Mav 6. 2003 §:03AM QUALITY OF LIFE HOME HEALTH No.6509 P. STATE OF FLORIDA 03 AGENCY FOR HEALTH CARE ADMINISTRATION 2 AGENCY FOR HEALTH CARE AOMnGS ADMINISTRATION, Petitioner, AHCA No.: 2002047921 ‘ Return Receipt Requested: v. 7000 1670 0011 4847 2239 7000 1670 0011 4847 2246 ATLANTIC COMMUNITY CARE d/b/a LYFORD 7000 1670 0011 4847 2277 COVE AT LAWNWOOD, O Q60d- Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Atlantic community Care d/b/a Lyford Cove at Lawnwood (hereinafter “Lyford Cove at Lawnwood”), 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 $10,000.00 pursuant to Section 400.419, Florida Statutes (2001), for the protection of the public health, safety and welfare. Received Time May. 6. 8:00AM May §. 2003 8:04AM = QUALITY OF LIFE HOME HEALTH No.6509 P. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57 Fla. Stat., Chapter 28-106, Florida Administrative Code. 3. venue lies in St. Lucie County, pursuant to Section 120.57 Fla. Stat, 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 ITI, Florida Statutes (2001), and Chapter 58A-5 Florida Administrative Code. . 5. Lyford Cove at lLawnwood operates a 112-bed assisted living facility located at 1550 North Lawnwood Circle, Ft. Pierce, Florida 34950. Lyford Cove at Lawnwood is licensed as an assisted living facility under license number 9872. Lyford Cove at Lawnwood was at ail times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with ail applicable rules and statutes. Received Time May. 6. 8:00AM 3 » 2003) 8:04AM == QUALITY OF LIFE HOME HEALTH No.6909 COUNT I LYFORD COVE AT LAWNWOOD RETAINED TWO (2) EMPLOYEES WITH UNSATISFACTORY FDLE BACKGROUND SCREENINGS. SECTION 400.4174(2), FLORIDA STATUTES (STAFF RECORDS STANDARDS) CLASS I VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Lyford Cove at Lawnwood was cited with one (1) Class I deficiency pursuant to a Background Screening Compliance Appraisal Visit conducted on October 4, 2002. 8. Based on a Background Screening Compliance Appraisal Visit conducted on October 4, 2002 and based upon record review and interview it was revealed that the facility did not ensure that employees who do not meet the required level I screening were not retained. Findings include the following. 9. BR review of the facility's policies and procedure manual states that all employees must have a satisfactory background screening to be employed. During the review of all 37 facility staff records of individuals currently on payroll as of 10/3/02 revealed that two stati members did not have evidence of a satisfactory FDLE Level I screening. These two staff members had unsatisfactory screenings and were intentionally retained by the facility despite the Received Time May. 6. 8:00AM P. 4 May. 6 2003 8:04AM QUALITY OF LIFE HOME HEALTH No.6504 high probability of their endangering the residents' safety and well being. 10. One employee hired 5/17/01 had evidence dated 1/26/02 of an unsatisfactory FDLE Level TI screening dated 1/26/02. The facility intentionally continued the employment of this individual for another 10 months. 11. One employee hired 6/21/00 had evidence dated 7/31/00°o0f an unsatisfactory FDLE Level I screening. The facility intentionally continued the employment of this individual for over two years. 12. Based on the foregoing, Lyford Cove at Lawnwood violated Section 400. 4174(2), Florida Statutes herein classified as a Class I violation which carries an assessed fine of $10,000.00. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a Judgment in favor of the Agency for Health Care Administration against Lyford Cove at Lawnwood on Count I. 2. Assess an administrative fine of $10,000.00 against Lyford Cove at Lawnwood on Count I for violation of Section 400.4174(2), Florida Statutes. Received Time May. 6. 8:Q0AM p, 5 May. 6. 2003 8:04AM QUALITY OF LIFE HOME HEALTH No.6909 =P. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. Grant such other relief as this Court deems is just and proper. Respondent is notified that it 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 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 Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE KR REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF Received Time May. 6. 8:00AM 6 . 6. 2008 8:04AM = QUALITY GF LIFE HOME HEALTH No.6509 P. THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Qeba, DY). Boduguts Alba M. Rodriguez Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 E. Tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (U. S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Adult Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Received Time May. 6. 8:00AM ] May. 6. 2003 8:04AM = QUALITY OF LIFE HOME HEALTH No.6909 ?. 8 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 Debra Flinn, Administrator, Lyford Cove at Lawnwood, 1550 North Lawnwood Circle, Ft. Pierce, Florida 34950; Atlantic Community Care, Inc., 7235 Bryan Dairy Road, Largo, Florida 33777; James Heenan, 1235 Bryan Dairy Road, Largo, Florida 33777 on this wed day of 0) Os. , 2007. Poel Alba M. Rodriguez Received Time May. 6. 8:Q0AM

Docket for Case No: 03-002002