STATE. OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, ‘¢ y e Petitioner, AHCA NO: 06-99-157-NK, So Ly, 7. Mlb, P vs. BEVERLY HEALTH AND REHAB CENTER BRANDON (Beverly Enterprises-Florida, Inc., d/b/a Beverly Health and Rehab Center Brandon), Respondent. ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that after twenty one (21) days from receipt of this Complaint, the Agency for Health Care ‘Administration (hereinafter referred to as the "Agency") intends to impose a civil penalty in the amount of $1,400.00 upon Beverly Health and Rehab Center Brandon (hereinafter referred to as "Respondent"). As grounds for the imposition of this civil penalty, the Agency alleges as follows: (1) The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. (2) Respondent is licensed to operate as a Nursing Home at 1465 Oakfield Drive, Brandon, Florida 33511, in compliance with Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. UO: Y (5) Notice was provided in writing to the Respondent of each of the above violation(s) and the time frame for correction. (6) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.57, Florida Statutes, to be represented by counsel (at its expense), to take testimony, to call or cross-examine witnesses, to have subpoenas and/or subpoenas duces tecum issued, and to present written evidence or argument if it requests a hearing. Chapter 59-1, Part II, Florida Administrative Code, constitutes the Agency's procedural rules for administrative proceedings resulting from this complaint. In order to obtain a formal proceeding under Section 120.57(1), Florida Statutes, your request for an administrative hearing must conform to the requirements in Rule 29-5. 201, Florida Administrative Code, and must state which issues of material fact you dispute. Failure to dispute material issues of fact in your request for a hearing may be treated by the Agency as an election by you of an informal proceeding under Section 120.57(2), Florida Statutes. All requests for hearing shall be made to the Agency for Health Care Administration, Division of Health Quality Assurance, 6800 North Dale Mabry Highway, Suite 220, Tampa, Florida 33614; Attention: Thomas W. Caufman, Senior Attorney. Payment of fines shall be sent to the Agency for Health Care Administration, P.O. Box 13749, Tallahassee, Florida 32317-3749. oe al (Please reference the case number and facility name on the front of your check). (7) RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY ONE (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. I HEREBY CERTIFY that a true copy was sent by U.S. Certified Mail, Return Receipt (Number Z 296 602 978), to Corporation Service Company, Registered Agent for Beverly Enterprises-Florida, Inc., 1201 Hays Street, Tallahassee, Florida 32301-2525, on the £7 aay of Qe cece. ho/ > 1999, Agency for Health Care Administration Division of Health Quality Assurance Copies furnished to: Administrator Beverly Health & Rehab Center Brandon 1465 Oakfield Drive Brandon, Florida 33511 U WW (3) The Respondent has violated the provisions of Chapter 400, Part II, Florida Statutes, and provisions of Chapter 59A-4, Florida Administrative Code, in that it repeated and/or failed to correct, within the mandated time frame, two (2) deficiencies cited during the survey of August 21, 1998. These deficiencies set forth below, were still uncorrected when a follow-up visit was made on previously cited at the licensure survey of October 15, 1999, and constitute repeat deficiencies. (a) The Respondent failed to comply with administration standard in that 2 nurses newly hired did not have Level II background screening initiated and both had Not lived in Florida for more than five (5) years. This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule 59A-22.003, Florida Administrative Code. Fine: $700.00." (b) The Respondent failed to comply with administration standard in that all clinical records were not accurately updated and systematically organized. This is a violation of Sections 400.102, 400.121, and 400.23, Florida Statutes, and Rule 59A-4.118(2), Florida Administrative Code. Fine: $700.00. (4) The above referenced violations constitute grounds to levy this civil penalty pursuant to Section 400.102(1)c, Florida Statutes, in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation of a nursing home.

Docket for Case No: 00-000776