OOS & STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2007007858 Ve PERFORMANCE MEDICAL CENTER, INC. a/b/a PERFORMANCE MEDICAL CENTER, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Performance Medical Center, Inc. d/b/a Performance Medical Center, Inc. (hereinafter “Performance Medical Center, Inc.”), pursuant to Chapter 400, Part xX, and Section 120.60, Florida statutes (2006), and alleges: NATURE OF THE ACTION 1. This is an action to impose a revocation of the health care clinic license and to impose an administrative fine of $5,000.00 pursuant to Sections 400.9915, 400.995(1) and 408.810(4), Florida Statutes (2006), for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2006), and Chapter 28-106, Florida Administrative Code (2006). 3. Venue lies in Miami-Dade County pursuant to Section 120.57, Florida Statutes (2006), and Rule 28-106.207, Florida Administrative Code (2006). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing health care clinics pursuant to Chapter 400, Part xX, Florida Statutes (2006), and Chapter 59A-33 Florida Administrative Code (2006). 5. Performance Medical Center, Inc. operates a health care clinic located at 1257 w. 44% Place, Hialeah, Florida 33012. Performance Medical Center, Inc. is licensed as a health care clinic under license number 3654. Performance Medical Center, Inc. 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 PERFORMANCE MEDICAL CENTER, INC. IS NOT AN OPERATING HEALTH CARE CLINIC. ’ SECTION 408.810(4), FLORIDA STATUTES (2006) SECTION 400.9915(2) (3), FLORIDA STATUTES (2006) SECTION 400.995(1), FLORIDA STATUTES (2006) SECTION 408.811(1), FLORIDA STATUTES (2006) CODE VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Performance Medical Center, Inc. was cited with one (1) deficiency due to an attempted complaint investigation survey dated June 1, 2007. 8. An unannounced complaint investigation survey was attempted on June 1, 2007. The surveyor went to the facility, but it was closed. The surveyor knocked several times and nobody answered the door. Mail was seen on the floor in the waiting area. 9. Based on the foregoing facts, Performance Medical Center, Inc. violated Section 400.9915(2) (3), Florida Statutes (2006), Section 400.995(1), Florida Statutes (2006), and Section LOO S Quark 408.810(4), Florida Statutes (466-810(4), herein classified as a code violation, which warrants an assessed fine of $5,000.00 and also gives rise to the revocation of license. 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 Performance Medical Center, Inc. on Count I. 2. Assess an administrative fine of $5,000.00 against Performance Medical Center, Inc. on Count I for the violation cited above. 3. Revoke the license of Performance Medical Center, Inc. pursuant to Section 400.9915, Florida Statutes and Section 400.995(1), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5. 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. 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER Alba M. Rodrigudz, Es Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Kriste Mennella Field Office Manager Agency for Health Care Administration 8355 N. W. 5374 Street Miami, Florida 33166 (U.S. Mail) Karen Davis 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 a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Fred H. Quintana, 940 Sun Flower Circle, Weston, Florida 33327; Isabel Naranjo, 16028 N. W. 82 Place, Miami, Florida 33016 on this ‘st aay of October, 2007. Alba M. ees Esq. rs) y VERIFIED RETURN OF SERVICE State of Florida County of Dade o County Court Pe Case Number: 2007007858 Plaintiff: STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION vs. Defendant: PERFORMANCE MEDICAL CENTER, INC. dé/bfa PERFORMANCE MEDICAL CENTER, INC. For: Alba Rodriguez AHCA 2728 Fort Knox Blvd Room 34188 Tallahassee, FL 32308 Received by SERVICE OF PROCESS, INC. on the Sth day of December, 2007 at 2:10 pm to be served on ISABEL NARANJO @ 16028 NW 82 PLACE, MIAMI, FLORIDA 33016. |, RAFAEL GONZALEZ, do hereby affirm that on the 13th day of December, 2007 at 9:46 pm, I: Individually Served BY SERVING THE PERSON NAMED HEREIN A COPY OF THIS ADMINISTRATIVE COMPLAINT WITH THE DATE AND HOUR ENDORSED THEREON BY ME, PURSUANT TO FL. STAT, | certify that | arn over the age of 18, have no interest in the above action, and am a Process Server, in good Standing, in the judicial circuit in which the process was served and have proper authority in the jurisdiction in which this service was made. Under penalties of perjury, | declare that | have read the foregoing document and that the facts stated in it are true, F.S. 92.525 Verification of documents. copy RAFAEL GONZALEZ Certified P.S. #1250 SERVICE OF PROCESS, INC. P.O. Box 45-2354 Miami, FL 33248-2354 (305) 226-6809 Our Job Serial Number: 2007004090 Ref: 00749650 Copyrigh © 9992-2005 Dalabuse Servicos. ing. - Process Server's Toolbox V5.5,

Docket for Case No: 08-000586