@- 3-03;10:174M; STATE OF FLORIDA’ ©} we” AGENCY FOR HEALTH CARE ADMINISTRATION ge’ ; op Py, al’ STATE OF FLORIDA hay OS AGENCY FOR HEALTH CARE Les oa, ADMINISTRATION, une Petitioner, v. AGENCY NO: 2003005886 Helen M. Sawyer Plaza Certified Mail No. 7160 3901 9844 4494 0676 Respondent. - _/ ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTHCARE ADMINISTRATION (“AGENCY”), by and through the undersigned counsel, and files this Administrative Complaint against Helen M. Sawyer Plaza (hereinafter, "Respondent”), pursuant to Sections 120.569, and 120.57 Florida Statutes (2002), and alleges: Nature of the Action 1. This is an action for licensure suspension and/or licensure revocation pursuant to Sections'400.414(1)(n) and 400.4275(3) Florida Statutes. Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57 Florida Statutes and Chapter 28-106 Florida Administrative Code. 3. Venue lies in Dade County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28 Florida Administrative Code. EXHIBIT " B" 9- 3-03:10:17AM; Parties 4. AGENCY 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 is an assisted living facility located at 1150 NW 11th Street Road, Miami, Florida 33136. Respondent, is and was at all times material hereto, a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code. COUNTI RESPONDENT FAILED TO MAINTAIN LIABILITY INSURANCE COVERAGE Fla. Admin. Code R. 58A-5.021(8); Sections 400.4275(3), And 400.414(1)(n) Fla. Stat. (2002) 6. The AGENCY re-alleges and incorporates paragraphs (1) through (5) above as if fully set forth herein. 7. On or about May 16, 2003, the AGENCY verified that the Respondent’s liability insurance policy had expired. 8. On or about July 11, 2003, the AGENCY sent a Notice of Violation to the Respondent requesting the Respondent to submit evidence that liability insurance coverage was obtained. 9. Respondent failed to maintain liability coverage at all times in accordance with licensure requirements of Rule 58A-5.021(8) Fla. Admin. Code; and section 400.4275 (3) Fla. Stat. 10. Failure to maintain liability insurance coverage at all times constitutes an act upon which a license may be suspended or revoked pursuant to section 400.414(1)(n), Fla. Stat. (2002). @- 3-03:10:174M; CLAIM FOR RELIEF WHEREFORE, the AGENCY respectfully requests the following relief: 1) Factual and legal findings in favor of the AGENCY on Count I; 2) Upholding the AGENCY’S imposition of license suspension and/or revocation. Respondent is notified that it has a right to request an administrative hearing pursuant to section 120.569 and 120.57, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shal] be made to the Agency for Health Care Administration and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop Code #3, Tallahassee, Florida, 32308; Ursula Eikman, Attorney. 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. Respectfully submitted, Ursula Eikman Agency for Health Care Administration Attorney FBN 0500941 2727 Mahan Drive, MS-3 Tallahassee, FL 32308 (850) 922-5873 9- 3-03;10:17AM; i 7 I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail Return Receipt No. 7160 3901 9844 4494 0676, to Luis Reyes, Helen M. Sawyer Plaza, 1150 NW 11th Street Road, Miami, FL 33136, ibd day of August, 2003. A 4 Ursula Eikman

Docket for Case No: 03-003848