Dec 23 2008 10:55 DEC-23-2088 11:83 AHCA LEGAL DEPARTMENT STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION MAXINE SHARON GENTRY, Patitioner, AHCA No.: 2008012575 v. . DOAH No.: 08-6051 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (“AHCA” or the “Agency”), by and through the undersigned counsel, and files this administrative complaint against Maxine Sharon Gentry (hereinafter “Maxine Sharon Gentry”), pursuant to Chapters 408, Part II, 429, Part II, and Section 120.60, Florida Statutes, (2008), and alleges: NATURE OF THE ACTION 1. This is an action to deem application of an adult family home care license incomplete and withdrawn from further review pursuant to Sections 408.806(3) (pb) and 408.815(1) (c) ‘Florida Statutes for the protection of the public health, safety and welfare. Dec 23 2008 10:55 DEC-23-2088 11:83 AHCA LEGAL DEPARTMENT JURISDICTION AND VENUE e. This Court has jurisdiction pursuant to Sections 120.569 and 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, ANCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing adult family home care facilities pursuant to Chapter 429, Part If, Florida Statutes (2007) and Chapter 458A-14, Florida Administrative Code. 5. Maxine Sharon Gentry is an applicant for an adult family care home license for a facility to be located at 2750 N. W. 2° street, Boynton Beach, Florida 33435. COUNT I MAXINE SHARON GENTRY FAILED TO SUBMIT ALL OMMITTED DOCUMENTS WITH 21 DAYS AFTER THE AGENCY’S REQUEST FOR OMITTED INFORMATION. SECTION 408.806(3) (b), Florida Statutes 6. AHCA reralleges and incorporates paragraphs (1) through (5) as if fully set forth herein. Dec 23 2008 10:55 DEC-23-2088 11:83 AHCA LEGAL DEPARTMENT 7. By later dated November 6, 2008, the Agency sent Respondent a Notice advising the Respondent of the Agency’s intent to deem her application for initial licensure incomplete and withdrawn from further consideration. 8. The Notice alleged that Respondent had failed to timely submit a request form and $24 processing fee for background screening for the relief person listed on the application and a remaining balance of $9 for Respondent’s own level 2 background screening fee. 9. The Respondent had been notified by certified mail received October 15, 2008 that failure to submit the required form and remaining balance within 21 days would result in the Agency's determination that the application was incomplete and withdrawn. 10. Based on the forgoing, the Agency has determined that the Respondent’s initial application for licensure should be deemed incomplete and withdrawn from further consideration pursuant to Section 408.803(3) (b), Flerida Statutes. COUNT ITI MAXINE SHARON GENTRY FAILED TO PASS A LEVEL TI CRIMINAL HISTORY BACKGROUND SCREENING TEST. SECTIONS 408.809(1) (a), 408.810(1), 408.815(1) (c) and SECTION 435.04(2), FLORIDA STATUTES (STAFF RECORDS STANDARDS) ii. AHCA re-alleges and incorporates paragraphs (1) 3 Dec 23 2008 10:57 DEC-23-2088 11:84 AHCA LEGAL DEPARTMENT through (5) as if fully set forth herein. 12. Section 435.04(2), Florida Statutes requires that in order to pass a level 2 background screening, the individual subject of the screening must not have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under the pertinent provisions of Florida Statues or under any similar statue of another jurisdiction. 13. Maxine Sharon Gentry failed to pass a level 2 background screening as required by Section 408.809(1) (a) due to a disqualifying offense. On December 2, 2008, a letter was mailed to Maxine Sharon Gentry by the Agency’s licensing unit notifying her of the same. 14. Based on the foregoing, the Agency seeks to have the application deemed incomplete and withdrawn from further consideration pursuant to Section 408.815(1) (a), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a Recommended Order in favor of the Agency for Health Care Administration against Maxine Sharon Gentry on Counts I and II. Dec 23 2008 10:57 DEC-23-2088 11:84 AHCA LEGAL DEPARTMENT 2. Uphold the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review addressed to Maxine Sharon Gentry as reflected on Counts I and Ii. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. Grant such other relief this Court deems proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120,569 and 120.57, Florida Statutes (2008). 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. Alba M. Ae. Esc Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 (305) 470-6804 Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration §150 Linton Blvd ~ Suite 500 Delray Beach, Florida 33484 (U.3. Mail) Dec 23 2008 10:57 DEC-23-2088 11:84 AHCA LEGAL DEPARTMENT P.@6 Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Intereffice Mail) Assisted Living Facility 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. Mail, to Maxine Sharon Gentry, 2750 N. W. 2" Street, Boynton Beach, Florida 33435 and Felicia La“Ruth Howard, 1274 West 3374 Street, Rivera Beach, Florida 33404 on this 23rd day of December, 2008. ~ QLbas 4). Bad ehoei ine Alba M. Rodriguez, Esq TOTAL F.@6

Docket for Case No: 08-006051