Cectified Ne 7001 0360 0003 3804 3875 ~ STATE OF FLORIDA ay Wy AGENCY FOR HEALTH CARE ADMINISTRATION ne A AGENCY FOR HEALTH CARE ADMINISTRATION, Ve Petitioner, vs. Case No. 2002046635 THE SOCIAL CENTER, INC., . 07-200 { THE SOCIAL CENTER Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against THE SOCIAL CENTER, INC., d/b/a THE SOCIAL CENTER, hereinafter referred to as “Respondent,” pursuant to Section 120.569, and 120.57, Florida Statutes, (2002), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine upon the Respondent, pursuant to Section 400, Part V, Florida Statutes, (2002). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). 3. AHCA has jurisdiction over the Respondent pursuant to Chapter 400, Part V, Florida Statutes (2002). 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2002). PARTIES 5. Pursuant to Chapter 400, Part V, Florida Statutes, and Rules 58A-6, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to adult day care centers laws and rules. 6. The Respondent is an adult day care centers located at: 6318 Arlington Rd., Jacksonville, FL 32211. The Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part V, Florida Statutes (2002), and Chapter 58A-6, Florida Administrative Code (2002), having been issued license number 306. COUNT I The Respondent failed to maintain a satisfactory fire safety inspection. Fla. Admin. Code R. 58A-6.011(11) (2002) § 400.562(1)(a), Fla. Stat. (2002) 7. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through six (6) as if fully set forth herein. 8. On or about April 17, 2002, AHCA conducted a survey at the Respondent’s facility; and on or about June 18, 2002, AHCA conducted a revisit to the facility. 9. During the April 19, 2002, initial survey a review of facility documentation revealed the most recent annual fire safety inspection was revealed to have been conducted on May 13, 2002. In addition it was revealed the facility did not have evidence of a satisfactory annual fire safety and failed to meet the minimum standards during the May 13, 2002 fire inspection. 10. Based on a review of facility documentation and interviews with staff it was determined the facility did not have evidence of a satisfactory annual fire safety inspection during the revisit on or about June 18, 2002. 11. Based on the foregoing violation AHCA assesses a fine against the Respondent pursuant to Sec. 400,.556(2)(a and (b) of Fla. Stat. (2002) for the violations of Fla. Admin. Code R. 58A-6.011(11) (2002) and Sec. 400,.562(1)(a), Fla. Stat. (2002) WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of this Administrative Complaint. 2. Impose a fine in the amount of $500.00. ' 3. All other general and equitable relief allowed by law. eel Submitted on this 3°" day of A pe \ 2003, on behalf of the Agency for Health Care Administration by, A rake Cb yn» Ursula Eikman, Esquire Staff Attorney, Fla. Bar. No. 0500941 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5865 (office) (850) 413-9313 (fax) tu STATE OF FLORIDA i q r AGENCY FOR HEALTH CARE ADMINISTRATION o 3 *29 AGENCY FOR HEALTH CARE ‘hop, ADMINISTRATION, WS R VE Petitioner, vs. Case No. 2002046635 THE SOCIAL CENTER, INC., d/b/a THE SOCIAL CENTER. Respondent. NOTICE The Respondent, THE SOCIAL CENTER, INC., d/b/a THE SOCIAL CENTER, is notified that it has a right to request an administrative hearing pursuant to Section 120.569, 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 hearing shall be made to Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida, 32308; Attention: Ursula Eikman, Esquire- Staff Attorney. THE RESPONDENT IS FURTHER NOTIFIED, if the request for hearing is not received by the Agency for Health Care Administration within twenty-one (21) days of receipt of this Administrative Complaint, a Final Order will be entered. acl Submitted on this_2 day of A pel 2003, on behalf of the Agency for Health Care Administration by, y oy a nal A Pdr Ursula Eikman, Esquire Staff Attorney, Fla. Bar. No. 0500941 Counsel for Petitioner Agency for Health Care Administration Bidg. 3, MSC#3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5865 (office) (850) 413-9313 (fax) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent by U.S. Certified Mail, Retum Receipt Requested (return receipt #10 cee 3 44%, to THE SOCIAL CENTER, INC., d/b/a THE SOCIAL CENTER, at 6318 Arlington Rd., Jacksonville, FL 32211. Submitted on this 24 day of a, il 2003, on behalf of the Agency for Health Care eit by wi LN (Uaashe Eikman, Esquire Staff Attorney, Fla. Bar. No. 0500941 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5865 (office) (850) 413-9313 (fax)

Docket for Case No: 03-002001