1. 2. STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No.: 2018013295 Facility Type: Assisted Living TROPICAL HIDEOUT, INC. and LORNA G. TROTMAN, Individually, Respondents. 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 Respondents, Tropical Hideout, Inc. and Lora G. Trotman, Individually (“Respondents”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2018), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of seventy eight thousand dollars ($78,000.00) based upon Respondents’ operation and maintenance of an unlicensed assisted living facility and its provision of assisted living services for which it did not have an assisted living facility license. JURISDICTION AND VENUE The Agency has jurisdiction pursuant to §§ 20.42, 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2018). Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part I, and 429, Part I, Florida Statutes, and Chapter 58A-5, Florida Administrative Code, respectively. Respondents, individually or collectively, operated an unlicensed assisted living facility located at 1102 Beacon Street NW, Palm Bay, FL 32907. COUNT I The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. That Florida law provides: It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider. Section 408.804, Florida Statutes (2018). That Florida law provides: (1) A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with 10. 11. this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation. (6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency. Section 408.812, Florida Statutes (2018). That on or about June 11, 2018, the Agency conducted a complaint survey of Respondents’ facility. That based on observation, record review, and interview, the Agency determined that the facility located at 1102 Beacon Street NW, Palm Bay, Florida, without having a license to operate, provided assisted living services, including assistance with self-administration of medication to 4 of 4 sampled residents (Resident #1, #2, #3, and #4). That the property located at 1102 Beacon Street NW is listed as owned by Lorna G. Trotman. That on or about June 11, 2018, at approximately 11:17 am, Petitioner’s representative learned 14. 16. 17. 19. that there were four (4) residents who resided and received assisted living services at Respondents’ facility. That Resident #1 informed Petitioner’s representative that Ms. Trotman assisted him/her with bathing, meals, and taking him/her to appointments. That Petitioner’s representative observed Resident #2 eating breakfast. The resident needed to be reminded to eat, and was unable to provide any information. That Resident #3 informed Petitioner’s representative that Ms. Trotman took care of him/her, which included assistance with medications, meals, and transporting him/her to doctors’ appointments. That Resident #4 informed Petitioner’s representative that Ms. Trotman took care of him/her, which included bathing and changing of clothing, assistance with medications, and meals. That during an interview with Ms. Trotman, she informed Petitioner’s representative that she assisted the residents with their medications and kept those medications in her room. That Ms. Trotman also confirmed that she assisted the residents with their activities of daily living (ADLs), which included bathing, dressing, and toileting. That Petitioner’s representative contacted the pharmacy used by Respondents’ facility to fill residents’ prescriptions and the pharmacy confirmed that it provided medications for two residents (Residents #2 and #4). That Ms. Trotman stated the residents’ monthly payments to her were as follows: - Resident #1 - $1,500.00 - Resident #2 - $1,600.00 - Resident #3 - $1,100.00 - Resident #4 - $1,000.00 20. 2i. 22. 23. 24. 25. 26, ya 28. That on or about June 11, 2018, at approximately 2:38 PM, Petitioner’s representative spoke to Troy Denault, the administrater for a senior living referral agency who confirmed that he placed the residents at Respondents’ facility. He stated he was paid by the facility for each tesident he placed there, That Mr. Denault stated he had a contract with Respondents which stated the facility was licensed. That Mr. Denault stated he was not aware that Respondents’ facility was unlicensed until two weeks prior when he was notified by another State agency. That on or about June 11, 2018, at approximately 12:10 pm, Petitioner’s representative notified Ms. Trotman of the unlicensed activity and she signed the Notice. The Notice is attached hereto as Exhibit “A.” That on or about July 9, 2018, the Agency conducted a follow up to a complaint survey of June 11, 2018, at Respondents’ facility. That the Agency learned in addition to property owned at 1102 Beacon Street NW, Ms. Trotman rented property at 1103 Beacon Street NW, Palm Bay, which was located across the street from the property she owned, That the residence at 1103 Beacon Street NW was not a licensed facility. That based on observation, record review, and interviews, the Agency determined that Respondents transferred three residents ftom the unlicensed facility located at 1102 Beacon Street NW, Palm Bay, to the residence across the street at 1103 Beacon Street NW, and continued to provide assisted living services, including assistance with self-administration of medication, to 3 residents (Resident #1, #2, and #3). That on or about July 9, 2018, at approximately 10:15 am, Petitioner’s representative toured 29. 30. Kv 32. 33: 34, 35. 36. a7; the residence and observed that it was cluttered with boxes of personal items and furniture. That Petitioner’s representative observed Resident #2 in a bed with a % bed rail and a medical device at the end of the bed. That Petitioner’s representative observed Resident #1 in the dining area and the resident appeared to be appropriately groomed. That Resident #3 was not in the residence at the time of the survey. However, Petitioner’s representative observed Resident #3’s medications on a bureau in a second bedroom. That Petitioner’s representative observed Residents’ #1 and #2 medications on a bureau in the dining area. Additionally, there were notes that recorded the times Residents #1, #2, and #3 were assisted with their medications throughout the day. That on or about July 9, 2018, during an interview with Vanessa Adrien, a caretaker at the residence, she informed Petitioner’s representative that she lived in the home with three (3) residents. That Ms. Adrien stated she provided assistance with bathing and dressing, meals, and assistance with medications to all three (3) residents. That Ms. Adrien stated she previously worked across the street at 1102 Beacon Street NW, and that she moved into the current residence with the three (3) residents a few weeks prior to the survey. She confirmed the current residence was rented by Ms. Trotman. That Ms. Adrien stated Ms. Trotman paid her wages with cash weekly. That Petitioner’s representative spoke to Ms. Adrien’s daughter who stated that she also lived at the residence and provided services to all three (3) residents which included meals, transportation, assistance with medications and assistance with activities of daily living (ADLs). She stated she worked part-time and Ms. Trotman paid her wages. apy 40. 41. 42. 43. 45. 46. That Ms. Adrien’s daughter stated the three (3) residents were transferred over from Ms. Trotman’s property across the street at 1102 Beacon Street NW. That on or about July 9, 2018, at approximately 11:10 am, during a telephone interview with Ms. Tretmnan, she stated that Resident #3 no longer lived at her rented property. However, she was unable to provide Petitioner’s representative with contact information for the resident and/or the resident's family member. That on or about July 9, 2018, at approximately, 2:03 pm, Resident #3 contacted Petitioner’s representative and confirmed that he/she resided at 1103 Beacon Street NW. The resident stated that he/she paid Ms. Trotman $850.00 in rent and handled his/her own medications and meals. That during the phone conversation with Resident #3, Petitioner’s representative could hear Ms, Trotman coaching Resident #3 with his/her responses. That Ms. Tretman confirmed that Residents #1 and #2 previously lived across the street at 1102 Beacon Street NW, and were moved to the current residence to meet capacity regulations. That Ms. Trotman confirmed that she provided services to all three (3) residents which included meals, transportation, assistance with medication and assistance with activities of daily living (ADLs). That on or about July 9, 2018, at approximately 11:30 am, Petitioner's representative notified Ms. Trotman she was cngaged in continuing unlicensed activity. Ms. Adrien, the caregiver signed the Notice of Unlicensed Activity. The Notice is aitached hereto as Exhibit “B.” That on or about July 23, 2018, the Agency conducted a follow up visit to a survey conducted on July 9, 2018. That based on observation and interviews, the Agency determined that Respondent continued 47. 48, 49. 50. 31. 52. 33. $4. to engage in unlicensed activities with residents who were transferred from 1102 Beacon Street NW to a property across the street at 1103 Beacon Street NW. That on or about July 23, 2018, at approximately 12:00 pm, Petitioner’s representative observed Residents #1 and #2 sitting in the dining area, and Resident #3 lying in bed. That the residents’ belongings were still in the residence. Medications for Residents #1 and #3 were on the dining cabinei, Resident #2°s medication was in the resident’s bedroom. That Petitioner’s representative observed Staff “A” serving lunch and Staff “B” talking on her phone. That on or about July 23, 2018, at approximately 12:00 pm, during an interview with Ms. Trotman, she confirmed that all three (3) residents were still living at the residence. However, Ms. Trotman claimed that Resident #2 would be taking over the lease and would be responsible for taking care of Residents #1 and #3. That on or about July 23, 2018, at approximately 1:00 pm, during an interview with Staffs “A” and “B,” they both stated they continued to live in the residence since the July 9, 2018, and were paid by Ms. Trotman to provide personal services to three (3) residents. That on or about July 23, 2018, at approximately 1:30 pm, Petilioner’s representative spoke with ali three (3) residents who confirmed they resided in the home and received services from Ms. Trotman‘s staff, which included meals, bathing, grooming, and assistance with medications, All three {3) residents stated that Ms. Trotman sometimes assisted them with meals, medication, and transportation, That Resident #2 denied knowing about taking over the lease from Ms. Trotman. That on or about July 23, 2018, at approximately 2:00 pm, Petitioner’s representative notified Ms. Trotman of the unlicensed and gave her the Notice. Ms. Trotman refused to sign the 55. 56. 37, 58. 59. 60. 61. 62. 63. Notice and threw her copy in the trash, The Notice is attached hereto as Exhibit “C.” That on or about August 22, 2018, the Agency conducted a second follow up visit to a survey conducted at 1102 Beacon Street NW and 1103 Beacon Street NW. That based on observation and interviews, the Agency determined that Ms. Trotman transferred three residents who resided at 1103 Beacon Street NW, Palm Bay, back to her residence across the street at 1102 Beacon Street NW, and continued to provide assisted living services, including assistance with self-administration of medication, to 4 residents (Resident #1, #2, #3, and #4). That on or about August 22, 2018, at approximately 11:00 am, Petitioner’s representative attempted to make contact with residents and caretakers at 1103 Beacon Street NW, but it appeared that no one was there. That Petitioner's representative went across the street to 1102 Beacon Street NW where Ms. Trotman resided. Ms. Trotman’s husband was present and permitted Petitioncr’s representative entry into the residence. That Ms. Trotman’s husband informed Petitioner’s representative that Residents #1, #2, and #3 who resided across the street had moved back into the residence abeut a month prior to the survey. That Petitioner’s representative observed three residents in the living area, one of whom already resided in the residence prior to the other three residents” transfer. That Residents #1 and #3 confirmed that Ms. Trotman moved them from the 1103 Beacon Street NW address about a month prior, and they did not know why. That Resident #2, was asleep in his/her bedroom and was unable to be interviewed. That Ms. Trotman’s husband confinned that all four residents resided in the home. 65. 66. 67. 68. 69. 70. 71. That Ms. Trotman’s husband informed Petitioner’s representative that his wife maintained two staff members who she paid weekly wages and who continued to reside at 1103 Beacon Street NW. That on or about August 27, 2018, at approximately 3:30 pm, Petitioner’s representative spoke with Ms. Trotman who stated she moved one of the residents back to the 1103 Beacon Street address, but the other three (3) residents resided at 1102 Beacon Street NW. That while interviewing residents, Petitioner’s representative heard Ms. Trotman yelling to her husband to take one of the residents to the 1103 Beacon Street address so there would only be two residents residing in each home. That Petitioner’s representative informed Ms. Trotman that she would still receive a notice of unlicensed activity because the findings were that at least three (3) residents resided in the home and received personal services including meals, assistance with medication, bathing, grooming, other activities of daily living, and transportation. That on or about August 27, 2018, at approximately 5:15 pm, Petitioner’s representative notified Ms. Trotman of the unlicensed activity and she signed the Notice. The Notice is attached hereto as Exhibit “D.” That the aforementioned facts reflect that Respondents provided personal services to persons residing in a building not licensed as an assisted living facility, including provision of personal care and assistance with self-administration of medications. That Respondents continued to engage in unlicensed activity despite having been notified of the unlicensed activity and a direction to discontinue such activity in accord with law. That the operation of an assisted living facility without appropriate licensure subjects the Respondents to a daily fine during any period of unlicensed activity after Respondents had 10 72. been notified of the unlicensed activity. That Respondents operated an assisted living facility without appropriate licensure from June 11, 2018 through at least August 27, 2018. WHEREFORE, the Agency intends to impose an administrative fine against Respondents for operating an unlicensed assisted living facility in the State of Florida, pursuant to § 408.812, Florida Statutes (2018), in the amount of one thousand dollars per day, from June 11, 2018 through August 27, 2018, representing seventy-eight (78) days or seventy-eight thousand dollars ($78,000.00), and any additional sums which may accrue after August 27, 2018, until Respondents cease their unlicensed activity. Respectfully submitted this R day of October, 2018. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION By: Micalhe Keen Nicola Brown Assistant General Counsel Fla. Bar. No. 492507 Agency for Health Care Administration 525 Mirror Lake Drive N., 330H St. Petersburg, FL 33701 727.552.1946 (office) Nicola.Brown@ahca.myflorida.com 11 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 I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by USS. Certified Mail, Return Receipt No. 7013 2250 0001 4950 3431 on October__@_, 2018, to Lorna G. Trotman, Operator/Owner of Tropical Hideout, Inc., 1102 Beacon Street NW, Palm Bay, FL 32907, and by U.S. Certified Mail, Return Receipt No. 7013 2250 0001 4950 3455 to Lorna G. Trotman, Individually, 1102 Beacon Street NW, Palm Bay, FL 32907, and by U.S. Regular Mail to George Linval, Registered Agent for Tropical Hideout, Inc., 1102 Beacon Street NW, Palm Bay, FL 32907. Nicola Brown, Esq. Copy furnished to: Arlene Mayo-Davis Field Office Manager 12 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re: TROPICAL HIDEOUT, INC. Case No.: 2018013295 ELECTION OF RIGHTS This Election of Rights form is attached to a proposed agency 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 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 receive the attached proposed agency action. If your Election of Rights with your selected option is not received by AHCA within 21 days of the day that you received this proposed agency action, you will have waived your right to contest the proposed agency 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, and Chapter 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 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. | 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 fine, sanction or other agency action. OPTION TWO (2) I admit the allegations of fact contained in the Administrative Complaint, but wish to be heard at an informal hearing (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 in 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 13 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) Thereby 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: 14 RICK SCOTT GOVERNOR NOTICE OF UNLICENSED ACTIVITY — ee The Agency for Health Care Administration has determined that you and/or this fa are operating a / an Assisted Living Facility at the above address without the required ficense. Under Florida law, it is unlawful for any person or entity to: own, operate, or maintain an unlicensed provider; or perform any services that require Agency licensure without proper licensure; or offer or advertise services that require Agency licensure to the public without first obtaining a valid license from the Agency. An existing licensehokler may not advertise or hold Fee a ER RE SS RI ETAL RE AEA Se RY holds the license. Any person and entity that fails to immediately cease operation of an unlicensed provider is subject to the penalties set forth under Florida law. This Inciudes, but is not limited to, the imposition of fines of $1,000.00 for each day of noncompilance and an injunction to restrain Such violation or enjoin the future operation or maintenance of the unlicensed provider or the performance of any services requiring licensure. Each day of continued operation Is a separate offense. If you have any questions regarding this Notice of Unlicensed Activity, you may contact me at (407) 420-2502. cc: AHCALicense Unit Office of the Attomey General RILV aia raoaen St. Sutte 8-309 Facebook com/ACHAFlorida pen ‘Youtubs.com/AHCAFIorida DNA kiyelorkiacom BildeShare.net/AHCAFIoride AGENCY EXHIBIT “Aa” Scanned with CamScanner NOTICE OF UNLICENSED ACTIVITY dune 25, 2018 (s) Owner/Occupant(: 1103 Beacon Street, Nw Palm Bay, FL 32907 The Agency for Health Care Administration ‘you y fs operating an Assisted Living Facility at the above without the required license. Under Florida law, it is unlawful for any person or entity to: own, operate, or maintain an unlicensed provider; or perform any services that require Agency licensure without proper licensure; or offer or advertise services that require Agency licensure to the public without first obtaining a valid license from the Agency. An existing licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. Any person and entity that falls to immediately cease operation of an unlicensed provider Is subject to the penalties set forth under Florida law. This Includes, but is not limited to, the imposition of fines of $1,000.00 for each day of noncompliance and an injunction to restrain such violation or enjoin the future operation or maintenance of the unlicensed provider or the performance of any services requiring licensure. Each day of continued operation is a separate offense. ff you have any questions regarding this Notice of Unlicensed Activity, you may contact me at (407) 420-2502. Sincerely, . ts. Theresa DeCaniol, RN Fleld Office Manager Field Office Manager cc: ee ICA Medicaid Program Integrity Office of the Atlomey General RILV SOW. Ratneon ot ara "yas AGENCY EXHIBIT “RB” USPS Tracking: Tracking FAQs_ Track Another Package + Remove Tracking Number: 70132250000149503431 Your item was delivered to an individual at the address at 2:36 pm on October 11, 2018 in PALM BAY, FL 32907. Status Delivered October 11, 2018 at 2:36 pm Delivered, Left with Individual PALM BAY, FL 32907 USPS Tracking: Tracking FAQs_ Track Another Package + Remove Tracking Number: 70132250000149503455 Your item was delivered to an individual at the address at 2:36 pm on October 11, 2018 in PALM BAY, FL 32907. Status Delivered October 11, 2018 at 2:36 pm Delivered, Left with Individual PALM BAY, FL 32907

Docket for Case No: 19-002532