STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE Certified Article Number ADMINISTRATION, 7L06 4575 1294 2050 Ob&e , SENDERS RECORD Petitioner, AHCA CASE NO. 2002048548 lege me JUST LIKE HOME, D> 017K INC., f/k/a JUST LIKE HOME AT ORANGE CITY, Respondent. gach wa BH f° / ADMINISTRATIVE COMPLAINT COMES NOW THE AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter referred to as AHCA), by and through its undersigned counsel, and files this Administrative Complaint against JUST LIKE HOME, INC., F/K/A JUST LIKE HOME AT ORANGE CITY, (hereinafter referred to as “Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2002), and alleges the following: Nature of the Action 1. This is an action to impose an administrative fine upon Respondent, pursuant to Section 400.414, Florida Statutes. Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4. Venue vests pursuant to Rule 28-106.207, Florida Administrative Code. Parties 5. Pursuant to Chapter 400, Part III, Florida Statutes, and Rules 58A-5, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. At all times material, Respondent operated an assisted living facility located at 202 Strawberry Oaks Drive, Orange City, Florida 32763. Respondent was at all times material hereto a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code, with 45 beds and having been issued license number 9243. COUNT I RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO TRANSFER ALL RESIDENT FUNDS ON DEPOSIT, ADVANCE PAYMENTS OF RESIDENT RENTS, RESIDENT SECURITY DEPOSITS AND RESIDENT TRUST FUNDS AT THE TIME OF TRANSFER OF OWNERSHIP. Rule 58A-5.014 Florida Administrative Code (2002); Section 400.414 Fla.Stat (2002) 7. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 8. On or about September 23, 2002, AHCA performed a survey at the facility referenced in paragraph 6 above. AHCA cited the facility based on the findings below: Through facility record review, family interview and interview with the administrator the following was found: 1. All resident funds were not transferred at the change of ownership to the new owners from the past owners. The administrator contacted by telephone the Senior Living Management Corporation and was told that the transfers have not been made. 2. A telephone call from a family member whose mother is a current resident revealed that the relative had not received a refund of $1650 from Just Like Home, the previous owner, nor have the funds been transferred to Savannah Court. 9. The facility was given a mandated correction date of October 23, 2002 (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes. 10. On or about October 29, 2002, AHCA performed a follow-up survey at the facility. AHCA cited the facility based on the findings below: Through facility record review, family interview and interview with the administrator on the day of the follow-up survey the following was found: 1. All resident funds were not transferred at the change of ownership to the new owners from the past owners. The administrator contacted by telephone the Senior Living Management Corporation and was told that the transfers have not been made. 2. A telephone call from a family member whose mother is a current resident revealed that the relative had not received a refund of $1650 from Just Like Home, the previous owner, nor have the funds been transferred to Savannah Court. 3. At the time of the follow-up, interview with staff confirmed that funds had not been transferred since cited during the survey on September 23, 2002. 11. Based on the foregoing, Respondent has violated Rule 58A-5.014(2) (c) Florida Administrative Code (2002) by reason of the fact that Respondent failed to transfer all resident funds on deposit, advance payments of resident rents, resident security deposits and resident trust funds at the time of transfer of ownership. 12. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem remains uncorrected, or was previously corrected but is subsequently cited at a later date, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. Dated: December 5, 2002 Agency for Health Care Administration nai neg Senior Attorney Fla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax) NOTICE Respondent, JUST LIKE HOME, INC., f£/d/b/a JUST LIKE HOME AT ORANGE CITY hereby is notified that Respondent has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Jodi C. Page, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE ADMINISTRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY AHCA. Dated: December 5, 2002 AGENCY FOR HEALTH CARE ADMINISTRATION mess Ey © Jod . Se , Senior Attorney Fla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax) CERTIFICATE OF SERVICE —_—S eee eee I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent by U.S. Certified Mail, Return Receipt Requested, (Return Receipt #4106 4575 1294 2050 0682) to JUST LIKE HOME, INC., £/d/b/a JUST LIKE HOME AT ORANGE CITY, 3111 Castle Shannon Blvd., Pittsburgh P.A. 15234, and a copy sent to Charles F. Johnson, III, Registered Agent, 822 11° Street West, Bradenton, Florida 34205 this 5°? day of December, 2002. ’ AGENCY FOR HEALTH CARE ADMINISTRATION Jodd . Page, re, Senior Attorney Fla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax)

Docket for Case No: 03-000778