STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. ; Case No. 2009013097 MARY ALEXANDER, Respondent. / 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, Mary Alexander (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2009), and alleges: NATURE OF THE ACTION This is an action against an adult family care home to impose an administrative fine in the amount of five hundred dollars ($500.00) based upon one Class I violation and to revoke the Respondent’s adult family care home license based upon one Class II violation. ‘ JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2009). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, and Chapters 408, Part II, and 429, Part II, Florida Statutes (2009). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. Filed December 17, 2009 3:40 PM Division of Administrative Hearings. PARTIES 4. The Agency is the licensing and regulatory authority that oversees adult family care homes in Florida and enforces the applicable state statutes and rules governing such facilities. Chs. 408, Part II, 429, Part Ii, Fla. Stat. (2009), Ch. 58A-14, Fla. Admin. Code. The Agency may deny, suspend or revoke the license of, and in addition to any liability or penalty provided by law, impose an administrative fine on, an adult family care home. §§ 408.813, 408.815, 429.69, 429.71, Fla. Stat. (2009). “Licensure under this part is a public trust and a privilege, and not an entitlement.” § 429.63(4), Fla. Stat. (2009). 5. The Respondent was issued a license by the Agency (License No. 6906177) to operate a 5-bed adult family care home located at 17180 S.W. 39" Circle, Ocala, Florida 34473 (39" Circle address), and was at all times material required to comply with the applicable statutes and rules governing such facilities. An “adult family-care home" means “a full-time, family-type living arrangement, in a private home, under which a person who owns or rents the home provides room, board, and personal care, on a 24-hour basis, for no more than five disabled adults or frail elders who are not relatives.” § 429.65(2), Fla. Stat. (2009). “Adult family-care homes provide housing and personal care for disabled adults and frail elders who choose to live with an individual or family in a private home. The adult family-care home provider must live in the home. The purpose of this part is to provide for the health, safety, and welfare of residents of adult family-care homes in the state.” § 429.63(2), Fla. Stat. (2009). COUNT I (Tag F001) 6. The Agency re-alleges and incorporates by reference paragraphs | through 5. 7. The Florida Legislature has declared that adult family care home licensure isa public trust and a privilege, and not an entitlement. This principle must guide the finder of fact or trier of law at any administrative proceeding or circuit court action initiated by the department to enforce this [Chapter 429, Part Il, Florida Statutes, 2008] part. § 429.63(4), Fla. Stat. (2009). 8. Under Florida law, a license to operate an AFCH is not transferable and is valid only for the provider named, the capacity stated, and the premises described on the license. Fla. Admin. Code 58A-14.004(2). 9. On October 28, 2009, the Agency conducted an appraisal visit of the Respondent and her Facility. 10. Based on observations and interview, the Respondent utilized her AFCH license valid only for the 39" Circle address, to generate residents in excess of her licensed capacity in order to place residents in unlicensed facilities. This practice has resulted in an unlicensed facility providing medication management without the knowledge of the medication records of its residents. 11. Review of resident records on October 28, 2009 at the 39 Circle address revealed records for two residents who were not residing at the licensed facility. 12. Interview with an AHCA registered nurse on October 28, 2009, at approximately 8:50 a.m., revealed that she located three residents residing at a 2121 S.W. 166" Lane, Ocala, Florida 34473 (2121 address). 13. Two of the three residents located at the 2121 address were residents whose records had been located at the 39" Circle address. 14. Interview with the three residents (Residents #1-#3) at the 2121 address on October 28, 2009, beginning at approximately 7:30 a.m., revealed that they all had previously dealt with the Respondent. 15. Interview with Resident #1 on October 28, 2009, at approximately 7:30 a.m., revealed that he or she was placed in the Respondent’s care approximately 6-7 weeks prior. 16. Resident #1 stated that he or she was recuperating from injuries sustained in a motorcycle accident and had been hospitalized in the recent past, but could not remember the name of the hospital. 17. According to Resident #1, the Respondent’s staff provides him or her with his or her medications as well as driving him or her to his or her doctor’s appointments, but is rarely timely. 18. Interview with Resident #2 revealed that he or she was placed in the Respondent’s care after discharge from the Veterans Affair (VA) Medical Center in Gainesville, Florida in order to regain strength following the recuperation from a vehicle accident. 19. Resident #2 stated that he or she received little to no therapy as was intended, other than “hanging out and watching television.” 20. Resident #2 stated that he or she was convinced to remain with the Respondent an extended period of time despite feeling that he or she was ready to return to his or her personal home. 21. Interview with Resident #3 revealed that he or she had been under the Respondent’s care for approximately five months. 22. Resident #3 revealed that he or she has short term memory deficits that make him or her forget to take medication. 23. According to Resident #3, he or she has bipolar disorder for which he or she is prescribed Seroquel and other medications. 24, Resident #3 was unaware of his or her dosages as the Respondent’s “staff at the other home give me my medication.” 25. Resident #3 stated that he or she has not been to see a psychiatrist as he or she is waiting for “them” [Respondent] to schedule him or her an appointment. 26. Resident #3 stated that his or her money goes to the Respondent. 27. On October 28, 2009, the surveyor visited the 2120 166" Lane, Ocala, Florida 34473 address (2120 address) where the medications for the residents at the 2121 address were kept. 28. Medications found at the 2120 address for the residents at the 2121 address were located in a locked cabinet along with food items as well as in a two-drawer filing cabinet in the kitchen. 29. — Interview on October 28, 2009, at approximately 10:20 a.m. with friends of Resident #2 revealed that they had made numerous attempts to visit Resident #2, however had been delayed by the Respondent. 30. They stated that the Respondent permitted them to visit Resident #2 at the 39" Circle address, however when they asked to see his or her sleeping quarters they were told by the Respondent that Resident #2 slept at another location. 31. They also revealed that after some time they were permitted to view the sleeping quarters of Resident #2 at the 2121 address. 32. Prior to entering the 2121 address on October 28, 2009, at approximately 7:15 a.m., a signed was observed on the home’s door indicating a six person occupancy for a independent/transitional living facility. 33. During the entrance conference with the employee on duty on October 28, 2009, at approximately 7:15 a.m. it was revealed that the residents were sleeping. 34. Permission was granted to open and observe the contents of the cabinets and file cabinet located in the kitchen. 35. Observation on October 28, 2009, revealed that there were multiple pill reminder boxes with various names on them in the file cabinet. 36. | Medications for people who were not located within the home were found. 37. Unlabeled medication was located, which the staff indicated was for a resident in the 2120 address. 38. A storage cupboard was located in the dining room, which contained medications in bubble-packs. Some of this medication was for current residents of the 2121 address, some was not. 39. Interview with the staff revealed that he or she did not place the medication in the pill reminder boxes, as it was done by another person that the staff could not identify. 40. The staff was not aware of the medication she was giving, nor was she recording any dosages given. 41. In the event of an emergency, the staff stated that she would contact the Respondent. 42. On October 28, 2009, at approximately 7:50 a.m., medications were observed in the kitchen cabinet labeled, “medicine.” 43. Medications found were prescribed to the Respondent. 44, Another medication was found prescribed to another named individual. 45. Interview with Resident #3 on October 28, 2009, at approximately 9:00 a.m. while the Resident was taking his or her medications, revealed that he or she was unaware of the medications that he or she was taking. 46. The staff was also unaware. 47. During this interview Resident #3 also stated that he or she had been sent money from a sibling for clothing and spending and that he or she was still owed approximately $100.00. 48. Resident #3 also stated that he or she has lost approximately 20 Ibs since being under the Respondent’s care. 49. The Respondent’s actions and/or inactions constituted a class I violation. 50. Class | violations are those conditions or practices related to the operation and maintenance of an adult family-care home or to the care of residents which the agency determines present an imminent danger to the residents or guests of the facility or a substantial probability that death or serious physical or emotional harm would result therefrom. The condition or practice that constitutes a class I violation must be abated or eliminated within 24 hours, unless a fixed period, as determined by the agency, is required for correction. A class I deficiency is subject to an administrative fine in an amount not less than $500 and not exceeding $1,000 for each violation. A fine may be levied notwithstanding the correction of the deficiency. § 429.71(1)(a), Fla. Stat. (2009). 51. The Respondent was cited for a class I violation. 52. The Respondent was given a mandatory correction date of October 29, 2009. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks a final order imposing an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT II (Tag F609) 53. | The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 54, Under Florida law, the agency shali initiate a level 1 background screening as provided under chapter 435 on the adult family-care home provider, the designated relief person, all adult household members, and all staff members. § 429.67(4), Fla. Stat. (2009). 55. Under Florida law, the provider, all staff, each relief person, and all adult household members must meet Level 1 background screening requirements established in Section 435.03, F.S., or have been exempted from disqualification as provided in Section 435.07, F.S. The provider must submit a completed AHCA Forms 3110-0002, or other evidence of compliance as provided in Section 429.67, F.S., and Rule 58A-14.003, F.A.C., for any staff, relief persons, or adult household members not screened at the time of initial license application pursuant to the screening schedule provided in Section 435.05, F.S. Fla. Admin. Code 58A- 14.008(1)(b). 56. Under Florida law, each [AFCH] resident has the right to live in a safe and decent living environment, free from abuse and neglect. § 429.85(1)(a), Fla. Stat. (2009). 57. On October 28, 2009, the Agency conducted an appraisal visit of the Respondent and her Facility. 58. Based on record review and interview, the Respondent failed to ensure that 1 of 4 employees (Employee #1) met Level 1 background screening requirements or had been exempted from disqualifications, which led to the Respondent knowingly allowing the employee with felony convictions to transport the facilities’ residents and periodically reside at the 39" Circle address. 59. Interview with Employee #1 on October 28, 2009, at approximately 8:05 a.m., revealed that he was the driver for the Respondent’s residents, and was unaware where an absent resident was located. 60. Further interview with Employee #1 on October 28, 2009, at approximately 8:45 a.m., revealed that he sometimes resides at the licensed facility and that he transports the residents. 61. He stated that the Respondent’s daughter is the actual relief person. 62. During review of the employee book, it was revealed that neither Employee #1’s name nor his picture was listed. Names and pictures were located for the other employees, including the Respondent. 63. Review of the Comprehensive Case Information System using Employee #1’s name and date of birth revealed that Employee #1! has prior felony convictions, which would disqualify him from working or residing at the Facility. 64. Interview with the Assisted Living Facility Unit’s (ALF) Senior Human Services Program Specialist (Specialist) on October 29, 2009, at approximately 12:10 p.m. via electronic mail revealed that during the licensure application process, the Respondent listed no household members and Employee #1 was listed as a relief person who resided at a different address. 65. The Specialist further revealed that the Respondent removed Employee #1 as the relief person during the application process by sending correspondence to the ALF Unit. 66. Review of correspondence sent by the Respondent to the ALF Unit revealed receipt of the letter on September 10, 2007 and September 17, 2007. 67. The contents of the correspondence revealed the Respondent’s refusal to employ Employee #1 due to his unsatisfactory background screening and that he is “NOT A EMPLOYEE OR RELIEF PERSON or RESIDENT.” 68. The Respondent’s actions and/or inactions constituted a class II violation. 69. Class II violations are those conditions or practices related to the operation and maintenance of an adult family-care home or to the care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the residents, other than class I violations. A class II violation is subject to an administrative fine in an amount not less than $250 and not exceeding $500 for each violation. A citation for a class II violation must specify the time within which the violation is required to be corrected. If a class II violation is corrected within the time specified, no civil penalty shall be imposed, unless it is a repeated offense. § 429.71(1)(b), Fla. Stat. (2009). 70. | The Respondent was cited for a class II violation. 71. The Respondent was given a mandatory correction date of November 28, 2009. 72. Under Florida law, the Agency may deny, suspend, and revoke an AFCH license for failure of any of the persons required to undergo background screening under s. 429.67 to meet the level 1 screening standards of s. 435.03, unless an exemption from disqualification has been provided by the agency. § 429.69(1), Fla. Stat. (2009). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks a final order revoking the Respondent’s adult family care home license. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks a final order that: 1. Makes findings of fact and conclusion of law in favor of the Agency. 2. Imposes an administrative fine against the Respondent as set forth above. 3. Enters any other relief authorized by law that is just and appropriate. Respectfully submitted on this 18th day of November, 2009. Q Agency for Health Care Administration Office of the General Counsel 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Telephone: (850) 922-5873 Facsimile: (850) 921-0158 NOTICE The Respondent has the right to request a hearing to be conducted in accordance with Sections 120.569 and 120.57, Florida Statutes, and to be represented by counsel or other qualified representative. Specific options for the administrative action are set out within the attached Election of Rights form. The Respondent is further notified if the Election of Rights form is not received by the 10 Agency for Health Care Administration within twenty-one (21) days of the receipt of this Administrative Complaint, a final order will be entered. The Election of Rights form shall be made to the Agency for Health Care Administration and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 922-5873. CERTIFICATE OF SERVICE J HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to: Mary Alexander, 17180 S.W. 39" Circle, Ocala, Florida 34473, by United States Certified Mail, Return Receipt No. 7003 1010 0000 9715 4976, and Miquell G. Mack, Esquire, 151 S.E. 8"" Street, Ocala, Florida 34471, by United States Certified Office of the General Counsel 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Telephone: (850) 922-5873 Facsimile: (850) 921-0158 Copies furnished to: Mary Alexander Ann Lopez 17180 S.W. 39" Circle Facility Evaluator Supervisor Ocala, Florida 34473 Agency for Health Care Administration (U.S. Certified Mail) 14101 N.W. Hwy 441, Ste. 800 Alachua, Florida 32615 (interoffice Mail) Miquell G. Mack, Esquire Jamie L. Jackson, Assistant General Counsel 151 S.E. 8" Street Agency for Healthcare Administration Ocala, Florida 34471 2727 Mahan Drive, MS #3 (U.S. Certified Mail) Tallahassee, Florida 32308 (Interoffice Mail) SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY A. Signature fo} » (4) 0 Agent xf], Aktipnd-~. Wrrossee ™ Complete items 1 ind 3. Also complete | item 4 if Restrictea vélivery 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 mailpiece, Bhi. a (Prifed Name) C. Date of Palvery or on the front if space permits. Mths SGA SL fii pd DB. Is delivery address different from item: O Yes : if YES, enter delivery address below: O1No 4. Article Addressed to: | ! 3. ice Type : Certified Mail (1 Express Mail ; CO Registered O Return Receipt for Merchandise i C insured Mail = C.0.D. . | 4. Restricted Delivery? (Extra Fee) O Yes : 2. Article Number (iranster from service k 7003 1010 O000 9715 45976 . PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 & Complete items 1/ *ynd 3. Also com lete item 4 if Restrictec.-dlivery is desire O Agent & Print your name and address on the réverse } | | | | Z CO Addressee : ie - ‘i by (Rrigted Nam C. Date of Delivery ; )4e-delivery address different from item 1? O Yes If YES, enter delivery address below: O1 No so that we can return the card to you, ®@ Attach this card to the back of the mallpiece, or on the front if space permits. 3. Service Type C Certified Mail © Express Mail D Registered C Return Receipt for Merchandise O Insured Mail = C.0.D. | 4. Restricted Delivery? (Extra Fee) OD Yes 2. Article Number 7003 1010 O0000 4?15 4983 i (Transfer from service L. i PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 | i

Docket for Case No: 09-006833