O2°12/02 10:49 FAX 561 863 6451 PEPSI BOTTLING COMPANY R @ 002 Apr 12 02 10:21a TRACY HARRIS 561-881-7615 p-2 DA-IT%Y) 9 ec ; MRI2° 0 | py 4 Legal Deparument | GOLDEN YEARS A.L.F. 321 WEST BLUE HERON BLVD RIVIERA BEACH, FL 33404 TEL: (S61) 881-7615 t April 11, 2002 ° Alba Rodriguez Agency for Health Care Administration 8335 N.W. 53™ Street Manchester Building First Floor Miami, F1 33166 20 12 Udy ADMMINISTRATIVE COMPLAINT AHCA NO:2002007301 = a os In response Golden Years A.L.F, Tracy Harris, Owner/Operator dispute ail, 2 allegations in complaint AHCH NO: 2002007301. ~ Respondent hereby make request for a Formal Hearing based on the the following facts:- ; ae 65:6 WY B- KH 20 1. Galden Years ALF previously licensed on License#AL9276 closed on November 30, 2001 by final order dated October 11, 2001 and was given 30 days in which to comply and pay fines, REASON: FLORIDA STATUTES SECTION 400.428 (k) RESIDENT BOLL OF RIGHTS STATES — AT LEASE 45 DAYS NOTIFICATION OF RELOCATION OR TERMINATION OF A RESIDENT. 2. The following allegations and findings based on complaint investigation 4200200485 on Jannary 24, 2002 carried out by Merill Gottlibe was just another racist attack trying to close another black owned business. The real reason for his visit was to find a reason to hinder negotiations between AHCH & Golden Years ALF regarding settlement of License Denial Case #200200182 that was being negotiated. 3. At 4:00p.m. the time of his visit, there were nine residents not 11 as alleged, living at Golden Years Independent Living which is located at 311 & 331 West Blue Heron Blyd. No assistive service was given to the niue residents. 4. All nine persons living independently at the time of the visit were taking their own medication and were aware of what medication they were taking, 04°12-02 10:49 FaX 561 863 6451 PEPSI BOTTLING COMPANY R Apr 12 02 10:22a TRACY HARRIS 561-891-7615 5. All medication that were held in the office which were shown to surveyors were held for safe keeping and the prevention of being stolen for sale. This was made very clear to the inspectors. 6. 1did NOT admit to inspectors that I assisted residents with medication or any other assistive care as alleged by surveyors. 7. The premises consist of three buildings of which two, #311 and #331 are for the sole purpose and use for independent living. These buildings are fully equipped with kitchen facilities including microwaves for residents to use. [ offered to show the surveyors where and how cach resident lived but they denied my offer. 8. By observation, residents interviewed and statements from Tracy Haris, Owner/Operator, AKICA personnel should have determined that personal 003 e.g and or assistive services were NOT being given to residents and, therefore, an assisted living facility was not being operated! as alleged. 9. The provision of personal and or assistive service requires the provider to be a licensed assisted living facility which Tracy Harris , Owner never claimed to be a licensed ALF but was managing independent living residents at the time of surveyors visit. 10. $400.402 (6) defines an assisted living facility as a facility which uudertakes through its wnuership to provide housing, meals and assistive care with one or more A.D.L, -- This was not supplied! 11. fn summary charges for 100 days at $1,000.00 per day as assessed by AHCA is based on fraudulent alfegations made by surveyors whose sole intentions/motives were to disrupt the negotiations that were in progress. FLORIDA STATUTES SECTION 400.419 — (6) states.....Any unlicensed facility that continues to operate after agency notification is subject toa $1,000.00 fine. Each day beyond 5 working days after agency uotification.,.in this instauce final order dated October 11, 2001 giving Golden Years ALF 30 days to comply with said order cannot be constituted ag notification. These being the material facts, 1am respectfully asking for a formal hearing. Respectfully submitted, HARRIS FILED STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION PPR 2 AD AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2002007301 Return Receipt Requested: 7000 1670 0011 4845 7090 Vv. GOLDEN YEARS ALF, TRACY HARRIS, OWNER/OPERATOR, Respondent. ADMINISTRATIVE COMPLAINT 65:6 WY 8- AH 20 COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Golden Years ALF, and Tracy Harris, owner/operator, (hereinafter “Golden Years”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $100,500 pursuant to Section 400.419(6), Florida Statutes (2001), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes, (2001). 3. Venue lies in Leon County, pursuant to Rule 28.106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities, pursuant to Chapter 400, Part III, Florida Statutes (2001) and Chapter 58A-5 Florida Administrative Code. 5. Golden Years ALF operated a licensed 15-bed assisted living facility located at 321 West Blue Heron Blvd., Riviera Beach, Florida 33404, license number AL9276; certificate number 4446, effective June 4, 1998 through June 3, 2000. Golden Years’ license renewal application was received by AHCA on March 29, 2000 but was denied by Final Order entered on October 1, 2001. Golden Years subsequently re-applied for an assisted living facility license, which was denied by Notice of Intent to Deny letter dated January 10, 2001. This denial is presently under appeal before the Agency’s informal hearing officer. COUNT I GOLDEN YEARS OPERATED WITHOUT A LICENSE AFTER AGENCY NOTIFICATION THAT RENEWAL APPLICATION FOR LICENSE WAS DENIED BY FINAL ORDER DATED OCTOBER 11, 2001 § 400.408(1) (a), § 400.402(6), § 400.402(17), § 400.402(1) § 400.419(6), Florida Statutes and Rule 58A-5.0131 (a)- £), Florida Administrative Code 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. The following are the allegations and findings based on complaint investigation #200200485 of January 24, 2002. (a) At 4:00 p.m. an unannounced visit was made to 321 West Heron Blvd., Riviera Beach. There were 11 residents residing at the facility and each was interviewed regarding the services .being provided to them. Eight of the residents interviewed stated that their medications were being held in a locked drawer in the office and Tracey Harris, owner/operator, would administer them. Seven of the residents interviewed stated that their medications were centrally stored in a file cabinet drawer and brought to the residents at the times they were due. Tracey Harris would then take the medications out of their containers and put them into the residents’ hands or in the cover of the pharmacy bottles. Two of the residents interviewed were able to name the medications taken. The others could not. (ob) During interview with Tracy Harris, he admitted to assisting the residents with their medications in the manner described above. Mr. Harris showed both surveyors conducting the investigation where the medications were stored in a locked file cabinet. The residents had between 1 and 6 different medications prescribed for each of them, twice and three times a day. Most of these medications were psychotropic medications. (c) The premises consisted of three buildings with separate numbered addresses - 311, 321 and 333 West Blue Heron Blvd. Individuals were housed in 311 and 333 and were provided food and medications in 321 West blue Heron Blvd. A sign with the facility’s name and old license number was posted on the front of the building at 321 West Heron Blvd. (d) By observation, resident interview and admission with owner/operator, Tracy Harris, AHCA personnel determined that personal services were being provided to the residents at Golden Years and therefore the facility was operating as an assisted living facility. (e) The provision of personal services requires the provider to be a licensed assisted living facility pursuant to §400.408(1) (a) which states that it is unlawful to operate or maintain an assisted living facility without obtaining a license from the Agency. (f) §400.402(6) defines an assisted living facility as a facility which undertakes through its ownership or Management to provide housing, meals and one or more personal services for a period exceeding 24 hours to one or more adults who are not related to the owner or administrator. §400.402(17), Fla. Stat. defines personal services as direct physical assistance with or supervision of the activities of daily living’ and the self- administration of medication and other similar services. 8. The foregoing deficiency is in violation of $400.408(1) (a), $400.402(6). §$400.402(17), §400.402(1) and § 400.419(6), Fla. Stat. and Rule 58A-5.0131 (a) (£), Florida Administrative Code, carrying in this instance a fine of $100,000. This amount is based on a total of 100 days of operating an unlicensed assisted living facility (from October 16, 2001 to January 24, 2002) at $1,000 a day x 100 days = $100,000 pursuant to Section 400.419(9) Florida Statutes. 9. In addition to any administrative fines imposed, AHCA may assess a survey fee equal to the lesser of one "§400.402(1) defines activities of daily living as “..functions and tasks for self-care, including ambulation, bathing, dressing, eating, grooming, and toileting, and other similar tasks”. half of the facility’s biennial license and bed fee or $500 to cover the cost of conducting a complaint investigation that results in finding of a violation that was subject of the complaint conducted under Section 400.419(9), Florida Statues. 10. Based on the foregoing, AHCA is imposing a $500 survey fee. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court order the following relief: 1. Make factual and legal findings in favor of the Agency on Count I. 2. Impose a fine of $100,000 upon Golden Years ALF. 3. Assess costs related to the survey of this matter in the amount of $500 pursuant to Count I. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 N.W. 53 Street, Miami, Florida 33166; Attn: Alba M. Rodriguez. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. Respectfully submitted, Loa Alba M. Rodriguez Jd Assistant General Counsel Fla. Bar No. 0880175 Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Dated Tasks slelnd 1 2002 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive West Palm Beach, Florida 33407 (U.S. Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Tracey Harris, Administrator, Golden Years ALF, 321 West Blue Heron Blvd., Riviera Beach, Florida 33404 on this QQyd day of 72)0.2.0h0 2002. thas; Boachguttags Alba fad L)

Docket for Case No: 02-001790