STATE OF FLORIDA STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA No: 10-01-0044 ALF SUNVIEW RETIREMENT HOME, INC., G1-3I d/b/a SUN VIEW RETIREMENT, Respondent. ADMINISTRATIVE COMPLAINT _ YOU ARE HEREBY NOTIFIED that after Twenty One (21) days from the receipt of this complaint, the Agency for Health Care Administration (hereinafter referred to as the "Agency") intends to impose an administrative fine in the amount of Ten Thousand ($10,000) Dollars upon Sunview Retirement Home, Inc., d/b/a Sun View Retirement (hereinafter referred to as "Respondent"). As grounds for this administrative fine, the Agency alleges as follows: 1. The Agency has jurisdiction over Respondent by virtue of the provisions of Chapter 400, Part II, Florida Statutes (eS .) 2. Respondent is licensed to operate at 4005 Ss. Lake Terrace, Miramar, Florida 33023 as an assisted living facility in compliance with Chapter 400, Part III, (F.S.) and Chapter 58A-5, Florida Administrative Code (F.A.C.) 3. On or about May 30, 2001, during a complaint investigation conducted by personnel from the Broward Office of the Agency for Health Care Administration it was revealed that: (a) Tag A510. Staffing Standards. A designated staff person at least 18 years old was not left in charge of the facility and residents. During a temporary absence of the iid Aa caddal * a administrator, a designated staff person over the age of 18 was not left in charge of the facility. The findings were: qd) Based on interviews and information provided in the complaint, it was determined that on May 29, 2001, the administrator was out of the facility and left her 17 year old daughter in charge. The daughter then left the facility and abandoned the residents. (2) Based on observations and interview on the day of the complaint investigation it was determined that when surveyor arrived at the facility an adult woman was . nominally in charge of the facility. She was not an employee or staff person of the facility. The administrator and the two designated staff were nowhere to be found at the facility, and did not respond to telephone calls to the phone numbers reportedly left by the administrator. This is in violation of rule 58A-5.019(4)(a)5, F.A.C., Class I deficiency, carrying in this instance a $5,000 fine. (b) Tag A525. Staffing Standards. One staff person trained in CPR and First Aid was not within the facility at all times when residents were present. The findings were: (1) Based on information and interviews it was determined that on May 29, 2001 the administrator left her 17 year old daughter in charge of the facility. The daughter is not a staff person and is not trained in CPR and First Aid. (2) Based on observations and interviews on the day of the complaint investigation it was determined that the woman left in charge of the facility and residents was not a staff person and was not trained in First Aid and CPR. - This is in violation of rule 58A-5.019(4)(a)4, F.A.C., Class I deficiency, carrying in this instance a $5,000 fine. 4. The above referenced violations constitute grounds to levy this administrative fine pursuant to Section 400.414, (F.S.), authorizing the imposition of the above fine under Section 400.419(4), Florida Statutes, in that the Respondent has violated the minimum standards, rules and regulations promulgated by the Agency under Chapter 400, Part IN, (F.S.) fe pmeege agree i : Ree RRA emo BEST sites Hb a aetna Bons Hee 5. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, (F.S.); to be represented by counsel (at its expense); to take testimony, to call and cross- “examine witnesses, to have subpoenas and/or subpoenas duces tecum issued, and to present written “evidence or “argument if it requests a hearing. In order to obtain a formal proceeding, your request for an administrative hearing must conform to the requirements in Rule 28- 106. 201, (F.A.C.), and must state which i issues of material fact you dispute. Failure to dispute material is issues of fact in your r request for a hearing may be treated by the Agency as an election by you of an n informal proceeding under Section 120. 572), . S. y ELECTION AND EXPLANATION OF RIGHTS FORMS ATTACHED 6. 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 and correct copy of the foregoing has been furnished by US. Certified Mail, Return Receipt Requested to Diane Liz Ali, Administrator, Sun View Retirement, 4005 South Lake Terrace, Miramar, Florida 33023, and Olive Williams, 4005 S. Lake Terrace, Miramar, Florida 33023 on 4 A ?, 2001. DianeXeiland, Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive, Suite 100 West Palm Beach, FL 33407 ee cp re ee

Docket for Case No: 01-003144