Findings Of Fact At all times material hereto, Respondent has been licensed as a practical nurse in Florida with license number 28131-1. Respondent's license was previously suspended for a two year period from 1975 to 1977 but has been active since that time. On or about February 7, 1975, Respondent entered a plea of guilty to a charge of grand larceny in Case No. 74-3162, Circuit Court, Pinellas County. Adjudication of guilt and imposition of sentence were withheld, but the Court ordered Respondent to be placed on probation for five years. On or about March 24, 1977, Respondent was arrested and charged with grand larceny, to which she plead nolo contendere in Case No. 77-1689, Circuit Court, Pinellas County. On April 15, 1977, Respondent's probation officer executed an affidavit of probation violation as a result of the March 24, 1977 grand larceny charge, and Respondent subsequently entered a plea of guilty to the charge of violation of probation. Respondent was adjudicated guilty of the crime of grand larceny and also violation of probation on September 21, 1977, and was sentenced to one year in jail, with all but sixty days suspended and with credit for six days already spent in jail. Respondent was also placed on probation for three years. On August 16, 1978, Respondent completed an employment application for a nursing position at Beverly Manor Convalescent Center. In response to a question on the application, "Have you been convicted of a crime in the past ten (10) years?", Respondent checked the box for "No". Respondent was employed at Beverly Manor from the Fall, 1978, until May 15, 1984, when she was terminated for her failure to reveal her prior conviction of a crime on her employment application. Respondent's performance evaluations while at Beverly Manor were generally "satisfactory" to "very good", although she did receive four written warnings and a three day suspension during 1983 and 1984. On her employment application, Respondent also falsely indicated she was employed at Sunshine Nursing Home in 1975 and 1976 during a time when her license was suspended. The only evidence presented concerning the charge that Respondent diverted Tylenol #2 and Tylenol #3 for her own use from 1982 to May, 1984 was the "post test statement" contained in the polygraph examination report, Exhibit P-7. Respondent denies making the statement contained therein. She testified that at the end of the examination she answered what she understood to be a hypothetical question from the examiner about whether it was possible for a nurse to divert controlled substances. Her response was that it was possible, hypothetically, for nurses to do this, but she denies ever having actually taken these controlled substances for her own personal use. However, she did admit to taking Tylenol #2 and Tylenol #3 for other employees of Beverly Manor and giving it to them when they were not feeling well on particular days at work. Respondent's testimony on this point was very credible and convincing, and having weighed the evidence, it is the finding of the undersigned Hearing Officer that Respondent did not take controlled substances for her own personal use, but she did divert Tylenol #2 and #3 for other employees.
Recommendation Based upon the foregoing, it is recommended that a Final Order be issued suspending Respondent's license for a period of three years. DONE and ENTERED this 29th day of July, 1985 at Tallahassee, Florida. DONALD D. CONN, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 480-9675 Filed with the Clerk of the Division of Administrative Hearings this 29th day of July, 1985. COPIES FURNISHED: Judie Ritter, Executive Director Board of Nursing Room 504 111 East Coastline Drive Jacksonville, Florida 32202 Stephanie A. Daniel, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Darryl Ervin Rouson, Esquire 556 1st Avenue North St. Petersburg, Florida 33701 Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street_ Tallahassee, Florida 32301 Salvatore A. Carpino General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue Whether Respondent, Manor Care of Sarasota, Inc., d/b/a Manor Care Nursing Center, committed a Class II deficiency at the time of a survey conducted on August 10 through 12, 2004, so as to justify the issuance of a "conditional" license and the imposition of an administrative fine of $2,500.
Findings Of Fact Based upon the evidence presented at the final hearing, the following relevant findings of fact are made: At all times material hereto, AHCA is the state agency charged with licensing of nursing homes in Florida under Subsection 400.021(2), Florida Statutes (2004), and the assignment of a licensure status pursuant to Subsection 400.23(7), Florida Statutes (2004). AHCA is charged with evaluating nursing home facilities to determine their degree of compliance with established rules as a basis for making the required licensure assignment. AHCA is also responsible for conducting federally-mandated surveys of long-term care facilities receiving Medicare and Medicaid funds for compliance with federal statutory and rule requirements pursuant to Florida Administrative Code Rule 59A-4.1288. Pursuant to Subsection 400.23(8), Florida Statutes (2004), AHCA must classify deficiencies according to the nature and scope of the deficiency when the criteria established under Subsection 400.23(2), Florida Statutes (2004), are not met. The classification of any deficiencies discovered determines whether the licensure status of a nursing home is "standard" or "conditional" and the amount of the administrative fine that may be imposed, if any. Surveyors note their findings on a standard prescribed Center for Medicare and Medicaid Services (CMS) Form 2567 entitled, "Statement of Deficiencies and Plan of Correction," which is commonly referred to as a "Form 2567." During the survey of a facility, if violations of regulations are found, the violations are noted and referred to as "Tags." A tag identifies the applicable regulatory standard that the surveyors believe has been violated, provides a summary of the violation, and sets forth specific factual allegations that the surveyors believe support the violation. Manor Care is a 178-bed nursing home located at 5511 Swift Road, Sarasota, Florida. Manor Care is licensed as a skilled nursing facility. On August 10 through 12, 2004, AHCA's staff conducted a survey at Manor Care. The Form 2567 completed during this survey found the facility in violation of Tag F425. This alleged violation formed the basis of AHCA's Administrative Complaint. Tag F425 relates to pharmacy services. The federal regulation with which Manor Care allegedly failed to comply is 42 C.F.R. Section 483.60, which provides in relevant part: The facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in Sec. 483.75(h) of this part. 42 C.F.R. Section 483.75 provides generally that a facility "must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, psychosocial well-being of each resident." 42 C.F.R. Section 483.75(h) provides: (h) Use of outside resources. If the facility does not employ a qualified professional person to furnish a specific service to be provided by the facility, the facility must have that service furnished to residents by a person or agency outside the facility under an arrangement described in section 1861(w) of the Act[1/] or (with respect to services furnished to NF residents and dental services furnished to SNF residents) an agreement described in paragraph (h)(2) of this section. Arrangements as described in section 1861(w) of the Act or agreements pertaining to services furnished by outside resources must specify in writing that the facility assumes responsibility for-- Obtaining services that meet professional standards and principles that apply to professionals providing services in such a facility; and The timeliness of the services. Resident 10, a female who was 51 years old at the time of the survey, was initially admitted to Manor Care on December 19, 2003, with diagnoses that included diabetes mellitus, arteriosclerotic heart disease, peripheral vascular disease, depression, chronic obstructive pulmonary disease, and cerebral vascular accident with hemiparesis and intercerebral hemorrhage. Resident 10 was admitted to Sarasota Memorial Hospital for a surgical procedure on her leg, then re-admitted to Manor Care on August 2, 2004. The hospital's medical impression history and background included status post bilateral iliac angioplasty and stent, hypertension, a history of nicotine addiction, cigarette abuse, status post previous coronary stent, severe osteoarthritis, a history of lumbosacral disk disease with chronic pain syndrome, status post left thoracotomy, lower lobectomy for adenocarcinoma, a history of seizure disorder, and a history of moderate carotid stenosis on the right and left. Upon her re-admission to Manor Care on August 2, 2004, Resident 10 had an intravenous morphine pump at 25 mg per day for severe pain and a clonopin pump at 250 mg per day for back pain. She was also prescribed oxycodone (Percocet) "prn," or as needed, for breakthrough pain. Finally, she was prescribed fentanyl citrate (Actiq), a narcotic analgesic, in the form of a lozenge often referred to as a "lollipop," every three hours, as needed, for breakthrough pain. As a potent opiate, fentanyl is a Schedule II controlled substance that is subject to misuse, abuse, and addiction. The nurses' notes for August 2, 2004, indicated that Resident 10 was offered Percocet for her pain, but that she declined it. On August 3, 2004, the attending physician changed Resident 10's fentanyl prescription from "3 hr. prn" to "q. 2h," meaning from every three hours, as needed, to every two hours regardless of her expressed need. Manor Care's pharmaceuticals were provided by an outside pharmacy pursuant to a contract comporting with 42 C.F.R. Section 483.75(h). On August 7, 2004, Manor Care's staff faxed a refill order to the contract pharmacy requesting a refill of Resident 10's fentanyl. During the day shift on August 9, 2004, Diane Hinrichs, the LPN performing the narcotics count, noticed that the fentanyl count was low and that the pharmacy had not filled the August 7 refill order. She faxed a repeat refill order and phoned the pharmacy, which assured her that the fentanyl would be included in the pharmacy's 4:00 p.m. delivery to Manor Care. When the fentanyl was not delivered at 4:00 p.m., another Manor Care nurse phoned the pharmacy again. The pharmacy assured the nurse that the fentanyl would be included in the next scheduled delivery, at about 2:00 a.m. on August 10, 2004. Shortly before 2:00 a.m., Ms. Hinrichs was back on duty and phoned the pharmacy, asking whether she could obtain the fentanyl at Walgreens or some other alternate source. The pharmacist told her that she could not, but assured her that the fentanyl was "on its way." The fetanyl was not included in the 2:00 a.m. delivery. The duty nurse called the pharmacy immediately, then again at approximately 5:20 a.m., and was again told that the fentanyl was "on its way." The last dose of fentanyl in the facility was administered to Resident 10 at midnight on August 9, 2004. Resident 10 did not receive fentanyl, as ordered, at 2:00 a.m., 4:00 a.m., and 6:00 a.m. on August 10, 2004. She continued to receive the morphine and clonopin on the intravenous pump throughout the night. During the night, Resident 10 was offered Percocet as a substitute for the unavailable fentanyl. She declined the Percocet, stating that "it does not help at all." Manor Care's medication administration records indicated that Resident 10 had never taken Percocet. As noted above, Resident 10's physician had prescribed Percocet for breakthrough pain. The pharmacy delivered the fentanyl at approximately 7:40 a.m. on August 10, 2004, and the nursing staff administered the medication to Resident 10 at about 8:30 a.m. The pharmacy later investigated the situation and informed Manor Care that a pharmacy technician had miscalculated the amount of fentanyl that Manor Care was allowed to keep on hand and had placed the refill order in a "holding bin" for later delivery. The Manor Care nursing notes indicate that Resident 10's physician was notified of the unavailability of the fetanyl at some time on August 10, 2004. On August 11, 2004, the physician discontinued his order for Percocet and instead prescribed oral morphine (Roxanol) for Resident 10's breakthrough pain. The physician continued the prescription for fetanyl. One of Resident 10's diagnoses was a "history of nicotine addiction, cigarette abuse." Her night and early morning routine was sleep punctuated by frequent trips in her wheelchair to an outdoor gazebo designated by Manor Care as a smoking area. During the early morning hours of August 10, 2004, Resident 10 followed this routine. During the early morning hours of August 10, 2004, Resident 10 was observed by an experienced RN, Angela Miguel, and an experienced LPN, Diane Hinrichs, both of whom were familiar with Resident 10's condition, personality, and habits. Resident 10 did not complain to either nurse regarding pain caused by the missed doses of fentanyl. Neither nurse observed Resident 10 to exhibit any behavior indicative of pain. Resident 10 appeared to be going about her usual routine of sleeping, then going outside to smoke. Under the circumstances, neither nurse saw any reason or need to conduct a formal pain evaluation of Resident 10. Jane Sargent-Jefferson, the food service director, arrived at Manor Care at her usual time of 5:00 a.m. on August 10, 2004. She found Resident 10 asleep in her wheelchair outside in the smoking gazebo, which is adjacent to the Manor Care dining room. Ms. Sargent-Jefferson often found Resident 10 asleep in the gazebo during the early morning hours and would wake up Resident 10 and talk to her. She did so on the morning of August 10, 2004. Ms. Sargent-Jefferson testified that "the first thing out of [Resident 10's] mouth" was that "she was mad because her meds had been missed." Ms. Sargent-Jefferson stated that it was not unusual for Resident 10 to be angry and to complain when she was unhappy. Just the day before, Resident 10 had "stormed out" of the dining room when the chef's salad was not to her liking. Ms. Sargent-Jefferson had frequent conversations with Resident 10. On the morning of August 10, 2004, she spoke with Resident 10 on three separate occasions between 5:00 a.m. and noon. Resident 10 did not say that she had been in pain during the previous night. Ms. Sargent-Jefferson testified that Resident 10 "would tell you" if she was in pain. Ms. Sargent- Jefferson observed nothing out of the ordinary in Resident 10's appearance or behavior on the morning of August 10, 2004. On the morning of August 10, 2004, AHCA surveyor Barbara Pescatore was in the smoking gazebo when she was approached by a resident subsequently identified as Resident 10, who complained that she had not received prescribed pain medication from midnight until 8:30 a.m. Ms. Pescatore transferred the inquiry to Anne Dolan, the RN who had been assigned to survey the care of Resident 10. Ms. Dolan reviewed the facility's records and interviewed the staff. She learned that Resident 10's fentanyl doses were missed at 2:00 a.m., 4:00 a.m., and 6:00 a.m. on August 10, 2004, and that the 8:00 a.m. dose on that date was administered at about 8:30. She further learned the circumstances surrounding the lack of fentanyl in the facility in the early morning hours of August 10, 2004. At the hearing, Ms. Dolan, an expert in long-term care nursing, opined that Manor Care and its nurses had an absolute responsibility to ensure that Resident 10 had her medication and had it on time. She testified that at 10:00 p.m. on August 9, 2004, the nursing staff knew that there was only one dose of fentanyl remaining to administer and that it was the staff's responsibility to do whatever was needed to ensure there would be more medication to give Resident 10 after the last dose at midnight. Ms. Dolan testified that missed doses of a routine pain medication can cause unnecessary pain and a delay in the medication's effect when the doses are resumed. Ms. Dolan testified that she could see Resident 10 grimacing and wincing when she would feel pain in her leg. She testified that Resident 10's pain was relieved immediately when she received the fetanyl "lollipop."2/ However, Ms. Dolan was not present on the night in question, and the record gives no indication whether Ms. Dolan or any other AHCA surveyor simply asked Resident 10 whether she experienced increased pain when she missed the doses of fentanyl. No direct evidence was presented that Resident 10 expressed pain or complained of pain or discomfort due to the missed doses of fentanyl, either at the time or later. Dr. Franklin May, a senior pharmacist for AHCA, offered expert testimony and testified that the nursing staff's actions during the night of August 9, 2004, evidenced a "very severe" failure to deliver pharmaceutical services. He based this opinion on the fact that the regulations require that medication be provided in a timely manner. Dr. May was not involved in the survey process and did not interview Resident 10. Based on the records he reviewed, Dr. May testified that he could not say whether Resident 10 "needed" the fentanyl for pain between midnight and 8:00 a.m. Dr. May opined that when the dose of fentanyl was missed due to its unavailability and Resident 10 refused to take the alternative drug Percocet, the staff nurses should have performed an immediate pain evaluation and contacted the resident's physician for instructions. If the attending physician had been unavailable, then the nurses should have contacted Manor Care's director of medicine for instruction. Dr. May emphasized that the staff nurses did not have the discretion to allow the resident to simply miss doses of prescribed medicine. The contracting pharmacy's policy and procedure manual set forth the following policy: "When medication orders are not received or unavailable, the licensed nurse will immediately initiate action in cooperation with the attending physician and the pharmacy provider. All medication orders unavailable to the customer will be managed with urgency." The manual sets forth the following process to implement the policy, in relevant part (emphasis in original): If a medication shortage is discovered during normal pharmacy hours: A licensed nurse calls the pharmacy and speaks to a registered pharmacist to determine the status of the order. If not ordered, place the order or re-order to be sent with the next scheduled delivery. If the next available delivery causes delay or missed dose in the customer's medication schedule, take the medication from the emergency stock supply to administer the dose. If medication is not available in the emergency stock supply, notify the pharmacist and arrange for an emergency delivery. If a medication shortage is discovered after normal pharmacy hours: A licensed nurse obtains the ordered medication from the emergency stock supply. If the ordered medication is not available in the emergency stock supply, a licensed nurse calls the pharmacy's emergency answering service and request to speak with the registered pharmacist on duty to manage the plan of action. Action may include: Emergency delivery. Use of emergency (back-up) pharmacy. If an emergency delivery is unavailable, a licensed nurse contacts the attending physician to obtain orders or directions which may include: Holding the dose/doses. Use of an alternative medication available from the emergency stock supply. Change in order (time of administration or medication). * * * When a missed dose is unavoidable: Document missed dose on the Medication Administration Record (MAR) or Treatment Administration Record (TAR): Initial and circle to indicate any missed dose. Document explanation for missed dose according to physicians order: e.g. "hold dose" on back of MAR/TAR and indicate "See nurses notes for explanation." Document explanation of missed dose in the Nurses Notes: Describe circumstance of medication shortage. Notification of pharmacy and response. Action(s) taken. Manor Care staff did not completely fulfill the requirements of the quoted procedures. The MAR for Resident 10 complied with the documentation requirement that missed doses be initialed and circled, but made no reference to explanatory nurses' notes. The records indicate that the nurses' notes regarding the missed doses were not made contemporaneously, but were completed later in the morning of August 10, 2004. As noted above, the nursing staff made several attempts to have the pharmacy deliver the fentanyl, but never proceeded to the next step of using a back-up pharmacy or contacting the attending physician because of the attending nurses' observations that Resident 10 was not in pain or discomfort. The federal CMS issues a "State Operations Manual" containing guidelines that are relied upon by surveyors when assessing compliance with regulatory requirements. The State Operations Manual provides, as follows regarding alleged violations of 42 C.F.R. Section 483.60: A drug, whether prescribed on a routine, emergency, or as needed basis, must be provided in a timely manner. If failure to provide a prescribed drug in a timely manner causes the resident discomfort or endangers his or her health and safety, then this requirement is not met. There was no allegation made nor evidence presented that Resident 10's health or safety was endangered by the missed doses of fentanyl. Thus, the issue, as framed by the Guidance to Surveyors documents, is whether Resident 10 experienced "discomfort." The evidence presented at hearing did not establish that Resident 10 experienced pain or more than minimal additional discomfort due to the missed medication. At most, the evidence proved that Resident 10 was upset by the fact that she missed doses of fentanyl. She did not tell anyone that she was in pain and displayed few, if any, outward behavioral indications of pain. Resident 10 went about her normal routine, including sleeping for a time and going outside to smoke cigarettes on the gazebo. Subsequently, in September 2004, Resident 10 was discharged from Manor Care and returned to her own residence. The alleged violation of C.F.R. Section 483.60 was classified by the surveyors as an isolated "Class II" deficiency. Subsection 400.23(8)(b), Florida Statutes (2004), provides, in relevant part: A class II deficiency is a deficiency that the agency determines has compromised the resident's ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class II deficiency is subject to a civil penalty of $2,500 for an isolated deficiency . . . A fine shall be levied notwithstanding the correction of the deficiency. Subsection 400.23(7)(b), Florida Statutes (2004), provides that the presence of one or more Class II deficiencies requires AHCA to assign a conditional licensure status to the facility. Conditional licensure means that a facility "is not in substantial compliance at the time of the survey with criteria established under this part or with rules adopted by the agency." Subsection 400.23(8)(c), Florida Statutes (2004), defines a "Class III" deficiency as follows, in relevant part: A class III deficiency is a deficiency that the agency determines will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident's ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class III deficiency is subject to a civil penalty of $1,000 for an isolated deficiency . . . A citation for a class III deficiency must specify the time within which the deficiency is required to be corrected. If a class III deficiency is corrected within the time specified, no civil penalty shall be imposed. Under all the facts and circumstances set forth above, it is found that Manor Care did not provide Resident 10 with her prescribed fentanyl during the late night hours of August 10, 2004. It is further found that though Manor Care's nursing staff made repeated efforts to obtain the fentanyl through its contracted pharmacy and received repeated assurances that the medication was "on its way," Manor Care's nursing staff did not follow all of the procedures set forth in the pharmacy's policy and procedure manual to secure the medication on an urgent basis. However, the evidence did not establish that Resident 10's "ability to maintain or reach . . . her highest practicable physical, mental, and psychosocial well-being" was compromised by the missed doses of fentanyl. At most, Resident 10 suffered "minimal physical, mental, or psychosocial discomfort," and the alleged violation should have been classified as an isolated Class III deficiency.
Recommendation Based on the foregoing Findings of Facts and Conclusions of Law, it is RECOMMENDED that AHCA enter a final order dismissing the Administrative Complaint. DONE AND ENTERED this 26th day of August, 2005, in Tallahassee, Leon County, Florida. S LAWRENCE P. STEVENSON 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 26th day of August, 2005.
Findings Of Fact On or about July 20, 1990, the Respondent, Patrick Thomas Wells, visited a friend, Chuck Schmidt, at Anclote Manor Hospital. Anclote Manor, now known as The Manors, is a residential psychiatric hospital that admits both voluntary and involuntary patients for treatment of mental illness. It is not clear from the evidence whether Chuck Schmidt was a voluntary or involuntary patient at Anclote Manor. It also is not clear from the evidence what Schmidt's "code" status was on July 20, 1990, i.e., whether and to what extent the hospital was restricting his physical movement. However, based on what transpired on July 20, 1990, it seems that the hospital did not want Schmidt to leave the hospital. The Respondent, and another individual, visited with Schmidt in a visiting room off the lobby at the entrance to the hospital. The entrance lobby is serviced by two tandem doors separated by a small and narrow vestibule. The inner of the two doors is locked. To gain entry to the entrance lobby, it is necessary to enter the outer of the two doors, proceed through the small and narrow vestibule to the inner door, and wait for the receptionist, sitting at the receptionist's desk in the lobby, to press a button that operates a buzzer and unlocks the inner door. To leave the building, it also is necessary to wait for the receptionist to unlock the inner door. During the Respondent's visit with Schmidt, a hospital medical technician named Theodore Carabelas waited in the lobby immediately outside the door to the visiting room. It was his job to supervise the whereabouts of Schmidt and escort Schmidt back to his quarters inside the hospital when the visit was over. Although Carabelas did not know what Schmidt's "code" status was on July 20, 1990, he clearly understood part of his job to be to prevent Schmidt from leaving the hospital unless Carabelos was given proper authorization from hospital personnel to let him leave. During the visit, the Respondent sent the other individual with him out to the car in the parking lot purportedly to get some paperwork. In light of what transpired soon after, it seems that their real purpose was to allow the individual to provide information to the Respondent and Schmidt so that they could plan an escape from the hospital. A short time after the individual returned to the group, he again went out to the car, again purportedly to get more paperwork. This time, another hospital employee, Suzette Jouvere-Nicosia, waited in the small and narrow vestibule for the individual to return. On the individual's return, when the receptionist unlocked the inner door, and the individual opened the door, the Respondent shouted, "let's go," and he and Schmidt burst out of the visiting room door and ran through the lobby towards the open door. In the process of the escape through the lobby, the Respondent's shoulder bumped into Carabelas, who was standing just outside the door to the visiting room, and knocked him to the floor. There was no evidence that the Respondent intended to hurt Carabelas or went out of his way to shoulder Carabelas to the ground. Carabelas simply was in the way of the charge and basically was run over. Carabelas was not injured. When the Respondent and Schmidt got to the inner door, essentially the same thing happened to Jouvere-Nicosia. Where she was standing in the narrow vestibule near the inner door, it was impossible for either Schmidt or the Respondent alone, much less together, to get through the passageway without bumping into her. As the Respondent passed by, he also bumped into her with his shoulder, and she was knocked into the wall of the vestibule. The three "escapees" continued to exit the building and hopped into a waiting "getaway" car. As with Carabelas, there was no evidence that the Respondent intended to hurt Jouvere-Nicosia or went out of his way to shoulder her into the door frame. As with Carabelas, she simply was in the way of the charge and basically was run into. There was no evidence on which a finding can be made that she was injured. The Respondent is licensed in Florida as a watchman and has a Florida gun permit. 2/ But the Respondent was not in uniform, and there was no evidence that he was acting in his capacity as a licensee on July 20, 1990. Nor was there any evidence that he displayed or was carrying a gun on July 20, 1990. 3/
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that the Respondent, the Department of State, Division of Licensing, enter a final order: (1) finding the Respondent, Patrick Thomas Wells, guilty of a two violations of Section 493.6118(1)(j), Fla. Stat. (Supp. 1990), one as to Carabelos and one as to Jouvere-Nicosia; (2) fining him $250; (3) reprimanding him; and (4) placing him on probation for the next year in which he engages in activities regulated under Chapter 493, Fla. Stat. (Supp. 1990). RECOMMENDED this 15th day of July, 1991, in Tallahassee, Florida. J. LAWRENCE JOHNSTON Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 15th day of July, 1991.
Conclusions Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency has jurisdiction over the above-named Respondent pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaints and Election of Rights forms to the Respondent. (Ex. 1 and Ex. 2) The Election of Rights form advised of the right to an administrative hearing. The Respondent returned the Election of Rights forms selecting “Option 3.” (Ex. 3 and Ex. 4) On October 17, 2011, the Administrative Law Judge entered an Order consolidating both cases (Ex. 5). On February 6, 2012, the Administrative Law Judge entered an Order granting the Agency’s Motion to Relinquish Jurisdiction and Closing Files. (Ex. 6). On April 2, 2012, Richard J. Saliba, the Informal Hearing Officer, entered an Order Relinquishing Jurisdiction and Closing File based on Briarwood’s decision that it was abandoning its request for a hearing (Ex. 7). Based upon the foregoing, it is ORDERED: 1. The findings of fact and conclusions of law set forth in the Administrative Complaints are adopted and incorporated by reference into this Final Order. 2. The assisted living facility license of Briarwood Manor is REVOKED. The Respondent shall pay the Agency $35,500.00. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the “Agency for Health Care Administration” and containing the AHCA ten-digit case number should be sent to: Filed June 26, 2012 11:00 AM Division of Administrative Hearings Office of Finance and Accounting Revenue Management Unit Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 14 Tallahassee, Florida 32308 ORDERED at Tallahassee, Florida, on this_A*e*-day of C Ste AL , 2012.
Other Judicial Opinions A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct cpey otis Final Order was served on the below-named persons by the method designated on this 7S “day of , 2012. Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Finance & Accounting Facilities Intake Unit Revenue Management Unit (Electronic Mail) (Electronic Mail) Lourdes A. Naranjo, Senior Attorney Cindy Dookeran Office of the General Counsel Administrator Agency for Health Care Administration Briarwood Manor (Electronic Mail) 5721-5631 N. W. 28" Street Lauderhill, Florida 33313 (U.S. Mail) Katrina Derico-Harris Arlene Mayo-Davis Medicaid Accounts Receivable Field Office Manager Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) Shawn McCauley Errol H Powell Medicaid Contract Management Agency for Health Care Administration (Electronic Mail) Administrative Law Judge Division of Administration Hearings (Electronic Mail) Richard Saliba, Esq. Informal! Hearing Officer Agency for Health Care Administration (Electronic Mail) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2011005869 Return Receipt Requested: v. 7009 0080 0000 0586 1985 DDJJ LLC d/b/a BRIARWOOD MANOR, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA”’), by and through the undersigned counsel, and files this administrative complaint against DDJJ LLC d/b/a Briarwood Manor (hereinafter “Briarwood Manor”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2010), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the assisted living facility license of Respondent [License No.: 7478], pursuant to Section 408.815(1) (c) &(d), Florida Statutes, and Section 429.14(1) (e), Florida Statutes, and to impose an administrative fine of $14,500.00, pursuant to Sections 429.14 and 429.19, Florida Statutes (2010), for the protection of public health, EXHIBIT 1 safety and welfare. Section 429.14(1)(e), Florida Statutes, provides that the Agency may revoke an assisted living facility license if the facility is cited with three or more Class II deficiencies. The Agency has considered the factors outlined in Section 419.19(3), Florida Statutes, in imposing the penalty and in fixing the amount of the fine. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2010), and Chapter 28-106, Florida Administrative Code (2010). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2010). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 429, Part I, Florida Statutes (2010), and Chapter 58A-5 Florida Administrative Code (2010). 5. Briarwood Manor operates a 34-bed assisted living facility located at 5621-5631 N. W. 28" Street, Lauderhill, Florida 33313. Briarwood Manor is licensed as an assisted living facility under license number 7478. Briarwood Manor was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I BRIARWOOD MANOR FAILED TO KEEP RESIDENTS’ MEDICATIONS LOCKED IN THE REFRIGERATOR. RULE 58A-5.0185(6) (b)1, FLORIDA ADMINISTRATIVE CODE (MEDICATION STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Briarwood Manor was cited with five (5) Class II deficiencies as a result of an Operation Spot Check Appraisal visit that was conducted on May 20, 2011. 8. An Operation Spot check appraisal visit was conducted on May 20, 2011. Based on observation and interview, it was determined that the facility did not keep residents' #1 and #4's medications locked within the refrigerator in the kitchen to ensure residents did not ingest potentially harmful medications. The findings include the following. 9. In an observation on 5-20-11 at 9:30 AM in the main kitchen, inside a non-lockable refrigerator and not in a lockable container, there were 2 boxes containing Risperdal 5O0mcg suspension, each marked for intramuscular administration for residents #1 and resident #4. 10. During this observation, it was determined the area where this refrigerator was located could not be locked and it was accessible by the general facility population of residents without encumbrances. ll. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.0185(6)(b)1, Florida Administrative Code, herein classified as a Class II violation, which warrants an assessed fine of $1,000.00 and gives rise to the revocation of the assisted living facility license. COUNT II BRIARWOOD MANOR FAILED TO MAINTAIN A SAFE AND SANITARY FOOD SERVICE AND KITCHEN AREA. RULE 58A-5.020(1) (b), FLORIDA ADMINISTRATIVE CODE (NUTRITION AND DIETARY STANDARDS) CLASS II VIOLATION 12. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 13. An Operation Spot check appraisal visit was conducted on May 20, 2011. Based on observations, it was determined the facility failed to maintain a safe and sanitary food service and kitchen area. The findings include the following. 14. Observations on 5/20/11 at approximately 9:15 AM revealed the following concerns in the kitchen area: a. The kitchen floor was dirty throughout, with a heavy layer of soil built up behind the three compartment sink area, equipment, and food storage area. b. The kitchen stovetop, cabinet under sink, food equipment shelving, potholders, utensil drawers, switch plates, walls and window sills were dirty. c. Cutting boards were blackened and deeply scored. d. Several kitchen refrigerators were missing thermometers. The microwave oven door was rust laden and the microwave was soiled in the interior. e. The deep chest freezer, which was full of frozen food, had a large build-up of ice, needed defrosting, and had no thermometer in the interior. f. The dirty window sill directly about the 3 compartment sink continued uncovered single serve plastic utensils, dirty scrub pads, brushes, measuring cups and a ladle. g. The kitchen back door was not vermin-proof as the door did not fit in the frame tightly. Live roaches were observed in the kitchen. h. There were paints and chemicals stored within the food storage room. i. Approximately 10 lbs. of ground beef was left in a sheet pan defrosting on a kitchen table. 15. There was a bucket of dirty dishes on the table alongside the ground meat. Various clean cooking vessels were stored on a shelf underneath this table. 16. Note: A representative from the Department of Health was on the premises on 5/20/11 and issued an unsatisfactory food service inspection report to the facility. 17. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.020(1) (b), Florida Administrative Code, herein classified as a Class II violation, widespread, which warrants an assessed fine of $5,000.00 and gives rise to the revocation of the assisted living facility license. COUNT III BRIARWOOD MANOR FAILED TO MAINTAIN A RESIDENTIAL AREA WHICH PROMOTED A RESIDENTIAL, HOMELIKE, AND SAFE CARING ENVIRONMENT FOR RESIDENTS; FAILED TO PROVIDE A SAFE AND DECENT ENVIRONMENT WITH RESPECT TO PERSONAL DIGNITY AND PRIVACY; AND FAILED TO ENSURE THAT FURNITURE AND FURNISHINGS WERE CLEAN AND IN GOOD REPAIR SECTION 429.28(1) (a), FLORIDA STATUTES RULE 58A-5.023(3) (a)1. & 2., FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS II VIOLATION 18. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 19. An Operation Spot check appraisal visit was conducted on May 20, 2011. Based on observations and interviews, it was determined that the facility failed to maintain a residential area which promoted a residential, homelike, and safe care environment for the census of 27 residents, and failed to provide a safe an decent environment with respect to dignity and privacy as required by the Residents’ Bill of Rights. The facility also failed to ensure that furniture and furnishings were clean, functional, and in good repair. The findings include the following. 20. During the tour of the facility on 05/21/11 at 9:30 a.m. in the resident bathroom located in Building A adjacent to room 5, the bathroom door was observed to be open. There were residents observed in the vicinity. Inside the bathroom was a large hole in the tile wall where the sink used to be. There was a pipe coming out of the hole in the wall and a large bucket positioned under the pipe as the pipe was leaking water. The bucket was observed to be full of dirty water. The hole in the wall had jagged edges, was approximately two to three feet wide, about two feet high and at least a foot or more deep, exposing bare blackened dirt and debris. 21. The area also was moisture laden from the leaking pipe. There were broken tiles littering the area, exposed metal piping and water valves from the missing sink. The floor under the bucket was also missing several tiles (a square area of approximately two feet by two feet) and exposing the brown sub floor. The brown sub floor was noted to be blackened with biogrowth. The bathroom door was observed open with no barrier or signage to alert residents, staff and visitors to the hazard. 22. Adjacent to the bathroom in Building A by room 5 was a storage closet that was easily opened, and not locked. Inside the closet there were construction materials, a green garden hose, buckets, and 2 containers of pesticides. 23. The maintenance staff member was interviewed on 05/20/11 at 9:45 a.m. He said that he is in the process of working on the sink and confirmed that the bathroom door was open. In addition, he confirmed that there was no lock on the storage closet adjacent to the bathroom and said he would find a way to lock it. The facility has a Limited Mental Health license and the census on the day of the survey was 27. 24. During observations on 05/20/11 at 10:30 a.m. in the laundry room in Building B there was a ladder and construction materials observed stored behind the door. There was a silver air conditioning (a/c) duct running along the wall just below the ceiling that was noted to have a large hole, exposing the insulation. The edges were blackened. There was a large shelving unit with folded blankets and comforters stored right below the a/c duct and next to the ladder and construction materials. In addition, the a/c vent just above the clean linens was observed to be dirty, and blowing directly onto the folded linens. The laundry room floor was filthy. This was brought to the attention of the maintenance staff member. 25. During observations on 05/20/11 at approximately 10:45 a.m. in the resident bathroom in Building A on the North side of the building the tub was observed to have no faucet. Instead there was just a bare metal thin spout with a sharp metal end coming out of the tub. In addition, the tub was very dirty. This was brought to the attention of the maintenance staff member. 26. On 05/20/11 at approximately 10:00 a.m. in Building B the bathroom outside room 11 was observed to be very dirty with a dried brownish substance smeared in places on the floor. On 05/20/11 at 11:00 a.m., about an hour later, the substance was noted to still be there. 27. Observations of Room 3 and 4 at approximately 10:30 AM on 5/20/11 revealed the rooms were adjoined together through the closet opening of room 3. A torn plastic shower curtain was hung at the opening in room 3 and the resident's bed in room 3 was placed in front of the shower curtain blocking access between rooms 3 and 4. 28. Room 4 had no window to the outside and was occupied Observations of room 4 on 5/20/11 revealed the by resident #4. room was dark, dreary, dimly lit, musty, warm, and difficult to maneuver around in. There was no closet either in room 3 and 4. 29. A referral was made to the City of Lauderhill Code Enforcement officer, who was present during the survey. The Code Enforcement Unit issued the facility a "Notice of Violation" on 5/20/11 with numerous violations. 30. A referral was made to the Broward County Health Department. Their representative arrived at the facility during the survey and issued an unsatisfactory inspection report to the facility. 31. During the tour of the facility on 05/20/11 at 9:30 a.m. the following was observed with the maintenance staff 32. In Building A room 4, there was a lamp with no shade and the bare bulb was exposed. 33. In Building A's day room, the window curtains were observed to be soiled and not hanging properly as many of the curtain hooks were not attached to the rod and hanging loosely. In the bathroom on the North side of Building A the vanity cabinet was observed to be in disrepair as it was separating from the wall. 34. In Building B, the bathroom off the day room was observed to have window blinds that were in disrepair. The sink vanity was in disrepair as the veneer was peeling off and worn. The toilet tank lid had a large crack in the middle. The shower 10 curtain was torn and the floor was very dirty with black scuff marks and a large puddle of water. 35. In Building B, the bathroom adjacent to room 11 was very dirty including old feces on the floor. 36. A leather sofa in the common area in Building B had a large tear in the cushion. 37. The bathroom outside room 13 was observed to have a very dirty floor, a hole behind the toilet, and a rusty opened can of food was found stored inside the mirrored vanity door. 38. The administrator was interviewed on 05/20/11 at 11:30 a.m. and no additional information was provided. 39. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.023(3)(a)l. & 2., Florida Administrative Code, and Section 429.28(1) (a), Florida Statutes, herein classified as a Class II violation, widespread, which warrants an assessed fine of $5,000.00 and gives rise to the revocation of the assisted living facility license. 11 COUNT IV BRIARWOOD MANOR FAILED TO ENSURE THAT THE DOORS WERE FUNCTIONAL AND IN GOOD WORKING ORDER, AND THAT PEELING PAINT WAS REPAIRED OR REPLACED. RULE 58A-5.023(3) (a)3, FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS II VIOLATION 40. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 41. An Operation Spot check appraisal visit was conducted on May 20, 2011. Based on observations and interviews, it was determined that the facility failed to ensure that doors were functional and in good working order, and that peeling paint was repaired or replaced. The findings include the following. 42. During the tour of the facility on 05/20/11 at 9:30 a.m. the following was observed: a. In Building A room 4, observations revealed the room had a door to the outside of the facility. The door was observed to be ill fitting, so that a large gap was between the door and the door jamb. b. In Building B room 10, there was a door to the outside that had a large gap between the door and the door jamb, allowing the potential for insect infestations. 12 c. In Building B room 14, there was a door to the outside that did not fit the door jamb so that there was a large gap. d. In Building B, the bathroom by the large paint storage closet was labeled with a sign that said the bathroom was out of order due to the bathtub leaking. 43. During the tour of the facility on 05/20/11 at 09:30 a.m. in Building A room 4, there was peeling paint on the walls. In addition, throughout Building B the walls were observed to be patched and not painted over in several places throughout the building. The maintenance staff member was present and confirmed the findings. 44, The maintenance staff person was present during the observations on 05/20/11 and confirmed the findings. 45. Based on the foregoing facts, Briarwood Manor violated Rule 58A~5.023(3) (a)3, Florida Administrative Code, herein classified as a Class II violation, patterned, which warrants an assessed fine of $2,500.00 and gives rise to the revocation of the assisted living facility license. 13 COUNT V BRIARWOOD MANOR FAILED TO HAVE A SATISFACTORY HEALTH DEPARTMENT INSPECTION. RULE 58A-5.016(6), FLORIDA ADMINISTRATIVE CODE RULE 58A-5.0161(1), FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS II VIOLATION 46. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 47. An Operation Spot check appraisal visit was conducted on May 20, 2011. Based on record reviews and interviews, it was determined that the facility failed to have a satisfactory health department inspection. The findings include the following. 48. During observations of multiple physical plant issues at the facility, a referral was made to the Broward County on 05/20/11 at approximately 9:45 a.m. The Health Department representative arrived at the facility and was apprised of all of the findings of the survey team. At the conclusion of their visit the facility was issued an unsatisfactory Group Care and Food Service inspection on 05/20/11. 49. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.016(6), Florida Administrative Code, and Rule 58A- 5.0161(1), Florida Administrative Code herein classified as a Class II violation, which warrants an assessed fine of $1,000.00 14 and gives rise to the revocation of the assisted living facility license. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Briarwood Manor on Counts I through vi. 2. Revoke the assisted living facility license [License No.: 7478] of Briarwood Manor on Counts I through V for the violations cited above. 3. Assess an administrative fine of $14,500.00 against Briarwood Manor on Counts I through V for the violations cited above. 4. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2010). Specific options for administrative action are set out in the attached Election of Rights. All 15 requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER Komen @ koe an td Lourdes A. Naranjo, Esq. Fla. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8333 N.W. 537? Street Suite 300 Miami, Florida 33166 305-718-5906 Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) 16 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Cindy Dookeran, Administrator, Briarwood Manor, 5621-5631 N. W. 28th Street, Lauderhill, Florida 33313 on a \ this2Z@ "day of , 2011. Dr lie, Glew orf Ourdes A. Naranjo, Esq. 17 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: DDJJ LLC d/b/a Briarwood Manor AHCA No.: 2011005869 ELECTION OF RIGHTS This Election of Rights form is attached to a proposed 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 must be returned by mail or by fax within 21 days of the day you receive the attached Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 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. Phone: 850-412-3630 Fax: 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 Fine or Fee, 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, the 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)____—sid dispute the allegations of fact contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) 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 administrative 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. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4. A statement of all disputed issues of material fact. If there are none, you must state that there are none. 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: Name Title Address: Street and number City Zip Code Telephone No. Fax No. Email(optional) I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: 0 Dates Print Name: Title: Late fee/fine/AC STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2011009335 Return Receipt Requested: v. 7009 0080 0000 0586 2180 DDJJ LLC d/b/a BRIARWOOD MANOR, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA”’), by and through the undersigned counsel, and files this administrative complaint against DDJJ d/b/a Briarwood (hereinafter “Briarwood Manor”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2010), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the assisted living facility license of Respondent [License No.: 7478], pursuant to Section 408.815(1) (c)&(d), Florida Statutes, and Section 429.14(1) (e), Florida Statutes, and to impose an administrative fine of $21,000.00 pursuant to Sections 429.14 and 429.19, Florida Statutes (2010), for the protection of public health, EXHIBIT 2 safety and welfare. Section 429.14(1)(e), Florida Statutes, provides that the Agency may revoke an assisted living facility license if the facility is cited with one or more Class I deficiencies. Section 408.815(1) (c)&(d), Florida Statutes, provides that the Agency may revoke a license for a violation of “this part, authorizing statues, or applicable rules” or “for a demonstrated pattern of deficient practice”. The Agency has considered the factors outlined in Section 419.19(3), Florida Statues, in imposing the penalty and fixing the amount of the fine. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2010), and Chapter 28-106, Florida Administrative Code (2010). 3. Venue lies pursuant to Rule = 28-106.207, Florida Administrative Code (2010). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 429, Part I, Florida Statutes (2010), and Chapter 58A-5 Florida Administrative Code (2010). 5. Briarwood Manor operates a 34-bed assisted living facility located at 5621-5631 N. WwW. 28° Street, Lauderhill, Florida 33313. Briarwood Manor is licensed as an assisted living facility under license number 7478. Briarwood Manor was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. 6. On August 17, 2011, the Agency entered an Immediate Moratorium on Admissions (AHCA No.: 20110090890) on the basis that the Agency determined that the current practices and conditions at Briarwood Manor present a threat to the health, safety, or welfare of the residents of the facility; present an immediate serious danger to the public, health, safety, or welfare; and present an immediate or direct threat to the health, safety, or welfare of the Residents who reside at Briarwood Manor. COUNT I BRIARWOOD MANOR FAILED TO PROVIDE APPROPRIATE SUPERVISION FOR EACH RESIDENT INCLUDING GENERAL AWARENESS OF THE RESIDENT’S WHEREABOUTS, AND A WRITTEN RECORD AFTER A MAJOR INCIDENT. RULE 58A-5.0182(1), FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE - SUPERVISION STANDARDS) CLASS I VIOLATION 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. Briarwood Manor was cited with two (2) Class I deficiencies and one (1) Class II deficiency as a result of a survey conducted on August 11, 2011. On August 17, 2011, an Immediate Moratorium on Admissions was served on Briarwood Manor 9. A survey was conducted on August 11, 2011. Based on Based on interview and record review, it was determined that the facility failed to provide appropriate supervision for each resident including: General awareness of the resident's whereabouts and a written record, updated after a major incident for 1 of 3 sampled residents reviewed (Resident #1). The findings include the following: 10. Record review on 8/11/11 revealed Resident #1 was admitted to the facility on 1/22/09 with a diagnosis to include schizophrenia and renal cell cancer. A facility note on 7/20/11 documented the resident did not return to the facility until 2:00 AM. Note on 7/23/11 documented the resident did not return to the facility until 11:30 PM. On 7/28/11 the resident left the facility. A Resident Elopement Prevention Drill Form dated 7/29/11 at 7:00AM did not identify the employees who noticed the resident missing, the time she was last seen, employees who assisted in the search or a description of the resident. Further review of the record did not contain an incident report. 11. During an interview with the administrator on 8/11/11 at 10:45 AM, she stated the facility has not identified any residents who may be at risk for elopement. She also stated the residents are not required to sign in or out when they leave the property as it is all done verbally. The surveyor was unable to determine the last time Resident #1 was seen at the facility. 12. A review with the administrator of the facility staffing schedule identifies one staff member working the 11:00 PM-7:00 AM shift. Two days a week the staff member working the overnight shift works a 16 hour double shift. During the review the administrator stated this is the facility's permanent schedule. 13. A review with the administrator of the policy and procedure manual did not identify a policy regarding resident supervision. A review of the elopement policy revealed the facility will: "conduct elopement drills with all the staff twice a year to protect our residents from elopement." "Any elopement will be documented in the resident file along with a copy of the adverse incident report. “A review of the elopement drills did not identify a drill in 2011 and only one drill in 2010. 14. During an interview on 8/11/11 at 11:46 AM with several unsampled residents, they were asked if they had to notify anyone when they leave the facility's property. All the residents interviewed stated they did not need to notify anyone, and they just needed to be back by 11:00 PM. As of 8/11/11 at 3:00 PM Resident #1 has not been found. 15. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.0182(1), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $10,000.00. COUNT IT BRIARWOOD MANOR FAILED TO HAVE MEDICATIONS AVAILABLE TO ADMINISTER IN ACCORDANCE WITH HEALTH CARE PROVIDER’S ORDER OR PRESCRIPTION LABEL. RULE 58A-5.0185(4)&(5), FLORIDA ADMINISTRATIVE CODE (MEDICATION ADMINISTRATION STANDARDS) CLASS II VIOLATION 16. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 17. A survey was conducted on August 11, 2011. Based on record review and interview, it was determined that the facility failed to have medications available to administer in accordance with a health care provider's order or prescription label, for 1 of 3 sampled residents reviewed (Resident #3). The findings include the following. 18. Resident #3 was admitted to the facility on 6/3/11 with a diagnosis to include Psychosis and COPD. An 1823 health assessment form completed by the physician on 6/14/11 identified the residents medications to include Simvastin 40 mg 1 tab daily and Risperidone 4 mg 1 tablet HS. A review of the medication observation record (MOR) did not list the medications. 19. During an interview on 8/11/11 at 2:30 PM with the med tech, it was confirmed the MOR did not include Simvastin 40 mg 1 tab daily or Risperidone 4 mg 1 tablet HS. She acknowledged the facility did not have the medications and stated they were probably discontinued. The facility was not able to provide evidence the physician discontinued any of the resident's medications. The facility must maintain a daily medication evaluation record (MOR) for each resident who receives assistance with self-administration of medication or medication administration. The MOR must include a chart recording each time the medication is taken, any missed dosages, refusals to take medication, or medication errors. The MOR must be immediately updated each time the medication is offered or administered. 20. Based on the foregoing facts, Briarwood Manor violated Rule 58A-5.0185(4)&(5}, Florida Administrative Code, herein classified as a Class II violation, which warrants an assessed fine of $1,000.00. COUNT III BRIARWOOD MANOR FAILED TO ESTABLISH A RISK MANAGEMENT AND QUALITY ASSURANCE PROGRAM. SECTION 429.23, FLORIDA STATUTES RULE 58A-5.0241, FLORIDA ADMINISTRATIVE CODE (RISK MANAGEMENT AND QUALITY ASSURANCE STANDARDS) CLASS I VIOLATION 21. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 22. A survey was conducted on August 11, 2011. Based on record review and interview, it was determined that the facility failed to establish a risk management and quality assurance program, the purpose of “which is to assess resident care practices, facility incident reports, and adverse incident reports, for 2 of 3 records reviewed (Resident #1 and #2). The findings include the following. 23. Record review on 8/11/11 revealed Resident #1 was admitted to the facility on 1/22/09 with a diagnosis to include schizophrenia and renal cell cancer. A facility note on 7/20/11 documented the resident did not return to the facility until 2:00 AM. Note on 7/23/11 documented the resident did not return to the facility until 11:30 PM. On 7/28/11 the resident left the facility. A Resident Elopement Prevention Drill Form dated 7/29/11 at 7:00 AM did not identify the employees who noticed the resident missing, the time she was last seen, employees who assisted in the search or a description of the resident. Further review of the record did not contain an incident report. 24. During an interview with the administrator on 8/11/11 at 10:45AM, she stated the facility has not identified any residents who may be at risk for elopement. She also stated she faxed an adverse incident report to the agency on 7/29/11 but could not provide confirmation. At 10:55 AM the AHCA complaint unit was contacted and confirmed the agency had not received the required notification regarding the elopement. 25. The surveyor was unable to determine the last time Resident #1 was seen at the facility. As of 8/11/11 at 3:00 PM Resident #1 has not been found. 26. Resident #2 was admitted to the facility on 11/16/93 with a diagnosis to include Diabetes, COPD, and Neuropathy. A note dated 3/27/11 documents the resident was dizzy and fell. The resident was transferred to the hospital and returned to the facility on 3/30/11. During an interview on 8/8/11 at 1:45 PM with the administrator and med tech, it was revealed the med tech stated 911 was contacted and the resident was transported by ambulance to the local hospital. She could not remember what happened to the resident and did not complete an incident report. 27. Based on the foregoing facts, Briarwood Manor violated Section 429.23, Florida Statutes, and Rule 58A-5.0241, Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $10,000.00. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Briarwood Manor on Counts I through IIl. 2. Revoke the assisted living facility license [License No.: 7478] of Briarwood Manor for the citations cited in counts I through III. 3. Assess an administrative fine of $21,000.00 against Briarwood Manor on Counts I through III for the violations cited above. 4. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2010). Specific options for administrative action are set out in the attached Election of Rights. All 10 requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS ~= 4#3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER vo Ve vile, blwraus.) Lourdes A. Naranjo, Esq. Fla. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8333 N.W. 53°? Street Suite 300 Miami, Florida 33166 Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) 11 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Cindy Dookeran, Administrator, Briarwood Manor, 5621-5631 N. W. 28° Street, Lauderhill, Florida 33313 on this [7 aay of ih. , 2011. Lourdes A. Naranjo, Esq. 12 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: DDJJ LLC d/b/a Briarwood Manor AHCA No.: 2011009335 ELECTION OF RIGHTS This Election of Rights form is attached to a proposed 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 must be returned by mail or by fax within 21 days of the day you receive the attached Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 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. Phone: 850-412-3630 Fax: 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 Fine or Fee, 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, the 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, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) 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 administrative 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. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4. A statement of all disputed issues of material fact. If there are none, you must state that there are none. 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: Name Title Address: Street and number City Zip Code Telephone No. Fax No. Email(optional) I hereby certify that ] am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name: Title: Late fee/fine/AC 000 p.1 Jan170106:28p STATE OF FLORIDA ; to. AGENCY FOR HEALTH CARE ADMINISTRATION Fr | 1 rE D RE: DDJJ LLC d/bfa Briarwood Manor AHCA No.: 2011005869 _ AGE eva, ERK ; 20H AUG Te ECTION OF RIGHTS BPI) This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice jof Entent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Cd maplaint. pour Election of Rights must be returned by mgit or by fax within 22 days of the dav you receive the attached Notice of Intent to Impose a Lite /Fes. Notice of Intent to Impose a Late Fin Administrative Complat Hf your Election of Rights with your selected optjon is not received by AHCA within twenty- one (21) days from the date you received this noticd of proposed action by AHCA, you will have given up your right to contest the Agency's proposed < and a fial order will be issued. (Please use this form unless you, your attomey or yo feprescntative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Fk rida Administrative Code.) PLEASE RETURN YOUR CTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration j Attention: Agency Clerk ; 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308. Phone: 850-412-3630 Fax: 850-921-0158. PLEASE SELECT Q GF THESE 3 OPTIONS OPTION ONE (1). I admit to the allegatipns of facts and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and | waive my right to object and to have a hearing, | understand that by}giving up my right to a hearing, a final order will be issued that adopts the proposed agency actionjand imposes the penalty, fine or action. OPTION TWO (2) L adunit to the allegati$ns of facts contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent td Impose a Late Fine, or Administrative Complaint, but J wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Flocida Statutes) where I may submit testimony and written evidence to the Agoncy to show that -the proposed admuinistrative action is too severe or that the fine should be reduced. ; OPTION THREE (3)_X 1 dispute the allegatiqas of fact contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent td Impose a Late Fine, or Administrative Complaint, and 1 request a formal hearing (pursupnt to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by thd Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (4), by itself, is NOT sufficient te obtain a forma! hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Se¢tion 120.57(1), Florida Statutes. It must be + 1 srg CeLbt Le ezine EXHIBIT 3 000 p2 Jan 1704 06:28» received by the Agency Clerk at the address above Within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to tbe requirements of Rule 28- 106.2015, Florida Administrative Code, which requifes that it contain: 1. Your name, address, and telephone number, ang the name, address, and telephone number of your representative or Lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4, A statement of all disputed issues of material fapt. If there are none, you soust state that there are none. Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees. License type: ALF (ALF? nursing hoche? medical equipment? Other type?) Licensee Name: BATARWoAD MANOR | License number: Contact person: SNE DookFA AN ‘DUN Name Title Address; °°71 maw? 2aty S71 name pL 33313 Street and number City Zip Code Telephone No. 784-135: #179 Pax No, 44 -486-30}) |Email(optional) [hereby certify that I am duly authorized to submit tliis Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licengee referred to above. Sign od: Cu ws, Date: “At ‘ PrintName:_ Cand) —_Dot/tep.An/ Title:_Abran Late fee/fine/AC 6rd Bebb bE BZ ine 99/22/2011 3:26PM FAX 905919 PHARHCO {21000170008 - Ye \. . STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: DDIJ LLC d/b/a Briarwood Manor AHCA No.: 2011009436 ae wa) ty _ ELECTION OF RIGHTS 2 By, ee Co ceeeecee ee OP, This form is attached to a proposed action ‘by the “Agency for Health Care Administration en, ‘The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint, vecelve ve attached Notice of inte ‘ent ty Impose 2 Late 2 Fee, Notice of ‘Tatent ‘0 Impose a Late Fine or Adminisirative Complaint, jf tf If your Election of Rights with your selected option Is not received od By AHCA within twenty. _ one ys trom the date you received this notice of propos lion Dy , you will have given up your right to contest the Agency's proposed action and a final order will be issued. - (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for ilealth Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 ° Tallahassee, Florida 32308, Phone: 850-412-3630 Fax: 850-921-0158, PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONF (i) T admit to the allegations of factsjand law contained in the Notice of Intent to Ympose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing, T 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 nally, fine or action. OPTION TWO (2) _ lL admit to the allegations of facts contained i in the Notice of Intent to, Impose a Late Fee, the 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)_ 46 J dispute the allegations of fact contained in the Notice of Intent to. Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaini, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. : Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain » formal hearing. You also must file a written petition in order to obtain a formal hearing bofore the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be EXHIBIT 4 VOefeVll S.cOrM FAA suOMIET PHARMUU (g0902/0008 received by the Agency Clerk at the address above within 21 days of your recoipt of this proposed + administrative action, The request for formal hearing must conform to the roquirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain: L. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if arty. : - ; Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees, a Ligense type: ALE (ALF? nursing home? medical equipment? Other type?) ? Contact person: cxeupy DoockErans ADAENE SRA TDR. . Name - Title Address S62! NW gerd Sr Lauber aril AL 333) Street and number : City Zip Code Telephone No, 98V - 735" Pax No. 8Y~ ¥95_ Rmail(optional) FPF BEY) : I hereby certify that [ am duly authorized to submit this Notice of Election of Rights to the Agency for Health Cure Administration on behalf of the licensee referred to above. Signed: Grip). Date; ahs) : i Print Name:_G2N0 nokeRan rite Abu, Late fee/fine/AC STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ) ADMINISTRATION, ) ) Petitioner, ) ) vs. ) Case Nos. 11-4432 ) 11-5103 DDJJ, LLC d/b/a BRIARWOOD ) MANOR, ) ) Respondent. ) ) ORDER OF CONSOLIDATION These cases having come before the undersigned on the Agreed Motion to Consolidate, filed October 14 and 17, 2011, and the undersigned having reviewed the records in these cases, it is, therefore, ORDERED that: 1. DOAH Case Nos. 11-4432 and 11-5103 are consolidated pursuant to Florida Administrative Code Rule 28-106.108. 2. The style of this cause is amended as reflected above. DONE AND ORDERED this 17th day of October, 2011, in Tallahassee, Leon County, Florida. Erol A Verb ERROL H. POWELL Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us EXHIBIT 5_ Filed with the Clerk of the Division of Administrative Hearings this 17th day of October, 2011. COPIES FURNISHED: Lourdes A. Naranjo, Esquire Agency for Health Care Administration 8333 NW 53rd Street, Suite 300 Miami, Florida 33166 Cindy Dookeran Briarwood Manor 5631 Northwest 28th Street Lauderhill, Florida 33313 Cindy Dookeran DDJJ, LLC d/b/a Briarwood Manor 5621 Northwest 28th Street Lauderhill, Florida 33313 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ) ADMINISTRATION, ) ) Petitioner, ) ) vs. ) Case Nos. 11-4432 ) 11-5103 DDJJ, LLC d/b/a BRIARWOOD ) MANOR, ) ) Respondent. ) ) ORDER CLOSING FILES AND RELINQUISHING JURISDICTION These causes having come before the undersigned on Petitioner's Motion to Relinquish Jurisdiction, filed January 25, 2012, to which Respondent did not file a response, having been provided an opportunity to do so, and the undersigned being fully advised, it is, therefore, ORDERED that: 1. The final hearing scheduled for February 27 and 28, 2012, is canceled. 2. The files of the Division of Administrative Hearings are closed. Jurisdiction is relinquished to the agency. EXHIBIT G_ DONE AND ORDERED this 6th day of February, 2012, in Tallahassee, Leon County, Florida. COPIES FURNISHED: Lourdes A. Naranjo, Esquire Euol A Veurll ERROL H. POWELL Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 6th day of February, 2012. Agency for Health Care Administration 8333 NW 53rd Street, Suite 300 Miami, Florida 33166 Cindy Dookeran Briarwood Manor 5631 Northwest 28th Street Lauderhill, Florida 33313 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA NO.: 2011009335:2011005869 CASE NO.: 12-106PH vs. DDJJ LLC d/b/a BRIARWOOD MANOR, Respondent. / ORDER CLOSING FILE AND RELINQUISHING JURISDICTION This cause came before the undersigned upon receipt from the Respondent informing of the withdrawal of the request for a hearing. Based upon this notice from the Respondent informing that the facility is closed the Respondent specifically informs that the Respondent no longer requests a hearing. A copy of this writing from the Respondent is attached hereto as Exhibit ‘A’ and by reference made a part hereof. The undersigned being fully advised, it is, therefore, ORDERED that: 1. This informal hearing file is closed and jurisdiction is relinquished to the Agency for Health Care Administration for entry of final order. DONE AND ORDERED at Tallahassee, Leon County, Florida, this and day of April, 2012. Agency for Health Care Administration Rickard. Joseph. ‘Sahiba Richard Joseph Saliba Informa! Hearing Officer EXHIBIT 7_ Copies furnished to: Lourdes Naranjo, Esquire Agency for Health Care Administration (Electronic Mail) Ms. Cindy Dookeran DDJJ LLC d/b/a BRIARWOOD MANOR 5621 NW 28" Street Lauderdale Hill Fl 33313 rwood Manor Phone: 954-735-8989 Fax: 954-485-3641 Reference to case #: 12-106PH. AHCA Nos. 20110056869 & 2011009335. Formerly DOAH Nos. 41-4432 & 11-5103. ATTN: Mr. Saliba rm you that Briarwood Manor was officially closed and is as of 3/21/12. Briarwood Manor is no longer interested in This letter is to inf no longer in operatio defending this case. Thank you a dobg Cindy Dookeran
Findings Of Fact In January of 1977, Ethel Hall, a frail nonagenerian about 5' 3" tall, was confined as a patient at Beverly Manor Convalescent Center in St. Petersburg. On the afternoon of January 5, 1977, respondent Hagstrand was wheeling a cart from room to room along the corridor onto which Ms. Hall's room opened. As part of her duties as a nurse at Beverly Manor Convalescent Center, respondent was dispensing medicine to the patients from the cart. She stopped the cart in front of Ms. Hall's room, and began pouring medicine for another patient. Ms. Hall came out of her room and asked for aspirin. Respondent told her she would have to wait her turn but Ms. Hall protested. Respondent then took Ms. Hall by her shoulder and led her back into her room. While this was taking place, respondent continued to insist in a loud voice to Ms. Hall, who is hard of hearing, that Ms. Hall would have to wait for her medicine and Ms. Hall answered in a loud voice to the effect that she feared her medicine was going to be forgotten. The loud voices attracted the attention of Ms. Effie Corryele, a state employee who happened to be at a nurse's desk nearby examining records. When Ms. Corryele reached the door to Ms. Hall's room, she saw respondent seating Ms. Hall, handling her roughly.
Recommendation Upon consideration of the foregoing, it is RECOMMENDED That petitioner reprimand respondent. DONE AND ORDERED in Tallahassee, Leon County, Florida, this 2nd day of December, 1977. ROBERT T. BENTON, II Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Mr. Julius Finegold, Esquire 1005 Blackstone Building Jacksonville, Florida 32202 Mr. Thomas Saieva, Esquire 621 Sixth Avenue South St. Petersburg, Florida 33701 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE THE FLORIDA STATE BOARD OF NURSING HELEN BROWN HAGSTRAND 626 5th Avenue South St. Petersburg, Florida 33701 CASE NO. 77-822 As a Registered Nurse License Number 82454-2 /
