15-004812 Agency For Health Care Administration vs. Residential Plaza At Blue Lagoon, Inc.
 Status: Closed
Recommended Order on Monday, February 1, 2016.


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Summary: Petitioner failed to prove by clear and convincing evidence any neglect by Respondent of ALF residents.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8AGENCY FOR HEALTH CARE

12ADMINISTRATION,

13Petitioner,

14Case No. 15 - 4812

19vs.

20RESIDENTIAL PLAZA AT BLUE

24LAGOON, INC. ,

26Respondent .

28_______________________________/

29RECOMMENDED ORDER

31On October 27, 2015 , Robert E. Meale, Administrative Law

40Judge of the Division of Administrative Hearings (DOAH), conducted

49the final hearing by videoconference in Miami and Tallahassee,

58Florida.

59APPEARANCES

60For Petitioner: Nelson E. Rodney , Esquire

66Agency for Health Care Administration

718333 Northwest 53rd Street, Suite 300

77Miami , Florida 3 3166

81For Respondent : Barbara Galindo , Qualified Representative

88Residential Plaza at Blue Lagoon, Inc.

945617 Northwest 7th Street

98Miami, Florida 33126

101STATEMENT OF THE ISSUE S

106The issues are whether Respondent , an assisted living

114facility (ALF) , failed to provide adequate supervision of the

123residents and failed to perform a duty to cont act a health care

136provider after one resident was struck and injured by another

146resident. If so, an additional issue is the penalty that should

157be imposed.

159PRELIMINARY STATEMENT

161By Administrative Complaint dated April 24, 2015 , Petitioner

169alleged that R espondent operates a 350 - bed ALF located in Miami

182that is licensed as an ALF with license number ALF7551.

192The one - count Administrative Complaint alleges a "class II

202violation" of section 429.26(7), Florida Statutes, and Florida

210Administrative Code R ule 58A - 5.0182(1). The Administrative

219Complaint mentions a failure to complete a health assessment for

229two residents, but the operative claims of the Administrative

238Complaint, as well as the Joint Pretrial Stipulation filed on

248October 19, 2015, and Respon dent's P roposed R ecommended O rder, are

261that Respondent allegedly failed to provide adequate supervision

269for resident activities at the time of the physical confrontation

279described below and Respondent allegedly failed to perform a duty

289to contact the physi cian of the resident who was injured in the

302physical confrontation. The Administrative Complaint alleges that

309these failures constitute a Class II violation and seeks a f ine of

322$2500 for this violation .

327Respondent timely requested a formal hearing.

333At t he hearing, each party called two witnesses. Petitioner

343offered into evidence all or part of five exhibits : Petitioner

354Exhibit 1 (checked paragraphs on pages 2, 3, and 6), Exhibit 2

366(page 16), Petitioner Exhibit 3 (pages 26 through 30, 35, and 38 ) ,

379Petitioner Exhibit 4 (pages 39 through 42 (not for truth) and 43),

391and Petitioner Exhibits 6 and 7. Respondent offered into evidence

401eight exhibits : Respondent Exhibit s 4, 6 through 8, 10 through

41312, and 14, which is pages 24 and 25 of Petitioner Exhibit 3. All

427exhibits were admitted.

430The court reporter fi led the transcript on November 12 , 2015 .

442The parties filed proposed recommended orders on December 2 , 2015 .

453FINDING S OF FACT

4571. Respondent operates a ALF in Miami that is licensed for

468350 beds. The ALF occupies a 14 - story tower . The fr ont desk is

484on the first floor. T he second floor contains common area,

495including an activities area, a beauty salon, a cafeteria, a

505physical therapy room, offices for human resources, accounting and

514administration , a behavioral analyst's office, and offices for

522health care staff and visiting physicians.

5282. Team leaders of the health care staff perform rounds on

539the second floor. Seven days per week, one team leader is on duty

552from 5:30 a.m. to 4:00 p.m., one te am leader is on duty from

5661:00 p.m. to 11:30 p.m., and one team leader is on duty from

57911:30 p.m. to 5:30 a.m. At the time of the subject incident,

591rounds were performed every two hours, 24 hours per day.

6013 . Resident #1 and Resident #2 were admitted to Respondent's

612ALF in the summer of 2014 . At the time of the subject incident,

626Resident #1 was 64 years old, and Resident #2 was 88 years old.

6394 . The health assessment prepared at the time of the

650admission of Resident #2 states that Resident #2 suffered from

660moderate progressive dementia and poor cognitive or behavioral

668status, and he required 24 - hour supervision of his a ctivities of

681daily living . The assessment states that Resident #1 needed

691assistance eating and needed supervision ambulating, bathing,

698grooming, toileting, and transferring. The assessment a dds that

707Resident #1 was not a danger to self or others, but needed 24 - hour

"722nursing or psychiatric care." However, the assessment concludes

730that his needs could be met in an ALF that was not a medi cal,

745nursing, or psychiatric facility.

7495 . Between 2:00 p.m. and 3:00 p.m. on Sunday, November 30,

7612014, Resident #1 and Resident #2 were playing dominoes in the

772activities area on the second floor. Respondent's posted

780activities list dominoes at this loc ation daily from 9:00 a.m. to

7928:00 p.m . The activities area is an ope n area that does not have

807doors, so it cannot be locked, but, a t 8:00 p.m. daily, staff turn

821off the lights . The dominoes games in the activities area are

833initiated by the residents and unsupervised by Respondent's staff,

842except as the games are observed during routine rounds.

8516 . A disagreement between Resident #1 and #2 emerged during

862the game, and the disagreement quickly escalated to a brief

872physic al confrontation between the two men. Resident #1 struck

882Resi dent #2 who fell to the ground where he remained for about 30

896seconds, but did not lose consciousness. Other residents

904separated Resident # 1 and Resident # 2 after Resident # 2 stood back

918up .

9207 . None of the residents reported this physical

929confrontation to Respondent's staff , none of whom witnessed the

938incident . On Sundays, health care staff total 25 persons working

949various shift s throughout the 24 - hour day. Other staff are

961present onsite, incl uding 20 or 21 persons in housekeeping, memory

972care staff, maintenance staff, and a manager.

9798 . On Monday, December 1 , a staff person noticed blood on

991the floor where Resident #2 had fallen . Respondent's staff

1001initiated an investigation, and, by the end of the day, staff

1012learned of Resident #1's participation in the confrontation .

1021Later in the day on Monday or possibly early on the following day,

1034Respondent's staff learned that the other resident in the

1043confrontation was Resident #2. Independently, on December 2 , the

1052director of health care, who is a registered nurse, ran into

1063Resident #2 and noticed that he had a bruise on his right ear.

1076She had Resident #2 accompany her to her office where she asked

1088him what happened. Resident #2 said that he cou ld not recall. He

1101had no other visible wounds , and he seemed fine .

11119 . Later on the same day, a fter the director of health

1124care learned from other staff what had happened, she went to

1135Resident #2's room and conducted a general assessment of the

1145reside nt. She discovered some small bruises on his chest. At

1156this point, the director of health care did not know that

1167Resident #2 had fallen to the floor during the incident.

1177Resident #2 said that he was fine. Due to the s ize of the bruises

1192on the chest a nd having seen no other sign of injury besides the

1206bruise on the ear, the director of health care did not document

1218anything except the bruise on the ear and did not contact

1229Resident #2's health care provider .

123510 . On Wednesday, December 3, a family member visited

1245Resident #2 and, seeing his injured ear, called the police to

1256investigate. A law enforcement officer visited the ALF that day

1266and conducted some interviews. Later that eveni ng, staff took

1276Resident #2 to Baptist H ospital for an evaluation.

128511 . Resident #2 presented at the hospital with bruising of

1296the right ear and "small skin abrasion[s]" on both elbows. During

1307the three hours that Re sident #2 remained at the hospital, he

1319underwent a CT scan of the head due to the fall and a claim of

1334loss o f consciousness. After discharge, Resident # 2 went to a

1346family member's home and never returned to the ALF.

135512. Petitioner failed to prove any act or omission that

1365constitutes an intentional or negligent act seriously affecting

1373the health, safety, or w elfare of Resident #2.

1382CONCLUSIONS OF LAW

138513 . DOAH has jurisdiction over the subject matter .

1395§§ 120.569 and 120.57(1), Fla. Stat.

140114. Section 429.29(1) directs Petitioner to impose an

1409administrative fine for " an intentional or negligent act seriously

1418affecting the health, safety, or welfare of a resident of the

1429facility. " Section 408.813(2)(b) , Florida Statutes, defines

1435class II violations as " those conditions or occurrences related

1444to the operation and maintenance of a provider or to the care of

1457cl ients which the agency determines directly threaten the physical

1467or emotional health, safety, or security of the clients " that are

1478not class I violations, which pose an imminent danger or

1488substantial probability of death or serious physical or emotional

1497ha rm. Section 429.29(2)(b) authorizes an administrative fine of

1506between $1000 and $5000 for each class II violation.

151515. Section 429.26(7) states in relevant part: " The

1523facility must notify a licensed physician when a resident exhibits

1533signs of dementia o r cognitive impairment or has a change of

1545condition in order to rule out the presence of an underlying

1556physiological condition that may be contributing to such dementia

1565or impairment."

156716. Florida Administrative Code R ule 58A - 5.0182(1) provides:

1577An assist ed living facility must provide

1584care and services appropriate to the needs

1591of residents accepted for admission to the

1598facility.

1599(1) SUPERVISION. Facilities must offer

1604personal supervision as appropriate for each

1610resident, including the following:

1614(a) Monitoring of the quantity and quality

1621of res ident diets in accordance with r ule

163058A - 5.020, F.A.C.

1634(b) Daily observation by designated staff

1640of the activities of the resident while on

1648the premises, and awareness of the general

1655health, safety, and physica l and emotional

1662well - being of the resident.

1668(c) Maintaining a general awareness of the

1675residentÓs whereabouts. The resident may

1680travel independently in the community.

1685(d) Contacting the residentÓs health care

1691provider and other appropriate party such as

1698the residentÓs family, guardian, health care

1704surrogate, or case manager if the resident

1711exhibits a significant change; contacting

1716the residentÓs family, guardian, health care

1722surrogate, or case manager if the resident

1729is discharged or moves out.

1734(e) M aintaining a written record, updated

1741as needed, of any significant changes, any

1748illnesses that resulted in medical

1753attention, changes in the method of

1759medication administration, or other changes

1764that resulted in the provision of additional

1771services.

177217 . Petitioner bears the burden of proving the material

1782allegations by clear and convincing evidence. Dep't of Banking &

1792Fin. v. Osborne Stern & Co. , 670 So. 2d 932 (Fla. 1996).

180418. As noted above, Petitioner failed to prove any act or

1815omission seriousl y affecting the health, safety, or welfare of

1825Resident #2, even given his vulnerability. In particular,

1833Petitioner failed to prove that Respondent's staff was not

1842conducting rounds every two hours; that rounds at such a frequency

1853were inadequate; that Res pondent was on notice that Resident #1 or

1865Resident #2 had tendencies to engage in or provoke confrontations;

1875or any other facts establishing a lack of adequate supervision.

1885The physical confrontation could not reasonably have been

1893anticipated, arose sudde nly, and ended quickly. Even if staff

1903were conducting rounds every 15 minutes, they probably would not

1913have witnessed the confrontation.

191719. Petitioner failed to prove a failure to perform a duty

1928to inform Resident #2's health care provider of his injuri es. The

1940existence of such a duty does not arise from the cited authority,

1952but, for the sake of discussion, may be inferred from the general

1964duty not to commit " an intentional or negligent act seriously

1974affecting the health, safety, or welfare of a residen t of the

1986facility." The injuries at issue were scratches and bruises of no

1997consequence. Petitioner faults Respondent for failing to rule out

2006a closed head injury, but the director detected no signs of such

2018an injury during two assessments of Resident #2 , and it is

2029unlikely that the hospital would have discharged Resident #2 in

2039three hours if the CT scan that it conduct ed had revealed such an

2053injury.

2054RECOMMENDATION

2055It is

2057RECOMMENDED that the Agency for Health Care Administration

2065enter a final order dismis sing the Administrative Complaint.

2074DONE AND ENTERED this 1st day of February , 2016 , in

2084Tallahassee, Leon County, Florida.

2088S

2089ROBERT E. MEALE

2092Administrative Law Judge

2095Division of Administrative Hearings

2099The DeSoto Building

21021230 Apalachee Parkway

2105Tallahassee, Florida 32399 - 3060

2110(850) 488 - 9675

2114Fax Filing (850) 921 - 6847

2120www.doah.state.fl.us

2121Filed with the Clerk of the

2127Division of Administrative Hearings

2131this 1st day of February , 2016 .

2138COPIES FURNISHED:

2140Nelson E. Rodney, Esquire

2144Agency for Health Care Administration

21498333 Northwest 53rd Street , Suite 300

2155Miami, Florida 33166

2158(eServed)

2159Barbara Galindo , Qualified Representative

2163Residential Plaza at Blue Lagoon, Inc.

21695617 Northwest 7th Street

2173Miami, Florida 33126

2176Richard J . Shoop, Agency Clerk

2182Agency for Health Care Administration

21872727 Mahan Drive, Mail Stop 3

2193Tallahassee, Florida 32308

2196(eServed)

2197Elizabeth Dudek, Secretary

2200Agency for Health Care Administration

22052727 Mahan Drive, Mail Stop 1

2211Tallahassee, Florida 32308

2214(eServed)

2215Stuart Williams, General Co unsel

2220Agency for Health Care Administration

22252727 Mahan Drive, Mail Stop 3

2231Tallahassee, Florida 32308

2234(eServed)

2235NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

2241All parties have the right to submit written exceptions within

225115 days from the date of this Recommended Order. Any exceptions

2262to this Recommended Order should be filed with the agency that

2273will issue the Final Order in this case.

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 03/30/2016
Proceedings: Agency Final Order filed.
PDF:
Date: 03/14/2016
Proceedings: Agency Final Order
PDF:
Date: 02/01/2016
Proceedings: Recommended Order
PDF:
Date: 02/01/2016
Proceedings: Recommended Order (hearing held October 27, 2015). CASE CLOSED.
PDF:
Date: 02/01/2016
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 01/29/2016
Proceedings: Notice of Ex-parte Communication.
PDF:
Date: 12/02/2015
Proceedings: Petitioner's Proposed Recommended Order filed.
PDF:
Date: 12/02/2015
Proceedings: Respondent`s Proposed Recommended Order filed.
Date: 11/12/2015
Proceedings: Transcript of Proceedings (not available for viewing) filed.
Date: 10/27/2015
Proceedings: CASE STATUS: Hearing Held.
Date: 10/23/2015
Proceedings: Respondent's (Proposed) Exhibit Index filed (exhibits not available for viewing).
Date: 10/22/2015
Proceedings: Petitioner's Proposed Exhibits filed (exhibits not available for viewing).
PDF:
Date: 10/19/2015
Proceedings: Joint Prehearing Stipulation filed.
PDF:
Date: 09/10/2015
Proceedings: Notice of Filing Petitioner's Request for Admissions, Interrogatories, and Request for Production filed.
PDF:
Date: 09/08/2015
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 09/08/2015
Proceedings: Notice of Hearing by Video Teleconference (hearing set for October 27, 2015; 9:00 a.m.; Miami and Tallahassee, FL).
PDF:
Date: 09/04/2015
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 08/28/2015
Proceedings: Notice of Withdrawal of Counsel and Substitution of Authorized Representative filed.
PDF:
Date: 08/28/2015
Proceedings: Initial Order.
PDF:
Date: 08/28/2015
Proceedings: Petition for Formal Administrative Hearing filed.
PDF:
Date: 08/28/2015
Proceedings: Administrative Complaint filed.
PDF:
Date: 08/28/2015
Proceedings: Notice (of Agency referral) filed.

Case Information

Judge:
ROBERT E. MEALE
Date Filed:
08/28/2015
Date Assignment:
08/28/2015
Last Docket Entry:
03/30/2016
Location:
Middleburg, Florida
District:
Northern
Agency:
Other
 

Counsels

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Related Florida Statute(s) (5):