STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2015003659 Vv. Return Receipt Requested: 7002 02410 0001 4240 2407 Otto Egea (Operator) Unlicensed at 20700 SW 122 Ave. Miami, FL 33177 Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Otto Egea unlicensed Operator (hereinafter “20700 SW 122nd Avenue”), pursuant to Chapter 429, Part I, Chapter 408, Part II and Section 120.60, Florida Statutes, (2014), and alleges: NATURE OF THE ACTION 1, This is an action to impose an administrative fine of $18,000.00 pursuant to Sections 408.812, Florida Statutes (2014), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies 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 assisted living facilities, pursuant to Chapter 429, Part I, Florida Statutes (2014), and Chapter 58A-5, Florida Administrative Code. 5. Otto Egea, unlicensed operator at 20700 SW 122nd Avenue operates an assisted living facility located at 20700 SW 122nd Avenue, Miami, Florida 33143, without first obtaining a license from AHCA. COUNTI OTTO EGEA, AT 20700 SW 122nd Avenue WAS OPERATING WITHOUT A LICENSE BECAUSE IT WAS PROVING HOUSING, MEALS SERVICES AND ASSISTANCE WITH MEDICATION TO THREE RESIDENTS Section 408.812, Florida Statutes (UNLICENSED ACTIVITY) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During complaints investigation conducted on 02/26/2015 and 02/27/2015,. and based on based on observation and interview, it was determined that the undefined facility was operating without a license because it provided residents #1, 8 and 9 with housing, meal services and assistance with their personal medications. 8. In an interview with staff member A on 02/26/2015 at 10:25am, she stated that the facility provided housing and meal services to all of the residents, that the facility maintained 2 locked medication boxes located in 2 separate resident’s rooms and that the facility staff had access to the medication boxes. 9. In an interview with resident #9 on 02/26/2015 at 10:29a.m., she stated that has been living in the facility for about 4 days and that the facility staff helped her by giving her the prescription medications every day, which they keep locked up in a box. She stated that the staff cooked for her and she received three meals per day, and she attended group therapy in the facility. 10. In an interview with the owner on 02/26/2015 at 10:45am, he stated that in the resident room with the front door marked with a sign that read "assisted living" had a locked medication box, which contained the medications for several residents. In an observation at this time, the owner unlocked and opened this medication box and the medications for residents #1, 2, 3, 4 and 5 were stored inside this medication box. The owner stated on 02/26/2015 at 10:45am, that he or his staff would sometimes open up the medication box for the low functioning residents like residents # 7, 8 and 9, to remind them when to take their medications. 11. ‘In an interview with the owner on 02/26/2015 at 11:05am, he stated that the other resident room that had the second locked medication box, which contained the medications for several residents. In an observation at this time, the owner unlocked and opened this medication box and the medications for residents # 6, 7, 8 and 9 were stored inside this medication box. The owner stated on 02/26/2015 at 11:05am that the residents would sometimes have to ask the staff to access their medications. 12, In an interview with resident #6 on 02/26/2015 at 11:25am, he stated that he lived onsite and the facility provided housing, meals and laundry services to him. He stated that he managed his own medications, which were stored inside the black box inside his room, but other residents ' medications were also kept there and he has seen the owner assist other residents with their medications. 13. In an interview with resident #8 on 02/26/2015 at 11:35am, she stated that she lived onsite, slept there overnight and that the owner assisted her with her medications every day. 14, In an interview with resident #1 on 02/26/2015 at 11:50am, he stated that he lived onsite and that the owner assisted him with his medications every day. 15. During a follow-up conducted from 3/17/2015 to 3/19/2015, and based on observation and interview, it was determined that the undefined facility did not correct its previously cited deficiency, and was operating without a license because there were 6 residents (residents #7, 12, 13, 14, 16 and 17) that received housing, meal services and medication management services in the undefined facility. 16. In an interview with owner/operator on 03/17/2015 at 10:50am, he stated that neither him nor any of the staff lived onsite and that the facility provided housing and meal services to all of the residents. He stated that him and the staff maintained a copy of every key for each medication box located inside the residents' rooms and that some lesser functioning residents needed to come to the facility office to retrieve the keys to their medication lock boxes. 17. In an interview with resident #12 on 03/17/2015 at 10:55am, he stated that he lived in the facility for approximately 2.5 years and that he usually slept in the living room couch. He stated that he took medications daily, that his medications were kept inside someone else's room and he had to go to the owner/operator's office every day to ask for the key that unlocked the medication box inside another resident's room so he may have access to his own medications. He stated that his medications were then placed inside a daily pill organizer, which he kept on him throughout the day. He stated that the owner/operator helped him get his medications from the pharmacy. 18. In an interview with resident #17 on 03/17/2015 at 11:05am, he stated that he had been living in the facility for about 16 months and that the owner/operator got his medications from the pharmacy for him. 19. In an observation on 03/17/2015 at 11:12 am., resident #12 attempted to demonstrate how he would get the key to retrieve his own medications, but was not able to do so because the owner/operator and the staff member were occupied and unable to give him the key for him to retrieve his own medications. 20. In an interview with resident #15 on 03/17/2015 at 11:15am, he stated that he had been living there about 1 week and he had to ask the staff for a key to get his medications from inside the locking box. He stated that he took medications every evening. 21. In. an observation on 03/1 7/2015 at 11:20am inside the staff office, residents #7, 13, 14, 16 and 17's medications were being stored in a shelf as per the attached photographs. In an interview with the owner/operator on 03/17/2015 at 11:20am, he stated that a nurse was responsible to place the residents’ medications into separate weekly pill organizers so the residents are facilitated to take the correct amounts of medications throughout the week. He stated that the nurse was expected to come to the facility on 03/17/2015 to organize the residents’ medications. 22. In an interview with the nurse on 3/182015 at 3:10pm, she stated that that she managed several residents' medications in the facility and that, although she was employed by a home health agency, she worked for the owner/operator independently. She stated that the owner/operator and she entered into a verbal agreement for her to systematically place several residents' medications into pill organizers at least once weekly and that the owner/operator paid her $10 per resident per day. She stated that the owner/operator paid her directly with cash and she usually received about $100 per week from him.’ She stated that she was currently managing six residents’ medications in the facility and that the number of residents she managed changed ona weekly basis. She stated that she was aware that the owner/operator handled the residents! medical prescriptions and medication deliveries from the pharmacy to the facility. 23. In an interview with the case manager on 3/19/2015, 12:55 p.m., she stated that she managed the psychosocial cases for residents #7 and 16 in the facility. She stated that she was not sure of the residents' medication assistance status, but it was her professional opinion that resident #7 was unlikely to be able to manage his own medications due to his erratic behavior and schizophrenia diagnosis. 24. Based on the foregoing facts, the Operator at 20700 SW 122nd Avenue violated Section 408.812(4), Florida Statutes, herein classified as a deficiency that carries a fine of $1,000.00 per day (18 days from 02/27/2015 through 3/19/2015), which warrants on this case an assessed fine of $18,00000.00 pursuant to Section 408.813(3)(c), Florida Statutes. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I. B. Assess an administrative fine of $18,000.00 against Otto Egea, operator at 20700 SW 122nd Avenue on Count I, pursuant to Section 408.812, Florida Statutes (2014). Cc. Grant such other relief as this Court deems is just and proper. Respondent is hereby notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2014). Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 412-3630. . RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN 21 DAYS OF RECEIPT 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED Ae E. Rodney ( Assistant General Counsel Agency for Health Care Administration 8333 NW 53" Street, Room 300 Miami, Florida 33166 BY AN ATTORNEY IN THIS MATTER. Copies furnished to: Field Office Manager Agency for Health Care Administration 8333 NW 53” Street, Suite 300 Miami, Florida 33166 (Inter-office mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that U.S. Certified Mail, Return Receipt Requested to Otto Egea, operator at 20700 SW 122nd Avenue, Miami, Florida 33177, has furnished a true and correct copy of the foregoing on Sul, f [__, 2015. Moe 0 Son K Rodney STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: Otto Egea (Owner) AHCA No: 2015003659 Unlicensed at 20700 SW 122"! Avenue : Miami, Florida 33177 . ELECTION OF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. Your Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Administrative Complaint. If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2008) and Rule 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308. Phone: 850-412-3630 Fax: 850-921-0158. PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1)_ I admit to the allegations of facts and law contained in the Administrative Complaint and I waive my right to object and to have a hearing. 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 to the allegations of facts 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 should be reduced. OPTION THREE (3) I dispute the allegations of fact contained in the Administrative Complaint, and I request a formal hearing (pursuant to Subsection 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 administrative 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. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4. A statement of all disputed issues of material fact. If there are none, you must state that there are none. Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees. . License type: (ALF? nursing home? medical equipment? Other type?) Licensee Name: License number: Contact person: Name . Title Address: Street and number City Zip Code Telephone No. Fax No. Email(optional) I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name: Title: Late fee/fine/AC

Docket for Case No: 15-004412