FILED STATE OF FLORIDA agent? oA AGENCY FOR HEALTH CARE ADMINISTRATION ENCY CLERK 2013 HAR - oT STATE OF FLORIDA, AGENCY FOR M-H P BYP | HEALTH CARE ADMINISTRATION, a Petitioner, . u 4 He - a v. , AHCA No. 2012005108 ALL AMERICA ADULT CONGREGATE LIVING FACILITY, INC. d/b/a ALL AMERICA ACLF', Respondent. / ee ADMINISTRATIVE COMPLAINT. COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (“the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, All America Adult Congregate Living Facility, Inc. d/b/a All America ACLF (“the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2011), and alleges: _ 1 According to the Florida Division of Corporations website, this fictitious name is not registered. Under Florida law, a person may not engage in business under a fictitious name unless the person first registers the name with the division by filing a sworn statement listing: (a) The name to be registered. (b) The mailing address of the business. (c) The name and address of each owner and, if a corporation, its federal employer’s identification number and Florida incorporation or registration number. (d) Certification by the applicant that the intention to register such fictitious name has been advertised at Jeast once in a newspaper as defined in chapter 50 in the county where the principal place of business of the applicant will be located. (e) Any other information the division may deem necessary to adequately inform other governmental agencies and the public. as to the persons so conducting business. - Such stateirient shall be accompanied by the applicable processing fees and any other taxes or penalties owed to the state. § 865.09(3), Fla. Stat. (2011). Under Florida law, ifa business fails to.comply with this section, the business,. ; its members, and those interested in doing such business may rot-avaintain any action, suit; of proceeding in any court of this state until this section is complied with. An action, suit, or proceeding may not be maintained in any court of this state by any successor or.assignee of such business on any right, claim, or demand arising out of the transaction of business by such business’in this state until this section has been complied with. § 865.09(9), Fla. Stat. (2011). NATURE OF THE ACTION This is an action against an assisted living facility to impose an administrative fine in the amount.of one thousand five hundred dollars ($1,500.00) based upon one Class II deficiency. PARTIES 1, The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable state statutes and rules governing such facilities. Ch. 408, Part Il, Ch. 429, Part I, Fla. Stat. (2011); Ch. 58A-5, Fla. Admin. Code. The Agency may. deny, revoke, and suspend any license issued to an assisted living facility and impose an administrative fine for a violation of the Health Care Licensing Procedures Act, the authorizing statutes or applicable rules. §§ 408.813, 408.815, 429.14, 429.19, Fla. Stat. (2011). In addition to licensure denial, revocation or suspension, or any administrative fine imposed, the Agency may assess a survey fee against an assisted living facility. § 429.19(7), Fla. Stat. (2011). 2. The Respondent was issued a license by the Agency to operate an assisted living facility located at 808 West Ist Avenue, Hialeah, Florida 33010 (“the Facility”), and was at all times material required to comply with the applicable statutes and rules governing assisted living facilities. Assisted living facilities are residential care facilities that provide housing, meals, personal care and supportive services to older persons and disabled adults who are unable to live independently. These facilities are intended to be a less costly alternative to the more restrictive, institutional settings for individuals who do not require 24-hour nursing supervision. Assisted living facilities are regulated in a manner so as to encourage dignity, individuality, and choice for residents, while providing them a reasonable assurance for their health, safety and welfare. Generally, assisted living facilities provide supervision, assistance with personal care and supportive services, as well as assistance with, or administration of, medications to residents who require such services. COUNT I Deficient Staffing Standards 4. Under Florida law assisted living facilities shall be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff and the provision of adequate care to all residents. The administrators shall: (1) be at least 21 years of age; (2) if employed on or after August 15, 1990, have a high school diploma or general equivalency diploma (G.E.D.), or have been an operator or administrator of a licensed assisted living facility in the State of Florida for at least one of the past 3. years in which the facility has met minimum standards. Administrators employed on or after October 30, 1995, must have a high school diploma or G.E.D.; (3) Be in compliance with Level 2 background screening standards pursuant to Section 429,174, F.S.; and (4). Complete the core training requirement pursuant to Rule 58A-5.0191, F.A.C. Ch. 58A-5.019, Fla. Admin. Code. 5. In addition, administrators may supervise a maximum of either three assisted living facilities or a combination of housing and health care facilities or agencies on a single campus. However, administrators who supervise more than one facility shall appoint in writing a separate “manager” for each facility who must: (1) be at least 21 years old; (2) complete the core training requirement pursuant to Rule 58A-5.0191, F.A.C, Ch, 58A-5.019, Fla. Admin. Code. 6. Pursuant to Section 429.176, F.S., assisted living facility owners shall notify both the Agency Field Office and Agency Central Office within ten (10) days ofa change ina facility administrator on the Notification of Change of Administrator, AHCA Form 3180-1006, January 2006, which is incorporated by reference and may be obtained from the Agency Central Office. ‘The Agency Central Office shall conduct a background screening on the new administrator in accordance with Section 429.174, F.S., and Rule 58A-5.014, F.A.C. Ch. 58A-5.019, Fla. Admin. Code. 7. On or about March 27, 2012, the Agency conducted a monitor survey of the Respondent. 8. Based on record review, and interview the facility failed to ensure all staf who are employed after 8/1/10, whose responsibilities may require him or her to provide personal care or services directly to clients or have access to client funds, personal property, or living areas, has a level II background screening for 1 (Staff A) of 7 staff reviewed. 9, During an interview with Staff E, the medication tech, she revealed the p.m. shift signatures on the Medication Observation Records for 3/23/12,.3/24/12, 3/25/12 and 3/26/12 belonged to Staff A, a newly hired and training medication tech. 10. During an interview with the administrative assistant on 3/27/12, at 10:30 a.m. sthe administrative assistant stated Staff A was not a Staff. 11. Staff. A was hired on 3/16/12. 12. When asked if she was telling the surveyor, a non-staff person had access to and passed resident medications for 4 nights, the administrative assistant stated yes. 13. The adrninistrative assistant then qualified by saying the person was hired and was being trained, but had not been put on the staff schedule yet. Staff A's record was requested at that time. 14. A review of the file for Staff A revealed no Level II background screening. 15. The administrative assistant then stated she knew Staff A had gone down and had her prints taken, but may not have results yet. 16. The administrative assistant stated she would contact the staff for the receipt of payment or results. 17, None were received by exit at 2:00 p.m. 18, The Respondent’s actions or inactions constituted a class II violation. 19, Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the Agency determines directly threaten the physical or emotional health; safety, or security of the-clients,-other-than class_I.. violations. § 408.813(2)(a), Fla. Stat. (2011). 20. Under Florida law, the Agency shall impose an administrative fine for a cited class U violation in an amount not less than $1,000 and not exceeding $5,000 for each violation. § 429.19(2)(b), Fla. Stat. (2011). A fine shall be levied notwithstanding the correction of the violation. § 408.813(2)(a), Fla. Stat. (2011). WHEREFORE, the State of Florida, Agency for Health Care Administration, seeks an administrative fine against the Respondent in the amount of $1,500.00. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief: 1. Make findings of fact and conclusions of law in favor of the Agency. 2. Impose the relief against the Respondent as set forth above. Respectfully submitted on this 19 day of February, 2013. /s/JohnBradley John E. Bradley Assistant General Counsel Florida Bar No. 92277 Office of the General Counsel Agency for Health Care Administration 272’1 Mahan Drive, Suite 3431 Fort Knox Building 3, MS3 Telephone: (850) 412-3658 Facsimile: (850) 921-0158 NOTICE The Respondent is notified that it/he/she has the right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. If the Respondent wants to hire an attorney, it/he/she has the right to be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights form. The Respondent is further notified if the Election of Rights form is not received by the — Agency for Health Care Administration within twenty-one (21) days of the receipt of this Administrative Complaint, a final order will be entered. The Election of Rights form shall be made to the Agency for Health Care Administration and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 412-3630. CERTIFICATE OF SERVICE EAL 1 HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights were served to: Pedro Rojas, Administrator, 808 West 1st Avenue, Hialeah, Florida 33010, by Certified Mail Receipt (7011. 1570 0000 3003 1483), on this 19 day of February 2013. /s/John Bradley _ John E. Bradley Assistant General Counsel Florida Bar No. 92277 Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3, MS3 Telephone: (850) 412-3658 Facsimile: (850) 921-0158 Copies: Arlene Mayo-Davis, FOM SENDER: COMPLETE THIS SECTION m Complete items 1,2, and 3. Also complete | _ {tem att Restricted Dellvary Is desired. | mt Print your name and. address on the reverse so that we gan return the card to you. | m Attach this’card to the back of the mailplece, or on the front If space permits. 1. Article Addressed to: D. Is delivery address different from item 1? 1 Yes IFYES, entet delivery address below: CINo © ‘3, Service Type . “Cy Certified Mall C1:Express Mall C1 Registered aturn Receipt for Merchandise Di insured Mall F.C... 4. Restricted Delivery? (Extra Fee) 0 Yes 2. Article Number { (Transfer from service label) Se 700 8 323 a oon3 5 O48 24 & 5 PS Form 381 1, February 2004 Domestic Return Recelpt 102595-02. M1640 Certified Fea Postmark Fleturn Receipt Fee * Here (Endorsement Flequired) Restricted Delivery Feo (Endorsement Flaqhlred) ‘Fotal Postage & Faes aks fi 7008 3230 0003 5046 2489

Docket for Case No: 13-002939