~ a C f em : o7 of Ps STATE OF FLORIDA Ny ae 4 AGENCY FOR HEALTH CARE ADMINISTRATION *y " 40 a Myo ty STATE OF FLORIDA, AGENCY FOR WM sn 7 fro 6 HEALTH CARE ADMINISTRATION, 4a heag Big] t Petitioner, AHCA CASE NO.: 04-00-043-ALF vs. Ol- C20Le FL HOME HEALTH CARE INC., Respondent. / ADMINISTRATIVE COMPLAINT YOU ARE HEREBY notified that after twenty-one (21) days from receipt of this Complaint, the Agency for Health Care Administration (hereinafter referred to as the “Agency”) intends to impose a civil penalty in the amount of $1,000.00 upon FLORIDA HOME HEALTH CARE, INC. (hereinafter referred to as “Respondent”). As grounds for the imposition of this civil penalty, the Agency alleges as follows: (1) The State of Florida, Agency for Health Care Administration has jurisdiction over the Respondent by virtue of the provisions to Chapter 400 Part III, Florida Statutes (1999) and Section 58A-5, Florida Administrative Code. (2) Respondent is licensed to operate as an Assisted Living Facility at 2 Black Oak Court, Palm Coast, FL 32137 in compliance with Chapter 400 Part III, Florida Statutes, and Rule 58A-5, Florida Administrative Code. (3) | The Respondent has violated the provisions of Chapter 400 Part III, Florida Statutes, and provisions of 58A-5, Florida Administrative Code, in that it was cited for one (1) unclassified deficiency during an ALF complaint investigation visit conducted on September 15, 2000, and constitutes an unclassified deficiency. ‘a 7 (a) (A114) The former owner failed to ensure that resident security deposits held by him were transferred to the new owner. This is a violation of Section 400.431(1), and Section 400.431(5), F.S. Unclassified deficiency. Fine $1,000.00. (4) These above-referenced violations constitute grounds to levy this civil penalty pursuant to Section 400.431(1), and Section 400.431(5), Florida Statutes, in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules, and regulations for the operation of an ALF (Assisted Living Facility). (5) Respondent is notified that they have a right to request an administrative hearing pursuant to Section 120.57, Florida Statutes, to be represented by counsel (at its expense), to take testimony, to call or cross-examine witnesses, to have subpoenas and/or subpoenas duces tecum issued, and to present written evidence or argument if they requests a hearing. Chapter 59-1, Part II, Florida Administrative Code, constitutes the Agency’s procedural rules for administrative proceedings resulting from this complaint. In order to obtain formal proceeding under Section 120.57 (1), Florida Statutes, your request for an administrative hearing must conform to the requirements in Rule 28-5.201, Florida Administrative Code, and must state which issues of material fact you dispute. Failure to dispute material issues of fact in your request for a hearing may be treated by the Agency as an election by you of an informal proceeding under Section 120.57 (2), Florida Statutes. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Division of Health Quality Assurance, 2727 Mahan Drive, Building #3, Suite 3408-D, Tallahassee, Florida 32308; Attention Michael O Mathis, Senior Attorney. Payment of fines shall be sent to the Agency for Health Care ‘a o Administration, P. O. Box 13749, Tallahassee, Florida 32317-3749. (Please reference the case number and facility name on the front of your check). (6) RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. I HEREBY CERTIFY that a true copy hereby was sent U.S. Certified, Return Receipt Requested, to Mr. Louis Klein, Administrator, Florida Home Health Care, Inc., Post Office, Box 350215, Palm Coast, Florida 32137 on the aT tay of 0: Lt; ber 2000. S Karen Swann ‘ Area Office #4 Supervisor Division of Health Quality Assurance Agency for Health Care Administration 921 North Davis Street Building A, Suite 115 Jacksonville, Florida 32209 Copies furnished to: Michael O. Mathis, Esquire Senior Attorney Agency for Health Care Administration 2727 Mahan Drive Bldg. #3, Suite 3408-D Tallahassee, Florida 32308 Agency for Health Care Administration Finance & Accounting Department. P.O. Box 13749 Tallahassee, Florida 32317-3749 r Karen Swann Area Office #4 Supervisor Division of Health Quality Assurance Agency for Health Care Administration Building A, Suite 115 921 North Davis Street Jacksonville, Florida 32209 Mr. Louis Klein, Administrator Florida Home Health Care, Inc. P. O. Box 350215 Palm Coast, Florida 32137

Docket for Case No: 01-000306

Orders for Case No: 01-000306