STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE Certified Article Number ADMINISTRATION, ?U0b 4575 1294 2OS0 Ob44 SENDERS RECORD AHCA CASE NO. 2002048392, O67 Petitioner, JUST LIKE HOME, INC., £/k/a JUST LIKE HOME AT HAINES CITY Respondent. 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 HOMES AT HAINES CITY, (hereinafter referred to as “Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2001), 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 5S. 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 301 Peninsular Drive, Haines City, Florida 33844. 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 9382. COUNT II 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 19, 2002, AHCA performed a complaint investigation at the assisted living facility referenced in paragraph 6 above. AHCA cited the facility based on the findings below: Based on records review and interview, it was determined the facility failed to secure resident security deposits at the time of the change of ownership. Findings include: Interview with the Administrator on 09/19/02 at 9:45 stated, "We are in the same situation and issues as the other facility." The administrator indicated that at the time of the Change of Ownership all resident funds on deposit and resident advance payments and security deposits failed to be transferred to the new owners. 9. The facility was given a mandated correction date of October 18, 2002 (Class III offense) in accordance with Section 400.419(1) (c), Florida Statutes. 10. On or about October 21, 2002, AHCA performed a follow-up complaint investigation at the facility. AHCA cited the facility based on the findings below: Based on record review and interviews, it was determined the facility failed to receive all resident funds on deposit, advance payments of resident rents, resident security deposits and resident trust funds held by the former licensee at the time of transfer of ownership. Findings include: During an interview from approximately 2:37 p.m. to 2:44 p.m. on 10/21/02, the Administrator stated, "As far as Just Like Home we still are waiting, the requests were made and continue to be made for Just Like Home to transfer resident funds over to Savannah Court of Haines City.” After the Administrator called the Corporate Office and spoke to the Supervisor of Operations, at approximately 2:56 p.m. on 10/21/02, the Administrator stated, "The Supervisor of Operations stated, "We do not have any resolution yet, we are as much in the dark as the Residents are." At approximately 3:05 p.m. on 10/21/02, the Administrator further stated, "Our Attorney is working with the State Attorney to resolve this issue." Therefore, all resident funds on deposit and resident advance payments and security deposits failed to be transferred to the new owners at the time of the Change of Ownership and have not been transferred from the old owners (Just Like Home of Haines City) to the new owners (Savannah Court of Haines City) as of this investigation revisit on 10/21/02. 18. Based on the foregoing, Respondent 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 held by it at the time of transfer of ownership. 19. 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. 20. The facility was given a mandated correction date of November 20, 2002(Class III offense) in accordance with Section 400.419(1)(c), Florida Statutes. 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 2, 2002 Agency for Health Care Administration Jodi C. Page, Esquire, 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., £/d/b/a JUST LIKE HOME AT HAINES CITY hereby is notified that Respondent 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 form and explained in the attached Explanation of Rights form. All requests fora hearing shall be sent to AHCA, Jodi Cc. 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 4, 2002 AGENCY FOR HEALTH CARE ADMINISTRATION Ses Jo C. Page, Eéqyire, 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 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 #7106 4575 1294 2050 0644) to JUST LIKE HOME, INC., £/d/b/a JUST LIKE HOME AT HAINES 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 4*® day of December, 2002. , AGENCY FOR HEALTH CARE ADMINISTRATION SBecbs6S JO C, Page, Esq e, 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: 03-000779