STATE OF FLORIDA . AGENCY FOR HEALTH CARE ADMIN ISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Vs. ‘AHCA No. 2013013444 HARBORCHASE OF GAINESVILLE, INC d/b/a HARBORCHASE OF GAINESVILLE, Respondent. / ADMINISTRATIVE COMPLAINT ERATIVE COMPLAINT. COMES NOW the Petitioner, State Of Florida, Agency For Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Harborchase of Gainesville, Inc. d/b/a Harborchase of Gainesville (hereinafter “the Respondent”), pursuant to sections 120.569 and 120.57, Florida Statutes (2012), and alleges: NATURE OF THE ACTION 1, This is an action impose an administrative fine in the amount of ($2,200.00), based upon two class II violations. PARTIES 2. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable state statutes and rules governing assisted living facilities pursuant to the Chapter 408, Part II, Chapter 429, Part I, Florida Statutes, and Chapter 38A-5, Florida Administrative Code, respectively. 3. The Respondent operates a six (79)-bed assisted living facility located at 1415 Fort Clarke BLVD, Gainesville, Florida 32606 and is licensed as an assisted living facility, with Extended Congregate Care (ECC), license number 9185, and was at all times material hereto required to comply with all applicable rules and statutes. COUNTI Resident Care - Rights & Facility Procedures 4. Florida Administrative Code Rule 58A-5.0182(6) states in pertinent part: Resident Care Standards, An assisted living facility shall provide care and services appropriate to the needs of Residents accepted for admission to the facility. (6) RESIDENT RIGHTS AND FACILITY:PROCEDURES. (a) A copy of the Resident Bill of Rights as described in Section 429.28, | F.S., or a summary provided by the Long-Term Care Ombudsman Council shall be posted in full view in a freely accessible Resident area, t and included in the admission package provided pursuant to Rule 58A- i 5.0181, F.A.C. (b) In accordance with Section 429.28, F.S., the facility shall have a written grievance procedure for receiving and responding to Resident complaints, and for Residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint. (c) The address and telephone number for lodging complaints against a facility or facility staff shall be posted in full view in a common area accessible to all Residents. The addresses and telephone numbers are: the District Long-Term Care Ombudsman Council, 1(888)83 1-0404; the Advocacy Center for Persons with Disabilities, 1(800)342-0823; the Florida Local Advocacy Council, 1(800)342-0825; and the Agency Consumer Hotline 1(888)419-3456. (d) The statewide toll-free telephone number of the Florida Abuse Hotline “1(800)96-ABUSE or 1(800)962-2873” shall be posted in full view in a common area accessible to all Residents. 5. Section 429.28 Florida Statutes states in pertinent part: Resident bill of rights — (1) No Resident of a facility shall be deprived of any civil or legal tights, benefits, or privileges guaranteed by law, the Constitution of the i State of Florida, or the Constitution of the United States as a Resident of i a facility. Every Resident of a facility shall have the right to: (a) Live in a safe and decent living environment, free from abuse and neglect. De ak oe (7) Any person who submits or reports a complaint concerning a suspected violation of the provisions of this part or concerning services and conditions in facilities, or who testifies in any administrative or judicial proceeding arising from such a complaint, shall have immunity from any civil or criminal liability therefor, unless such person has acted ~ in bad faith or with malicious purpose or the court finds that there was a complete absence of a justiciable issue of either law or fact raised by the losing party. 6. Section 429.14(1)(a), Florida Statutes states in pertinent part Under Florida law, in addition to the requirements of part II of chapter 408, the agency may deny, revoke, and suspend any license issued under this part and impose an administrative fine in the manner provided in chapter 120 against a licensee for a violation of any provision of this part, part II of chapter 408, or applicable rules,-or for any of the following actions by a licensee, for the actions of any person subject to level 2 background screening under s. 408.809, or for the actions of any facility employee: (a) An intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility, 7. Under Florida law, an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. 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-5.013 1(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. S8A- 5.0182(1), Fla. Admin Code. 8. Based on interviews and record reviews the facility failed to provide an environment free from abuse for 1 of 7 residents (#1). 9. On 11/18/2013 at approximately 9:30 AM an interview was conducted with the Administrator in reference to the incident between residérits #1 and #2 on 10/20/2013. She stated that resident #2 was sleep walking and attempting to get into other resident rooms in the memory care unit. She stated Care Manager D tried to redirect resident #2 back to his room without success. Care Manager D called for assistance from Care Manager C and together they attempted to redirect resident #2 to his room. Resident #2 went into resident #1 room and laid in the bed next to her and put his hand on top of resident #1 breast area on top of her clothes. The Administrator stated resident #1 was removed from her room for her safety because resident #2 refused to leave the room. The Administrator stated. she called the Department of Children and Family abuse hotline and attempted to make a report but they refused to accept it. She was asked if she called law enforcement about the incident and she said no. She said the family called DCF and the Alachua Sheriffs Office which responded and conducted an investigation. 10. On 11/18/2013 a record review was conducted on facility incident report and progress notes dated 10/20/13. According to the reports on 10/20/13 at approximately 12:00 AM care Manager C responded to the memory care unit to assist Care Manager D. with resident #2. Care Manager C witnessed resident #1 being touched inappropriately on her breast by resident #2 who had gone into resident #1 room. Resident #2 was unable to be redirected out of resident #1 room by staff. Resident #1 was removed from her room to a furnished spare room to sleep for the night. Resident #1 was observed to be in a deep sleep during the incident and unaware of what was happing when she was wakened and moved to another room. There was no apparent physical injuries to resident #1, 11. On 11/18/2013 a record review was conducted on the facilities policy and procedures for Abuse, Neglect and Exploitation. It was observed that the policy under section "External Reporting/Notification" pg. 6 paragraph d) it states; The Executive Director or designee should notify local law enforcement when it appears that a crime has been committed. Regulatory Affairs should be contacted if there is a question regarding whether law enforcement should be notified. 12. On 11/18/2013 at approximately 12:40 PM an interview was conducted with the Administrator in reference to her call to DCF hotline. She stated that she called DCF hotline because she thought the incident was possible abuse. When she was asked if she suspected abuse (which is a crime) why did she not call law enforcement and report the incident herself. She stated that was why she called DCF so they could determine if the incident was abuse or not and then they could notify law enforcement. 13. On 11/18/2013 at approximately 3:51 PM an interview was conducted with Care Manager C by phone about the incident between resident #1, C stated that he and another Care Manager D were the only staff members working between 10 PM -6 AM on 10/20/13. He said he had gotten a call from Care Manager D who was working in the memory unit about resident #2. who was trying to get out of the memory unit. C stated when he arrived he observed resident #2 who only had a T shirt on and was naked from the waist down banging on the entrance doors to the unit attempting to get out. When he entered the unit and tried to redirect resident #2, resident #2 started yelling and swearing and waving his arms around. He attempted to enter several rooms until he got into resident #1 room. When resident #2 got inside resident #1 room he held the door shut so staff could not get inside and redirect him out of the room. C stated when he and Care Manager D finally was able to get in the room resident #2 was laying on top of resident #1 who was sleeping under the covers dressed in night clothes. C stated he attempted to get resident #2 off of resident #1 and was unable to do so. C then pulled resident #1 from out under resident #2. C stated as he was puling resident #1 from out under resident #2, resident #2 reached up and grouped resident #1 breast area on top of her clothes. Resident #1 was then removed to another room until resident #2 could be removed from resident #1 room. Care Manager D was not available for an interview. 14. On 11/19/2013 at approximately 12:31 PM an interview was conducted with the Administrator (Executive Director) in reference to the facility policy and procedure regarding Abuse and if she had made contact with her Regulatory Affairs to determine whether law enforcement should have been called or not. She stated no, according to her supervisors she did not need to because DCF did not except her report. 15. The Respondent’s actions or inactions constituted a class II violation. 16. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the Agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. § 408.813(2)(b), Fla. Stat. (2013). 17. Under Florida law, the Agency shall impose an administrative fine for a cited class II violation in an amount not less than $1,000 and not exceeding $5,000 for each violation. A fine shall be levied notwithstanding the correction of the violation. § 429.19(2)(b), Fla. Stat. (2013). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration > secks to impose an administrative fine of $1,200.00 against the Respondent. Count IT STAFF IN SERVICE TRAINING 18. Florida Administrative Code Rule 58A-5.0191(2) states in pertinent part: 58A-5.0191 Staff Training Requirements and Competency Test, (2) STAFF IN-SERVICE TRAINING. Facility administrators or managers shall provide or arrange for the following in-service training to facility staff: (a) Staff who provide direct care to residents, other than nurses, certified nursing assistants, or home health aides trained in accordance with Rule 59A-8.0095, F.AC., must receive a minimum of 1 hour in-service training in infection control, including universal precautions, and facility sanitation procedures before providing personal care to residents. Documentation of compliance with the staff training requirements of 29 CFR 1910.1030, relating to blood borne pathogens, may be used to meet this requirement. (b) Staff who provide direct care to residents must receive a minimum of 1 hour in- service training within 30 days of employment that covers the following subjects: 1, Reporting major incidents. 2. Reporting adverse incidents. 3. Facility emergency procedures including chain-of-command and staff roles relating to emergency evacuation. (c) Staff who provide direct care to residents, who have not taken the core training program, shall receive a minimum of 1 hour in-service training within 30 days of employment that covers the following subjects: 1, Resident rights in an assisted living facility, 2. Recognizing and reporting resident abuse, neglect, and exploitation. (d) Staff who provide direct care to residents, other than nurses, CNAs, or home health aides trained in accordance with Rule 59A-8.0095, F.A.C., must receive 3 hours of in-service training within 30 days of employment that covers the following subjects: 1. Resident behavior and needs. 2. Providing assistance with the activities of daily living. (e) Staff who prepare or serve food, who have not taken the assisted living facility core training must receive a minimum of 1-hour-in-service training within 30 days of employment in safe food handling practices. (f) All facility staff shall receive in-service training regarding the facility’s resident elopement response policies and procedures within thirty (30) days of employment. 1. All facility staff shall be provided with a copy of the facility’s resident elopement response policies and procedures. 19. Based on record reviews the facility failed to provide training documentation in Reporting Major Incidents, Reporting Adverse Incidents, Facility Emergency Procedures, Resident Rights, Recognizing and Reporting Resident Abuse, Neglect and Exploitation, Resident Behavior Needs, Resident Elopement training, for 2 of 3 staff members reviewed (D &E). 20. On 11/19/2013 a record review was conducted on training records for 3 facility direct care staff members #C #D and #8. It was observed that D & E did not have the following training documentation showing they have received in service training for, Elopement Training, Emergency and Evacuation Procedures, Reporting of major and adverse incidents, Resident Rights, Recognizing and Teporting resident abuse, neglect, and exploitation. 21, On 11/19/2013 at approximately 12:31 PM the Administrator was asked why the training documentation was missing for staff members D & E. She said she did not know because she was new to the facility but she will be looking in to the training records of the facility. 22. The Respondent’s actions and/or inactions constituted an uncorrected class II violation. 23. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the Agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. § 408.813(2)(b), Fla. Stat. (2013). 24. Under Florida law, the Agency shall impose an administrative fine for a cited class II violation in an amount not less than $1,000 and not exceeding $5,000 for each violation. A fine shall be levied notwithstanding the correction of the violation. § 429.19(2)(b), Fla. Stat. (2013). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to impose an administrative fine of $1000.00 against the Respondent. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief: 1. Make findings of fact and conclusions of law in favor of the Agency. 2. Impose the relief against the Respondent as set forth above. Respectfully submitted on this 14th day of February 2014, /s/ John Bradley John E, Bradley, Assistant General Counsel Florida Bar No. 92277 Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3, MS3 Tallahassee, Florida 32308 Telephone: (850) 412-3658 Facsimile: (850) 921-0158 John.Bradley@ahca.myflorida.com NOTICE THE RESPONDENT IS NOTIFIED THAT IT HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS FORM. THE RESPONDENT JS FURTHER NOTIFIED IF THE ELECTION OF RIGHTS FORM IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. THE ELECTION OF RIGHTS FORM 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, MAIL STOP 3, TALLAHASSEE, FL 32308; TELEPHONE (850) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form has been served to: Heather Crumley, Administrator, Harborchase of Gainesville, 1415 Fort Clarke Bivd, Gainesville, Florida 32606, by U.S. Certified Mail, Return Receipt Requested (7011 1570 0000 3003 2060) and Thomas Caufman, Quintaros, Prieto, Wood & Boyer, P.A., 4905 West Laurel Street, Suite 200, Tampa, Florida 33607 by Electronic Mail on this 14th day of February 2014. ___/sJohnBradley John E. Bradley, Assistant General Counsel Florida Bar No. 92277 Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3, MS3 Tallahassee, Florida 32308 Telephone: (850) 412-3658 Facsimile: (850) 921-0158 John.Bradley@ahca.myflorida.com Copy furnished to: Kriste Mennella, Field Office Manager Shad Haston, Assisted Living Unit Manager STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: HARBORCHASE OF GAINESVILLE, INC. AHCA No: 2013013085 d/b/a HARBORCHASE OF GAINESVILLE ELECTION OF RIGHTS This Election of Rights form is attached to a proposed agency 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 may be returned by mail or by facsimile transmission, but must be filed within 21 days of the day that you receive the attached proposed agency action. If your Election of Rights with your selected option is not received by AHCA within 21 days of the day that you received this proposed agency action, you will have waived your right to contest the proposed agency 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, and Chapter 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. Telephone: 850-412-3630 Facsimile: 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 Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine, or 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 Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine, or 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 Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Section 120.57(1), Florida Statutes) 1i 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 agency action. The request for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it contain: 1. The name, address, telephone number, and facsimile number (if any) of the Respondent. 2. The name, address, telephone number and facsimile number of the attomey or qualified representative of the Respondent (if any) upon whom service of pleadings and other papers shall be made. 3. A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate, 4. A statement of when the respondent received notice of the administrative complaint. 5. A statement including the file number to the administrative complaint. 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: ; Title: Address: . Number and Street City Zip Code Telephone No. Fax No. E-Mail (optional) I hereby certify that I am duly authorized to submit this Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name: Title: 12 . |. Complete items . SENDER: COMPLETE THIS SECTION Jand 3. Also complete. , § Print your name. and address on the reverse A so that we can:return’the card to-you. : ‘® Attach this. card to the back ofthe mailpiece, __ item.4 if Restricted Delivery is desired. ‘or on the front if:spacé permits, i \ | OA) Addressee 1. Article Addressed to: | i i in 1415 Fort Clarke Blvd. ' Gainesville, FL 32602 i Heather Crumley, Administrator Harborchase of Gainesville D. Is delivery address different from item 1? ‘es. if YES, enter delivery address below: * Seeman ertified Mail’ . (1 Express-Mail C Registered 1 Return Receipt for: Merchandise O insured Mall — 1.6.0.0. 4, Restricted Delivery? (Extra Fee) C1 Yes ° i i i i A l i ! | 2. Article Number. _ (Transfer fromiservice Jebel) i! ! PS Form 3811; August 2001 i 7011 14570 OO000 3003 2oOL0 Return Recelpt Feo (Endorsement Required) Restricted Delivery Fee Endorsoment Rleguirech “2011 1570 ‘goog 3003 2080 | Domestic Return Receipt 102595-02.-1

Docket for Case No: 14-001043