. STATE OF FLORIDA moe ee ree rere ee AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2015003636 TH COMMERCIAL PROPERTY, LLC d/b/a PALM’S EDGE ASSISTED LIVING AND MEMORY CARE, Respondent. / ADMINISTRATIVE 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, TH COMMERCIAL PROPERTY, LLC d/b/a PALM’S EDGE ASSISTED LIVING AND MEMORY CARE (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2014), and states: NATURE OF THE ACTION This is an action to impose an administrative fine against an assisted living facility in the sum of TEN THOUSAND DOLLARS ($10,000.00) based upon two (2) Class II violations pursuant to Section 429.19(2)(b), Florida Statutes (2014). JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2014). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2014). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable state regulations, statutes and rules governing such facilities. Chapters 408, Part II, and 429, Part I, Florida Statutes (2014); Chapter 58A-5, Florida Administrative Code. The Agency may deny, revoke, or suspend any license issued to an assisted living facility, or impose an administrative fine in the manner provided in Chapter 120, Florida Statutes (2014). Sections 408.815 and 429.14, Florida Statutes (2014). 5. The Respondent was issued a license by the Agency (License Number 10181) to operate a 65-bed assisted living facility located at 4201 Leo Lane, Palm Beach Gardens, Florida 33410, and was at all times material required to comply with the applicable state regulations, statutes and rules governing assisted living facilities. COUNT I The Respondent Failed To Provide A Safe, Decent Living Environment, Free From Abuse And Neglect In Violation Of Rule 58A-5.0182(6)(a)-(d), Florida Administrative Code And Section 429.28(1)(a) and (b), Florida Statutes (2014) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, an assisted living facility must provide care and services appropriate to the needs of residents accepted for admission to the facility. (a) A copy of the Resident Bill of Rights as described in Section 429.28, Florida Statutes, or a summary provided by the Long-Term Care Ombudsman Council must be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to Rule 58A-5.0181, Florida Administrative Code. (b) In accordance with Section 429.28, Florida Statutes, the facility must 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. 2 (c) The telephone number for lodging complaints against a facility or facility staff must be posted in full view in a common area accessible to all residents. The telephone numbers are: the Long-Term Care Ombudsman Program, 1(888) 831-0404; Disability Rights Florida, 1(800) 342-0823; the Agency Consumer Hotline 1(888) 419-3456, and the statewide toll-free telephone number of the Florida Abuse Hotline, 1(800) 96-ABUSE or 1(800) 962-2873. The telephone numbers must be posted in close proximity to a telephone accessible by residents and must be a minimum of 14-point font. (d) The facility must have a written statement of its house rules and procedures that must be included in the admission package provided pursuant to Rule 58A-5.0181, Florida Administrative Code. The rules and procedures must at a minimum address the facility’s policies regarding: 1. Resident responsibilities; 2. Alcohol and tobacco; 3. Medication storage; 4. Resident elopement; 5. Reporting resident abuse, neglect, and exploitation; 6. Administrative and housekeeping schedules and requirements; 7, Inféction control, sanitation, and universal precautions; and 8. The requirements for coordinating the delivery of services to residents by third party providers. (e) Residents may not be required to perform any work in the facility without compensation, unless the facility rules or the facility contract includes a requirement that residents be responsible for cleaning their own sleeping areas or apartments. If a resident is employed by the facility, the resident must be compensated in compliance with state and federal wage laws. (f) The facility must provide residents with convenient access to a telephone to facilitate the resident’s right to unrestricted and private communication, pursuant to Section 429.28(1)(d), Florida Statutes. The facility must not prohibit unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there must be, at a minimum, a readily accessible telephone on each floor of each building where residents reside. _ (g) In addition to the requirements of Section 429.41(1)(k), Florida Statutes, the use of physical restraints by a facility must be reviewed by the resident’s physician annually. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint. Rule 58A-5.0182(6), Florida Administrative Code. Pursuant to Florida law, no resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of 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. (b) Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy. Section 429.28(1)(a) and (b), Florida Statutes (2014). 8. On or about March 5, 2015 through March 9, 2015, the Agency conducted a Complaint Survey (CCR# 2015001324) of the Respondent’s facility. 9. Based on observation, interview and record review, the Respondent failed to comply with the Resident's Bill of Rights, to ensure that residents are treated with respect and dignity and provided appropriate care and services. This was evidenced by the facility failure to provide prescribed pain medications to 1 of 1 sampled resident, specifically resident #1, on hospice services with an end of life diagnosis. 10. _—_— In an observation of Resident #1 on 3/5/2015 at 11:20 a.m., the resident was lying in a hospital bed, and had been asleep for most of the morning. Resident #1’s arms and legs were observed to be severely contracted and positioned with pillows. When the facility staff awakened the resident and asked how she was feeling, Resident #1 spoke in a barely audible voice, expressing that the resident was okay. 11. ‘In an interview with a care giver on 3/5/2015 at 11:45 am., she stated that resident #1 was on hospice services and required total care for activities of daily living but "the resident could feed him/herself when he/she felt up to it". The care giver stated that resident #1 received scheduled pain medication and was able to inform the staff when having pain. The care giver stated that she had never observed resident #1 to have any signs of pain when staff provided activities of daily living care. 12. A review of Resident #1's medical record indicated the resident has medical diagnoses including end stage dementia, coronary and valvular heart disease, diabetes, anxiety, depression, hypertension, hypothyroidism and hyperlipidemia. A review of the resident health assessment dated on 1/23/2013 indicated the resident was forgetful and agitated at times and ambulated with wheelchair. The resident required supervision with ambulation, independent for eating and required assistance with bathing, dressing, self-care, toileting, transfers and self- administration of medications. A further review indicated the resident was admitted to hospice services on 5/16/2013 with a.diagnosis of dementia. A review of the facility monthly assessment report dated on 2/1/2015 indicated the resident was assessed to be profoundly confused, anxious, easily upset, and was unable to express needs. Resident #1 was documented as having daily pain; mobility was limited to a wheelchair with staff assistance and incontinent of bowel and bladder. The resident had few visitors and remained on hospice services. 13.