Findings Of Fact At all times relevant hereto, Respondent was licensed by Petitioner as an Adult Congregate Living Facility (ACLF) and operated a home with thirteen residents. At a survey conducted April 25, 1985 some seventeen (17) class III deficiencies were noted by the survey team and these discrepancies were brought to the attention of the ACLF administrator at the exit interview held. Respondent was given thirty (30) days to correct these discrepancies. A follow-up inspection on Respondent's ACLF was conducted July 9, 1985. At this inspection the following discrepancies remained uncorrected: there was no assurance that staff providing assistance with personal hygiene have inservice or other training in personal hygiene care from a qualified instructor; four residents' files did not contain a completed Health Assurance form; physical examinations of three (3) of thirteen (13) residents did not include a statement that on the day of the examination the individual was free of communicable disease; and there was no three-compartment sink or other approved system available to sanitize kitchen utensils. Respondent acknowledged the deficiencies above-noted had not been corrected at the time of the reinspection. In mitigation, Respondent presented evidence that requests had been made of the doctors for the missing evidence in the residents' files and the doctors were inordinately slow in forwarding such information. With respect to staff training in personal hygiene, Respondent attempted to enroll its staff in the required training but ran into delays of a month or so in getting its personnel in these classes. With respect to the three-compartment sink, Respondent ordered the first replacement sink from a plumber who went out of business before installing the sink; a second sink was ordered but the sink was too small; and finally, Respondent replaced the deficient sink with the proper type.
Recommendation It is recommended that a final order be entered assessing an administrative fine of $550 against Trevor Jones, d/b/a Brer Fox Retirement Home, Inc., with interest as provided by Section 687.01, Florida Statutes. DONE AND ORDERED this 10th day of April 1986 in Tallahassee, Leon County, Florida. K. N. AYERS 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 10th day of April, 1986. COPIES FURNISHED: Mr. William Page, Jr. Secretary Department of HRS 1323 Winewood Blvd. Tallahassee, Florida 32301 Steve Huss, Esquire General Counsel Department of HRS 1323 Winewood Blvd. Tallahassee, Florida 32301 Carol M. Wind, Esquire 2255 East Bay Drive Clearwater, Florida 33518 Mr. Trevor Jones 9675 94th Avenue North Sarasota, Florida 33546
Findings Of Fact At all times material hereto, Respondent has been licensed by the Department to operate an adult congregate living facility (hereinafter "ACLF"), which is located at 2610 Southwest 14th Avenue, Fort Lauderdale, Florida, and is known as Ficus Manor. The Department performs an announced annual survey on every ACLF. A survey is simply an inspection of the facility in order to determine the degree of compliance with Departmental rules and regulations. HRS-AA Form 1806, Classification of Deficiencies for ACLF Licensure Requirements, is completed by the Department's surveyors and forwarded to the facility, designating the deficiency and reference, class of deficiency, and date by which each deficiency must be corrected. A follow-up visit is normally scheduled to determine whether the earlier cited deficiencies have been corrected. On October 19, 1988, then-Department employee Elizabeth Balle performed the annual survey of Ficus Manor. During that survey, she cited twenty-seven deficiencies. Compliance dates were established for each deficiency. A follow-up survey was conducted by Baller on January 26, 1989, at which time she noted on Form 1806 that only seven of the previously-cited deficiencies had not been corrected. Those deficiencies noted by Baller as not having been corrected by January 26, 1989, are as follows: ACLF 41 Facility does not provide documentation of daily awareness of the general health, safety and physical and emotional well being of residents. Ref: 10A-5.128(1)(b) ACLF 51 The facility does not provide staff and services appropriate to the needs of the residents as evidenced by a lack of towels and toilet paper. (refer to ACLF 49, 41, 23, 17) Ref: 10A-5.182(4) ACLF 52 Owners or administrators are to protect residents rights and freedoms in accordance with the following: evidenced by 49, 41, 23, 17, 106 Ref: Ch. 400.428, F.S. and Ch. 10A-5.182(5), F.A.C. ACLF 89 The facility does not provide uncrowded safe and sanitary housing to its residents, in the following was observed: as evidenced by dirty sheets. Ref: Ch. 10A-5.23(1), F.A.C. ACLF 109 The interior and exterior of buildings are not kept reasonable [sic] attractive, in that: rusted and or dirty legs on chair and tables. Ref: Ch. 10A-5.22(1)(d), F.A.C. ACLF 112 The building is not maintained in a clean, safe and orderly condition in that the following was observed: as evidenced by 108, 109, & 110. Ref: Ch. 10A-5.22(1)(g), F.A.C. ACLF 115 There was slight odor of urine in room #1400. Ref: 10A-5.22(1)(j) On March 7, 1989, a second follow-up visit was performed by Baller and by Gary Warnok, a registered dietician employed by the Department. On October 19, 1988, on January 26, 1989, and on March 7, 1989, there was no documentation of daily awareness of the general health, safety, and physical and emotional well being of the residents by designated staff. On October 19, 1988, towels and toilet paper were not available to all residents. Many of the residents' bathrooms had no toilet paper and no towels. The few bathrooms that did have toilet paper and towels only contained one towel even though that bathroom was utilized by four to six residents. By the time of the January 26, 1989, or of the March 7, 1989, follow-up visit, the facility had placed a handwritten, paper sign in each bathroom advising the residents that if they needed towels or toilet paper they should "ask the person in charge." However, the supply of towels and toilet paper in each bathroom had not been increased. On January 26, 1989, and on March 7, 1989, the supply of towels and toilet paper remained inadequate. At the time of the annual survey and at the time of the two follow-up visits, the sheets on the beds in some of the resident bedrooms were dirty or were clean but had stains which appeared to have resulted from dried feces or urine. On October 19, 1988, and on January 26, 1989, there were rusted and/or dirty legs on the chairs and tables in the dining room at the Ficus Manor facility. At the time of the annual survey and at the time of the two follow-up visits, there was a slight odor of urine in room 1400.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED that a Final Order be entered finding Respondent guilty of three Class III violations and imposing a civil penalty in the amount of $250 each, for a total of $750, to be paid within 30 days from the date of the Final Order. DONE AND ORDERED in Tallahassee, Leon County, Florida, this 29th day of May, 1990. LINDA M. RIGOT 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 29th day of May, 1990. APPENDIX TO RECOMMENDED ORDER The proposed findings of fact found in Petitioner's 1st, 6th, 7th, and 10th unnumbered paragraphs have been adopted either verbatim or in substance in this Recommended Order. The proposed findings of fact found in Petitioner's 2nd - 4th and 8th unnumbered paragraphs have been rejected as being irrelevant to the issues under consideration in this cause. The proposed findings of fact found in Petitioner's 5th, 9th, 11th, 13th, 14th, and 16th unnumbered paragraphs have been rejected as not constituting findings of fact but rather as constituting recitation of the testimony, argument of counsel, or conclusions of law. The proposed findings of fact found in Petitioner's 12th and 15th unnumbered paragraphs have been rejected as not being supported by the weight of the credible evidence in this cause. Respondent's proposed findings of fact numbered 1-3 have been adopted either verbatim or in substance in this Recommended Order. Respondent's proposed findings of fact numbered 4-11 have been rejected as not constituting findings of fact but rather as constituting recitation of the testimony, argument of counsel, or conclusions of law. Copies furnished: Leonard T. Helfand, Esquire Department of Health and Rehabilitative Services 401 Northwest Second Avenue North Tower, Room 526 Miami, Florida 33128 Donna Szczebak O'Neill, Esquire 2800 West Oakland Park Boulevard Suite 205 Fort Lauderdale, Florida 33311 Sam Power, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 John Miller, General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Findings Of Fact Petitioner, Sheffield Convalarium, is a skilled nursing facility with 118 beds in Fort Lauderdale. During the last licensing survey on January 7 and 8, 198' 0, the Respondent found six Class II deficiencies and sixteen Class III deficiencies; the former had a corrective date of January 11, 1980, and the latter, February 7, 1980. Presum- ably, all corrections were timely made, and the "C" rating and license were subsequently issued on March 13, 1980. The Class II deficiencies were concerned with inappropriate therapeutic menus (two) and patient medical care (four). While most of the Class III deficiencies were concerned with records, one dealt with food storage facilities, one with minor plumbing problems, and two with the handling of medication. In mitigation, Petitioner's witness points out that: the minimum standards or criteria and procedure had not been furnished prior to the survey; he has been the administrator of the facility for only one year and has made great strides in correcting known deficiencies; none of the deficiencies related to lack of patient care, unsanitary conditions, or other serious problems; and, that the Respondent's survey team head, who had evaluated the findings and assigned the rating, lacked the necessary experience.
The Issue The issues in this case are whether Respondent violated Pinellas County School Board Policies 8.25(1)(j) and 8.25(1)(t), and, if so, whether Petitioner should suspend Respondent for three days.
Findings Of Fact Ms. Rosenthal is employed by Petitioner as a clerk specialist III in the specialized hiring section of the human relations department of the Pinellas County School District. Part of her assigned duties includes processing applications for substitute teachers to be employed by Pinellas County Schools. Ms. Rosenthal has been employed as a clerk specialist III since 2000. Her job responsibilities include the accurate and timely processing of data and files in the specialized hiring department of the Pinellas County School District. On January 12, 2008, Ms. Rosenthal met with Starla Metz, who at that time was the human resources director for specialized hiring, concerning the length of time Ms. Rosenthal was taking to process on-line substitute applications. Ms. Rosenthal was directed to use a weekly list to track the status of the on-line applications and to enter information in the sub database when she spoke with or emailed an applicant. Terri Alford, a human resources specialist, was directed to meet with Ms. Rosenthal each Friday to offer support as needed. In February Marilyn Lusher replaced Ms. Metz as director. Beginning on April 10, 2008, and continuing for about five meetings thereafter, Ms. Lusher met with the specialized hiring department to clarify and explain the department’s processes, to communicate transitions within the department, and to emphasize her expectations regarding accuracy and the need for confidence in the clerks’ data entry process. A checklist for the front of each file was updated, as well as detailed instructions for the clerks. Terri Alford and Karen Cope, a human resource specialist, supervised Ms. Rosenthal. They advised Ms. Lusher that Ms. Rosenthal continued to make clerical errors. Ms. Lusher requested that they provide her with specific instances in which errors were made. Ms. Alford and Ms. Cope documented the errors and presented them to Ms. Lusher. Additionally, Ms. Alford and Ms. Cope were instructed to document errors made by others in the department. On August 7, 2008, Ms. Lusher met with Ms. Rosenthal concerning performance deficiencies in Ms. Rosenthal’s work. Ms. Rosenthal had inaccurately retrieved information on an individual which would make the individual ineligible for hiring. A letter to the individual stating that the individual was a no hire had to be retrieved from the mailroom. Additionally, Ms. Rosenthal had made other errors such as: filing information in an applicant’s file that should have been filed in another applicant’s file, making inaccurate data entries in Winocular, and delaying the processing of applications. Ms. Rosenthal was given some steps to take in order to improve her work performance. Ms. Alford was to continue to meet with Ms. Rosenthal on Fridays to determine what support Ms. Rosenthal might need. Ms. Rosenthal always declined any additional help. Ms. Rosenthal’s poor work performance continued, and Ms. Lusher met with Ms. Rosenthal on August 15, 2008, to again discuss performance deficiencies. Ms. Rosenthal had taken some steps to correct her errors, but she continued to have delays in processing, inaccurate data entry, incomplete files, and errors in pulling the correct files. At that time, it was determined that future evaluations of Ms. Rosenthal’s performance were to be done using the Supporting Services Performance Appraisal form, which meant that Ms. Rosenthal’s performance would be rated as unsatisfactory, needs improvement, satisfactory, or better than satisfactory. On August 15 and September 12, 2008, Ms. Lusher met with Ms. Rosenthal to discuss errors that Ms. Rosenthal continued to make in her work. On September 26, 2008, Ms. Lusher and Dr. Ron Stone, assistant superintendent of Human Resources, met with Ms. Rosenthal to discuss Ms. Rosenthal’s inappropriate use of the computer and the Internet during working hours. Ms. Rosenthal was cautioned to refrain from the inappropriate use of the computer and to improve the accuracy and timely completion of her work. She was advised that there appeared to be a correlation between her inordinate use of the Internet and her poor work performance. Prior to the September 26, 2008, meeting, Ms. Rosenthal had requested that she be given additional time beyond her scheduled work hours to complete her work. This time would be compensated either as overtime or as compensatory time. At the September 26, 2008, meeting, Ms. Lusher informed Ms. Rosenthal that she would no longer be given additional time to complete her work. On October 23, 2008, Ms. Rosenthal was given a written reprimand for the unacceptable quality and quantity of her work. Ms. Rosenthal was directed to improve her work performance. After the written reprimand was issued, Ms. Rosenthal continued to make numerous clerical errors. Ms. Lusher’s job responsibilities increased dramatically, and she did not have the time to devote to meetings with Ms. Rosenthal to discuss Ms. Rosenthal’s deficient work performance. However, in August 2009, Ms. Lusher again met with Ms. Rosenthal to discuss Ms. Rosenthal’s errors in the processing or the absence of processing additional duty forms that were needed to process payroll for certain employees. Ms. Rosenthal had also provided some inaccurate information on extra duty time that was used in an agenda item for Petitioner, resulting in a complaint from the Superintendent of the Pinellas County Schools. Other issues were discussed such as Ms. Rosenthal’s personal telephone conversations while at work, Ms. Rosenthal’s transferring telephone calls to other team members when Ms. Rosenthal should have been able to answer the telephone inquiries, and Ms. Rosenthal’s failure to stay at her desk to answer the telephone when other team members were at lunch. On September 29, 2009, Ms. Rosenthal received a performance appraisal. She received an unsatisfactory rating for quality of work and a needs-to-improve rating for job knowledge, quantity of work, and initiative. She received satisfactory ratings for the other areas of her work. Ms. Rosenthal argues that, although she made mistakes, other team members also made mistakes. When Ms. Rosenthal’s mistakes are compared to the mistakes of other team members, Ms. Rosenthal’s are significantly greater in number. The use of the Internet and the conduct of personal business during work time contribute to Ms. Rosenthal’s inability to improve the quantity of her work.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered finding that Ms. Rosenthal is guilty of incompetence in violation of Pinellas County School Board Policy 8.25(1)(j) and failure to correct performance deficiencies in violation of Pinellas County School Board Policy 8.25(1)(t) and suspending her for three days without pay. DONE AND ENTERED this 7th day of July, 2010, in Tallahassee, Leon County, Florida. S SUSAN B. HARRELL 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 7th day of July, 2010.
The Issue The issue for consideration in this hearing is whether Respondent's license to operate an Adult Congregate Living Facility should be disciplined because of the deficiencies identified in the Administrative Complaint filed herein.
Findings Of Fact At all times pertinent to the matters alleged in the Administrative Complaint, the Agency for Health Care Administration, (Agency), was the state agency responsible for the licensure and regulation of Adult Congregate Living Facilities, (ACLF), in Florida. Respondent, Gem House, is licensed to operate an ACLF at 2809 Round About Lane in Orlando, Florida. On December 19, 1994, representatives of the Agency conducted an inspection visit of the Respondent's facility and discovered certain deficiencies. These included: The facility had not maintained a file of all previous reports for the past five (5) years. This deficiency, cited at the initial visit, was still uncorrected at the follow-up visit of March 28, 1995 and at the desk review conducted on April 21, 1995. The facility had not provided a handout to residents, family or guardians outlining its provisions for assisting residents to obtain health care. This deficiency, cited at the initial visit, was uncorrected at the March 28, and June 14, 1995 follow-up visits. The facility had not maintained complete personnel files on each staff as documentation they are competent and properly trained. This deficiency, cited at the initial visit, was uncorrected at the March 28 and June 14, 1995 follow-up visits and at the April 21, 1995 desk review. The facility continued to use staff who had no training in infection control procedures within ten (10) days of beginning employment. This deficiency, cited at the December 19, 1994 visit, was uncorrected at the March 28 and June 14, 1995 follow-up visit and at the April 21, 1995 desk review. No staff had participated in continuing education related to nutrition on an annual basis. The last course taken was in May, 1993. This deficiency, cited at the December 19, 1994 survey, was uncorrected at the March 28, 1995 follow-up visit. The facility did not execute contracts for each resident upon admission or prior thereto. This deficiency, cited at the December 19, 1994 survey, was uncorrected at the March 28 and June 14, 1995 follow-up visits, and at the April 21, 1995 desk review. The facility gave no admission packets to the residents' responsible parties or guardians. They had not received a copy of the resident contract, facility rules and regulation, a copy of the Resident Bill of Rights, the facility admission policies, retention and discharge policies, medication storage policies, refund policies or the fee schedule for additional services. This deficiency, cited at the December 19, 1994 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visits and at the April 21, 1995 desk review. The facility had not completed demo- graphic data reports on file for each resi- dent. This deficiency, cited at the December 19, 1994 survey, remained uncorrected at the March 28, 1995 follow-up visit and at the April 21, 1995 desk review. The health assessments were not complete in their entirety to give a full view of the residents' capabilities. This deficiency, cited at the December 19, 1995 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visits. The administrator had not provided in- service training to her staff concerning ACLF core areas relevant to their job duties. This deficiency, cited at the December 19, 1994 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visits. The facility did not provide staff with a current certification in an approved first aid course. This deficiency, cited at the December 19, 1994 survey, remained uncorrected on the March 28 and June 14, 1995 follow-up visits. The administrator had not designated in writing any staff person trained in first aid to act in her behalf during her absences from the ACLF. This deficiency, cited at the December 19, 1994 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visits and at the April 21, 1995 desk review. The method of management for resident medications (self-administer, supervision of self-administration, or administration), was not identified on all resident health assess- ments. The administrator chose to supervise the self-administration of medication rather than contact the physician for clarification. This deficiency, cited at the December 19, 1994 survey, remained uncorrected on the March 28 and June 14, 1995 follow-up visits. No staff person had been designated in writing as properly trained and available at all times, with access to the supervised medications. The medication log was not accurately maintained with the timely recording of the dosages observed by staff as taken by the residents. Staff did not always observe residents take medications but recorded them as taken. Medications were not given to residents at the times indicated on the prescription labels. This deficiency, cited at the December 19, 1994 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visits. Due to uncorrected deficiencies in medi- cations a pharmacist consultant's services were required within fourteen days of March 28, 1995. The time allowed for corrected was May 15, 1995, but no report was received until May 31, 1995. No further reports have been received. This deficiency, cited at the March 28, 1995 follow-up visit, remained uncorrected at the April 21, 1995 desk review and at the June 14, 1995 follow-up visit. No notations of changes in residents' conditions had been recorded in the resident files. This deficiency, cited in the December 19, 1994 survey, remained uncorrected at the March 28, 1995 follow-up visit. The facility had not documented procedures in effect at the ACLF for the receipt, resolution and documentation of complaints from any source. This deficiency, cited at the December 19, 1994 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visits and at the April 21, 1995 desk review. The facility had no current diet manual nor evidence that a current diet manual was accessible as needed. This deficiency, cited in the December 19, 1994 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visit and at the April 21, 1995 desk survey. Menus were not dated. Substitutions were not recorded. Menus with recorded substitutions were not kept on file for six months. This deficiency, cited at the December 19, 1994 survey, remained uncorrected at the March 28 and June 14, 1995 follow-up visits. Notice of the deficiencies was provided in writing to the Respondent at the time of the survey and a time frame was given for their correction. These deficiencies were alleged in an Administrative complaint filed in this matter on November 1, 1994. Respondent has admitted the allegations.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration enter a Final Order in this matter assessing an administrative fine against the Respondent, Gem House, in an amount determined to be appropriate under the statute and rules of the Agency. DONE and ENTERED this 15th day of February, 1996, in Tallahassee, Florida. ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 15th day of February, 1996. COPIES FURNISHED: Linda L. Parkinson, Esquire Agency for Health Care Administration 400 W. Robinson Street, Suite S-309 Orlando, Florida 32801 Dean F. Mosley, Esquire McCrary & Mosley 47 E. Robinson Street, Suite 211 Orlando, Florida 32801 Sam Power Agency Clerk Agency for Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308 Jerome W. Hoffman General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Douglas M. Cook Director Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32399
Findings Of Fact Following an April, 1985 inspection of the ACLF known as Family Affairs, Respondent timely obtained certificates for its two employees viz. Elinore Kolligs and Kathy Cisterna showing them free from communicable diseases and presented these certificates at the follow up inspection to satisfy the cited deficiency. Those two employees were employed during the April, 1986 annual inspection which resulted in a repeat citation for the same alleged violation, i.e. no certification that the employees were free from communicable disease. There is no requirement that employees of an ACLF obtain certificates annually that they are free from communicable diseases. The fact that documentation had been provided to DHRS following the April, 1985 inspection that these same employees cited in 1986 were free from communicable diseases should have carried over to the 1986 inspection. Exhibit 3 lists three employees under ACLF 26, the third being Virginia Sumter who worked as a volunteer at the facility. Ms. Sumter was a former resident at the facility who had provided a certificate that she was free of communicable diseases when she entered as a resident. In this connection during the proceedings Respondent inquired of Petitioner's witness if non-paid volunteers required certificates showing them free from communicable diseases and the response was in the affirmative. When asked if this also applied to Boy or Girl Scouts who worked at the ACLF as volunteers no satisfactory answer was forthcoming. One of the two uncorrected violations listed in the Administrative Complaint dated March 19, 1987 is that Respondent had six residents when the facility was licensed for only five (ACLF 2). This violation was noted at the April 14 inspection and also at a follow up inspection on July 14, 1986. The house in which this facility is located is large and on a minimum square feet per resident basis can accommodate nine residents. On March 18, 1986, before the April, 1986 inspection, Respondent obtained zoning approval from the City of Clearwater to increase the capacity of the ACLF to seven persons (Exhibit 15). Respondent had also communicated with the ACLF Program Manager in Petitioner's Jacksonville office and had been assured that her application to increase the licensed capacity to six residents would be approved. By letter dated May 14, 1986, (Exhibit 10) Respondent was advised by Petitioner that at the time of the April 14, 1986 survey an appraisal for the application to increase licensed capacity from five to six was conducted and the facility met all standards related to the increase. By letter dated May 29, 1986, Petitioner acknowledged that notice of approval of the application to increase the licensed capacity had been received and a recommendation approving the increase had been forwarded to the Office of Licensure and Certification in Jacksonville, Florida (Exhibit 16). By letter dated July 21, 1986, Respondent was issued a new license authorizing six residents at the facility. During the survey conducted on April 14, 1986 the facility did not have a week's supply of non-perishable food on hand as required (ACLF 67) and this deficiency remained uncorrected at the follow up inspection on July 14, 1986. Respondent acknowledged that during that period Mrs. Kolligs' daughter was injured in an accident, that Mrs. Kolligs devoted much time to her daughter and authorized the cook to use the emergency supplies if necessary due to the curtailment of Mrs. Kolligs' shopping time. Subsequent to the July, 1986 re-inspection Mrs. Kolligs sold the facility and no longer operates this ACLF.
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 Petitioner is the Department of Health and Rehabilitative Services. Respondent is ETC Investments, Inc., licensed at all times pertinent to these proceedings to operate Tarpon Springs Care Center, an adult congregate living facility in Tarpon Springs, Florida. Petitioner's employees conducted inspections of Respondent's facility on September 30, 1986; May 29, 1987; and June 30, 1987. As a result of these inspections, certain deficiencies were discovered. Dates for correction of the deficiencies were determined by Petitioner's employees. Respondent was informed of the correction deadlines. Upon subsequent inspections by Petitioner's employees, some of the deficiencies continued to exist. On September 30, 1986, Petitioner's employees determined that Respondent did not have an admission and discharge record which was being properly maintained. Respondent was required to make available to Petitioner's representative by October 7, 1986, documentation indicating that a current register was being maintained. The deficiency remained uncorrected on May 29, 1987. The deficiency consisted of Respondent's failure to record the name of one resident on the facility's central log or register and a failure to note the discharge of three other residents in that register. A required health assessment form was not present in the file of one resident in Respondent's facility on September 30, 1986; a correction deadline of October 30, 1986 was set. The required form was still not in the file as required on May 29, 1987. On May 29, 1987, Respondent still had not provided proof of continuing liability insurance availability for Petitioner's review. This deficiency had been noted on September 30, 1986, with correction to be made by Respondent by October 30, 1986. Respondent failed to provide evidence at the September 30, 1986 inspection that weights of two residents of the facility were recorded semiannually. The purpose of weight records is to assist in ascertaining if a resident has a health problem. This deficiency remained uncorrected on May 29, 1987, although, as a result of the September 30, 1986 inspection, correction had been required to be made by October 30, 1986. On May 29, 1987, Respondent had not provided documentation for review by Petitioner's representative indicating that quarterly fire alarm tests were conducted; likewise, Respondent had not provided documentation indicating the performance of required smoke detector tests and inspections. These deficiencies were noted in the September 30, 1986 inspection. Documentation of testing in both instances was required to be made available by Respondent no later than October 30, 1986. Respondent has been charged with failure to provide documentation of food service policies as a result of the September 30, 1986 inspection. However, in the absence of direct testimony, Petitioner exhibit number 1, alleged to be a statement of deficiencies issued by Petitioner, is not corroborative or credited with probative value as to existence of Respondent's failure to provide documentation of the facility's food service policies and procedures by the deadline of October 30, 1986. Further, testimony of Respondent's witness, that correction of this deficiency was overlooked during subsequent inspections by Petitioner's employees, is corroborated by the witness' provision of a copy of Respondent's policies dated October 3, 1986.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED the Department of Health and Rehabilitative Services enter a final order finding the commission of six class III violations by Respondent and assessing total civil penalties of $900 for such violations. DONE AND ENTERED this 15th day of February, 1989, in Tallahassee, Leon County, Florida. DON W. DAVIS Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 15th day of February, 1989. COPIES FURNISHED: Edward A. Haman, Esquire 7827 N. Dale Mabry Highway Tampa, Florida 33614 Elaine Chicles, pro se President, ETC Investments, Inc. 1210 East Oakwood Street Tarpon Springs, Florida 34689 Gregory L. Coler Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 John Miller, Esquire General Counsel 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 =================================================================
