rule 58A-5.020, F.A.C, (b) Daily observation by designated staff of the activities of the resident. while on the premises, and awareness of the general health, safety, and physical and emotional: well-being of the individual. (c) General awareness of the resident's whereabouts, The resident may travel independently in the community, (d) Contacting the resident’s health care provider and other appropriate party such as the resident's family, guardian, health care Surrogate, or case manager if the resident exhibits a significant change; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out. (e) A written record, updated as needed, of any significant changes as defined in subsection 58A- 5.0131(33), F.A.C., any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services, 8, On May 7, 2012, the Agency conducted a biennial relicensure survey of Respondent. 9. Based on the Agency’s surveyor’s observations, review of Respondent's records, and interviews, the Agency determined that for two residents, Residents #1 and #2, the Respondent failed to have documented verification that each resident's physician was contacted regarding a significant change, and Respondent failed to document each resident's change in method of medication administration. Page 3 of 21 10. On 05/07/12, at 10:30 AM, the Agency’ s surveyor interviewed Respondent's medication tech. Respondent's medication tech reported that if Resident #1 does not get up for breakfast she does not take her 8:00 AM médications until 12 noon. Review of the Medication Observation Record (“MOR”) for . 05/07/12 revealed that Resident #1's 8:00 AM medications had not been recorded as taken. Further file review revealed that Resident #1's blood pressure was scheduled to be taken at 8:00 AM, and that her pain patch was to be taken off at 8:00 AM, and the MOR for 05/07/12 did not reflect that her blood pressure had been, taken, or that the patch was taken off. 11. During the 05/07/12, 10:30 AM interview, Respondent’ s medication tech also related to the Agency’s surveyor that the resident's physician was aware of Respondent’s practice as -described in above paragraph 10, to change Resident #1’s method of medication, but review of the available physician’s orders revealed that the facility did not have an order indicating that the resident's physician was aware of this practice, nor did Respondent have an order advising the facility to continue with this practice. 12. During 12:15 PM lunch, the Agency’s surveyor observed Resident #2 sitting at the table with her lunch in front of her, but not attempting to eat. At 12:19 PM Respondent’s staff was observed to attempt to feed her spaghetti; her eyes were closed, Page 4 of 21 and she was not accepting the regular diet texture. At 12:28 PM staff made a second attempt to feed the resident, and again she did not accept the food, and the staff person walked away. At 12:32 PM, a second staff person asked Resident #2 if she wanted to eat, Resident #2 did not respond, and Resporident’s second staff person took the resident's plate away. Jell-O was served for lunch, but was not offered to the resident, and no fluids were offered during the Agency’ s surveyor’s observations. At 12:35 PM the resident was taken to the 1 room, and placed ina recliner. At 2:30 PM Resident #2 was still in the recliner, and observation of the staff interactions with the residents revealed that no other attempts were made of offer the resident food or fluids. 13. On 05/07/12 starting at approximately 4:00 PM, the Agency's surveyor interviewed Respondent’s administrator. Respondent’ s administrator reported that Resident #2 sometimes does not eat, and on other days she will eat.. Review of the resident's file revealed no documentation of the facility notifying the resident's physician of the resident’s not eating or drinking fluids. Further review of the resident's file revealed that the facility did not have physician's orders instructing the facility of the steps to take when the resident refuses to eat. 14. The Agency determined that this deficient practice of Page 5 of 21 failing to have documented verification that each resident's physician was contacted regarding a significant change, and “failing to document each resident’s change in method of medication administration are each related. to the personal care of Respondent’ s residents that directly threatened the health, safety, or security of the residents and cited Respondent for a State Class II deficiency pursuant to §§ 408.813 and 429.19, Florida Statutes. 15. The Agency provided Respondent with a mandatory correction date of June 7, 2012. 16. On July 12, 2012, the Agency conducted a revisit survey to the Agency’s prior survey of May 7, 2012. 17. Based on the Agency’s surveyor’s observations, interviews and review of Respondent's records, the Agency determined that for one resident, Resident #4, of the four ' residents whose care was reviewed, the Respondent failed to have documentation verifying that the resident's health care provider was contacted regarding the resident’s significant changes in condition and changes in amounts of food intake, and there was no documentation of the significant changes. 18. The Agency’s surveyor interviewed Resident #4 on 7/12/12 at 12:20 PM. Resident #4 stated he had been sick to his stomach and unable to eat and his feet had swollen and were painful. The resident was offered lunch on 7/12/12, but refused Page 6 of 21 ete all but the watermelon. He stated, "I've been unable to eat what they have, so I eat whatever I can get down, I asked for some tomato soup'the other day, and I threw that up toos I'ma mess." The resident stated he was going to the doctors on the date of the survey to see about his UTI infection and his feet. 19, On 7/12/12 at 3:45 PM, the Agency’s surveyor interviewed Respondent’s administrator. Respondent’ s administrator stated that she was not aware of the resident's eating difficulty or of the increased swelling of Resident #4’s feet. 20. The administrator pulled Resident #4's record. Resident #4’s Extended Congregate Care notes had 5 entries: 5/7/12, 5/10/12, 5/29/12, 6/25/12, and 7/2/12. The last entry ‘dated 7/2/12 included the documentation: "Resident encouraged to dangle for lunch, stated he has back pain when sitting up, ate well." The administrator stated, "I don't know why there is no documentation about his eating and his foot problems; I didn't know anything about them." The administrator was unable to find documentation informing the resident's physician about Resident #4’ 8 changes in eating and increased pain in Resident #4’s feet, 21. The Agency determined that this deficient practice of failing to have documented verification that each resident! s physician was contacted regarding a significant was related to the personal care of Respondent’s residents that directly Page 7 of 21 threatened the health, safety, or security of the residents and cited Respondent for a State Class II deficiency pursuant to §§ 408.813 and 429,19, Florida Statutes. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $3,000.00 against Respondent, an assisted living-facility in the State of Florida, pursuant to Sections 408.813 and 429,19, Florida Statutes. COUNT IT A50 22. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth in this count. , 23. . Section 429.256, Florida Statutes, requires: (2) Residents who are capable of self-administering their own medications without assistance shall be encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed prescription’s label or the package directions of an over-the-counter medication, assist a resident whose condition is medically stable with the self-administration of routine, regularly scheduled medications that are intended to be self-administered. Assistance with self- medication by an unlicensed person may occur only upon a documented request by, and the written informed . consent of, a resident or the resident's surrogate, guardian, or attorney in fact.:For the purposes of this ' section, self-administered medications include both legend and over-the-counter oral dosage forms, topical dosage forms and topical ophthalmic, otic, and nasal dosage forms including solutions, suspensions, Sprays, and inhalers. (3) Assistance with self-administration of medication includes: (a) Taking the medication, in its previously dispensed, properly labeled container, from where it is stored, and bringing it to the resident. (b) In the presence of the resident, reading the label, opening the container, removing a prescribed amount of Page 8 of 21 on oy eee medication from the container, and closing the container. , (c)’ Placing an oral dosage in the resident’s hand or placing the dosage in another container and helping the resident by lifting the container to his or her mouth. (d) Applying topical medications. (e) Returning the medication container to proper storage. f) Keeping a record of when a resident receives assistance with self~administration under this section. (4) Assistance with self-administration does not include: a) Mixing, compounding, converting, ox calculating medication doses, except for measuring a prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed. b) The preparation of syringes for injection or the administration of medications by any injectablé route. (c) Administration of medications through intermittent positive pressure breathing machines or a nebulizer. (d) Administration of medications by way of a tube inserted in a cavity of the body. (e) Administration of parenteral preparations. (£) Irrigations or debriding agents used in the treatment of a skin condition. (g) Rectal, urethral, or vaginal preparations. (h) Medications ordered by the physician or health care professional with prescriptive authority to be given ‘as needed,” unless the order is written with specific parameters that preclude independent judgment on the part of the unlicensed person, and at the request of a competent resident. (1) Medications for which the time of administration, the amount, the strength of dosage, the method of administration, or the reason for administration requires judgment or discretion on the part of the unlicensed person. 24, Section 429.07(3), Fla. Stat., provides; (3) ASSISTANCE WITH SELF-ADMINISTRATION. (a) For facilities which provide assistance with self- administered medication, either: a nurse; or an _ unlicensed staff member, who is at least 18 years old, trained to assist with self-administered medication in accordance with Rule 58A~-5.0191, F.A.C., and able to demonstrate to the administrator the ability to Page 9 of 21 eet accurately read and interpret a prescription label, must be available to assist residents with self- administered medications in accordance with procedures described in Section 429.256, F.S. (6) Assistance with self-administration of medication includes verbally prompting a resident to take medications as prescribed, retrieving and opening a properly labeled medication container, and providing assistance as specified in Section 429.256(3), F.S. In order to facilitate assistance with self- administration, staff may prepare and make available such items as water, juice, cups, and spoons. Staff may also return unused doses to the medication container. Medication, which appears to have been contaminated, shall not be returned to the container. (c) Staff shall observe the resident take the medication. Any concerns about the resident’s reaction to the medication shall be reported to the resident's health care provider and documented in the resident's record. (5) MEDICATION RECORDS. (a)... _ (b) The facility shall maintain a daily medication observation record (MOR) for each resident who receives assistance with self-administration of medications or “medication administration. A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident's health care provider, the health care provider's telephone number; the name, strength, and directions for use of each medication; and a chart for recording each time the . Medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered. 25. Rule 58A-5,0185, Florida Administrative Code, requires: Pursuant to Sections 429.255 and 429.256, F.S., and this rule, licensed facilities may assist with the self-administration or administration of medications to residents. in a facility. A resident may not be compelled to take medications but may be counseled in accordance with this rule. (1) SELF ADMINISTERED MEDICATIONS. Page 10 of 21 csinciskt:ssexuuntencnieel vata ssintmilct cpesicvaskvelcuaaacecnuae, saeneen hae (a) Residents who are - capable of self-administering their medications without assistance shall be encouraged and allowed to do so. (b) If facility staff note deviations which could reasonably be attributed to the improper self- administration of medication, staff shall consult with the resident concerning any problems the resident may be experiencing with the medications; the need to permit the facility to aid the resident through the use of a pill organizer, provide assistance with self- administration of medications, or administer medications if such services are offered by the facility. The facility shall contact the resident’s health care provider when observable health care changes occur that may be attributed to the resident’s medications. The facility shall document such contacts in the resident’s records. 26. Rule 58A-5.024, Florida Administrative Code, requires: (3) RESIDENT RECORDS. Resident records shall be maintained on the premises and include: (h) For facilities which manage a pill organizer, assist with self-administration of medications or administer medications for a resident, the required medication records maintained pursuant to Rule 58A- 5.0185, F.A.C. 27. On May 7, 2012, the Agency conducted a biennial relicensure survey of Respondent. 28. Based on the Agency’s surveyor’s review of Respondent’s records and interviews, the Agency determined that for one resident, Resident #1, of the two residents whose care by Respondent was reviewed, the Respondent failed to have documented verification of contacting the resident's health care provider after noted deviations which could reasonably be attributed to the improper self-administration of medications. Page 11 of 21 ~~ 29. During an interview conducted by the Agency’s surveyor on 05/07/12, at 10:30 AM, the medication tech reported that if Resident #1 does not get up for breakfast, she does not take her 8:00 AM medications until 12 noon. Review of the Medication Observation Record (MOR) for 05/07/12 revealed that the . following 8:00 AM medications and procedures had not been recorded as taken or completed: Lidoderm Patch 5% (12hours on) On at 8 P off at 8 A Hydrocholodiazide 25 mg Mryoptolol Tartrate 100 mg Hydrorocone 10/50 mg Amlodipine 10 mg Folic Acid 1 mg Omeprazole DR 4 mg Colcrys 0.6 mg Mult-Vit W/Iron Blood Pressure at 8 AM Alphagan 0.1% both eyes Lumingagn 0.01% both eyes Dorzalamide Timolol both eyes 30. Although it was also reported by Respondent’ s medication tech to the Agency’s surveyor during the 05/07/12, 10:30 AM interview that the resident's physician was aware of this practice of failure to regularly and timely self-administer Page 12 of 21 medications, Respondent had no documentation. And, review of the available physician orders revealed that the Respondent did not have an order indicating that the resident's physician was aware of this practice, or an order advising the facility to continue with this. practice of missing or delaying scheduled medications. 31. The Agency determined that this deficient practice of failing to note deviations by Resident #1 which could reasonably be attributed to improper self-administration of medication was related to the personal care of Respondent's residents that directly threatened the health, safety, or security of the residents and cited Respondent for a State Class II deficiency ‘pursuant to §§ 408.813 and 429.19, Florida Statutes. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,500.00 against Respondent, an assisted living facility in the State of Florida, pursuant to Sections 408.813 and 429.19, Florida Statutes. “COUNT III AE207 32. The Agency re~alleges and incorporates paragraphs one (1) through five (5), as if fully set forth in this count. 33. Section 429.02, Florida Statutes, defines: (11) “Extended congregate care” means acts beyond those authorized in subsection (16) that may be performed pursuant to part I of chapter 464 by persons licensed thereunder while carrying out their professional duties, and other supportive services which may be Page 13 of 21 ee, specified by rule. The purpose of such services is to enable residents to age in place in a residential environment despite mental or physical limitations that might otherwise disqualify them from residency in a facility licensed under this part. (16) “Personal services” means direct physical assistance with or supervision of the activities of daily living and the self-administration of medication and other similar services which the department may define by rule. “Personal services” shall not be construed to mean the provision of medical, nursing, dental, or mental health services. 34. Rule 58A-5.030, Florida Administrative Code, requires: (4) STAFFING REQUIREMENTS. Each extended congregate care program shall: (a) Specify a staff member to serve as the exténded congregate care supervisor if the administrator does not perform this function. If the administrator supervises more than one facility,. he/she shall appoint a separate ECC supervisor for each facility holding an extended congregate care license. 1. The extended congregate care supervisor shall be _ responsible for the general supervision of the day-to- day management of an ECC program and ECC resident service planning. . 2. The administrator of a facility with an extended “congregate care license and the ECC supervisor, if separate from the administrator, must have a minimum of two years of managerial, nursing, social work, therapeutic recreation, or counseling experience in a residential, long term care, or acute care setting or agency serving elderly or disabled persons, A baccalaureate degree may be substituted for one year of the required experience. A nursing home administrator licensed under Chapter 468, F.S., shall be considered qualified under this paragraph. (b) Provide, as staff or by contract, the services of a nurse who shall be available to provide nursing services as needed by ECC residents, participate in the development of resident service plans, and perform monthly nursing assessments. (c) Provide enough qualified staff to meet the needs of ECC residents in accordance with Rule 58A 5.019, F.A.C., and the amount and type of services Page 14 of 21 he established in each resident’s service plan. (d) Regardless of the number of ECC residents, awake staff shall be provided to meet resident scheduled and unscheduled night needs. (e) In accordance with agency procedures established in Rule 58A-5.019, F.A.C., the agency shall require facilities to immediately provide additional or more qualified staff, when the agency determines that service plans are not being followed or that residents’ needs are not being met because of the lack of sufficient or adequately trained, staff. (f) Ensure and document that staff receive extended congregate care training as required under Rule 58A 5.0191, P.A.C. (7) SERVICE PLANS, -(a) Prior to admission the extended congregate care supervisor shall develop a preliminary service plan which includes an assessment of whether the resident meets the facility’s residency criteria, an appraisal of the resident’s unique physical and psycho social needs and preferences, and an evaluation of the facility’s ability to meet the resident's needs. (b) Within 14 days of admission the congregate care supervisor shall coordinate the development of a written service plan which takes into account the .resident’s health assessment obtained pursuant to subsection (6); the resident’s unique physical and psycho social needs and preferences; and how the facility will meet the resident’s needs including the following if required: . » Health monitoring; . Assistance with personal care services; . Nursing services; . Supervision; . Special diets; . Ancillary services; . The provision of other services such as transportation and supportive services; and 8. The manner of service provision, and identification of service providers, including family and friends, in keeping with resident preferences. (c) Pursuant to the definitions of “shared responsibility” and “managed risk” as provided in Section 429,02, F.8., the service plan shall be developed and agreed upon by the resident or the resident's representative or designee, surrogate, SNHKOBWNHE Page 15 of 21 guardian, or attorney~in-fact, the facility designee, and shall reflect the responsibility and right of the resident to consider options and assume risks when making choices pertaining to the resident's service needs and preferences. (d) The service plan shall be reviewed and updated © quarterly to reflect any changes in the manner of service provision, accommodate any changes in the resident’s physical or mental status, or pursuant to _ recommendations for modifications in the resident's care as documented in the nursing assessment. (8) EXTENDED CONGREGATE CARE SERVICES. All services shall be provided in the least restrictive environment, and in a manner which respects the resident’s independence, privacy, and dignity. (a) An extended congregate care program may provide supportive services including social service needs, counseling, emotional support, networking, assistance with securing social and leisure services, shopping service, escort service, companionship, family support, information and refertal, assistance in developing. and implementing self-directed activities, and volunteer services. Family or friends shall be encouraged to provide supportive services for residents. The facility shall provide training for family or friends to enable them to provide supportive services in accordance with the resident’s service plan. (6) An extended congregate care program shall make available the following additional services if required by the resident’s service plan: ; 1. Total help with bathing, dressing, grooming and toileting; 2. Nursing assessments conducted more frequently than monthly; 3. Measurement and recording of basic vital functions and weight; 4. Dietary management including provision of special diets, monitoring nutrition, and observing the vesident’s food and fluid intake and output; 5. Assistance with self-administered medications, or the administration of medications and treatments pursuant to a health care provider's order. If the individual needs assistance with self-administration the facility must inform the resident of the qualifications of staff who will be providing this assistance, and if unlicensed staff will be providing such assistance, obtain the resident’s or the Page 16 of 21 i vesident’s surrogate, guardian, or attorney-in-fact’s informed consent to provide such assistance as required under Section 429.256, F.S.; 6. Supervision of residents with dementia and cognitive — impairments; 7. Health education and counseling and the implementation of health-promoting programs and preventive regimes; 8. Provision or arrangement for rehabilitative services; and 9. Provision of escort services to health related appointments. (c) Licensed nursing staff in an extended congregate care program may provide any nursing service permitted within the scope of their license consistent with the residency requirements of this rule and the facility's written policies and procedures, and the nursing services are: 1. Authorized by a health care provider’s order and pursuant to a plan of care; 2. Medically necessary and appropriate for treatment of ‘the resident’s condition; 3. In accordance with the prevailing standard of practice in the nursing community; 4. A service that can be safely, effectively, and efficiently provided in the facility; 5. Recorded in nursing progress notes; and 6. In accordance with the resident’s service plan. (d) At least monthly, or more frequently if required by the resident’s service plan, a nursing assessment of the resident shall be conducted. (9) RECORDS, (a) In addition to the records required under Rule 58A 5.024, F.A.C., an extended congregate care program . shall maintain the following: 1. The service plans for each resident receiving extended congregate care services; 2, The nursing progress notes for each resident receiving nursing services; 3. Nursing assessments; and 4. The facility’s ECC policies and procedures. 35. On July 12, 2012, the Agency conducted a revisit to the Agency’s prior survey of May 7, 2012. Page 17 of 21 | | Se 0S eS 36. Based on the Agency’s surveyor’s observations and. interviews, the Agency determined that Respondent failed to provided services specified in a resident's service plan to one resident, Resident #4, of the four residents whose care by Respondent was reviewed by the Agency. 37. The Agency’s surveyor reviewed Respondent! s records for Resident #4. Resident #4's Extended Congregate Care (“ECC”) Monthly Nursing Assessment had the "Service to be Provided" section dated 5/7/12 filled out with "Assistance to resident's dependent to staff with feeding," and for the outcome section of ‘the ECC assessment: "Maintain 3 balance meal with adequate food intake." 38. Resident #4’s ECC notes included 5 entries since the resident's admission on 5/7/12, with the last entry dated 7/2/12 recorded as "ate well" and "stable." 39, The Agency’s nurse surveyor observed and concurrently interviewed Resident #4 on 7/12/12 at 12:15 PM. The resident was given watermelon for lunch with a. protein shake. The protein shake was handed to the resident, and the bowl of watermelon was. put on a tray located out of Resident #4's reach. The resident ‘attempted to find his food and was unable to reach his bowl of . watermelon, spoon, and napkin. The resident stated, "I think I'm gonna need my teeth," then attempted to find them and could not. The resident stated, "I'm blind so I just wait for them to _ Page 18 of 21 as oe tee bade a. come back if I need something; they are real busy at lunch." The resident added "I haven't been eating so well lately and have been throwing up; my legs have been bothering me and are swollen." 40. The Agency’s surveyor interviewed Respondent’ s administrator on 7/12/12 at 3:30 PM. Respondent’s administrator admitted, "I don't know what happened; we have more staff than usual and none of them helped him." The administrator added, "TI didn't know about his legs and his throwing up, and I don't know why there is no documentation about his (Resident #4's) changes; they should have notes." 41. The Agency determined that this deficient practice of failing to assist Resident #4 with eating as specified in Resident #4’s service plan was related to the personal care of Respondent’s residents that directly threatened the health, safety, or security of the residents and cited Respondent for a state Class II deficiency pursuant to §§ 408.813 and 429,19, Florida Statutes. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,500.00 against Respondent, an assisted living facility in the State of Florida, pursuant to Sections 408.813 and 429.19, Florida Statutes. COUNT IT SURVEY FEE 42, The Agency re-alleges and incorporates above Count Page 19 of 21 I, TZ and III. 43. Section 429.19(7), Florida Statutes, provides: (7) In addition to any administrative fines imposed, the agency may assess a survey fee, equal to the lesser of one half of the facility’s biennial license and bed fee or $500, 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 conducted under s. 429.28(3) (c) to verify the correction of the violations. 44, Section 429,28(3) (c), Florida Statutes, provides: (c) During any calendar year in which no survey is conducted, the agency shall conduct at least one monitoring visit of each facility cited in the previous year for a class I or class II violation, or more than three uncorrected class III violations. 45. One or more of the above Agency surveys found one or more Class II violations that will be the subject of a monitoring visit. WHEREFORE, the. Agency intends to impose a survey feé of $1,000 or as determined by this tribunal against Respondent, an assisted living facility in the State of Florida, for the above- described class I violation, pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes, or such further relief as this tribunal deems just. NOTICE OF RIGHTS Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Page 20 of 21 Sn a ee eed ee Rights. All requests for hearing shall be made to the Agency for Health Care Administration and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, FL 32308, whose telephone number is 850-412-3630. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY, CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No, 7012 1010 0000 5357 3504, to Mary Ann Vinarta, ; Administrator, Apple House II, 2301 South Highway 17, Crescent City, Florida 32112, and by regular U.S. Mail to Ulysses F. Vinarta, .Jr., Registered Agent for Florida Caring Hands Corporation d/b/a Apple House II; 2301 South Highway 17, Crescent City, Florida 32112, on Februar Zz 2013. A tant General Counsel Fla, Bar. No. 817775 Agency for Health Care Admin. 525 Mirror Lake Drive, 330D se . St. Petersburg, Florida 33701 _ . 727-552~1944 (office) 727-552-1440 (facsimile) Copies furnished to: Anna Lopez, HFE Supervisor, Alachua Page 21 of 21 oe onal } . Vinarta fAdmind str : [Apple House ‘IT... 72301 South Highway 17 } Crescent City, Florida 32112 DELIVERY

Docket for Case No: 13-001105

Orders for Case No: 13-001105