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AGENCY FOR HEALTH CARE ADMINISTRATION vs GENE COWLES AND AMELIA COWLES, D/B/A HILLANDALE ASSISTED LIVING, 13-004783 (2013)
Division of Administrative Hearings, Florida Filed:Safety Harbor, Florida Dec. 13, 2013 Number: 13-004783 Latest Update: Feb. 14, 2014

Other Judicial Opinions A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and comect gepy of this Final Order was served on the below-named persons by the method designated on this {30-day of Fora , 2014. Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Shaddrick Haston, Unit Manager Facilities Intake Unit Assisted Living Unit (Electronic Mail) Agency for Health Care Administration (Electronic Mail) Finance & Accounting Patricia R. Caufman, Field Office Manager Revenue Management Unit Areas 5 and 6 (Electronic Mail) Agency for Health Care Administration (Electronic Mail) Katrina Derico-Harris Medicaid Accounts Receivable Agency for Health Care Administration (Electronic Mail) Thomas J. Walsh II, Senior Attorney Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Shawn McCauley Medicaid Contract Management Agency for Health Care Administration (Electronic Mail) Tracy George, Chief Appellate Counsel Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Lynne A. Quimby-Pennock Administrative Law Judge Division of Administrative Hearings (Electronic Mail) Christina Mesa, Esquire MESA Law, P.A. P.O. Box 10207 Tampa, Florida 33679-0207 Thomas P. Crapps Administrative Law Judge Division of Administrative Hearings (Electronic Mail) NOTICE OF FLORIDA LAW 408.804 License required; display.-- (1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider. (2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued. 408.812 Unlicensed activity. -- (1) A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation. (6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency.

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AGENCY FOR HEALTH CARE ADMINISTRATION vs SHIBOR GROUP, INC., D/B/A ABUNDANT LIFE ALF, 05-002031 (2005)
Division of Administrative Hearings, Florida Filed:Lauderdale Lakes, Florida Jun. 02, 2005 Number: 05-002031 Latest Update: Dec. 11, 2006

The Issue Whether the Respondent, Shibor Group, Inc., d/b/a Abundant Life ALF (Respondent or Abundant Life), committed the violations alleged in the Administrative Complaint and, if so, what penalty should be imposed. The Petitioner, Agency for Health Care Administration (Petitioner or AHCA) asserts an administrative fine in the amount of $1,313.00 ($1,000.00 fine and $313.00 survey fee) should be imposed in this matter.

Findings Of Fact The Petitioner is the state agency charged with the authority to regulate and administer laws regarding the operation of assisted living facilities (ALF) within the State of Florida. This authority extends to all matters governed by or complained of in this case. The Respondent operates a six-bed ALF located at 7040 Fillmore Street, Hollywood, Florida. Abundant Life is licensed and is subject to all laws governing the operation of ALFs within the State of Florida. In accordance with Florida law, the Respondent is required to maintain records at its facility so that duly authorized persons from the Petitioner can review the records to assure compliance with the various regulations and rules governing the operation of ALFs. An administrator of an ALF is charged with knowing the pertinent laws and with maintaining the appropriate records to show compliance with such rules and regulations. Sherifat Orukotan is the administrator of the Abundant Life facility in this case. Generally speaking there are two types of surveys performed at an ALF. “Survey” is another word for “inspection” or “investigation.” The first type of survey is a routine review of the facility and a verification of its records to assure compliance with law. These surveys are performed on a scheduled basis for purposes of licensure or relicensure. Typically, before a renewal of a license, the facility is “surveyed.” The Respondent pursues a second type of survey when it receives a complaint regarding the licensed facility. The complaint causes a health facility evaluator to be directed to the licensed facility to review the complaint in the context of the operation of the home. In this case, both of these types of surveys were involved. On February 23, 2004, Mr. Sanders conducted a complaint survey at the facility. This matter involved an 84- year-old resident at Abundant Life who had received a notice on February 12, 2004, that directed her to leave the facility. The notice to this resident provided, in pertinent part, “You are here by given 30days to leave the facility, Starting from 02-12-04.” (Errors in original.) The subject resident required the highest level of care in that she needed assistance with all activities of daily living. She also suffered from an altered mental status that meant supervision and assistance were required. At the time of the survey, Ms. Orukotan was advised that the pertinent provisions of Florida law require a minimum of 45 days' notice to a resident who is being requested to vacate. Ms. Orukotan did not acknowledge knowing the 45-day requirement. The contract forms used by Ms. Orukotan represented a resident would only be provided with 30 days' notice. As a result of the surveyor’s findings regarding this resident, the Respondent was given until March 24, 2004, to correct the violation found on February 23, 2004. When Mr. Sanders did the follow up survey, the Respondent had corrected the problem by extending another 15 days to the resident so that a total of 45 days notice was provided. On December 22, 2004, Mr. Sanders responded to the Respondent in connection with another complaint. This complaint dealt with another resident. The resident, a 62-year-old male stroke victim, was scheduled to leave the facility on December 19, 2004. The resident had paid for accommodations through that date. On December 14, 2004, however, Ms. Orukotan had locked the resident out of the facility. Due to a dispute with the resident over expenses that were claimed to be owed, the administrator did not want the resident to come back into the home. As it happened, the resident’s girlfriend had come to the facility on December 14, 2004, and picked him up. At that time, according to the chart notes for the resident, Ms. Orukotan told the girlfriend she would not let the man back in unless the facility received additional payment. Ms. Orukotan gave the girlfriend the man’s medications and refused to open the door for him when they returned to the home at around 7:15 p.m. Only after police came to the scene did Ms. Orukotan relent and let the resident back into the home. When Mr. Sanders met with Ms. Orukotan regarding the incident, she provided the chart notes that chronicled the events as outlined above. (See Petitioner’s Ex. 6) As a result, Mr. Sanders cited the Respondent for a repeat violation, as he deemed this situation the same as the February 23, 2004, incident. A 45-day notice had not been provided to the resident. This was the second time the Respondent had failed to provide a resident with sufficient notice to vacate. Both of the citations regarding the 45-day notice issue were given as Class III violations. The Petitioner maintains that failure to provide the requisite notice may put a resident at risk for physical or emotional injury. Generally speaking, residents of ALFs are there because they are frail or unable to meet all of their daily living needs without assistance. A discharged resident without appropriate accommodations cannot provide for him or herself. Many residents are elderly or, like the second resident in this case, require assistance while they recover from a medical event. Finding a proper place to reside under these circumstances can prove difficult. The 45-day requirement is to assure that sufficient time is given to the relocating resident. Persons who work in ALFs must be free from tuberculosis (TB). Tuberculosis is a highly communicable disease that is very serious, especially to frail or at-risk populations. In order to diagnose whether or not someone has TB, a person must have some medical evaluation. The most common test for TB is a skin screening. This “TB skin test” is routinely administered and is considered a credible proof of whether a person should be considered a health risk. Unfortunately, the TB skin test does not work, or is inadequate, to provide a credible medical response if the person taking the skin test has ever received a BCG vaccine. The BCG vaccine causes a person to register a false positive on the TB skin test. Accordingly, only a chest X-ray or a sputum test (not relevant to the instant case) could rule out TB under that situation. In this case, because Ms. Orukotan had received a BCG vaccine at some point in her history, she was required to present evidence of a chest X-ray to establish that she was TB-free. In order for Ms. Orukotan’s doctor to document annually that she is free from TB, the administrator must have a chest X-ray every year. This requirement is known to Ms. Orukotan because she had been cited for (and had corrected) this deficiency prior to January 11, 2005. On January 11, 2005, Mr. Sanders requested the valid annual documentation showing that Ms. Orukotan was free from TB. At that time the only report provided to him was a statement from Dr. Siegel that stated Ms. Orukotan was free from “communicable disease.” Ms. Orukotan had not had a chest X-ray within a year of the January 11, 2005, survey date. On January 11, 2005, the administrator did not have any documentation that stated she was free from TB on any date within a year of that time. On January 14, 2005, Ms. Orukotan obtained a TB screening and chest X-ray from Dr. Siegel to document she was free from TB. This documentation was provided to AHCA on the follow-up survey date. Based upon her prompt response, the deficiency cited was deemed corrected. A chest X-ray is not valid for two years to rule out TB. On January 11, 2005, Ms. Orukotan had not had a chest X-ray within two years.

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 against the Respondent that imposes an administrative fine in the amount of $1000.00 for the repeated Class III violations and a survey fee that equals the lesser of one half of the facility's biennial license and bed fee or $500.00. S DONE AND ENTERED this 11th day of April, 2006, in Tallahassee, Leon County, Florida. J. D. PARRISH Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 11th day of April, 2006. COPIES FURNISHED: Sherifat J. Orukotan Shibor Group, Inc. 6641 Southwest 8th Street Pembroke Pines, Florida 33023 Lourdes Naranjo, Esquire Agency for Health Care Administration Spokane Building, Suite 103 8350 Northwest 52nd Street Miami, Florida 33166 Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Station 3 Tallahassee, Florida 32308 Christa Calamas, General Counsel Agency for Health Care Administration Fort Knox Building, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308

Florida Laws (1) 120.57
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AGENCY FOR HEALTH CARE ADMINISTRATION vs HARBORVIEW ACRES, INC., 98-004633 (1998)
Division of Administrative Hearings, Florida Filed:Port Charlotte, Florida Oct. 19, 1998 Number: 98-004633 Latest Update: Oct. 20, 1999

The Issue The issues are whether Respondent is guilty of caring for a resident beyond the scope of Respondent's license and whether Respondent failed to ensure that an employee timely obtained a tuberculosis test.

Findings Of Fact Respondent owns and operates a licensed assisted living facility (ALF) known as Harborview Acres in Port Charlotte. Respondent's ALF license does not include an extended congregate care license or a limited nursing service license--both of which authorize an ALF to provide additional services to its residents. Petitioner conducted an biennial survey of Respondent's facility on August 24, 1998. As a result of findings made during the survey, Petitioner cited Respondent for two deficiencies that are at issue in this case. The first cited deficiency is Tag A 006, which asserts that Respondent's license does not authorize the type of care that it was providing to one resident, who is identified as Resident 3. Petitioner's surveyors saw one meal during which Resident 3 refused to feed herself. She ate while a staffperson helped her eat, but, as soon as the staffperson walked away, Resident 3 began to spill food onto herself. Resident 3 was confined to a wheelchair and required assistance in transfers from and to her wheelchair. She required assistance in various activities of daily living, such as dressing herself, combing her hair, and bathing. However, unknown to the surveyor and staff, Resident 3 was ill with a urinary tract infection. A few days previously, she had been walking with a walker, but otherwise without assistance, and had been feeding herself. The record does not permit a finding that the condition of Resident 3 was such as to require services beyond the scope of Respondent's license. During the survey, one surveyor reviewed staff files and found that the documentation for Staff 3, who had been hired on July 12, 1996, revealed no tuberculosis test since August 17, 1997. Zia Butt, the administrator, admitted that the employee's test was overdue. As Ms. Butt explained, the employee had gone to the County Public Health Office for a tuberculosis test, but the office had been unable to conduct the test and told her to return in a week. Petitioner properly classified this deficiency as a Class III deficiency. The failure of a caregiver to obtain annual tuberculosis tests indirectly or potentially threatens the physical or emotional health, safety, or security of the residents of the facility. The surveyor gave Respondent until September 21, 1998, for Staff 3 to obtain a tuberculosis test. The record does not establish that Respondent failed to correct this deficiency within the time permitted. Likewise, the record does not establish the factual basis for the allegation that this is a repeated offense.

Recommendation It is RECOMMENDED that the Agency for Health Care Administration dismiss the Administrative Complaint against Respondent. DONE AND ENTERED this 4th day of June, 1999, in Tallahassee, Leon County, Florida. ROBERT E. MEALE Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 4th day of June, 1999. COPIES FURNISHED: Karel L. Baarslag Senior Attorney Agency for Health Care Administration Post Office Box 60127 Fort Myers, Florida 33906-0127 Zia Butt Administrator Harborview Acres, Inc. 4950 Pocatella Drive North Port, Florida 34287 Paul J. Martin, General Counsel Agency for Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308 Sam Power, Agency Clerk Agency for Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308

Florida Laws (1) 120.57 Florida Administrative Code (1) 58A -5.0184
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AGENCY FOR HEALTH CARE ADMINISTRATION vs NORTHPOINTE RETIREMENT COMMUNITY, INC., D/B/A NORTHPOINTE RETIREMENT COMMUNITY, 06-005152 (2006)
Division of Administrative Hearings, Florida Filed:Pensacola, Florida Dec. 18, 2006 Number: 06-005152 Latest Update: Oct. 01, 2007

The Issue Whether Respondent committed the violations alleged in the Administrative Complaint and, if so, what penalty should be imposed.

Findings Of Fact AHCA is the agency responsible for the licensing and regulation of assisted living facilities in Florida pursuant to Chapter 400, Florida Statutes. At all times material hereto, Northpointe was licensed as an assisted living facility consisting of two buildings with a total licensed capacity of 100 beds. Northpointe is located in Pensacola, Florida. As the result of a complaint received by AHCA, Norma Endress, a registered nurse and agency surveyor employed by AHCA, conducted a complaint inspection of Northpointe on September 7 and 8, 2006. The health assessment form is a document completed by the resident’s physician or physician’s assistant prior to or shortly after admission to the facility. During her survey visit, Ms. Endress reviewed certain residents’ health assessments, interviewed residents, and made observations. All of the counts contained in the Administrative Complaint are primarily based upon the same set of facts regarding two residents, Residents 1 and 2. Background-Resident 1 Dr. Mohamad Mikhchi, administrator of Northpointe, explained the unusual circumstances surrounding the admission of Resident 1 to Northpointe. Resident 1 was flown from out-of- state to Pensacola on an ambulance jet and arrived at Respondent’s facility in the evening of August 31, 2006. Resident 1 arrived on a stretcher. Dr. Mikhchi had immediate concerns as to whether his facility was an appropriate placement for Resident 1. Upon her arrival, Resident 1’s family brought in a hospital bed with full bed rails for Resident 1’s use. Dr. Mikhchi explained to the family that full bed rails were not permitted in assisted living facilities. Because Resident 1 kept trying to climb out of bed that first night, Dr. Mikhchi instructed staff to place Resident 1’s mattress on the floor, so that she would not fall and risk breaking a bone. Resident 1 made a screaming or yelling sound continuously that first night and was combative with staff. Resident 1 has a diagnosis of dementia. The morning following her admission, staff dressed Resident 1 and took her to the dining room where she continued to make the same yelling sound. Dr. Mikhchi and staff received complaints from other residents in the dining room. Resident 1 was moved to the living room area, where she continued to make the same sound. Again, Dr. Mikhchi received complaints from other residents about her yelling. The morning after her arrival, Resident 1’s family took her to a doctor for a health assessment. The doctor referred her to an emergency room. Late that evening, the emergency room called and informed Respondent that Resident 1 would not be admitted to the hospital, and returned Resident 1 to Northpointe around midnight. At that point, great efforts were made to find a more appropriate placement for Resident 1. Because of the continuing complaints he received from other residents regarding Resident 1’s behavior, and because he was concerned with the rights of these other residents, Dr. Mikhchi determined that Resident 1 be kept in her room most of the time, including at mealtime, in order not to disturb and annoy other residents. He also instructed staff not to use the bed with full bed rails, and to keep Resident 1’s mattress on the floor for her safety. Resident 1 continued to be combative with staff and make the yelling sound. Resident 1 stayed at Northpointe a little more than one week, until an appropriate placement was found for her. It was during that week that Ms. Endress made her complaint inspection. Background-Resident 2 Resident 2 was admitted to Northpointe in July 2006. Her admission papers and physician’s health assessment note that she has a vision impairment (macular degeneration) and wore a colostomy bag. Resident 2’s health assessment form indicates that Resident 2 needs “supervision w/self administration” of medication, that she needed assistance with activities of daily living (ADLs) and her colostomy bag, and that her needs could be met in an assisted living facility. The staff’s role regarding the colostomy bag was limited to assisting with changing and/or emptying the bag, not cleaning the skin area called the stoma, which was done by Resident 2 while she showered. Some of Northpointe’s staff were trained to assist Resident 2 with changing and emptying her colostomy bag, and some were not. Resident 2 was verbal with staff, and had a television in her room. Staff notes document that Resident 2 often refused her medication when it was offered to her by staff. At times, Resident 2 would tell staff not to change her colostomy bag when they had entered her room to do just that. Count I Tag A609 Count I of the Administrative Complaint alleges that based on record review and observation, unlicensed staff administered medications to 6 of 7 sampled residents who were unable to self administer medications; that unlicensed staff performed accu check blood glucose monitoring for 1 of 7 sampled residents; and administered as needed (prn) medications for 1 of 7 sampled residents. While Count I of the Administrative Complaint references six residents (1, 2, 3, 4, 6, and 7), Ms. Endress only testified about three residents (1, 2 and 6) regarding the allegations in Count I, with emphasis on Residents 1 and 2. According to Ms. Endress, the crux of this “tag” is that unlicensed staff administered medications to residents who are unable to self administer their medications. Based upon her review of Resident 1’s health assessment and her observation of Resident 1, Ms. Endress determined that Resident 1 was a total care resident. Ms. Endress determined that Resident 1 could not tell anything to her about her medications, was unable to self-administer her medications, and that staff administered all of Resident 1’s medications. On her health assessment form, Resident 1’s physician checked “yes” in answer to the question, “does the individual need help with her medications.” He also checked “yes” in answer to the question of whether this resident’s needs can be met in an assisted living facility, as opposed to a medical or nursing facility. Regarding Resident 2, Ms. Endress determined that Resident 2 had a diagnosis of being blind and needed supervision taking her medications. Ms. Endress observed that Resident 2 could identify some but not all of her medications. Ms. Endress determined that Resident 6 was severely demented, unable to recognize medication and/or assist with her medications, and that staff were administering all of Resident 6’s medications. Resident 6 was a Hospice patient at the time of the survey visit. Resident 6’s health assessment form indicates that Resident 6 needs assistance with her medications with the notation “dispense all to pt,” and that Resident 6’s needs could be met in an assisted living facility. Dr. Mikhchi explained that Resident 6 lived at Northpointe for several years, and eventually was placed under Hospice care after her condition worsened. Regarding the allegation that staff performed a resident’s accu-check device, Ms. Endress based that allegation solely on her interview with Resident 5. She did not base this allegation on a review of Resident 5's records or from observations. According to Dr. Mikhchi, however, the staff takes the accu-check device to the resident and holds it against the resident's finger. The resident then pushes the button. Staff then reads and records the information from the accu-check device. Count II Resident Care Standards Tag A700 Count II of the Administrative Complaint alleges that Respondent failed to provide care and services to meet the needs of Residents 1 and 2. Regarding Resident 1, Ms. Endress cited Tag A700 based upon her determination of the following: Resident 1's health assessment form indicated “total care”; Resident 1 had a foley catheter, yet Ms. Endress found no documentation referencing the catheter or about the catheter being discontinued; Resident 1 had full side rails on her bed; and Resident 1 was secluded in her room. However, Resident 1's health assessment form contains the notation “total assist,” not “total care.” Resident 1’s record also includes a prescription form from Comfort Care Medical Group dated September 1, 2006, which states "DC Foley cath" followed by the notation “FYI (Baptist Home Health will be there at 5pm 9/1/06 to remove.)" Below that is the notation “Done on 9-5-06.” While there is disagreement as to whether this last notation means that the catheter was removed on September 5, 2006, or that the “9-5-06” notation means that the prescription was noted and filed on that date, there is clearly documentation regarding the catheter and Resident 1, that is, that a physician ordered it to be removed and that a home health agency had been contacted (apparently by the physician since it is referenced on his prescription form) to remove it. Ms. Endress’ primary concern regarding Resident 2 was in regard to Resident 2’s colostomy bag. Only certain staff members were trained on how to care for a colostomy bag. As a result of her interview of Resident 2, Ms. Endress concluded that there was a lot of confusion regarding the colostomy bag, resulting in Resident 2 having to wait long periods of time for assistance with her colostomy bag, and that the colostomy bag was not being properly maintained. Additionally, Ms. Endress determined that Resident 2 needed assistance with her activities of daily living and with her medications, and that her medications were not being given according to the doctor’s order. Staff notes show that Resident 2 clearly and repeatedly refused medications, as well as meals, in her interaction with staff. Further, the staff notes contain repeated references to staff assisting in changing Resident 2’s colostomy bag, and repeated references to Resident 2 refusing to allow staff to change her colostomy bag when they arrived at her room to do so. Ms. Endress was also concerned that Resident 2 had experienced a fall, and that her record lacked documentation that the family or a physician had been called. However, the incident report states that staff heard a noise, went to Resident 2’s room and found her on the floor with a skin tear. Staff called EMS who cleaned and bandaged the skin tear. There is clear documentation that Resident 2 refused to be taken to the hospital. The incident report clearly indicates that the staff member “notified my supervisor and also her daughter of this incident.” Counts III and IV, Tags A718 and A724, Residents’ Rights Count III of the Administrative Complaint alleges that Respondent failed to treat Resident 1 with personal dignity and respect. Count IV of the Administrative Complaint alleges that Respondent physically restrained Resident 1 with side rails, a recliner, and by keeping the resident in her room. At hearing, Ms. Endress explained that she cited Tag A718 because of Resident 1: “The lady was screaming and hollering, banging the rails, pinching, fighting. The staff did not know what to do with her. There were side rails up at that time. They also told me that they were told to keep her in the room because of her hollering and screaming. Pretty much that’s it. It fell under resident rights and it was restraining a resident and it’s for dignity and respect and it was based on seclusion.” Ms. Endress cited Tag A724 because “this is pertaining to restraints. And it’s speaking to having a physician’s order for restraints. . . . Resident number 1 was . . . climbing out of bed, they put a mat on the floor for safety, put her on the floor.” Counts V and VI, Tags A402 and A403, Residency Criteria Count V (Tag A402) alleges that Respondent admitted Residents 1 and 2 who were unable to perform activities of daily living with assistance, including assistance with colostomy care. Ms. Endress cited Tag A402 because, based upon her review of the health assessment form and her observations, Ms. Endress determined that Resident 1 could not perform any ADLs without assistance. She included Resident 2 in this Tag because of the issues previously discussed regarding her colostomy care. In citing Tag 403, Ms. Endress focused on Resident 1, who Ms. Endress determined could not stand up on her own, pivot, or ambulate. Dr. Mikhchi insists that Resident 1 could bear weight and walk with assistance of staff. Staff assisted her to the bathroom for bathing and toileting. He acknowledges that Resident 1 was “borderline,” and that great efforts were made to find an appropriate placement for Resident 1 as soon as possible. Count VII, Tag 517, Staffing Standards Count VII alleges that Respondent failed to provide minimum staff for the week of September 1 through 7, 2006. This allegation was based on Ms. Endress’ belief that the two buildings which comprise Northpointe must be counted separately. That is, when determining staff counts, she looked at each building separately, despite the fact that the license is for the total census of the two buildings combined. At hearing, Ms. Endress conceded, “so clearly, if you add building two staff, you come up with more than the minimum [staff].” Count VIII, Tag A608, Assistance With Self-Administration Count VIII alleges that Respondent failed to make available staff to assist with self-administration for medications for one of seven sampled residents and all others which may have needed assistance. Ms. Endress observed Resident 1 yelling for 25 minutes. Ms. Endress reviewed Resident 1’s file and noted that it indicated Haldol for agitation, as needed, and Methodone for pain. While she was observing, no one assessed Resident 1 for agitation or pain. According to Ms. Endress, an assisted living facility must have a nurse or an unlicensed staff member, e.g., a med tech, who is trained in medication. Ms. Endress determined that the staff in the room with Resident 1 had not been trained and that there was no one in the building who could assess the patient. Part of Ms. Endress’ concerns rest again on her perception that staff requirements apply to each building of Respondent. “I met the med tech but she was not assigned to that building, she was not on schedule for that building, she is not assigned to that building. . . . So, to me, a facility is a building.” Tarnecia Smith, a med tech, was on the schedule for that shift, but was not in the building where this incident occurred at the time of the incident. She holds a certificate for “the completion of the Assisted Living Facilities Assistance with Medication Training.” Count IX Tag A1105, Records Count IX alleges that Respondent failed to provide CPR training for 2 of 3 sampled employees. Ms. Endress cited this tag because, based upon her interview with staff present, she determined that there was no one in the building who had been trained in CPR and first aid. Tarnecia Smith was on duty on the evening in question. She holds certificates in CPR and first aid. Both certificates show a completion date of April 15, 2006. The CPR certificate shows that it is valid for one year from the date of completion. The first aid certificate shows that it is valid for three years from the completion date. Accordingly, both certificates were valid at the time of the inspection which gave rise to this proceeding. Following the inspection visits Dr. Mikhchi expressed frustration that there had been no exit interview with Ms. Endress following the inspection visits on September 7 and 8, 2006. During cross examination Dr. Mikhchi asked the following of Ms. Endress: Q At this time does it seem or do you agree, ma’am, that if we did have an exit interview, we would have cleared these out at the beginning? A True. And I was directed not to do an exit interview. Q I understand that. A And at that time, I was not complete, finished with my investigation, at that point. But you should have gotten an exit interview some time thereafter when it was completed. Q But when we would have the exit interview, do you believe the questions about this or the hours of— A Yes. We usually talk about these things, yes, and you show me things. Q For twenty years we’ve done that? A Yes. Q At this time we didn’t? A I agree. There is no dispute that during a follow-up visit to Respondent in November 2006, all tags were cleared by AHCA.

Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law set forth herein, it is RECOMMENDED: That the Agency for Health Care Administration enter a final order assessing an administrative fine of $1,000 and a survey fee of $500 against Respondent, Northpointe Retirement Community. DONE AND ENTERED this 24th day of August, 2007, in Tallahassee, Leon County, Florida. S BARBARA J. STAROS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 24th day of August, 2007.

Florida Laws (7) 120.569120.57429.19429.256429.275429.28464.003
# 7
AGENCY FOR HEALTH CARE ADMINISTRATION vs THE APPLE HOUSE, INC., 04-002715 (2004)
Division of Administrative Hearings, Florida Filed:Jacksonville, Florida Aug. 04, 2004 Number: 04-002715 Latest Update: Dec. 23, 2024
# 8
AGENCY FOR HEALTH CARE ADMINISTRATION vs SUNSHINE GARDENS, 03-002959 (2003)
Division of Administrative Hearings, Florida Filed:Gainesville, Florida Aug. 14, 2003 Number: 03-002959 Latest Update: Dec. 23, 2024
# 9

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