STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Ol ~ S5Y0 Case Nos. 2007007279 vs. CHAI SENIORS, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“Agency” or “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against CHAI SENIORS, INC. (“Respondent” or “Respondent Facility”), pursuant to Section 120.569, and 120.57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine of one thousand two hundred fifty dollars ($1,000.00) based upon four (4) deficiencies pursuant to §§ 408.813, 429.911 and 429.913({1), Florida Statutes (2006). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, 408.802(18) and 429.903, Florida Statutes (2006). 2. Venue lies pursuant to Florida Administrative Code R. 28- 106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of adult day care centers and enforcement of all applicable federal regulations, state statutes and rules governing adult day care center pursuant to the Chapter 408, Part II and Chapter 429, Part III, Florida Statutes, and Chapter 58A-6, Florida Administrative Code. 4. Respondent operates a 40-participant adult day care center located at 1835 Northeast Miami Gardens Drive, #359, North Miami Beach, Florida 33179, and is licensed as an adult day care center, license number 9037. 5. Respondent was at all times material to the allegations of this complaint a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs 1 through 5 as if fully set forth in this count. 7. Rule 58A-6.011(10), Florida Administrative Code, requires: (10) Pursuant to Section 429.929(1)(g), F.S., asa part of the licensure process, each center shall develop and follow a written Comprehensive Emergency Management Plan for emergency care during an internal or external disaster in accordance with Emergency Management Planning Criteria for Adult Day Care Facilities, dated July 2001, incorporated by reference. (a) The Emergency Management Plan shall include the following: 8. 1. Provisions for both internal and external disasters and emergencies which could include hurricanes, tornadoes, fires, power outages, floods, bomb threats, acts of terrorism, bio-terrorism, hazardous materials and nuclear disasters. 2. Provisions for care and services to participants during the emergency including pre-disaster or preparation, notification of family members or responsible parties, securing the center, supplies, staffing and emergency equipment. 3. Provisions for care and services to participants who must remain in the center and who must evacuate during the emergency including emergency evacuation transportation. 4. Identification of staff position responsible for implementing each aspect of the plan. 5. Identification of and coordination with designated agencies including Red Cross and the county emergency management office. 6. Post-disaster activities including responding to family inquiries, obtaining necessary emergency medical attention or intervention for participants, transportation and re-entry to the center. (ob) The plan shall be available for immediate access by center staff. (c) The initial Plan shall be reviewed by the local Emergency Management Agency to ensure compliance with the Emergency Management Planning Criteria for Adult Day Care Facilities, dated July 2001. (ad) The county emergency management agency has 60 days in which to review and determine if the plan satisfies the Emergency Management Planning Criteria or advise the center of necessary revisions. Any revisions must be made and resubmitted to the county emergency management agency within 30 days of receiving notification from the county agency the plan must be revised. (e) The center shall review and update its Plan on an annual basis. The Plan shall be submitted annually, or more often if needed, to the local Emergency Management Agency. On May 30, 2007, the Agency conducted a Biennial License Renewal Survey of the Respondent Facility. 9. Based upon observation, interview, and record review, the Respondent Facility failed to ensure that the Respondent Facility’s Emergency Management Plan was submitted annually to the local Emergency Management Agency: 9.1. During the Center Records Standards portion of the relicensure survey conducted on May 30, 2007, at approximately 12:00 PM, it was noted that the facility's Emergency Management Certificate had expired on August 3, 2006. 9.2. It was also noted that a letter from the Emergency Management Agency stated that the Comprehensive Emergency Management Plan was due from the Respondent Facility on April 23, 2006. 9.3. No documentation that the Plan was sent to the Agency could be located by the Respondent Facility. 9.4. The Administrator of the Respondent Facility was interviewed on the day and time of the survey and after investigation, the Administrator confirmed the above Agency findings. 9.5. Failure to have a current and reviewed emergency plan can subject the participants in an adult day care center to confusion or a failed evacuation, in the event of an emergency such as a hurricane. 9.6. The Agency cited Respondent Facility for a violation of applicable law pursuant to § 429.913(1) (b), Florida Statutes (2006). 10. The Agency provided Respondent with a mandatory correction date of June 29, 2007. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $250.00 against Respondent Facility, an adult day care center in the State of Florida, pursuant to § 429.913({1) (b), Florida Statutes (2006). COUNT IT 11. The Agency re-alleges and incorporates paragraphs 1 through 5 as if fully set forth in this count. 12. Rule 58A-6.009(2), Florida Administrative Code, requires: (2) To be licensed as an Adult Day Care Center, the following nutrition services shall be provided: (e) In centers with 17 or more participants, all matters pertaining to food service shall comply with the provisions of Chapter 64E-11, F.A.C. 13. Rule 64E-11.013(1), Florida Administrative Code, states: (1) Certificate Required. All food service establishment certificates shall expire on September 30. Certificates may be issued for a period less than a calendar year so long as they are prorated on a quarterly basis. Certificates shall be posted ina conspicuous location in the establishment. 14. On May 30, 2007, the Agency conducted a Biennial License Renewal Survey of the Respondent Facility. 15. Based on record review and interview, the Respondent Facility failed to have available a valid Department of Health Food Service Inspection Report: 15. 15. 15. 15. 15. 16. 1. During the Center Records Standards portion of the relicensure survey conducted on May 30, 2007, at approximately 12:00 PM, the facility was unable to make documentation available of a 'satisfactory' food service inspection conducted within the past 365 days. 2. The most recent ‘satisfactory' food service report was dated January 31, 2006. 3. The Administrator was interviewed on the day and time of the survey and after investigation, the Administrator confirmed the finding that the Facility did not have a current Department of Health Food Service Inspection Report. 4. Failure to have an annual food service inspection can subject the participants in an adult day care center to unsafe or contaminated food. 5. The Agency cited Respondent Facility for a violation of applicable law pursuant to § 429.913(1) (b), Florida Statutes (2006). The Agency provided Respondent with a mandatory correction date of June 29, 2007. fine WHEREFORE, the Agency intends to impose an administrative in the amount of $250.00 against Respondent Facility, an adult day care center in the State of Florida, pursuant to § 429.913(1) (b), Florida Statutes (2006). 17. 18. 19. COUNT III The Agency re-alleges and incorporates paragraphs 1 through if fully set forth in this count. Rule 58A-6.006(11), Florida Administrative Code, requires: (11) The governing authority shall establish policies and procedures to facilitate reporting of abuse, neglect or exploitation as defined in Section 415.102, F.S., and in accordance with Section 415.103, F.S., and shall insure that the statewide toll free telephone number of the Central Abuse Registry, accompanied by the words “To Report the Abuse, Neglect, or Exploitation of an Elderly or Disabled Person, Please Call the Toll Free Number 1(800) 96- ABUSE” is posted in a prominent place in the center and made clearly visible. Based on observation and interview, the facility failed to ensure that a copy of the Central Abuse Registry poster is located in a prominent place in the center. 19. 1. During the Center Records Standards portion of the relicensure survey conducted on May 30, 2007, at approximately 12:00 PM, it was observed that nowhere within the Respondent Facility was a copy of the Abuse Registry Poster in full view and freely accessible to all participants. 19.2. The Administrator of the Respondent Facility was interviewed on the day and time of the survey and after investigation, the Administrator confirmed that the Respondent Facility did not have posted the statewide toll free telephone number of the Central Abuse Registry, accompanied by the words “To Report the Abuse, Neglect, or Exploitation of an Elderly or Disabled Person, Please Call the Toll Free Number 1(800)96-ABUSE” in a prominent place in the Respondent Facility and made clearly visible. 19.3. Failure to post the required public notice of the toll free number for reporting abuse can leave participants in an adult day care center unaware of how to easily report suspected abusive conduct. 19.4. The Agency cited Respondent Facility for a violation of applicable law pursuant to § 429.913(1)(b), Florida Statutes (2006). 20. The Agency provided Respondent with a mandatory correction date of June 29, 2007. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $250.00 against Respondent Facility, an adult day care center in the State of Florida, pursuant to § 429.913(1) (b), Florida Statutes (2006). 21. 22. 23. COUNT IV The Agency re-alleges and incorporates paragraphs 1 through if fully set forth in this count. Section 429.919(2), Florida Statutes (2006), requires: (2) The owner or administrator of an adult day care center must conduct level 1 background screening as set forth in chapter 435 on all employees hired on or after October 1, 1998, who provide basic services or supportive and optional services to the participants. Such persons satisfy this requirement if: (a) Proof of compliance with level 1 screening requirements obtained to meet any professional license requirements in this state is provided and accompanied, under penalty of perjury, by a copy of the person's current professional license and an affidavit of current compliance with the background screening requirements. (o) The person required to be screened has been continuously employed, without a breach in service that exceeds 180 days, in the same type of occupation for which the person is seeking employment and provides proof of compliance with the level 1 screening requirement which is no more than 2 years old. Proof of compliance must be provided directly from one employer or contractor to another, and not from the person screened. Upon request, a copy of screening results shall be provided to the person screened by the employer retaining documentation of the screening. (c) The person required to be screened is employed by a corporation or business entity or related corporation or business entity that owns, operates, or manages more than one facility or agency licensed under chapter 400 or this chapter, and for whom a level 1 screening was conducted by the corporation or business entity as a condition of initial or continued employment. Based on record review and interview, the Respondent facility failed to ensure that background screening has been conducted on all employees hired on or after October 1, 1998, who provide basic services or supportive services to participants: 23. 23. 23. 23. 23. 1. During the Staffing Standards portion of the relicensure survey conducted on May 30, 2007, at approximately 12:00 PM, it was noted that all employee records examined do not have documentation satisfying the background screening requirement in their personnel files. 2. All employees at the Respondent Facility were hired after October 1, 1998, and all are subject to background screening. 3. The Administrator of the Respondent Facility was interviewed on the day and time of the survey and after investigation, the Administrator confirmed that Respondent Facility had not satisfied the background screening requirement for any employees who provide basic services or supportive and optional services to the participants. 4, Failure to obtain the statutory, required background screening for each employee who provides basic services or supportive and optional services to participants can expose participants to dangerous or unsuitable employees. 5. The Agency cited Respondent Facility for a violation of applicable law pursuant to § 429.913(1) (b), Florida Statutes (2006). 10 24. The Agency provided Respondent with a mandatory correction date of June 29, 2007. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $250.00 against Respondent Facility, an adult day care center in the State of Florida, pursuant to § 429.913(1) (b), Florida Statutes (2006). Respectfully submitted this 2 ” day of August, 2007. ,an es H. tA van F¥a. Bar. No. 817775 Assistant General Counsel Agency for Health Care Administration 525 Mirror Lake Drive, 330H St. Petersburg, FL 33701 727-552-1435 Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7007 0710 0004 0429 1457 on August 2—, 2007, to Usher Bryn, Registered Agent, Chai Seniors, Inc., 2999 N.E. 191st Street, Penthouse Six, Aventura, Florida 33180, and by regular U.S. Mail to Morris Kievman, Administrator, Chai Seniors, Inc., 1835 N.E. Miami Gardens Drive, #359, North Miami Beach, Florida 33179. ‘eK hs Games H. Harris ssistant General Counsel Copies furnished to: Usher Bryn, Registered Agent Chai Seniors, Inc. 2999 NE. 191st Street, Penthouse Six Aventura, Florida 33180 (U.S. Certified Mail) James H. Harris, Esq. Agency for Health Care Admin. 525 Mirror Lake Drive, 330H St. Petersburg, Florida 33701 (Interoffice) Morris Kievman Administrator Chai Seniors, Inc. 1835 N.E. Miami Gardens Dr., #359 North Miami Beach, Florida 33179 U.S. Mail) Diane Reiland Field Office Manager State of Florida, AHCA 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 12 SENDER: COMPLETE, & Complete items 1, 2, u.. 3. Also complete item 4 If Restricted Delivery is desired. if Print your name and address on the reverse so that we can return the card to you. @ Attach this card to the back of the mailpiece, or on the front If space permits. 1. Article Addressed to: “Usher Bryn, Keg, Agent Cai Sentocs, Ine 2999 N.E. 19184 &. . 3. Servi Fe ent house Siy Or Cention Mall CO Express Mall c C1 Registered Oo Receipt for Merchandise A-ventura, FL 331£0 oe Gon O Yes 8 Complete items 1, ttem 4 if Restricted @ Print your name and add so that we can return the card to you. ig Attach this card to the back of the mailpiece, ‘or on the front If space permits. * hephan Allen, Esg Reg. A wt washsdad 1 dtors Tne 3L06 Wes Swann Gn pa FL 33604 D. Is delivery address different from item 1? {f YES, enter delivery address below; 2. Artic aH (irar 7007 o7io goo4 o4e4 U4?1 - PS Form 3811, February 2004 Domestic Return Receipt

Docket for Case No: 07-005540