STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, : AHCA NO: 05-00-028-NH vs. PASCO NURSING & REHAB CENTER (Newcare Nursing Corporation, d/b/a Pasco Nursing & Rehab Center), 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 $700.00 upon Pasco Nursing & Rehab Center (hereinafter referred to as "Respondent"). As grounds for the imposition of this civil penalty, the Agency alleges as follows: (1) The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. (2) Respondent is licensed to operate as a Nursing Home at 14433 Fifth Street, Dade City, Florida 33523, in compliance with Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. Ww Nv] (3) The Respondent has violated the provisions of Chapter 400, Part II, Florida Statutes, and provisions of Chapter 59A-4, Florida Administrative Code, in that it was cited for one (1) deficiency cited during the survey of December 21, 1999. This deficiency set forth below, was previously cited at the licensure survey of February 18, 1999, and constitutes a repeat deficiency: (a) The Respondent failed to comply with Life Safety Code standard in that miscellaneous areas of electrical non compliance were identified. This is a violation of Sections 400.102, 400.121 and 400.23, Florida Statutes, and Rule 59A-4.130, Florida Administrative Code. Class III deficiency. Fine: $700.00. (4) The above referenced violation constitutes grounds to levy this civil penalty pursuant to Section 400.23, Florida Statutes, in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation of a nursing home. (5) Notice was provided in writing to the Respondent of each of the above violation(s) and the time frame for correction. ‘ oS YY (6) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, 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 it 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 a formal proceeding under Section 120.57(1), Florida Statutes, your request for an administrative hearing must conform to the requirements in Rule 28-106, 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. Respondent may be entitled to mediation pursuant to Section 120.573, Florida Statutes. Requesting mediation is not a substitute for requesting a hearing. All requests for hearing shall be made to the Agency for Health Care Administration, Division of Health Quality Assurance, 6800 North Dale Mabry Highway, Suite 220, Tampa, Florida 33614; Attention: Michael R. Hope, Senior Attorney. Payment of fines shall be sent to the Agency for Health Care Administration, P.O. Box 13749, Tallahassee, Florida 32317-3749. (Please reference the case number and facility name on the front of your check). \w/ Y (7) 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 was sent by U.S. Certified Mail, Return Receipt (Number Z 219 886 178), tocT Corporation System, Registered Agent for Newcare Nursing Corporation, 1200 South Pine Island Road, Plantation, Florida 33324, on the P7Aday of ceeege~Z 2000. bt Cet PATRICIA A. REID-CA Field Office Manager Agency for Health Care Administration Division of Managed Care and Health Quality Copies furnished to: Administrator Pasco Nursing & Rehab Center 14433 Fifth Street Dade City, Florida 33523

Docket for Case No: 00-003790