FILED ‘OCT 2 CHIEF FINANCIAL OFFICER Tero MoMA Docketed by IN THE MATTER OF: CASE NO,; 139085-13-FC PRESTWOOD FUNERAL HOME, INC, F040708 / ADMINISTRATIVE COMPLAINT To: PRESTWOOD FUNERAL HOME, INC. 105 US 90 West . Baldwin, FL 32234 PRESTWOOD FUNERAL HOME, INC., is hereby notified that the State of Florida Department of Financial Services, Division of Funeral, Cemetery, and Consumer Services (hereafter “the Department”) has conducted an investigation in connection with its license to operate as a funeral establishment, The investigation has foynd probable cause to charge PRESTWOOD FUNERAL HOME, INC., with violations of Chapter 497, Florida Statutes and the Florida Administrative Code as set forth in this Administrative Complaint, This Administrative Complaint includes violations alleged within investigation report number ATN- 20097, GENERAL ALLEGATIONS 1, Pursuant to Section 20.121, Florida Statutes, Chapter 497, Florida Statutes, the , “Florida Funeral, Cemetery, and Consumer Services Act” and Chapter 69K, Florida Administrative Code, (hereinafter “the Act”), the Department is the state agency charged with regulating the practice of funeral establishments, funeral directing, and embalming. 2, The Board of Funeral, Cemetery, and Consumer Services (hereinafter “the Board”) has the authority to determine through probable cause panels whether there is probable cause to believe there is a violation of the Act and the Florida Administrative Code and whether a proposed administrative prosecution of a licensee shall go forward, as set forth in Sections 497,103( 1) and 497,153(3), Florida Statutes, 3, At all times material and relevant to this Administrative Complaint, PRESTWOOD FUNERAL HOME, INC., was licensed as a funeral establishment within the State of Florida, having been issued license number F040708, pursuant to the provisions of the Act. 4, On or about April 3, 2013, the Department conducted an investigation into PRESTWOOD FUNERAL HOME, ING''s activities based upon previous inspections conducted by the Department and complaints received by the Department. COUNT ONE 5. The above General Allegations are hereby realleged and fully incorporated herein by reference, 6. During the April 3, 2013 inspection it was revealed that PRESTWOOD FUNERAL HOME, INC. had no biomedical waste pickups from September 2011 until February 11, 2013. These pickups were necessary to properly dispose of biomedical waste produced at PRESTWOOD FUNERAL HOME, INC. Accordingly, it was determined that PRESTWOOD FUNERAL HOME, INC, did not properly manage its biomedical waste removal. IT IS THEREFORE CHARGED that PRESTWOOD FUNERAL HOME, INC., has violated or is accountable under the following provisions of the Act: (a) Section 497.152(1)(a), Florida Statutes, which provides that it-is a disciplinable offense to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department. (b) — Section 497.152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Rule 69K-21,003(5), Florida Administrative Code, which provides that the preparation room shall meet the requirements of the Department of Health Chapter 64E-16, F.A.C., which prescribes minimum sanitary practices relating to the managetnent of biomedical waste, including segregation, handling, labeling, storage, transport and treatment. COUNT TWO 7. The above General Allegations are hereby realleged and fully incorporated herein by reference. 8. Based on the inspection completed on or about April 3, 2013, it was revealed that PRESTWOOD FUNERAL HOME, INC, failed to submit monthly Bodies Handled Reports, required by section 497,382(1), Florida Statutes, from November 2010 until February 11, 2013. IT IS THEREFORE CHARGED that, PRESTWOOD FUNERAL HOME, INC., has violated or is accountable under the following provisions of the Act: (a) Section 497,152(1)(a), Florida Statutes, which provides that it is a disciplinable offense to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department, (b) Section 497.152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497,382(1), Florida Statutes, which provides, in relevant part, that each funeral establishment shal! report on a form prescribed and furnished by the licensing authority the name of the deceased and such other information as may be required with respect to each dead human body embalmed or otherwise handled by the establishment or facility. Such forms shall be signed by the embalmer who performs the embalming, if the body is embalmed, and the . funeral director in charge of the establishment or facility or by the direct disposer who disposes of the body. The licensing authority shall prescribe by rule the procedures in submitting such documentation, Reports required by this subsection shall be filed by the 20th day of each month for final dispositions handled the preceding month. WHEREFORE, the Department respectfully requests that the Board enter an Order imposing one of more of the following penalties: revocation or suspension of license; imposition of an administrative fine not to exceed five thousand dollars ($5000) for each count or separate offense; issuance of written reprimand; placement on probation, assessment of costs associated with investigation and prosecution; requiring making restitution; imposition of any or all penalties delineated within Section 497.153(5), Florida Statutes; and any other relief that the Board is authorized to impose pursuant to Chapter 497, Florida Statutes, and the rules promulgated there under, NOTICE OF RIGHTS Pursuant to Sections 120.569 and 120,57, Florida Statutes, and Rule 28-106, Florida Administrative Code, licensees have the right to request a proceeding to contest this action by the Department of Financial Services ("Department"), The proceeding request must be in writing, signed by the licensee, and must be filed with the Department within twenty-one (21) days of receipt of this notice, Completion of the attached Election of Proceeding form and/or a petition for administrative hearing will suffice as a written request. The request must be filed with Julie Jones, DFS Agency Clerk, at the Florida Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0390, Written response must be received by the Department no later than 5:00 p.m. on the twenty-first day after receipt of this notice. Mailing the response on the twenty-first day will not preserve the right to a hearing: FAILURE TO RESPOND IN WRITING WITHIN TWENTY- ONE (21) DAYS OF RECEIPT OF THIS NOTICE WILL CONSTITUTE A WAIVER OF THE RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF SUSPENSION OR REVOCATION WILL BE ENTERED. If a proceeding is requested, information must be provided that complies with the requirements of Rule 28-106.2015, Florida Administrative Code, As noted above, completion of the attached Election of Proceeding form conforms to these requirements, Specifically, response must contain: (a) The name, address, and telephone number, and facsimile number (if any) of the respondent (for the purpose of requesting a hearing in this matter, licensee is the "respondent'). (b) The name, address, telephone number, facsimile number of the attorney or gualified representative of the respondent (if any) upon whom service of pleadings and other papers shall be made, (c) A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate, (d) A Statement of when the respondent received notice of the administrative complaint. (e) A Statement including the file number to the administrative complaint. If a hearing of any type.is requested, requester has the right to be represented by counsel or other qualified representative at their own expense, to present evidence and argument, to call and cross-examine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. If a proceeding is requested and there is no dispute of material fact, the provisions of Sections 120.57(2) and 497,153(4)(b), Florida Statutes, apply. Either a written statement and documentary evidence can be submitted to the Board in lieu of a hearing, or requester can personally attend a hearing conducted by the Board at the location of a regularly scheduled Board meeting. However, if material facts that are the basis for the Department’s action are disputed, the request must be for an adversarial proceeding pursuant to Sections 120.569 and 120.57(1), Florida Statutes, These proceedings are held before a State Administrative Law Judge of the Division of Administrative Hearings, Unless the majority of witnesses are located elsewhere, the Department will request that the hearing be conducted in Tallahassee, Florida, Failure to follow the procedure outlined with regard to a response to this notice may result in the request being denied, All prior oral communication or correspondence in this matter shall be considered freeform agency action, and no such oral communication or correspondence shall operate as a valid request for an administrative proceeding. Any request for an administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above, Mediation of this matter pursuant to Section 120.573, Florida Statutes, is not available, No Department attorney will discuss this matter until the response has been received by the Department, L DATED and SIGNED this a |S day of Ocber- , 2013. STATE OF FLORIDA BOARD OF FUNERAL, CEMETERY AND CONSUMER SERVICES IN THE MATTER OF; Prestwood Funeral Home, Inc. CASE NO.: 139085-13-FC F040708 / ELECTION OF PROCEEDING Thave received and have read the Administrative Complaint filed by the Florida Department of Financial Services ("Department") against me, including the Notice of Rights contained therein, and I understand my options, I am requesting disposition of this matter as indicated below, (CHOOSE ONE) wo] 1 do not dispute any of the Department's factual allegations and I do not desire a hearing, 1 understand that by waiving my right to a hearing, the Board of Funeral, Cemetery and Consumer Services (“Board”) may enter a final order that adopts the Administrative Complaint and imposes the sanctions sought, Including suspending or revoking my license(s) as may be appropriate. 1 do not dispute any of the Department's factual allegations and I hereby elect a proceeding to be conducted in accordance with Sections 120,57(2) and 497,153(4)(b), Florida Statutes. In this regard, I desire to (CHOOSE ONE): {] Submit a written statement and documentary evidence to the Board in ficu of a hearing; or {] Personally attend a hearing conducted by the Board at the location of a regularly scheduled Board meeting, I do dispute one or more of the Department's factual allegations, | hereby request a hearing pursuant to Section 120,57(1), Florida Statutes, to be held before the Division of Administrative Hearings, I have attached to this election form the information required by Rule 28-106.2015, Florida Administrative Code, as specified in subparagraph (c) of the Notice of Rights, Specifically, I have identified the disputed issues of materlal fact in the response attached hereto, TO PRESERVE RIGHT TO A HEARING, RESPONSE MUST BE FILED WITH THE DEPARTMENT OF FINANCIAL SERVICES WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THE ADMINISTRATIVE COMPLAINT. THE RESPONSE MUST BE RECEIVED BY THE DEPARTMENT NO LATER THAN 5:00 P.M, ON THE TWENTY-FIRST DAY AFTER RECEIPT OF THE ADMINISTRATIVE COMPLAINT. The address for filing is: Julie Jones, Agency Clerk, Florida Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0390. : Signature Print Name Date: Address; ere Date Administrative nee Complaint Received: If represented by an attorney or qualified Phone No representative, please attach to this election form his or her name, address, telephone and fax numbers Fax Nos ee CERTIFICATE OF SERVICE . I HEREBY CERTIFY that a copy of the foregoing Administrative Complaint and Election of Proceeding form has been furnished to PRESTWOOD FUNERAL HOME, INC,, 105 US 90 West, Baldwin, FL 32234, by U.S. Certified Mail, return receipt requested this i day of _Qoxv sey , 2013. Linje 1 < General Counsel Fla. Bar. No.: 0079063 Florida Department of Financial Services - 200 E. Gaines Street Tallahassee, FL 32399-0333 Phone: (850) 413-4230 Fax: (850) 488-0697 Counsel for the Department

Docket for Case No: 15-001289