SST ie oor tare ct age cepa cr eae Ene OSE eae ARIES — OL2807 STATE OF FLORIDA * /, & AGENCY FOR HEALTH CARE ADMINISTRATION 7! $e 4 OA) | ® p . STATE OF FLORIDA OF 2 AGENCY FOR HEALTH CARE “ohn S04 0 38 ADMINISTRATION, Hey Taye gllve Petitioner, vs. AHCA NO: 06-01-0184-ALF MCNEALY ENTERPRISES, INC., d/b/a MCNEALY’S ALF, 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 a civil penalty in the amount of $1000.00 upon McNealy Enterprises, Inc., d/b/a McNealy’s ALF (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 III, Florida Statutes. (2) Respondent is licensed to operate as an Assisted Living Facility at 410 E. Oak Avenue, Tampa, Florida 33850, in centage i ep eet compliance with Chapter 400, Part III, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. (3) The Respondent has violated minimum licensure standards, as evidenced by each deficiency set forth below, as found to exist during the survey of July 27, 2001. (a) The Respondent failed to have available and/or to have required business records indicating income from residents by source and separately identifying income and expenses from other sources. This is a violation of Rule 58A-5.021(2) and/or 58A-5.024(4), Florida Administrative Code. This violation is a repeat violation, having been previously cited in the survey of October 27, 1999. Class III deficiency. Fine: $1,000.00. (4) The above referenced violation[s] constitute[s] grounds to levy this civil penalty pursuant to Section 400.419, Florida Statutes, in that the above referenced | conduct of Respondent constitutes a violation of the minimum standards, rules, and regulations for the operation of an Assisted Living Facility. (5) Notice was provided in writing to the Respondent of each of the above violations. (6) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, 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 28-106, 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, and delivered to Division of Managed Care and Health Quality, 525 Mirror Lake Drive North, Suite 310d, St. Petersburg, Florida 33701; attention Patricia J. Hakes, Senior Attorney. Payment of fines shall be sent to the Agency for Health Care Q . i Administration, P.O. Box 13749, Tallahassee, Florida 32317-3749. (Please reference the case number and facility name on the front of your check). nas pH BR Be (7) RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEPT 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 hereof has been sent by U.S. Certified Mail, Return Receipt (Z 170 444 482) Requested, to McNealy Enterprises, Inc., through its Registered Agent, Kathy L. Mouling, 205 KE. M. L. King Boulevard, #204, Tampa, Florida 33603, on the 224, day of CfegeeX , 2001. : TOE R Couper PATRICIA REIN’CAUFMAN Field Office Manager Agency for Health Care Administration Division of Managed Care and Health Quality Copies furnished to: Patricia J. Hakes, Esquire Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 310g St. Petersburg, Florida 33701 ALF Section Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Area 6 Office Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 410A St. Petersburg, Florida 33701 Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Wendy Adams Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Administrator McNealy’s ALF 410 E. Oak Avenue Tampa, FL 33602 Sor mee nermatreer ee ne ereenreme RR Sa gn ceca

Docket for Case No: 01-003807