STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, O3~-U0P5 vs. AHCA NOS: 2003003934 2003004855 Petitioner, AVANTE AT INVERNESS, INC., Respondent. ; ey ADMINISTRATIVE COMPLAINT The AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), through undersigned counsel, files this Administrative Complaint against AVANTE AT INVERNESS, INC. [hereinafter “AVANTE’], reflecting the respective status of AHCA and AVANTE as Petitioner and Respondent, respectively. Pursuant to Sections 120.569, and 120.57, Florida Statutes (2002), and alleges: NATURE OF THE ACTION 1. AHCA case number 2003003934 [Count | of the within Complaint] is an action whereby AHCA seeks to impose certain administrative fines, both for the alleged violation of Florida’s “excessively hot tap water’ regulatory rule [a $12,500 fine for a patterned deficiency} and for the mandated 6-month survey cycle in the additional amount of $6,000. Additionally, AHCA seeks to impose an administrative fine for the alleged failure of the administration of the facility to develop and implement Policies and procedures for the monitoring of the back-up water heater to ensure that hot water temperatures meet the parameters mandated in Florida’s “excessively hot tap water” regulatory rule [a $12,500 fine for a patterned deficiency]. The case pertains to the alleged existence of a dangerous hot tap water situation at AVANTE’S skilled nursing facility on or about May 29 — 30, 2003 and to the failure of the administration of the facility to develop and implement policies and procedures for the monitoring of the back-up water heater and the failure of the facility to monitor the back-up water heater, resulting in excessively hot tap water [a $12,500 fine for a patterned deficiency]. AHCA alleges that the excessively hot tap water resulted in a situation likely to cause serious injury or harm to residents. 2. AHCA case number 2003004855 [Count I! of the within Complaint] is an action whereby AHCA seeks to impose certain administrative fines, for the alleged violation of the provisions of Chapter 13, Section 13-1.6.3, and Section 13-3.5.1, NFPA 101 (1985), resulting from two uncorrected deficiencies, in the amount of $2,000 for each alleged violation, for an aggregate amount of $4,000. AVANTE is alleged to have violated Chapter 13, Section 13-1.6.3, NFPA 101, which mandates that all interior walls or partitions in an existing health care occupancy be of noncombustible or limited-combustible materials by virtue of the presence of a nonconforming wall in the employees’ lunchroom of the facility. The nonconforming wall was originally cited as a deficiency in the fire and life Safety inspection conducted by AHCA on or about May 28, 2003 as part of the annual licensure and recertification survey. The facility was provided with a mandatory correction date of June 30, 2003 for this deficiency. A follow-up Survey conducted by AHCA at AVANTE on July 3, 2003 revealed that the facility had failed to correct the nonconforming wall, resulting in the issuance of the instant citation for an uncorrected deficiency [a mandatory doubling of the $1,000 fine for an uncorrected isolated deficiency]. Additionally, AVANTE is alleged to have violated Chapter 13, Section 13-3.5.1, NFPA 101, which mandates that all health care facilities be protected throughout by an approved automatic sprinkler system due to the installation of one sprinkler head too close to a wall and the failure to have any sprinkler head installed in a new air conditioner room at the facility, with the result that the automatic sprinkler system failed to provide complete coverage for all portions of the facility. These deficiencies relating to the facility's automatic sprinkler system were originally cited in the fire and life safety inspection conducted by AHCA on or about May 28, 2003 as part of the annual licensure and recertification survey. The facility was provided with a mandatory correction date of June 30, 2003 for this deficiency. A follow-up survey conducted by AHCA at AVANTE on July 3, 2003 revealed that the facility had failed to correct the defects in the automatic sprinkler system, resulting in the issuance of the instant citation for an uncorrected deficiency and the assessment of a $2000 fine against AVANTE [a mandatory doubling of the $1,000 fine for an uncorrected isolated deficiency]. AHCA submits that the existence of the non-conforming wall in the facility creates a situation that could increase the risk of harm to residents in the event of a fire, as a result of the more rapid spread of fire due to the presence of unprotected combustible materials. AHCA further submits that the failure of the automatic sprinkler system to provide complete coverage for all portions of the facility due to improperly placed and/or missing sprinkler heads creates a situation that could increase the risk of harm to residents in the event of a fire. EVIDENTIARY BURDENS 3. AHCA submits to DOAH and to the ALJ that the Agency has determined as a matter of law, the evidentiary burden applicable to the Agency's fine cases. Here, the evidentiary matter over which disagreement may exists, concerns the standard of proof applicable in this fine case to prove the proper and lawful classification of the seriousness of the alleged violation, upon the violation being proven to exist in the fine case by the strict “clear and convincing” evidence standard. 3.1. In the fine case, AHCA must first prove the existence of the underlying alleged violations [as to Count |, the existence of excessively hot tap water temperatures and as to Count Il, the two uncorrected violations of the NFPA Life Safety Code provisions relating to the nonconforming wall in the facility and the defects in the automatic sprinkler system]; and then, second, if the violations are proven to exist, must prove the separate but related issue concerning the correctness of the “classification” of the seriousness of those proven violations, pursuant to Section 400.23(8), Florida Statutes (2002). If no violation exists, then any question of the seriousness of the alleged violation is moot. 3.2. In AHCA’S fine case, the standard of proof is “clear and convincing” evidence as to proof of the violation [here, the existence of excessively hot tap water], but AHCA has determined as a matter of law that in the fine case, as to proof of the classification of the seriousness of the proven violation, the burden of proof remains the less strict “preponderance of the evidence”. The Agency has determined, as a matter of law, that there has been no extension of the clear and convincing evidence standard to the proof by the Agency of the correctness of the classification of the seriousness of a proven violation in a fine case. JURISDICTION AND VENUE 4. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2002) and the Agency's submission of these two cases to DOAH for formal hearing. 5. AHCA has jurisdiction pursuant to Chapter 400, Part Il, Florida Statutes (2002) and can confer upon DOAH only such jurisdiction as the Agency possesses and as authorized by law. Here, the Agency expressly reserves unto itself whatever jurisdiction the Agency possesses to determine, as a matter of law, the standard of proof applicable in its fine cases to proof of the correctness of the classification of the seriousness of a proven violation. 6. Venue is determined pursuant to Rule 28-106.207, Florida Administrative Code (2002). PARTIES 7. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing skilled nursing facilities pursuant to Chapter 400, Part II, Florida Statutes (2002) and Chapter 59A-4, Florida Administrative Code. 8. AVANTE is a foreign limited liability corporation with a principal address of 4000 Hollywood Bivd., Suite 540N, Hollywood, FL 33021-6747. 9. AVANTE operates a 104-bed skilled nursing facility located at 304 South Citrus Avenue, Inverness, FL 34452. AVANTE is licensed by AHCA as a skilled nursing facility having been issued license number SNF1024096, certificate number 10274, with an effective date of May 30, 2003 and an expiration date of September 30, 2003. 10, AVANTE is and was at all times material hereto a licensed skilled nursing facility required to comply with all applicable laws and rules. THE ALLEGED VIOLATIONS 11. The regulatory rule pertinent to the alleged violations in Count | of this case is Rule 59A-4,133(16)(d), Florida Administrative Code, regarding minimum standards for nursing homes. The Rule states: (16) All facilities shall comply with the following standards: * * * (d) The temperature of hot water supplied to resident use lavatories, showers and baths shall be between 105 degrees Fahrenheit and 115 degrees Fahrenheit. 12. 42 C.F.R. 483.75 provides: Administration A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, psychosocial well being of each resident. (b) Compliance with Federal, State and local laws and professional standards. The facility must operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in such facility. (d) Governing body. (1) The facility must have a governing body that is legally responsible for establishing and implementing policies regarding the management and operation of the facility; 13. On or about May 29 - 30, 2003, AHCA performed an annual survey at AVANTE’S subject facility. AHCA cited AVANTE for two deficiencies [alleged violations of the regulatory rule enunciated in paragraph number 10 and of the provisions of the Code of Federal Regulations referenced in paragraph number 11 relating to the duties of the facility's administration]. 14. On or about May 29, 2003, Agency surveyors, using calibrated thermometers, observed and documented hot tap water temperatures as follows: a. On 5/29/03 at 5:25 pm, a survey team member washed their hands in the visitor bathroom on the first floor across from the lobby, and discovered the water was very hot to the touch and caused the palms to become reddened. Direct measurement with a calibrated thermometer revealed the hot water temperatures to be 140 degrees. b. On 5/29/03 at 5:30 pm, measurements of hot water temperatures on the Safety Harbor (Alzheimer Unit) revealed that the hot water temperature in the resident's sink in room 204 to be 140 degrees and the hot water temperature in the resident's sink in room 216 to be 136 degrees. The affected sinks are both accessible to all 29 residents located in the Alzheimer's unit. c. On 5/29/03 at 5:50 pm, measurements of the hot water temperatures in the sink in the Physical Therapy Department on the first floor revealed the temperature to be 150 degrees. Interview with the physical therapy staff revealed that the sink was in the part of the occupational therapy program that was used by residents involved in relearning kitchen skills. 15. On May 29, 2003 an interview at 6:00 p.m. with the facility maintenance director revealed that the source of the excessively hot tap water in the sinks specified in paragraph 13 was a back-up hot water heater. The maintenance director stated that the facility's water temperatures are monitored weekly, but that the temperature of the back-up hot water heater was not included in the weekly monitoring. 16. On May 30, 2003, an interview with AVANTE’S administrator revealed that the facility did not have a policy or procedure for monitoring the temperatures of the facility's back- up hot water heaters. The facility administrator stated that she was not aware that the water temperatures for the back-up hot water heaters were not being monitored. 17. The regulatory rules pertinent to the alleged violations in Count Hl of this case are contained in the NFPA 101 Life Safety Code, Chapter 13, Section 13-1, establishing and mandating compliance with life safety requirements for all existing health care occupancies, specifically Section 13-1.6.3 and Section 13-3.5.1. Section 13-1.6.3 provides: “All interior walls and partitions in buildings of Type | or Type Il construction shall be of noncombustible or limited-combustible materials’. Section 13-3.5.1 provides: “All health care facilities shall be protected throughout by an approved automatic sprinkler system”. 18. On or about May 28, 2003, during the annual Life Safety Code Survey conducted by AHCA during the annual licensure and recertification survey conducted between May 27 - May 30, 2003 at AVANTE, a non-conforming interior wall was identified in the employees’ lunch room through observation by the AHCA Life Safety surveyor, which could hasten the spread of fire in the event of fire at the facility. During his tour AHCA life safety surveyor observed that the air handler unit in the employees’ lunchroom was constructed using wooden studs. There was no separation between the air handler unit and the employees’ lunchroom. The presence of this condition violated the mandate of Section 13-1.6.3 of the NFPA 101 Life Safety Code, resulting in the citation by AHCA of an isolated Class III deficiency against AVANTE, with a mandatory correction date of June 30, 2003. On July 3, 2003, during a follow-up life safety survey, the AHCA surveyor observed and identified that the nonconforming wall in violation of Section 13- 1.6.3, NFPA 101 Life Safety Code, continued to exist in the employees’ lunchroom at the AVANTE facility, resulting in the citation of an uncorrected isolated Class III deficiency against the facility. AHCA is seeking to impose a fine in the amount of $2,000 against AVANTE for this violation. The fine in the amount of $2,000 represents a mandatory doubling of the fine amount as a result of the facility having been cited for two Class | deficiencies at the annual survey conducted on May 27-30, 2003. 19. On or about May 28, 2003, during the annual Life Safety Code Survey conducted by AHCA during the annual licensure and recertification survey conducted between May 27 — May 30, 2003 at AVANTE, the AHCA life safety surveyor observed and identified a violation of NFPA 101 Life Safety Code, Section 13-3.5.1 on the basis that the facility's automatic sprinkler system did not provide complete coverage for all portions of the facility due to a sprinkler head being placed too close to a wall and the failure to install a sprinkler head in a new air conditioner room. The AVANTE facility was cited by the AHCA surveyor with an isolated Class Ill deficiency as a result of this alleged Code violation and was provided with a mandatory correction date of June 30, 2003. On July 3, 2003, during a follow-up life safety survey, the AHCA surveyor observed and identified that the stated conditions, violative of the mandate of Section 13-3.5.1, NFPA 101 Life Safety Code continued to exist and had not been corrected. Thus AHCA cited AVANTE with an uncorrected isolated Class Ill deficiency and seeks to impose a fine against the facility in the amount of $2,000 for this violation. The fine in the amount of $2,000 represents a mandatory doubling of the fine amount as a result of the facility having been cited for two Class | deficiencies at the annual survey conducted on May 27- 30, 2003. CLASSIFICATION OF THE VIOLATIONS IN COUNT | AS “CLASS |” “PATTERNED” DEFICIENCIES and CLASSIFICATION OF THE VIOLATIONS IN COUNT II AS “CLASS III” “ISOLATED” DEFICIENCIES 20. When a nursing home has been cited for a deficiency in meeting regulatory requirements, AHCA is mandated by Section 400.23(8), Florida Statutes (2002) to classify each deficiency “according to the nature and the scope of the deficiency”. The statute mandates both that the “scope shall be cited as isolated, patterned, or widespread” and that the “classification” of the deficiency be indicated on “the notice of deficiencies” as one of four (4) classifications listed and defined in subsection (8)(a) through (8)(d). 21. With regard to the scope of the alleged violation here, at the time of the survey, the excessively hot water temperatures measured by AHCA Surveyors were found (a) in the visitor's bathroom on the first floor of the facility, accessible to residents and visitors; (b) in sinks in two resident rooms in the Alzheimer's Unit, both of which were accessible to all 29 residents in that Unit; and (c) in the sink used by residents involved in relearning kitchen skills that is located in the Physical Therapy Department on the first floor of the facility. Based upon these facts, AHCA established the scope of the deficiency as “patterned”. 22. _ As to the “classification” of the alleged deficiencies, the Agency must choose between: a. A Class | deficiency which “is a deficiency that the agency determines presents a situation in which immediate corrective action is necessa because the facility's non-compliance has caused, or is likely to cause, serious injury, harm, impairment or death to a resident receiving care...” [Emphasis added]. b. A Class li deficiency which “is a deficiency that the agency determines has compromised the resident's ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services.” c. A Class Ill deficiency which ‘is a deficiency that the agency determines will result in no more than minimal physical, mental, or psychosocial discomfort to the resident, or has the potential to compromise the resident’s ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services.” [Emphasis added]. [The Class IV option is omitted]. 23. The presence of hot water temperatures above 115 degrees Fahrenheit presents the risk of scalding and burns. Elderly persons are especially susceptible to scalding and burns as a result of excessively hot water due to the condition of the skin of elderly people in addition to the slower physical reaction times. The excessively hot water temperatures identified and documented in AVANTE’S skilled nursing facility on May 29, 2003 -— 140 degrees Fahrenheit, 136 degrees Fahrenheit and 150 degrees Fahrenheit — affected 29 residents on one of three wings of the facility — the Alzheimer’s Unit. Also, one of the sinks with a 150-degree temperature reading was located in the sink in the Physical Therapy Department utilized by residents engaged in relearning kitchen skills. All of these combined factors resulted in and support the propriety of the classification of the deficiencies as Class | by AHCA. 24, It is critical that the system for delivery of hot water to residents of a facility be well planned, well designed, well maintained, properly monitored and well-implemented to ensure compliance with Florida’s excessively hot tap water rule and to protect elderly facility residents from scalding and burns. The source of the excessively hot tap water identified and documented at AVANTE on May 29, 2003 was a back-up hot water heater. Although the facility had a plan in place and implemented the plan for weekly monitoring of hot water temperatures in the facility for water delivered through the primary hot water heater, no such plan was in place for monitoring of hot water temperatures for water delivered through the back-up hot water heaters. Indeed, the water temperatures of the back-up hot water heaters were not monitored and the facility administrator was not even aware that they had not been monitored. This failure on the part of the administration resulted in the facility's noncompliance with Florida's excessively hot water rule, forming the basis for the second deficiency cited. This second deficiency, based on this violation, was likewise characterized by AHCA as a “patterned”, “Class !" deficiency for reasons more fully detailed in Paragraphs numbered 17 and 19 of this Complaint. 25. Count I! of the within Complaint] is an action whereby AHCA seeks to impose certain administrative fines, for the alleged violation of the provisions of Chapter 13, Section 13- 1.6.3, and Section 13-3.5.1, NFPA 101 (1985), resulting from two uncorrected deficiencies, in the amount of $2,000 for each alleged violation, for an aggregate amount of $4,000. AVANTE is alleged to have violated Chapter 13, Section 13-1.6.3, NFPA 101, which mandates that all interior walls or partitions in an existing health care occupancy be of noncombustible or limited- combustible materials by virtue of the presence of a nonconforming wall in the employees’ lunchroom of the facility. The nonconforming wall was originally cited as a deficiency in the fire and life safety inspection conducted by AHCA on or about May 28, 2003 as part of the annual licensure and recertification survey. The facility was provided with a mandatory correction date of June 30, 2003 for this deficiency. A follow-up survey conducted by AHCA at AVANTE on 10 July 3, 2003 revealed that the facility had failed to correct the nonconforming wall, resulting in the issuance of the instant citation for an uncorrected deficiency [a mandatory doubling of the $1,000 fine for an uncorrected isolated deficiency}. Additionally, AVANTE is alleged to have violated Chapter 13, Section 13-3.5.1, NFPA 101, which mandates that all health care facilities be protected throughout by an approved automatic sprinkler system due to the installation of One sprinkler head too close to a wall and the failure to have any sprinkler head installed in a new air conditioner room at the facility, with the result that the automatic sprinkler system failed to provide complete coverage for all portions of the facility. These deficiencies relating to the facility's automatic sprinkler system were originally cited in the fire and life safety inspection conducted by AHCA on or about May 28, 2003 as part of the annual licensure and recertification survey. The facility was provided with a mandatory correction date of June 30, 2003 for this deficiency. A follow-up survey conducted by AHCA at AVANTE on July 3, 2003 revealed that the facility had failed to correct the defects in the automatic sprinkler system, resulting in the issuance of the instant citation for an uncorrected deficiency and the assessment of a $2000 fine against AVANTE [a mandatory doubling of the $1,000 fine for an uncorrected isolated deficiency]. AHCA submits that the existence of the non-conforming wall in the facility creates a situation that could increase the risk of harm to residents in the event of a fire, as a result of the more rapid spread of fire due to the presence of unprotected combustible materials. AHCA further submits that the failure of the automatic sprinkler system to provide complete coverage for all portions of the facility due to improperly placed and/or missing sprinkler heads creates a situation that could increase the risk of harm to residents in the event of a fire. 11 COUNT I ADMINISTRATIVE FINES FOR THE VIOLATIONS & FOR THE MANDATED 6-MONTH SURVEY CYCLE FINE: AVANTE WAS IN VIOLATION OF THE APPLICABLE HOT TAP WATER RULE DURING THE ANNUAL SURVEY OF MARCH 27-30, 2003; THE ADMINISTRATION AT AVANTE FAILED TO HAVE ANY POLICY OR PROCEDURE IN PLACE FOR THE MONITORING OF HOT WATER TEMPERATURES FOR THE FACILITY’S BACK-UP HOT WATER HEATERS, WHICH VIOLATIONS ARE “CLASS |” DEFICIENCIES § 400.23(8)(a), Florida Statutes (2002) Rule 59A-4.1288; Rule 59-A4.133(16)(d), Florida Administrative Code (2002) 42 CFR 483.75(b) and (d)(1) 26. AHCA re-alleges and incorporates by reference Paragraphs one (1) through twenty-five (25) above as if fully set forth herein. 27. AVANTE’S conduct, actions and inaction in this matter establish: (a) the violation by AVANTE of the referenced regulatory rule that hot tap water temperatures may not exceed 115 degrees Fahrenheit for resident use; (b) the violation of the referenced provisions of the Code of Federal Regulations as a result of the failure of AVANTE to have any procedure for the monitoring of hot water temperatures for the facility's back-up hot water heaters; and (c) that these thus-proven violations are Class | violations that are “patterned” as defined by Florida taw. 28. Section 400.23(8)(a), Florida Statutes (2002) mandates assessment of a fine in the amount of $12,500 for a Class | violation that is a patterned violation. COUNT I! ADMINISTRATIVE FINES FOR THE VIOLATIONS ON JULY 3, 2003, AT A FOLLOW-UP TO THE ANNUAL FIRE LIFE SAFETY CODE SURVEY, AVANTE CONTINUED TO BE IN VIOLATION OF THE APPLICABLE NFPA 101 LIFE SAFETY CODE PROVISIONS AS A RESULT OF ITS FAILURE TO CORRECT THE VIOLATIONS PREVIOUSLY CITED IN THE ANNUAL SURVEY OF MARCH 28, 2003, WHICH VIOLATIONS ARE UNCORRECTED ISOLATED “CLASS Ill” DEFICIENCIES 29. AHCA re-alleges and incorporates by reference paragraphs one (1) through twenty-eight (28) above as if fully set forth herein. 30. | AVANTE’S conduct, actions and inaction in this matter establish: (a) the violation by AVANTE of Chapter 13, Section 13-1.6.3, NFPA 101 Life Safety Code (1985) which mandates that interior walls of buildings of Type | or Type |! construction be of noncombustible or limited combustible materials. (b) the violation by AVANTE of Chapter 13, Section 13-3.5.1, NFPA 101 Life Safety Code (1985) which mandates that all health care facilities be protected throughout by an approved automatic sprinkler system. (c) the identification of the deficiencies creating these violations during the Annual Life Safety Survey at AVANTE on May 28, 2003 and the assignment of a mandatory correction date of June 30, 2003; (d) the continued existence of the deficiencies resulting in these violations at the follow-up survey on July 3, 2003 as a result of the failure of AVANTE to have corrected these deficiencies within the time provided; (e) that AVANTE had been cited for two Class | violations at the annual health and licensure survey conducted by AHCA on May 27-30, 2003; and (f) that these thus-proven violations are uncorrected Class III violations that are “isolated” as defined by Florida law. CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1) Make factual and legal findings in favor of the Agency on Count |; 2) Impose a fine in the amount of $12, 500 for each of the two Class | deficiencies, together with the mandated fine in the amount of $6,000 for the 6-month survey cycle, for an aggregate fine as to Count | in the amount of $31,000; and 3) Make factual and legal findings in favor of the Agency on Count |i; 4) Impose a fine in the amount of $2,000 for each of the two uncorrected Class III deficiencies, for an aggregate fine as to Count Il in the amount of $4,000; and 5) Assess costs related to the investigation and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2002). NOTICE The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (two pages). All requests for hearing shall be made to the attention of AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, MAIL STOP #3, TALLAHASSEE, FL 32308. AVANTE IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. Respectfully submitted this Sl 4, of October 2003. NA RIS. I Fla. Bar. No. 325821 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-5873 (office) (850) 921-9313 (fax) CERTIFICATE OF SERVICE | HEREBY CERTIFY that the original Administrative Complaint has been sent by U.S. Certified Mail Nancy E. Hall, Administrator, Avante at Inverness, Inc., 304 South Citrus Avenue, Inverness, FL 34452 (return receipt # “ICCC 1S20 Comm 5¢71Cjand that a true and correct copy of the Administrative Complaint has been sent by U.S. Certified Mail Return 1520 COLE SETI CA Receipt Requested (return receipt # “4 CC © The Prentice-Hall Corp. System, Inc., Registered Agent for Avante at Inverness, Inc., 1201 Harp Street, Suite 105, Tallahassee, FL 32301

Docket for Case No: 03-004685

Orders for Case No: 03-004685