Apr i? 2009 14:54 APR-17-2889 16:87 AGENCY HEALTH CARE ADMIN 856 921 4158 P.@6/11 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2009001852 v. Return Receipt Requested: 7008 0500 0002 0764 9848 FAMILY HOME HEALTH LLC D/B/A FAMILY HOME HEALTH LLC, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (SAHCA”), by and through the undersigned counsel,, and files this administrative complaint against Family Home Health LLC d/b/a Family Home Health LLC (hereinafter “Family Home Health LLG ”), pursuant to Chapter 400, Part IIZ, and Section 120.60, Florida Statutes (2008), and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $5,000.00 pursuant to Section 400.476(2)(b), Florida Statutes (2008), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes (2008). Apr i? 2009 14:54 APR-17-2889 16:87 AGENCY HEALTH CARE ADMIN 856 921 4158 P.@?71i 3. Venue lies in Broward County pursuant to 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 home health agencies, pursuant to Chapter 400, Part III, Florida Statutes, and Chapter 59A-8 Florida Administrative Code. 5. Family Home Health LLC operates a home health agency presently located at 2175 SW 78%? Place, Miami, Florida 33155. Family Home Health LLC is licensed as a home health agency under license number 299993244, with an expiration date of August 11, 2010. Pamily Home Health LLC 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 T FAMILY HOME HEALTH LLC OPERATED WITHOUT A DON FOR MORE THAN 30 DAYS Section 400.476(2) (b), Florida Statutes (2008) CLASS II DEFICIENCY 6. ARCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. The Home Care Unit was informed by the outgoing DON by mail dated December 10, 2008, that she would no longer be Family Home Health’s DON effective December 190, 2008, The Apr i? 2009 14:54 APR-17-2889 16:87 AGENCY HEALTH CARE ADMIN 856 921 4158 P.@811 Home Health Agency was notified in a letter dated) December 17, 2008 that a new DON needed to be appointed and the qualifications needed to be approved by AHCA per 400.476(2), Florida Statutes. 8. In addition, the home health agency was advised in the letter that effective July 1, 2008, home health agencies that operate without a DON for 30 days commit a Class II deficiency. The Home health agency has operated without a DON for more than 30 days. 9. Based on the foregoing facts, Family Home Health LLC violated Section 400,.476(2)(b), Florida Statutes, herein a Class II deficiency, which carries in this case an assessed fine of $5,000.00. 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 Family Home Health LLC on Count I. 2. Assess against Family Home Health LLC an administrative fine of $5,000.00 on Count I, for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. Grant such other relief as the court deems is just and proper on Count I. Apr i? 2009 14:55 APR-17-2889 16:87 AGENCY HEALTH CARE ADMIN 856 921 4158 P.@911 Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. 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 RECETPT 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. ria “Law ~On- Russell, Assistant General Counsel Agency for Health Care Administration 8355 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (Interoffice Mail) Revenue and Management Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Apr i? 2009 14:55 APR-17-2889 16:88 AGENCY HEALTH CARE ADMIN 856 921 4158 P1811 Home Health Agency 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 feregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Victor Felipe Perez, 175 Sw 78%? Place, Miami, Florida on this L day #@f 2009. f Tria Lawton-Russel 35 Apr 1? 2009 14 matt 856 921 4158 . AGENCY HEALTH CARE ADMIN APR-17-2889 16:69 COMPLETE THIS SEE 2, and 8. Also completa Delivery ts desired re8s on the reverse rd to Viola, Fakjoe. fe ob ge, Fiswretee Bhs Mate ay ce Wed 7B FT Tee are, FL, BB os 2. Article Number — 0 Yes (aneter trom servieg j 7008 oso O02 o7Ry Fay4g en PS Form 3877, February 2004 Domestic Return Receipt NR59502Merg40 : US. Postal Service |, | CERTIFIED MAIL.., RECEIPT a (Domestic Mait Only; No Insuranes Caverage Provided) . 454 For delivery information visit Our website at WWW.uspS.camy OF E AL &4 FRetum Recetpt Fae (Endorgeman| Feduiredt) Aostrictart Delivery Foe (Erdorsemant Required) ‘Total Postige & Fees Bisae Agh Nepreen-eene— end, orbe ‘Na, Ohi Sista, i 7008 9500 oo0e o7 (3 Form 380, August 2008 Ber Reverse tar lastiuiene TOTAL P.14

Docket for Case No: 09-002072