STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, 6 \e lo 0 O > AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2008011292 ANGEL COX, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against Angel Cox (hereinafter Respondent), pursuant to Section 120.569 and 120.57, Florida Statutes (2008), and alleges: NATURE OF THE ACTION This is an action to revoke the Respondent’s license to operate an adult family care home (hereinafter also referred to as “AFCH”) pursuant to §§ 408.815 and 429.69(5), Florida Statutes (2008). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, Florida Statutes (2008) and Chapters 408, Part II, and 429, Part II, Florida Statutes (2008). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of adult family care homes and enforcement of all applicable federal regulations, state statutes and rules governing adult family care homes pursuant to the Chapters. 408, Part II, 429, Part II, Florida Statutes (2008), and Chapter 58A-14 Florida Administrative Code. 4. Respondent operates a five (5)-bed adult family care home located at 2897 Harson Way, Ft. Pierce, Florida 34947, and is licensed as an adult family care home, license number 6905686. 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. That pursuant to Florida law, the Agency may deny, suspend, or revoke the license of an AFHC operator for any violation of Chapter 429, Part II, Florida Statutes (2008), or any rule adopted by the Agency under this chapter, which results in conditions or practices that directly threaten the physical or emotional health, safety, or welfare of the residents. § 429.69(5), Fla. Stat. (2008). 8. That under Florida law, the Agency may deny or revoke the license of an AFCH operator based upon the facility’s (a) intentional or negligent act materially affecting the health or safety of a resident of the facility or (b) a violation of the facility’s authorizing statutes or applicable rules, in this particular instance, Chapter 429, Part II, Florida Statutes (2008), and Chapter 58A- 14, Florida Administrative Code, respectively, or (c) a violation of this part, authorizing statutes, or applicable rules. § 429.815 Florida Statutes (2008). 9. That pursuant to Florida law, a person who is licensed as an AFCH provider must own or rent the adult family care home facility and must reside in the AFCH facility. § 429.67(2), Fla. Stat. (2008). In addition, a person who is licensed as an AFCH provider must live in the adult family care home facility. R. 58A-14.008(2)(a)2, Florida Administrative Code. AFCHs “provide housing and personal care for disabled adults and frail elders who choose to live with an individual or family in a private home. The adult family-care home provider must live in the home. The purpose of this part is to provide for the health, safety, and welfare of residents of adult family-care homes in the state.” § 429.63(2), Fla. Stat. (2008) (emphasis supplied). 10. That based upon observation and interviews, Respondent failed to ensure that the provider resided in the licensed facility. 11. That Angel Cox is the AFCH provider and licensee of a licensed AFCH facility. 12. That on September 16, 2008, the Agency conducted an annual survey of the Respondent and the Respondent’s facility. 13. That based upon the observation and interview, Respondent did not reside in the AFCH facility, the same being contrary to law. 14. That on September 16, 2008 at 3:00 PM, Petitioner’s representative observed a bed in the living room of the Respondent’s facility during a tour of the facility. 15. That Petitioner’s representative interviewed Respondent’s employee number one (1) during the survey who indicated as follows: a. That she slept on the bed in the living room; b. That she lived in the facility Monday through Thursday and Respondent’s employee number two (2) lived in the facility during the weekends; c. That Respondent Angel Cox did not reside in the facility. 16. That Petitioner’s representative interviewed resident number one (1) during the survey who indicated as follows: a. That employee number one (1) resides in the facility from Monday through Thursday of each week; b. That employee number two (2) resided in the facility over the weekends; c. That Angel Cox does not reside in the facility. 17. That both confirmed that the Angel Cox did not live at the facility. 18. That Petitioner’s representative interviewed Respondent Angel Cox telephonically on September 16, 2008 who confirmed that staff were sleeping on the bed in the living room and that the three (3) bedrooms and a converted garage were occupied by residents. 19. That the failure of an AFCH provider to reside and live within the AFCH facility is a condition or practice that directly threatens the physical or emotional health, safety, or welfare of the residents. § 429.69(5), Fla. Stat. (2008). 20. That an AFCH provider must reside and live in an AFCH facility in order to properly care for the residents. 21. That among the duties and responsibilities created by Chapter 429, Florida Statutes, and Chapter 58A-14, Florida Administrative Code, an AFCH provider must ensure that: a. The residents are appropriate for placement and continued residency in the home as provided under Rule 58A-14.0061; b. The personal care and services provided to the residents (including assistance with activities of daily living and assistance with medication or the supervision of self administration of medication) is in accordance with Rule 58A-14.007(1); c. The residents are properly supervised, which includes being aware of their general whereabouts and well-being while the residents are on the premises of the AFCH in order to ensure the residents’ safety and security, and reminding the residents of any important tasks or activities, including appointments, as needed by them, as provided under Rule 58A-14.007(2). Under no circumstances shall a resident be left unattended for more than 2 hours under this rule; d. The observation, recording and reporting of any significant changes in a resident’s normal appearance, behavior or state of health to the resident’s health care provider and representative or case manager as provided under Rule 58A- 14.007(3); and e. The operation and maintenance of the AFCH facility under the Florida Statutes and Florida Administrative Code as provided under Rule 58A-14.008(2)(b)1. 22. That by failing to reside and live in the AFCH facility, the Respondent failed to properly care for the residents and created a condition or practice that directly threatened the physical or emotional health, safety, or welfare of the residents. 23. That by failing to reside and live in the AFCH facility, the Respondent committed an intentional or negligent act that materially affected the health or safety of a resident of the facility. 24. That by failing to reside and live in the AFCH facility, the Respondent violated the facility’s authorizing statutes or applicable rules, in this particular instance Chapter 429, Part II, Florida Statutes (2008), and Chapter 58A-14, Florida Administrative Code, respectively. 25. | The Agency provided the Respondent with a mandatory correction date of October 16, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter an order revoking the Respondent’s license to operate an adult family care home. Respectfully submitted this ZB day of October, 2008. ; Thomas J. Walsh II Vv Counsel for Petitioner Agency for Health Care Administration . 525 Mirror Lake Drive, 330G St. Petersburg, Florida 33701 727.552.1525 (office) 727.552.1440 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. 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: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida 32308. Telephone (850) 922-5873 RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been 5 2 Soe by US. Certified Mail, Return Receipt No. 7008 0500 0001 0420 1903 on October_Z § 72008 to: Angel Cox, Licensee/Administrator, 2897 Harson Way, Fort PiercesFlorida 34947. yAhomas J. Walsh II, Esquire Copies furnished to: Angel Cox ; Arlene Mayo-Davis Thomas J. Waish II Licensee/Administrator Field Office Manager Agency for Health Care Admin. 2897 Harson Way Agency for Health Care Admin. | 525 Mirror Lake Drive, 330G Fort Pierce, Florida 34947 | 5150 Linton Blvd, Suite 500 St. Petersburg, Florida 33701 (U.S. Certified Mail) Delray Beach, FL 33484 (Interoffice Mail) S. Mail) COMPLETE THIS SECTION ON @ LIVERY & Complete items 1, 2, and 5. . «80 complete item 4 if Restricted Delivery is desired. im Print your name and address on the reverse so that we can return the card to you. l@ Aitach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1 If YES, enter delivery address below: O1No Angel Cox Licensee/Administrator nine 2897 Harson Way PAcertified Mat C1 Express Mall Fort Pierce, Florida 34947 Cl Registered _,[8kReturn Receipt for Merchandise Ci Insured Mat =) C.0.D. 4, Restricted Delivery? (Extra Fee) 2 -3nge OSO0 O01 o420 1903) -* CaO) 292. PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 |

Docket for Case No: 08-006023