Mar 31 2009 11:06 MAR-31-2089 11:18 AGENCY HEALTH CARE ADMIN 856 921 4158 P1338 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2008013928 SUNSHINE ACRES, 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 SUNSHINE ACRES, (hereinafter “Respondent” or “facility”), 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 assisted living facility pursuant to 429.14 and impose an administrative fine of five thousand five hundred dollars ($5,500.00) based upon four (4) State Class II deficiencies (Counts I through IV) pursuant to $400.41 9(2)(c). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and Chapters 408, Part Il, and 429, Part I, 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 assisted living facilities and enforcement of all applicable state statutes and rules governing assisted living Mar 31 2009 11:06 MAR-31-2089 11:19 AGENCY HEALTH CARE ADMIN 856 921 4158 P.14/a8 facilities pursuant to the Chapters 408, Part I, and 429, Part I, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. 4. Respondent operates a fifty two (52) bed assisted living facility located at 2563 River Road, Caryville, Florida, 32427, and is licensed as an assisted ving facility, license number 5461. 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, COUNTI 6. The Agency re-alleges and incorporates paragraphs (1) through (3) as if fully set forth herein- 7. Pursuant to Florida law, an assisted living facility shall maintain written records for the Residents which are on the property accessible to Agency staff. The resident’s records must include any health care provider's orders for medications, hursing services, therapeutic diets, do not resuscitate order, or other services to be provided, supervised, or implemented by the facility that require a health care provider's order. S8A-5.024, Florida Administrative Code 8. That the Agency conducted a biennial inspection survey on November 11, 2008. 9. That based on observation, record review, and interview with the facility staff the facility failed to ensure physician’ medication orders were included for nine of 10 sampled residents. 10. On November 7, 2008, a medication pass observation was conducted at approximately 8:30am. The medication pass observation consisted of observing 10 residents being "assisted with medications" for the moming medication pass, in the dining hal! following breakfast. After the completion of the medication pass, a reconciliation of medication pass was initiated by reviewing the sampled residents' records (AHCA Form 1823), and a blue binder provided by the Mar 31 2009 11:06 MAR-31-2089 11:19 AGENCY HEALTH CARE ADMIN 856 921 4158 P1538 med tech which was labeled “MEDICATION CHANGES/PRESCRIPTION COPIES.” The results of the reconciliation revealed discrepancies. 11. Resident #4: The label on the blister pack reads: SMZ/TMP 800-160, 1 tab twice a day with large glass of water (given J tab), hydrocodone/APAP 5-500, 1 tab by mouth every 4-6 hours as needed (given | tab), tetracycline 500 mg capsule, 1 capsule by mouth three times a day (given | capsule), Review of AHCA Form 1823 dated 11/01/2006 reveals no orders for these medications for this resident, and no orders for these medications were found in the Prescription Copy/New Order file provided by the facility. 12. Resident #13: The label on the blister pack reads "benztropine 1 mg tablet by mouth three times a day " (one tablet was given). Record review of AHCA Form 1823 dated 03/29/06 for “cogentin 1 mg by mouth at 2 a.m. and 2 p.m." The time of administration for the medication is not in agreement with the most recent physician order found in the records. No physician order was found for the dose given on either the AHCA Form 1823 or the Prescription Copy/New Order file provided by the facility. 13. Resident #14: During the medication pass, the following labeled medications were allowed to be taken by the resident: atenolol 25 mg tab, 1 tablet by mouth every morning and evening (given). Crestor 10 mg tablet, 1 tablet by mouth every morning (given), aspirin-low 81 mg EC, | tablet by mouth every morning (given), haloperidol 10 mg tab, 1 tab by mouth every day (given). No order was found during record review for the atenolol, crestor, aspirin-low, or the haloperidol (by mouth). An order was found on AHCA Form 1823 dated 10/26/2001 for " haldol IS 150 mg IM every 4 weeks ". 14. Resident #15: Blister pack labels read: " clogaril 100 mg tab, 1 tab by mouth moming and night " (morning dose given), benztropine | mg tab, ] tab by mouth three times a day (given Mar 31 2009 11:07 MAR-31-2869 11:19 AGENCY HEALTH CARE ADMIN 856 921 @158 P. 16-38 one dose), famotadine 40 mg tab, two tabs by mouth twice a day (given 2 tabs), clonazepam 0.5 mg tab, | tab by mouth three times a day (given 1 tab), fluphenazine 10 mg tab, | tab twice a day (given | tab), and sucralfate 1 mg tab, 1 tab four times a day (given 1 tab). Review of AHCA form 1823 dated 09/17/2008 noted “see copy of medication record.” The copy of medication record referred to on the AHCA Form 1823 was not found in review of the resident ' s records or the Prescription Copy/New Order file provided by the facility. Physician orders for these medications were not found. 15. Resident #16: The label on the blister pack reads: advair diseus 250/50, 1 puff by mouth twice a day (1 puff given), lorazepam 1 mg tab by mouth daily (given), lipitor 10 mg tab by mouth daily (given), crestor 10 mg tab by mouth every morning in (given), enterontin 325 mg tablet by mouth every morning (given), famotadine 20 mg tablet, 1 tab by mouth every day (given), metoprolol 50 mg tablet ER by mouth every morning (given), divalproex DR 500 mg tab, 1 tab by mouth every morning (given). Review of AHCA Form 1823 for this resident reveals no orders for these medications, and no orders for these medications were found in the Prescription Copy/New Order file provided by the facility. 16, Resident #17: Label on the blister pack for “Actos 30 mg tab, 1 tab by mouth daily " (given). Record review of AHCA form 1823 dated 03/29/2006 reveals no order for this medication and no copy of prescription or other order change was found during record review. 17, Resident #19: The label on blister pack reads “amlopidine 5 mg tab, 1 tab by mouth daily " (given). Record review of AHCA Form 1823 dated 12/19/2007 reveals no order for this medication, and no copy of prescription or other order change was found during record review. 18. Resident #20: The label on the blister pack reads: ferrous sulfate 325 meg tablet, ] tablet three times a day (1 tablet given). Review of AHCA Form 1823 dated 09/09/2007 reveals no Mar 31 2009 11:07 MAR-31-2089 11:28 AGENCY HEALTH CARE ADMIN 856 921 4158 P1738 orders for this medication, and no orders for these medications were found in the Prescription Copy/New Order file provided by the facility. 19. Resident #2]: The label on the blister pack reads: meloxicam 7.5 mg tab, } tab by mouth twice a day (given 1 tab), loratadine 10 mg tablet, 1 tablet by mouth daily (given), crestor 10 mg tab, one tab by mouth daily (given), abilify 10 mg tab, | tab by mouth daily (given), namenda 10 mg tab, 1 tab by mouth daily (given), clonazepam 1 mg tab, %4 tab every morning and 1 tab by mouth every evening (given 4 tab). Review of ANCA Form 1823 dated 03/26/2008 reveals no orders for these medications, and no orders for these medications were found in the Prescription Copy/New Order file provided by the facility. 20. That, based on the facts noted above, the Agency determined that the facility failed to ensure that physician orders were maintained in the residents’ records as required by Florida Administrative Code 584-5,024(3)(c). 21. ‘That the Agency determined that this deficiency constituted a State Class II violation in that these conditions or occurrences were related to the operation and maintenance of a facility or to the personal care of residents which directly threaten the physical or emotional health, safety, or security of the facility residents. The Agency cited the Respondent for an isolated Class II deficiency. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(b), Fla. Stat, (2008). COUNT II 22. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5), and Count I as if fully set forth herein, MAR-31-2089 11:28 AGENCY HEALTH CARE ADMIN 856 921 4158 Mar 31 2009 11:07 P.18/38 23. Pursuant to Florida law an assisted living facility shall maintain medical records for residents who are prescribed medications which serve as chemical restraints, Pursuant to Section 429.41, PS., and rule 58A-5.0185(5)(c) the facility shall maintain a record of the prescribing physician’s annual evaluation of the use of the medication. 24, That the Agency conducted a biennial inspection survey on November 11, 2008. 25. That based on observation, record review, and interview with the facility staff the facility failed to maintain a record of a prescribing physician's review of the need to continue, increase, decrease, or discontinue medications for 6 of 10 residents in the sample (resident #s 13, 14, 13, 17, 20, and 21) who have been prescribed, and are given, medications which may be used as a chemical restraint. 26, On November 7, 2008, an observation was conducted of a medication pass for resident #13, who has orders for, and was given Abilify 30 mg by mouth, and 200 mg Seroquel by mouth at approximately 08:30 a.m. 11/07/2008. Record review of this resident confirms physician order for Abilify 30 mg by mouth every morning, and Seroquel 200 mg by mouth. An annual evaluation of the use of these medications was not found during the record review. Interview with the facility Administrator at approximately 13:00 on 11/07/2008 reveals the facility was not aware of the requirement and has no knowledge of the physician conducting an annual review for any of the residents who have been prescribed medications which may be used as chemical restraints. 27. On November 7, 2008, an observation was conducted of a medication pass for resident #14 who was given Haloperidol 10 mg by mouth at approximately 08:35 on 11/07/2008, During the course of the record review for resident # 14, a physician's order for Haloperido] was not found. A review of the facility folder containing prescription copies, and physician order Mar 31 2009 11:08 MAR-31-2089 11:28 AGENCY HEALTH CARE ADMIN 856 921 4158 P1938 changes (provided by the facility Administrator) did not find any order for Haloperidol for resident #14. An annual evaluation of the use of these medications was not found during the record review. Interview with the facility Administrator at approximately 13:00 on 11/07/2008 reveals the facility was not aware of the requirement and has no knowledge of the physician conducting an annual review for any of the residents who have been prescribed medications which may be used as chemical restraints, The facility Administrator could not explain why the medication is given to the resident without a valid physician order. 28, On November 7, 2008, an observation was conducted of a medication pass for resident #15 who was given Clozaril 100 mg by mouth at approximately 08:40 on 11/07/2008. During the course of the record review for resident #15, a physician's order for Clozaril was not found. A review of the facility folder containing prescription copies, and physician order changes (provided by the facility Administrator) did not find any order for Clozaril for resident #15. An annual evaluation of the use of these medications was not found during the record review. Interview with the facility Administrator at approximately 13:00 on 11/07/2008 reveals the facility was not aware of the requirement and has no knowledge of the physician conducting an, annual review for any of the residents who have been prescribed medications which may be used as chemical restraints. The facility Administrator could not explain why the medication is given to the resident without a valid physician order. 29. On November 7, 2008, an observation was conducted of a medication pass for resident #17 who was given Haloperidol 5 mg tablet at approximately 08:45 on 11/07/2008, During the course of record review for resident #1 7,a physician's order was found for Haloperidol 5 mg tablet by mouth three times a day. An annual evaluation of the use of these medications was not found during the record review. Interview with the facility Administrator at approximately 13:00 on 11/07/2008 reveals the facil ity was not aware of the requirement and has Mar 31 2009 11:08 MAR-31-2869 14:21 AGENCY HEALTH CARE ADMIN 856 921 @158 P. 26/38 no knowledge of the physician conducting an annual review for any of the residents who have been prescribed medications which may be used as chemical restraints. The facility Administrator could not explain why the medication is given to the resident without a valid physician order, 30. On November 7, 2008, an observation was conducted of a medication pass for resident # 20 who was given Seroquel 200 mg tablet at approximately 08:50 a.m. on 11/07/2008. During the course of record review for resident #20, a physician's order was found for Seroquel 200 mg by mouth every morning. An annual evaluation of the use of these medications was not found during the record review. Interview with the facility Administrator at approximately 13-00 on 11/07/2008 reveals the facility was not aware of the requirement and has no knowledge of the physician conducting an annual review for any of the residents who have been prescribed medications which may be used as chemical restraints. The facility Administrator could not explain why the medication is given to the resident without a valid physician order. 31. On November 7, 2008, an observation was conducted of a medication pass for resident #21 who was given Abilify 10 mg tablet by mouth at approximately 09:00 a.m. on 11/07/2008. During the course of the record review for resident # 21, a physician's order for Abilify was not found. A review of the facility folder contaiing prescription copies, and physician order changes (provided by the facility Administrator) did not find any order for Abilify for resident #21. An annual evaluation of the use of these medications was not found during the record review. Interview with the facility Administrator at approximately 13:00 on 11/07/2008 reveals the facility was not aware of the requirement and has no knowledge of the physician conducting an annual review for any of the residents who have been prescribed medications which may be used as chemical restraints. The facility Administrator could not explain why the medication is given to the resident without a valid physician order. Mar 31 2009 11:08 MAR-31-2869 14:21 AGENCY HEALTH CARE ADMIN 856 921 @158 P.21-38 32, That the above noted medications, Abilify, Seroquel, Haloperidol, Clozaril, are all medications which serve as chemical restraints. 33. Failure to maintain a record of a prescribing physician’s review of the need to continue, increase, decrease, or discontinue medications for 6 of 10 residents in the sample who have been prescribed, and are given, medications which may be used as a chemical restraint, can endanger the health and safety of residents and is contrary to Florida law. 34. That, based on the facts noted above, the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the physical or emotional health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 35. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(b), Fla. Stat. (2008). COUNT 10 36. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5), and Count I as if fully set forth herein. 37. That pursuant to Florida law, when food service is provided by the facility, the administrator or a person designated in writing by the administrator shall perform his/her duties in a safe and sanitary manner. (58A-5,020 (1)(b), FAC.) 38. That the Agency conducted a biennial inspection survey on November 11, 2008. 39. That based on observation, record review, and interview with the facility staff, the administrator or food service designee failed to perform his or her duties in a safe and sanitary manner, Mar 31 2009 11:09 MAR-31-2089 14:21 AGENCY HEALTH CARE ADMIN 856 921 4158 P.22/38 40. Based on observation and interview, it was determined the facility administrator and cook failed to ensure food preparation and service duties were carried out in a safe and sanitary Manner. 41. That observations during the noon meal on 11/6/08 beginning at approximately 12:35 PM revealed the following: 42. — Two food service personnel were serving food without hair covering. 43, Numerous flies were observed buzzing around the food preparation, service, and dining areas. Two fly strips were suspended from the ceiling in the dining area, one completely covered with dead flies. The side door and several windows in the dining hall were being left open without screen covering to prevent the flies from entering the building. 44. A table fan was sitting on a counter in the kitchen near the sinks and was blowing air directly toward the stove and food preparation table. The fan grates were covered with an accumulation of dust and dirt. 45. A package of cigarettes was lying on a food preparation table, with a partially smoked cigarette lying directly on the table. 46. Observations at approximately 12:55 PM revealed residents scraping uneaten food onto their plates from the plates of other residents. One resident was even observed taking a dirty plate from the dirty plate bus bin and scraping the uneaten food onto his/her plate and then proceeded to eat the food. This resident was observed asking a dietary staff member if he/she could take the uneaten food from the dirty bus bin, to which the staff member replied, "I guess 80.” 47, Observations and interview with the head cook on 11/6/08 beginning at approximately 2:15 PM revealed staff washing plastic eating utensils. When the surveyor questioned the need 10 Mar 31 2009 11:09 MAR-31-2089 11:22 AGENCY HEALTH CARE ADMIN 856 921 4158 P2338 to wash the disposable spoons, staff confirmed the re-use of the disposable, single-use eating utensils. 48. Staff was questioned regarding the water/soap/sanitizer content of the three sinks being used to wash all food preparation and service equipment (the facility does not have an automatic dishwasher and must manually wash and sanitize all food preparation and service equipment). The employee washing dishes at the time stated that the first sink contained water, soap, and bleach, the second sink contained water and bleach and the third and final sink contained water only. The food service staff were washing equipment using the three sinks in consecutive order, therefore, using the water only as the final step in the dishwashing process. 49. Interview with the food service staff revealed there was no thermometer available in the kitchen for measuring food temperatures, therefore, no means to ensure foods were being cooked to and served at safe temperatures. 30, Observations, at approximately 2:35 PM, of the food storage freezers located in the portable storage unit next to the kitchen/dining hall revealed no evidence of thermometers to measure the temperature of the freezer units. 31. Failure to ensure food preparation and service duties are carried out in a safe and sanitary manner can endanger the health and safety of residents and is contrary to Florida law. 52. That, based on the facts noted above, the Agency determined that this deficient practice was related to the operation and maintenance of a facility or to the personal care of the resident that directly threatened the physical or emotional health, safety, or security of the resident and cited Respondent for a State Class IT deficiency. 53. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(2)(b), Fla. Stat. (2008). Mar 31 2009 11:09 MAR-31-2089 11:22 AGENCY HEALTH CARE ADMIN 856 921 4158 P.24/38 COUNT IV 54. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5), and Count I as if fully set forth herein. 55. Pursuant to Florida law the owner or administrator of an assisted living facility must conduct level 1 background screening, as set forth in chapter 435, on all employees hired on or after October 1, 1998, who perform personal services as defined in s. 429.02(16). The agency may exempt an individual from employment disqualification ag set forth in chapter 435. 429.174 FS. 56. That the Agency conducted a biennial inspection survey on November 11, 2008. 57. That based on observation, record review, and interviews the facility was in violation of this statutory requirement because it continued to employ an employee (#5) in a personal services position from which he/she was disqualified. 58. Review of the personnel record of employee #5 revealed the employee was hired on 9/27/07. The employee was listed on the personnel roster as a Direct Care Staff/Medication Technician and was on the current work schedule (November 1-7) as the only staff on duty from 4:30 PM to 11:00 PM from November 3-6, 2008. 39. The duties of Direct Care Staff/Medication Technician fall within the meaning of personal services. 60. "Personal services" means direct physical assistance with ot supervision of the activities of daily living and the self-administration of medication and other similar services which the department may define by rule, 429.02 (16), F.S. 61. Further review of the employee's personnel record revealed a letter from the Agency for Healthcare Administration Background Sercening Unit, dated February 4, 2008, which was 12 Mar 31 2009 11:10 MAR-31-2089 11:25 AGENCY HEALTH CARE ADMIN 856 921 4158 P2534 informing the employee of the Agency's decision regarding the employee's request for an exemption from disqualification from employment, The letter stated the employee had been granted an exemption from disqualification for NON-PATIENT care employment. 62. During interview on 11/7/08 at approximately 1:30 PM, both the administrator and assistant administrator stated they were unaware of the limitations of the exemption that had been granted for employee #5. The assistant administrator stated, "T must have missed that.” 63. Even though employee #5 did not meet the background screening requirements for direct care to residents, the facility continued to employ him/her in a position for which he/she was disqualified because of background screening requirements. 64. Failure to ensure 1 of 7 sampled employees (#5) had necessary background screening exemptions to allow continued employment in a personal services position can endanger the health and safety of residents and is contrary to Florida law, 65. That, based on the facts noted above, the Agency determined that this deficient practice was related to the operation and maintenance of a facility or to the personal care of the resident that directly threatened the physical or emotional health, safety, or security of the resident and cited Respondent for a State Class II deficiency. 66. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 429,19(2)(b), Fla, Stat, (2008). COUNT V 67. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and the entirety of this Complaint as if fully recited herein. 68. That the Agency can revoke any license issued under Part I of Chapter 429 for an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the 13 Mar 31 2009 11:10 MAR-31-2089 11:25 AGENCY HEALTH CARE ADMIN 856 921 4158 P2638 facility. Section 429.14(1)(a) Florida Statutes (2008). 69. That the deficiencies noted above in counts I, II, IJ, and IV constitute intentional or negligent acts seriously affecting the health, safety, or welfare of a resident of the facility. 70 That the Agency may revoke any license issued under Part I of Chapter 429 Florida Statutes (2008) for the citation of one (1) or more cited Class I deficiencies, three (3) or more cited Class II deficiencies, or five (5) or more cited Class III deficiencies that have been cited on a single survey and have not been corrected within the specified time period, Section 429.14(1)(e) Florida Statutes (2008). 71, That the Respondent has been cited with four (4) Class II deficiencies on an Agency complaint survey of November 7, 2008. 72. That the Agency seeks the revocation of the Respondent’s licensure. That should the Respondent admit the facts herein by action or inaction, the Petitioner shall enter an Order revoking the Respondent’s, WHEREFORE, the Agency intends to revoke the license of the Respondent to operate an assisted living facility in the State of Florida, pursuant to §§ 408.815(1)(d) and 429.14(1}(e) , Florida Statutes (2008). CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: {A) Make factual and legal findings in favor of the Agency on Counts I, I, II, TV, and V; (B) Recommend administrative fines against Respondent in the amount of $5,500 (five thousand five hundred) $5,000 for four state Class II deficiencies (five thousand); Mar 31 2009 11:10 MAR-31-2869 11:23 AGENCY HEALTH CARE ADMIN 856 921 @158 P2738 (C) Revoke the Respondent’s license number 546] to operate as an assisted living facility. (D) Assess attorney’s fees and costs; and (E) Grant all other general and equitable relief allowed by law. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the atiached Election of Rights form. Al} requests for hearing: shail be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308, (850) 922-5873. If you want to hire an attomey, you have the right to be represented by an attorney in this matter. ' 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, gp PR 3 Respectfully submitted this.) __ day of March, 2009. Bitte sseylidcck Ub Nieneh MaryAlice H. David, Esquire Assistant General Counsel Florida Bar No. 0831921 Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Mar 31 2009 11:11 MAR-31-2089 11:25 AGENCY HEALTH CARE ADMIN 856 921 4158 P.28/38 CERTIFICATE OF SERVICE T HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7001 0360 0003 3808 3604 on March 5, 2009 to Sheila Hall, Registered Agent, 2563 River Road, Caryville, Florida 32427, and by U.S. Certified Mail, Return Receipt No. 7001 0360 0003 3808 3611 on March 5, 2009 to Sheila Hall, Officer, 2563 River Road, Caryville, Florida 32427. Copies furnished to: MaryAlicé H. David Assistant General Counsel Barbara Alford HQA Field Office Manager Agency for Health Care Administration 2727 Mahan Drive, MS #46 Tallahassee, Florida 32308 wa ftore Midd Sheila Hall Administrator 2563 River Road Caryville, Flonda 32427 (U.S. Certified Mail) Alberta Granger MaryAlice H. David Manager Assistant General Counsel Assisted Living Facilities Unit Agency for Health Care Administration 2727 Mahan Drive MS$# 30 2727 Mahan Drive M$# 3 Tallahassee, Florida 32308 Tallahassee, Florida 32308 (nterofffice) (Interoffice) Mar 31 2009 11:11 MAR-31-2689 11:24 AGENCY HEALTH CARE ADMIN 858 921 8158 _P. 29438 Bad rosin sence. Hom | Hei Stann _ | Track &Contim FAQs Track & Confirm Search Results Labal/Receipt Number: 7001 0360 0003 3808 3604 Status: Delivered Your item was delivered at 3:29 PM on March 9, 2009 in CARYVILLE, FL 32427, Notiticatian Options Track & Confirm by email Get current event information or updates for your item sent to you or others by email. Ce =) Site Map Gontae, Ws Forma, Gov Berviows dake Privacy Polley Terms of Mae National & Premer Acrounts Copyright® 1994-2007 USPS, All Rights Reserved. NoFEARAGCLEEQDala FOIA @ http://trkenfrm1.smi.usps.com/PTSInternetWeb/InterLabellnquiry.do 3/25/2009 Mar 31 2009 11:11 856 921 4158 P. 3838 MAR-31-2089 11:24 AGENCY HEALTH CARE ADMIN ; s. Postal Service CERTIFIED MAIL REGEIPT (Domestic Mai} Only: No insurance Coverage Pravided) Postaga | $ chttesre| | Fotum Racelpt Feg Bu (Enciorsemment Baquies) CD Restrictod Delivary Fea I (Endersoment Aequirad) co CTotal Postaye & Foes 3808 3604 wei lO. Cel), Bes Soersr may Street, Apt No; 5[" FO Box Now) iG . Berton. . . A ‘ ha U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only: No Insurance Coverage Provided) Poatage | $ Cortiflad Fea Return Racalpt Fea (Endorsement Required) Rostricted Dallvary Rea (Endorsement Required) | [1 Total Postage & Fans 0 0003 3808 3L11 ee at oe i ee: ‘ wie “TOTAL P. 38

Docket for Case No: 09-001663