Findings Of Fact On August 10, 1977, Petitioner filed an application for an Adult Congregate Living Facility License. Thereafter, on nine separate occasions Petitioner was visited by representatives of Respondent, the Dade County Fire Department, and the Dade County Health Department. The results of the inspections by these governmental agencies were numerous lists showing deficiencies in Petitioner's staff, physical plant, sanitary practices, and in diets being furnished to the residents of the facility. At the final hearing in this cause, Petitioner's President admitted that the deficiencies noted in the May 22, 1978 letter of Respondent's Supervisor of the Aging and Adult Services Program, which was marked as Petitioner's Exhibit Number 3, were correct as of the date of the letter. Petitioner contends, however, that the deficiencies noted in Petitioner's Exhibit Number 3 have since been corrected. However, the issue in this proceeding is whether there was substantial competent evidence in existence on May 22, 1978, to justify the denial by HRS of Petitioner's application for an Adult Congregate Living Facility License. Corrections made by Petitioner after that date are irrelevant to this proceeding, although Petitioner would not, of course, be estopped to show correction of these deficiencies in a later application. Inspections conducted by or on behalf of HRS on April 7, 1978, May 12, 1978, and May 16, 1978, showed that staff on duty at Petitioner's facility was inadequate to properly supervise residents in the facility. On the April 7, 1978, visit, there were only one or two staff members on duty to care for thirty-four residents of the facility. The inspection conducted on May 16, 1978, revealed only one staff member on duty. The Administrator of the facility on both occasions was not in attendance at the facility at the time of the inspections. Fire inspections on Petitioner's facility were conducted on January 6, 1978, and again on April 20, 1978. The January 6, 1978, inspection resulted in a lengthy list of deficiencies, which included citations for no building evacuation plan, improper fire extinguishers, lack of proper latching devices on doors, improper hanging of doors, improper installation and maintenance of electrical equipment, no emergency lighting, obstruction in facility corridors, lack of exit signs, lack of smoke detectors, insufficient landing size on stairways, improper storage of flammable chemicals, and improper safety precautions in the electrical equipment room. The April 20, 1978, inspection also resulted in a lengthy list of deficiencies, including lack of an evacuation plan, no record of evacuation drills having been held, lack of proper latching devices on stairway fire doors, and lack of exit signs. There is no evidence of record from which to conclude that these deficiencies were corrected prior to the date on which HRS denied Petitioner's application for a license to operate an Adult Congregate Living Facility. Sanitary inspections of Petitioner's facility were conducted on August 29, 1977, and April 18, 1978. The August 29, 1977 inspection resulted in a lengthy list of deficiencies which is contained in Petitioner's Exhibit Number Among these deficiencies were improper doors, windows and screens in the facility, lack of handrails, improper lighting, improper heating, insufficient number of toilets for the existing number of residents in the facility, and numerous electrical code violations. The inspection conducted on April 18, 1978, revealed many of the same deficiencies noted in the earlier inspection. In addition, a serious fly problem was observed in the kitchen area which was caused by improper sanitary procedures in the kitchen and disrepair of windows, screens and doors. In addition, live roaches and roach eggs were observed in the kitchen, also due to improper sanitary procedures. Further, a live rat and significant quantities of rat droppings were also observed in the kitchen area. The April 18, 1978 inspection also revealed cracked ceilings, holes in walls, malfunctioning lights, holes in floors, and use of a common drinking cup at the water fountain in the facility. There is insufficient evidence in the record in this cause to appropriately demonstrate that the deficiencies noted in the August 29, 1977 and April 18, 1978 inspections were adequately corrected prior to the denial of Petitioner's request for a license on May 22, 1978. On May 12, 1978, the kitchen facilities belonging to Petitioner were inspected by an HRS staff nutritionist. On the day of the inspection, the Administrator was not in attendance at the facility, and the only staff member present was a young woman who had difficulty communicating in English, and who was in charge of both residents of the facility and total food service, including preparation, serving and cleaning. The lunch menu posted for the date of the inspection did not provide one third of established recommended dietary allowances. The menu was also calculated to be deficient in calories, protein, calcium, iron, Vitamin A, Vitamin C, Thiamine, Riboflavin and Niacin. The food on hand in the facility did not correspond to posted menus, and the meal observed together with the food inventory were not sufficient for the age group residing in the facility and could result in malnutrition. The kitchen area was dirty, and food preparation utensils required scrubbing and sanitizing. Dishes were being washed with tepid water which was not sufficient for sterilization, and other sterilization methods being used for kitchen utensils were not sufficient to sterilize them. A serious fly problem existed in the kitchen, at least in part due to poor installation of doors. It was impossible to determine the qualifications of the Food Service Supervisor, no policy manual regarding food preparation was found in the facility, and no job description, work assignment, orientation plan, training record, health exam, or employee evaluation could be located for food service personnel. There were no written menus approved by a qualified consulting dietician, no written procedures for ordering, receiving and storing foodstuffs, and no food preparation or recipe file.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That a Final Order be entered by the State of Florida, Department of Health and Rehabilitative Services, denying Petitioner's Application for a License to Operate an Adult Congregate Living Facility. RECOMMENDED THIS 5th day of January, 1979, in Tallahassee, Florida. WILLIAM E. WILLIAMS Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Stuart E. Wilson, Esquire Franklin International Plaza 255 Alhambra Circle, Suite 100 Coral Gables, Florida 33134 Leonard Helfand, Esquire DHRS District XI Legal Counsel State Office Building 401 Northwest 2nd Avenue Miami, Florida 33128
The Issue May Respondent be discharged from the Robert H. Jenkins Veterans' Domiciliary Home of Florida for four violations of Rule 55-11.009(1), Florida Administrative Code, as more fully set out in the February 16, 2001, letter of dismissal.
Findings Of Fact The Robert H. Jenkins Veterans' Domiciliary Home of Florida (hereafter, "The Veterans' Home"), is licensed by the Florida Agency for Health Care Administration as an extended congregate care facility and is also licensed to provide limited nursing services and limited mental health services. It is commonly known as an "ALF," or "assisted living facility." The Department of Veterans' Affairs has oversight of The Veterans' Home. All of its residents are military veterans. Some have significant physical limitations, such as missing limbs and blindness. Approximately thirty of its 130 residents suffer one or more forms of psychiatric disturbance, including, but not limited to, geriatric conditions. Respondent served with distinction in the United States Navy during World War II. Thereafter, he graduated from college and pursued a teaching career at P. B. Young Laboratory School. He is now retired. He has been a continuous resident of The Veterans' Home since approximately January 2000. On February 16, 2001, Respondent was issued a letter of discharge based on the following alleged incidents: FAC 55-11.009(1)(b)3: Members shall maintain a courteous relationship toward other members and members of the staff. A Behavior Management Report (January 12, 2001), reflects that you verbally responded inappropriately to another member. FAC 55-11.009(1)(b): Members shall conduct themselves in a way that does not endanger the safety or security of other members of the home. A Behavior Management Report (February 2, 2001) reflects that you hit another member in the stomach. FAC 55-11.009(1)(b): Members shall conduct themselves in a way that does not endanger the safety or security of other members of the home. A Behavior Management Report (February 5, 2001) reflects that you pushed another member. FAC 55-11.009(1): Members of the home shall cooperate fully in the preservation of order and discipline in the Home. Behavior Management Reports (February 13, 2001 and February 15, 2001) reflect that you attempted to interfere with nursing services to another member. (Emphasis supplied). The Veterans Home administrator testified that no single incident was cause to dismiss Respondent, but that the cumulative nature of the incidents was behind her decision. No evidence related to the dates of February 2, 13, or 15, 2001, was offered. Mr. Cook is a wheelchair-bound amputee, whom Respondent regularly assists with daily living. On January 1, 2001, Mr. Cook was unable to feed himself, and Respondent had, according to their custom, prearranged a tray and two chairs in the lunchroom so he could feed Mr. Cook. However, there were no assigned chairs in the lunchroom, and another male resident, Mr. Gordon Flash, took the seat in the lunchroom customarily taken by Respondent. Respondent retaliated by pushing over the chair in which Mr. Flash was seated. Nurse Leahy observed a fresh cut on Mr. Flash's face as a result of the January 1, 2001, altercation. No one observed Respondent kick Mr. Flash. Mr. Flash was sent to a hospital where he was diagnosed with one or two broken ribs. However, no nexus by medically competent testimony tied Mr. Flash's broken ribs to his January 1, 2001, altercation with Respondent. The Home's administrator had previously observed Mr. Flash taking the lunchroom chair in which Mr. Cook customarily sat and concluded that Mr. Flash was the instigator and Respondent was the reactor in the January 1, 2001, incident. Nonetheless, she issued a written warning to both Mr. Flash and Respondent. Respondent's warning charged him with violating Rule 55-11.009(1), Florida Administrative Code, not cooperating fully in the preservation of order and discipline in The Home and subsection (8), not maintaining a courteous relationship towards other residents and members of staff. Respondent acknowledged receipt of this warning and knew that future similar offenses could result in his dismissal from The Veterans' Home. Nurse Leahy, who reported the January 1, 2001, incident, recommended that Mr. Flash and Respondent be kept separated. After the January 1, 2001, incident, Respondent was observed modifying his own behavior by moving himself and Mr. Cook to other chairs in the lunchroom. On January 12, 2001, Custodial Supervisor Craig Bracht observed Respondent and another resident, Mr. Pullio, in a hallway, pulling a legally blind female resident between them in something akin to a tug-of-war. Respondent had cocked his arm back, apparently threatening to hit Mr. Pullio if he did not turn the female resident loose. Mr. Bracht asked the males to "behave" and directed the female on her way. Mr. Bracht had observed Mr. Pullio acting mildly erratic before. Mr. Pullio has psychiatric infirmities. Mr. Bracht counseled Respondent that what he was doing was not a good thing. Respondent and Mr. Pullio went on their respective ways. On February 5, 2001, Marjorie Rigdon, Nursing Supervisor, witnessed Respondent pull Mr. Flash by his arm out of a medication line and push Mr. Flash so violently that Mr. Flash "staggered backwards" but "managed to catch himself before he fell." Ms. Rigdon wrote a Behavior Management Report memorializing this incident and recommending as alternative means to prevent recurrence of such incidents, that Respondent and Mr. Flash report for medication at different times or that Respondent be missed. Mr. Flash had a reputation for butting ahead in the medication line. It is probable Mr. Flash broke in line out of turn on February 5, 2001. Misunderstandings regarding the medication line and alleged breaking in line are frequent at The Veterans' Home. Mentally impaired patients frequently will not wait in turn. Counseling or case management concerning the problem is a frequent occurrence. There was evidence that residents who observed the February 5, 2001, incident were divided on whether Respondent was a hero for defending fair play (waiting in line) or a villain for interfering with Mr. Flash's position in line. Mr. Flash voluntarily checked out of The Veterans' Home prior to the disputed-fact hearing. Respondent has no known mental infirmity, but he has frequently evidenced lack of patience and demonstrated intolerance of mentally infirm residents. At the same time, he has been a valiant defender of those physically infirm patients he has been asked by the Home's staff to assist and those physically infirm patients he has appointed himself to assist. He has always responded to the administrator's requests to help other residents. Even now, the administrator would trust him to orient new residents. As of the date of hearing, Respondent had resided at The Veterans' Home for 18 months and had served as elected vice- president of the Residents' Council for the last six months. During the five months between the February 5, 2001, incident and the date of hearing, Respondent's behavior seems to have remediated. Instructed and cautioned by Mr. Orwell, the elected President of the Residents' Council, Respondent has modified his impatience and his aggressive behavior by writing- up reports of residents' conflicts for resolution by the Administrator or for mediation by the Residents' Council, Mr. Orwell, or himself. The administrator acknowledged Respondent's recent good behavior but attributed it to the potential of the instant cause to dismiss him from The Veterans' Home.
Recommendation Upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the Department of Veterans Affairs enter a final order which: Rescinds the February 16, 2001, letter of dismissal and returns Respondent to full status in the Robert H. Jenkins Veterans' Domiciliary Home. DONE AND ENTERED this 27th day of September, 2001, in Tallahassee, Leon County, Florida. ELLA JANE P. DAVIS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 27th day of September, 2001. COPIES FURNISHED: James Sloan, General Counsel Department of Veterans Affairs Koger Center, Douglas Building, Suite 100 2540 Executive Center Circle, West Tallahassee, Florida 32301-4746 Weyman T. Johnson, Qualified Representative Suite 2400 600 Peachtree Street Northeast Atlanta, Georgia 30308-2222 Jennifer Carroll, Executive Director Department of Veterans Affairs Koger Center, Douglas Building, Suite 100 2450 Executive Center Circle, West Tallahassee, Florida 32301-2222
The Issue Whether or not Thomas Singleton, Jr. should have the ACLF license application denied for incidents alleged to have occurred on January 13, 1978, when the Respondent spoke with slurred speech and was inarticulate in trying to discuss matters of the care and protection of the residents of his licensed facility and further for the reason that later in the day on January 13, 1978, members of the Petitioners staff went to the licensed premises and found insufficient qualified staff to assure the safety and proper care of the residents; found that the Respondent, or the person acting in the official capacity was not on duty, alert and appropriately dressed; found that the administrator had failed to insure that the staff as mentally and physically capable of performing their assigned duties and found that the facility failed to have at least one staff member on call at all times for the benefit of the residents. Whether or not the Respondent, Thomas Singleton, Jr. should have his ACLF license application denied for allegedly issuing certain checks, to wit: check no. 138, dated January 13, 1978, in the amount of $40.00; check no. 149, dated January 13, 1978, in the amount of $10.00, drawn on the Atlantic Hank of Springfield and unpayable due to "insufficient funds"; and issuance of a check in the amount of $50.00, on January 15, 1978, and alleged to be nonpayable due to insufficient funds.
Findings Of Fact Thomas Singleton, Jr. is the holder of ACLF License No. P-4-l6-0089C held under the provisions of Chapter 400, Part II, Florida Statutes. This is a form of temporary license for operating adult congregate living facilities. Mr. Singleton is also an applicant for a permanent license for operating an adult congregate living facility. Carolyn Bothwell, is a social worker with the Department of Health and Rehabilitative Services, who specifically works in the field of aging and adult services. Some of her clients were residents of Tom's Rest Home, 1834 Silver Street, Jacksonville, Florida, which is owned and operated by Thomas Singleton, Jr. On January 10, 1978, Ms. Bothwell received a call from Mr. Singleton In which Mr. Singleton expressed some consternation about trying to collect money owed by one of his former boarder's at Ton's Rest lone. In Ms. Bothwell's opinion, Mr. Singleton's speech was slurred and he seemed very different than for prior contacts with him. On January 15, 1978, Mr. Singleton came to her office to further discuss the problem about the payment by the boarder. His appearance was disheveled and his speech was incoherent. In this conversation of January 13, Singleton also mentioned that his wife had left him and that he wanted Ms. Bothwell to be at the boarding home when he told the boarders of his wife's departure. Ms. Bothwell went to the location of the boarding hone around 12:00 noon on the date, January 13, 1978, in the presence of other members of the Department of Health and Rehabilitative staff. When she arrived at the boarding home, she discovered that the boarding home was locked and the boarders were on the front porch, locked out of the hone. Mr. Singleton had difficulty remembering why he had gone to meet with Ms. Bothwell earlier that day and made no mention of the fact that his wife had left. In Ms. Bothwell's opinion he appeared very vague and confused. Ms. and the other members departed the premises a short time later. On that same date, January 13, 1978, June K. Frye, a District Program Specialist, with the Department of Rehabilitative Services dealing with adult congregate living facilities, spoke with Mr. Singleton. This conversation apparently took place in the morning. In the course of the conversation Ms. Frye mentioned that she had called Mr. Singleton to advise him of an upcoming reinspection on the question of considering his probationary license status. Ms. Frye felt that Mr. Singleton was incoherent and unable to give concrete information about the license situation. She asked to speak to someone else at the facility but Mr. Singleton was unable to assist her in that request. Prior to this conversation with Mr. Singleton, Ms. Frye had never noticed any slurred speech or inability on the part of Mr. Singleton to respond to requests or to give information. Later that afternoon, Ms. Frye, in the presence of Mr. Otto G. Hrdlicka, went to the facility at 1834 Silver Street. When they arrived they found that Bertie Mae Baldwin was in charge of the facility. Mr. Singleton's wife was not at the-facility and Mr. Singleton was on the bed in his room, out of contact with the boarders. Several attempts were made to awaken Mr. Singleton, but none of those attempts were successful. It should be mentioned that Mrs. Baldwin was hired as a housekeeper whose hours were from 9:00 a.m. to 3:00 p.m. each day and at the time of the visit by Mrs. Frye and Mr. Hrdlicka, Ms. Baldwin was preparing to leave the facility. Ms. Baldwin had no responsibility in terms of cooking the food or attending to the overall needs of the boarders in the home. Testimony was also given in the course of the hearing that Mr. Singleton had written a check for insufficient funds to April Russel on January 15, 1978. This check was in the amount of $50.00. Restitution was made on the check, however. Testimony was also given that Mrs. Frye had been approached by Marion Thomas, a cab driver who claimed that Mr. Singleton had written him checks on January 13, totaling $50.00, for which there were no sufficient funds. Again restitution was made for those checks. A representative of the Atlantic Hank of Springfield, Jacksonville, Florida, testified in the course of the hearing and indicated that the operating account of Mr. Singleton for his business Tom's Rest Hone had been closed out in February at a time when the account was overdrawn $151.90. Subsequent to the January 13, 1978, incidents at the rest home, the boarders have been moved and placed in other facilities. Part of the motivation for such removal was due to the fact that some of the patients had cone to the boarding home after being released from the Northeast Florida State Hospital, at Macclenny, Florida, an institution for the treatment of patients with mental illness. It was felt by the program coordinators of the adult congregate living facilities that Mr. Singleton would be unable to properly care for those individuals and others in his boarding home and in view of the fact that no other employees were in a position to take care of the needs of the individual boarders, the decision was made to remove them from Tom's Rest Hone. Mr. Singleton gave testimony in the course of the hearing and indicated that he had suffered a severe stomach disorder beginning in April, 1977 and had undergone an operation to remove part of his colon. He says this caused him to take a number of pills as treatment. In addition he indicated that he had had some domestic problems with his wife. He also stated that on January 19, 1978 through January 23, 1978, he received psychiatric treatment in a local hospital, in Jacksonville, Florida, for his condition. He described the condition as a collapse of his nerves, which was brought on, according to Mr. Singleton, by failure of the treating physician who dealt with his colon problem to respond to a need to control his blood pressure. The events of January 13, 1978, and the state of Mr. Singleton's finances have lead to a complaint letter of January 19, 1978. Mr. Singleton has received that letter and been given an opportunity to respond to it. The complaint letter falls into two broad categories. The first category pertains to the matters of January 13, 1970 and the second category pertains to the financial situation of Mr. Singleton. Under the matters of January 13, 1978, the Department of Health and Rehabilitative Services has alleged violations of Chapter 10A-5.06(5)(b)(2); 10A-5.00(1), (4)(a), and (6), Florida Administrative Coda, and Section 400.414(2)(a)(d) and Section 400.441(2), Florida Statutes. Those provisions read respectively: 10A-5.06 Operational Standards. Facilities shall offer close supervision and living conditions as is necessary to the condition of the resident. This includes supervision of diets as to quality and quantity, and watchfulness ever the general health, safety and wellbeing of residents. There shall be daily awareness of the residents by designated staff of the facility as to the apparent well-being of the individuals with sufficient provision for contacting the resident's physician, if the resident has not already done so, at any time there appears to be significant deviation from his normal appearance or state of health and well-being. Appropriate notice of such instances shall be recorded in the personal records of the individual. * * * (5) The minimum personnel staffing for adult congregate living facilities shall be: * * * 2. There shall be at least one staff member on call at all times when residents are in the facility. 10A-5.09 Personnel Standards. The administrator of a facility shall: Provide such qualified staff as are necessary to assure the safety and proper care of residents in the facility. * * * (4) Assure that each person serving in any official capacity in the facility shall: (a) Be on duty, alert and appropriately dressed during the entire tour of duty. In smaller facilities it is permissible for the administrator to he on call during normal sleeping hours. * * * (6) Insure that the staff is mentally and physically capable of performing their assigned duties. They shall be free of any communicable diseases which would present the hazard of transmission to resident or other staff member. If any staff member is found to have or is suspected of having such disease, ha will be removed from his duties until the administrator determines that such risk no longer exists. 400.414 Denial, suspension, revocation of license; grounds. * * * Any of the following actions by a facility or its employee shall be grounds for act ion by the department against a facility: An intentional or negligent act materially affect- ing the health or safety of a resident of the facility * * * (c) Violation of the provision of this act or of any minimum standard or rule promulgated hereunder. 400.441 Rules establishing minimum standards. Pursuant to the intention of the Legislature to provide safe and sanitary facilities, the department shall promulgate, publish, and enforce rules to implement the provisions of this act, which shall include reasonable and fair minimum standards in re- lation to: * * * (2) The number and qualifications of all personnel having responsibility for the care of residents. It is established through the evidence that at all times on January 13, 1978, when the events as described took place, those boarders who had been assigned to Tom's Rest Home were living in that facility. Therefore, an examination of the events of January 13, 1978, as reported above, in view of the requirements set forth in the Florida Administrative Code which are related herein; demonstrates that Thomas Singleton, Jr. was in violation of those conditions and is subject to the penalties for such violation, to include revocation of the temporary licence ACLF License no. P-4-l6-009C and the denial of an unrestricted license. Moreover, the financial disarray of Mr. Singleton's business account for Tom's Rest Home, which was shown in the months of January and February, 1978, demonstrates a violation of Rule 10A-5.08(1), Florida Administrative Code, which reads: 10A-5.08 Fiscal Standards. The administrator of a facility shall maintain fiscal records in accordance with the requirements of Chapter 400 F.S., Part II. There shall be a recognized system of accounting used to accurately reflect details of the business including residents' "trust funds" and other property. The fiscal and "trust fund" records shall reflect a verified statement. The facility shall: Be administered on a sound financial basis consistent with good business practices. Evidence of issuance of bad checks or accumulation of delinquent bills for such items as salaries, food, or utilities shall constitute prima facie evidence that the ownership lacks satisfactory proof of financial ability to operate the facility in accordance with the requirements of Chapter 400 F.S., Part II. This would also establish a sufficient basis for denying any application for an unrestricted license, because it would show that the applicant has failed to demonstrate satisfactory proof of financial ability to operate and conduct the facility as required by Section 400.411(2), Florida Statutes.
Recommendation It is recommended that the permanent license to operate an ACLF facility as requested by Thomas Singleton, Jr. be denied. DONE AND ENTERED this 17th day of May, 1978, in Tallahassee, Florida. CHARLES C. ADAMS Hearing Officer Division of Administrative Hearings 530 Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Robert M. Eisenberg, Esquire Department of HRS Post Office Box 24l7F Jacksonville, Florida 32231 Thomas Singleton, Jr. Ton's Rest Hone 1834 Silver Street Jacksonville, Florida 32206
The Issue By administrative complaint dated November 23, 1982, the Respondent, Mae Revles, was charged with operating an adult congregate living facility without a license. At the formal hearing, the Petitioner called as witnesses Barbara Wavell, Barbara Witham-Petruney, and June Bryant, all employees of the Petitioner, the Department of Health and Rehabilitative Services. The Respondent testified on her own behalf and also called as a witness Mary Burks. The Petitioner offered four exhibits into evidence. Petitioner's Exhibits 1 and 2 were admitted without restriction as to their use, and Petitioner's Exhibits 3 and 4 were admitted over objection as being hearsay solely for the purpose of supplementing or explaining other admissible evidence in the record. Counsel for the Petitioner submitted proposed findings of fact and conclusions of law for consideration by the undersigned Hearing Officer. To the extent that those proposed findings of fact and conclusions of law are not adopted in this order, they were considered and determined to be irrelevant to the issues in this cause or not supported by the evidence.
Findings Of Fact The Respondent previously held a license to operate an Adult Congregate Living Facility in the State of Florida. The Respondent, on January 26, 1982, voluntarily surrendered her license and has not since that time been licensed to operate an Adult Congregate Living Facility. On November 3, 1982, an employee of HRS went to the boarding home operated by the Respondent at 551 Broadway, Kissimmee, Florida. On that date, Mr. Andrew Karr and Mr. Marcus Grady, both residents of the Respondent's boarding home, were found locked in their rooms. The doors were locked from the outside. On November 3, 1982, Mr. Andrew Karr was disoriented as to time and space and needed nursing home custodial care. He could not respond appropriately to others present in the boarding home and was not able to bathe himself and had to be helped in bathing. On November 3, 1982; another resident, Inez Smith, was disoriented. She was not capable of taking her prescribed medication without the help of another person. A lady who shared the room with Inez Smith gave her the medication. On November 3, 1982, there were three other residents in the boarding home. These residents were oriented, lucid, and desired to remain in the boarding home. Mr. Karr, prior to his removal in November, 1982, had been a resident of the boarding home since December, 1981. Mr. Grady had been a resident of the home for approximately five years prior to November, 1982, and Inez Smith had been a resident for three weeks prior to November, 1982.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is: RECOMMENDED: That the Respondent be found not guilty of the violation charged and that the administrative complaint be dismissed. DONE and ENTERED this 11 day of May, 1983, in Tallahassee, Florida. MARVIN E. CHAVIS Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 11th day of May, 1983. COPIES FURNISHED: Douglas E. Whitney, Esquire 400 West Robinson Street Suite 911 Orlando, Florida 32801 Richard H. Hyatt, Esquire 918 North Main Street Kissimmee, Florida 32741 Mr. David H. Pingree Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
Findings Of Fact The respondent was licensed in 1976 as a foster home, and obtained a license to operate an adult congregate living facility on May 31, 1981. This was the first ACLF license issued in Gadsden County. On September 12, 1983 two representatives of the Department visited the Fletcher Group Home in response to an abuse complaint. Although the abuse complaint was not substantiated, they found unsanitary conditions which led to a concern about the general cleanliness of the facility, and they found that the noon meal was being served around 3:50 in the afternoon. The facility's cleanliness and the late mealtime became a concern because the residents are non-verbal or have low verbal skills, and are in the facility because they are unable to care for their basic personal needs. Because of these conditions, the Department's representatives brought their supervisor to the facility on an unannounced visit at noon on September 14, 1983, to do a complete investigation. When they arrived, the noon meal was just beginning to be prepared, and was not ready until about 1:00 p.m. The conditions of the facility were found to be a potential threat to the health, safety and welfare of the residents in that flies were observed in the kitchen area; the entire kitchen was generally dirty and unsanitary; roaches were found in the refrigerator; food containers in the refrigerator had no covers; there was unwrapped meat stored in the refrigerator; and the refrigerator was generally unclean. The medicine cabinet was unlocked. In the bedroom areas, beds were dirty and unmade; there were roach droppings found in the beds and in the dresser drawers; the ceiling and walls were wet from rain due to the roof leaking; the ceiling sheetrock had fallen out in one of the closets with the clothes still in there, and the clothes were wet because of the leak; the facility had mold and mildew on the walls and ceilings; and generally smelled musty. In the bathroom, the toilet was stopped up and had been used until it was filled with feces; the bathtub was dirty; the sink was dirty; the hot water did not work in the sink; and the cold water tap would not turn off. Outside the facility, the kitchen sink drained into an open pipe which discharged onto the ground. The linoleum in the facility was not tacked down properly, and the metal trim was exposed so that a resident could be injured. 4.. Another visit was made on September 15, at approximately 1:30 p.m. During this investigation, the menus had not been kept on a weekly basis nor corrected with changes in the meals. The records were incomplete or were missing from their folders. There was no indication of any special diets for two of the residents who had diabetes. The contracts between the facility and the residents were out of date. Roaches were still found to be present in the closets and in the refrigerator and the kitchen waste water was still being piped onto the ground behind the facility. On September 16 the Department made another inspection. This revealed that the facility had improper wiring, and did not meet the requirements of the standard building code. Plates were off the wiring receptacles making it possible for residents to come in contact with electrical wiring; exterior wiring was done improperly; interior lighting fixtures were put on the exterior of the building; LP gas heaters were improperly installed; and the beds were too close to the gas heaters. Neither the plumbing, nor the wiring, nor the building itself were in compliance with the applicable building codes. The-respondent either denied that the conditions found by Department representatives existed, or she contends that those which existed have been corrected. However, there was no evidence presented by the respondent to show that the plumbing, electrical wiring or the building itself is in compliance with the applicable building codes. Thus, there is substantial, competent evidence to support a finding that the violations alleged existed on September 12, 14, 15 and 16, 1983.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the license of Carrie Fletcher to operate the adult congregate living facility known as the Fletcher Group Home, be revoked. THIS Recommended Order entered this 4 day of June, 1984, in Tallahassee, Florida. WILLIAM B. THOMAS Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 4 day of June, 1984. COPIES FURNISHED: John L. Pierce, Esquire 2639 North Monroe Street Suite 200-A Tallahassee, Florida 32303 Conrad C. Bishop, Jr., Esquire Post Office Box 167 Perry, Florida 32347
Findings Of Fact During times material hereto, Respondent, Ray C. Dorman, is the owner and administrator of Scarlet Manor. Scarlet Manor is an adult congregate living facility at 13009 Lake Carl Drive in Hudson, Florida. The facility has a census of 40 beds and of that census, two residents are elderly patients and the remaining 38 residents are "hard core" mental patients who require intensive and specialized nursing care. Ray Dorman (Respondent) is named as the confirmed perpetrator of neglect (FPSS No. 90-091417) based on a finding that Respondent neglected a resident at the ACLF. A certified letter from Petitioner dated September 22, 1990, which was received by Respondent on September 27, 1990, advised Respondent that he could challenge the confirmed finding of neglect if he considered that the classification was inaccurate or that it should otherwise be amended or expunged. Although Petitioner maintains that Respondent failed to challenge the confirmed finding of neglect, Respondent and his wife, Winifred Dorman, credibly testified that on October 10, 1990, she accompanied Respondent to an HRS office in Clearwater to deliver a written request to challenge the finding of neglect. While the office which would have addressed Respondent's challenge (Mr. Morton's office) is situated in St. Petersburg, on that point, it appears that Respondent's wife was either unclear as to exactly where the Respondent's challenge to the confirmed classification was delivered and nothing more. Respondent's facility has been the subject of regular survey reports wherein it was determined that Respondent's facility was deficient in maintaining minimum licensure requirements based on inspection surveys dating back to September, 1989. Mrs. Diane Cruz, a human services surveyor specialist employed by Petitioner, was part of a three (3) member team of surveyors at Respondent's facility during late September, 1989. During the September, 1989 survey, it was determined that Respondent's facility was deficient in several areas including fiscal policies, facility records, client records, medication records, staffing, food service standards, maintenance and housekeeping standards, resident care, admission criteria and fire safety standards. In all of the cited areas, Respondent corrected the deficiencies and no cited deficiency was outstanding at the time of the hearing herein. Significantly, of the numerous deficiencies that Respondent was cited, only three of the deficiencies were repeat deficiencies during the annual 1990 annual survey. Respondent's facility is a fairly new and modern facility and Respondent prides himself in providing his residents the high degree of nursing services which the residents of his ACLF require. In this regard, in each instance wherein Respondent was cited for deficiencies, the matter was corrected by the time that the follow-up survey was conducted with only two exceptions. Regarding those exceptions, Respondent credibly testified that he had undertaken a good faith effort to correct the deficiency by the time of the follow-up survey. In any event, all of the cited deficiencies were corrected and Respondent has abided by the terms of any restrictions including the payment of any administrative fines which were imposed by Petitioner. Such conduct evidences that Respondent is conscientious in the operation of his adult congregate living facility and, to his credit, more than one of and Petitioner's witnesses testified that Respondent operates a good ACLF.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that: Petitioner enter a final order granting Respondent a conditional license to operate Scarlet Manor as an adult congregate living facility. 1/ Afford Respondent an opportunity to challenge the confirmed classification naming him as the perpetrator in FPSS Report No. 90-091417 as soon as practical. DONE and ENTERED this 30th day of October, 1991, in Tallahassee, Leon County, Florida. JAMES E. BRADWELL Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 30th day of October, 1991.
The Issue The issue presented here concerns the question of the entitlement of Petitioners to be granted a further license to own and operate an Adult Congregate Living Facility. Pursuant to Subsection 400.414(2)(b) Florida Statutes, Respondent has denied the relicensure of petitioners based upon the contention that the facility owner or operator "lacks the financial ability to provide continuing adequate care to residents." Respondent further relies on Rule 10A-5.21 Florida Administrative Code, for the licensure denial, claiming that evidence of issuance of bad checks or accumulation of delinquent bills constitutes prima facie evidence that the owners do not have the necessary financial ability to operate the facility. In particular, Respondent offered the following explanation of the license denial: Your credit history with the local credit bureau indicates long term delinquent accounts and civil judgments. During the period from January 4, 1982, until April 8, 1982, five (5) civil judgments were filed against you in the County Court of Citrus County. Copies of those actions (Aultman, Citrus Publishing, Allen, Schultz, Citrus Memorial) are enclosed. A report, a copy of which is attached, from the Citrus County Clerk of the Court indicates you have been convicted of worthless check charges. The Marion County Sheriff's Department has confirmed the existence of an outstanding warrant against you for worthless checks, a copy of which is attached. The Citrus County Sheriff's Department has levied against the real estate on which your facility is located, on instructions from a Judgment being issued out of the County Court of Pinellas County, Florida. You stated on the License Renewal Questionnaire that you owed no accounts which were over 60 days overdue. Your credit history, the levy against your property and a letter of 5/17/82 from the Citrus County Sheriff's office refute that claim. You stated on the License Renewal Questionnaire that you had had no checks in the last six (6) months returned for insufficient funds. Pending charges, set forth in the attached copy of warrant refute that claim.
Findings Of Fact Prior to April 7, 1982, the date that Respondent received the most current application for licensure as an Adult Congregate Living Facility, Petitioners had owned and operated such a facility in Inverness, Florida, under the business name Guiding Star. On that date, Respondent received the application for relicensure, a copy of which is Respondent's Exhibit 12, 2/ in the form as shown by that exhibit with the exception of the signatures found on the fourth, fifth and sixth pages. The application form indicated that Mrs. Wilder was the owner of the facility as had been reported in the past in other periods when the facility was licensed as an Adult Congregate Living Facility pursuant to Chapter 400, Florida Statutes. On the occasions prior to the April 7, 1982, request for relicensure, records of Respondent had shown Peggy Thornburg Wilder to be the owner and had also shown her to be the operator and administrator of the facility. In actuality, Peggy Thornburg Wilder had ownership interest in the facility, to include hiring practices; however, with the exception of twenty-three (23) days in August, 1981, Roy Wilder has been in charge of the day-to-day operations of the facility. (Peggy Thornburg Wilder, Petitioner, has been variously referred to for purposes of this hearing as Peggy Thornburg Wilder, Peggy A. Wilder, Peggy Ann Stone Wilder, Peggy Wilder, Peggy Ann Wilders and Peggy Thornburg.) On April 7, 1982, the date of receipt of the application, Roy Wilder and Peggy Thornburg Wilder were divorced. Nonetheless, with the exception of the twenty-three (23) days mentioned before, Roy Wilder had continued to live in the facility. On April 24, 1982, the Wilders were remarried. On April 29, 1982, an official with Respondent spoke to Mrs. Wilder and was told that Mr. Wilder was not in charge of the facility, notwithstanding his continued involvement as operator. As a result, the official believed Mrs. Wilder to be in charge of operations on the occasion of relicensure. On May 3, 1982, Mrs. Wilder told the official, a Karen Hubbell, that Mrs. Wilder had remarried her husband. During the pendency of the communications involving the application for the annual relicensure, it was discovered that the application signatures were missing and Hubbell requested that the application he signed in the appropriate places, which was subsequently accomplished as shown in Respondent's Exhibit 12. It was signed by Roy Wilder as operator and applicant. Mrs. Wilder did not sign as owner/applicant, and the form continued to reflect an application made in the name of Peggy Thornburg, as opposed to Peggy Thornburg Wilder. Respondent did not attempt to have Mrs. Wilder sign the application, and the application was processed with the name Peggy Thornburg being reflected as facility owner/operator/administrator in the body of the application form, and Roy Wilder being shown as the operator and applicant by signature. Nonetheless, it is evident, as it was in the past history of the facility, that Mrs. Wilder had ownership interest in the facility and Roy Wilder was operator of the facility. In deciding the question of relicensure under the April 7, 1982, application, Respondent focused its attention on the financial responsibility of Peggy Thornburg Wilder. In this process, the following items were discovered: A final judgment in the County Court in and for Citrus County, Fifth Judicial Circuit of Florida, Civil Division, against Roy L. Wilder (also known as Roy Wilder) and Peggy A. Wilder in the amount of $786.56 plus $25.00 court costs. See Respondent's Exhibit 1. A final judgment in the County Court in and for Citrus County, Fifth Judicial Circuit of Florida, Civil Division, against Peggy Wilder d/b/a Guiding Star Nursing Home in the amount of $100.00 and $22.00 costs. See Respondent's Exhibit 2. A final judgment in the County Court in and for Citrus County, Fifth Judicial Circuit of Florida, Civil Division, against Peggy Wilder and Roy Wilder d/b/a Guiding Star ACLF Home, in the amount of $275.00. See Respondent's Exhibit 3. A final judgment in the County Court in and for Citrus County, Fifth Judicial Circuit of Florida, against Roy Wilder and Peggy Wilder in the amount of $61.95 and $15.00 costs. See Respondent's Exhibit 4. A final judgment in the County Court in and for Citrus County, Fifth Judicial Circuit of Florida, against Peggy Wilder in the amount of 44.50 and $21.00 costs. See Respondent's Exhibit 5. In the County Court of Citrus County, Florida, a plea by Peggy Wilder to the offense of obtaining property by means of a worthless check in the amount of $300 as nolo contendere to the offense charged, a finding of guilt and $115.00 costs in an action in which restitution was made. See Respondent's Exhibit 6. Reference Peggy Wilder in the County Court of Citrus County, Florida, a misdemeanor finding of violation of probation, a nolo contendere plea to that violation, a finding of guilt, a payment of $115.00 cost, a jail sentence of thirty (30) days. See Respondent's Exhibit 7. In County Court of Citrus County, Florida, misdemeanor worthless check charge in the amount of $168.29 against Peggy Wilder, a plea of nolo contendere to the offense charged, a finding of guilt, $115.00 cost, six months probation, special conditions of payment of $25.00 per month and an indication that restitution had been made. See Respondent's Exhibit 8. Copy of a Capias for the arrest of Peggy A. Wilder for two counts of worthless check Subsection 832.05(4), Florida Statutes, dating from April 1, 1982. Respondent's Exhibit 9. From the County Court, in and for Pinellas County, Florida, a notice of levy against Peggy Ann Stone Wilder, reference property in Citrus County, Florida, Lot 8, Block E of Highlands Trailer Park. See Respondent's Exhibit 10. Correspondence from the law firm of Jenkins, Brooks, Wharrier, Kaiser & Walters reference Item 10 instructing the Sheriff's office of Citrus, Florida, to withdraw the levy, in view of indication that Mrs. Wilder would make payments towards settlement of the matter. In view of the circumstances, that have been related above, on June 9, 1982, the application for relicensure of the Adult Congregate Living Facility known as Guiding Star was denied. 3/ Mrs. Wilder gave testimony in the course of the hearing. By way of explanation on the subject of her financial problems, she indicated that, following an October, 1981, notification of accusations which had been placed against Mr. and Mrs. Wilder, related to the then current license for the subject facility, there was a reduction of clients from twelve (12) in December, 1981; two (2) in July, 1982, and finally a closing of the facility in August, 1982. (A copy of the charges involved in DOAH Case No. 82-104 and the balance of the grounds for denial of license reapplication which have been withdrawn in the present action may be found as attachment "A" to this Recommended Order, to assist in understanding Mrs. Wilder's explanation.)
