06-003731 Agency For Health Care Administration vs. Caso, Inc., D/B/A Paradise Manor Ii Status: Closed Recommended Order on Tuesday, March 20, 2007.

Summary: Respondent is guilty of two class 2 violations and therefore is subject to an administrative fine in the amount of $2,000, and a survey fee in the amount of $500.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Petitioner , )

)

vs. )

) Case No. 06 - 3731

CASO, INC., d/b/a PARADISE )

MANOR II , )

)

Respondent . )

)

R ECOMMENDED ORDER

A formal hearing was conducted in this case on January 30,

2007, in Deland, Florida, before Suzanne F. Hood, Administrative

Law Judge with the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Gerald L. Pickett, Es quire

Agency for Health Care Administration

Sebring Building, Suite 330K

525 Mirror Lake Drive, North

St. Petersburg, Florida 33701

For Respondent: Christal Caso, O wner

Caso, Inc., d/b/a Paradise Manor II

435 Greenleaf Square

Port Orange, Florida 32127

STATEMENT OF THE ISSUE S

The issues are as follows: (a) whether Respondent is

guilty of a C las s II violation because Respondent failed to

discharge a resident who no longer met the criteria for

continued residency contrary to Sections 400.426 and 400.428,

Florida Statutes (2005), and Florida Administrative Code Rule

58A - 5.0181; (b) whether Responde nt is guilty of a C lass II

violation because Respondent transferred a resident’s

prescription medication from one storage container to another

contrary to Florida Administrative Code Rule 58A - 5.0185; and (c)

what penalties, if any, should be imposed.

PRE LIMINARY STATEMENT

On August 6, 2006, Petitioner Agency for Health Care

Administrative (Petitioner) issued an Administrative Complaint

against Respondent Caso, Inc., d/b/a Paradise Manor II

(Respondent). The complaint alleges that Respondent had two

clas s II violations during a biennial survey on May 17, 2006.

Petitioner seeks to impose an administrative fine and a survey

fee against Respondent.

On September 22, 2006, Respondent filed a request for an

administrative hearing to contest the allegations in the

Administrative Complaint. On October 2, 2006, Petitioner

referred the request to the Division of Administrative Hearings.

The undersigned issued an Initial Order on October 3, 2006.

The parties filed a Joint Response to Initial Order on

October 9, 2006.

A Notice of Hearing dated October 12, 2006, scheduled the

hearing for December 15, 200 6 .

On November 28, 2006, Petitioner filed an unopposed Motion

for Continuance of the Final Hearing. That same day, the

undersigned issued an Order Granting Continuance and Re -

scheduling Hearing for January 30, 2007.

During the hearing, Petitioner presented the testimony of

two witnesses. Petitioner offered five exhibits that were

accepted as evidence.

Respondent presented the testimony of five witnesses .

Respondent offered three exhibits that were accepted into

evidence.

The Transcript was filed on February 9, 2007.

On February 14, 2007, Petitioner filed an unopposed request

for extension of time to file proposed recommended order. The

undersigned issued an Order Granting Extension of Time on

February 16, 2007. On February 28, 2007, the parties timely

filed their Proposed Recommended Orders.

FINDINGS OF FACT

1. Petitioner is the agency charged with licensing of

assisted living facilities (ALFs) in Florida. Petitioner has

the duty to ensure that ALFs comply with the provisions of

Chapter 400, Part III, Florida Statutes (2005). In the

performance of its duties, Petitioner is required to conduct

biennial surveys and monitoring visits to veri f y co rrection of

any deficient practices.

2. The evaluation, or survey, of a facility includes a

resident review/observation and, depending on the circumstances,

a record review and interviews with family and facility staff.

Surveyors note their findings on an agency Form 3020 - 0001,

titled “Statement of Deficiencies and Plan of Correction.”

3. If deficiencies are found during a survey, the

violations are noted as “Tags” on the Form 3020 - 0001. A Tag

identifies and summarizes the applicable regulatory stan dard

that the surveyor believes the licensee has violated. A Tag

also sets forth specific facts in support of alleged

deficiencies, identifies the classifications of deficiencies

depending on their nature and gravity, and identifies the

probable effect th at deficiencies have on facility residents.

4. Respondent operates a licensed ALF facility (the

facility) located in Port Orange, Florida. Respondent is also

licensed to provide its residents with limited nursing services

(LNS). Respondent is authori zed to admit a maximum of six

residents.

5. Resident 2 was admitted to the facility on October 11,

2004. She was an elderly female who had psychological and

medical problems, including schizophrenia, chronic obstructive

pulmonary disease, and hyperten sion.

6. Resident 2 needed supervision for ambulation with a

walker, dressing, eating, grooming, bathing, and total care for

toileting due to incontinence of bowel and bladder. Resident 2

never received LNS from Respondent.

7. Resident 2 was a stro ng - minded person who would not

always cooperate with the efforts of the facility’s staff to

keep her repositioned in her wheelchair or bed. At times she

refused to take her medicines.

8. Because Resident 2 was forgetful, the facility’s staff

had to pro vide her with reminders so that she could stay

oriented to time and place. She was always very verbal about

her wishes, especially her desire to be left alone.

9. Christal Caso is Respondent’s administrator and owner.

She is also a licensed practical nurse.

10. In March 2006, Resident 2 experienced trouble with

vomiting for several days before she would allow Ms. Caso to

take her to the hospital. After receiving treatment for kidney

failure in the hospital, she recovered sufficiently to travel in

a wheelchair on a seven - day cruise with Ms. Caso.

11. After the cruise, Resident 2's health seemed to

decline rapidly. She began to los e weight because she was not

eating properly.

12. Around the first of May 2006, Ms. Caso took Resident 2

for an app ointment with her personal physician. After that

appointment, she was referred to a local hospice.

13. Resident 2 was admitted to hospice care on May 10,

2006. The hospice agreed to provide her hospice care in

Respondent’s facility. Because hospice did not provide 24 - hour

day - to - day care, Respondent continued to provide care for her .

14. A nurse from the local hospice visited with Resident 2

on May 12, 2006. The hospice nurse noted that she was very thin

with poor appetite. The hospice nurse observ ed that she was

very stiff with multiple skin breakdowns that seemed to get

worse every day. The hospice nurse also noted that Respondent’s

staff used normal saline solution and triple antibiotic ointment

to treat the pressure sores.

15. Resident 2 yel led when the hospice nurse or anyone

touched her. She would not let the hospice nurse treat her

pressure sores.

16. On May 12, 2006. the hospice nurse requested the

hospice physician to order ibuprofen (Motrin) suspension for

Resident 2. The physician ’s order stated that she could take

the Motrin every six hours as needed for pain.

17. On May 17, 2006, Petitioner’s staff performed a

biennial survey of the facility. The survey involved an

evaluation of the facilities’ care for Resident 2.

18. Pet itioner’s surveyor observed the following problems

with Resident 2’s skin integrity: (a) a medical dressing at

mid - calf on her right leg, draining a yellow, serosanguineous

substance; (b) a bandage on her right foot, covering an swollen

area that was deep red to bluish in color; (c) a pressure sore

on her right heel that was black but not draining; (d) a black,

draining ulcer on the outer side of her right foot about the

size of a quarter; (e) a large bandage under her incontinent

brief that covered an ulc er approximately 7 centimeters wide, 11

centimeters long, and 2 - 3 centimeters deep, with a yellow,

serosanguineous drainage and that constituted a sta g e 4 ulcer

almost exposing the hip bone. Petitioner’s surveyor could not

see other parts of Resident 2’s body because she refused to

change her position.

19. During the course of viewing her pressure sores,

Petitioner’s surveyor observed Respondent’s certified nurse

assistant (CNA) removing Resident 2’s bandages. The CNA took

off the dressings, one at a time, and laid them on the over - bed

table. The CNA put the s ame dressings back on her after

handling her clothing and the over - bed table, thus contaminating

the dressings and the table. Contamination of the reapplied

dressings created a direct threat of infection.

20. The CNA stated that he was the only staff member that

performed wound care at the facility. Ms. Caso admitted that

she did not perform wound care. She also admitted that the

facility did not have a staff member who was licensed and

pro perly trained to provide wound care.

21. During the surveyor’s observation, Resident 2 had

periods of clearly understanding what was being said to her. At

other times, she would either refuse to talk or was unable to do

so. She yelled during the obse rvation because she was annoyed

and/or in pain.

22. On May 17, 200 6 , Respondent could not provide

Petitioner’s surveyor with a record more recent than 2004 or

2005 of Resident 2’s health status. There was no documentation

to show that she received app ropriate management of her pressure

sores in Respondent’s facility before or after her admittance to

hospice care.

23. Respondent did not have a written plan of care for

Resident 2 reflecting wound care, pain management, or hospice

care. Ms. Caso admit ted that she did not have time to keep

records. More important, she could not produce any records kept

by hospice.

24. Petitioner’s surveyor checked Resident 2’s medication.

As of May 17, 2007, she had not received a dose of the Motrin

ordered for he r on May 12, 200 6 . Respondent did not pick up the

medicine from the pharmacy until May 16, 200 6 .

25. Petitioner’s surveyor also observed that Resident 2

had a prescription bottle of medicine by the name of Metoprolol,

a medicine commonly prescribed for high - blood pressure and heart

problems such as angina. The medicine bottle contained two

kinds of tablets: pink and round tablets and white oval

tablets.

26. When the pharmacist filled Resident 2’s prescription

for Metoprolol, he did not have enough of the medicine to

complete the physician’s order. When the pharmacist received a

shipment of the same medicine from a different manufacturer, he

sent Resident 2 the balance of the physician’s order. The

Metoprolol tablets from the two manufacturers were different in

color and shape.

27. A member of Respondent’s staff combined all the

tablets of Metoprolol in one prescription bottle. Thereafter, a

third person would not know if these tablets in the same bottle

were actually the same prescribed medicat ion or whether someone

mixed the wrong medications. Combining the tablets from two

prescription bottles was a class II violation of Tag A626

because it created a direct threat to Resident 2‘s health.

28. At the request of Ms. Caso, the hospice nurse v isited

Resident 2 during the survey on May 17, 2006. The hospice nurse

noted that her skin continued to break down. The hospice nurse

decided to consult a wound care specialist regarding Resident

2’s skin breakdown. During the hearing, the hospice nurse

conceded that at least one of Resident 2’s pressure sores had

advanced to a stage 3.

29. During the survey on May 17, 2006, Petitioner’s

surveyor recommended that Resident 2 be transfer red to a

facility with a higher level of nursing care. The surveyo r

contacted Resident 2 ’s personnel physician to advise the doctor

about her health status and the advanced state of her pressure

sores. After making that call, the surveyor was unable to get

Resident 2 to voluntarily go see her physician at the emergency

room. Ms. Cas o took the position that Resident 2 was receiving

appropriate care and refused to initiate discharge proceedings.

30. Resident 2 required wound care on a daily basis.

Hospice did not perform that care. A hospice nurse visited her

on a w eekly basis to monitor her condition. A hospice home

health aide bathed her three times a week. Respondent’s CNA

continued to provide all of her wound care, a task outside the

scope of a CNA’s license.

31. Resident 2 ’s skin breakdown had become very s evere by

May 17, 2006. Her admission to Respondent’s facility did not

include LNS. Clear and convincing evidence indicates that

Resident 2 required a higher level of nursing care for her

pressure sores than Respondent provided or was licensed to

provide.

32. Resident 2 ’s admission to hospice care did not relieve

Respondent of the duty to ensure that Resident 2 received

appropriate care or, in the alternative, to initiate steps to

discharge her. Respondent’s failure to do so was a class II

violation of Tag A509 because it created a direct threat to

Resident 2 ’s health.

33. The hospice nurse made a weekly visit to Resident 2 in

Respondent’s facility on May 23, 2006. The hospice nurse made

the following progress notes: (a) patient has been eating thre e

meals a day, consisting of approximately three ounces per meal;

(b) b r ought out air pressure seat for wheelchair; (c) instructed

ALF to use home health aide to give patient bath that is OK and

allowed by ALF’s; (d) patient sitting up in wheelchair and fe eds

self puree diet very slowly; (e) wounds continue to look clean

and without signs of infection; (e) see assessment; (f) poor

circulation, poor nutritional status, daily wound care once a

day; and (g) continue to assess diet, circulation, and wounds

once a week and as needed. Resident 2 died a few days after the

hospice nurse’s visit.

CONCLUSIONS OF LAW

34. The Division of Administrative Hearings has

jurisdiction over the parties and the subject matter of this

proceeding pursuant to Sections 120.569 an d 120.57(1), Florida

Statutes (2006).

35. Petitioner has the burden of proving by clear and

convincing evidence that Respondent has committed two class II

violations, and therefore, is subject to an administrative fine

and a survey monitoring fee. See Department of Banking and

Finance v. Osborne Stern and Company , 670 So. 2d 932 (Fla.

1996).

36. Regarding class II violations and their accompanying

penalties, Section 400.419, Florida Statutes (2005), as follows

in relevant part:

(2) Each vio lation of this part and

adopted rules shall be classified according

to the nature of the violation and the

gravity of its probable effect on facility

residents. The agency shall indicate the

classification on the written notice of the

violation as follows :

* * *

(b) Class “II” violations are those

conditions of occurrences related to the

operation and maintenance of a facility or

to the personal care of residents which the

agency determines directly threaten the

physical or emotional health, safety , or

security of the facility residents, other

than class I violations. The agency shall

impose an administrative fine for a cited

class II violation in an amount not less

than $1,000 and not exceeding $5,000 for

each violation. A fine shall be levied

no twithstanding the correction of the

violation.

* * *

(3) In determining if a penalty is to

be imposed and in fixing the amount of the

fine, the agency shall consider the

following factors:

(a) The gravity of the violation,

including the probability that death or

serious physical or emotional harm to a

resident will result or has resulted, the

severity of the action or potential harm,

and the extent to which the provision of the

applicable laws of rules were violated.

(b) Action t aken by the owner or

administrator to correct violations.

(c) Any previous violations.

(d) The financial benefit to the

facility of committing or continuing the

violation.

(e) The licensed capacity of the

facility.

* * *

(10 ) In addition to any administrative

fines imposed, the agency may assess a

survey fee, equal to the lesser of one half

of the facility’s biennial license and bed

fee or $500, to cover the cost of conducting

initial complaint investigations that result

in the finding of a violation that was the

subject of the complaint or monitoring

visits conducted under s. 400.428(3)(c) to

veri f y the correction of the violations.

Tag A427

37. Admissions and discharges from ALFs are regulated by

Florida Administrative Code Rule 58A - 5.0181, the applicable

version of which states as follows in pertinent part:

58A - 5.0181 Residency Criteria and

Admission Procedures.

(1) ADMISSION CRITERIA. An individual

must meet the following minimum criteria in

order to be a dmitted to a facility holding a

standard, limited nursing or limited mental

health license :

* * *

(j) Not have any stage 3 or 4 pressure

sores. A resident requiring care of a stage

2 pressure sore may be admitted provided

that:

1. The facili ty has a LNS license and

services are provided pursuant to a plan of

care issued by a physician, or the resident

contracts directly with a licensed home

health agency or a nurse to provide care;

2. The condition is documented in the

resident’s recor d; and

3. If the resident’s condition fails

to improve within 30 days, as documented by

a licensed nurse or physician, the resident

shall be discharged from the facility.

* * *

(n) Have been determined by the

facility administrator to be app ropriate for

admission to the facility. The administrator

shall base the decision on:

1. An assessment of the strengths,

needs, and preferences of the individual,

and the medical examination report required

by Section 429.26, F.S., and subsection (2 )

of this rule;

2. The facility’s admission policy,

and the services the facility is prepared to

provide or arrange for to meet resident

needs; and

* * *

(4) CONTINUED RESIDENCY. Criteria for

continued residency in a facility holding a

standa rd, limited nursing services, or

limited mental health license shall be the

same as the criteria for admission, except

as follows:

(a) The resident may be bedridden for

up to 7 consecutive days.

(b) A resident requiring care of a

stage 2 pr essure sore may be retained

provided that:

1. The facility has a LNS license and

services are provided pursuant to a plan of

care issued by a physician, or the resident

contracts directly with a licensed home

health agency or a nurse to provide care ;

2. The condition is documented in the

resident’s record; and

3. If the resident’s condition fails

to improve within 30 days, as documented by

a licensed nurse or physician, the resident

shall be discharged from the facility.

(c) A te rminally ill resident who no

longer meets the criteria for continued

residency may continue to reside in the

facility if the following conditions are

met:

1. The resident qualifies for, is

admitted to, and consents to the services of

a licensed hosp ice which coordinates and

ensures the provision of any additional care

and services that may be needed;

2. Continued residency is agreeable to

the resident and the facility;

3. An interdisciplinary care plan is

developed and implemented by a licensed

hospice in consultation with the facility.

Facility staff may provide any nursing

service permitted under the facility’s

license and total help with the activities

of daily living; and

4. Documentation of the requirements

of this paragrap h is maintained in the

resident’s file.

(d) The administrator is responsible

for monitoring the continued appropriateness

of placement of a resident in the facility.

* * *

(5) DISCHARGE. If the resident no

longer meets the criteria for conti nued

residency, or the facility is unable to meet

the resident’s needs, as determined by the

facility administrator or health care

provider, the resident shall be discharged

in accordance with Section s 400. 426 [9] and

429.28(1), F.S.

38. Under the resi dent bill of rights, a resident of an

ALF is entitled to certain relocation or termination of

residency notice provisions. These notice provisions do not

apply when a resident requires “an emergency relocation to a

facility providing a more skilled level of care . . . .” See

§ 400.428(1)(k), Fla. Stat. (2005).

39. The owner or administrator of an ALF is responsible

for determining the “appropriateness of admission of an

individual to the facility and for determining the continued

appropriateness of re sidence of an individual in the facility.”

See § 400.426(1), Fla. Stat. (2005). The appropriateness of

admission and/or continued residency depends on several factors,

including but not limited to statutory and rule limitations.

Id.

40. As a general rule, “[a] resident may not be moved from

one facility to another without consultation with and agreement

from the resident.” Id. However, Section 400.426(9), Florida

Statutes (2005), sets forth the procedure to follow when a

resident will not agree to transfer to a facility with a higher

level of care.

41. Section 400.426(9), Florida Statutes (2005), states as

follows:

(9) If, at any time after admission to

a facility, a resident appears to need care

beyond that which the facility is license d

to provide, the agency shall require the

resident to be physically examined by a

licensed physician or licensed nurse

practitioner. This examination shall, to

the extent possible, be performed by the

resident’s preferred physician or nurse

practitioner and shall be paid for the

resident with personal funds, except as

provided in s. 400,418(1)(b). Following the

examination, the examining physician or

licensed nurse practitioner shall complete

and sign a medical form provided by the

agency. The completed medical form shall be

submitted to the agency within 30 days after

the date the facility owner or administrator

is notified by the agency that the physical

examination is required. After consultation

with the physician or licensed nurse

practitioner who performed the examination,

a medical review team designated by the

agency shall then determine whether the

resident in appropriately residing in the

facility. The medical review team shall

base its decision on a comprehensive review

of the resident’s phys ical and functional

status, including the resident’s

preferences, and not on an isolated health -

related problem. In the case of a mental

health resident, if the resident appears to

have needs in addition to those identified

in the community living support plan, the

agency may require an evaluation by a mental

health professional, as determined by the

Department of Children and Family Services.

A facility may not be required to retain a

resident who requires more services or care

than the facility is able to provide in

accordance with its policies and criteria

for admission and continued residency.

Members of the medical review team making

the final determination may not include the

agency personnel who initially questioned

the appropriateness of a residen t’s

placement. Such determination is final and

binding upon the facility and the resident.

Any resident who is determined by the

medical review team to be inappropriately

residing in a facility shall be given 30

days’ written notice to relocate by the

ow ner or administrator, unless the

resident’s continued residence presents an

imminent danger to the health, safety, or

welfare of the resident or a substantial

probability exists that death or serious

physical harm would result to the resident

if allowed to remain in the facility.

42. Hospice organizations may provide care in an ALF

pursuant to Section 400.426(10), Florida Statutes (2005), which

states as follows:

(10) A terminally ill resident who no

longer meets the criteria for continued

resi dency may remain in the facility if the

arrangement is mutually agreeable to the

resident and the facility; additional care

is rendered through a licensed hospice, and

the resident is under the care of a

physician who agrees that the physical needs

of the resident are being met.

43. In this case, Resident 2 did not meet the requirements

for continued residency in Respondent’s facility under Florida

Administrative Code Rule 58A - 5.0181(4)(b) because she had at

least one pressure sore that was stage 3 or stage 4. As a

terminally ill hospice patient, Resident 2 could not remain in

Respondent’s facility for the following reasons: (a) neither

Respondent nor the hospice organization provided Resident 2 with

required wound care from an individual who was prop erly licensed

and trained to care for such severe bed sores; (b) there is no

evidence of an interdisciplinary care plan that was developed

and implemented by the hospice in consultation with the

facility; (c) the facility provided wound care that it was no t

licensed to provide, using a CNA to provide services beyond the

scope of his license; and/or (d) the facility failed to maintain

documentation in Resident 2 ’s file regarding Resident 2 ’s

hospice care, including but not limited to, the care plan. See

Fla . Admin. Code R. 58A - 5.0181(4)(c).

44. The evidence is clear and convincing that Resident 2 ’s

continued residency in Respondent’s facility was not appropriate

on May 17, 2006. When Resident 2 ’s pressure sores were no

larger than a stage 2, Respondent did not comply with the

requirements of Florida Administrative Code Rule 58A -

5.0181(4)(b). When Resident 2 developed a stage 3 or stage 4

bed sore, Respondent refused to take whatever steps were

necessary to have Resident 2 re - evaluated by her physician, to

initiate discharge proceedings, and to facilitate her transfer

to a skilled - nursing facility.

45. Resident 2 was not an appropriate patient to receive

hospice services in Respondent’s facility when her medical needs

exceeded the scope of Respondent’s license and neither hospice

nor Respondent made arrangements for a qualified professional to

provide daily wound care. Respondent never attempted to correct

the class II violation before Resident 2 ’s death at the end of

May 2007. Respondent is subject t o a $1000 administrative fine

for failing to follow the requirements Florida Administrative

Code Rule 58A - 5.0181(5). See § 400.419(2)(b), Fla. Stat.

(2005).

Tag A626

46. An ALF’s staff may prepare pill organizers for

residents to use when self - administe ring medication. See Fla.

Admin. Code R. 58A - 5.0185(2). A pill organizer is “a container

which is designed to hold solid doses of medication and is

divided according to day and time increments.” See Id.

47. While ALF staff are allowed to transfer a p ill from a

prescription bottle to a pill organizer, the staff is not

allowed to transfer the contents of one prescription bottle to

another. Florida Administrative Code Rule 58A - 5.0185(7)

provides as follows in relevant part:

(7) MEDICATION LABELING AND ORDERS.

(a) No prescription drug shall be kept

or administered by the facility, including

assistance with self - administration of

medication, unless it is properly labeled

and dispensed in accordance with Chapters

465 and 499, F.S., and Rule 64B 16 - 28.108,

F.A.C. If a customized patient medication

package is prepared for a resident, and

separated into individual medicinal drug

containers, then the following information

must be recorded on each individual

container:

1. The resident’s name; a nd

2. Identification of each medicinal

drug product in the container.

(b) Except with respect to the use of

pill organizers as described in subsection

(2), no person other than a pharmacist may

transfer medications from one storage

container to another.

The prohibition against transferring prescription medicine from

one original prescription container to another makes no

exception for tablets of different shapes and colors for the

same medicine from different manufacturers.

48. Ms. Caso st ated during the hearing that she has

implemented policy to correct this violation. She reprimanded

her staff and instructed them as follows: (a) empty

prescription bottles should not be thrown away; (b) medicine

removed from a pill organizer but refused by a resident should

not be replaced in the prescription bottle; and (c) medicine

from two different prescription bottles should not be combined

under any circumstance. Additionally, Ms. Caso is in the

process of hiring a pharmacist to fill pill organizer s and to

review the medication administration records on a bi - weekly

basis.

49. Clear and convincing evidence indicates that

Respondent’s staff committed a class II violation of Florida

Administrative Code Rule 58A - 5.0185(7)(b) when they mixed the

cont ents of two prescription bottles of Resident 2 ’s Metoprolol.

Respondent is subject to an administrative fine in the amount of

$1,000 pursuant to Section 400.419(2)(b), Florida Statutes

(2005).

Survey Fee

50. The record clearly establishes that Responde nt is

guilty of two class II violations. Petitioner is entitled to

assess a monitoring fee in the amount of $500 under Section

400.419(10), Florida Statutes (2005).

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is

RECOMMENDED:

That Petitioner enter a final order finding that Respondent

is guilty of two C lass II violations and imposing an

administrative fine in the amount of $2,000 and a survey fee in

the amount of $500.

DONE AND ENTERED this 20th day of March , 2 007 , in

Tallahassee, Leon County, Florida.

S

SUZANNE F. HOOD

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 20th day of March , 2007 .

COPIES FURNISHED :

Gerald L. Pickett, Esquire

Agency for Health Care Administration

Sebring Building, Suite 330K

525 Mirror Lake Drive, North

St. Petersburg, Florida 33701

Christal Caso, Owner

Caso, Inc., d/b/a Paradise Manor II

435 Greenleaf Square

Port Orange, Florida 32127

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mah an Drive, Mail Station 3

Tallahassee, Florida 32308

Dr. Andrew C. Agwunobi, Secretary

Agency for Health Care Administration

Fort Knox Building, Suite 3116

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

Craig H. Smith, General Counsel

Age ncy for Health Care Administration

Fort Knox Building, Suite 3431

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions

to this Recommended Order should be filed with the agency that

will issue the Final Order in this case.