Findings Of Fact Respondent is an Adult Congregate Living Facility licensed by Petitioner. Maria Mier is a district programs specialist employed by Petitioner in its Adult Congregate Living Facility program. She was assigned the responsibility of working with Respondent to assure Respondent's compliance with Petitioner's regulations on May 5, 1981. Petitioner presented no testimony regarding the conditions at the Aloha prior to that date. Isabell Arango is a long-term care administrator for Petitioner. She has the responsibility for assessing the amount of administrative fine to be imposed as a result of any violation of Petitioner's regulations. In doing so, she reviews the recommendation of the specialist in charge of that facility and then applies her personal set of guidelines, which were not introduced in evidence. Mier and Arango signed both Administrative Complaints under consideration herein. Petitioner filed a Petition for the Appointment of a Temporary Receiver to operate the Aloha. Petitioner's Petition was heard in the circuit court of the 11th Judicial Circuit in and for Dade County, Florida, on May 15, 1981, and a receiver recommended by Petitioner was appointed to operate and manage the facility. By order entered June 11, 1981, a circuit court judge granted an Agreed Motion for Substitution of Court-Appointed Receiver and appointed a substitute receiver recommended by the Petitioner. By order entered October 5, 1981, a circuit court judge granted the Moha's Motion to Terminate the Receivership. On May 4, 1981, a resident of the Aloha was found naked by the police somewhere outside of the facility. He was taken to Jackson Memorial Hospital, and his daughter was contacted. Adult Congregate Living Facility residents are free to come and go as they wish and do not require permission from facility personnel in order to be allowed to leave the facility. The resident located by the police had left the facility on a regular basis in the past, and no evidence was offered to indicate the resident in question would be likely to be in danger at any time that he was away from the facility or that there had been any prior problems regarding his absence from the Aloha. On November 10, 1981, Mier went to the Aloha to investigate a complaint from a resident that an envelope addressed to her containing a check had been opened. Mier did not see any opened mail at the Aloha and did not observe the facility's procedure for handling residents' mail. On December 17, 1981, Mier prepared a citation for that complaint and had the citation delivered to the administrator of the Aloha, although the citation itself advised that Petitioner considered the alleged deficiency to have been corrected as of December 1, 1981. (These facts form the basis for an allegation found in the Administrative Complaint filed in Case No. 82-179.) On January 20, 1982, Petitioner received a complaint from a different resident that an envelope addressed to her had been opened. On February 2, 1982, the same resident filed with Petitioner a written authorization requesting that the Aloha personnel open her mail for her. (These facts form the basis for an allegation found in the Administrative Complaint filed in Case No. 82-737.) According to the facility's records, during June, 1981, a resident refused to take medication on numerous occasions. The records did not reflect that the resident's doctor was notified. A resident in an Adult Congregate Living Facility cannot be forced to take medication. The resident in question had a history of drug and alcohol addiction, and his physician had advised the staff at the Aloha to withhold any medication from him at any time they believed he had been drinking due to the dangerous combination of his medication and alcohol. On July 29 and August 3, 1981, 15 residents observed in the lobby had foul body odor and dirty clothing. Four male residents needed shaving. If a resident of an Adult Congregate Living Facility does not wish to shave or wants to wear dirty clothing, personnel at the facility cannot force that resident to shave or to remove dirty clothing. On July 19, 1981, one resident of the Aloha was determined by a physician to be in need of nursing home care, services which the Aloha is not licensed to provide. On July 29, 1981, that resident was still at the Aloha. Only a medical doctor can order a transfer of a resident from an Adult Congregate Living Facility to a nursing home. Once the doctor orders it, the Adult Congregate Living Facility is in charge of making arrangements. If no nursing home beds are readily available, then a unit within the Petitioner's organization is in charge of placement into nursing homes. A wealthy patient can be placed easily; placement for a Medicaid patient may take time. On August 3, 1981, 24 out of 27 resident files reviewed lacked the required physician's statement regarding the resident's physical condition. Those records were brought into compliance, and Mier knows of no medical problems involving those 24 residents during the time of noncompliance. On August 3, 1981, the admission/discharge register for the residents of the Aloha was not properly maintained. The register was subsequently brought into compliance. On August 3, 1981, seven out of 27 resident files reviewed lacked a properly executed contract for services between the resident and the Aloha. Seven contracts had the resident's date of admission as the date the contract was signed, although the charges listed in the contract were effective after the admission date. This deficiency was subsequently remedied. On August 3, 1981, 23 out of 27 resident files reviewed lacked complete demographic data, i.e., the information pertinent to a death certificate. On August 3, 1981, four out of 24 personnel records reviewed lacked references in the employment application, and one record lacked the employment application. On August 3, 1981, nine out of 24 personnel files reviewed lacked the proper documentation that the employee was free of communicable diseases. Respondent admits that during surveys conducted on June 2, June 15, July 17, August 3 and November 2, 1961, the following facility maintenance and housekeeping standards were violated: Strong urine odors in resident rooms; Lack of toilet supplies in bathrooms; Inoperable drapes in resident rooms; Broken fixtures in resident bathrooms; Presence of vermin in the locked physician's examination room; A broken corner on a mirror in a resident's room; Two areas of cracked tile in the dining room; Furniture in need of repair. Mier, who conducted the inspections, has no knowledge as to what furniture was in need of repair. Petitioner conducted inspections of the facility's physical plant on June 2, June 15 and November 2, 1981. An additional inspection was commenced on July 29 and was concluded on August 3, 1981. On June 2, Rooms 25 and 59 had no air conditioners, but both rooms had large windows which opened for ventilation. On July 29, 1981, the air conditioning units in Rooms 31 and 40 were not working. On July 29, 1981, Rooms 27 and 73, which were being used for storage, lacked proper ventilation from either air conditioning or windows. On July 29, 1981, Rooms 1 and 10 had light bulbs missing from fixtures in the bathrooms. New light bulbs were installed while Mier was still present. (c) On July 29, 1981, Rooms 36, 40, 60, 68 and 70 lacked non-slip safety devices in the bathrooms. On November 2, 1981, only Room 36 of those inspected on July 29 still lacked non-slip safety devices. Additionally, non-slip safety devices were missing in the bathrooms of Rooms 46, 48 and 57. On July 29, 1981, the Aloha lacked handrails in 43 resident bathrooms. The Aloha purchased over 40 handrails, the total number that could be located in Miami at the time, and placed an order for an additional 45. The Aloha filed a copy of that order with Petitioner at the time. On each of her inspections, Mier found the second floor lobby to be uncomfortably hot. She therefore determined that the lobby was unusable and that the facility, therefore, did not comply with the required 35 square feet per resident in common-use areas. She did not take the temperature of the area which she determined to be uncomfortably hot on any of those occasions. She does not know the measurements of the second floor lobby, and no evidence was introduced regarding the size of the common areas in order to determine whether the 35- square-foot-per-resident requirement was met. Mier admits that based upon her recommendation, Aloha installed fans in that lobby. An air conditioning unit was later placed on the roof in order to cool the second floor rooms even more. Martha Perez is a nutrition consultant for the Petitioner. She conducted inspections of the food service standards at the Aloha on June 3 and November 3, 1981. On June 3, 1981, the Aloha had 129 residents. The chart of one of those residents indicated a need for a diabetic diet. Perez found no diabetic foods or special menus regarding a diabetic diet at the Aloha. On November 3, 1981, the Aloha still had 129 residents. Perez found no special provision for anyone needing a special diet but was also unable to identify anyone residing at the Aloha whose file indicated a need for a special diet. On June 3, 1981, the Aloha had only a one-and- a-half days' supply of non-perishable food, rather than the one-week's supply required. On November 3, 1981, the emergency food supply had been increased so that it was sufficient for two and a half days. On June 3, 1981, Perez found frozen raw meat being defrosted at room temperature. On November 3, 1981, Perez found a fully cooked meatloaf cooling off on the stove.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED THAT: A final order be entered dismissing the Administrative Complaint filed against Respondent in Case No. 82-179 and further dismissing the Administrative Complaint filed against Respondent in Case No. 82-737. DONE and RECOMMENDED this 1st day of December, 1982, in Tallahassee, Leon County, Florida. LINDA M. RIGOT, 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 1st day of December, 1982. COPIES FURNISHED: Martha F. Barrera, Esquire Department of HRS 1320 South Dixie Highway Coral Gables, Florida 33146 Barry L. Halpern, Esquire Koger Executive Center, Suite B-106 8405 NW 53rd Street Miami, Florida 33166 David H. Pingree, Secretary Department of HRS 1317 Winewood Boulevard Tallahassee, Florida 32301
The Issue The issue for consideration in this case is whether Petitioners should be granted approval by the City of Clearwater of their request for expansion of a six-bed group home facility, located at 1430 Palmetto Street in Clearwater, to eight beds.
Findings Of Fact Petitioners, Generosa T. Santos and Rose W. Milam, operate the White Palace, an assisted living facility, in a residence owned by Petitioner Milam, located at 1430 Palmetto Street in Clearwater. The facility is currently licensed for six residents and has been in operation for several years. The property in question is a single family residence located in an area zoned RS 8, (residential urban), on the north, east and west, and recreational/open space on the south. In actuality, all parcels, including the property in question, except for the golf course on the south, are occupied by single family residences. On December 15, 1996, Ms. Santos applied to the City's Planning and Zoning Board for a conditional use permit to expand the existing six bed Level I Group Care Facility to a maximum capacity of eight residents. The Petitioners' request was considered by the Board at its public meeting held on February 4, 1997. Prior to that time, the Petitioners' application was reviewed by Sandra E. Glatthorn, a planning administrator for the City who determined that the property, a single family residence, has been utilized since 1983 as an assisted living facility for six adults. In 1985, the facility was permitted for eight residents, but for two years thereafter, the facility did not operate as such and that permit lapsed. In March 1994, Ms. Santos requested zoning approval for six clients, which was approved. After her review of the application in issue, Ms. Glatthorn prepared a staff report which supported the request. This report was based on the matters submitted with the application. Her review indicated that the intended use for which the application was submitted appeared to be compatible with the neighborhood and the zoning requirements, but at the meeting of the Board held on February 4, 1997, several neighbors came forward to present evidence that the proposed use, based on demonstrated conditions, was not compatible with but had a negative impact on surrounding properties. An RS 8 zoning category is generally limited to single family residences or to family care facilities for up to six clients. Once the projected client population exceeds six residents, the category becomes Level I Group Care. Clients in either case can be elderly, physically or mentally handicapped, or non-dangerously mentally ill. Criminal or dangerous clients are not allowed within either category. Distance requirements between the residence in issue and surrounding properties are not in issue here. On reconsideration of this application, after the Board meeting, the planning staff now recommends denial. At the Board meeting, several neighbors expressed their opposition to the approval of the requested permit. They cited what they considered to be incidents of a nature inconsistent with the quiet enjoyment of their property, including aberrant and disconcerting behavior by residents of the existing facility which made them uncomfortable and precluded them from a worry-free occupancy of their property. Residents of the facility were seen to wander the neighborhood, to verbally abuse neighbors and shout out obscenities, to seek access to neighboring properties and to occasion a police response to complaints by neighbors. Mr. Santos opined that the neighborhood opposition to the increase in the number of beds is based on an opinion held that Petitioners are not capable of running the facility and on the Petitioners as a family. He rejects the contention by some neighbors that his children, who occupy the house along with their parents and the clients, are not being brought up in a good environment. This is not in issue. The decision to operate the home as an assisted living concept was not a spur of the moment decision by the Petitioners. They researched the possibility thoroughly before deciding to operate it. Mr. Santos asserts that the neighbors claim the residents at the facility are abandoned, but this is not so. The residents have families who visit them and who take the residents for off- facility visits. In addition, he claims, the residents are not violent. Before admission to the facility, potential residents are screened to insure they are not violent or dangerous. He contends he would not expose his family, which lives in the facility, to dangerous residents. The staff of the facility is made up of members of the Santos family. Any clients who created trouble at the facility have been removed from it at Mr. Santos' instigation. Though residents are not restricted to the facility grounds, if there is a problem with a resident, that resident is removed from the home in an effort to satisfy the neighbors. Though Mr. Santos believes he has a good relationship with most of the neighbors, he cannot seem to get through to the Popes. Ms. Santos and Ms. Milam are willing to work with the neighbors to alleviate their anxieties regarding the facility and, if that is what it takes to do so, will agree to limit the occupancy of the facility only to elderly clients. Only Mr. and Mrs. Pope appeared at the instant hearing. Both expressed substantial objection to the expansion of the facility. Their concerns are based on the fact that residents of the facility have come to their home next door and banged on the door seeking entrance; have screamed obscenities at them while they were in their back yard; and on the report that the owners will move out if the increase in resident authorization is approved and bring in other people to care for the residents. Neither Mr. nor Mrs. Pope have ever been in the facility. It appears, also, that on only one occasion did residents come to their home to seek entry. Mr. Pope admits to being quick to anger and to being prejudiced against Orientals. He served in the South Pacific during World War II. Mr. And Mrs. Santos are Orientals. Neither the Popes nor their neighbors who appeared at the Board's February 4 meeting want the facility in their residential community. Most of them have spent their entire lives working towards providing a comfortable and secure home for their retirement and they feel that the insertion of a group home, with the attendant additional activity, would be incompatible with the quiet enjoyment of their property and would adversely affect their property values, which make up a large portion of their financial worth. On the other hand, representatives of Directions For Mental Health, Inc., an agency devoted to the placement of disabled adults, primarily the mentally ill, consider the White Palace a much needed resource. They recommend the bed increase sought be granted.
Findings Of Fact Petitioner Department of Health and Rehabilitative Services (hereinafter the Department), filed an Administrative Complaint alleging that Respondent, The Villa Cabana, Inc. (hereinafter Villa Cabana), violated minimum licensing standards for an Adult Congregate Living Facility in the following manner: The Respondent failed to assure, and have available documentation, that each person employed by the facility, who may come into contact with potentially infectious materials is trained in infection control procedures for blood and other bodily fluids. It was further alleged that the deficiency was found to exist during the surveys completed on July 31, 1989 and July 18, 1990. By letter dated January 5, 1991, the administrator for Villa Cabana disputed the allegations set forth in the Administrative Complaint and requested a formal hearing. During the hearing, the Department presented one witness and filed two exhibits, which were admitted into evidence. The Respondent called two witnesses, and showed the Hearing Officer the nursing license of Floretta Young. A transcript of the proceeding was not ordered. Both parties waived their opportunity to submit proposed findings of fact.
Recommendation Based upon the foregoing, it is RECOMMENDED: The Respondent be found guilty of having violated Rule 10A-5.019(5)(h), Florida Administrative Code, during the survey conducted on July 18, 1990, as alleged in the Administrative Complaint. The alleged violation of the same Florida Administrative Code provision which was recorded in the survey conducted July 31, 1989, be considered as an improperly classified deficiency. The July 18, 1990 violation be deemed the facility's first offense of Rule 10A-5.019(5)(h), Florida Administrative Code. The civil penalty which the Department seeks to assess against the facility administrator be dismissed as such penalties may only be imposed if the violation is a repeated offense. DONE and ENTERED this 24th day of April, 1991, in Tallahassee, Leon County, Florida. VERONICA E. DONNELL Hearing Officer Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 904/488-9675 Filed with the Clerk of the Division of Administrative Hearings this 24th of April, 1991. COPIES FURNISHED: Paula M. Kandel, Esquire HRS - Office of Licensure and Certification 7827 North Dale Mabry Highway Tampa, Florida 33614 Keith Young, Administrator The Villa Cabana 2600 - 4th Street South St. Petersburg, Florida 33705 R. S. Power, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Linda K. Harris, Esquire General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Findings Of Fact At all times pertinent to the allegations herein, Petitioner, Department, was the state agency responsible for the regulation of Adult Congregate Living Facilities, (ACLF), in Florida, and Respondent operated an ACLF, Palmetto Guest Home, at 820 5th Street West, Bradenton, Florida. On March 28, 1980, Ms. Alice P. Adler, and Ms. Mary C. Cook, both surveyors for the Department's Office of Licensure and Certification, did a routine survey of the Respondent's facility for compliance with the requirements of Chapter 10A-5, F.A.C., and Chapter 400, Florida Statutes. As a result of their survey they discovered several discrepancies which required correction. The eight pertinent to this hearing were: The facility did not have written accounting procedure that clearly outlined the operation of the business, including resident trust funds and other property. (Sec.400.417(1) and 400.427, Florida Statutes). Several resident contracts did not reflect the current rate being paid for care. (Section 400.402(10) and 400.424, Florida Statutes). There were no assurances that staff were free of infection or communicable diseases, (Rule 10A-5.019(5), F.A.C.). All centrally stored medications were not kept in a locked cabinet, in that medications were observed placed on top of the north wing medicine cabinet. (10A- 5.0182(3)(a), F.A.C.) Residents who were prescribed therapeutic diets by their physician were not served these diets as ordered. (10A- 5.020(1), F.A.C.). Various violations of the Food Service Code were identified. (10D-13, F.A.C.) Each resident record did not contain a report of physical examination to assure that the resident was free of communicable or infectious disease. (Sec. 400.426, Florida Statutes, and Rule 10A- 5.0181(2)(a), F.A.C.) The facility did not provide the resident or guardian with an admission package upon admission. Sec. 400.426(4)(5), Florida Statutes and Rules 10A-5.0181(1)(a)(c) and 10A-5.024(2)(c), F.A.C.). As was normal practice, on the day of the survey, prior to departure, the team went over its findings with Ms. Miller, the Executive Director of the facility and Ms. Brown, the Administrator, pointed out each discrepancy, and advised as to what was needed to bring the discrepancy into compliance. Thereafter, a copy of the written survey report, with the classification of deficiencies, was sent to the facility and on May 8, 1989, Ms. Brown acknowledged receipt of the survey report form. A follow-up survey was conducted by both Ms. Adler and Ms. Cook on June 5, 1989. At that time, several previously identified discrepancies had been corrected, but those listed above in Paragraph 2 were still not corrected.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore: RECOMMENDED that the Department of Health and Rehabilitative Services enter a Final Order herein imposing an Administrative Fine of $250.00 for each of the eight violations established for a total fine of $2,000.00. RECOMMENDED this 1st day of June, 1990, in Tallahassee, Florida. ARNOLD H. POLLOCK, 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 1st day of June, 1990. COPIES FURNISHED: Edward A. Haman, Esquire DHRS Office of Licensure and Certification 7827 North Dale Mabry Highway Tampa, Florida 33614 James D. Biggins Palmetto Guest House 820 5th Street West Palmetto, Florida 34221 Sam Power Agency Clerk DHRS 1323 Winewood Blvd. Tallahassee, Florida 32399-00700 John Miller General Counsel DHRS 1323 Winewood Blvd. Tallahassee, Florida 32399-0700
Findings Of Fact On January 24, 1994, the Respondent, Aries Retirement Living, which is owned by W.T. Holding, Inc., filed an application for renewal of its license as an ACLF. The Aries application, completed by its administrator Patricia Holland, provided the following information: The mailing address for the administrator was completed as: 817 11th Street, West Palm Beach, Florida 33401. The mailing address for the corporate or limited partnership-corporate president or partner was: 817 11th Street, West Palm Beach, Florida 33401. At the time of the surveys (inspections) pertinent to these cases, Respondent had a conditional license to operate an ACLF for eight residents. The surveys were performed by two Agency employees who divided the review into two areas of expertise. Irwin Fried, a fire protection specialist, surveyed the Aries property for fire safety and physical plant regulation compliance. Meryl McDonald, a human services surveyor specialist, reviewed the property for all other areas of compliance. On March 14, 1994, and subsequently on June 1, 1994 and August 26, 1994, the financial records for the Aries facility were not available for review. Ms. McDonald requested the documents on each visit, but they were not provided by Aries until January 19, 1995. As a result, the Agency was unable to determine whether the facility was administered on a sound financial basis consistent with good business practice at the times of the surveys. Ms. McDonald also noted on the survey beginning March 14, 1994, that personal funds from one resident's account were used to purchase plastic gloves without the resident's consent. On December 7, 1994, the resident signed a consent for this appropriation of her funds. Despite requests from Ms. McDonald, Aries could not produce a certificate of liability insurance for review during the surveys. In this instance, Ms. McDonald asked Mr. Davis for the certificate but Aries did not present the information until January 19, 1995. For the survey and follow-ups conducted on March 14, 1994, June 1, 1994, and August 26, 1994, the last Health Quality Assurance inspection report was not posted in the Aries facility. At the times of the survey and follow-ups, Aries did not produce proof of radon testing. According to Mr. Davis, the radon testing was completed in October, 1994 (again several months after the request was made). Ms. McDonald brought several inaccuracies or deficiencies in the admission and discharge register maintained by Aries to their attention at the March 14, 1994 survey. Such inaccuracies included that seven residents were living in the facility but only three names were noted on the admission register. Further, none of other residents allegedly living in building two were listed. These inaccuracies continued uncorrected at the June 1, 1994, and August 26, 1994 follow-up visits. At the time of the March 14, 1994, survey and the follow-ups of June 1, 1994, and August 26, 1994, Aries could not establish that its Disaster Preparedness Plan had been reviewed by the Palm Beach County Disaster Preparedness Authority. According to Mr. Davis, this requirement was satisfied by the time of hearing. The Aries contract did not clearly provide a 30 days prior written notice of rate increase at the times of the survey or follow-ups. The statement disclosing Aries' medication storage policy was not given to each resident on admission. This deficiency was cited at the March 14, 1994, survey and remained uncorrected on June 1, 1994 and August 26, 1994. However, as of December 8, 1994, Aries corrected this deficiency. Aries could not produce the required demographic data for all residents, and military service information was not included for any resident. This deficiency was cited at the March 14, 1994, survey and remained uncorrected on June 1, 1994 and August 26, 1994. At the time of the March 14, 1994, survey, it was noted that a nurse was transferring insulin from labeled containers to syringes for one resident's later use. This procedure, although cited by Ms. McDonald, continued uncorrected on the June 1, 1994, follow-up. Later, the resident changed to tablets, and the deficiency was changed to corrected as of the August 26, 1994, follow-up. Also with regard to medications, Aries could produce no records or documentation to show how medications were disposed of when the resident left the facility. This lack of documentation was noted on March 14, 1994, and remained uncorrected on June 1, 1994 and August 26, 1994. When Ms. McDonald surveyed the food supply, she noted that a one week supply of non-perishable food, based on the number of weekly meals the facility had contracted to serve, was not on hand. Nor was there enough water in storage for emergencies. Food supplies on hand lacked sufficient protein. This shortage was noted on March 14, 1994, and remained uncorrected on June 1, 1994 and August 26, 1994. Mr. Davis removed dented and bulging cans after the March 14, 1994 survey. Mr. Fried surveyed the Aries property on March 14, 1994, and found the following conditions: Hot water temperature for resident use was recorded at 126 degrees F at 12:30 p.m. on the dates of the survey. On January 19, 1995, this was still uncorrected. The structure had openings in the walls which were uncorrected on June 8, 1994. The facility had exposed water pipes and exposed electrical wires or missing plates which were uncorrected on June 8, 1994. The fire and smoke detector system did not interconnect the front and back buildings to warn staff of an emergency. This condition continued from April 11, 1994 through January 19, 1995. The doors to the sleeping rooms were not self closing and latching to reduce smoke circulation during an emergency. This condition was noted during the April 11, 1994, survey and was uncorrected on June 8, 1994. The Aries facility did not have a secondary means of egress from the upstairs of the front building. This condition was noted during the April 11, 1994, survey and was uncorrected on June 8, 1994. The exit lights were not illuminated in the front Aries building and two locks were noted on the upstairs front exit and downstairs rear exit. This condition was noted during the June 8, 1994, visit and remained uncorrected for the August 25, 1994, follow-up. Ms. Holland, the administrator for Aries at all times material to these cases, was not at the property during any of the surveys or follow-up visits. Ms. Holland is employed full-time at a hospital and spends irregular hours at the Aries facility. Mr. Davis was present for the March, 1994, survey but was not present for the subsequent visits. Aries employees attempted to reach Mr. Davis when survey or follow-up visits were made to the facility. At the times of the visits, both Ms. McDonald and Mr. Fried requested to speak to the Aries staff member in charge. All deficiencies noted were itemized to Aries personnel in discussion at the times of the surveys. Additionally, written notice of the alleged deficiencies was provided to Aries at its address of record. Respondent's allegations of poor mail delivery or lack of notice have not been deemed credible. The Respondent did not claim it had not received the deficiency notices until December 7, 1994. During the June and August, 1994, follow-up surveys, Aries did not claim it had not received the deficiency statement from the prior survey or follow-up. All deficiencies alleged in these cases are Class III violations.
Recommendation Based on the foregoing, it is, hereby, RECOMMENDED: That the Agency for Health Care Administration enter a final order imposing an administrative fine in the amount of $8000.00. DONE AND RECOMMENDED this 5th day of April, 1995, in Tallahassee, Leon County, Florida. JOYOUS D. PARRISH 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 5th day of April, 1995. APPENDIX TO RECOMMENDED ORDER, CASE NOS. 94-5078 and 94-6908 Rulings on the proposed findings of fact submitted by the Petitioner: 1. Paragraphs 1 through 13 are accepted. Rulings on the proposed findings of fact submitted by the Respondent: The Respondent's "Proposed Order" was not in a format to readily review for proposed findings of fact. Paragraph 1 states: Petitioner has failed to meet its burden pursuant to Florida Statutes Section 400.419(1)(a) of communicating a recommended corrective action and informing the facility of the deficiencies prior to imposing violations and penalties. Such statement is rejected as a conclusion of law which is not established by this record. Paragraphs 1a. through 1e. are rejected as irrelevant, contrary to the weight of credible evidence, or argument. Paragraph 1f. is a restatement of law, not a fact and is rejected as such. Paragraph 2 is rejected as irrelevant or contrary to the weight of credible evidence. Paragraph 3 is rejected as argument or conclusion of law not applicable to this case. Paragraphs 4a. through 4u., except as specifically found above, are rejected as contrary to the weight of the credible evidence or irrelevant. Paragraph 5 is rejected as argument or conclusion of law not applicable to this case. COPIES FURNISHED: Tom Wallace, Assistant Director Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303 Sam Power, Agency Clerk Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303 Esther Zaretsky 1655 Palm Beach Lakes Boulevard Forum III, Suite 900 West Palm Beach, Florida 33401 Linda L. Parkinson Agency for Health Care Administration Division of Health Quality Assurance 400 W. Robinson Street, Suite S-309 Orlando, Florida 32801
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: On November 20, 1985, License Number B03139 was issued to Swan Care Homes II to operate as an adult congregate living facility. This license was issued to Wayne Veccitto, who was a tenant of respondent and his wife. The expiration date of the license was May 19, 1986. Due to the facts that Mr. Veccitto had not made his rental payments in several months and the property was falling into disrepair, respondent evicted Mr. Veccitto on or about May 1, 1986. Respondent and his wife operated the facility during the month of May, 1986, and advertised for someone else to live in the facility and operate it. Neither the respondent nor his wife desired to personally operate the facility. According to the respondent, the Millers responded to his advertisement and began operating the facility around June 1, 1986. On June 9, 1986, the petitioner received an application dated June 6, 1986, from respondent's wife to operate the subject property as an adult congregate living facility. By letter dated June 16, 1986, respondent's wife was advised that her application for initial license was incomplete and that no further action on the application would be taken until the requested information was received. This letter further advised that it was unlawful to offer adult congregate living facility services or to advertise such services without having obtained a valid license. Respondent was aware of this correspondence but was not concerned because he knew the Millers were assuming the operation of the facility. On June 27, 1986, a representative of the petitioner conducted a complaint investigative visit to the facility. At that time, there were residents at the facility and a couple in charge of the facility who stated that they were working for the respondent. There was no valid license for the facility on June 27, 1986. By letter dated July 2, 1986, and received by the petitioner on July 7, 1986, respondent requested petitioner to rescind or void his application for licensure and to accept an enclosed application from Dorothy V. Miller for the same facility. The respondent and his wife have owned and/or operated approximately 12 adult congregate living facilities in Michigan and 5 or 6 in Florida.
Recommendation Based upon the findings of fact and conclusions of law recited herein, it is RECOMMENDED that respondent Louis E. Smith be found guilty of violating Section 400.407(1)(a), Florida Statutes, and that an administrative fine of $1,000.00 be imposed. Respectfully submitted and entered this 1st day of February, 1988, in Tallahassee, Florida. DIANE D. TREMOR 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 1st day of February, 1988. APPENDIX (Case No. 87-1377) The proposed findings of fact submitted by the petitioner have been accepted and/or incorporated in this Recommended Order, except as noted below: 2. Last sentence rejected as immaterial. 5. Reference to Exhibit 2 is rejected. The proper Exhibit Number is 6. Also, no competent evidence to support the statement that Exhibit 6 was rejected by HRS. COPIES FURNISHED: Gaye Reese, Esquire Office of Licensure and Certification 7827 N. Dale Mabry Hwy. Tampa, Florida 33614 Louis E. Smith 6060 Shore Blvd. South Gulfport, FL 33707 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Blvd. Tallahassee, Florida 32399-0700 R. S. Power, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
The Issue The issue is whether the deficiencies cited by the Agency for Health Care Administration during its survey of Respondent's facility in March 2002, justify the imposition of a conditional license and/or the assessment of fines and costs against Respondent.
Findings Of Fact Based upon the testimony and evidence received at the hearing and the parties' stipulations, the following findings are made: Parties The Agency is the state agency responsible for licensure and regulation of nursing homes pursuant to Part II of Chapter 400, Florida Statutes, and Rule Chapter 59A-4, Florida Administrative Code. Respondent is a licensed nursing home in Bradenton, Florida. The Facility's Dementia Unit Generally Respondent's facility includes a secured 45-bed "dementia unit" where residents suffering from Alzheimer's disease or dementia are located. The dementia unit has five "private" (single-resident) rooms and 20 "semi-private" (two- resident) rooms. The dementia unit is staffed with two nurses and between three to seven certified nurse assistants on each eight- hour shift. The unit is headed by a director who reports to the facility's executive director. Dementia Unit Director The job description for the dementia unit director position stated a preference for an individual with a master's degree in social work, psychology, gerontology or therapeutic recreation. However, a master's degree was not a mandatory requirement or minimum qualification because the job description also permitted the facility to hire an individual with a bachelor's degree in those fields or an individual "who has signed up or completed an activities certification course and meets clinical competency's [sic]." At the time of the survey, the director of the dementia unit was Paul Kibelhan. Mr. Kibelhan was hired in August 2001, and although he did not have a master's or bachelor's degree in social work, psychology, gerontology or therapeutic recreation, he had signed up for the next-available activities certification course. Accordingly, Mr. Kibelhan met the qualifications for the position set forth in the job description. Mr. Kibelhan has implemented a number of positive changes in the dementia unit since his hiring. Call Light System and Staffing at Nursing Station The dementia unit has a call light system to alert staff when a resident requests assistance. The system includes a lighted panel at the nursing station as well as a light above each hallway in the unit and a light above the door of each resident's room. The system also includes an audible sound which can be heard throughout the unit. The panel at the nursing station is not visible from the adjacent medical records room, but the audible sound can be heard in that room. At the time of the survey, a number of the caps covering the lights on the panel at the nursing station were missing. The missing caps did not prevent staff from identifying the room from which a call light request was made because the underlying lights on the panel were in place and were still illuminated on the panel. There was no evidence that a nurse or other staff member who looked at that panel would be confused as to the location of the call light request even without the caps. Accordingly, the absence of the caps is insignificant to the operation of the system. Moreover, even if the panel was not operational or effective for alerting staff to the location of a call light request, the other aspects of the system would still allow staff to identify the location of the request. Specifically, when a call light request is made on the dementia unit, an audible sound is made and the light at the end of the appropriate hallway and the light over the resident's door are activated. Thus, upon hearing the audible sound, a staff member can simply look up at the light at the end of the hall to determine which hall to enter, and then follow that hall to the door which is lighted to respond to the request. The call light system is more than sufficient to allow staff to respond to the needs of the dementia unit's residents. Indeed, it is significant that the Agency's survey did not identify any incident where a call light was activated, but the facility's staff failed to timely respond, whether staff was in the medical records room or at the nursing station. The Agency's surveyors did not observe any nurses at the nursing station in the dementia unit at the time of the survey. However, because the survey was conducted during the lunch hour, the nurses' absence from the nursing station is not unexpected or unreasonable. Indeed, at that time of the day, the residents of the unit are in the dining room and the nurses are either assisting with the feeding of residents in the dining room or eating their own lunch or working in the records room adjacent to the nursing station. Change in the Facility's Ownership and Relevant Policies Respondent acquired the facility in December 2001 from Beverly Health Care. In order to minimize potential staff confusion after the change in ownership, Respondent's corporate management body, Seacrest Health Care Management, directed the facility's staff to continue utilizing the existing policies and procedures for the dementia unit through the Agency's March 2002 "annual" survey. One of those policies addressed neglect, abuse, or mistreatment of residents of the dementia unit. That policy, which was received as Exhibit 46, sets forth the procedures by which the staff is to identify potential incidents of neglect or abuse of residents, and how such incidents are to be investigated and reported. The staff of the dementia unit is also required to document in a "24 hour report" any unusual incidents or otherwise notable events that occur in the unit during each shift. That report goes to the nursing director and is discussed at a staff meeting each morning. The facility also has written "strategies" for addressing sexual behavior by residents of the dementia unit. Those documents, which were received as Exhibits 13 and 14, were developed for the facility by psychological and counseling specialists and identify interventions that are constructive or helpful in dealing with sexually inappropriate behavior by a demented resident as well as interventions that could be non- constructive or aggravate a problem in such situations. The recommended interventions include redirecting the resident, and reacting in a low-key, non-emotional, matter-of- fact fashion. The discouraged interventions include overreacting, isolating the resident, assuming deliberateness, taking a moral stance, and using restraints or medication before all other interventions have been tried. The Agency's Survey The Agency completed its "annual" on-site survey of Respondent's facility on March 15, 2002. As part of that survey, the Agency conducted a "focused appraisal" of the dementia unit. At the time of the survey, the facility's licensure status was standard. The survey and focused appraisal were conducted by a "team" that included nurse Wanda Lamz and health facility evaluator Raymond Wytovich, both of whom testified at the hearing. The team also included Suzanne Knapp, who did not testify at the hearing. The members of the survey team worked collaboratively during the survey, but they each focused on different aspects of the facility during the course of their review. The separate, but collaborative nature of the survey process affected the weight given by the undersigned to the testimony of Ms. Lamz and Mr. Wytovich on issues for which Ms. Knapp had primarily responsibility. The survey team identified several deficiencies at the facility. The deficiencies were detailed on a "Form 2567," which is the standard form used to document the survey team's findings. The deficiencies were identified by numbers or "Tags" which correspond to standards in the federal regulations governing nursing homes, and were rated based upon the survey team's opinion of the severity of the deficiency. The only deficiencies at issue in this proceeding are those referenced on the Form 2567 as Tag F698, Tag F490, and Tag F493. The survey team rated the Tag F698 as a Class I violation, and rated the Tag F490 and the Tag F493 as Class II violations. Each of those Tags are related to the actions taken or not taken by the facility's staff and administration in connection with the sexually inappropriate behavior exhibited by one resident, L.M. or Resident 1, between February 15 and February 22, 2002. As discussed below, that behavior culminated in Resident 1 performing oral sex on another resident, W.S. or Resident 15. Circumstances Giving Rise to the Cited Deficiencies Generally Resident 1 was a 93-year-old male, and Resident 15 was a 95-year-old male. Both had advanced stages of dementia, and both were residents of the facility's dementia unit. Dementia is a progressive mental disease which affects the patient's memory, ability to reason, and ability to control his or her inhibitions. Alzheimer's disease is a type of dementia. It is not uncommon for patients with dementia or Alzheimer's disease to do things that they would not do in their normal cognitive state, such as disrobing, masturbating in public, and engaging in other socially or sexually inappropriate behavior. Because of the patient's demented mental state, he or she does not understand that these behaviors are inappropriate. The primary interventions used in a nursing home to address sexually inappropriate behaviors exhibited by a resident with advanced dementia are to monitor the resident, protect other residents who may be affected, and either give the resident privacy or redirect the resident. Isolation of the resident or moral condemnation of the resident for the behavior are not appropriate interventions. There are no medications which eliminate or reduce sexually or otherwise inappropriate behavior of demented residents. The resident may be transferred to a psychiatric hospital as a last resort if the resident's behavior becomes unmanageable by staff or if it harms other residents, but the resident will typically be transferred back to the facility after a period of time. Resident 1's Sexually Inappropriate Behavior The facility identified that Resident 1 was engaging in sexually inappropriate behavior as early as August 2001. The care plan developed by the facility at that time to address that behavior included close monitoring of Resident 1, involving him in activities, and redirecting him when he manifested the behavior. Resident 1's care plan was reassessed and updated periodically as reflected in Exhibit 10, which is a care plan dated December 31, 2001, that includes a series of hand-written notes with dates between January and March 2002. However, the care plan was not specifically updated during the period of February 15 through 22, 2002. Despite the care plan, Resident 1 continued to exhibit sexually inappropriate behavior. The specific behavior which gave rise to the administrative complaints occurred between February 15 and 22, 2002. On February 15, Resident 1 was observed making verbal propositions to several female residents and trying to touch female residents on their breasts and thighs. On February 16, Resident 1 was again observed making verbal propositions and suggestive comments to female residents. He was also observed masturbating himself. Staff redirected Resident 1 from that conduct. On February 17, Resident 1 was observed trying to put the hand of a female resident down the front of his pants. Staff intervened, separated the two residents and redirected Resident 1. There was no indication that the female resident was upset, traumatized, or otherwise harmed by her contact with Resident 1. Staff called Resident 1's physician after the February 17 incident and notified him of Resident 1's behavior. The physician did not order any new interventions. Resident 1 shared a room with Resident 15. In the early morning hours of February 18, staff found Resident 1 in Resident 15's bed with his penis exposed and his hands positioned behind Resident 15's head. Resident 1 told staff that "I like it when he does it for me," presumably referring to oral sex. Staff interceded before any sexual act occurred, and redirected Resident 1 to his bed. The facility did not contact Resident 1's physician after the February 18 incident because staff interceded before any sexual contact between the residents occurred. Under the circumstances, the facility's action was not unreasonable. No similar contact occurred between Resident 1 and Resident 15 for the next four days, although Resident 1 intermittently engaged in other sexually inappropriate behavior during that period. He was observed masturbating himself on several occasions and he was also observed trying to touch female residents. Staff continued to intervene and redirect Resident 1 from that conduct. Around midnight on February 22, staff found Resident 1 performing oral sex on Resident 15. Staff intervened and redirected Resident 1. Staff monitored both residents throughout the remainder of the night, and no further contact between the residents occurred. Resident 15, though demented and without legal capacity to "consent" to Resident 1's advances, was capable of expressing his unwillingness to participate in an activity in which he did not want to participate. He was physically strong and had a history of combativeness with staff when they attempted to provide personal care such as bathing, dressing, or feeding him. There was no evidence that, during the either incident on February 18 or February 22, Resident 15 objected to Resident 1's actions, attempted to resist them, or was upset, traumatized, or otherwise harmed by them. At the time of the February 18 and February 22 incidents involving Resident 1 and Resident 15, each room in the dementia unit was fully occupied. As a result, staff could not have relocated Resident 1 to a private, single-resident room. Moreover, staff's failure to move Resident 1 into a different room away from Resident 15 was not unreasonable under the circumstances because both residents accepted redirection from staff after each event. The facility contacted Resident 1's physician early the next morning to notify him of the incident between Resident 1 and Resident 15. The physician directed staff to "Baker Act" Resident 1 and send him to the psychiatric unit of Manatee Hospital for evaluation. Though Resident 15 did not manifest any signs or symptoms of injury or trauma, the facility sent him to the hospital for evaluation. There, it was determined that he had not suffered any injury or harm from the oral sex performed on him by Resident 1. Resident 15 was subsequently diagnosed with a urinary tract infection, and he had an episode of nausea of February 28, 2002. The urinary tract infection was medically unrelated to the sexual contact, and the nausea on February 28 cannot be reasonably attributed to stress or trauma from the February 22 incident. Resident 1 was evaluated at the psychiatric hospital and was given an anti-psychotic medication. The psychiatrist who evaluated Resident 1 noted that he only needed close supervision, which was already being provided at the facility. The psychiatrist did not order any additional interventions besides those already in place. Thereafter, Resident 1 was returned to the facility and was placed in a private, single-resident room that had become available. A velcro strip was placed over the door to prevent any demented residents from wandering into Resident 1's room. However, Resident 1's sexually inappropriate behavior continued to be an issue. The Agency's characterization of Resident 1 as the "perpetrator" and Resident 15 as the "victim" and its characterization of Resident 1's conduct as "abuse," "sexual aggression," or an "assault" is not appropriate under the circumstances of this case. Indeed, it was undisputed that Resident 1's behaviors were typical of persons suffering from advanced dementia and that the behaviors could not be eliminated. It was also undisputed that Resident 1 was not aware of the nature of his conduct, and was not cognitively capable of forming the "intent" to abuse or assault another person. The staff of the dementia unit addressed Resident 1's persistent sexually inappropriate behavior in accordance with the unit's adopted policies and procedures and Resident 1's care plan. The incidents were fully documented in the nursing notes, were reported to the nursing director on the "24 hour reports" as required by the unit's incident reporting policy, and appropriate interventions were instituted. The nursing notes reflect the high level of monitoring that Resident 1 received during the pertinent timeframe. Indeed, the Agency has not directly cited the facility for neglecting Resident 1 or Resident 15 or for providing them an inadequate level of care. The record does not reflect what, if anything, the facility's administration or governing body did in response to the incident reports regarding Resident 1's sexually inappropriate behavior. Because it has not been shown that the care plan for Resident 1 was inadequate or that the interventions implemented by staff in accordance with the facility's policies were inappropriate, it is unclear what the Agency expected the administration or governing body to do under the circumstances.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration issue a final order dismissing the administrative complaints against Respondent in AHCA Case No. 2002020381 and AHCA Case No. 2002026171. DONE AND ENTERED this 12th day of June, 2003, in Tallahassee, Leon County, Florida. S T. KENT WETHERELL, II 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 12th day of June, 2003. COPIES FURNISHED: Joanna Daniels, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Donna H. Stinson, Esquire Broad & Cassel 215 South Monroe Street, Suite 400 Post Office Box 11300 Tallahassee, Florida 32302 R. Davis Thomas, Jr. Broad & Cassel 215 South Monroe Street, Suite 400 Post Office Box 11300 Tallahassee, Florida 32302-1300 Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Valda Clark Christian, General Counsel Agency for Health Care Administration 2727 Mahan Drive Fort Knox Building, Suite 3431 Tallahassee, Florida 32308 Rhonda M. Medows, M.D., Secretary Agency for Health Care Administration 2727 Mahan Drive Fort Knox Building, Suite 3116 Tallahassee, Florida 32308
Findings Of Fact Respondent, L. D. Terry, operates a thirty-bed adult congregate living facility under the name of Golden Paradise at 1200 Old Dixie Highway, Delray Beach, Florida. The facility is licensed by petitioner, Department of Health and Rehabilitative Services (HRS), and as such, is subject to that agency's regulatory jurisdiction. On June 9, 1986 James Valinoti, an HRS inspector, conducted a routine annual license renewal inspection of respondent's facility in the presence of the facility's administrator, Katherine Stevens. The inspection focused on all aspects of the facility's operations, including safety, physical plant, recordkeeping and sanitation. It was Valinoti's purpose to determine if the facility was in compliance with various requirements of Chapter 10A-5, Florida Administrative Code (1987) During the course of his inspection, Valinoti observed the following deficiencies: The facility did not document and place in its records the services delivered by a third party contractor (nurse) as required by Rule 10A-5.024(1)(a)4., FAC. The facility employed three or more staff but did not maintain a record of personnel policies, including state- ments of work assignments for each position as required by Rule 10A-5.024 (1)(a)5., FAC. The facility did not maintain a time sheet for all employees as required by Rule 10A-5.024(1)(a)7., FAC. The respondent failed to assure that there was at least one staff member within the facility at all times who had a certification in an approved first aid course and that the staff was free of communicable diseases as required by Rule 10A-5.019(5)(f), FAC. The facility failed to furnish each staff member with a copy of written policies governing conditions of employment including the work assign- ments of his position as required by Rule 10A-5.019(5)(h), FAC. The resident contract did not contain a refund policy if transfer of ownership, closing of facility or resident discharge should occur as required by Rule 15.024(1)(b)1., g., FAC. The facility failed to note in the residents' records the disposition of drugs after a resident had left the facility as required by Rule 10A- 5.0182(3)(a)7., FAC. The facility had no policies or pro- cedures for assisting residents in the making of appointments or providing transportation to and from appropriate medical, dental, nursing or mental health services as required by Rule 10A-5.0182(8) and (9), FAC. The facility did not participate in continuing in-service education on an annual basis at a minimum as required by Rule 10A-5.020(1)(c), FAC. The dietary allowances were not met offering a variety of foods adapted to the food habits, preferences and physical abilities of the residents, and prepared by the use of standardized recipes as required by Rule 10A-5.020 (1)(g), FAC. There was evidence of rodent dropping in the food storage room in violation of Rule 10A-5.020(1)(n)1. and 5., FAC. The facility did not assure that food service employees were free of communicable disease as required by Rule 10A-5.020(1)(n)15., FAC. Linoleum in the facility was peeling causing a tripping hazard and sinks and toilets were rusted in violation of Rule 10A-5.022(1)(a),(c), and (g), FAC. With the exception of item (a), which was unclassified, all deficiencies were Class III violations. After the inspection was completed, Valinoti discussed the deficiencies with the administrator and suggested ways to correct them. A letter was then prepared by the HRS area supervisor on July 23, 1986 and mailed the same date to Terry with a copy of the Classification of Deficiencies. That document provides a description of each deficiency, the class of deficiency and the date by which the deficiency must be corrected. Except for a requirement that the deficiency pertaining to rodent droppings be corrected immediately, Terry was given thirty days, or to August 23, 1986, in which to correct the cited deficiencies. Terry acknowledged he received a copy of the letter and attachments. On September 24, 1986 Valinoti reinspected respondent's facility. He found that none of the items had been fully correct. By letter dated September 29, 1986 HRS advised Terry of its findings and warned him that a "recommendation for sanction" would be made. It advised him further that another inspection would be made after October 29, 1986. On October 30, 1986 Valinoti made a second follow-up visit to respondent's facility. Valinoti found that all items had been corrected except item (j). The results of his inspection were reduced to a written report on November 13, 1986, a copy of which was sent to Terry. A year later, an administrative complaint against respondent was issued by HRS. Terry acknowledged, through admissions or testimony at hearing, that most of the allegations were correct but offered mitigating testimony as to why certain corrections were not made on a timely basis. When he purchased his facility in 1982, it was in a state of disrepair through neglect by the previous owner. Since then, he has attempted to upgrade the facility through a series of repairs and renovations. He currently has nineteen residents, most of whom were referred from a nearby mental health center. A mental patient is more difficult to care for, and this type of patient is prone to tear up furniture and equipment. Terry pointed out that he has only three employees, and they fully understand their duties and responsibilities. For this reason, he did not have documentation outlining their job assignments. When the June 9 inspection was made, Terry contended that HRS was in the process of implementing new rules, which he did not identify, and which he claims he did not understand. As evidence of his good faith, Terry pointed to the fact that all deficiencies except one were corrected by October 30, 1986.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that respondent be found guilty of twelve Class III violations and one unclassified violation and that he be assessed a $1,250 civil fine to be paid within thirty days after the date of the final order entered in this matter. DONE AND ORDERED this 5th day of October, 1988, in Tallahassee, Leon County, Florida. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 5th day of October, 1989. COPIES FURNISHED: Leonard T. Helfand, Esquire North Tower, Room 526 401 Northwest Second Avenue Miami, Florida 33128 John W. Carroll, Esquire Post Office Box 31794 Palm Beach Gardens, Florida 33410 R. S. Power, Esquire Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Building One, Room 407 Tallahassee, Florida 32399-0700 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Findings Of Fact The Respondent, Lori Engelleiter, advertised in the Island Trader, a local shopper publication, and in the newspaper, holding herself out to provide regular care for the elderly, the handicapped and the retarded in her private home for unspecified monthly rates. In response to these advertisements, at least two individuals were taken into the Respondent's home for care, as arranged by relatives of these clients. The Respondent provided regular personal care for not more than three residents at a time. This personal care consisted of housing, meals, help with bathing, and with dressing and changing clothes. In the cases of the two clients of the Respondent whose stays at the facility were detailed at the hearing, the personal care was provided by the Respondent for a period of three weeks in one instance, and for more than four weeks in the other instance.
Recommendation Based upon the foregoing Findings of Fact and conclusions of Law, it is RECOMMENDED that the Department enter a Final Order finding that the Respondent is guilty of operating an Adult congregate Living Facility without a license, and imposing a fine of $500 as penalty therefor. THIS RECOMMENDED ORDER entered this 12 day of April, 1984. 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 12th day of April, 1984. COPIES FURNISHED: Douglas E. Whitney, Esquire 400 East Robinson Street Suite 911 Orlando, Florida 32801 Lori Engelleiter Post Office Box 24 Melbourne Beach, Florida 32951 Alicia Jacobs, Esquire General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301 David H. Pingree, Secretary Department of Health and Rehabilitative Services 1321 Winewood Boulevard Tallahassee, Florida 32301
