Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: MIGDALIA`S ACLF
Judges: FRED L. BUCKINE
Agency: Agency for Health Care Administration
Locations: Tampa, Florida
Filed: Aug. 09, 2002
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Friday, October 4, 2002.
Latest Update: Dec. 24, 2024
STATE OF FLORIDA Q2
AGENCY FOR HEALTH CARE ADMINISTRATION | ¢/;,,,
STATE OF FLORIDA “
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Petitioner,
vs AHCA NO: 06-01-0352-ALF
MIGDALIA’S ACLF
Respondent.
ADMINISTRATIVE COMPLAINT
COMES NOW the Agency for Health Care Administration
(hereinafter “AHCA”), by and through the undersigned
counsel, and files this Administrative Complaint against
MIGDALIA’S ACLF (hereinafter “Respondent”) and alleges:
NATURE OF THE ACTION
1. This is an action to impose an administrative
fine on MIGDALIA’S ACLF in the amount of FIVE HUNDRED
dollars ($500) pursuant to Sections 400.414(1) (a) and
400.419(1) (a) Florida Statutes.
Jurisdiction And Venue
2. This Court has jurisdiction pursuant to Section
120.569 and 120.57 Florida Statutes and Chapter 28-106
Florida Administrative Code.
3. Venue lies in Hillsborough County, Division of
Administrative Hearings, pursuant Lo 120.57 Florida
Statutes, and Chapter 28 Florida Administrative Code.
Parties
4. AHCA, Agency for Health Care Administration,
State of Florida, is the enforcing authority with regard to
assisted living facility licensure law pursuant to Chapter
400, Part III, Florida Statutes and Rules 58A-5, Florida
Administrative Code.
5. Respondent, MIGDALIA’S ACLF, is an assisted
living facility located at 2302 Lincoln Avenue, Tampa,
Florida. MIGDALIA’S ACLF, is and was at all times material
hereto, a licensed facility under Chapter 400, Part III,
Florida Statutes and Chapter 58A-S, Florida Administrative
Code.
COUNT I
MIGDALIA’S ACLF FAILED TO ENSURE THAT HOSPICE RESIDENT’S
RECORD CONTAINED AN INTERDISCIPLINARY CARE PLAN
FOR ONE SAMPLED RESIDENT
Fla. Admin. Code R. 58a-5.024(3) (n); Fla. Admin. Code R.
S58A- 5.0181(4) (c)3; § 400.428(1) (J) Fla. Stat. (2001)
CLASS III DEFICIENCY
6. AHCA re-alleges and incorporates paragraphs (1)
through (5) as if fully set forth herein.
7. On or about 11/19/01 based on record review and
interview, the facility did not ensure a Hospice Resident's
record contained an interdisciplinary care plan for one
sampled Hospice resident.
8. This same Class III deficiency regarding hospice
resident's records remained uncorrected from an earlier
visit on September 4, 2001, which had a mandated correction
date of October 4, 2001.
9. The above referenced actions and or inactions,
are violations of Fla. Admin. Code R. 58A.5-0181 and Fla.
Admin. Code R. 58A-5.024(3)(n); requiring that an assisted
living facility Hospice Resident's record will contain an
interdisciplinary care plan, and Section 400.428 (1) (4)
Florida Statutes; requiring that every resident of a
facility have the right to access to adequate and
appropriate health care consistent with established and
recognized standards with in the community.
10. The above referenced violations constitute the
grounds for the imposed uncorrected Class III deficiency
and for which a fine of five hundred dollars ($500) is
authorized under Section 400.419(1)(c) Florida Statutes.
WHEREFORE, AHCA intends to impose a fine against the
Respondent under Section 400.419(1) (c) Florida Statutes in
the amount of five hundred dollars ($500).
The Respondent is notified that it has a right to
request an administrative hearing pursuant to Section
120.569, Florida Statutes (2001). Specific options for
administrative action are set out in the attached
Explanation of Rights (one page) and Election of Rights
(one page). All requests for hearing shall be made to the
attention of Eileen O'Hara Garcia, Senior Attorney, Agency
for Health Care Administration, 525 Mirror Lake Dr., St.
Petersburg, Florida, 33701.
RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO
REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS
COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED
IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE
AGENCY.
Regpectfully submitt
Eileen O'Hara Garci Esquire
AHCA ~- Senior Attoyney
525 Mirror Lake Drive North,
St. Petersburg, Florida 33701
I HEREBY CERTIFY that a true copy hereof has been sent
by U.S. Certified Mail Return Receipt No.Z 259 496 234, to
Administrator Migdalia’s ACLF, 2302 Lincoln Avenue, Tampa
Florida 33607, [Bay
hot ° :
ara /Garcia, Esquire
Copies furnished to:
Administrator
Migdalia's ACLF
2302 Lincoln Avenue
Tampa, Fl 33607
(U.S. Certified Mail)
Elizabeth Dudek
Deputy Secretary
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308
(Interoffice Mail)
Eileen O'Hara Garcia, Esquire
AHCA - Senior Attorney
525 Mirror Lake Drive North,
St. Petersburg, Florida 33701
PAYMENT FORM
Agency for Health Care Administration
Finance & Accounting Department
P.O. Box 13749
Tallahassee, Florida 32317-3749
Enclosed please find check No. in the
amount of §$ , which represents payment of the
administrative fine imposed by AHCA.
Facility Name AHCA NO.
Op fi
STATE OF FLORIDA Uy og
AGENCY FOR HEALTH CARE ADMINISTRATION <7, 9 4,
ie, WY o
EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDASTATUTES — 57
(To be used with Election of Rights for Administrative Complaint form - attached)
In response to the allegations set forth in the Administrative Complaint issued by the Agency for
Health Care Administration (‘AHCA” or “Agency”), you must make one of the following elections within
twenty-one (21) days from the date of receipt of the Administrative Complaint. Please make your election of
the attached Election of Rights form and return it fully executed to the address listed on the form.
OPTION 1. If you do not dispute the allegations in the Administrative Complaint and waive your right to
be heard, you should select OPTION 1 on the election of rights form. A final order will be entered finding you
guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a
copy of the final order,
OPTION 2. If you do not dispute any material fact alleged in the Administrative Complaint (you admit
each of them), you may request an informal hearing pursuant to Section 120.57(2), Florida Statutes before
the Agency. At the informal hearing, you will be given an opportunity to present both written and oral
evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal
hearing, you should select OPTION 2 on the Election of Rights form.
OPTION 3. if you dispute the allegations set forth in the Administrative Complaint (you do not admit
them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal
hearing, select OPTION 3 on the Election of Rights form.
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 a 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 Administrative Complaint. If you do not respond at all within
twenty-one (21) days from receipt of the Administrative Complaint, a final order will
be issued finding you guilty of the violations charged and imposing the penalty
sought in the Complaint.
STATE OF FLORIDA Q>
AGENCY FOR HEALTH CARE ADMINISTRATION tip
oe
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#2) plo, “ ‘ of
RE: MIGDALIA’S ACLF CASE NO. 06° 49952-AL ey,
ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT”/:.. OS,
PLEASE SELECT ONLY 1 OF THE 3 OPTIONS
An Explanation of Rights is attached.
OPTION ONE (1) Q ! do not dispute the allegations of fact contained in the Administrative Complaint
and waive my right to object or to be heard. | understand that by waiving my rights, a final order will be
issued that adopts the Administrative Complaint and imposes the sanctions sought.
OPTION TWO (2) Qf do not dispute and | admit the allegations of fact in the Administrative
Complaint, but do wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida
Statutes, at which time | will be permitted to submit oral and/or written evidence to the Agency in mitigation
of the penalty imposed.
OPTION THREE (3) Q / do dispute the allegations of fact contained in the Administrative Complaint 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 Administrative
Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative
Complaint, a final order will be issued finding you guilty of the violations charged and imposing the
penalty sought in the Complaint.
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. O
Mediation under Section 120.573, Florida Statutes, is not available in this matter.
SEND NO PAYMENT NOW -- REGARDOLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL
YOU RECEIVE A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES.
{Please sign and fill in your current address.)
Respondent (Licensee)
Address:
License. No. and facility type: Phone No.
PLEASE RETURN YOUR COMPLETED FORM TO:
Eileen O’Hara Garcia, Senior Attorney
Agency for Health Care Administration
§25 Mirror Lake Drive North, Room 310
St. Petersburg, Florida 33701
Telephone: (727) 552-1439
Fax No. (727) 552-1440
TDD 1-800-955-8771
Docket for Case No: 02-003126
Issue Date |
Proceedings |
Dec. 06, 2002 |
Final Order filed.
|
Oct. 04, 2002 |
Motion to Relinquish Jurisdiction filed.
|
Oct. 04, 2002 |
Order Closing File issued. CASE CLOSED.
|
Sep. 06, 2002 |
Order of Pre-hearing Instructions issued.
|
Sep. 06, 2002 |
Notice of Hearing issued (hearing set for October 22, 2002; 9:00 a.m.; Tampa, FL).
|
Aug. 09, 2002 |
Initial Order issued.
|
Aug. 09, 2002 |
Administrative Complaint filed.
|
Aug. 09, 2002 |
Election of Rights for Administrative Complaint filed.
|
Aug. 09, 2002 |
Notice (of Agency referral) filed.
|