a 06 JUN 15 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION if PH 4s 2g Your i ST 44 STATE OF FLORIDA, AGENCY FOR HEALTH HE ARI eS YE CARE ADMINISTRATION, Petitioner, AHCA No.: 2006003507 Return Receipt Requested: v. 7002 2410 0001 4234 7449 7002 2410 0001 4234 7456 PARADISE VILLA RETIREMENT, INC. 7002 2410 0001 4234 7463 d/b/a PARADISE VILLA RETIREMENT HOME II AT SUNRISE, Respondent. Dw: div ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Paradise Villa Retirement, Inc. d/b/a Paradise Villa Retirement Home II at Sunrise (hereinafter “Paradise Villa Retirement Home II at Sunrise”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, (2005), and alleges: NATURE OF THE ACTION 1. This is an action for revocation of an assisted living facility license pursuant to Sections 400.414(1) (a) and 400.414(1) (e)1, Florida Statutes for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2005) and Chapter 28-106, Florida Administrative Code (2005). 3. Venue lies in Broward County pursuant to Section 120.57, Florida Statutes (2005) and Rule 28-106.207, Florida Administrative Code (2005). 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 (2005) and Chapter 58A-5 Florida Administrative Code (2005). 5. Paradise Villa Retirement Home II at Sunrise operates a 6-bed assisted living facility located at 2560 N. Ww. 93% Avenue, Sunrise, Florida 33322. Paradise Villa Retirement Home II at Sunrise is licensed as an assisted living facility under license number 10388. Paradise Villa Retirement Home II at Sunrise 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 PARADISE VILLA RETIREMENT HOME II WAS OPEN AND HOUSING RESIDENTS IN AN “UNSAFE BUILDING” . RULE 58A-5.023(1) (b), FLORIDA ADMINISTRATIVE CODE (PHYSICAL PLANT STANDARDS) CLASS I VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Paradise Villa Retirement Home II at Sunrise was cited with one (1) Class I deficiency due to an appraisal visit survey that was conducted on March 29, 2006. 8. An appraisal visit survey was conducted on March 29, 2006. Based on observation and interview with the Administrator/Owner of the facility on the day of the survey at approximately 2:30 PM, the facility was open and housing three residents in an "unsafe building". The findings include the following. 9. Upon the initial tour of the facility at approximately 2:30 PM, accompanied by the Administrator/Owner, it was observed that the facility remained open and was housing three residents in a building that was declared to be an “unsafe building" by the Sunrise Building Department. The structure was declared to be an "unsafe building, as defined in section 117 of the Florida building code. This building was ordered to be vacated and not occupied on 1/13/06. This order was posted with a large orange sign on the front window of the building and was also verbally related to the Administrator/Owner at that time by the Sunrise Building Department. The Administrator/Owner did not obey this order and continued to house three confused and elderly residents. The facility's fire alarm system was also found not to be in operable condition and could not be reset at the time of this survey. 10. Based on the foregoing facts, Paradise Villa Retirement Home II at Sunrise violated Sections 400.414(1) (a) and 400.414(1)(e)1, Florida Statutes, herein classified as a Class I violation, which warrants a revocation of its assisted living facility license. 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 Paradise Villa Retirement Home II at Sunrise on Count I. 2. Assess against Paradise Villa Retirement Home II at Sunrise a revocation of license 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 (2005). Specific options for administrative action are set out in the attached Election 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. t Alba M. Rodriguez, Beg % Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 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) 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 to Robin Stewart, Administrator, Paradise Villa Retirement Home II at Sunrise, 2560 N W. 837% Avenue, Sunrise, Florida 33322; Paradise Villa Retirement Home, Inc., 9050 Pines Blvd. - Suite 355, Hollywood, Florida 33024; Robin Stewart, 16167 S. W. 15 Street, Pembroke Pines, Florida 333027 on this 2 aay of Qerch , 2006. Alba M. Rodriguez, Esq. ‘ -U-S; Postal Services = § ‘CERTIFIED MAIL; REC SO that we can retum the Card to the b; OF on the front if Space permits. Certified Fea Retum Reclept Fea (Endorsement Requirad) Rastrictad Dallvery Fee (Endorsement Required) mo 3. Service Type = ‘ Groner! Sir egistered . Insured Mall con Rlecelpt tor Merchandise -Jestricted Dalivary? Extra Fes J Total Postage & Fees 7002 2430 0001 4234 7444 City, State, seen a ap fllas ers PS Form PS'Form 9800, June 2002 38 f SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY 1 U.S. Postal Servicer @ Complete items 1, 2, and 3. Also complate A. Signature on CERTI FIED M AlLa, RE¢ item 4 if Restricted Delivery is desired. x eo oor EXAgont f] (Domejitic Mail Only; No Insurance « Pai ithe wears ium the oe vere C) Addressee RCSL e rss M Attach this card to the back of the mailptece, 8. Fgceived by (Printed Name) | C. Dats of Delivery or on the front if space permits, f [TOL CL Lt 1/2706 1. Article Addrassed to: :D,, Is delivery address different from tem 1? OJ Yes Postage ILYES, enter delivery address below: [1 No OFFICIAL Sd Pa padiaa NHL mand Up, Cartified Fea CB 0 050 aK (enacaaron tes : Uno SU 345. (Endorsarnont Reqpied} Fo Uyurmed). Flintdw 34024 3 Sone (Oi Certified Mali (1 Express Mall 0 Registered O Returm Receipt for Merchandise I | | p Vas, Rela. insured Mall 01 C.0.D. ! { [ Total Postage & Faas Sent To 7002 2440 O001 4234 74sb ny sarssereal AG 4. Restricted Delivery? (Extra Fea) Sits6h ot. Nay 56 Voonen Ras, 7002 2420 000% 4234 74Sb 7s ela ee) y ' PS Form 3800, June 2002 ~ Bate w Complete itaiisit, 2, and'3: Also compere: ~~-ry7- U.S. Postal Service item 4 if Restricted Delivery is desired. (od =e Soe yy | eed = Print your name and address on-the reverse ? ‘ so that we can return the card to you. __(Domestic Mail Only; No insurance @ Attach this card to the back of the mailpiece, For del/very information visit our websit or on the front if space permits. PS Form 3811, August 2001 j 1. Articla Addressed to: : HYES, enter ont / Ulet Su) (5 Mnset Retum Recispt Feo (Endorsemant Required} ‘ Pom Orato Pinon Forde ' Restricted Delivery Fee : o : {Endorsement Required) : 34 AW $ Total Postage & Fees 3. Service Type C] Certified Mail +1 Express Mail C1 Registered C) Return Recelpt for Merchandise C1 Insured Mail += £1'C.0.D. S$ a an _ 4 Rastricted Delivery? (Extra Fea) 0 ¥e ar ew Fr t 7002 2420 O00 4234 7uL eee = povereg pe WI eA 3 7002 2420 0002 42354 P4eba ‘PS Farm 3800, June 2002

Docket for Case No: 06-002117