DeosIY 4 STATE OF FLORIDA ed Je AGENCY FOR HEALTH CARE ADMINISTRATION F STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2007008822 Return Receipt Requested: v. 7004 2890 000 5525 7484 7004 2890 000 5525 7491 ALL AMERICAN ADULT CONGREGATE LIVING FACILITY, INC. d/b/a ALL AMERICA ACLF, Respondent. 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 All America Adult Congregate Living Facility, Inc. d/b/a All America ACLF (hereinafter “All America ACLF”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $500.00 pursuant to Sections 429.14 and 429.19, Florida Statutes (2006), 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 (2006), and Chapter 28-106, Florida Administrative Code (2006). 3. Venue lies in Miami-Dade County pursuant to Section 120.57, Florida Statutes (2006), and Rule 28-106.207, Florida Administrative Code (2006). 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 429, Part I, Florida Statutes (2006), and Chapter 58A-5 Florida Administrative Code (2006). 5. All America ACLF operates a 100-bed assisted living facility located at 808 West 1%* Avenue, Hialeah, Florida 33010. All America ACLF is licensed as an assisted living facility under license number 7890. All America ACLF 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 ALL AMERICA ACLF FAILED TO ENSURE THAT EACH MENTAL HEALTH RESIDENT HAS BEEN ASSESSED AND DETERMINED TO BE ABLE TO LIVE IN THE COMMUNITY IN AN ASSISTED LIVING FACILITY WITHIN 30 DAYS OF ADMISSION. SECTION 429.075(3) (b), FLORIDA STATUTES SECTION 429.26(6), FLORIDA STATUTES (FACILITY/RESIDENT RECORD STANDARDS) CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. All America ACLF was cited with one (1) Class III deficiency as a result of a licensure survey and complaint investigation survey that were conducted on April 11, 2006 and July 9, 2007. 8. A licensure survey was conducted on April 11, 2006. Based on three (Residents #1, #3, and #7) of seven records reviewed, the Administrator failed to ensure that the facility had documentation provided by the Department of Children and Families showing that each mental health resident had been assessed and determined to be able to live in the community in an assisted living facility within 30 days after the mental health resident had been admitted to the assisted living facility. The findings included the following. 9. Resident #1's facility admission date was 7/11/03. Resident #1's record had no documentation provided by the Department of Children and Families showing that the resident had been assessed by a psychiatrist, clinical psychologist, clinical social worker, or psychiatric nurse, or an individual who is supervised by one of these professionals who has determined that the mental health resident is appropriate to reside in an ALF. Resident #1's health assessment dated 12/08/05 did not include a psychiatric diagnosis. 10. Resident #1's record had the following documentation: 1) a mental health resident’‘s annual community living support plan dated 10/12/03, which was not signed by Resident #1 but was signed by the facility administrator and case manager; 2) a cooperative agreement for assisted living facilities and mental health providers. 11. Resident #3's facility admission date was 7/31/03. Resident #3 had a diagnosis of schizophrenic chronic paranoid type documented on the health assessment dated 2/11/05. Resident # 3 had a mental health assessment dated 4/10/06, which was not within 30 days of admission to the facility. 12. Resident #7's facility admission date was 3/02/95. Resident #7 had a diagnosis of major depression documented on the health assessment dated 2/15/05. Resident #7 had a mental health assessment dated 4/10/06, which was not within 30 days of admission to the facility. 13. The mandatory date of correction was designated as May 11, 2006. 14. A complaint investigation survey was conducted on July 9, 2007. Based on record review and interview, it was determined that the facility failed to provide evidence of assessment by a mental health professional indicating that 2 out of 3 mental health residents (#1 and #2) were appropriate for placement in an assisted living facility. The findings include the following. 15. Facility's record review revealed that residents #1's file (mental health resident, admitted 3-5-2007) and #2's file (mental health resident, admitted 4-13-2007) were missing documentation provided by the Department of Children and Families showing that both mental health residents have been assessed and determined to be able to live in the community in an assisted living facility. 16. Interview with the facility's assistant administrator that took place on 7-9-2007 at 1:45 PM, confirmed the findings. This is a repeat deficiency from the survey of April 11, 2007. 17. Based on the foregoing facts, All America ACLF violated Section 429.075(3)(b), Florida Statutes (2006), and Section 429.26(6), Florida Statutes (2006), herein classified as a repeat Class III violation, which warrants an assessed fine of $500.00. 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 All America ACLF on Count I. 2. Assess an administrative fine of $500.00 against All America ACLF 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 (2006). 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER verte, E. Cem cveeey ourdes A. Naranjo, Esq. Fla. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Copies furnished to: Kriste Mennella Field Office Manager Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 (U.S. Mail) Karen Davis 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) Florida 33166 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 Teresita Feal, Administrator, All America ACLF, 808 West 1%* Avenue, Hialeah, Florida 33010; Teresita M. Feal, Registered Agent, ee W. 27° Road, Miami, Florida 33129 on this /4” day of , 2007. Lourdes A. Naranjo Kats Gleacen? SENDER: COMPLETE THis SECTION ALS. Postal Service, Cons PLETE THIS SECTION ON DELIVERY B® Complete item: . fate 1 By CERTIFIED MAIL... ai eee een = ata eee cit Print your name and address on the reverse D Agent For delivery information visit our Jam snet we fan return the card to you. D Addressee in " = meet ich this Card to the back of the mailpiece, C. Date of Delivery ru |) PP | ‘ye ___F on the front if space permits, L@-73-0> nj postage |§ 1. Article Addressed to: renttiomtem 1? C1 Yes { Tones. ES, enter delivery addressibel; gq = Cotttled Fes lerasdins Feas i’ ears Xe 5 i Ss Rietum Receipt Fee Choe Annies AC LE (Endorsement Required) g a = _Bopticed Denony Foe &% (cear (ar Cheeni ndorsement Flequir ~ =D Piolo, Foorides 3 = . yea) Ay aA : Total Postage & Fees | $ Express Mail = Sl C1 Retiitn Receipt for Merchandise . 3 Mail” "Ci c.0.p, : ™ pepper reo OAU,./ O04 2850 cong S525 7yay ONT Rr Oe =» (Transter from service label) 00 2) PS Fain 3800, Jane 2002 Domestic Return Receipt \ 4) 2ACPRI-03-2-0985 Ten Com fe U.S. Postal Services: fee ‘ CERTIFIED MAIbn @ * itd thal SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVESY Fort delivery information visit our w = eS j e i j ™ Complete items 1, 2, and 3. Aiso complete ope rir item 4 if Restricted Delivery is desired. Ke x) C Agent _ _M@ Print your name and address on the reverse © Addressee ] Postage | $ so that we can return the care p you. E} Received by,( Printed Name) 4 SBeinal Qelvery ‘ @ Attach this card to the back of the mailpiece, 4 ede Certtied Fee : or onthe front if space permits. LAX o> Qa ~s AT . Receipt Fe D. Is delivery addrass diffe (Enddvournort Recuiredh 1. Article Addressed to: icted Dativery Fee . (Endsrsomnent Requited) Tontasdes Fert Total Postage & Fees | $ 4Su IF Asan i 7004 2690 g000 S525 7441 Miami, F Joride AIK “| 3. Service Type O Certified Mail (1 Expreagy “ 0 Registered OD Retum Rewaliitiorffandise Onsured Mat = C.0.D. PS. Farin 9800, dine 2002 <0 4. Restricted Delivery? (Extra Fee) O Yes . . 7004 2890 Oo00 5525 7444 ant bb OE: (Transfer from service label) 0 srimiin. if PS Form 3811, August 2001 Domestic Retum Receipt 2ACPRI-03-Z-0985 Qs Nim Cormpeg

Docket for Case No: 08-000314