“% ram yoors STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS Smi-Clos. Petitioner, CASE NO: 02-0029 AHCA NO.: 2001074751 AVANTE AT LAKE WORTH, Vv. AGENCY FOR HEALTH CARE > BR Loup] ADMINISTRATION, 222m oq ers FO ewenin Respondent. Bal Ss Pe / Se-- =» IT Om ey ZS Ned a nm mn FINAL ORDER Having reviewed the Notice of Intent to Assign Conditional Licensure Status, dated October 24, 2001, attached hereto and incorporated herein, (Ex. 1). The Agency for Health Care Administration (“Agency”) finds and concludes as follows. FINDINGS OF FACT 1. The Agency issued its Notice of Intent to Avante at Lake Worth, (“Avante”) a skilled nursing facitity. The Notice of Intent charged tHat: * Avante’s licensure status would change to conditional effective 9/14/01 based on an Agency survey conducted 9/14/01 pursuant to Section 400.23(7)(b) Fla. Stat. (2001). 2. Enclosed with the Notice of Intent was an Election of Rights form (Ex. 2) (attached hereto and incorporated herein), which advised Avante of its right to a hearing pursuant to §120.57(1) or §120.57(2), Fla. Stat (2001). 3. On November 8, 2001, Avante Returned the Election of Rights form choosing option 3, disputing the allegations, of fact and requesting a formal hearing. 4. The Request for a formal hearing was forwarded to the Division of Administrative Hearings (‘DOAH”) on December 27, 2001. 5. DOAH assigned case number 02-0029 to hear the matter. 6. Avante issued its Notice of Voluntary Dismissal to DOAH, on February 19, 2002 and DOAH closed its file on February 21, 2002. 7. The facts as alleged and found, establish: Avante’s licensure status would change to conditional effective 09/14/01 based on an Agency survey conducted 9/14/01 pursuant to Section 400.23(7)(b) Fla. Stat. (2001). CONCLUSIONS OF LAW 1... Avante is a skilled nursing facility over which the Agency-has jurisdiction pursuant to the provisions of § 20.42 and Chapter 400, Part II, Fla Stat. (2001). 2. Based upon Avante’s Notice of Voluntary Dismissal to DOAH, the Agency has jurisdiction and may order changing Avante’s licensure status. Based on the foregoing findings of fact and conclusions of law, it is ORDERED: 1. The Respondent’s change in licensure status is upheld. DONE and ORDERED this _C%~day of Blt , 2002. in Tallahassee, Leon County, Florida, A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished. to: Gerald Pickett Assistant General Counsel Agency for Health Care Administration 2727 Mahan Dr. MS#3 Tallahassee, FL. 32308 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bidg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) Molly McKinstry Agency for Health Care Administration 2727 Mahan Drive Mail Stop #33 Tallahassee, Florida 32308 (Interoffice Mail) Jonathan S. Grout Goldsmith, Grout & Lewis, PA 2180 Park Ave North, Ste 100 Post office Box 2011 , Winter Park, FL. 32790-2011 (U.S. Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the method designated, on this AU day of ; , 2002. r! on orn, Virgiyva Daire, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865 . ‘ | STATE OF FLORIOA Qo AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR RHONDA M. MEDOWS, MD. FAAFP, SECRETARY October 24, 2001 CERTIFIED MAIL -":7 > * RETURN RECEIPT REQUESTED Administrator #7000-0520-0024-8387-9454 Avante-at Lake Worth 2501 North A Street Lake Worth, Florida 33460-6013 NOTICE OF INTENT TO ASSIGN CONDITIONAL LICENSURE STATUS Dear Administrator: In this case, the imposition of a conditional licensure status is effective 9/14/01, and is issued Conditional as a result of the survey completed on 9/14/01. During this survey a Class II deficiency, for a violation of 59A-4.1288 Florida Administrative Code (F.A.C.), was cited for failure to protect residents from another resident who was acting inappropriately. This license reflects your current license status and must be displayed in a conspicuous place in your facility pursuant to section 400.062(5), F.S. . Pursuant to section 120.569, F.S., you have a right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, (F.A.C.), and must state the material facts you dispute. The license that was issued for your annual renewal of October 1, 2001 with certificate number 7629, must be returned to the Agency immediately. That license is now void. SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS Sincerely, Molly McKinstry Program Manager Long Term Care Health Facility Regulation cc: Agency Clerk, Dianne Grubbs, MS-3 West Palm Beach Field Office K. Munn, LTC Unit File Exhibit 1 Visit AHCA Online at www fdhe.state flius 2727 Mahan Drive © Mail Stop # 33 Tallahassee, FL 32308 Ses ARE RACER At “sp9q “OT: Mies ar a £109-09VEE “I HLUOM SIV. LAAULS V HLYON 1087 : :SUIMOT[OJ oy arerado 01 pazuoypae,” ; be ; ; tigasuannt ous B pue‘sayMeIS. epuoLy ‘TI eg ‘0Op JaideyD ur pezuomne ‘uonensturpy ans, ney Joy: ey ‘epHOLy “39 eis .ou Aq: paido 2 suOne[ngar pue soln ou a ‘Peyduroo at oN HLYOM VT, LV, ALNVAV * fe MM Dee ALIIVNO HL'IVaH GNV TuvO OVNI 4O NOISIAIG _ NOLLVULSININAY aUVO HLTVaH Yor XONHOV TOOOSTOTANS ,# ASNSOIT . 7 Doe ye SRE avonmago THES it ty ve Mea v SETH €109-O9VEE “Td ‘HILO SAT LAMALS V HLYON 1057" “i “SuIMOTOR. om ayeredo. OF peznown Sen’ frabed Sey 2d 9 peti mc wave am & Pue sojns om Ip ALITVND HLIVaH Nv TAVD daOVNVN dO NOISIAIG - NOLLVULSININGV aavo HLIVa HOA AONAOV STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: Avante at Lake Worth for Conditional Licensure Status Change of 9/14/01 ELECTION OF RIGHTS FOR NOTICE OF INTENT PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE (1) GI do not dispute the allegations of fact contained in the Notice of Intent and waive my right to object or to be heard. OPTION TWO (2) G Ido not dispute and I admit the allegations of fact in the Notice of Intent, but do wish to be afforded an informal proceeding, pursuant to Section {20.57(2), Florida Statutes, at which time I will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) 1 do dispute the allegations of fact contained in the Notice of Intent and request a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. If you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C.), and must state the material facts you dispute. In order to preserve your right to any hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Notice of Intent. If you do not respond at all within twenty-one (21) days from receipt of the Notice of Intent, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Notice of Intent. If you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. 0 Mediation under Section 120.573, Florida Statutes, is not available in this matter. . Nh : (Biease sign and fill in your current address.) fuss (FB fe lh Wa. o Respondent / Licensee aw ' coe Address: 50 \ N St. License No. and facility type: SN E | 025 0 TG \ Phone No} PLEASE RETURN YOUR COMPLETED FORM TO: Agency Clerk, Dianne Grubbs Agency for Health Care Administration 2727 Mahan Drive (MS 3), Tallahassee, Florida 32308 (phone $850-922-5873, fax #850-413-9313, TDD 1-800-955-8771) , exhibit 2. war STATE OF FLORIDA DIVISION OF ADMINISTRATION HEARINGS AVANTE AT LAKE WORTH Petitioner, vs. ” Case No. 02-0029 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent, / NOTICE OF VOLUNTARY DISMISSAL _. COMES NOW, Petitioner, AVANTE AT LAKE WORTH, herein files a voluntary dismissal of the request for hearing that was filed in this cause. I HEREBY CERTIFY that a copy of the foregoing Notice of Voluntary Dismissal has been furnished by facsimile to Stuart Lemer, Administrative Law Judge, Division of Administrative Hearings, The DeSoto Building 1230 Apalachee Parkway, Tallahassee, Florida 32399-3060, - 850/921-6847 with a copy via mail delivered to Gerald L. Pickett, Esquire, Agency for Health Care Administration, 2727 Mayhan Drive, Fort Knox Building 3, Suite 3431, Tallahassee, Florida 32308, this _/ 7 day of February, 2002. , JOMATHAN S. GROUT GOLDSMITH, GROUT & LEWIS, P.A. 2180 Park Avenue North, Suite 100 Post Office Box 2011 Winter Park, Florida 32790-2011 Attomeys for Respondent Florida Bar No. 296066

Docket for Case No: 02-000029