* Mar-28-2000 10:2fam = From- T-629 = P.002/007 = F~998 L4G St AT LEE UEULG a £ P82 STATE OF FLORIDA . Fl L E D AGENCY FOR HEALTH CARE ADMINISTRATION, JUN 14 PH 2: 52 AGENCY FOR HEALTH GARE " DIVISION OF ADMINISTRATION, se ADMIRISTRATIVE HEARINGS Petitioner, (D-74 aD ve AHCA No. 05-00-02NH 0° CT CORP., SYSTEM d/b/a SPANISH GARDENS NURSING AND CONVALESCENT ” vo ‘ CENTER, Respondent. ; . ~ I . ADMINISTRATIVE COMPLAINT : “s oe EE COMPLAINT YOU ARE HEREBY NOTIFIED that after Twenty-ane fn says “fram ‘the receipt .of this complaint, the Agency intends ta impose a fine in the ‘dinaint ot seven hundred doltars ($700.G0} upen the Respordent. As grounds for the impusition of this fine. the Agency alleges 45 follows; {1} The Agency for Health Care Administration, State of Forida, has jurisdiction | aver the Respondent by virtue of the provisions of Chapter 409, Part th. Florida Statutes. a ‘ oT (2) The Respondent js licensed to operate the above named fadtiity at 1061 Virginia Street, ‘Dunedin, Florida 34698, as a nursing home in comeli hance with Chapear 400, Part n, Florida Statutes, and Rule 888-4, Florida Administrative Cade. —) The Respondent has violated minimum licensure standards, as evidenced by each deficiency set forth below, as = found to exist during the annual aaQvd “aI WOLlYOTT aS SNHE' HONS ze: py @a-¢e2-aun * War-28-2000 10:21am _ From T-629 = P.003/007 = F~998 mp, TT rN 4 ST NE“BEV TLE BLSG4E5255 TO 1S41so7Ea39 P83 wy ll « survey of December 31 . 1998. and recited at the annual survey of Nevermber §, 1993. The Respondent faited to timely correct the deficiency 2 as follows: {a) F 332 ~ This Standard is not met as evidenced based on recard Review, the facility did not ensure that it was tree of medication errors of five percent or greater. The medication eltor rate was 7.8 per cent. This deficiency is in violation of Rule 5944.1288, Alorida Administrative Code. This is a Class I deficiency. Fine amount: $700.00. {4} The above referenced vialatian constitutes grounds 1 to levy ihe | 20 indicated fine pursuant to Section 400.102 and 400.121, Florida Statutes, in that the ahove referenced conduct of the Respondent constitutes violations “of the minimum standards, rules, and regulations for the operation of @ nursing home. {5} Notice was proVided in writing to the Respondent of the dhave = Violations and a time frame was given for correction. HEARING RIGHTS AND PROGEDURE (REAR CARFFULLY) - ; IN GENERAL. You have the night to request an administrative hearing pursuant to ‘Section “130. 569, “Flarida Statures, ‘to be ‘represented by ‘counsel {at your expense}, to take testimony, to call or cross-examine witnesses, ta have subpoena and Subpoena duces Tecum issued, and to present written evidence or argument if you request a hearing. The Uniform Rules found at Chapter 59-28-108, Florida Administrative Code, constitutes the Petitioner’ s Procedural Tules far sxiministrative proceétinge resulting from this compat. 2/E 390d 71 WOIAOTA AS Sana: nos Spl @a-2e-aww , a SaWvd . 7a Mar-28-2000 10:22am = From- ¢ T-629 P.004/007 -F~998 Hen ty Ge LOPE PR OSU IUE- HEED 4 9134865295 TO 1Sars27ce3q wt Ww P.ag -HEARING REQUESTS. A request for a hearing shall be made to the Agency for Health Care Administration, G800 N. Dale Mabry Highway, Suite 220, Tampa, Florida 33614. Attention: Thomas Caufman,-Senior Attomey. An individual owner, corporation, or partnership requesting a hearing must submit a written request signed by the individual owner; a corporate officer ar. director; a partner: an attomey: or another person having written authorization ‘to repriisent the owner, corporation, or partnership. A copy of the authorization MUST be Submitted with the hearing request. A request for a hearing must be.in writing and. should include your address, and a see telephone number whers yeu may be reached during weekdays. aan FORMAL HEARINGS. in order to abtain @ formal nit under Section 120.5711), Rorida Statutes, the request for an administrative heasing rust conform to the requirements in Rules 28-166.201, Rorida Admmistrative. Code, and 120.569, Florida Statutes, and must state which issues of material fact are in dispute. FAILURE TQ DISPUTE MATERIAL ISSUES OF FACT IN THE REQUEST WILL BE DEEMED A WAIVER OF TRE RIGHT Ta A FORMAL HEARING, AND AN ELECT ION: FOR AN INFORMAL HEARING UNDER SECT iON 120. 57(2), FLORIDA STATUTES. INFORMAL HEARINGS. A request for an informal hearing under Section WOIMOIS AS SHHS'woaa ee-et aay zw ( Mare “8 2000 10:22am — From- T-629 = P.005/007 F-998 qadd ay WIR 47 0 157 ER S-SC-OFF CE-ReU-mapi4 8136468205 4 19519279238 ¢ P.6s 120.57(2}, Florida Statutes, must conform to the requements in Rule 28- 106.301, Florida Administrative Code, By requesting an informal hearing you agree ta the existence of the facts cited in this administrative complaint. At an mformal hearing you will be permitted to present questions of faw and any mitigating cicumstances you wish the hearing officer to consider; however, no evidence disputing the existence of the violations may be presented. REPRESENTATION BY NOR-ATTORNEY. A non-attomey seeking to represent the owner of a taciliry in a farmal proceeding must be qualified by the adrniitstrative law fudge as provided in Rule 28-106. 107, Florida Administrative Cove. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE Ta FILE A-REQUEST FOR 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. 7 we PAYMENT OF FINES. Fines should be mailed to the Agency for Health Care Administration, Finanoe & Accounting Deparment, P.O. Box 13748, Tallahassee, Administration, Finance & Accounting Department, P.Q. Bax 13749, Tallahassee, FL 32317-3743. Attemtion: Jim Mitchell. To insure proper credit, you must attach the payment form on the last page of this complaint with your payment. FOR CLARIFICATION AFTER YOU HAVE READ THE COMPLETE VOlHATI ms SAHG*WOHA Ez: py @@Q-2%-aow 1-829 P.006/007 F~9gg SNOT TS SU"UPTLLE“BEU-PEDIG 81 3agesnes To 18419279238 P.aS wd e ‘ “ Mar-28-2000 10:23am = From- ren wees ADMIMISTRATIVE COMPLAINT, CALL THOMAS CAUFMAN AT (813) 871-7402. | HEREBY CERTIFY that a tue copy hereof was sent by U.S. Certified Mail, Return Receipt Requested to, Registered Agent of Spanish Gardens Nursing and Convalescent Center, CT Corp., System, 100 Biscayne Boulevard, Miami, Florida 33132, this _[(G* gay of (Nawch _. 2000, eld Office Manager, Krea 5 Divisian of Managed Care and Health Quality Agency for Heath Care Administration _ 877 Executive Center Dr. West. The Glades Building, Suite 207 |: St. Petersburg, Florida 33702 - Capies to: Patricia Hall: * 4 HOA, HFC-LTC 2727 Mahan Drive ee Ft. Knox #1, Room 223 ee ae Tallahassee, Florida 32308 . ts Thomas Caufman _- Senior Attamey a Agency for Health Care Administration 6800 N. Dale Mabry Highway, Suite 220 Tampa, Florida 33614 478 3avd *Qy WOTdaTa ms SaHe * noag ES+et @a-2z-auw errr omer

Docket for Case No: 00-002484