STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JUN -9 PH WIS AGENCY FOR HEALTH CARE ADMIAIS ADMINISTRATION, HEARINGS AHCA No.: 2004003689 Return Receipt Requested: 7002 2410 0001 4237 0843 7002 2410 0001 4237 0850 7002 2410 0001 4237 0867 Petitioner, Vv. ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA STERLING HOUSE OF TEQUESTA II, . Respondent. / ADMINISTRATIVE COMPLAINT COMES Now the Agency for Health Care Administration (eAHCA”) , by and through the undersigned counsel, and files , this administrative complaint against Alterra Healthcare Corporation, d/b/a Alterra Sterling House of Tequesta II (hereinafter “Alterra Sterling House of Tequesta II”), pursuant to Chapter 400, Part III and Section 120.60, Florida Statutes, (2003), ard alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $500.00 pursuant to Sections 400.414 (1) (a) and 400.419(1)(c), Florida Statutes (2003) for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 ancl 120.57 Florida Statutes, Chapter 28-106, Florida Administrative Code. 3. Venue lies in Palm Beach County pursuant to Section 120.57 Florida Statutes,, 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 III, Florida Statutes (2003) and Chapter 58A-5 Florida Administrative Code. 5. Alterra Sterling House of Tequesta II operates a 6- bed assisted living facility located at 211 Village Boulevard, Tequesta, Florida 33469. Alterra Sterling House of Tequesta ITI is licensed as an assisted living facility under license number 9321. Alterra Sterling House of Tequesta II was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I ALTERRA STERLING HOUSE OF TEQUESTA II FAILED TO ENSURE THAT ALL STAFF WERE TRAINED BIENNIALLY ON HIV AND AIDS Section 400.4275(2), Florida Statutes, and/or Rules 58A-5.0191(3)& (10), and 58A-5.024(2) (a)1, Florida Administrative Code (STAFF RECORDS STANDARDS) REPEAT CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During, the Re-licensure survey conducted on 4/16/2002 five of six personnel records reviewed did not contain any evidence that staff had received the required biennial update training in HIV/AIDS. The acting administrator, when requested to by the surveyor, was unable to produce records of this training and confirmed that it had ' not been accomplished. Mandated Correction Date:5/16/02 8. During the Re-licensure survey conducted on 4/12/2004 and based upon record review and interview it was revealed that the facility did not ensure that staff received the required training in HIV and AIDS. 9. Two of five staff personnel records sampled did not contain any evidence of this required training. The administrator, when requested to by the surveyor, was unable to produce this documentation and confirmed that it was not present. This is a repeat deficiency from the survey of 4/16/02. 10. Based on the foregoing, Alterra Sterling House of Tequesta II violated Section 400.4275(2), Florida Statutes (2003), and/or Rules 58A-5.0191(3)& (10), and S58A- 5.024(2) (a)1, Florida Administrative Code, herein classified as a repeated Class III violation, which warrants an assessed fine of $500.00. io) 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 Alterra Sterling House of Tequesta II on Count I. 2. Assess an administrative fine of $500.00 against Alterra Sterling House of Tequesta II on Count I for the violations cited above. 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 (2003). 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 A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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 . urdes A. Naranjo, lace la. Bar 997315 Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52™ Terrace Miami, Florida 33166 (305) 470-6801 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive, Suite 100 West Palm Beach, Flovida 33407 (U.S. Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that q true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Carolyn Hartwig, Administrator, Alterra Sterling House of Tequesta II, 211 Village Blvd., Tequesta, Florida 33469; Alterra Healthcare Corporation, 10000 Innovation Drive, Tax Dept., Milwaukee, Wisconsin 53226, and CT Corporation System, 1200 South Pine Island Road, se to Plantation, Florida 33324 on this day of urdes A. Naranjo

Docket for Case No: 04-002039