STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2003006152 Return Receipt Requested: Vv. 7002 2410 0001 4237 2724 7002 2410 0001 4237 2731 SUNSHINE OAKS, INC. d/b/a SUNSHINE 7002 2410 0001 4237 2793 OAKS, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or the “Agency”), by and through the undersigned counsel, and files this administrative complaint against Sunshine Oaks, Inc. d/b/a Sunshine Oaks, Inc. (hereinafter “Sunshine Oaks” or the “facility”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, (2002), and alleges: NATURE OF THE ACTION 1. This is an action to impose and maintain the Agency’s administrative fine totaling $1,000.00, pursuant to Sections 400.414 and 400.419, Florida Statutes, 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, Chapter 28-106, Florida Administrative Code. 3. Venue lies in Indian River County pursuant to Section 120.57 Florida Statutes, 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 400, Part III, Florida Statutes (2002) and Chapter 58A-5 Florida Administrative Code. 5. Sunshine Oaks operates a 49-bed assisted living facility located at 690 15 Street, Vero Beach, Florida 32960. Sunshine Oaks, Inc. is licensed as an assisted living facility under license number 8783. Sunshine Oaks 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 I SUNSHINE OAKS FAILED TO TRAIN STAFF IN RESIDENT’S RIGHTS. RULE 58A-5.0191(2) (c), FLORIDA ADMINISTRATIVE CODE , RULE 58A-5.0191(10) (e), FLORIDA ADMINISTRATIVE CODE (STAFFING STANDARDS) UNCORRECTED CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. The Agency cited Sunshine Oaks with one (1) Class III deficiency pursuant to complaint investigation survey. 8. Based on the complaint investigation survey conducted by the Agency on May 27, 2003 and based on record review and interview, the Agency found that the facility did not ensure that staff were trained on resident’s rights and reporting abuse neglect and exploitation, as required. The findings include the following, to wit: 9. Review of facility records did not produce any evidence of six of the six staff records reviewed being trained in resident’s rights and reporting of abuse, neglect and exploitation. The administrator, when requested to by the surveyor, was unable to produce this required information and confirmed that it was not present. 10. The mandated correction date for the violation was designated as June 26, 2003. ll. Based on a revisit survey conducted on August 19, 2003 and based on record review and interview, the Agency again found that the facility did not ensure that staff were trained on resident’s rights and reporting abuse neglect and exploitation, as required. The findings include the following, to wit: 12. Review of facility records did not produce any evidence of one of the six staff records reviewed being trained in resident’s rights and reporting of abuse, neglect and exploitation. The administrator, when requested to by the surveyor, was unable to produce this required information and confirmed that it was not present. 13. This is an uncorrected violation from the 5/27/03 survey report. 14. Based on the foregoing, Sunshine Oaks violated Rule 58A-5.0191(2)(c), Florida Administrative Code and Rule 58A- 5.191(10) (e), Florida Administrative Code, herein classified as an uncorrected Class III violation, which warrants an assessed fine of $500.00. SURVEY FEE 15. Pursuant to Section 400.419(9), Florida statutes, AHCA May assess a survey fee of $500.00 to cover the cost of monitoring visits. A survey fee of $500.00 was assessed. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Sunshine Oaks, Inc. on Count I. 2. Assess an administrative fine of $500.00 against Sunshine Oaks, Inc. on Count I for the violation cited herein. 3. Assess a survey fee of $500.00 against Sunshine Oaks, Inc. pursuant to Section 400.419(9), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5. 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 (2002). 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 Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration Respectf submitted, Kathryn F. Fenske, Esq. Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 N. W. 53 Street Miami, Florida 33166 (305) 499-2165 1710 E. Tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (U.S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE soe ee EER 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 Jacqueline Menhenott, Administrator, Sunshine Oaks, Inc., 690 15 Street, Vero Beach, Florida 32960; Sunshine Oaks, Inc. 845 8 Street, Vero Beach, Florida 32960; d, ,Port St. Lucie, Florida Frank Liggieri, Wes S.E. Abcor 34952 on this . , 2003. day of Kathryn Fenske, Esq.

Docket for Case No: 03-004504