Findings Of Fact The Respondent, R & R Guest Home, Inc., is located at 720 S. W. 5th Street in Dania, Florida, and consists of four apartments which are designated as A building, B building, C building, and D building. Buildings A, B and C are contiguous. Building D is located east of the main complex. The Respondent facility received license number 10-06-0046 on December 2, 1981, allowing a capacity of 21 beds. This license had an expiration date of September 9, 1982. On March 31, 1982, the Respondent was advised that the allowable capacity had been increased to 37 beds, and on November 8, 1982, license number 10-06-0046 was reissued to show a capacity of 37. The capacity set by HRS was based on its regulations which require a usable floor space of 60 square feet per bed in rooms designated for multiple occupancy. A representative of HRS visited the R & R Guest Home on February 9, 1982, and on July 6, 1982, and found resident beds in use in excess of the licensed capacity of the facility. By notice dated July 7, 1982, HRS advised the Respondent that corrective action must be taken by July 21, 1982. Specifically, the HRS representative found 53 beds in place. The HRS representative again visited the R & R Guest Home on August 24 and on August 26, 1982, and once again found beds in the facility in excess of the licensed capacity of 37. In November of 1982 the HRS representative visited the Respondent, R & R Guest Home, and the excess beds found on the August visits were still in place. Respondents facility had been cited previously, in July of 1981 and in February of 1982, for having beds in excess of the licensed capacity, but these violations had been corrected. The Respondent's owner admits that on July 6, 1982, there were 43 beds on the licensed premises, and that on this date the authorized capacity was 37. The excess beds in the Respondent's facility were situated across doorways in the A building and in the B building, creating a situation that presented potential danger to the residents, in that they might not be able to exit the buildings in an emergency.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health and Rehabilita tive Services assess fine of $1,000. against the Respondent, R & R Guest Home, Inc. THIS RECOMMONDED ORDER entered this 7th day of March, 1983, in Tallahassee, Florida. WILLIAM B. THOMAS Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 7th day of March, 1983. COPIES FURNISHED: Harold L. Braynon, Esquire 201 West Broward Boulevard Fort Lauderdale, Florida 33301 Jesse H. Diner, Esquire Post Office Drawer 2088 Hollywood, Florida 33022-2088 David Pingree Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
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
Findings Of Fact Jules Montouri is a retarded adult. Rahya Montouri is his mother. Prior to March, 1980, Jules Montouri resided at a facility maintained by the Department of Health and Rehabilitative Services in Gainesville, Florida. Jules Montouri's mental capacity is retarded to an extent that he will never be able to completely care for himself and meet his own needs. He can, however, with proper training become capable of living a somewhat normal life with minimal supervision. Since March, 1980, Jules Montouri has resided at "Hillcrest House." Hillcrest House is an adult group residential facility maintained by the Provider, Sheltered Community Residence, Inc. The Provider is under contract with the Department of Health and Rehabilitative Services to provide a residential educational setting for retarded adult males. The concept of the program offered by the Provider is to move clients out of heavily restricted institutional environments into less restrictive ones. The program is designed to train clients to meet as many of their own needs as they can, and to gradually move them into less and less restrictive living situations. The Provider has sought to teach Jules Montouri to live in harmony in a minimally supervised environment, and to do his own cleaning and cooking. The Provider's goal with respect to Jules Montouri would be to move him into an apartment-type living facility with several other retarded adult males with a minimal degree of supervision. The Provider's program is an appropriate one for Jules Montouri. Except for problems that have developed between the Provider and Rahya Montouri, the program offered by the Provider would have a reasonable prospect of successfully training Jules Montouri to live in a substantially independent manner. Rahya Montouri disagrees with the goal of the Provider's program to steer Jules Montouri toward a level of substantial independence. She has objected to programs designed to train Jules Montouri for marginal employment, and to programs designed to teach him how to cook for himself. While Rahya Montouri maintains that she wants her son to remain as a resident in the Hillcrest House facility, she has found very little but fault with the program. Since Jules Montouri has been a client of the Provider, Rahya Montouri has complained on a constant basis about virtually every aspect of the Provider's program. She visits her son often at the facility, and has complained verbally to staff members on virtually every visit. She has made many complaints through telephone conversations with members of the staff. She has written numerous letters to complain about the facility, the program, other clients, and the staff. For example, she has expressed suspicion that her son has engaged in homosexual conduct and has implied that members of the staff may have been involved. These suspicions and accusations appear to have been based upon no evidence whatever. Mrs. Montouri's antagonistic attitude toward the Provider's program has become disruptive to the program. The Provider's staff at the Hillcrest facility has spent from five to ten hours per week since Jules Montouri has been a client dealing with complaints from Mrs. Montouri. On at least two occasions, Mrs. Montouri has violated the rights of other clients at the facility by going through their belongings looking for items that she asserted had been taken from her son. Mrs. Montouri's antagonism toward the program has affected the ability of Jules Montouri to participate in it. Jules is caught in the unfortunate cross fire between the program and his mother. As can be expected, it has confused him considerably. Recently, he has told several of the Provider's staff members and social workers from the Department of Health and Rehabilitative Services that he wishes to leave the program. Mrs. Montouri has complained to the Human Rights Advocacy Committee for Retardation. This committee is a group of volunteers who serve to investigate potential emotional, psychological, or sexual abuse of clients. Mrs. Montouri's complaints have resulted in investigations by the Human Rights Advocacy Committee of the Provider's program. The investigations have not revealed any instances of actual abuse. The investigations have, however, had a demoralizing effect upon the staff of the Provider's program, and could seriously damage the program's reputation. Mrs. Montouri's antagonistic attitude toward the Provider's program has become abusive. The time that the Provider's staff has had to devote to her complaints is unjustified. Her antagonistic attitude has rendered it difficult for her son to progress in the program. Her complaints have demoralized the program's staff and could eventually injure the program's reputation. While the program offered by the Provider is an appropriate one for Jules Montouri and could serve to prepare him to live the most normal life possible for him, it is not practical that he continue in the program.
The Issue By administrative complaint dated November 23, 1982, the Respondent, Mae Revles, was charged with operating an adult congregate living facility without a license. At the formal hearing, the Petitioner called as witnesses Barbara Wavell, Barbara Witham-Petruney, and June Bryant, all employees of the Petitioner, the Department of Health and Rehabilitative Services. The Respondent testified on her own behalf and also called as a witness Mary Burks. The Petitioner offered four exhibits into evidence. Petitioner's Exhibits 1 and 2 were admitted without restriction as to their use, and Petitioner's Exhibits 3 and 4 were admitted over objection as being hearsay solely for the purpose of supplementing or explaining other admissible evidence in the record. Counsel for the Petitioner submitted proposed findings of fact and conclusions of law for consideration by the undersigned Hearing Officer. To the extent that those proposed findings of fact and conclusions of law are not adopted in this order, they were considered and determined to be irrelevant to the issues in this cause or not supported by the evidence.
Findings Of Fact The Respondent previously held a license to operate an Adult Congregate Living Facility in the State of Florida. The Respondent, on January 26, 1982, voluntarily surrendered her license and has not since that time been licensed to operate an Adult Congregate Living Facility. On November 3, 1982, an employee of HRS went to the boarding home operated by the Respondent at 551 Broadway, Kissimmee, Florida. On that date, Mr. Andrew Karr and Mr. Marcus Grady, both residents of the Respondent's boarding home, were found locked in their rooms. The doors were locked from the outside. On November 3, 1982, Mr. Andrew Karr was disoriented as to time and space and needed nursing home custodial care. He could not respond appropriately to others present in the boarding home and was not able to bathe himself and had to be helped in bathing. On November 3, 1982; another resident, Inez Smith, was disoriented. She was not capable of taking her prescribed medication without the help of another person. A lady who shared the room with Inez Smith gave her the medication. On November 3, 1982, there were three other residents in the boarding home. These residents were oriented, lucid, and desired to remain in the boarding home. Mr. Karr, prior to his removal in November, 1982, had been a resident of the boarding home since December, 1981. Mr. Grady had been a resident of the home for approximately five years prior to November, 1982, and Inez Smith had been a resident for three weeks prior to November, 1982.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is: RECOMMENDED: That the Respondent be found not guilty of the violation charged and that the administrative complaint be dismissed. DONE and ENTERED this 11 day of May, 1983, in Tallahassee, Florida. MARVIN E. CHAVIS Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 11th day of May, 1983. COPIES FURNISHED: Douglas E. Whitney, Esquire 400 West Robinson Street Suite 911 Orlando, Florida 32801 Richard H. Hyatt, Esquire 918 North Main Street Kissimmee, Florida 32741 Mr. David H. Pingree Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
The Issue The issues in DOAH Case No. 10-0528 are whether the allegations set forth in the Administrative Complaint dated December 4, 2009, are correct, and, if so, what penalty should be imposed. The issue in DOAH Case No. 10-1672 is whether the application for license renewal filed by Avalon's Assisted Living LLC, d/b/a Avalon's Assisted Living and d/b/a Avalon's Assisted Living at Avalon Park (hereinafter Avalon I), should be approved. The issue in DOAH Case No. 10-1673 is whether the application for license renewal filed by Avalon's Assisted Living II LLC, d/b/a Avalon's Assisted Living at Southwest (hereinafter Avalon II), should be approved.
Findings Of Fact Avalon I is a six-bed assisted living facility (ALF), operating at 1250 Willow Branch Drive, Orlando, Florida, 32828, and holding license number 10813 with Limited Nursing Services licensure. Avalon II is a six-bed ALF operating at 13230 Early Frost Circle, Orlando, Florida, 32828, and holding license number 11318 with Limited Nursing Services licensure. Avalon I and Avalon II are operated by a limited liability company owned by Chiqquittia Carter-Walker and Robert Walker. Mrs. Carter-Walker acts as the administrator of the facilities. On July 23, 2009, the Agency conducted an inspection of Avalon I and determined that there were three "Class II" deficiencies, commonly cited as "tags" in reference to applicable regulatory standards. Tag A029 alleged that the training certifications, contained within the facility's personnel files to document the provision of required employee education, were false and that the training had not been provided. The training certificates for one Avalon I staff member were not accurate and falsely indicated that the referenced employee received training that had not been provided. The falsification was deliberate and was not erroneous. The inaccurate documentation of employee training misstated the qualifications of the ALF staff, falsely indicated that the staff was adequately trained, and presented the potential for harm to the health of the residents. The Agency correctly identified the deficiency as Class II. Tag A427 was based on regulatory provisions that permitted a terminally ill resident, no longer meeting the criteria for continued ALF residency, to remain in the ALF under certain conditions. The July 23, 2009, inspection indicated that such a resident continued to reside at Avalon I without compliance with relevant conditions. The conditions under which the terminally ill resident was permitted to remain at the ALF required that the hospice coordinate the care and provision of additional medical services and that an interdisciplinary care plan be developed and implemented by the hospice in coordination with the ALF. The July 23, 2009, inspection revealed that the interdisciplinary care plan failed to adequately designate responsibility for the various kinds of care required by the resident. The inspection revealed that a terminally ill resident remained in Avalon I without receiving appropriate medication for pain management even though such medications had been authorized. Although the ALF had undertaken the responsibility of administering the pain medication, there were occasions when no Avalon I staff member authorized to administer the pain medication was present at the ALF. Patient records indicated that the hospice representative attempted at several junctures to contact Mrs. Carter-Walker by telephone to resolve the problem and that Mrs. Carter-Walker was not accessible to the hospice representative. The resident unnecessarily suffered pain because the issue was not resolved in a timely manner. The failure to provide a terminally ill resident with appropriate pain medication resulted in a direct threat to the physical and emotional health of the resident, and, therefore, the Agency correctly identified the deficiency as Class II. Tag A700 reflects standards for resident care and requires that appropriate services be provided to residents. The July 23, 2009, inspection indicated that one resident was not being provided a nutritional supplement and that two residents were not being provided appropriate pain-relieving medications. As to the provision of nutritional supplementation, one resident with a history of weight loss had been prescribed a daily can of "Ensure" nutritional supplement. According to the facility records, the supplement had not been acquired by the ALF and had not been provided to the resident. As to the residents who were not receiving proper pain medication, one of the two was the terminally ill resident referenced in relation to Tag A427. As stated previously, the resident unnecessarily suffered pain because medication was not appropriately administered, which resulted in a direct threat to the health of the resident. Therefore, the Agency also correctly identified the deficiency cited as Tag A700 as Class II. The second resident had a history of hypertension and hypothyroid issues and had been prescribed a daily Ibuprofen (400mg) for pain. The Avalon I medication records indicated that, on some days, the medication had been provided twice daily to the patient, and, on other days, it had not been provided at all. The evidence establishes that the deficiencies identified in Tags A427 and A700 indicate a failure of the ALF to provide appropriate care and service to the residents of the facility. According to the uncontroverted testimony of Agency investigators as documented by the reports of their inspections, numerous lesser deficiencies were identified at Avalon I between 2007 and 2009, constituting a continuing pattern of inadequate performance and a failure to meet relevant standards. On August 5, 2009, an inspection conducted by the Agency at 1812 Crown Hill Boulevard, Orlando, Florida, 32828, indicated that an unlicensed ALF was operating at that address. On August 5, 2009, the Agency's investigator observed five individual residents in Avalon III. The investigator reviewed health assessments for the residents, all of whom required assistance with activities of daily living, including personal hygiene, ambulation, and meals. Medications for the residents were stored in a central area. The investigator reviewed medication observation records, indicating that the residents self-administered medications with observation by the Avalon III staff. Signage was present at Avalon III that identified Mrs. Carter-Walker as the administrator of the Avalon III facility. During the August 5, 2009, inspection, Mrs. Carter- Walker arrived at Avalon III and identified herself as the administrator of the facility. The investigator was familiar with Mrs. Carter-Walker and knew her as the administrator for Avalon I and Avalon II. Mrs. Carter-Walker identified herself as the Avalon III administrator to other care providers, including a clinical social worker, a registered nurse providing contract health care services to facility residents, and Administrators at other local ALFs. According to the testimony of an employee of Avalon III, there had been residents in the Avalon III location since at least June 16, 2009, at which time the staff member began to work at the facility. She worked five days per week, providing the resident services identified herein. During that time, there were always at least three residents in the facility. The same residents were present on a day-to-day basis. There is no evidence that such residents were transported out of the facility during the evening or that they did not otherwise remain at the Avalon III location overnight. A licensed practical nurse present at the Avalon III location on August 5, 2009, was the person who permitted the Agency's investigator to enter into the facility. The nurse was at the location to provide personal care assistance to a terminally ill resident receiving care through an agreement between the Mrs. Carter-Walker, as the facility administrator, and the hospice. After Mrs. Carter-Walker arrived at the Avalon III location, she was apparently unhappy that the nurse had permitted the investigator to enter the facility, and directed the nurse to leave immediately without providing further assistance to the resident. On the day of the investigation, the Agency investigator issued a "Notice of Unlicensed Activity/Order to Cease and Desist" to Robert Walker and Chiqquittia Carter-Walker for the Avalon III operation. Mr. Walker arrived during the inspection and identified himself as an owner to the Agency investigator. On August 14, 2009, the Agency received an application for licensure of an ALF at 1812 Crown Hill Boulevard, Orlando, Florida, 32828. The application, submitted by Robert Walker as the administrator, referenced the Avalon I and Avalon II as affiliated with Avalon III through ownership. Both Mr. Walker and Mrs. Carter-Walker submitted affidavits of compliance with background screening requirements as part of the Avalon III application. At no time was Avalon III licensed as an ALF. There was no evidence that the Avalon III residents were related to Mrs. Carter-Walker or her husband. There was no evidence that Avalon III was exempt from, or otherwise not required to comply with, relevant ALF licensing requirements.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration issue a final order revoking the licenses of Avalon I and Avalon II, denying the applications for license renewal filed by Avalon I and Avalon II, and assessing an administrative fine in the amount of $3,000 for the specific Class II deficiencies identified herein. DONE AND ENTERED this 28th day of January, 2011, in Tallahassee, Leon County, Florida. S WILLIAM F. QUATTLEBAUM 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 28th day of January, 2011.
Findings Of Fact Respondent is licensed to operate an adult congregate living facility known as Vereene's Love and Care Home, which is located at 1304 E. Gibbs Street, Melbourne, Florida. On February 27 and March 20, 1986, two representatives of Petitioner conducted an inspection of Respondent's facility. This inspection uncovered numerous violations, including 16 Class III violations. The facility was re-inspected on March 23 and 26 and April 21, 1987, and representatives of Petitioner determined that five Class III violations remained uncorrected. The uncorrected Class III violations were the failure of Respondent: to provide at least one staff member at the facility at all times with certification in an approved first aid course and documentation that all staff are free of communicable diseases; to maintain and make available physical examination records for one resident; to provide that one resident received medication in accordance with her prescription; to ensure that a refrigerator and chest freezer had accurate thermometers; and to maintain two freezers at a temperature below 0 degrees Fahrenheit. Representatives of Petitioner discussed the violations with Respondent at the time of the 1986 inspections. The parties agreed that Respondent would have varying deadlines, ranging from immediately to May 1, 1986, within which to correct the violations. Respondent proved at the hearing that the bottle of Diazide prescribed for a Mrs. Smith bore an incorrect dosage. Respondent and Mrs. Smith both testified that the physician had orally changed the dosage to one tablet every other day. Mrs. Smith produced a bottle containing this medication and bearing this dosage. The thermometers in the refrigerator and chest freezer were constantly falling off their shelves. The thermometers were always present in these two appliances.
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 Based upon the oral and documentary evidence adduced at the hearing, the following relevant facts are found: On or about 1:00 p.m. on September 2, 1978, a Saturday, Deputy Reder from the Hillsborough County Sheriff's Office went to the "Sweet Magnolia Boarding Home," a licensed adult congregate living facility (ACLF) operated by the petitioner, as a result of a call from either the petitioner's daughter or a relative of one of the residents. Upon his arrival, Deputy Reder found four elderly boarders or residents, petitioner's, fifteen or sixteen year old daughter and her female friend of about the same age. The petitioner's daughter and the residents were upset, but none of the residents needed emergency medical assistance. The relatives of the residents and the respondent were notified that the four residents were without adult supervision, and the residents were removed from the facility that day. On the Monday preceding Saturday, September 2, 1978, petitioner received a telephone call informing her that her husband had had an accident in Detroit, Michigan and had injured his back. Petitioner left Tampa on that day and flew to Detroit. It was her testimony that she left Mary Ann Cowley, who had worked for her for about one year, in charge of the "Sweet Magnolia Boarding Home" while she was gone. She further testified that she left approximately $700.00 with her fifteen or sixteen year old daughter to pay the rent and buy food for the residents during her absence. When she returned to the facility late Saturday night on September 2, 1978, no one was there and many of her belongings were gone. Petitioner did not contact the respondent regarding this incident. Her husband was not hospitalized for his back injury. On or about September 22, 1978, an administrative complaint against petitioner was filed by the respondent seeking to revoke her ACLF license. Having failed to respond to the complaint, respondent, on October 18, 1978, entered a "Judgment of Revocation of License" by default. Said judgment found that petitioner voluntarily discontinued operation of the facility without providing advance notice to respondent and without surrendering her license, that she left residents boarded at the home without adult supervision while she left the state and that a deputy reported that there was no food in the premises on September 2, 1978, and that the residents had not been fed for two days. Deputy Reder did not check the premises for food and one of the boarder's daughter did not hear her mother complain of being hungry on the day she removed her from the petitioner's facility. Petitioner testified that she never received the administrative complaint or notice that her ACLF license had been revoked. Petitioner applied for another ACLF license in March of 1980. Before this was processed, and in April of 1980, she was hospitalized for two or three days for elbow surgery and left her husband in charge of the unlicensed facility. Her husband had never assumed this responsibility in the past. On Monday, April 14, 1980, petitioner's husband prepared a bath for one of the residents who was approximately eighty-nine years old and frail, helped her into the bathtub and then left the bathroom to complete some chores in the kitchen. While he was gone, this elderly resident drowned in the bathtub. The incident was described in the police report as an "accidental death" and no charges were brought against petitioner or her husband. Respondent was not notified of the drowning incident until several weeks later. During this same general time period, from March through early July, 1980, negotiations were had between petitioner and respondent regarding her March application for ACLF licensure. Respondent's Aging and Adult Services Program Office had many concerns regarding the issuance of a license to petitioner, including the prior incidents of lack of supervision, inappropriate placements and the drowning incident. Respondent did not feel that a legal basis existed for denial of petitioner's application for licensure, so they offered her a compromise. Petitioner was told that if she removed her present residents, respondent would issue her a license and she could start over with more appropriate residents or boarders. On June 25, 1980, petitioner notified respondent that it was her decision to discontinue her operation as a boarding home and not accept the license to operate as an ACLF. By letter dated June 26, 1980, respondent notified petitioner that she had thirty days to remove the residents from her facility and that legal action would be brought against her if she reopened another unlicensed facility in Hillsborough or Manatee Counties. By letter dated July 3, 1980, respondent again informed petitioner that her decision not to accept the license was considered as final and that a license could not be issued to her at that time. On February 3, 1981, at approximately 3:00 p.m., employees of the respondent made an unannounced visit to petitioner's unlicensed facility. They found that petitioner was not on the premises and that the only people there were petitioner's father, approximately 70 years of age, and two elderly residents. One of the residents was in a hospital bed and was being fed by means of a tube down her throat. Respondent's employees remained on the premises for about 30 minutes and petitioner did not appear during this time. During the time of the unannounced visit by respondent's employees, petitioner had gone to the store. It was her testimony, which was corroborated by her father, that she had asked another person to stay at the facility while she went to the store. That other person was not there when petitioner returned from the store. Betty P. Steiger, R.N., who specializes in geriatric nursing, observed the tube-fed resident in petitioner's facility on February 4, 1981. She was described as an elderly black woman who was incontinent, unable to ambulate, incoherent and a candidate for round-the-clock skilled nursing care. An ACLF was not an appropriate placement for this person. Feeding tubes should be changed only by a registered nurse or a physician and a suction machine should be available in case of aspiration. Ms. Steiger did not observe a suction machine on the petitioner's premises. This tube-fed resident had been living in petitioner's facility for four or five months and had been tube-fed since her arrival. Petitioner is a licensed practical nurse. In February of 1981, she had no other employees. Petitioner again applied for an ACLF license on March 5, 1981. By letter dated May 14, 1981, she was notified by the respondent's Aging and Adult Services Program Office that her application was being denied for the following reasons: You have exhibited a disregard for, and a failure to assume appropriate responsibility for, the welfare of residents under your care. This is evidenced by the following: On October 18, 1978, your license to operate "Sweet Magnolia Boarding Home", an adult congregate living facility, was formally revoked due to your having left the boarders at the facility without any adult supervision during or about September, 1978 while you left the state. When discovered on September 2, 1978, the residents had not been fed for two days and there was no food on the premises. In April, 1980, an elderly resident at your unlicensed facility at 822 Whatley Place, Tampa, Florida, drowned in the bathtub while not receiving proper supervision. On or about February 3, 1981, a resident at your home at 822 Whatley Place, Tampa, Florida, was discovered by the Department's employees to be bedridden and to be in need of full time skilled nursing care. Said resident was being fed through a tube and such condition, without appropriate full time skilled nursing care, materially affected the health, safety, and welfare of said resident in that had such resident regurgitated, this resident, being elderly and very debilitated, would have been unable to clear herself and would have "drowned" in her own bodily fluids. Your retention of this resident, without ap- propriate full time skilled nursing care, constituted a disregard for her welfare. On or about February 3, 1981, employees of the Department made an unannounced visit to your unlicensed facility and discovered that you were not present and that you had not provided for adequate supervision of the residents. Besides the residents, the only person present was your elderly father who, due to his age and physical condition, could not provide safe and adequate supervision to the residents. The actions referred to in paragraphs 1(a) through (d) constitute intentional and/or negligent acts which seriously affected the health, safety, and/or welfare of residents of your facility and constitute grounds to deny your application for a license pursuant to section 400.414(2)(a), Florida Statutes (1980). Your physical plant is short one toilet and one sink. According to Rule 10A-5.11(3)(a)1, Florida Administra- tive Code, there must be a bathroom exclusively for the use of the residents. Since you fail to meet the minimum standards for Adult Congregate Living Facilities, your license is being denied on that basis also. The parties stipulated that petitioner's physical plant was short one bathroom. It was agreed that if all other bases for denial of the license were found to be without merit; petitioner would have 60 days to install a bathroom and, if completed, respondent would issue petitioner a license.
Recommendation Based upon the above findings of fact and conclusions of law, it is RECOMMENDED that petitioner's application for an adult congregate living facility license be DENIED. Respectfully submitted and entered this 10th day of November, 1981, 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 10th day of November, 1981. COPIES FURNISHED: Robert A. Warner, Esquire Caltgirone & Warner, P.A. 238 East Davis Boulevard, Suite I Davis Island Tampa, Florida 33606 Janice Sortor, Esquire District VI Assistant Legal Counsel 4000 West Buffalo Avenue Tampa, Florida 33614 David Pingree, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: Prior to its licensure as an adult congregate living facility, the respondent H & E Guest Home received an initial inspection by HRS on June 24, 1985. Various deficiencies were cited during this visit and all such deficiencies were corrected by September 10, 1985, the date of the revisit by HRS. Among the deficiencies cited by HRS were that "the facility income and expense records were not available for review," denominated by HRS as an "unclassified" deficiency, and that "menus were not dated and planned one week in advance," denominated as a Class III deficiency. At the time of this initial survey on June 24, 1985, there were no residents in the respondent's facility as it was not yet licensed or opened for operation as an adult congregate living facility. On June 17, 1986, HRS performed an annual survey on respondent's facility. During this survey, several deficiencies were found. As pertinent to the charges in this proceeding, HRS found that there were no fiscal records relating to the facility's financial operating status available at the facility site for review. This deficiency was denominated by HRS as a Class III repeat deficiency. The other repeat deficiency noted, also denominated as Class III, was that menus were not dated and planned one week in advance. Residents were in the respondent's facility on June 17, 1986. HRS proposes to levy a fine of $250.00 for the fiscal records deficiency, and a fine of $200.00 for the deficiency relating to menus. According to HRS, the impacts upon patients resulting from such deficiencies are, respectively, "without the records it would be difficult to determine the financial stability of the facility," and "it would be difficult to maintain a sufficient food supply, and the residents would not be aware of their meals in advance."
Recommendation Based upon the findings of fact and conclusions of law recited herein, it is RECOMMENDED that the Administrative Complaint be DISMISSED, without prejudice to HRS to conduct an unannounced visit to the respondent's facility to determine if the cited deficiencies have been corrected. Respectfully submitted and entered this 6th day of October, 1987, in Tallahassee, Florida. DIANE D. TREMOR 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 6th day of October, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-1374 The proposed findings of fact submitted by the petitioner are accepted, except as follows: 2. Partially accepted; however, there was no evidence that the corrections were not timely made. 4. Accepted, but not included as irrelevant and immaterial to the issues in dispute. COPIES FURNISHED: Gaye Reese, Esquire Senior Attorney Office of Licensure and Certification 7827 North Dale Mabry Highway Tampa, Florida 33614 Aubrey E. Estes 3116 Ninth Street, East Bradenton, Florida 33508 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Sam Power, Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
