May 29 2009 10:02 MAY-29-2889 11:15 AGENCY HEALTH CARE ADMIN S54 921 i538 P.iiv2? STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2009003769 BROOKDALE SENIOR LIVING COMMUNITIES, INC. d/b/a STERLING HOUSE OF LEHIGH ACRES, Respondent. i ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, BROOKDALE SENIOR LIVING COMMUNITIES, INC. Wb/a STERLING HOUSE OF LEHIGH ACRES (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2008), and states: NATURE OF THE ACTION This is an action to impose an administrative fine against an assisted living facility in the sum of THREE THOUSAND DOLLARS ($3,000.00) based upon three (3) Class Il deficiencies pursuant to Section 429.19(2)(b), Florida Statutes (2008). JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2008). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2008). May 29 2009 10:02 MAY-29-2889 11:15 AGENCY HEALTH CARE ADMIN 856 921 @158 P.12-27 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable federal and state regulations, statutes and rules governing such facilities. Chapters 408, Part II, and 429, Part I, Florida Statutes (2008); Chapter 58A-5, Florida Administrative Code. The Agency may deny, revoke, or suspend any license issued to an assisted living facility, or impose an administrative fine in the manner provided in Chapter 120, Florida Statutes (2008). Sections 408.815 and 429.14, Florida Statutes (2008). 5. The Respondent was issued a license by the Agency (License Number 9098) to operate a 60-bed assisted living facility located at 1251 Business Way, Lehigh Acres, Florida 33936, and was at all times material required to comply with the applicable federal and state regulations, statutes and rules governing assisted living facilities. COUNTI The Respondent Failed To Provide Care And Services Appropriate To The Needs Of Residents In Violation Of Rule 58A-5.0182(1)(c), Florida Administrative Code 6. The Agency revalleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, an assisted living facility shall provide care and services shall offer "appropriate to the needs of residents accepted for admission to the facility. Fa personal supervision, as appropriate for each resident, including the following: General awareness of the resident’s whereabouts. The resident may travel independently in the community. Rule 58A-5.0182(1)(c), Florida Administrative Code. 8. On or about February 6, 2009 through February 13, 2009 the Agency conducted a Focused Appraisal visit of the Respondent’s facility. May 29 2009 10:03 MAY-29-2889 14:15 AGENCY HEALTH CARE ADMIN 856 921 4158 P1327 9. Based on two (2) of two (2) resident records reviewed and staff interviews, the facility did not provide appropriate supervision for Resident number one (1) and Resident number two (2), resulting in an adverse incident of sexual contact. 10. A review of Resident number two’s (2) medical record showed on September 5, 2008 he/she was found kissing and hugging Resident number one (1). On September 10, 2008 Resident number one (1) was escorting a resident to his/her room. On September 11, 2008 he/she was separated from the same resident. S/he wanted to shake his/her hand. The resident told hirn/her to leave him/her alone and on October 3, 2008 a monthly summary showed he/she likes to approach residents (of the opposite sex). 11. During an interview on February 6, 2009 at 12:17 p.m., the nurse stated he went to Resident number two’s (2) room at 4:00 a.m. on February 3, 2009 and Resident number two (2) was not there. The nurse went to Resident number one’s (1) room and found Resident number two (2) there. The nurse stated Resident number two (2) is near Resident number one (L) alot and putting his/her hands on him/her. 12. During an interview on February 6, 2009 at 12:39 p.m., the adrninistrator stated on February 4, 2009 she was told by another staff member that she witnessed Resident number two (2) fondling Resident number one’s (1) breasts in the hallway on February 2, 2009. They were then separated. The administrator requested a psychological consultation and medications for Resident number two (2) and to lock Resident number one’s (1) bedroom door at night. 13. A review of Resident number one’s (1) medical record showed he/she had a diagnosis of Alzheimer's disease and is confused. He/she has a court appointed guardian. A review of Resident number two’s (2) medical record shows he/she is alert and oriented with a diagnosis of mild confusion. May 29 2009 10:03 MAY-29-2889 11:16 AGENCY HEALTH CARE ADMIN 856 921 4158 14. During an interview, the administrator stated Resident number two (2) had a psychological consultation on October 8, 2008 with no recommendations. Therefore, the facility did not put anything in place to supervise these two (2) residents for any further encounters. Documentation of an adverse incident report showed on February 4, 2009 Resident number one (1) was found in Resident number two’s (2) bedroom at approximately 7:30 p.m. with both uneclothed in bed. Resident number two (2) was on top of Resident number one (1). Resident number one (1) was sent to the hospital and Resident number two (2) was only then given one- on-one supervision. 15. The facility did not supervise Resident number one (1) and Resident number two (2) appropriately once these incidents started in September. These incidents continued to occur without appropriate supervision resulting in Resident number one (1) going to the hospital due to the incident of February 4, 2009. 16. The Respondent’s deficient practice constituted a Class II violation in that it related to the operation and maintenance of a facility or to the personal cate of residents which the Agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than a Class I violation. Section 429.19(2)(b), Florida Statutes (2008). 17. The Agency shall impose an administrative fine for a cited Class II violation in an P.14/2? ($5,000.00) for each violation as set forth in Section 429.19(2)(b), Florida Statutes (2008). A fine shall be levied notwithstanding the correction of the violation. 18. The Respondent was given a mandatory correction date of March 6, 2009. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE May 29 2009 10:03 MAY-29-2889 11:16 AGENCY HEALTH CARE ADMIN 856 921 4158 P.15/27 THOUSAND DOLLARS ($1,000.00) pursuant to Section 429.19(2)(b), Florida Statutes (2008). COUNT II The Respondent Failed To Contact A Resident’s Appropriate Party When Significant Change Was Exhibited In The Resident In Violation Of Rule 58A4-5.0182(1)(d), Florida Administrative Code 19. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 20. Pursuant to Florida law, an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. Facilities shall offer personal supervision, as appropriate for each resident, including the following: Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care swrogate, or case manager if the resident exhibits a significant change; contacting the resident’s family, guardian, health care surrogate, or case manager if the resident ig discharged or moves out. Rule $8.4-5.0182(1)(d), Florida Administrative Code. 21. Onor about February 6, 2009 through February 13, 2009 the Agency conducted a Focused Appraisal visit of the Respondent’s facility. 22, Based on two (2) of two (2) resident records reviewed for Resident number one (1) and Resident number two (2), staff and guardian interviews, the facility did not contact by Resident number two (2)). 23. A review of Resident number two’s (2) progress notes showed on September 5, 2008 he/she was hugging and kissing a resident; September 10, 2008 he/she was escorting the same resident to his/her room and on September 11, 2008 he/she had to separated by staff from shaking the same resident's hand. An interview was conducted on February 13, 2008 at 3:05 p.m. with a staff member who documented these incidents in Resident number two's (2) medical May 29 2009 10:04 MAY-29-2889 11:16 AGENCY HEALTH CARE ADMIN 856 921 4158 P1627 record. She stated the resident involved in these three incidents was Resident number one (1). 24. Arreview of Resident number one’s (1) medical records showed these three (3) incidents were not documented in his/her record and therefore not available to Resident number one’s (1) guardian when reviewing the resident's medical record. An interview was conducted with the administrator on February 6, 2009 who stated she is not aware if the guardian was notified of these incidents since the administrator was not employed at the facility at the time of these three (3) incidents. 25. A telephone interview was held with the guardian of Resident number one (1) on February 13, 2009 at 2:55 p.m. She stated that she was not aware of these three (3) incidents involving inappropriate physical contacts with Resident number two (2). The facility did not call her at the time of these incidents. She stated that she had never seen them together when she visited Resident number one (1). She added that she wished she had known of these incidents. She would have asked the facility not to allow that type of contact. 26. The Respondent’s deficient practice constituted a Class Il violation in that it related to the operation and maintenance of a facility or to the personal care of residents which the Agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than a Class I violation. Section 429.19(2)(b), Florida Statutes (2008). 27, The Agency shall impose an administrative fine for a cited Class IT violation in an te amount not legs than one thousand dollars ($1,000.00) and not exceeding five thousand dollars (35,000.00) for each violation as set forth in Section 429.19(2)(b), Florida Statutes (2008). A fine shall be levied notwithstanding the correction of the violation. ‘28. The Respondent was given a mandatory correction date of March 6, 2009. May 29 2009 10:04 MAY-29-2889 11:17 AGENCY HEALTH CARE ADMIN 856 921 @158 P.iv-27 WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00) pursuant to Section 429.19(2)(b), Florida Statutes (2008). COUNT Ii , The Respondent Failed To Comply With The Resident’s Bill Of Rights In Violation OF Section 429,28(1), Florida Statutes (2008) 29. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 30. Pursuant to Florida law, no resident ofa facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to: (a) Live ina safe and decent living environment, free from abuse and neglect. (b) Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy. (c) Retain and use his or her own clothes and other personal property in his or her immediate living quarters, so as to maintain individuality and personal dignity, except when the facility can demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other residents. (a) Unrestricted private communication, including receiving and sending unopened correspondence, access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. ata minimum..Upon request, the May 29 2009 10:04 MAY-29-2889 11:17 AGENCY HEALTH CARE ADMIN 856 921 4158 P1827 facility shall make provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar situations. (e) Freedom to participate in and benefit from community services and activities and to achieve the highest possible level of independence, autonomy, and interaction within the community. (f) Manage his or her financial affairs unless the resident or, if applicable, the resident's representative, designee, surrogate, guardian, or attomey in fact authorizes the administrator of the facility to provide safekeeping for funds as provided in Section 429.27, Florida Statutes (2008). (g) Share a room with his or her spouse if both are residents of the facility. (h) Reasonable opportunity for regular exercise several times a week and to be outdoors at regular and frequent intervals except when prevented by inclement weather. (i) Exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, nor any attendance at religious services, ——____ shall be imposed upon any resident inne ere erent Pon ern (j) Access to adequate and appropriate health care consistent with established and recognized standards within the community. (k) At least 45 days! notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a physician to require an emergency relocation to a facility providing a more skilled level of care or the resident engages May 29 2009 10:05 MAY-29-2889 11:17 AGENCY HEALTH CARE ADMIN 856 921 4158 P.19/27 in a pattern of conduct that is harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days’ notice of a nonemergency relocation or residency termination. Reasons for relocation shall be set forth in writing. In order for a facility to terminate the residency of an individual without notice as provided herein, the facility shall show good cause in a court of competent jurisdiction. (1) Present grievances and recommend changes in policies, procedures, and services to the staff of the facility, governing officials, or any other person without restraint, interference, coercion, discrimination, or reprisal. Each facility shall establish a grievance procedure to facilitate the residents’ exercise of this right. This right includes access to ombudsman volunteers and advocates and the right to be a member of, to be active in, and to associate with advocacy or special interest groups. Section 429,28(1), Florida Statutes (2008). 31. On or about February 6, 2009 through February 13, 2009 the Agency conducted a Focused Appraisal visit of the Respondent’s facility. 32. Based on two (2) of two (2) resident records reviewed, hospital records reviewed, observation, resident, guardian and staff interviews, the facility did not provide Resident number by not providing Resident number two (2) _ with the supervision required to prevent sexual contact. 33. Areview of Resident number two’s (2) medical record showed he/she was admitted into the facility on December 31, 2007. He/she is alert and oriented. There is a diagnosis of mild confusion. Progress notes showed on September 5, 2008 he/she was hugging and kissing a resident in the hall. On September 11, 2008 he/she was separated from the same May 29 2009 10:05 MAY-29-2889 11:18 AGENCY HEALTH CARE ADMIN 856 921 @158 P2827 2008 the progress notes showed documentation of the monthly review that Resident number two (2) likes to approach a resident (of the opposite sex). | 34, An interview was conducted with the administrator who stated she heard Resident number one (1) was the same resident mentioned in Resident number two’s (2) progress notes. Resident number two (2) wanted to be with Resident number one (1). A psychological consultation was ordered for Resident number two (2) after the October 13, 2008 monthly review. The recommendation from the evaluation was Resident number two (2) could not attempt independent living without personal assistance. The administrator stated since the consultation there were no more documented incidents between Resident number one (1) and Resident number two (2). 35. Aninterview was conducted on February 13, 2009 at 3:05 p.m. by phone with a staff member who no longer works at this facility. This former staff member worked with both Resident number one (1) and Resident number two (2). She stated the incidents documented on September 5, 2008, September 10, 2008 and September 11, 2008 in Resident number two’s (2) record involved Resident number one (1) each time. She reported these incidents to her supervisor and she was told to redirect Resident number two (2) if he/she comes in contact with Resident number one (1). 36. A review of Resident number one’s (1) medical record showed he/she has a diagnosis of Alzheimer's disease. An interview was attempted with him/her and he/she was unable to answer any of the surveyor's questions. An interview with several facility staff stated Resident number one (1) is confused, has dementia and is unable to answer any questions. 37. Areview of a Day one (1) Adverse Incident and Occurrence Report showed on February 4, 2009 Resident number one (1) was found in Resident number two’s (2) bedroom at 10 May 29 2009 10:06 MAY-29-2889 11:18 AGENCY HEALTH CARE ADMIN 856 921 @158 P2127 approximately 7:30 p.m. both unclothed in bed. Resident number two (2) was on top of Resident number one (1). 38: An interview with the administrator on February 6, 2009 at 12:39 p.m. stated on February 4, 2009 she was told by another staff member that on February 2, 2009 Resident . number two (2) was fondling Resident number one’s (1) breasts. They were separated. At that time, the administrator requested another psychological consultation and for medications. Resident number two’s (2) doctor was called and Seroquel 25 milligrams every night was ordered. The Advanced Registered Nurse Practitioner was in the facility at the time of this survey to perform a psychological evaluation with Resident number one (1) and Resident mumber two (2). Resident number two (2) refused to be evaluated. Neither resident was placed on one-on-one (1:1) observation after the February 2, 2009 incident. 39. An interview was conducted with the nurse on February 6, 2009 at 2:10 p.m. by telephone. She stated on February 3, 2009 she saw Resident number two (2). Resident number two (2) thought he/she heard someone call his/her name. She was watching him/her but did not let him/her know she was watching him/her. She followed Resident number two (2) go into Resident number one’s (1) bedroom and told him/her to get out of the room. After this incident staff was told to lock Resident number one’s (1) bedroom at night so Resident mumber two (2) could not go in; however, Resident number one (1) would be able to open the bedroom door to get out. Neither resident was placed on one-on-one (1:1) observation after the February 3, 2009 incident. 40. An interview was conducted with Resident number two (2) at 1:30 pm. He/she was in his/her room. He/she stated Resident number one (1) came to him/her and walked through his/her bedroom door on February 4, 2009. Their clothes were taken off and a male staff May 29 2009 10:06 MAY-29-2889 11:19 AGENCY HEALTH CARE ADMIN 856 921 @158 P.22/27 came in the room and separated them. They did not have intercourse. 41. Once the incident of February 4, 2009 occurred, the nurse stated both residents were placed on one-on-one (1:1) supervision. Resident number one (1) was sent to the hospital at that time. When he/she came back to the facility he/she was no longer on one-on-one (1:1) supervision. An observation at 1:30 p.m. showed a staff member sitting outside of Resident number two's (2) bedroom. She stated she was assigned to Resident number two (2) for one-on- one (1:1) supervision. Resident number two (2) continues to be on one-on-one (1:1) supervision since the February 4, 2009 incident. 42, A telephone interview was held with Resident number one’s (1) guardian on February 13, 2009 at 2:55 p.m. She stated that she was not aware of prior incidents involving inappropriate physical contacts with Resident number two (2). She stated that she had never seen them together when she visited Resident number one (1). On February 4, 2009, she was made aware for the first time of a prior incident involving Resident number one (1). The facility informed her that Resident number two (2) was seen fondling Resident number one’s (1) breasts. She was not told of the specific date the incident occurred. The facility tried to remind her that they had contacted her on the day of that particular incident but the guardian stated that she could not recall anyone contacting her about any incident prior to February 4, 2009. When asked if she was aware of any inappropriate touching or kissing that occurred back in September 2008, she stated that right now was the first time she heard about it. She added that she wished she had known of those other incidents. She would have asked the facility not to allow that type of contact. The guardian further stated that she didn't mind Resident number one (1) having friends and holding hands, She had seen that type of relationship before between residents; however, she would have asked the facility to make sure there was no inappropriate contact. The guardian May 29 2009 10:06 MAY-29-2089 11:19 AGENCY HEALTH CARE ADMIN 856 921 4158 revealed that she did not think Resident number two (2) understood Resident number one’s (1) capacity. She stated that she was satisfied with the way the facility handled the February 4, 2009 incident. She had just come from the facility and Resident number two (2) had moved out. She has asked the facility to keep Resident number one (1) supervised since the facility informed her that Resident number one (1) had once walked to a male visitor and kissed him. 43. Areview of Resident number one’s (1) medical record on February 13, 2009 ‘showed he/she was sent to the emergency room for "alleged sexual assault. He/she received medical clearance for arape exam and was to be sent to the Phoenix House, An interview with the administrator by phone on February 13, 2009 at 4:25 p.m. stated Resident number one (1) was picked up at the emergency room by his/her guardian and was sent back to the facility. She did not think Resident number one (1) was sent to the Phoenix House. — 44. Documentation in Resident number two's (2) medical record showed there were several incidents where Resident number one (1) and Resident number two (2) were found together engaged in sexual activities. The facility requested a psychological consultation with no recommendations. Resident number two (2) is alert and oriented and Resident number one (1) is not alert and oriented with Alzheimer's disease and confused. The facility did not put in place any type of monitoring system or supervision on Resident number two (2) to keep away from Resident number one (1) until after the ‘sexual contact on February 4, 2009. “The facility did not implement any monitoring of Resident number two (2) to provide a safe environment for Resident number one (1). Therefore, the facility neglected to provide Resident number one (1) a safe environment free from neglect. 45. The Respondent’s deficient practice constituted a Class II violation in that it related to the operation and maintenance of a facility or to the personal care of residents which P.2a/2? May 29 2009 10:07 MAY-29-2889 11:19 AGENCY HEALTH CARE ADMIN 856 921 @158 P2427 the Agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than a Class I violation. Section 429,19(2)(b), Florida Statutes (2008). 46, The Agency shall impose an administrative fine for a cited Class II violation in an amount not less than one thousand dollars ($1,000.00) and not exceeding five thousand dollars ($5,000.00) for each violation as set forth in Section 429,19(2)(b), Florida Statutes (2008). A fine shall be levied notwithstanding the correction of the violation. 47. The Respondent was given a mandatory correction date of March 6, 2009. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00) pursuant to Section 429,19(2)(b), Florida Statutes (2008). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to grant the following relief: 1. Enter findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of THREE THOUSAND DOLLARS (33,000.00). 3. Order any other relief that the Court deems just and appropriate. a - "Respectfully submitted on this ahh day of a es Z , 2009, Trny Seley J a Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 14 May 29 2009 10:07 MAY-29-2889 11:28 AGENCY HEALTH CARE ADMIN 856 921 4158 P2527 NOTICE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE 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 AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 922-5873. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form has been served to: Margaret Raelynn, Administrator, Brookdale Senior Living Communities, Inc. d/b/a Sterling House of Lehigh Acres, 1251 Business Way, Lehigh Acres, Florida 33936, by U.S. Certified Mail, Retum Receipt No. 7008 1140 0003 8889 7518, and to CT Corporation System, Registered Agent for Brookdale Senior Living Communities, Inc. d/b/a Sterling House of Lehigh Acres, 1200 South Pine Island Road, Plantation, Florida .. 33324, by U.S. Certified Mail, Retum Receipt No,. 7008 1140 0003.8889 7549 on this @MtAdy day of gauil , 2009. we w. J “ot Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Admirustration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 MAN -29-2889 11:28 Copies furnished to: _ Margaret Raelynn, Administrator Brookdale Senior Living Communities, Inc. d/b/a Sterling House of Lehigh Acres 1251 Business Way Lehigh Acres, Florida 33936 (U.S. Certified Mail) AGENCY HEALTH CARE ADMIN May 29 2009 10:07 856 921 4158 Mary Daley Jacobs, Assistant General Counsel Office of the General Counsel Agency for Health Care Administration 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) P2627 CT Corporation System, Registered Agent for Brookdale Senior Living Communities, Inc. d/b/a Sterling House of Lehigh Acres 1200 South Pine Island Road Plantation, Florida 33324 (U. 8. Certified Mail) Harold Williams, Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (nteroffice Mail) 16 May 29 2009 10:07 MAY-29-2889 11:28 AGENCY HEALTH CARE ADMIN 856 921 @158 Pore? SENDER: COMPLETE THIS SECTION " ® Complete Items 1, 2, and 3. Also complete Kem 4 Hf Restricted Dallvary Is desired. ® 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 mallplece, or on the front If space permits. 1. Article Addressed to: 2004 au 3 76 Pyargat t Raclynn, dn aut Arde Sheeting bhrst of Latish eves pest Bustiers Way Latin Hees, Flanda 33736 COMMLELE THIS SECTION ON DC IVERY Fall D. la delivery address different from item 17 1 Yes It YES, anter delivery address below: [1 No 3, Service Typa © Cartified Mail [2] Express Mall F Registered O Retum Aecelpt for Merchandise TO Insured Mail Ocop. 4. Restricted Delivery? (Extra Fee) 2. Artlela Number . (Traneter ftom servico labor 7008 1240 o003 8884 7514 PS Form 3811, February 2004 Domestic Return Recalpt TORINO TOTAL P.27

Docket for Case No: 09-002961