STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2015006836 SUN COAST RESIDENTIAL CARE, INCORPORATED, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, SUN COAST RESIDENTIAL CARE, INCORPORATED (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2014), and states: NATURE OF THE ACTION This is an action to impose an administrative fine against a licensed facility in the sum of ONE THOUSAND DOLLARS ($1,000.00) based upon one (1) violation pursuant to Section 408.812(4), Florida Statutes (2014), and to REVOKE the license pursuant to Section 429.14(1)(e) 2 and 3, Florida Statutes (2014). JURISDICTION AND VENUE 1. The Court has jurisdiction over the matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2014). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, and Chapters 408 and 429, Florida Statutes (2014). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4, The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable federal and state regulations, statutes and rules governing such facilities. Chapters 408, and 429, Florida Statutes (2014); Chapter 58A-5, Florida Administrative Code. 5. The Respondent was operating an unlicensed facility located at 817 S.W. 9th Street, Hallandale Beach, Florida 33009, and was at all times material required to comply with the applicable state regulations, statutes and rules governing assisted living facilities. COUNT I The Respondent Failed To Obtain A License For Operation In Violation Of Sections 429.08(1)(a) And 408.812, Florida Statutes (2014) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, Section 429.08, Florida Statutes (2014), applies to the unlicensed operation of an assisted living facility in addition to the requirements of Part II of Chapter 408. Section 429.08(1)(a), Florida Statutes (2014). Pursuant to Florida law, a person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of. any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under Section 408.814, Florida Statutes (2014) and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation.(6) In addition to granting injunctive relief pursuant to subsection (2), Florida Statutes (2014), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency. Section 408.812, Florida Statutes (2014), 8. On or about June 18, 2015, the Agency conducted a Limited Nursing Services Monitoring Survey of the Respondent’s facility. 9. Based on observation, interview and record review, it was determined that the facility was knowingly operating an unlicensed assisted living facility adjacent to the licensed facility, since it was providing housing, meals and personal care services, including medication assistance to 1 of 2 residents, specifically Resident #1, living within the undefined facility. 10. In an observation on 6/18/2015 at 9:10 am., Resident #1 was observed in the unlicensed facility, located adjacent to the licensed Assisted Living Facility (ALF). Resident #1 was observed sitting on the side of the bed. A rolling walker was observed positioned directly in front of the resident with a glass of juice and a breakfast pastry placed on the walker seat. A large bag of prescribed medication bottles was observed on the floor next to the resident’s bed and a pill organizer was observed on the resident's bed side table. 11. ‘In an interview with Resident #1 on 6/18/2015 at 9:15 am., the resident stated that he/she had just received assistance with a shower from a caregiver from the adjacent licensed Assisted Living Facility (ALF). Resident #1 stated that he/she was unable to complete any bathing/hygiene and required assistance daily. Resident #1 stated that the owner/operator of the ALF assisted him/her by placing medications inside a pill organizer and the ALF staff reminded the resident when to take the medications. Resident #1 stated receiving meals from the ALF staff since he/she was unable to prepare meals. Resident #1 stated that he/she pays monthly for a room and meals and had recently moved to the undefined facility from the ALF. 12. ‘In an interview with the ALF manager on 6/18/2015 at 11:00 a.m., she stated that the ALF facility owner/operator had provided direction about responsibilities with Resident #1 which included assisting Resident #1 with medications and providing meals. The manager stated that she did not reside at the ALF or undefined facility. She stated that she provided Resident #1 with required monitoring and oversight to take his/her daily medications. She stated that Resident #1 required assistance with showering. 13. A record review of the ALF admission/discharge log indicated that Resident #1 was admitted to the ALF on 8/6/2012. A further review of the log indicated no discharge date for Resident #1. 14. In an interview with the ALF facility co-owner/operator on 6/16/2015 at 11:30 a.m., she stated that Resident #1 was originally admitted to the ALF, and was noncompliant with the ALF house rules and had moved out 3 weeks ago. She indicated that she was providing room and board to Resident #1 and she did not live at either facility. She stated that Resident #1 required daily assistance with showering, meals and medication cueing. She stated that she had assisted Resident #1 with filling his/her medication pill box and the resident required the ALF staff to monitor and remind him/her to take medications as prescribed. 15. The Respondent’s actions or inactions constituted a violation of Section 408.812, Florida Statutes (2014). The Agency may impose an administrative fine for a violation that is not designated as a class I, class II, class III, or class IV violation. 16. Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance as set forth in Section 408.812(4), Florida Statutes (2014). A fine shall be levied notwithstanding the correction of the violation. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00) pursuant to Section 408.812(4) and (5) Florida Statutes (2014). COUNT Revocation Of Licensure Pursuant to Sections 408.815(1)(c) and (d), and 429.14(1)(e) 2 and 3 and (k), Florida Statutes (2014) 17. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5) and the allegations in Count I. 18. Pursuant to Florida law, in addition to the grounds provided in authorizing statutes, grounds that may be used by the Agency for denying and revoking a license include any of the following actions by a controlling interest: A violation of Section 408, Part Il, Florida Statutes (2014), authorizing statutes, or applicable rules, and a demonstrated pattern of deficient performance. Section 408.815(1)(c) and (d), Florida Statutes (2014). Pursuant to Florida law, in addition to the requirements of Part II of Chapter 408, Florida Statutes (2014), the Agency may deny, revoke, and suspend any license issued under Part I of Chapter 429, Florida Statutes (2014), and impose an administrative fine in the manner provided in Chapter 120, Florida Statutes (2014), against a licensee for a violation of any provision of Part I of Chapter 429 or Part II of Chapter 408, Florida Statutes (2014), or applicable rules, or for any of the following actions by a licensee: Any act constituting a ground upon which application for a license may be denied. Section 429.14(1)(e) 2 and 3 and (k), Florida Statutes (2014). 19. The Respondent’s facility violated provisions of Chapter 429, Part I, Florida Statutes (2014) and Chapter 408, Part II, Florida Statutes (2014) and applicable rules as outlined in Count I above. 20. The Respondent’s facility was cited for an unclassified deficiency arising from circumstances from the June 18, 2015 Limited Nursing Services Monitoring Survey. WHEREFORE, the Agency respectfully requests the Court enter an order REVOKING the license of Respondent, an assisted living facility in the State of Florida, pursuant to Sections 408.815(1)(c) and (d) and 429.14(1)(e) 2 and 3 and (k), Florida Statutes (2014). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to grant the following relief: 1, Make findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00). 3. Revoke the license of the Respondent. 4. Order any other relief that the Court deems just and appropriate. Respectfully submitted on this_ ot day of Ocbole __, 2015. QLinc eo Mm Sean Andrea M. Lang, Assistant Genéral Counsel Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 335-1253 NOTICE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO RETAIN AND BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS. ALL REQUESTS FOR HEARING SHALL BE MADE AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 412-3630. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form has been served to: Anthony A. Muthra, Administrator and Registered Agent, Sun Coast Residential Care, Incorporated, 813 S.W. 9th Street, Hallandale Beach, Florida 33009, by U.S. Certified Mail, Return Receipt No. 7007 1490 0003 3419 4275 on this Qk+ dayof_ Ockobe~ , 2015. Copies furnished to: Andrea M. Lang, Assistant ites Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C ' Fort Myers, Florida 33901 (239) 335-1253 Anthony A. Muthra Administrator and Registered Agent Sun Coast Residential Care, Incorporated 813 S.W. 9" Street Hallandale Beach, Florida 33009 (U.S. Certified Mail) Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) Arlene Mayo-Davis Field Office Manager 8355 N.W. 53% Street, First Floor Miami, Florida 33166 (Electronic Mail) Andrea M. Lang, Assistant General Counsel Agency for Health Care Administration Agency for Health Care Administration j STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re: Sun Coast Residential Care, Incorporated Case No. 2015006836 ELECTION OF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be an Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. Your Election of Rights must be returned by mail or by fax within twenty-one (21) days of the date you receive the attached Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. If your Election of Rights with your elected Option is not received by AHCA within twenty-one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a Final Order will be issued. Please use this form unless you, your attorney or your representative prefer to reply in accordance with Chapter 120, Florida Statutes (2015) and Rule 28, Florida Administrative Code. PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Phone: 850-412-3630 Fax: 850-921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) ___ I admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a Final Order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) ___ I admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. OPTION THREE (3)__I dispute the allegations of fact and law contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3) by itself is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain: 1. Your name, address, telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4. Astatement of all disputed issues of material fact. If there are none, you must state that there are none. Mediation under Section 120.573, Florida Statutes may be available in this matter if the Agency agrees. License Type: (Assisted Living Facility, Nursing Home, Medical Equipment, Other) Licensee Name: License Number: Contact Person: Name Title Address: Street and Number City State Zip Code Telephone No. Fax No. E-Mail (optional) I hereby certify that J am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the above licensee. Signature: Date: Print Name: Title: COMPLETE, THIS; SECTION:O} DELIVERY.

Docket for Case No: 15-006764

Orders for Case No: 15-006764