JAN-13-2005 THU 02:37 PM Shutts and Bowens FAK NO. 3053819982 STATE QF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HRALTH CiRE ADMINISTRATION, Petitioner, AHCA No. 2004010755 Return Receipt Requesred: 7003 1680 0006 9825 8373 Vv. ENRIQUETA EGEA (Owner), d/b/a HOME SWEET HOME I, Raspondent. / OS ~ O aYO ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Enriqueta Egea (Qwner), d/b/a Home Sweet Home I (hereinafter “Homa Sweet Home I”), pursuant to Chapter 400, Part III and Section 120.60, Florida Statutes, (2003), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the license of Home Sweet Home I pursuant to Saction 400.414(1)(g) Florida Statutes (2003) 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. PAGE 218° RCVD AT 12/10/2004 1:46:18 PM [Eastern Standard Tlme]* SVR.FAXSERVERI(5 * DNIS.7854 * CSID: DURATION (mm-ss):02.34 JAN-13-2005 THU 02:37 PM Shutts and Bowens FAX NO. 3053819982 3. Venue lies in Miami Dade 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 (2003) and Chapter S8~A-5 Florida Administrative Code. 5. Home Sweet; Home I operates a 6-bed assisted living facility located at 17321 sw 1o9** Avenue, Miami, Florida 33157, Home Sweet Home I is licensed ag an assisted living facility under license numbe: 5742. Home Sweet Home I 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 THE OWNER OR ADMINI:STRATOR OF HOME SWEET HOME I HAS NOT TAKEN ACTION TO REMOVE A PERSON WHO HAS ACCESS TO THE RESIDENTS OF THE FACILITY AND DOES NOT MEET THE CRITERIA SPECIFIED IN SECTION 435.03 FLORIDA STATUTES Section 400.414(1)(g), Florida Statutes (2003) 6. AHCA re-alleges and incorporates paragraphe (1) through (5) as if fully set forth herein. 2. During the course of surveys conducted at Home Sweet Home Ion 11/07/03, 12/16/03, and 11/02/04 surveyors noted that Mr. Otto Egea had full access to facility files, personnel files, PAGE JB *RCVD AT 42/10/2004 1:16:18 PM [Eastern Standard Time] ‘ SVR:FAXSERVER/{5 * ONIS:7854 * CSID:* DURATION (mm-ss}:02:34 JAN-13-2005 THU 02:37 PH Shutts and Bowens FAK NO. 3053819982 resident files and medications. Mr. Egea identified himself as a volunteer staff person or a consultant. The facility residents approach Mr. Egea and discuss what is in their mind. The residents at Homa Sweet Home I, are all personally familiar with Mr. Egea and refer to him as the parson responsible for the every day functions of the facility. 8. Mr. Egea was found quilty of a violation of Plorida Statute 893.13(6) (a), a 3™ degree felony, for cocaine possession on March. 27, 2003. Although the adjudication in that case wae etayed and withheld, Section 435.03(2) states “any person for whom employment screening is required by statute must not have been found guilty of, regardless of adjudication... any offense prohibited under..chaster 893 if the offense waa a felony”. 9. Because Mr. Egea has obvioue accesa to the residents of Home Sweet Home I he must meet the criteria specified in a. 435.03(2). 10. Based on che foregoing, Home Sweet Home I violated Section 400.414(1) (g), Florida Statutes (2003), which warrants the revocation of the facility license. CLAIM FOR RELIEF WHEREFORE, the Agency requesta the Court to. order the following relief: a. Enter a judgment in favor of the Agency for Health Care Administration againsc Homa Sweet Home 1 on Count I. 2. Revoke the license for Home Sweet Home I. 3 PAGE 4/8* RCVD AT 4214012004 1:16:18 PM [Eastern Standard Time] ‘ SVR:FAXSERVERI(S * DNIS:7854? CSID: * DURATION (tum-ss):02-24 JAN-13-2005 THU 02:37 PH Shutts and Bowens FAX NO. 3053819982 3. Assess costa related to the investigation and prosecution of this matter, if the Court finds costa applicable. 4. Grant suck. other relief ag this Court deema is just and proper. Respondent is notified that it hae a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2003). Specific optiens for administrative action are set out. in the attached Electicn 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 Administ:ration, 2727 Mahan Drive, MS #3, Tallahasgea, Plorida 32308. RESPONDENT IS FURTHiR 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. E. "Rodney, Eq. Fla. Bar 178081 Assistant General Counsel Agency for Health Care Administration Spokane Building, Suite #103 8350 N. W. 52™ Terrace Miami, Florida 33166 PAGE SA RCVD AT 42/10/2004 1:18:48 PM Eastern Standard Time] SVR:FAXSERVERIIG DNIS:7854 * CSID:* DURATION (rnm-ss):02.34 JAN-13-2005 THU 02:38 PM Shutts and Bowens Fak NO, 3053819982 Copies furnished to: Diane Lopez Castille Field Office Manager Agency for Health Care Administration 6355 N.W. 53°? Streat:, 1% Floor Miami, Florida 33166 (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 I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested te Enriqueta Egea, Owner, Home Sweet Home I, tn ; ; rok 17321 S.W. 109 Avenue, Miami, Florida 33157 on thig 3 . day of WDecemwlarn , 2004. iden Nelson E. Rodney 5 PAGE GIE* RCVD AT 12/40/2004 1:16:18 PM [Eastern Standard Time]’ SVR:FAXSERVERIS' DNIS:7854 * CSID;* DURATION (mnm-ss).02-34

Docket for Case No: 05-000340