STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, VS. Case Nos. 2009010662 FAMILY FRIEND RESPITE, 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 Family Friend Respite Care, (hereinafter _ “Respondent”), pursuant to Section 429, Part I, 408, Part II, 120.569 and 120.57, Florida Statues. NATURE OF THE ACTION This is an action to Revoke the license number 11502 issued to Family Friend Respite pursuant to § 408.815(c), Florida Statues. JURISDICTION AND VENUE 1. This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes. | 2. The Agency has jurisdiction over the Respondent pursuant to Chapter 429, Part I Florida Statutes, Chapter 58A-5, Florida Administrative Code and Chapter 400, Part II, Florida Statutes. Filed October 27, 2009 3:48 PM Division of Administrative Hearings. 3. Venue is pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the regulatory authority responsible for licensure of nursing facilities and enforcement of applicable federal regulations, state statutes and rules governing assisted living pursuant to Chapter 429, Part I, Florida Statutes; and, Rule 58A-5, Florida Administrative Code. 5. Respondent operates an assisted living facility located at 8436 Gamble Rd., Monticello, Florida 32344, having been issued license number 11502. 6. Respondent was at all times a licensed assisted living facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. | COUNT I THE RESPONDENT FAILED TO REFUND A PREVIOUS RESIDENT’S MONIES WITHIN 45 DAYS OF DISCHARGE 7. The Agency re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. Pursuant to Section 429.24(3)(a), Florida Statutes, a facility is required to provide a refund to the resident or responsible party within 45 days after the transfer, discharge, or death of the resident. 9. Pursuant to Section 429.14(c), Florida Statutes, the agency may revoke the license of a facility for the misappropriation or conversion of a resident’s property. 10. Pursuant to Section 408.815(c), Florida Statutes, the Agency may revoke the licensee of a facility for the failure a violation of this part, authorizing statutes, or applicable rules. 11. On or about March 12, 2009, the Agency conducted a survey of the Respondent's facility (“Facility”), and observed the following deficiency: A. Resident #2 Resident #2 was discharged from the facility on January 20, 2009, and the resident's room was vacated on 1/22/09. The family of Resident #2 stated that they sent funds to the facility on February 1, 2009 in the amount of ~ $3,930. The payment was sent approximately 11 days after the discharge of Resident #2. The family is requested remittance of those funds. An interview with the facility administrator was conducted on March 12, 2009, at approximately 12:15p.m. The administrator confirmed receiving a payment from the family of Resident #2 during the first week of February 2009. This was approximately 2 weeks after the resident moved out. The administrator stated that no invoice or explanation was received with the funds. The administrator confirmed depositing the funds about 1 week after receipt. The administrator confirmed that the funds had not been remitted. 12. Asa result of the above cited deficiencies, the Agency provided a mandatory correction date of April 12, 2009, to correct the deficiency. 13. On or about April 15, 2009, the Agency conducted a follow-up survey of the Respondent's facility, and observed the following deficiency: An interview was conducted with the facility administrator on April 15, 2009, at approximately 10:25a.m. The facility administrator confirmed that the payment of $3,930 dollars had not yet been remitted. The administrator stated that the facility did not have the money.. The administrator stated that the funds would be remitted when the facility received a new admission. This was inconsistent with the facilities earlier representation that the funds would be remitted by April 8, 2009. Prior to the April 15, 2009, survey of the facility, the family of resident #2:was contacted to verify whether the facility had refunded the monies owed, The family stated that the facility had not received the funds as of date. 14. On or about July 21, 2009, the Agency conducted another survey to determine whether the funds had been remitted and found the following: An interview with the Administrator revealed that the facility had not remitted the funds to the family. The administrator stated they did not have the funds because they were already spent. The administrator further stated that the funds would be remitted once they receive their tax return. 15. More than seven months have passed between the date the resident was removed from the facility and the date of the Agency’s July 21, 2009, survey and there has been no remittance of funds to aid the family in the care of their loved one. 16. Based on observation, interview and record review, the facility failed to refund the funds owed to the family or the resident within 45 days of discharge, which is in violation of Section 429.24(3)(a), Florida Statutes. 17. Respondent’s failure to provide these funds is in violation of Section 429.24(3)(a), Florida Statutes. 18. WHEREFORE, the Agency intends to Revoke the license number 11502 issued to Family Friend Respite pursuant to § 408.815(c), Florida Statues. Respectfully submitted this ___ day of October, 2009. Shaddrick A. Haston Fla. Bar. No. 31067 Agency for Health Care Administration 2727 Mahan Dr. MS#3 Tallahassee, FL 32301 850-487-9845 (office) 850-921-0158 (fax) CERTIFICATE OF SERVICE I. HEREBY .CERTIFY that the Administrative Complaint and Election of Rights form has been served to:, Edward G. Covington, Administrator, Family Friends Respite, Monticello, FL 32344, by U.S. Certified Mail, Return Receipt Requested, American Safety Council, Inc. C/O Covington Legacy Incorporated, 5125 Adanson St., Suite 500, Orlando, FL 32804, by U.S. £8 ihe Certified Mail, Return Receipt Requested on this _ 5°" " day of October, 2009. Shaddrick A. Haston Copies furnished to: Edward G, Covington, Administrator Shaddrick A. Haston Family Friend Respite Agency for Health Care Admin. 8436 Gamble Rd. Office of the General Counsel Monticello, Florida 32344 2727 Mahan Drive, MS #3 (U.S. Certified Mail) Tallahassee, Florida 32308 (interoffice) Barbara Alford Field Office Manager Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice) USPS - Track & Confirm Page 1 of 1 UNIT “2 STATES PS Bosh iL SERVICES: Home | Help | Sign in Track & Confirm Track & Confirm Search Results Label/Receipt Number: 7008 1300 0000 6174 2081 oo ar Service(s): Certified Mail™ Traok & Confirm Status: Notice Left Enter Label/Receipt Number. We attempted to deliver your item at 11:35 AM on October 10, 2009 in cece tenes ce contin eneeenn MONTICELLO, FL 32344 and a notice was left. 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Docket for Case No: 09-005960