ine ee | | STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR’ HEALTH CARE ADMINISTRATION, Petitioner, 1 vs. . , Case No. 2012000073 LINDA ALBERTINI, Respondent, / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against Linda Albertini (hereinafter Respondent), pursuant to. Sections 120.569 and 120.57, Florida Statutes (201 1), and alleges: , NATURE OF THE ACTION Chis is-an-action-toimpose-an-administrative-fine in the amount-of fifty-eight: thousand dollars ($58,000.00) pursuant to §§ 408.812, Florida Statutes (2011). ° JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and 429.07, Florida Statutes (2011). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facility. providers and the enforcement of all applicable state statutes and rules governing assisted living Filed March 13, 2012 10:56 AM Division of Administrative Hearings os yn See ren i | \ 1 | | | { | facilities pursuant to the Chapter 429, Part I, Florida Statutes, and Chapter 58A-5 Florida Administrative Code, respectively. 4, Respondent is located at 129 Snowbird Avenue, Lakeland, Florida 33815. 5. At all times relevant, Respondent did not hold licensure from the Agency for Health Care Administration to operate an assisted living facility at 129 Snowbird Avenue, Lakeland, Florida 33815, nor had the Agency for Health Care Administration issued licensure for the operation of an assisted living facility at said address. «6. Respondent was at all times material hereto operating an unlicensed assisted living : facility located at 129 Snowbird Avenue, Lakeland, Florida 33815. Under the licensing authority of the Agency, the Respondent was required to comply with all applicable rules and statutes under Chapters 429, Part I, and 408, Part I Florida Statutes (2011). | COUNT I 7 . The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. _____8,_That pursuant-to-Plorida-taw,“Assisted living facility” means any: building or buildings, section or distinct part of a building, private home, boarding home, home for the aged, or other residential facility, whether operated for profit or not, which undertakes through its ownership or management to provide housing, meals, and one or more personal services for a period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator. § 429,02(5) Fla. Stat, (2011). 9. That pursuant.to Florida law, “Personal services” means direct physical assistance with or supervision of the activities of daily living and the self-administration of medication and other similar services which the department may define by rule. “Personal services” shall not be construed to mean the provision of medical, nursing, dental, or mental health services. 8 429.02(16), Fla, Stat. (2011). 10. _ That pursuant to Florida law, “Activities of daily living” means functions and tasks for self-care, including ambulation, bathing, dressing, eating, grooming, and toileting, and other similar tasks. § 429.02(1), Fla. Stat. (2011). 11. That pursuant to Florida law, a person or entity may not offer or advertise services that require licensure as defined by the Florida Health Care Licensing Procedures Act, authorizing Statutes, or applicable rules to the public without obtaining a valid license from the Agency. A _ license holder may vot advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. § 408,812(1), Fla. Stat. (2011), 12, “That pursuant to Plorida law, the provisions of the Florida Health Care Licensing Procedures Act apply to the provision of services that require licensure as defined in this part and to the following entities licensed, registered, or certified by the agency, as described in chapters 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765 ... Assisted living facilities, as provided + ——-———aunder part of chupter429:802(14); Fla Stat (2011). — 13, That pursuant to Florida law, the operation or maintenance-of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of . the Florida Health Care Licensing Procedures Act and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The Agency may bring an action for an injunction to restrain unlicensed activity or to enjoin the future operation or maintenance of the unlicensed provider of the performance of any services in, violation of the Florida Health Care Licensing Procedures Act and the authorizing statutes, until compliance with the Act, authorizing statutes and Agency rules has been demonstrated to the we? satisfaction of the Agency. § 408.812(2), Fla, Stat. (2011). 14. That pursuant to Florida law, it is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the Agency, such person or ‘entity fails to ceasé operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules, Each day of continued operation is-a separate offense. § 408.812(3), Fla. Stat. (201 1), 15. That pursuant to Florida law, any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. § 408.812(4), Fla. Stat, (2011). 16. That Florida law provides: This section applies to the unlicensed operation of an assisted living facility in addition to'the requirements of part II of chapter 408. ) (b) Except as provided under paragraph (d), any person. who owns, operates, or maintains an unlicensed assisted living facility commits a felony of the third degree, opetation is a separate offense. (c) Any person found guilty of violating paragraph (a) a second or subsequent time commits a felony of the second degree, punishable as provided under s. 775.082, s, 775.083, ot s. 775,084. Each day of continued operation is a separate offense, (d) Any person who owns, operates, or maintains an unlicensed assisted living facility due to a change in this part or a modification in rule within 6 months after the effective date of such change and who, within 10 working days after receiving notification from the agency, fails to cease operation or apply for a license under this punishable: as-provided-in-s- 775,082; s-775;083; ors. 7750847 Bacirday of continued ~~ , ‘part commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, Each day of continued operation is a separate offense. | § 429.08(1), Fla. Stat. (2011). . 17. That-on or about October 6, 2011, Petitioner conducted a complaint survey, complaint number 201101 0548, of 129 Snowbird Avenue, Lakeland, Florida 33815, 18. That the address of 129 Snowbird Avenue, Lakeland, Florida 33815 is not an address licensed to operate as an assisted living facility in the State of Florida (hereinafter “unlicensed building”). See, § 408.804(2), Florida Statutes (201 1). | 19, That based upon observation and interview, Respondent operated an assisted living facility at 129 Snowbird Avenue, Lakeland, Florida 33815 without appropriate licensure. 20, That observation and interview reflected the unlicensed building was a five (5) unit - apartment building with seven (7) residents receiving daily assistance and care with the activities of daily living (ADL's) including bathing, dressing, transferring, ambulation, meal service and medication administration by staff employed by Respondent. +21: That on October 6, 2014, Petitioner's feprésenitative at 9°35 a.m. arrived at the unlicensed _ building identified by the complaint as an unlicensed assisted living facility and made the following observations: ‘a, Outside of the unlicensed building was a person who identified herself as a relative of resident number one (1). b. The relative was asked if this (unlicensed building) was an assisted living facility and she responded "Yes. [The relative has] lived here for two (2) years. This is an assisted living facility. They do everything for [the resident]: bathe [the resident), shave [the resident], feed [the resident], all of that." | c. The relative and spouse were taking the resident to a medical appointment. d. The resident was observed in the car as a frail, elderly person. 22, That on October 6, 2011 at 9:50 a.m., Petitioner’s representative entered the unlicensed building through a gated courtyard and observed the following: a b 5 & f There were five (5) doors. There was no indication of an office. Petitioner’s Tepresentative proceeded to tour the facility, obtained permission to enter three (3) of the five (5) apartments and conducted interviews with staff and residents from 9:50 a.m. until facility exit at 11:05 a.m. The unlicensed building consisted of five (5) apartments with a total of seven (7) residents, - ) | Two (2) of the apartments were vacant, Each apartment had two (2) bedrooms and a full kitchen and bath. 23, That county property records verified the ownership of the building as Respondent as sole-owner of the unlicensed building. See, EXHibit A. - 24. — That Petitioner’s representative interviewed resident number two (2), an alert and oriented individual, on October 6, 2011 at approximately 9:50 a.m. and the resident indicated as follows: ‘"We (the resident and spouse) have lived here for about a year, “They do everything for us. “They fix our meals, “The man (later identified as the maintenance person) was here and fixed our breakfast. — . PEE ee ne at Te [<7 f. g. “They help us to get dressed and give us showers." The resident also confirmed that "They give us our medications." Bedside commodes were seen in each of the two (2) bedrooms. 25. That Petitioner’s representative interviewed a staff member who identified herself as Susie Trisch, a certified nursing assistant, on October 6, 2011 at approximately 10:00 a.m. who was initially observed providing assistance to residents numbered four (4) and five (5), and the individual indicated as follows: She has worked there about one (1) year. She was employed by the owner of the unlicensed building stating "I am employed by [Respondent]. She writes my checks, I give care to all of the residents here for whatever they need." She added that the "Families make up the pill boxes and then I just give the residents their medications. I don't have to open the bottles. I just give the medications." a. { b. c. 1 d: | . 1 i i 1 e. 1 i Both the residents, residents numibered four (4) and five (5), had “dementia” and were confused. Other staff members included mark Ellis, maintenance; Marie, last name unknown, a sitter; Brittany J atvia, a certified nursing assistant; and Margo, last name unknown, a newly hired night shift certified nursing assistant. 26. That Petitioner’s representative determined that residents numbered four (4) and five (5) could not effectively be interviewed 4s they did not respond to pleasantries.of conversation. 27. That Petitioner’s representative interviewed a physical therapist who identified himself as Lee Hughes with Aegis at Home, on October 6, 2011 at approximately 10:10 a.m. who was initially observed providing physical therapy to a resident, and the therapist indicated as follows: . a. "This is my second week with this resident. [The resident] is non-ambulatory and needs some serious maximum assistance to transfer and ambulate." b. The resident has a home health nurse who visits "once or twice a week." c The resident's bed had full attached side rails. d. A pill organiser was observed on the dresser. e. The physical therapist also stated the resident was very hard. of hearing and had poor eyesight. ) - 28. That while Petitioner's representative was interviewing Ms. Trisch, at approximately 10:05 a.m. on October 6, 2011, in the room of residents numbered four (4) and five (5), the following occurred: . a. Resident number three (3) came to the door shouting "My [spouse] (resident number two [2]) fell ... help her." b. Ms. Trisch left to assist the resident. ¢,—A-person-who-identified-herself-as-a"sitter;““"l'm an unpaid sitter:-ldon't give any care, I just sit with the residents at night," atrived at the facility at 10:20 am. and proceeded to enter the apartment of residents numbered two (2) and three (3) to assist Ms. Trisch with resident number two (2). d. Resident number two (2) was later observed in bed waiting for a family member who had been called to artive. . e, The "sitter," who stated she did not give care to the residents, was observed at 10:50 a.m. turning resident number two (2) in the bed and placing an ice pack under the resident’s back, which constitutes the provision of personal services. sumephawilh «secs 29. . That Petitioner’s representative interviewed resident number seven (7), an alert and oriented. person, during the survey and the resident indicated as follows: a The resident had lived in the building for fifteen (15) years. b. Due to difficulty in speaking, the resident nodded "yes" when asked if the staff bathed the resident, dressed the resident, and helped with transfers. ) c. It was noted that the resident was in a hospital bed with full side rails and an ovethead trapeze. d. A Hoyer type hydraulic lift was observed in this resident’s room. e. When asked if the staff used this to transfer the resident to a wheel chair, the . resident nodded "yes," 30. That Ms. Trisch was subsequently asked about use of the lift and stated "We always use two (2) people when using the lift on [the resident]. In fact all of our transfers require that we use two (2) people." She further confirmed the resident required total incontinent care, 31. That a Notice of Unlicensed Activity was provided to a Violet Yacoub, a relative of the property owner who had amrived-at the-proporty-at-11:00 am, and-signed.the-notice.The Notice —- dated October 6, 2011, attached hereto as Exhibit “B,” notified Respondent that the provision of personal services to residents in a building not licensed as an assisted living facility is unlicensed activity and directed Respondent to immediately cease and desist such activity. A copy of the Notice dated October 6, 2011 was also mailed to Respondent on October 7, 2011 at 1749 West Chase Street, Lakeland, Florida 33815-3710. 32. . That a copy of the Notice of Unlicensed Activity was left with the self identified granddaughter of Respondent. | 33. . That the above reflects that Respondent was providing personal services to individuals on perlidbdsenunts er, a twenty-four (24) hour basis in the unlicensed building including, but not limited to the provision of assistance with the self-administration of medications, and assistance with activities of daily living, . 34, Thatonor about December 5, 2011, Petitioner conducted a follow-up to a complaint survey, complaint number 201101 0548, of the unlicensed building, 129 Snowbird Avenue, Lakeland, Florida 33 81 5. 35. That the unlicensed building is not an address licensed to operate as an assisted living facility in the State of Florida. See, § 408.804(2), Florida Statutes (2011). 36. That based upon observation and interview, Respondent operated an assisted living. . facility at 129: Snowbird Avenue, Lakeland, Florida 33815 without appropriate licensure. 37. . That personal services provided to resident in the unlicensed building included bathing, dressing, repositioning, meal service, and ambulation for individuals residing in this five (5) unit unlicensed building on a twenty-four (24) hour per day basis without the required license to provide those services. 38.—That-Petitioner’s-representative—arrived—atthe—unlicensed-~-building-and—knocked-on: apartment number one hundred thirty-three (133) and the following occurred: a. Respondent's staff member number five (5), Marie, opened the door and allowed the surveyor to enter by stating “come in.” b. Residents numbered one (1) and two (2) were present in the apartment, each "sitting ina recliner chair in the living room. c. Staff member number five (5) stated that she helped the residents with their showers. d. Staff member number six (6), Violet Yacoub, who identified herself -as a Respondent’s granddaughter, asked the surveyor to leave the apartment and proceeded to call the Respondent and allowed the surveyor ‘to speak with Respondent. e Respondent indicated that she could not allow the surveyor to enter any of the j . apartments without permission from the families and that the families would not . want for anyone to speak with the residents without being present. f. . When asked if it were possible to ask the residents directly if they could be met with by Petitioner’s representative, Respondent responded that some of them are “not of sound mind." g. ‘Respondent indicated "It's against the law to just let you in." . . h. Respondent indicated that they have monitors in each apartment that allows the staff to hear the residents so they can respond if needed, i, Respondent identified her staff members as Susie, Brittany, Marie, and Violet. j. Respondent indicated that all residents except one (1) still resided in the + ~—unlicensed-building. ——-——- k. Staff member number six (6) provided a list of family members and their telephone numbers to the Petitioner’s representative. 39. That Petitioner’s representative interviewed Amelie Beytell with Senior Home Care, an Occupational Therapist from on outside agency, on December 5, 2011 at 11:10 am. who was leaving the apartment of residents numbered one (1) and two (2) and the therapist indicated as follows; a. Resident number one (1) required maximum assistance. b. The residents live alone, but were never left alone as staff is always present on the 11 ak a taloe premises. c. There are cameras in each apartment so staff can keep an eye on them. d. She has always seen at least two (2) staff members on the premises. e. Staff shower and cook for the residents. 40. That Petitioner’s representative telephoned the grandchild of resident number three (3) on December 5, 2011 11:15 a.m. and the grandchild indicated that the resident is blind, requires assistance, and that the grandchild would come to the unlicensed building, 41. That at 11:30 a.m. on December 5, 2011, the grandchild of resident number three (3) arrived at the unlicensed. building, accompanied Petitioner’s representative inside the rooms of resident number three (3) and engaged in conversation during which the following was noted: a. There were two (2) bedrooms in the apartment. . b. Both bedroom doors were closed. . c. A camera was observed mounted near the ceiling in the living room near the front door. d,—Upon-entering;resident-number-three-)-was-observed-tying-in-a-hospital-type bed in a bedroom. e. The grandchild stated that if the grandparent needed anything, the grandparent/ resident could ask for assistance and the staff, hearing the grandparent/ resident through the monitor, would respond. f.. Staff helps the grandparent with hair, cleans nails, changes and showers the resident, repositions the resident, and assists the resident in sitting up in bed and with feeding. g. The grandchild pays for the rent which includes board, personal care, and food. 12 } Hf i i ! | 4 See ae ee es -+__-—_December 5,20. during -which-the-following-was-noted: Ne 42: That Petitioner’s representative then knocked on the second bedroom door and the - inhabitant, resident number four (4) indicated the representative could enter. 43. That Petitioner’s representative observed in this second bedroom resident number four (4), lying in a hospital type bed with a trapeze bar overhead, 44, That at that time, staff member number six (6) enteréd the apartment and Petitioner’s representative left the apartment, ) 45. That Petitioner’s representative interviewed Respondent’s staff member number six (6) during the survey who indicated as follows: | a. She and staff member number one (1) are volunteers. _b. When asked about the other aides that help with the residents being paid she responded, "I don't get into that." “46. That an unknown individual was observed entering the rooms of residents numbered one (1) and two (2) earlier during the survey, said individual observed sitting in her car upon Petitioner’s representative exiting the unlicensed building and an interview ensued at noon on a, The woman identified herself as Terri Bennett, a Physical Therapist for an outside agency. b, She was there for an evaluation of resident number one (1). c. . The resident was very dependent and requires a two (2) person assist. d. The resident requires assistance in personal care and with meals. e, There is a "doorbell" type buzzer in the apartment that lets the aides know when the residents need assistance. ’ £ A camera is used in the apartment, 13 tehsil scibetonenns determi fincas ot Se & When asked if she knew what kind of facility it may be she responded, "T guess it's an Assisted Living Facility. I don't know what kind of license they have. ‘The residents have either dementia or are cognitively impaired. They need twenty- four (24) hour supervision." | h, . She heard staff talking about making soup or a sandwich for the residents, - i, "They are pretty much deperident on everything." j. On that day, staff member number five (5) assisted her with getting resident number one (1) from a chair to a standing position at a walker, but that the resident was unable to use the walker on this day. 47. That the residents of the unlicensed building are being provided services which include twenty-four (24) hour personal services care and assistance in being fed, for which neither the unlicensed building nor Respondent holds the required licensure. 48. That the above reflects that Respondent was providing personal services to individuals residing in a building not licensed as an assisted living facility including, but not limited to the ‘provision-of personal-care-and-assistance-with-the-self-administration-of- medications: 49. That the above reflects that Respondent knew that personal services were being provided to residents in a building not licensed as an assisted living facility, | ) 50. That Respondent continued unlicensed activity despite having been notified of the unlicensed activity and a direction to discontinue such activity in accord with law. 51 . That the operation of an assisted living facility without appropriate licensure subjects the Respondent to a daily fine during any period of unlicensed activity after Respondent had been notified of unlicensed activity. 52. ‘That Respondent operated an assisted living facility without appropriate licensure from 14 October 6, 2011 through at least December 5, 2011. WHEREFORE, the Agency intends to impose an administrative fine in the amount of one. thousand dollars a day, October 6 through December 5, 2011 representing fifty-eight (58) days or fifty-eight thousand dollars ($58,000.00), and any additional sums which may accrue after , December 5, 2011 until Respondent ceases unlicensed activity, against Respondent for operating an unlicensed assisted living facility in the State of Florida, pursuant to § 408.812, Florida Statutes (2011), ‘Respectfully submitted this Ly day of February, 2012, J. Walsh, Il, Esq. ar. No, 566365 - ounsel for Petitioner : Agency for Health Care Administration ' 325 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1947 (office) 727:552:1440 (fax) Respondent is notified that it has a tight 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 Admin istration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida 32308; Telephone (850) 922-5873, , RESPONDENT IS FURTHER NOTIF TED 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 - ULS. Certified Mail, Return Receipt No. 7003 1010 0001 3600 4002 on February , 2012 to Linda Albertini, 129 Snowbird Avenue, Lakeland, FL 33815, and by U.S. Delivery Confirmation, No.0309 0330 0001 6996 4843, to Linda Albertinin, 1749 West Chase Street, Lakeland, Florida 33815-3710; : : ‘ ; IT HEREBY CERTIFY that a true and correct copy of the foregoing has O served by | il alsh II, Esquire | ‘Copies furnished to: Linda Albertini Thomas J. Walsh, II, Esq. Pat Caufman 129 Snowbird Avenue Agency for Health Care Admin. | Field Office Manager Lakeland, FL 33815 525 Mirror Lake Drive, 330G 525 Mirror Lake Drive, (U.S. Certified Mail) and St. Petersburg, Florida 33701 4" Floor ; : (Interoffice) : St. Petersburg, Florida 33701 Linda Albertini ; (Interoffice) 1749 West Chase Street Lakeland, FL 33815-3710 U.S. Mail Delivery Conf. " ? STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: Linda Albertini. CASE No.: 2012000073 TION s This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk ' 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308. Phone: 850-412-3630 Fax: 850-921-0158. PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) I admit to the allegations of facts and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. 1 understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action, OPTION TWO (2)___, IL admit to the allegations of facts contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Adntinistrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120,57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. OPTION THREE (3)___—_—‘I dispute the allegations of fact contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. 7 It must be received bythe Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it contain: 1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any, 2. The file number of the proposed action. j 3. A statement of when you received notice of the Agency’s proposed action, 4. A statement of all disputed issues of material fact, If there are none, you must state that there are none, Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees. License type: (ALF? nursing home? medical equipment? Other type?) Licensee Name: License number: Contact person: Name Title Address: \ Street and number City _ Lip Code Telephone No, Fax No. Email(optional) _ Thereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: __ Date: Print Name: Title: Late fee/fine/AC Property Search Home » Return To Search Results Parcel Detalls: 23-28-14-078000-003013 Owners ALBERTINI LINDA 100% Mailing Address Address 1 1749 W CHASE ST Address 2 : , Address 3 LAKELAND FL 33815-3710 Site Address Address 1 129 SNOWBIRD _ Address 2 City LAKELAND State . eL Zip Code. 33803 _ Parcel Information ) ‘Page 1 of 5 Mi precaic BeicRenort Arm Notice Property Desc } : .{ DISCLAIMER: This property description is a condensed version ofthe original legal description recorded in the public records. It doas not . Include the section, township, range, or the county where the property \s located. The property dascription should not be used when conveying property, The Property Appraiser assumes no responsibility for the consequences of Inappropriate uzes or interpretations of the Property description, No warranties, expressed or implied, are provided for the data herein, its use, or Its interpretation. 319010,08 Neighborhood = Show Recent Sales in this Neighborhood . TAMPA HIGHWAY INDUSTRIAL Subdivision ADD PB 30 PG 49 Property (DOR) Apartments (5-9 Use Code Units) (Code: 0830 Acreage 0.69 | ct LAKELAND /SWEWMD/LKLD. ‘Faxing-Bistrl "MASS (Code: 91510) Sales History Mapping Worksheets (plats) for 232014 . Mapping Worksheet Info jon. 4 oA” “A” Note: If the deed does not have blue link to official records, the deed is not available through the online records of the Clerk of the Circuit Court, In order to obtain a copy of this deed you will need to contact the Clark's Indexing Department at 863-534-4524, OR Book/Page Date Type Inst 5251/2178 | 01/2003 Q Vacant/ Improved Reason Grantee Sales Price © 01 ALBERTINI LINDA $100 EXHIBIT { Property. Search ' ) . ) Page 2 of 5 d- 2627/1713. (ayi988 SW 1 00 $175,000 - 4 2564/1251 —«09/1987 Q I 93 $100 ; 2486/726 12/1986 Q 03 $100: 4 Exemptions Nate: The drop down menus below provide information on the amount of exemptton applied to each taxing district. The HX—first, $25,000 horiestead examption may be alldcated to one or more owners. The HB ~second $25,000 amended homestead exemption reflects the name of the first owner only. Code Description % Ownership: Renew Cd Year Name Value i Bulldings 1 BUILDING 1 (MULTIPLE RESIDENCE) . Building Characteristics 129 SNOWBIRD | Total Under Roof: 5,536 sqft : 4 - Living Area (as originally constructed): 3,648 sqft 37. 5 Actual Year Bullt; 1983 { | Effective Year: 1983 6 GRS 8 SR4 6 : Wall Structure: CONCRETE a | . . Element Units Information ‘ , HEAT CODE AcP Exterior Wall NONE 1 c~ sat i i Stories . 1 ’ m 1 ; LIVING UNITS 5 : WALL HEIGHT 8 : % 6 4 Building Subareas . i Code Description Total | . BAS BASE AREA . : 3648 | SR4 SCREEN ROOM 40% 352 SR4 SCREEN ROOM 40% 944 GRS GARAGE 50% 592 : Total Under Roof 3,836 tt? eet Te ees Extra Features (Current) LN Code Description | BLD Length Width Units Year Built 1 MAC ASPHALT 0 0 0 2900 1983 2 CON CONCRETE ; 0 0 0° «684 1983 ° 3 SCR2 SCREEN ROOM 1500 0 46 8 1 2003 4 SCR3 SCREEN ROOM 2500 iy 60 “8 1 2003 Land Lines (Current) ; LN Land Dser Note Ag/GreenBelt Land Unit Type Front Depth Units Bai =n RICK SCOTT - Better Health Care for all Fiorfdians ELIZABETH DUDEK 4 GOVERNOR . . SECRETARY NOTICE OF UNLICENSED ACTIVITY Date: 10/06/11 To: = Albertini, Linda 129 Snowbird Avenue Lakeland, FL 33815 ~ The Agenoy-for Health Care Administration has determined that you and/or this facility are operating an Assisted Living Facility at the above address without the required license. Under Florida law, it is unlawful for any person ot entity to: own, operate, or maintain an unlicensed provider; or perform any’ services that require Agency licensure without proper licensure; or offer or advertise services that require . Agency licensure to the public without first obtaining a valid license from the Agency. An existing | license holder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license, Any person and entity that fails to immediately cease operation of an unlicensed provider is subject to the penalties set forth under Florida law. ‘This includes, but is not limited fo, the imposition of fines of $1,000.00 for each day of noncompliance and an injunction to restrain such violation or enjoin the future | operation or maintenance of the unlicensed provider or the performance of any services requiring licensure.Each-day-of continued-operation-is-a separate offense: If you have any questions regarding this Notice of Unlicensed Activity, you may contact me at 727-552- 2000. : : Sincerely, a Patricia Reid Caufman joel Field Office Manager a AHCA License Unit | Ole of the attones Goren _ EXHIBIT “R” 2727 Mahan Drive 2 Area Office 5/6 Mail Stop #1 526 Mirror Lake Dr North Tallahassee, FL 32308 Suite 410 ahca.myflorida.com : St. Petersburg, FL 33704 iLinda Albertini (129 Snowbird Avenue jLakeland, FL 33815 u WOE Sas balvety? (Bx 7003 1010 yooe “qo28a8-02-M-F640,

Docket for Case No: 12-000894