Lf AGA) STATE OF FLORIDA Co ae. AGENCY FOR HEALTH CARE ADMINISTRATION <3 {1 5 fae, Sips: AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2002021051 AHCA No.: 2002019061 Vv. Return Receipt Requested: 7000 1670 0011 4847 9641 d/b/a ARCH 7000 1670 0011 4847 9634 Respondent. DDMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care administration (hereinafter “AHCA”), bY and through the andersigned counsel, and files this administrative Complaint against Arch Plaza inc., d/b/a Arch Plaza Nursing and Rehabilitation center (hereinafter *Arch Plaza”) pursuant to 28-106.111, Florida Administrative Code (2001) (*F.A.C.), and Chapter 120, Florida Statutes (“Fla- Stat.”) hereinafter alleges: NATURE _OF THE ACTIONS 1. This is an action to impose an administrative fine in the amount of seven thousand five hundred ($7,500) dollars pursuant to § 400.121, Fla. Stat. 2. This is an action to impose a conditional licensure rating, effective February 27, 2002, pursuant to §400.23(7) (b), Fla. Stat. JURISDICTION AND VENUE 3. This court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 4. Venue lies in Dade County, pursuant to § 120.57 and §121(1)(e), Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 5. AHCA is the enforcing authority with regard to nursing home licensure pursuant to Chapter 400, Part II, Fla. Stat. and Rule 59A-4 F.A.C. 6. Arch Plaza is a nursing home located at 12505 NE 16° Avenue, North Miami, Florida 33161 and is licensed under Chapter 400, Part II, Fla. Stat., and Chapter 59A-4, F.A.C. COUNT I ARCH PLAZA FAILED TO PERFORM AN ACCURATE ASSESSMENT FOR 3 SAMPLED RESIDENTS 483.20(g), C.F.R., and 59A-4.109(2), F.A.C. (RESIDENT ASSESSMENT) CLASS III 7. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 8. During the survey conducted on 01/22-24/02 and based on observation, interview and record review, the facility failed to perform accurate MDS (minimum data set) for 5 (#2, 8, 9, 10, 12) of 13-sampled resident's. 9, Resident #2 was assessed on his/her most recent resident assessment instrument (5/28/01) as spending less than 1/3 of time awake in activities. on the most recent quarterly assessment (11/27/01) the resident was assessed as spending between 1/3 to 2/3 time awake in activities. Interview with the activities director at 4:00 pm on 1/23/02 and review of the one on one log, disclosed that the resident is scheduled for one on one(s) every Tuesday and Thursday. The director explained that each session is for 10 minutes and that resident #2 receives approximately 20 minutes per week in activities and acknowledged that the MDS was not accurate. 10. Resident #9 was assessed on the most recent resident assessment instrument (RAI) dated 7/2/01 for mode of locomotion as "wheeled self". Based on observation and record review, the resident is bed bound, contracted and has never been able to wheel him/herself. ll. Resident #9 was assessed on the most recent RAI dated 7/2/01 for modes of expression as speech and is sometimes understood by others. Based on observation and record review, the resident does not have the ability to speak and never had the ability. 12. Review of sampled resident # 12's medical record reveled that in the Minimum Data Set (MDS) dated 4/21/01 that the resident was assessed being frequently incontinent of bladder. However, review of the nursing assessment note dated 4/16/01 revealed that the resident had a Foley Catheter in place, which did not accurately reflect the resident's status. Interview with the administrative staff revealed that the resident was assessed in error, 13. Review of sampled resident #10's medical record on 1/23/02 revealed that the resident was assessed in the MDS dated 1/15/02 as being totally incontinent of bowel and bladder. However, review of the nursing note revealed that the resident was described as being totally continent of bowel and bladder, Interview with the restorative staff revealed that the resident was not correctly assessed and the assessment did not reflect the resident's status. 14. Review of sampled resident #8's medical record on 1/22/02 revealed that the resident was assessed in the MDS dated 11/18/01 as being totally continent of bowel and bladder function. However, review of the nursing notes revealed that the resident was being described as being occasionally incontinent of bladder function. Interview with the restorative staff revealed that the resident was occasionally incontinent in bladder and not fully continent as inappropriately assessed in the MDS. Correction time given 02/25/02. 15. During the follow up conducted on 02/27/02 based on interview, record review and review of the facility's plan of correction the facility failed to perform an accurate assessment for 3 (#9, 10 and 11) of 8 sampled resident's. 16. During an interview with licensed staff at 2:45 pm on 2/26/02, it was identified that the MDS (minimum data set) Coordinator is the previous director of nursing who works in the evenings only. 17. Resident #10 was coded as totally incontinent of bowel and bladder on the annual assessment (MDS) minimum data set dated 1/15/02, however, the resident was continent. Based on the facility's plan of correction dated 2/22/02, all MDS's identified for inaccuracies were re-assessed and the care plans would be revised to reflect resident's present status. 18. Review of the MDS's for resident #10 disclosed that a new MDS had not been initiated or revised. Review of the RESIDENT PERSONAL CARE RECORD for the month of February disclosed that the resident was continent on 2/22, 2/23, 2/24, 2/25, 2/26 and 2/27/02. Further review of the care plan for 5 resident #10 had not been revised and continues to identify the resident as being incontinent of bowel and bladder. 19. Interview with licensed nursing staff on 2/27/02 at 2:35 pm disclosed that the resident knows when s/he wants to void. During a later interview with the resident at 3:30 pm disclosed that the resident is ambulatory and reported that s/he can use the bathroom. 20. Resident #9 was assessed on the most recent RAI dated 7/2/01 for modes of expression as Speech and is sometimes understood by others, which is incorrect. Based on review of the facility's plan of correction date 2/22/02, "inaccuracies were identified and care plans were revised to reflect residents present status". Record review still showed the resident's mode of expression is speech and is sometimes understood by others, indicating that the MDS and care plan had not been revised. Based on observation and record review, the resident does not have the ability to speak and never had the ability. 21. Resident #11 was coded as totally continent of bowel and bladder on a quarterly MDS dated 11/27/01. Review of the updated care plan problem dated 2/26/02 also indicated that the resident was "Continent of bowel and bladder function". However, review of the RESIDENT PERSONAL CARE RECORD for the month of February disclosed that the resident was incontinent 6 for all shifts for the entire month. Interview with the resident on 2/27/02 at 8:35 am disclosed that s/he wears incontinent briefs and is occasionally incontinent. Interview with the resident's nursing assistant on 2/27/02 at 10:35 am revealed that the resident wears incontinent briefs and has 2 to 3 incontinent episodes during her 7:00 am to 3:00 pm shift, 22. Based on the foregoing, Arch Plaza Nursing violated 483.20(g), C.F.R., as incorporated by Rule and 59A-4.109(2), F.A.C., herein classified as a Class III violation pursuant to Section 400.23(8), Florida Statutes, which carries, in this case an assessed fine of $1,000. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statute. COUNT II ARCH PLAZA FAILED TO PROVIDE APPROPRIATE BLADDER AND BOWEL PROGRAMS TO RESTORE NORMAL OF IMPROVE FUNCTIONING FOR ONE RESIDENT 483.25 (da) (2), C.F.R., and 59A-4.1288, F.A.c. (QUALITY OF CARE) CLASS III 23. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 24. During the survey conducted on 01/22-24/02 and based on observation, interview and record review, the facility failed to provide appropriate bladder and bowel programs to restore or improve bladder function for one (1) of five (5) resident's sampled (#4,) for incontinence. 25. Resident #4 was re-admitted to the facility on 6/13/01 after a hospitalization. on the initial minimum data set (MDS) dated 6/26/01, the resident was coded as totally incontinent of bladder and on a scheduled toileting plan. The most current MDS dated 12/10/01 also coded the resident as totally .incontinent of bladder, but indicated that the resident was not on toileting program. 26. Review of the care plan addressing the incontinence due to cognitive impairment of resident #4 included "Incontinent care PRN and reposition resident every 2 hours when in bed. Check skin for any abnormalities monitor for signs of urinary tract infection such as strong urine odor, increasing temperature and report to nurse/MD if indicated". 27. Review of the facility policy entitled Bowel and Bladder Incontinence Care Program states that restorative staff will assure that each resident has an individualized program to meet his/her incontinence needs and that the nursing assistants will check approximately 1-2 hours to determine whether the resident has voided. Tracking will be for 3-7 days, or until a pattern of the residents voiding habits has been established. Interview with nursing administration at 1:20 pm on 1/23/02 disclosed that tracking is done for 4 consecutive days. 28. Review of the tracking for the resident form 1/16 through 1/19/02 disclosed that tracking occurred on the 3pm to llpm shift on the first day and ended on 1/19/02 (1/20/02) 11:00 pm to 7:00 am shift, totaling 3 days and 1 shift of tracking. The form indicates that a two-day summary is to be made by a supervisor to include daily supervisor checks, number of dry findings and the percent dry. The areas to be initialed and filled out by the supervisor were left empty. 29. Further review of the tracking sheets disclosed that for the 3 mornings the resident was found wet at either 8:00 or 9:00 am. However, this information was not utilized in determining a pattern for the resident, nor was the tracking continued as specified in the policy to establish a pattern. Correction time given 02/25/02. 30. During the follow up conducted on 02/26/02 and Based on interview, record review and plan of correction, the facility failed to provide appropriate bladder and bowel programs to restore or improve bladder function for one (1) of five (5) resident's sampled (#4) for incontinence, 31. Resident #4 was re-admitted to the facility on 6/13/01 after a hospitalization. On the initial minimum data set (MDS) dated 6/26/01, the resident was coded as totally 9 incontinent of bladder and on a scheduled toileting plan. The most current MDS dated 12/10/01 also coded the resident as totally incontinent of bladder, but indicated that the resident was not on toileting program. 32. Review of the care plan addressing the incontinence due to cognitive impairment of resident #4 included "Incontinent care PRN and reposition resident every 2 hours when in bed. Check skin for any abnormalities monitor for signs of urinary tract infection such as strong urine odor, increasing temperature and report to nurse/MD if indicated". 33. Review of the facility policy entitled Bowel and Bladder Incontinence Care Program states that restorative staff will assure that each resident has an individualized program to meet his/her incontinence needs and that the nursing assistants will check approximately 1-2 hours to determine whether the resident has voided. Tracking will be for 3-7 days, or until a pattern of the residents voiding habits has been established. 34. Based on the plan of correction dated 2/22/02 for resident #4, the resident would be re-assessed for an individualized bowel and bladder program, and would be tracked for 3 ~ 7 days or until a pattern could be established. 35. Review of the clinical record disclosed that the resident was re-tracked for 4 days, from 2/13 to 2/16/02. 10 Review of the restorative notes dated 2/17/02 revealed "Resident has been tracked from 2/13 - 2/16, s/he is totally incontinent of bladder and bowel, unable to establish a pattern. Will put on every two hours changing schedule." 36. Interview with the licensed staff on 2/27/02 at 10:00 am disclosed that he/she was not aware of the plan of correction (POC) and that the POC indicated that the resident was to be tracked for incontinence until a pattern could be established. Uncorrected deficiency. 37. Based on the foregoing, Arch Plaza Nursing violated 483.25(d) (2), C.F.R., as incorporated by Rule 59A-4.1288, F.A.C., herein classified as a Class II violation pursuant to Section 400.23(8), Florida Statures, which carries, in this case an assessed fine of $1,000. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes. COUNT III ARCH PLAZA FAILED TO IMPLEMENT PROCEDURES TO PREVENT ACCIDENTS FOR ONE RESIDENT 483.25 (h) (2), C.F.R., and 59A-4.1288 F.A.C. (QUALITY OF CARE) CLASS II 38. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 39. During the follow up conducted on 2/26-27/02 and based on observation, interview and record review, the facility failed to implement procedures to prevent accidents for one (1) of eleven (11) sampled residents. (#12) 40. On 2/26/2002, during the initial tour of the facility, resident #12 was observed with a purplish colored bruise to the chin. Staff interview during the initial tour revealed that the resident had fallen over the past weekend. Clinical record review revealed that resident #12 was readmitted to the facility on 1/5/2002 with diagnosis including arteriosclerotic heart disease, hypertension, diabetes mellitus, seizure disorder, glaucoma and schizophrenia. The annual (MDS) minimum data set, dated 1/28/2002, revealed that resident #12 is ambulatory with an unsteady gait, requiring the assistance of one (1) person when ambulating outside of his/her room. Further review revealed a care plan dated 1/29/2002, that identified resident #12, "at risk for additional falls and related injury due to the residents diagnosis and due to the use of psychoactive, cardiac and neurological medications and poor safety awareness." The care plan "goal" was that the resident would not fall and sustain any related injury over the next 90 days. 41. On 2/4/2002, resident #12 fell. The care plan "goals" had then been updated to indicate that the resident 12 would not have any "additional" falls. The interventions had also been updated to include (only} that the resident should be assisted with ambulating as necessary. A review of nurses note's revealed that on 2/22/2002, after the care plan update, resident #12 was found in the hallway in a sitting position on the floor with a hematoma on his/her left hand. 42. Observation of resident #12 on two separate occasions on 2/27/2002 at 11:26 am and again shortly thereafter, revealed the resident exiting his/her room and ambulating in the hallway. On one occasion without socks or shoes, then on the later observation ambulating in the hall with non-slip socks. However, on both occasions, the resident was observed ambulating in the hall without the assistance of staff as indicated in the care plan. 43. Interview with nursing administration on 2/27/2002 revealed that a post fall assessment is completed after each fall. The post fall assessment evaluates factors that places the resident at risk and identifies areas that may have contributed to the resident falling. The care plan is then updated, and forwarded to the Director of Nursing who reviews the interventions for additional recommendations. 44. Record review disclosed that the care plan was updated on 2/4/02 without the completion of the post fall assessment. Further interview with nursing administration on 13 2/27/02 at 6:30 pm and record review revealed that there were no post fall assessments developed for this resident after the falls on 2/4/2002 or 2/22/2002 and no care plan updates were noted for the 02/22/02 fall. 45. Based on the foregoing, Arch Plaza Nursing violated 483.25(h) (2), C.F.R., as incorporated by Rule 59A-4.1288, F.A.C., herein classified as a Class II violation pursuant to Section 400.23(8), Florida Statutes, which carries, in this case an assessed fine of $2,500. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes. COUNT IV ARCH PLAZA NURSING FAILED TO REDUCE PRACTICES WHICH MAY RESULT IN FOOD CONTAMINATION AND COMPROMISE FOOD SAFETY 483.35(h) (2), C.F.R., and 59A-4.1288, F.A.C. (DIETARY SERVICES) CLASS III 46. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 47. During the survey conducted on 01/22-24/02 and based on observation during the initial tour of the kitchen and revisits on 1/22/02 between 9:30 a.m. to 12:00 p.m., in the presence of administrative staff, the following observations were made: 14 a.) Inspection of the "reach in" refrigerator by the entrance to the kitchen revealed that outdated food and food with no dates were being stored. For example, hard-boiled eggs had a expiration date of 11/22/01 and bread dated 12/27/01. b.)} The gasket around the seam of the double door refrigerator by the entrance to the kitchen was observed with black colored material all the way around, which was removed by rubbing the finger over it, c.) Inspection of the walk-in refrigerator revealed that food was stored inappropriately and outdated food and food with no dates were being stored. For example, sour cream(potentially hazardous food) used half way, had a expiration date of 1/17/02 and was being stored above produce; Jell-O dated 1/14/02; puree meat (potentially hazardous food) with no date; puree vegetable with no date; sliced turkey dated 1/16/02, bran soup 1/16/02; frozen eggs (potentially hazardous food) not dated and kept above ready prepared food; large piece of smoked ham dated 1/16/02; and apple sauce dated 1/18/02. Interview with the FSD revealed that the facility's policy was to throw away used and opened food that is more than 2 days old. The FSD reported that the staff failed to check the food items and ensure that they were dated and not outdated. dad.) Checking the temperature of the thickened milk (potentially hazardous food) at approximately 12:00 p.m. revealed that it was out of safe temperature (was at 50 degrees Fahrenheit). According to the 1999 Food Code, proper holding temperature for potentially hazardous cold foods should be at or below 41 degrees F, 48. During the follow up conducted on 02/26-27/02 and based on observation and staff interview, the facility failed to reduce those practices which May result in food contamination and compromise food safety. 49, During the initial tour of the kitchen on 2/26/02 at approximately 9:20 am, in the presence of administrative staff, the following observations were made: a.) Inspection of the" walk in" refrigerator revealed that the caulking was dark in color appearing to be mold. b.) Four cutting boards (3 in white and 1 in pink) were observed to have deep grooves, and discoloration. The boards were observed to have black to brown markings/stains between the cuts and Surrounding the grooves. 50. The following was observed on 2/27/02 at 9:45 am in the kitchen: a.) During the inspection of the dish machine, Food Service Management was observed going to the clean side of the 16 “dish machine and removing clean utensils, prior to removing soiled gloves. b.) The concrete walls in the walk-in refrigerator were observed to be severely chipped, peeling and have green colored material which appeared to be mold/algae growth. 51. Based on the foregoing, Arch Plaza Nursing violated 483.25(h) (2), C.F.R., as incorporated by Rule 59A-4,.1288, F.A.C., herein classified as an uncorrected Class II violation pursuant to Section 400.23(8), Florida Statutes, which carries, in this case an assessed fine of $3,000. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Arch Plaza Nursing shall post the license in a prominent place that is clear and unobstructed public view at or near the place where residents are being admitted to the facility. The conditional License is attached hereto as Exhibit “a” PRAYER FOR RELIEF SOT ER EUR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Counts I, II, III and rv. B. Assess against Arch Plaza Nursing an administrative fine of $7,500 for the three (3) Class III violations on Counts I, II and Iv, and one (1) Class ITI violation on Count III, in accordance with Section 400.23(8) (b) (c) Fla. Stat. Cc. Assess against Arch Plaza Nursing a conditional license in accordance with Section 400.23(7), Florida Statutes. D. Assess costs related to the investigation and prosecution of this matter, if applicable. E. Grant such other relief as the 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 (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 Nw 53° Street, Miami, Florida 33166; Alba M. Rodriguez. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted. _ fo Alba M. aaeiee Assistant General Counsel Agency for Health Care Administration 8355 NW 537° Street Miami, Florida 33166 Copy to: Diane Castillo Field Office Manager Agency for Health Care Administration Manchester Building 8355 NW 53°¢ Street Miami, Florida 33166 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 19 EXHIBIT “ar Conditional License License # SNF 10200961; Effective date: 02-27-02 Expiration date: 12-31-02 20 Certificate No.: 8441 CERTIFICATE OF SERVICE Se RV ICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Michael Alexander, Administrator, Arch Plaza Nursing and Rehabilitation Center, 12505 NE 16 avenue, North Miami, Florida 33161, and to William Zubkoff, Registered Agent, 320 Collins Avenue, Miami Beach, Florida 33139, on this 5 day of Qhueres , 2002. thas 22. Alba M. Rodriguez 21 STATE OF FLORIDA ; AGENCY FOR HEALTH CARE ADMINISTRATION OES RE: ARCH PLAZA, INC., d/b/a ARCH PLAZA NURSING AHCAN AND REHABILITATION CENTER ° ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE (1) 6 ! do not dispute the allegations of fact contained in the Administrative Complaint and waive my right to object or to be heard. | understand that by waiving my rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) 6 ! do not dispute and | admit the allegations of fact in the Administrative Complaint, but do wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time | will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) 6 {do dispute the allegations of fact contained in the Administrative Complaint and request a formal hearing, pursuant to Section 120. 57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. If you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to any hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. If you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. 6 Mediation under Section 120.573, Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW - REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL YOU RECEIVE A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your current address. ) Respondent (Licensee) Address: License. No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: Alba M. Rodriguez, Assistant General Counsel, Agency for Health Care Administration, 8355 N. W. 53 Street, Miami, Florida 33166. STATE OF FLORIDA CO AGENCY FOR HEALTH CARE ADMINISTRATION & 25 fone, AW ° WI) (To be used with Election of Rights for Administrative Complaint form — attacted). .. we *, In response to the allegations set forth in the Administrative Complaint issued by the Agency for Health Care Administration (‘AHCA" or “Agency”), you must make one of the following elections within twenty- one (21) days from the date of receipt of the Administrative Complaint. Please make your election of the attached Election of Rights form and return it fully executed to the address listed on the form. QPTION 4. If you do not dispute the allegations in the Administrative Complaint and waive your right to be heard, you should select OPTION 1 on the election of fights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. OPTION 2. if you do not dispute any material fact alleged in the Administrative Complaint (you admit each of them), you may request an informal hearing pursuant to Section 120.57(2), Florida Statutes before the Agency. At the informal hearing, you wil! be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, you should select OPTION 2 on the Election of Rights form. OPTION 3. if you dispute the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal hearing, select OPTION 3 on the Election of Rights form. In order to obtain a formal Proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to a hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty- one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. aa Se

Docket for Case No: 02-002927