o> Z STATE OF FLORIDA & &, L AGENCY FOR HEALTH CARE ADMINISTRATION “ Oo by AGENCY FOR HEALTH CARE 5 rf ‘ ADMINISTRATION, OT ~ 347 Mange ; %9 (TTS Petitioner, AHCA No.: 2007004706 Vv. Return Receipt Requested: 7002 2410 0001 4235 6823 O.E.M.A., INC. d/b/a 7002 2410 0001 4235 6830 BETTER CARE HOME, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against O.E.M.A. Inc. d/b/a Better Care Home (hereinafter “Better Care Home”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $500.00 pursuant to Section 429.19, Florida Statutes (2006), for the protection of the public health, safety and welfare pursuant to Section 429.28(3) (c), Florida Statutes (2006). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies in Miami-Dade County, pursuant to Section 120.57, Fla. Stat. and Rule 28-106.207, Florida Administrative 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 429, Part I, Florida Statutes (2006), and Chapter 58A-5, Florida. Administrative Code. 5. Better Care Home operates a 6-bed assisted living facility located at 7599 West 4*» court, Hialeah, Florida 33014. Better Care Home is licensed as an assisted living facility license number AL10031 with an expiration date of June 6, 2009. Better Care Home 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 BETTER CARE HOME RECORDS DID NOT CONTAIN VERIFICATION OF FREEDOM FROM COMMUNICABLE DISEASE INCLUDING TUBERCULOSIS FOR 1 OUT 3 STAFF RECORDS REVIEWED Section 429.275(4), Florida Statutes, and/or Rule 58A-5.024(2) (a), Florida Administrative Code (STAFF RECORDS STANDARDS) REPEATED CLASS III VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the biennial licensure survey conducted on 02/28/07 and based on record review and interview, the facility personnel records did not contain verification of freedom from communicable disease including tuberculosis, for 1 out of 3 staff records reviewed (Staff #2). 8. The facility’s personnel records review on 2/28/07 revealed that staff member #2 (hired on 2/28/06) did not have verification of freedom from communicable disease including tuberculosis. 9. An interview with the Administrator on 2/27/07 at approximately 11:00 AM confirmed the findings. This is a repeat deficiency from the visit of 02/14/05. 10. During the visit conducted on 02/14/05 and based on observation, interview and record review it was revealed that 2 of 2 facility staff did not have documentation of current communicable disease statements. 11. A tour of the facility conducted at 8:30 am revealed that the following staff lacked documentation of freedom from a communicable disease, including tuberculosis: the Administrator and staff member. 12. An interview with the Administrator revealed that the above mentioned staffs were lacking current communicable disease statements. He/she stated that he/she would make sure that they obtain them. 13. A record review during the survey revealed that the personnel file for the Administrator, and facility staff lacked verification of freedom from a communicable disease including tuberculosis. 14. Based on the foregoing, Better- Care Home violated Section 429.275(4), Florida Statutes, and/or Rule 58A- 5.024(2) (a), Florida Administrative Code, a repeated Class III deficiency, which carries, in this case, an assessed fine of $500.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I. B. Assess an administrative fine of $500.00 against Better Care Home on Count I pursuant to Section 429.19, Florida Statutes. C. 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 (2006). Specific options for administrative > action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTE Assistant General Counsgs Agency for Health Care Administration 8350 N. W. 52°¢ Terrace Suite 103 Miami, Florida 33166 Copies furnished to: Kriste Mennella Field Office Manager Agency for Health Care Administration 8355 NW 53™¢ Street, First Floor Miami, Florida 33166 (Inter-office mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Inter-office 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 a true and correct foregoing has been furnished by U.S. Certified copy of the Mail, Return Receipt Requested to Yanett Rodriguez, Administrator, Better Care Home, 7599 West 4° Court, Hialeah, Florida 33014, and to Olimpia V. Martinez, Registered Agent, 2580 West 67" Hialeah, Florida 33016 on cae 2& , 2007. Place, #103, m Complete ftems: ‘Algo complete item 4 if Restricted Delivery is desired. @ Print your name and address on the reverse so that we can return the card to you... - “ @ Attach thie card to the back of the mailpiece, ~ or on theJront if space permits. oe -Dinsured Mal’ O-c.o.. 4, Restricted Delivery? (Extra Fee) SS You O00 4235 4823,

Docket for Case No: 07-003475