STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATIO > Petitioner, vs. AHCA No. 2013013207 License No. 1442096 PINES NURSING HOME 77, INC., d/b/a File No. 111335 PINES NURSING HOME, Provider Type: Nursing Home Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Pines Nursing Home (77), Inc. d/b/a Pines Nursing Home (hereinafter “the Respondent”), pursuant to sections 120.569 and 120.57, Florida Statutes (2013), and alleges: NATURE OF THE ACTION This is an action to revoke the Respondent’s nursing home license. PARTIES 1. The Agency is the licensing and regulatory authority that oversees skilled nursing facilities (also called nursing homes) and enforces the state statutes and rules governing such facilities. Ch. 408, Part II, Ch. 400, Part II, Fla. Stat.; Ch. 59A-4, Fla. Admin. Code. The Agency is authorized to deny, suspend, or revoke a license, and impose administrative fines pursuant to sections 400.121, and 400.23, Florida Statutes, assign a conditional license pursuant to subsection 400.23(7), Florida Statutes, and assess costs related to the investigation and prosecution of this case pursuant to section 400.121, Florida Statutes. 2. The Respondent was issued a license by the Agency to operate a skilled nursing facility located at 301 NE 141" Street, Miami, FL 33161, and was required to comply with the applicable state statutes and rules. COUNT I Disqualifying Criminal Offense - Lana Goldfinger 3. Under Florida law, the Agency shall require level 2 background screening for personnel as required in section 408.809(1)(e) pursuant to chapter 435 and section 408.809, § 400.215(1), Fla. (2013). 4. Under Florida law, level 2 background screening pursuant to chapter 435 must be conducted through the agency on each of the following persons, who are considered employees for the purposes of conducting screening under chapter 435: (a) The licensee, if an individual. (b) The administrator or a similarly titled person who is responsible for the day-to-day operation of the provider. (c) The financial officer or similarly titled individual who is responsible for the financial operation of the licensee or provider. (d) Any person who is a controlling interest if the agency has reason to believe that such person has been convicted of any offense prohibited by s. 435.04. For each controlling interest who has been convicted of any such offense, the licensee shall submit to the agency a description and explanation of the conviction at the time of license application. (e) Any person, as required by authorizing statutes, seeking employment with a licensee or provider who is expected to, or 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; and any person, as required by authorizing statutes, contracting with a licensee or provider whose responsibilities require him or her to provide personal care or personal services directly to clients. Evidence of contractor screening may be retained by the contractor’s employer or the licensee. § 408.809(1), Fla. Stat. (2013). 5. Under Florida law, every 5 years following his or her licensure, employment, or entry into a contract in a capacity that under subsection (1) would require level 2 background screening under chapter 435, each such person must submit to level 2 background rescreening as a condition of retaining such license or continuing in such employment or contractual status. For any such rescreening, the agency shall request the Department of Law Enforcement to forward the person’s fingerprints to the Federal Bureau of Investigation for a national criminal history record check. If the fingerprints of such a person are not retained by the Department of Law Enforcement under s. 943.05(2)(g), the person must file a complete set of fingerprints with the agency and the agency shall forward the fingerprints to the Department of Law Enforcement for state processing, and the Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history record check. The fingerprints may be retained by the Department of Law Enforcement under section 943.05(2)(g). The cost of the state and national criminal history records checks required by level 2 screening may be borne by the licensee or the person fingerprinted. Until the person’s background screening results are retained in the clearinghouse created under section 435.12, the Agency may accept as satisfying he requirements of this section proof of compliance with level 2 screening standards submitted within the previous 5 years to meet any provider or professional licensure requirements of the agency, the Department of Health, the Department of Elderly Affairs, the Agency for Persons with Disabilities, the Department of Children and Family Services, or the Department of Financial Services for an applicant for a certificate of authority or provisional certificate of authority to operate a continuing care retirement community under chapter 651, provided that: (a) The screening standards and disqualifying offenses for the prior screening are equivalent to those specified in section 435.04 and this section; (b) The person subject to screening has not had a break in service from a position that requires level 2 screening for more than 90 days; and (c) Such proof is accompanied, under penalty of perjury, by an affidavit of compliance with the provisions of chapter 435 and this section using forms provided by the Agency. § 408 .809(2), Fla. Stat. (2013). 6. Under Florida law, in addition to the offenses listed in Section 435.04, all persons required to undergo background screening pursuant to this part or authorizing statutes must not have an arrest awaiting final disposition for, must not have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, and must not have been adjudicated delinquent and the record not have been sealed or expunged for any of the offenses listed in Section 408.809(4) or any similar offense of another jurisdiction. § 408.809(4), Fla. Stat. (2013). 7. Under Florida law, if an employer or agency has reasonable cause to believe that grounds exist for the denial or termination of employment of any employee as a result of background screening, it shall notify the employee in writing, stating the specific record that indicates noncompliance with the standards in this chapter. It is the responsibility of the affected employee to contest his or her disqualification or to request exemption from disqualification. The only basis for contesting the disqualification is proof of mistaken identity. § 435.06(1), Fla. Stat. (2013). 8. Under Florida law, an employer may not hire, select, or otherwise allow an employee to have contact with any vulnerable person that would place the employee in a role that requires background screening until the screening process is completed and demonstrates the absence of any grounds for the denial or termination of employment. If the screening process shows any grounds for the denial or termination of employment, the employer may not hire, select, or otherwise allow the employee to have contact with any vulnerable person that would place the employee in a role that requires background screening unless the employee is granted an exemption for the disqualification by the Agency as provided under Section 435.07. § 435.06(2)(a), Fla. Stat. (2013). If an employer becomes aware that an employee has been arrested for a disqualifying offense, the employer must remove the employee from contact with any vulnerable person that places the employee in a role that requires background screening until the arrest is resolved in a way that the employer determines that the employee is still eligible for employment under this chapter. § 435.06(2)(b), Fla. Stat. (2013). The employer must terminate the employment of any of its personnel found to be in noncompliance with the minimum standards of this chapter or place the employee in a position for which background screening is not required unless the employee is granted an exemption from disqualification pursuant to Section 435.07. § 435.06(2)(c), Fla. Stat. (2013). 9. Under Florida law, any employee who refuses to cooperate in such screening or refuses to timely submit the information necessary to complete the screening, including fingerprints if required, must be disqualified for employment in such position or, if employed, must be dismissed. § 435.06(3), Fla. Stat. (2013). 10. Under Florida law, unless otherwise specified in this part, authorizing statutes, or applicable rules, any information required to be reported to the agency must be submitted within 21 calendar days after the report period or effective date of the information, whichever is earlier, including, but not limited to, any change of: (a) Information contained in the most recent application for licensure. (b) Required insurance or bonds. § 408.810(3), Fla. Stat. (2013). 11. Under Florida law, whenever a change of ownership occurs: The transferor shall notify the agency in writing at least 60 days before the anticipated date of the change of ownership. § 408.807(1), Fla. Stat. (2013). Under Florida law, whenever a change of ownership occurs: The transferee shall make application to the agency for a license within the timeframes required in section 408.806. § 408.807(2), Fla. Stat. (2013). 12. In June 2013, per the Respondent’s license renewal application, Julius L. Ast and Lana L. Goldfinger were each 50% owners of the Respondent, which qualified each of them as a “controlling interest” of the Respondent as that term is defined by section 408.803(7), Florida Statutes (2013). 13. In addition, per the Respondent’s license renewal application, Mr. Ast served as the Respondent’s Administrator and Chief Financial Officer. 14. In October 2013, Mr. Ast was arrested for and charged First Degree Grand Theft, Organized Fraud and Medicaid Fraud/Filing of False Claims by the State of Florida. Case No. F13-24401, Miami-Dade Circuit Court. As of the date of this Administrative Complaint, the charges against Mr. Ast are pending in the Circuit Court of Miami-Dade County, Florida. 15. The above referenced criminal offenses disqualify Mr. Ast from certain types of employment in a nursing home and from being a controlling interest in the Respondent. 16. Asa result, in early November 2013, Mr. Ast resigned from his positions with the Respondent and transferred his 50% interest in the Respondent to Ms. Goldfinger. 17. Thereafter, in December 2013, Ms. Goldfinger was arrested for and charged with First Degree Grand Theft and Medicaid Fraud/False Claim/Conspiracy by the State of Florida. Case No. F13-29492, Miami-Dade Circuit Court. As of the date of this Administrative Complaint, the charges against Ms. Goldfinger are pending in the Circuit Court of Miami-Dade County, Florida. 18. The above referenced criminal offenses disqualify Ms. Goldfinger from certain types of employment in a nursing home and from being a controlling interest in the Respondent. 19. As of the date of this Administrative Complaint, the Respondent has not provided any documentation or information to the Agency evidencing the removal of Ms. Goldfinger as a controlling interest in the Respondent. 20. As of the date of this Administrative Complaint, no entity has submitted a change of ownership application to the Agency for the Respondents facility. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to revoke the Respondent’s license to operate this skilled nursing facility. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks a final order that: 1, Makes findings of fact and conclusions of law in favor of the Agency. 2. Imposes the relief sought in the Administrative Complaint. Respectfully submitted on this 31% day of Decembef, 261 3. f man fe es / Sharon K. Jones, Esquire “&* Florida Bar No. 732291 Office of the General Counsel Agency for Health Care Administration NOTICE OF RIGHTS Pursuant to Section 120.569, F.S., any party has the right to request an administrative hearing by filing a request with the Agency Clerk. In order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), F.S., however, a party must file a request for an administrative hearing that complies with the requirements of Rule 28-106.2015, Florida Administrative Code. Specific options for administrative action are set out in the attached Election of Rights form. The Election of Rights form or request for hearing must be filed with the Agency Clerk for the Agency for Health Care Administration within 21 days of the day the Administrative Complaint was received. If the Election of Rights form or request for hearing is not timely received by the Agency Clerk by 5:00 p.m. Eastern Time on the 21" day, the right to a hearing will be waived. A copy of the Election of Rights form or request for hearing must also be sent to the attorney who issued the Administrative Complaint at his or her address. The Election of Rights ferm shall be addressed to: Ageney Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Maik Stop 3, Tallahassee, FL 32308; Telephome (850) 412-3636, Facsimile (850) 921-0158. Any party who appears in any agency proceeding has the right, at his or her own expense, to be accompanied, represented, and advised by counsel or other qualified representative. Mediation under Section 120.573, F-.S., is available if the Agency agrees, and if available, the pursuit of mediation will not adversely affect the right to administrative proceedings in the event mediation does not result in a settlement. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form have been served to the below named persons at the address stated by the method designated on this 31 day of December, 2013. ra # ¥ \. Sy Sharon K. Jones, Senior Attorney (“> Plorida Bar No. 732291 Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308 Telephone: (850) 412-3685 Facsimile: (850) 922-6484 Administrator Pines Nursing Home 301 NE 141* Street Miami, FL 33161 (Certified — 7012 1010 0003 2494 1919) Geoffrey D. Smith, Esquire Smith & Associates 2834 Remington Green Circle, Suite 201 Tallahassee, FL 32308 (Courtesy Copy) Bernard Hudson, Unit Manager Licensure Unit Agency for Health Care Administration (Electronic Mail) Arlene Mayo Davis, Field Office Manager Local Field Office Agency for Health Care Administration (Electronic Mail) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re: Pines Nursing Home AHCA No. 2013613207 LECTION OF RIGHTS This Election of Rights form is attached te an Administrative Complaint. The Election of Rights form may be returned by mail or by facsimile transmission, but must be filed with the Agency Clerk within 21 days by 5:00 p.m., Eastern Time, of the day that you received the Administrative Complaint. If your Election of Rights form with your selected option (or request for hearing) is not timely received by the Agency Clerk, the right to an administrative hearing to contest the proposed agency action will be waived and an adverse Final Order will be issued. In addition, please send a copy of this form to the attorney of record who issued the Administrative Complaint. (Please use this form unless you, your attorney or your qualified representative prefer to reply according to Chapterl20, Florida Statutes, and Chapter 28, Florida Administrative Code.) The address for the Agency Clerk is: Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3, Mail Stop #3 Tallahassee, Florida 32308 Telephone: 850-412-3630 — Facsimile: 850-921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) I waive the right to a hearing to contest the allegations of fact and conclusions of law contained in the Administrative Complaint. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) I admit the allegations of fact contained in the Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine, sanction or other agency action should be reduced. OPTION THREE (3) I dispute the allegations of fact contained im the Administrative Complaint and request a formal hearing (pursuant to Section 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed agency action. The request for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it contain: 1. The name, address, telephone number, and facsimile number (if any) of the Respondent. 2. The name, address, telephone number and facsimile number of the attorney or qualified representative of the Respondent (if any) upon whom service of pleadings and other papers shall be made. 3. A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. 4. A statement of when the respondent received notice of the administrative complaint. 5. A statement including the file number to the administrative complaint. Licensee Name: Contact Person: Title: Address: Number and Street City Zip Code Telephone No. Fax No. E-Mail (Optional) T hereby certify that I am duly authorized to submit this Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name: Title: USPS.com® - USPS Tracking™ English er Service USPS Hobie Enter up to 140 Tracking # Find fons Bu heute g Pickup, 2USPS Tracking™ Tracking Number: 70121010000324941919 Product & Tracking Information Postal Product: Features: Certified Mail” DATE & TIME STATUS OF ITEM. 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Docket for Case No: 15-000874