vi ie 4 pebe oes i PEED ; . STATE OF FLORIDA FE5 25 02 AGENCY FOR HEALTH CARE ADMINISTRATION capa ROTEL py DCPATMENT CLERK STATE OF FLORIDA ~ AGENCY FOR HEALTH CARE ADMINISTRATION, i Petitioner, ; : vs. AHCA NO: 10-00-077 ALF LMJ HEALTH CARE, INC., d/b/a DANIA BEACH RETIREMENT HOME #2, a 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") i al ll ik i intends to impose an administrative fine in the amount of Ten Thousand ($10,000) Dollars upon 4 LMJ Health Care, Inc., d/b/a Dania Beach Retirement Home #2 (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 I, Florida Statutes (F.S.) 2. Respondent i is licensed to operate at 705 sw 4m Terrace, Dania, Florida 33004 as an assisted living facility in compliance with Chapter 400, Part II, & 8.) and Chapter 58A-5, Florida Administrative Code (F.A.C.) ; 3. On or about September 18, 2000, during a complaint investigation conducted by persomnel from the Broward Office of the Agency for Health Care ¢ Administration it was Tevealed : eM A hl ll that: oo 7 (a) Based on interviews with the Dania Fire Marshall and Fire Inspector on o/ 18/00 at the ALF at 2:30 p.m., tour of the premises, and review of records, the facility was in violation of the fire/life safety code for the following conditions: ais Bed bey 4 i Fi Fl 4 Eoer es Terra qd) The fire sprinkler system was not operational. (2) The emergency exit lights were not functioning. (3) The front door of the facility was swollen shut and could not be opened. (4) There were no fire extinguishers in the building. (5) The fire alarm had an expired inspection dated December 1998. (6) The fire alarm was not hooked up at a central station for monitoring. (7) The facility had no record keeping of fire drills. Due to the severity of these violations in the life/safety code, the Dania Fire Marshall ordered the building to be closed. The residents were relocated to another facility and the building was secured by the Dania Fire Inspector at 5 p.m. Therefore, based on these findings it was determined the facility did not ensure the resident’s right to live in a safe environment This is in violation of section 400.428(1)(a), F.S. Class I deficiency. $10,000 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 II, (F.S.) 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 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), (F.S.) . All requests for hearings shall be made to: Agency for Health Care Administration 8355 NW 53" Street Miami, Florida 33166 Attention: Alba M. Rodriguez, Assistant General Counsel vil A ll el i a aa i il a ll a Bl i al arene Oana fra er ere Checks payable to: Agency for Health Care Administration Send directly (with Case number referenced) to: Gloria Collins Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, Mail Stop # 14 Tallahassee, Florida 32308 6. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN FIFTEEN (15) 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 hereof was sent by U.S. Certified Mail, Return Receipt Requested to LMJ Health Care Inc. 1120 NW 39% Street, Miami, FL 33065, and Lionel N. Jadoo, Registered Agent, 9978 North Springs Way, Coral Springs, Florida 33076, on this 4 uiay of Celober) 2000. P FEENEY, Filed Office Manager Agency for Health Care Administration 1400 West Commercial Blvd., Suite 100 Ft. Lauderdale, Florida 33309 Copy to: Alba M. Rodriguez, Assistant General Counsel Agency for Health Care Administration Manchester Building 8355 NW 53” Street Miami, Florida 33166 ALF Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Gloria Collins Finance and Accounting : Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 NOTE: In accordance with the Americans with Disabilities Act, persons needing a special accommodation to participate in this proceeding should contact Alba M. Rodriguez no later than ' fourteen (14) days prior to the proceeding or hearing at which such special accommodation is required. Alba M. Rodriguez may be contacted at 8355 NW 53” Street, Miami, Florida 33166. Telephone: (305) 499-2165 or 1-800-955-8770 (voice) via Florida Relay Service. a ak ll li all i hl U.S. Postal Service CERTIFIED MAIL RECEIPT Postage Certified Fee Return Receipt Fé {Endorsement Fequired) Restricted Delivery Fe (Endorsement Require) Total Postage & Fees 7000 O520 OO1b 7234 3453 SENDER: COMPLETE THIS SECTION lm Complete items 1, 2, and 3. Also complete itern 4 if Restricted Delivery is desiréd. lm Print your name and address on the reverse so that we can return the card to you. lm Attach this card to the back of the mailpiece, or on the front if space permits. (2) it il 1 ( lomestic Mail Only; No Insurance Coverage Provided) 1. Article Addressed to: Cesnek N- eheo Postmark Here COMPLETE THIS SECTION ON DELIVERY A Re ei ed by lease frint Clearly) | B. Date of Delivery win LPC oD les C. Signature m~ ™ mx ) \ DB Agent 5 ea Addressee Sue or item 1? 0 Yes aad abeBeisis O1No £m (acy 3. Service Type Mi if Exprasg Mg i Wy O Certified Mail 7 Return Receint46f Merchandise 1 Registered 1 Insured Mail 4. Restricted Delivery? (Extra Fee) Vv O Yes 2. Article Number (Copy from service labs N) 0 0940 00/6 VIZRY4 3653 Domestic Return Receipt PS Form 3811, July 1999 102595-00-M-0952

Docket for Case No: 02-000948