a FILED A AGENCY A ERK STATE OF FLORIDA “AD J ; AGENCY FOR HEALTH CARE ADMINISTRATION WI P 3 31. AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No.: 2013003851 Return Receipt Requested: 7009 0080 0000 0585 9586 Petitioner, v. ROYAL GARDENS VILLA, INC. Respondent. ADMINISTRATIVE COMPLAINT COMES Now the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Royal Gardens Villa, Inc. (hereinafter “Royal Gardens Villa”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2012), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of vee $500.00 pursuant to Sections 429.14, and 429.19 Florida Statutes (2012), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4, AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2012), and Chapter 58A-5, Florida Administrative Code. 5. Royal Gardens Villa operates a 12-bed assisted living facility located at 1270 N.B. 112 Street, Miami, Florida 33161. Royal Gardens Villa is licensed as an assisted living facility license number ALS5180. Royal Gardens Villa was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. couNT ROYAL GARDENS VILLA FAILED TO HAVE ONE EMPLOYEE THAT COMPLETED THE 12-HOURS OF CONTINUING EDUCATION IN TOPICS RELATED To ASSISTED LIVING FOR TWO YEARS IN HER FILE Rule 58A-5.0191(1), Florida Administrative Code (TRAINING-CORE & COMPETENCY TEST) UNCORRECTED CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the standard biennial survey conducted on 12/19/2012 and based on record review and interview, it was determined that the facility failed to have 1 out 4 sampled employees to have 12 hours of continuing education in topics related to assisted living every 2 years. 8. Record review revealed that employee #1; the Administrator did not have her 12 hours of continued education in the topics relating to assisted living for 2 years in her file. The Administrator started on 01/10/2007 and her CORE certification is dated 05/31/2007. 9. On an interview with the Administrator on 12/19/2012, at 9:00 am, she stated that she did not have her 12 hours for the in-services in continued education in her file. 10. During the follow-up conducted on 02/28/2013 and based on record review and interview, it was determined that the facility failed to have 1 out 4 sampled employees to have 12- hours of continuing education in topics related to assisted living every 2 years. 11. Record review revealed that employee #1, the Administrator, did not have her 12-hours of continued education in the topics relating to assisted living for 2 years in her file. The Administrator started on 01/10/2007 and her CORE certification is dated 05-31-07. 12. During an interview with the Administrator on 02/28/2013 at 9:00 am, she stated by phone that she did not have her 12 hours for the in-services in continued education in her file. 13. Based on the foregoing, Royal Gardens Villa violated Rule 58A-5.0191(1), Florida Administrative Code, an uncorrected 3 Class III deficiency, which carries, in this case, an assessed fine of $500.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agetncy for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I, B. Assess an administrative fine of $500.00 against Royal Gardens Villa, on Count I, pursuant to Section 429,.19(2)(c), Florida Statutes (2012). Cc. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2012). Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 412-3630. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. Nelson E. Rodney N Assistant General Counsel Agency for Health Care Administration 8333 N.W. 53°¢ Street, #300 Miami, Florida 33166 Copies furnished to: Field Office Manager Agency for Health Care Administration 8333 N.W. 53° Street, Suite 300 Doral, Florida 33166 (Inter-office mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Arlene Sanchez, Administrator, Royal Gardens Villa, 1270 N.E. 112° Street, Miami, Florida 33161 on Cone 7 , 2013. . ld OQ. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY Bi » & zAqticle Number ty |. Domestic Return Recelpt' "> 102595-02-M-1540 ' sith

Docket for Case No: 13-002938

Orders for Case No: 13-002938