STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 202 (. STATE OF FLORIDA, AGENCY FOR i022 Bee HEALTH CARE ADMINISTRATION, Petitioner, (SHCA No: 2022017622, y. License No. 7835 File No, 11912035 COTTAGES OF BRADENTON Provider Type: Assisted Living Facility HOME ALF, LLC, Respondent. EMERGENCY SUSPENSE ORDER THIS CAUSE came on for consideration before the Secretary of the Agency for Health Care Administration, or her duly appointed designee, who after careful review of the matter at hand and being otherwise fully advised, finds and concludes as follows: THE PARTIES 1. The Agency for Health Care Administration (hereinafter “the Agency”), is the licensure and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable stale statutes and rules governing assisted living facilities. Chs, 408, Part Il, and 429, Part I, Flla, Stat. (2022), Ch, 594-36, Fla. Admin. Code, As part of its statutory oversight responsibilities, the Agency has the authority to impose emergency orders, including a limitation of license, a moratorium on admissions, and an emergency suspension order, when circumstances dictate such action, §§ 120.60(6), 408.814, Fle, Stat, (2022). 2. The Respondent, Cottages of Bradenton Home ALF, LLC (hereinafier “the Respondent”), was issued a ficense (License Number 7835) by the Agency to operate un eighty- five (85) bed assisted living facility (hereinafier “the Facility”) located at 5700 24” Street East,Bradenton, Florida 34203, and was at all material times required to comply with the statutes and rules governing such facilities. 3, As the holder of such a license, the Respondent is a licensee. “Licensee” means “an individual, corporation, partnership, firm, association, or governmental entity, ot other entity that is issued a permil, registration, certificate, or license by the Agency.” § 408.8039), Fla. Stat, (2022). “The licensee is legally responsible for all aspects of the provider operation.” § 408.803(9), Fla, Stat (2022), “Provider” means “any activity, service, agency, or facility regulaied by the Agency and listed in Section 408.802,” Florida Statutes (2022). § 408.803(12), Fla, Stat, (2022), Assisted living facilities are regulated by the Agency under Chapter 429, Part 1, Plorida Statutes (2022), and tisted in Section 408,802, Florida Statutes (2022), § 408.802(13), Fla. Stat. (2022). Assisted living facility patients are thus clients. “Client” means “any person reeeiving services from a provider.” § 408.803(6), Fla, Stat. (2022). 4, The Respondent holds itself out to the public as an assisted living fecility that complies with the laws governing assisted living facilities. These laws exist to protect the health, safety, and welfare of the residents of assisted living facilities. As individuals receiving services from an assisted living facility, these residents are entitled to receive the benefits and protections under Chapters 120, 408, Part I, and 429, Part I, Florida Statutes (2022), and Chapter 594-36, Flotida Administrative Code, 5. Asof the date of this Emergeney Suspension Order the total census at the Facitity is forty (40) residents/clients in licensed beds and two (2) residents in beds under licensure suspension fiom an Ageney Emergeney Order dated November 4, 2022. THE AGENCY’S EMERGENCY ORDER AUTHOR 6 ‘The Agency may impose an immediate moratorium or emergency suspension as defined in section 120.60, Florida Stonites (2022), on any provider if the Agency determines thataay condition related to the provider or licensee presents 4 threat to the bealth, safety, or welfare ofacliont. § 408.814(1), Fla. Stet, (2022). Ifthe Ageney finds that immediate serious danger to the public beslth, safoly, or welfare requires emergency suspension, restriction, or imitation of a Vicense, the Agency may twke such action by any procedure that is fair under the cirewmnstances. § 120,60(6), Fla, Stat. (2022), LEGAL DUTIES OF AN ASSISTED LIVING FACILITY Staffing Standards 7, Florida law provides: (1) ADMINISTRATORS. Every facility must be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff end the provision of appropriate care to ail residents as required by chapters 408, part TI, 429, pact 1, F.S., and rule chapter 59A-35, F.A.C., and this rule chapter. (c} Administrators may supervise a maximum of either three assisted living facilities or a group of facilities on a single campus providing housing and health care Administrators who supervise more than one facility must appoint in writing a separate manager for each facility. However, an administrator supervising a maximum of three assisted living facilities, each licensed for 16 or fewer beds and all within a 15 mile radius of each other, is only required to appoint two managers to assist in the operation and maintenance of those facilities, (2) STAFE (b) Staff must be qualified to perform their assigned duties consistent with their level of education, training, preparation, and experience. Staff providing services requiring licensing or certification must he appropriately Ticensed or certified. All staff must exercise their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident’s record, and to report the observations to the resident’s health care provider in accordance with this rule chapter. (c) All staff mast comply with the training requirements of rule 594-36.011, FAC. (3) STAFFING STANDARDS. (b) Notwithstanding the minimum staffing requirements specified in pacagraph 4a), all facilities, including those composed of apartments, must have enoughqualified stuif (© provide resident supervision, and to provide or arrange for resident services in accordance with the residents’ scheduled and unscheduled service needs, resident contracts, and resident care standards as described in rule 59A-36.007, F.A.C. (e) The facility must maintain a written work schedule that reflects its 24-hour staffing pattern for e given time period, Upon request, the facility must make the daily work schedules of direct care staff available io residents or their representatives. Fla, Admin. Code R. 59A-36.010(1)(a) and (1)(6, (2)(b). (3b), and (3(6). Supervision 8. Florida law provides: An assisted living facility must provide cate and services appropriate to the peeds of residents accepted for admission to the facility (1) SUPERVISION. Pacilities must offer personal supervision as appropriate for each resident, including the following: (a) Monitoring of the quantity and quality of resident diets in accordance with rule 59A-36.012, FAC. (0) Daily observation by designated staff of the activities of the resident white on the premises, and awareness of the general health, safety, and physical and emotional well-being of the resident, (©) Maintaining a general awareness of the resident’s whereabouts, The resident may travel independently in the community. (d) Contacting the resident's heath care provider and other appropriate party such as the resident’s family, guardian, health care surrogete, of case manager if the resident exhibits a significant change. (©) Contacting the resident's family, guardian, health care surrogate, or case monager if the resident is discharged or moves out (© Maintaining « written record, updated as needed, of any significant changes, any illnesses that resulted in medical attention, changes in the method of medication administration, ot other changes thet resulted in the provision of additional services Fla, Admin, Code R. 59A-36.007(1). 9. Florida iaw provides: (7) ELOPEMENT STANDARDS. (a) Residents Assessed at Risk for Elopement, All residents assessed at risk for elopement or with any history of elopement must be identified so staff can be alerted to their needs for support and supervision. All residents must be assessed, for risk of elopement by a health care provider or a mental health care provider within 30 calendar days of being admitted to a facility. If the resident has had «health assessment performed prior to admission pursuant to paragraph S9A- 36.006(2)(a), F.A.C., this requirement is satisfied. A resident placed in a facitity on a temporary emergency basis by the Department of Children and Families pursuant to Section 415.105 or 415.1051, F.S., is exempt from this requirement for up to 30 days, 1. As part of its resident elopement response policies and procedures, the facility must make, at « minimum, a daily effort to determine that at risk residents have identification on their persons that inchides their name and the facility's name, address, and telephone number. Staff trained pursuant to paragraph S9A- 36,011 00M@) oF (c}, FAC, must be generally aware of the location of ail residents assessed at high risk for elopement at all times. 2. The facility must have 4 photo identification of at risk residents on file that is accessible to all facility stafffand Jaw enforcement as necessary. The facility's file must contain the resident's photo identification upon admission or upon being assessed at risk for elopement subsequent to admission, The photo identification may be provided by the facility, the resident, or the resident's representative. (b) Facility Resident Elopement Response Policies and Procedures, The facility must develop detailed written policies and procedures for responding to a resident clopement. At a minimum, the policies and procedures must provide for: L. An immediate search of the facility and premises, 2. The identification of staff responsible for implementing each part of the clopement response policies and procedures, including specific duties and responsibilities, 3, ‘The identification of staff responsible for contacting law enforcement, the resident’s family, guardian, health care surrogate, and case manager if the resident is not located pursuant to subparagraph (8)(b)1.; and, 4. The continued care of all residents within the facility in the event of an elopement. (c) Facility Resident Blopement Drills. The facility must conduet and document resident elopement drifls pursuant to Section 429.4 1(1)(K), FS. Fla, Admin. Code R. 594-36,007(7). 10, Florida law provides (il) FINANCIAL STABILITY, The facility must be administered on a sound financial basis in order to ensure adequate resources to meet resident needs pursuant to the requirements of chapter 408, part Il, part 1, F.S., and rule chapter 59A-35, .A.C, and this rule chapter Flu, Admin, Code R. S9A-36.013(2) Facility in Fac ISTH EMERG) YACTION On November 29, 2022, the Agency commenced a survey visit of the Respondent12. Based upon this survey, the Agency makes the following findings: A resident who had been told by her family that the resident would soon be relocated to another location thereafter grew notably anxious and pacing. A staff member reports that the resident was noted by staff to have wandered out of the ‘building three (3) separate times and had to be redirected by staff to return to the Facility, There is no record of these events in the resident's Pacility records. On November 19, 2022, a staff member reports this resident was observed at approximately 9:30 am, ‘The staff member was outside in the parking lot and noticed the resident walk to the end of the street and tum onto the msin road, The staff member sent @ text message to Respondent's administrator regarding the staff member's observation. The staff member then got in her car and retrieved the resident who hed traversed on foot a five (5) to ten (10) minute walk from the Focility. ‘The resident’s record does not document this event, ‘There is neither an intemal incident report nor an adverse incident report regarding the event, as required by jaw. See, § 429.23, Fla. Stat. (2022). There is no indication that any post- elopement evaluation was undertaken to determine the resident's physical or emotional status after this event. There is no indication that the resident’s health care provider and responsible party were notified of the event. Despite the noted wandering activity and the elopement, there is no indication that Respondent weighed or implemented any interventions to address these known increased pacing and exit-sceking behaviors of the resident. On November 27, 2022, time unknown, a resident reported to a staff member that the resident, who bad been sitting on the Faeility’s porch, saw another resident inthe wooded yard near the building that had appeared to have fallen and necded assistance, ‘The siaif member, with a second staff member, responded 10 this report and approached the resident who had been reported (0 have fallen. ‘The staff members discovered the resident was in fact on the knees, was being held in a choke hold by another resident, and was being held with the resident’s face near the genitel area of the resident administering the choke fokl. Upon approach by the staff members, the resident on the knees broke into tears. The resident administering the choke hold remarked, “You guys are always trying to ruin the flan.” ‘The assaulted resident was returned to the resident's room at approximately 2:30 pam. and no injuries were noted. At approximately 9:30 pam, that same day, another resident reported that the resident who had been subjected to this apparent assault was on the smoking patio and wes bloody. That staff member promptly responded and found the resident with a gash to the bead and contacted emergency medical services. The resident recoived emergency hospital care including stiches to the wound and was retumed to the Facility the following day ‘The staff member who initially responded to this event notified Respondent's receptionist that the event had occurred the following day. The resident family mensbers indicated that they were not notified of the event until the next day, November 28, 2022, and that the resident's room, upon ro- admission after the hospital cure, was infested with bedbugs ‘The resident’s record does not docament this event, There is neither an internal incident report nor an adverse incident report regarding the event, as required bylaw, See, § 429.23, Fla. Stat. (2022). There is no indication that any post-event evaluation was undertaken to weigh or implement interventions to protect the resident from future risk. ‘There is no indication that the resident's health care provider was nofified of the event, There is no indication that local law enforcement or Florida's Department of Children and Families was contacted regarding this incident of apparent assault, battery, abuse, or sexual assault, ‘The resident who suffered the choke hold was observed on November 29, 2022, by Agency personnel with stiches to the feft side of the head, a scrape to the nose, and braising to the right side of the face, ‘The resident declined to discuss the November 27, 2022, event with Agency personnel in detail. The resident who administered the choke hold to the ebove discussed resident was known by staff to imbibe alcohol on site, A staff member indicated that she had reported this alcohol use by the resident (0 the administrator, but she was aware of no action taken by the administrator ov any other person addressing this issue. Respondent's records related to the resident who administered the choke hold does not reflect the staff-known behavior of alcohot intake, does not document the event of November 27, 2022, and does not document any reports to local law enforcement or Florida’s Department of Children and Families regarding this incident of apparent abuse, assault, or sexual assault, There js neither an intemal incident report nor an adverse incident report regarding the event, as required by law, See, § 429.23, Ma, Stat, (2022), There is no indication that any post-event evaluation was undertaken to weigh or implement interventions to protect the resident and other residents from future risk, There is no indication that the sesident’s health care provider or responsible party was notified of the event.On November 4, 2022, the Agency issued an Emergency Limited Suspension, Order and Moratorium on Admissions against Respondent. This Emergency Order suspended the licensure of Respondent to operate an assisted living facility in four (4) smaller buildings on the Facility campus referred to collectively as “The Cabanas” effective November 7, 2022 at 12:01 p.m. Despite this ticense suspension, Respondent still maintained two (2) residents in the Cabanas and provided room, board, and af east one personal service to the residents in direct violation of the November 7, 2022, Emergency Order. Respondent’s administrator was not on site on November 29 or 39, 2622. The administrator, who is the administrator for two (2) other licensed assisted living facilities, has no designated manager at Respondent's Facility. See, Rule SOA- 36.010(1}(6), Florida Administrative Code, Respondent's resident care coordinator reports that Respondent's administrator has not been on site at the Facility for two (2) weeks Respondent has not timely satisfied invoices for utility services ( the Facility Respondent maintains three (2) accounts for electrical services. For one (1) of the accounts, as of November 28, 2022, Respondent had a balance of two thousand thirty dollars twenty-nine cents (82,030.29) due on December 8, 2022. ‘The last payment was made that day and covered the previous invoice’s past due amount of two thousand one hundred cighty-two dollars nivety-seven cents ($2,182.97), On the second clectrical services account, the total balance is eight hundred eighty-one dollars seventy-five cents ($881.75) with a past due amount of four hundred seventy dollars eighty-seven cents ($470.87). ‘The last payment towards the account was on November 14, 2022. The utility indicated that it agreed to az payment arrangement extending the past due payment to at least two bundred eighty-two dollars (282.00) by November 30, 2022, Another outstanding balance of one hundred eighty-vight dollars eighty-seven cents ($188.75) is due by December 12, 2022. For the third electrical services account, the current service balance was paid on November 14, 2022; however past payment extensions of five hundred eighty-one dollars ($581.00) and three hundred cighty-eight dollars thirty-nine cents ($388.39) were due on Novernber 30 and December 12, 2622, respectively, For water services, Respondent has an outstanding balance of four thousand four hundred fifty-five dollars twenty-six cents (84,455.26) with a past due sum of two thousand one hundred seven dollars sixty-five cents ($2,107.65). The utility indicates that, as of November 29, 2022, there is no payment plan arrangement and services would be terminated any day. Respondent’s dietary manager reports that. on November 26, 2022, he paid for food in the sum of two hundred dollars ($200.00) from his own pooket, as there was insufficient Facility-supptied foodstuffs to meet resident needs. Facility staff are not timely receiving their wages and, when paid, the payment is often made on money transfer smart phone applications, which are not reliable. Respondent’s sole ownership member candidly admits that Facility financial obligations are paid at the last moment and are satisfied through the use of credit cards. ‘These payments do not reflect the withholding of taxes and frequently require the employes pay the serviee a fee to access the finds. ‘The sir conditioner in the kitchen was not operational, had not been operational for at least two (2) weeks, and temperatures registered ninety-one (91) degrees 10Fahrenbeit just before noon on November 29, 2022. Tn addition, the hood air management system over the stove, the garbage disposal system, the left side of cone (1) oven, and the bottom of the other oven were non-operational, 13. On November 4, 2022, the Agency issued an Emergency Limited Suspension Onder and Moratorium on Admissions against Respondent, ‘This Order was based upon facts related to resident eloperent, financial instability, resident supervision, and the failure of Respondent's administrator to coordinate and ensure that day-to-day operations are organized in such a manner that resident needs are being met. This Bmergency Order cites numerous surveys since July 2022 during which multiple incidents of regulatory non-compfiance were noted. Since that time, Responcient has demonstrated no action to comect the deficient practices cited therein and conditions at the Facility have worsened, as illustrated by the above-recited survey findings. NECESSITY FOR EMERGENCY ACTION 14, The Ageney is charged with the responsibility of enforcing the laws enacted to protect the health, safety and welfare of residents and clients in Florida’s assisted living facilities. Ch, 429, Part I, Fla. Stat. (2022), Ch. 408, Part IE, Fla. Stat. (2022); Ch, S9A-36, Fla. Admin. Code, Ts those instances, where the health, safety or welfare of an assisted living facility resident is at risk, the Agency will take prompt and appropriate action, 15, Residents of assisted living facilities must receive the care and services, including supervision, appropriate to their needs, Fla, Admin. Code R. $94-36.010(1), The Facility administrator is responsible for the operation and maintenance of the entire Facility, ineluding the management of al staff and the provision of appropriate care to ail residents, Fla. Admin, Code R. S9A-36,010(1), 16. As the facts reflect, Respondent has failed to meet these minimum Hcensure standards and these failures are not isclated events, but operational and management system ideficiencies affecting the health, safety, and well-being of Respondent’s current or future resident population, Residents who reside in assisted fiving facilities oftentimes suffer from disease or disability. They typically consist of the frail, elderly or vulnerable. By law, the Respondent has been licensed sind entrusted to provide care and services to this elass of people, and as such, must comply with the statutes and rules that have been enacted for the special needs of these residents. In this instance, Respandent has demonstrated an inability or unwillingness to comply with the regulatory scheme related to providing care and servives appropriate to resident needs, including supervision and a general awareness of the health, safety, and physical and emotional wellbeing of residents, and the failure to promulgate and implement efopement procedures to promptly address resident elopement. 17. The scope of services which assisted living facility personnel provide is wide and varied. Competency in these services cover care and services whieh may be provided on a daily basis or required only in emergent conditions, and is absolutely necessary (0 ensure resident health, safely, and welfire, Staff qualified to competently perform the panoply of resident services required, including resident supervision, resident monitoting, and responding to clopement and other adverse incident events, must be availuble to meet resident needs. Further, the panoply of services must be avaitable and provided at ali times, 18, ‘The current and ongoing threat to Respondent's resictents and potential residents posed by the Facility’s ongoing deficiencies is vividly illustrated by Respondent's failure to take action to address an apparent assault, battery, abuse, or sexual assault, No action to investigate the incident, to address the ongoing safety of the victim resident, of to address the behaviors of the apparent aggressor to protect Facility residents and staff was undestaken by Respondent. ‘This inaction continued even though the resident suffered physical injury from the same aggressor requiring emergency hospital care later that seme day. This inaction constitutes @ clearviolation of the laws governing assisted living facilities and is per se an unsate condition for residents and potential residents. Ne concept of assisted living facility services could encompass a lotal lack of diligence fo address conditions where a violent assault took place between residents and to assure the physical and emotional safety of resident were protected. 19, To ad to this inaction to protect resident health, safety, and welfare, Respondent Imowingly took no action to address known alcohol usage on site by Facility residents, Whether this alcohol use added to the violent events described above is unknown, in part due to Respondent's failure to immediately investigate the event and failure to notify Jaw enforcement and Florida's Department of Children and Families, Respondent's failure to routinely provide the supervision, care, and other services that are required by law and are necessary to meet resident needs presents an immediate and serious threat and danger to residents’ and potential residents’ health, safety, and well-being. 20. Also, Respondent has failed to provide the supervision, care, and services needed to prevent resident clopement, Here risks were known fo the Respondent based on the resident’s recently demonstrated change in behavior, Rather than address the risks presented by the resideat’s demonstrated increased and anxious behaviors, Respondent chase to take no aetion to prevent a successfull elopement, a predictable event that ultimately came to fiuition, Respondent has, moreover, failed to ensure that its elopement practices comply with minimum requirements of Taw and that its staff are competent to implement the same. These failures demonstrate Respondent's inability or unwillingness to provide the services necessary to protect resident health, safety, and well-being as required by law. ‘These conditions again present an immediate and serions threat and danger to resident's and potential resident's health, safety, and well-being, 21. Respondent’s lure fo meet these requirements of law and the needs of its residents is not an isolated event, but a demonstrated pattern of non-compliance, as illustrated by 13the acts and omissions described more fully in the Agency’s November 4, 2022, Emergency Order, Exacerbating Respondent's ongoing non-compliance with the regulatory scheme is Respondent's defiance of the November 4, 2022, Emergency Order in continuing operation as an, assisted living facility in buildings, known as the Cabanas, where ficensure has been suspended. Whether this non-compliance is intentional or negligent in its ultimate genesis, it is clear that Respondent is unable or unwilling to comect its operations to comply with the minimum standards governing assisted living facilities. 22. Additionally, Respondent has demonstrated that its financial management, practices do not ensure adequate resources are available to meet resident needs pursuant te the requirements of law, As the fucts ebove demonstrate, Respondent’s Facility is in immediate danger of having its water ulility services cut off for non-payment, Electrical services similarly are at risk for termination based on ongoing outstanding balances owed. Electrical power and water are essential to resident health and well-being ranging ftom the maintenance of internal facility temperatures at a Jevel to promote comfort and prevent physieal or emotional stress, to the maintenance of refrigeration to maintain foodstuffs and to keep modications requiring refrigeration effective, to the maintenance of personel hygiene of both residents and staff to minimize infectton and promote personal dignity. The imminent loss of one or both of these public utilities presents an immediate and serious threat and danger to the health, safety, and welfare of all residents and potential residents. 23, Based on these multiple identified deficient practices, it is clear that Respondent's Facility is not being overseen by an administrator fo coordinate and ensure that day-to-day operations are organized in such @ manner that resident needs are being met, Respondent's ‘dwinistrator has not been on site for over two (2} weeks during a period where the Facility was under an emergency order nevessitated by Respondent's operational acts or omissions placing 14Jacility residents and potential residents at immediate and serious thteat and danger to the health, safety, and welfare, In addition to the administrator's absence from day-to-day operations and the management thereof, Respondent has not appointed a manager to undertake in the administrator's stead responsiblity for the operation and maintenance of the facility including the ‘management of ail staff and the provision of appropriate care to all residents. 24, Altogether, the shove-stated fucts and cirowmstances present an immediate and serious threat and danger to the health, safety, and welfare of residents and the public. ‘The deficient practices permeate Facility operations and are likely to continue or be repeated absent the emergency suspension of Respondent's license, 25, Individually and collectively, these fucts reflect that the residents of this Facility are not currently receiving care and services, including supervision, appropriate to their needs, Fla, Admin, Code R. 59A-36.007, and are not receiving the services of an administeator to provide appropriate care to all residents by qualified personnel, Fla. Admin, Code R. 59A- 36.010, No resident of an assisted living fecility should live in such an environment. 26, The Legislature created the Assisted Living Facilities Act. §§ 429.01, et seq., Pla Stat, (2022). “The purpose of this act is to promote the availability of appropriate services for elderly persons and adults with disabilities in the least restrictive and most homelike enviroment, to encourage the development of facilities that promote the dignity, individuality, privacy, ané decision making ability of such persons, to provide for the health, safety, and welfare of residents of assisted living facilities in the state, .. . to ensure that all agencies of the state cooperate in te protection of sueh residents, and to ensure that needed economic, social, mental health, health, and leisure services are made available to residents of such facilities through the efforts of” several state agencies. § 429.01(2), Fla, Stat, (2022). 27. Again, the Respondent's deficient practices exist presently, have existed in the 1spast, and more likely than not will continue fo exist if the Agency does not act promptly. If the Agency does not act, the Respondent's conduct will continue. This remedy is narrowly tailored to address conditions at the Facility. This remedy if fair under the circumstances presented in the case at hand, This is the second emergency order imposed on this provider in as many months. No lesser remedy would address the immediate danger at hand. CONCLUSIONS OF LAW 28, ‘The Agency has jurisdiction over the Respondent pursuant to Chapters 408, Part II, 429, Part I, Florida Statutes, and Chapter 594-36, Florida Administrative Code. 29. Bach resident of an assisted living facitty has the starutory right to five in a safe and decent living environment, § 429,28(1\(a), Fla. Stat. (2022), and fo receive care and services, including supervision, appropriate to meet their needs, Fla, Admin, Code R, $9A-36.007. 30, Based upon the above stated provisions of law and findings of fact, the Agency concludes that: (1) an immediate serious threat and danger to the public health, safety, or welfare presently exists at the Respondent’s Facility which justifies an emergency suspension of Respondent’s licensure to operate an assisted living facility; and (2) the present conditions related to the Respondent and its Facility present a threat to the health, safety, or welfare of resident, which requires an emergency suspension of Respondent’s licensure to operate an assisted living facility in the State of Florida, 31, Based upon the above-stated provisions of law and findings of fact, the Agency concludes that an Emergency Suspension of Respondent’s Licensure is necessary in order to protect the residents from (1) the unsafe conditions and deficient practices that currently exist, (2) being placed at risk of living in an environment ill-equipped to provide for resident health, safely and welfare, end (3) being placed in an assisted living facility where the regulatory mechanisms enacted for residents protection have been repeatedly overlooked, 1632, Conditions at the Facility constitute an emergency that must be immediately addressed by the Agency to protect residents and potential residents from the immediate threat and danger posed to their health, safety, and welfare. The Respondent's deficient practices exist presently, have existed for an extended period of time in the past without corrective action, and ‘will continue to exist if the Agency does not act prompily. Despite the previous Emergency Order, the conditions at the facility have not improved and in some instances have worsened. Further, Respondent hus not complied with the previous, less-restrictive emergency order. IF the Agency does not act, the Respondents conduet will contime, Respondent's deficient practices and conditions justify an emergency suspension of licensure, 33. The emergency action taken by the Agency in this particular instance is fair under the circumstances, narrowly tailed fo address the specific immediate and serious dangers and harms set forth above, and the least restrictive action that the Agency could take giver the facts and circumstances, The Agency bes already issued and emergency order to Respondent imposing @ moratorium on admissions and suspending its Ficense for the buildings known as the Cabanas. Respondent has failed to comply with thet emergency order and has permitted conditions at its Facilify to worsen while the emergency order was in place. The Agency has considered whether additional less restrictive actions. However, fess restrictive actions, such as the assessment of administrative fines will not ensure that the current residents or future residents receive the appropriate care, services, and environment dictated by law, TY IS THEREFORE ORDERED THAT: 34. ‘The Respondent's license to operate this assisted living facility is SUSPENDED effective December 5, 2022 at 5:00 p.m. 35, Upon receipt of this onder, the Respondent shall post this Order on its premises in a place that is conspicuous and visible to the public. 736. As of the effective date and time of the suspension, the Respondent shall not operate this assisted living facility. 37. The Agency shail promptly file an administrative action against the Respondent based upon the facts set out in this Emergency Order and provide notice to the Respondent of the right to a hearing under Section 120.57, Florida Statutes (2022), at the time such action is taken. ORDERED in Tellahassee, Florida, this 1st day of December, 2022. glint ‘Smoak, Deputy Secretary Agency fol Health Care Administration nd Dake NOTICE OF RIGHT TO JUDICIAL REVIEW This emergency order is a non-final order subject to facial review for legal sufficiency. See Brovles v. State, 776 S0.2d 340 (Fla. ist DCA 2601), Such review is commenced by filing a petition for review in accordance with Florida Rules of Appellate Procedure 9.100(b) and {c). Sec Fla. R. App. P. 9.190(b)2). Inn order to be timely, the petition for review must be fited within thirty (36) days of the rendition of this non-final emergency order. 18