STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2015007904 NEW BEGINNING II, ’ 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, NEW BEGINNING II (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 an unlicensed facility in the sum of SEVENTEEN THOUSAND DOLLARS ($17,000.00) based upon one (1) violation pursuant to Section 408.812(4), 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 1637 N.W. Sth Place, Cape Coral, Florida 33993, 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 July 1, 2015, the Agency conducted an unlicensed activity Complaint Survey (CCR# 2015005278) of the Respondent’s facility. 9. Based on observation and interview, New Beginning II, the undefined facility, was operating without a license as an Assisted Living Facility, providing 2 unrelated residents with housing, meals and personal services, as defined in Florida Statutes 429.65(2). The unlicensed facility also provided medication assistance to 2 out of 2 residents, specifically Resident #1 and Resident #2, by assisting the residents with self-administration of their medications, as defined in Florida Statutes 429.256. 10. On 7/1/15 at 11:00 a.m. a tour of the unlicensed facility was conducted. Two residents, Residents #1 and Resident #2, were observed in their rooms and in a common area of the home. A locked medication cart was observed in the common area of the home with the names of Resident #1 and Resident #2 handwritten on adhesive paper labeling the drawers of the medications. The labeling identified Resident #1's medication drawer, Resident #2's morning and evening medication, as needed medications (PRN) and a drawer labeled "meds ready." Staff A was asked to unlock the cabinet, and inside were medications for both Resident #1 and Resident #2. An activities board by the kitchen identified the facility as an Assisted Living Facility with the name of "New Beginning ALF" with the address and phone number of the unlicensed facility. (Photographic evidence obtained) 11. On 7/1/15 at 11:00 a.m. an interview was conducted with Staff A. Staff A said she has worked at the unlicensed location for approximately one month. Staff A said the name of the facility was New Beginning and said the facility was an Assisted Living Facility. The facility only had 2 residents and the residents were not related to the Operator. Staff A said she kept the facility clean and cooks breakfast, lunch, and dinner and provides snacks to the residents. Staff A said Resident #1 needed help in the shower and both residents needed 24 hour care and assistance with their medication. Staff A said the Operator did not live in the facility and the operator lived down the road. Staff A said Staff B did the medications at the unlicensed location. Staff B "Gets the medications ready for me for the day and I just give them out in the cups." Staff A said Staff B puts the medications in the cups and puts the cups inside the medication cart where it says "ready meds." Staff A said the medications are kept in the medication cart locked and she keeps the keys on her wrist. Staff A said medications are given in the morning around 8:00 a.m. and at night around 6:00 p.m. Staff A said Staff B will sometimes come and do the medications and sign the Medication Observation Records for each resident. (Photographic evidence obtained) 12. On 7/1/15 at 11:13 am. an interview was conducted with the Operator of the unlicensed facility. The Operator said she does not live in the home. She said the home is not licensed, She currently has 2 residents, but admitted to having a third resident in the past, which she realized was "over the limit" for the unlicensed facility. The Operator said she is trying to obtain a license as an Assisted Living Facility for 4 residents. She said she has another Assisted Living Facility in the area, New Beginning, licensed for 5 residents. She said Resident #1 needed assistance with bathing, dressing, medications, cooking, cleaning, and meals. Resident #2 needs assistance with medications and meals. 13. On 7/1/15 at 11:27 am. an interview was conducted with Resident #1. Resident #1 said he/she had a stroke 2 years ago and is provided assistance with bathing, dressing, meals, cleaning, medications and transportation. 14. On 7/1/15 at 11:40 a.m. an interview was conducted with Resident #2. Resident #2 said he/she has lived at the unlicensed location since March 2015. Resident #2 said the name of the facility was New Beginning and said the facility was an Assisted Living Facility. Resident #2 receives assistance with medication as “they make sure I get it in the night and morning." Resident #2 said the medications are given in a cup. The medications are prepared the night before by the Certified Nursing Assistant and whoever is on duty gives the medications. Resident #2 said they do laundry and change the sheets once a week. Resident #2 and Resident #1 lived in the facility currently but Resident #2 named two past residents who resided at the undefined facility. 15. A follow up interview was conducted on 7/1/15 at 12:05 p.m. with the unlicensed facility Operator. The Operator said she made a verbal agreement for services and payment between the residents or their families. The Operator said she and another employee (Staff B) who had taken the medication class gave out the medications to the residents at the unlicensed location. The Operator reported that she went over to the unlicensed location and did’ the medications by prefilling medication cups for the residents. 16. On 7/1/15 at 1:13 p.m. an interview was conducted with Staff B. Staff B said he had worked at the unlicensed location for 3 months and he is a Certified Nursing Assistant with medication technician training. Staff B said he assists the residents at the unlicensed location with Activities of Daily Living and occasionally a shower. Staff B said he takes vital signs and assists with blood sugar testing and watches the residents take their medication. Staff B said only Resident #1 and Resident #2 lives at the unlicensed location. Staff B said Resident #1 needed Activities of Daily Living care and bathing and he stands by while Resident #1 is in the shower in case the resident falls and also helps Resident #1 wash his/her back. Staff B said Resident #2 needs help with food and medications. Staff B said he prefills the cups for the medications and places the prefilled cups of medication in the drawer on the medication cart that says ‘ready meds' and "they are ready to go." 17. On 7/6/15 at 1:25 p.m. a telephone interview was conducted with the daughter of Resident #2. Resident #2's daughter said she was told the facility was a licensed Assisted Living Facility. Resident #2's daughter said she was told the owner just bought the home and was getting things together. She has seen her parent and 2 additional residents in the home. There are currently only 2 residents, as one passed away. The daughter states she writes out a check to the Operator monthly to pay for her parent's care. 18. - On 7/6/15 at 2:33 p.m. a telephone interview was conducted with the son of Resident #1. Resident #1’s son said he was told the facility was an Assisted Living Facility and said he writes a check monthly for $3,000 payable to New Beginning ALF, Inc. 19. On 7/6/15 at 2:51 p.m. a telephone interview was conducted with a Licensed ) Clinical Social Worker. She said she comes to the home to see two residents (Resident #1 and #2). She said she was aware the home is not a licensed facility. She was told by the Owner that she is currently in the process of getting a license: 20.