STATE OF FLORIDA 94 ACT ~y PN AGENCY FOR HEALTH CARE ADMINISTRATION My. 4 fg 1 ea AGENCY FOR HEALTH CARE at STR A ADMINISTRATION, EAE INGS Petitioner, AHCA No.: 2004007304 Return Receipt Requested: v. 7003 1680 0006 9825 9264 7003 1680 0006 9825 9288 KAREN S. LEGALL, OWNER/OPERATOR d/b/a KAREN LEGALL, C CL. 22 9 § [DSK Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Karen Legall, Owner/Operator d/b/a Karen Legall (hereinafter “Karen Legall”), pursuant to Chapter 400, Part VII, and Section 120.60, Florida Statutes, (2003), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in $11,500.00 pursuant to Section 400.6196 ({c), the amount of 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 Broward 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 adult family home care facilities pursuant to Chapter 400, Part VII, Florida Statutes (2003) and Chapter 58A-14, Florida Administrative Code. 5. Karen Legall operates a 5-bed adult family care home located at 2903 N. W. 115 Terrace, Pompano Beach, Florida 33065. Karen Legall is licensed as an adult family care home under license number 6905583. Karen Legall 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 KAREN LEGALL FAILED TO ENSURE THAT A RESIDENT RECEIVED THE PRORATED REFUND AND FAILED TO INCLUDE IN A RESIDENCY AGREEMENT THE REQUIRED REFUND POLICY THAT APPLIES WHEN A RESIDENT IS DISCHARGED OR DIES. RULE 58A-14.0062(1) and (2), FLORIDA ADMINISTRATIVE CODE (RESIDENT RECORDS STANDARDS) CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Karen Legall was cited with one (1) Class III violation as a result of a complaint investigation conducted onsite on February 13, 2004. 8. A complaint investigation was conducted on February 13, 2004. Based on record review and interview, it was determined that the facility failed to give a resident his/her prorated refund, and failed to include the required refund policy in a residency agreement. The findings are as follows: 9. Resident #1 was admitted to the facility on 09/04/03 and then discharged to the hospital on 11/18/03. The resident reported that the facility was paid a deposit of $200 (called a non-refundable admission fee in the agreement,) the first month's rent, and a month's security. The facility was also paid for the months of October, November and December. At the end of December, the resident was discharged from a rehab center into an assisted living facility due to the fact he/she required more care than he/she could receive in the AFCH. 10. The provider was interviewed by the surveyor. The provider denied that the resident was owed a refund of the security deposit, but could not provide documentation of financial records showing when the resident paid in order to determine if a refund was due, and could not explain why the residency agreement did not contain the required refund policy. 11. The mandated correction date was designated as March 14, 2004. 12. A revisit survey was conducted on April 29, 2004. Based on record review and interview, it was determined that the facility still failed to ensure that the resident received the prorated refund. The findings include the following: 13. Resident #1 was interviewed again on 04/29/04, and reported that no refund had been received to date. 14. The provider was again interviewed. The provider denied that the resident was owed a refund of the security deposit due to failure to provide a 30 day notice to the facility. However, there is no requirement in an AFCH for the resident to give the facility 30 day notice. This deficiency remains uncorrected from the survey of February 13, 2004. 15. The mandated date of correction was designated as May 28, 2004. 16. A second revisit survey was conducted on July 13, 2004. Based on record review and interview, it was determined that the facility still failed to ensure that the resident received the prorated refund. The findings are as follow: 17. The resident was interviewed again by telephone on 07/13/04, and reported that no refund had been received to date. 18. Telephone messages were left for the provider, but she did not return the calls. The facility's Plan of Correction dated 06/04/04 was reviewed, and it stated that no refund was owed because the resident's agreement states that the resident does not receive a refund of the security deposit because he/she did not give a 30 day notice. However, after reviewing the blank agreement, and the agreement originally signed by the resident, the surveyor found no provision stating that the resident would not receive the refund of the security deposit upon failure to give 30 day notice. In addition, there is no requirement in an AFCH for the resident to give the facility 30 day notice. This deficiency remains uncorrected from the surveys of February 13, 2004 and April 29, 2004. 19. Based on the foregoing, Karen lLegall violated Rule 58A-14.0062(1) and (2), Florida Administrative Code, herein classified as an uncorrected Class III violation, which warrants an assessed fine of $11,500.00 ($250.00 per day x 46 days). 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 Karen Legall on Count I. 2. Assess an administrative fine of $11,500.00 on Count I for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. 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 (2003). 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. . Margar Ju n, Esq. Assistant Geheral Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 305-470-6800 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 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) Home Care Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Karen S. Legall, Owner/Operator, 2903 N. W. 115 Terrace, Pompano Beach, Florida 33065; Karen Legall, 4930 N.W. 55 Street, Ft. Lauderdale, Florida 33318 on this Ql day of ’

Docket for Case No: 04-003598