bl sd STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ; ~ VS. : -AHCANo. 2014001640 YAN YAN HEALTHCARE, INC,, ; Respondent. ADMINISTRATIVE COMPLAINT COMES. NOW. the Petitioner, State of Florida, Agency. for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against the Respondent, Yan Yan Healthcare, Inc.( the “Respondent”), pursuant to Section 120.569 and 120.57, Florida Statutes (2013), and alleges: NATURE, OF THE ACTION This is an action to revoke the Respondent’s assisted living facility license and impose an administrative fine for $15,000.00 based upon one Class I deficiency, one Class II deficiency, and one unclassified deficiency. PARTIES 1. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable state statutes and rules governing assisted living facilities pursuant to the Chapter 408, Part II, Chapter 429, Part I, Florida Statutes, and Chapter 584-5, Florida Administrative Code, respectively. 2. The Respondent operates a licensed assisted living facility located at 585 Allen Drive, Merritt Island, Florida 32952 (license number 11992), and was at all times material . required to comply. with all applicable state and federal rules and statutes. COUNT. I SUPERVISION. 3. Under 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: (a) Monitor the quantity and quality of resident diets in accordance with Rule 58A-5.020, F.A.C. (b) Daily observation by designated staff of the activities of the resident while on the premises, and awareness of the general health, safety, and physical and emotional well-being of the individual. (c) General awareness of the resident’s. whereabouts. The resident may travel independently. in the community.(d). Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, 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 is discharged or moves out.(e) A written record, updated as needed, of any significant changes as defined in subsection 58A-5.0131(33), F.AC., any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services. 58A-5.0182(1), Fla. Admin Code. 4. On or about February. 5, 2014, the Agency conducted a complaint survey of the. Respondent. 5. The facility failed to provide care and services appropriate to meet the needs of 4 of 4 residents admitted to the facility (#1, 2,3 & 4).. 6. In an interview conducted on 1/30/14 at 2:05 PM with the fire inspector, he stated ° ° that a 911 call was placed from the residence today at 10:08 AM regarding an elderly female on the floor needing lift assistance getting up. The rescue squad arrived at the home at 10:27 AM finding 4 residents, 3 male and one female. The female resident was on the floor in the hall way. outside her bedroom. . She was assessed and found to have no apparent injuries. The rescue squad found two of the four residents could not self-evacuate the home. The Fire Inspector and Plans Reviewer were called to the home. He stated that the facility failed the fire drill due to the fact that two. of the four residents could not self-evacuate and there was no staff in the home at this time... The owner returned to the facility at 11:36 AM... She was dropped off at the facility by someone in a car. 7. In an interview conducted on 1/30/14 at 2:08 PM with the sheriff deputy, he stated the owner has changed her story. several times since ine arrived. . He has recorded all her statements. The sheriff deputy interviewed all four residents who stated that the owner has been gone since around 8 AM this morning, 1/30/14. 8. In an interview conducted on 1/30/13 at 2:15 P M with the owner of the facility, she stated that she left the facility at approximately 10 AM. . She stated she was going to the Cocoa Beach Pharmacy to pick up medications for resident #1 who. was admitted last night at 8:30. PM by her brother. . The owner went by bus because her car was in the shop... Another car was seen at this time in the driveway. but she said it did not run. The owner stated that she left a woman in charge whose name on her driver's license did not match the name on the other documents. There was an outdated " Freedom from Communicable Disease ". statement. . There was no evidence of Cardiopulmonary (CPR) training or First Aid training, no application or references, and no evidence that a background screening was completed. The owner stated that the woman told her she did have the documentation but did not provide it. e ° 9. In an interview conducted on 1/30/14 at 3:29 PM with resident #2, he stated that he saw the owner in the home around 7-8 AM that day. . He said she offered him coffee and a few donuts for breakfast. He stated that at night, he lies in urine because she does not change him. Resident #2 stated that this is not the first time the owner left them alone since he moved in on 1/02/14. He said she left the home with a woman called "H" to go grocery. shopping two nights ago. Resident #2. stated he spent the week between Christmas and New Years in jail due to an incident at the skilled nursing facility where he was prior to this placement. He said he does not have any family. He has a case worker at Coventry. Long Term Care but does not know the name. . He said his ex-sister in law sometimes visits him. 10. =‘ In an interview conducted on 1/30/14 at 3:40 PM with resident #4, he stated he has been in the facility a year and a half, since 2012. He stated that for long periods of time he was the only resident.. When he first came to the facility, he was bedbound and on hospice care. After six months, he improved. He currently goes to dialysis 3. times a week on Monday, Wednesday and Friday. His daughter takes him sometimes but sometimes the owner would take him or the woman known as _"H" . Resident #4 stated that when he got up this morning he found resident #1. lying on the floor in the hall outside her bedroom. . He stated that he tried to help her up but could not do it himself. He went to get resident #3 to assist him but even the two of them could not help her. . Both residents have vision problems but resident #3, dialed 9, and resident #4. gave them the information... When the fire department arrived at the facility, resident #4 let them in the house, Resident #4 stated that they have been left alone before... Specifically, - the owner went grocery shopping two. nights ago. She went with a woman called "H". "H" has been around for a couple of weeks. Resident #4 stated he did not see anyone else there this morning. He had coffee and donuts for breakfast. @ e ) } 11. In an interview with resident #1 on 1/30/14 at 5 PM, she could not recall falling this morning. She did not recall the fire department helping her up from the floor. . She did not know what she had for breakfast. She did give her brother 's name and phone number. . She denied any injuries. . 12. In an interview conducted on 1/30/14 at 5:15 PM with resident #3, he stated he was only in the facility for about two weeks. He stated he was in a large facility and his social worker. thought he would do better in a smaller facility. He regrets the move and wishes he had not moved... Resident #3 stated that there is not enough staff. He stated that today was not the first time they were left alone. He recalled two nights ago, the owner went grocery shopping and left them alone for several hours... In regards to the incident this morning, he was sleeping in bed when resident #4 came to my room and asked me to help him. The lady was on the floor, We tried to pick her up. but we could not. He said he got the phone but could not see the numbers. Resident #3 stated, " I dialed 911 and he gave them the information. .When the fire department arrived, resident #4 let them in. I do not want stay here." Resident #3 plans to speak to his case worker. because he wants to. move. 13. Telephone interview was conducted with family member resident #4 who. stated she was not aware that residents could not be left alone. She stated that residents have been left alone before yesterday. She recalled an incident about two months ago when she went to facility. after work to see her father and the owner asked her to stay. with the residents. At the time, there was one other resident beside her father while she went to a meeting. Two and a half hours went -by and the owner was not back, so she calied the owner. She did return about half an hour later. Over all, she has felt that her father 's needs were met but for most of the time, he is the only. resident in the home and had 1:1 care.. e : e 14. ‘In an interview conducted on 1/30/14 at 4 PM with the administrator, she was informed of the incident earlier today that 4 residents were found by. fire rescue to be in the home unattended by any. staff. The administrator ' s first statement was that there was only one resident residing in the facility. She was showed the files of the three residents admitted since 1/02/14. The administrator stated that she was not aware of the new admissions. The administrator briefly reviewed the files and noted that residents #1 and #3 did not have an 1823 form. . The administrator was informed that there is no staff schedule for the month of January, 2014. The administrator was asked when she was last at the facility and said she was not sure, about 1 to 2 weeks ago. She was asked if there was a time sheet or any documentation to prove that she had been at the facility. and she was not able to produce any. . The administrator was asked about the staffing issue and stated she was not aware there was no staff and said the owner had been working alone for the past month. The administrator stated to. owner, ." I told you that you had to have a written schedule. ".. The administrator was not aware of any staff applying for a position and she. has not seen any. applications or files. She was shown the file of the woman who. the owner states she left in the sole care of the residents and the administrator stated she has never seen this file or met this woman. The administrator stated she is not able to give any answers about the residents admitted until she can get some information for them. . 15. At 4:40 PM on 1/30/14, the fire inspector informed the administrator and the owner that he would return tomorrow... At this time, the facility. failed the fire drill. The fire. inspector observed that two of the four residents were not able to evacuate the facility without hands on assistance. They were in danger if there was no staff or inadequate. staff in the home.. He said the owner will have to demonstrate that she can evacuate all residents within three minutes. Ifthe residents cannot be evacuated safely in three minutes, the facility will have to be bf ° put on a fire watch. That means a person, not someone who is actively. working with residents, will have to. do a complete check of the whole house every 15 minutes. . He will also bring the fire department's ." Patient Assessment Form " for each resident for the owner to fill out. This form will assess the mobility and needs for each resident. 16. ‘In an interview conducted on 02/05/2014 11:00 AM via a telephone call from owner, she stated she is sending resident #3 to see a physician with a person she is considering as a new staff person to try her out. The administrator was asked if she was aware of this plan and she stated no. She was informed she cannot allow a person who is not an approved staff person to take a resident out of the facility, she must call the administrator. 17, A Monitoring Visit was conducted on 02/05/2014 at 6:35 PM. Upon arrival at the facility, resident #2. was heard calling out in pain. Resident #2 was on the floor in the bathroom. Two. staff members with the wheelchair and the owner were in the small bathroom with the resident. The resident was screaming that he was in pain. The owner was pulling on his left arm, that was paralyzed, and the other staff were in the bathroom watching. The owner was instructed to call 911. for assistance, Fire Rescue arrived. . It took three firemen to. assist the resident off the floor. It was observed that the resident cannot stand or pivot independently. Fire rescue assisted the resident onto the toilet and then to bed. 18. In an interview on 02/05/2014 at 7:20 PM with resident #3. and the owner, — resident #3. stated that a woman he never met took him to a physician’ s office earlier today. The physician would not see him because he does not have Medicare. He only. has Medicaid. . The -owner was asked who. took the resident to the physician 's office. She stated it was Staff E, who is not an employee, but a woman she was in the process of interviewing. She stated the Administrator was not aware she had interviewed the woman and was not aware that staff E took ° ? the resident to physician ' s office.. When the owner spoke to surveyor earlier that morning and was told the person applying for position could not take resident out of the facility, it was already. too late. She had already sent him with her. . Sanction 19. Class “I” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency. determines present an imminent danger to the clients of the provider or a substantial probability that death or serious _ physical or emotional harm would result therefrom. The condition or practice constituting a class I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by the agency, is required for correction. The agency shall impose an administrative fine as “provided by law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation. § 408.813(2){a), Fla. Stat. (2013). . 20. Under Florida law, the Agency shall impose an administrative fine for a cited class I violation in an amount not less than $5,000 and not exceeding $10,000 for each violation. § 429.19(2)(a), Fla. Stat. (2013). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks an administrative fine against the Respondent in the amount of $10,000.00. COUNT II (Tag 81 Background Screening 21. Under Florida law, the Agency. shall require Level II background screening for personnel as required in Section 408.809(1)(e) pursuant to Chapter 435 and Section 408.809... § 429.174, Fla. Stat. (2013). | 22. . Under Florida law, Level II background screening pursuant to Chapter 435. must be conducted through the Agency on each of the following persons, who are considered 3 e e employees for the purposes of conducting screening under Chapter 435: . (a). The licensee, if an individual. (b). The administrator or a similarly titled person who is responsible for the day-to- day. operation of the provider. (c). The financial officer or similarly titled individual who is responsible for the financial operation of the licensee or provider. . (d) Any person who is a controlling interest if the Agency has reason to believe that such person has been convicted of any. offense prohibited by Section 435.04... For each controlling interest who has been convicted of any such offense, the licensee shall submit to the Agency a description and explanation of the. conviction at the time of license application... (¢). Any person, as required by authorizing statutes, seeking employment with a licensee or provider who is expected to, or whose responsibilities may require him or her to, provide personal care or services directly. to. clients or have access. to ‘client funds, personal property, or living areas; and any person, as required by authorizing statutes, contracting with a licensee or provider whose responsibilities require him or her to provide personal care or personal services directly to. clients. Bvidence of contractor screening may be retained by the contractor’s employer or the licensee. . § 408.809(1), Fla. Stat. (2013). 23. Under Florida law, Every 5 years following his or her licensure, employment, or entry into. a contract in a capacity that under subsection (1) would require Level II background screening under chapter 435, each such person must submit to Level II background rescreening as a condition of retaining such license or continuing in such employment or contractual status. For any. such rescreening, the agency shall request the Department of Law Enforcement to forward the person's fingerprints to the Federal Bureau of Investigation for a national criminal history record check. If the fingerprints of such a person are not retained by. the Department of Law Enforcement under s. 943.05(2)(g), the person must file a complete set of fingerprints with the agency. and the agency shall forward the fingerprints to the Department of Law Enforcement e ® for state processing, and the Department of Law Enforcement shall forward the. fingerprints to the Federal Bureau of Investigation for a national criminal history record check. The fingerprints may be retained by the Department of Law Enforcement under s. 943.05(2)(g). The cost of the state and national criminal history records checks required by level 2 screening may be borne by the licensee or the person fingerprinted. Until the person's background screening results are retained in the cleatinghouse created under s. 435,12, the agency may accept as satisfying the requirements of this section proof of compliance with Level II screening standards submitted within the previous 5. years to meet any. provider or professional licensure requirements of the agency, the Department of Health, the Department of Elderly Affairs, the Agency. for Persons with Disabilities, the Department of Children and Family. Services, or the Department of Financial Services for an applicant for a certificate of authority or provisional certificate of authority to operate a continuing care retirement community under chapter 651, provided that: (a) The screening standards and disqualifying offenses for the prior screening are equivalent to those specified in s. 435.04 and this section; (b) The person subject to screening has not had a break in service from a position that requires level 2 screening for more than 90 days; and (c) Such proof is accompanied, under penalty of perjury, by. an affidavit of compliance with the provisions of chapter 435 and this section using forms provided by. the agency.. §. 408.809(2), Fla. Stat. (2013)... 24. Under Florida law, in addition to the offenses listed in Section 435.04, all persons required to undergo background screening pursuant to this part or authorizing statutes must not chave an arrest awaiting final disposition for, must not have been found guilty. of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, and must not have been adjudicated delinquent and the record not have been sealed or expunged for any of the offenses e @ listed in Section 408.809(4). § 408.809(4), Fla. Stat. (2013). 25. Under Florida law, if an employer or Agency has reasonable cause to believe that grounds exist for the denial or termination of employment of any employee as a result of background screening, it shall notify. the employee in writing, stating the specific record that indicates noncompliance with the standards in this chapter. . It is the responsibility of the affected employee to contest his or her disqualification or to request exemption from disqualification. The only basis for contesting the disqualification is proof of mistaken identity. § 435.06(1), Fla. Stat. (2013). . 26. Under Florida law, an employer may. not hire, select, or otherwise allow an employee to have contact with any vulnerable person that would place the employee in a role that requires background screening until the screening process is completed and demonstrates the absence of any grounds for the denial or termination of employment. If the screening process shows any. grounds for the denial or termination of employment, the employer may not hire, select, or otherwise allow the employee to have contact with any. vulnerable person that would place the employee in a role that requires background screening unless the employee is granted - an exemption for the disqualification by. the Agency as provided under Section 435.07. If an employer becomes aware that an employee has been arrested for a disqualifying offense, the employer must remove the employee from contact with any vulnerable. person that places the employee in a role that requires background screening until the arrest is resolved in a way that the employer determines that the employee is still eligible for employment under this chapter. The employer must terminate the employment of any of its personnel found to be in noncompliance with the minimum standards of this chapter or place the employee in a position for which background screening is not required unless the employee is granted an exemption ll ° ° from disqualification pursuant to Section 435.07. § 435,06(2)(a)-(c), Fla. Stat. (2013). 27. Under Florida law, any employee who refuses to cooperate in such screening or refuses. to. timely. submit the information necessary to complete the screening, including fingerprints if required, must be disqualified for employment in such position or, if employed, must be dismissed. § 435.06(3), Fla. Stat. (2013). 28. On or about February 5, 2014, the Agency conducted a complaint survey. of the Respondent. 29. Based on interview and record review, the facility failed to ensure 1 of 2 employee records. contained evidence of a level II back ground screening (staff #A). This person was left as the sole caretaker of 4. residents, was responsible for their personal care and services, and had access to personal property and living areas. 30. Employee Record Review conducted on 1/30/14 at 3 PM for staff #A did not reveal any documentation that a background screening was. conducted prior to. being left as the sole. caretaker of four residents. 31. In an interview conducted on 1/30/14 at 2:15 PM with the owner, she stated she was thinking of hiring staff #A and left her alone with the residents while she went to the drug store in order to see if staff #A could handle being alone with the residents. . The owner stated staff #A told her she has all the paper work regarding background screening, First Aid, cardiopulmonary resuscitation (CPR). and Communicable Disease Statement including tuberculosis (TB). The owner stated she did not have a job application or references for staff #A. 32. Inan interview conducted on 1/30/14 at 4 PM with the administrator, she stated she was not aware that any staff was interviewed. She had no knowledge that owner was leaving the residents in the sole care of staff #A, who is not actually employed. e ° Sanction 33. | Under Florida law, in addition to the requirements of Part II of Chapter 408, the Agency. may deny, revoke, and suspend any license issued under this part and impose an administrative fine in the manner provided in Chapter 120 against a licensee for a violation of any provision of Part I or Chapter 429, Part II of Chapter 408, or applicable rules, or for any. of the following actions by a licensee, for the actions of any person subject to Level II background screening under Section 408.809, Florida Statutes, or for the actions of any. facility employee. Failure to. comply. with the background screening standards of Chapter 429, Part I, Section 408.809(1), or Chapter 435, Florida Statutes. § 429.14(1)(f), Fla. Stat. (2013), 34. Under Florida law, the Agency. may impose an administrative fine for a violation that is not designated as a Class I, Class II, Class III, or Class IV violation. Unless otherwise specified by law, the amount of the fine may not exceed $500 for each violation. Unclassified violations include: Violating any provision of this part, authorizing statutes, or applicable rules, § 408.813(3)(b), Fla. Stat. (2013). WHEREFORE, the Petitioner, State of Florida, Agency, for Health Care Administration, seeks an administrative fine against the Respondent in the amount of $500.00. COUNT IT Staffing Standards 35. Pursuant to 58A-5.019, Florida Administrative Code: Every. facility shall be under the supervision of an administrator who is responsible for the operation and maintenance of the facility. including the management of all staff and the provision of adequate care to all residents as required by. Part I of Chapter 429, F.S., and this rule chapter. The administrators shall: 1, Be at least 21 years of age; 2. Ifemployed on or after August 15, 1990, havea high school diploma’ or general equivalency diploma (G.E.D.), or have been an operator or administrator of a licensed assisted living facility in the State of Florida for atleast one of 13 e by the past 3 years in which the facility has met minimum _ standards. Administrators employed on or after October 30, 1995, must have a high school diploma or G.E.D.; 3. Be in compliance with. Level 2 background screening standards pursuant to Section 429.174, F.S.; and 4, Complete the core training requirement pursuant to Rule 58A-5.0191,. F.A.C. (b) Administrators may. supervise a.maximum of either three assisted living facilities or a combination of housing and health care facilities or agencies on a single campus. However, administrators who supervise. more than one facility shall appoint in writing a. separate “manager” for each facility. who must: 1. Be at least 21. years old; and 2. Complete the core training requirement pursuant to Rule 58A-5.0191, F.A.C. (c) Pursuant to Section 429.176, F.S., facility owners shali notify. both the Agency Field Office and Agency Central Office within ten (10) days of a changeina facility administrator on the Notification of Change of Administrator, AHCA Form 3180-1006, January. 2006, which is. incorporated by reference and may be obtained ftom the Agency Central Office. The Agency. Central . Office shall conduct a background screening on the new administrator in accordance with Section 429.174, F.S., and Rule 58A-5,014, FAC. 36. On or about February 5, 2014, the Agency conducted a complaint survey of the Respondent. 37. Based on interview. and record review, the administrator failed to. ensure the operation and maintenance of the facility including the provision of adequate care to 4 of 4 residents admitted to the facility (#1, 2, 3 & 4). 38. In an interview conducted on 1/30/14 at 4 PM with the administrator, she was informed of the incident earlier today that 4. residents were found by Fire Rescue to be in the. home unattended by any staff. The owner returned to the facility. an hour after fire rescue atrived. The administrator ' s first statement was that there. was only. one resident residing in the. facility. She was shown the files of the three residents admitted since 1/02/14. . The administrator stated that she. was not aware of the new admissions. The administrator briefly reviewed the files and noted that resident #1. and #3 did not have a Facility Health Assessment @ ° Form 1823.. The administrator was informed that there was no staff schedule for the month of January, 2014. The administrator was asked when she was last at the facility. and said she was not sure, about 1 to 2 weeks ago. She was asked if there was a time sheet or any documentation to prove that she had been at the facility. but she was not able to produce any. The administrator was asked about the staffing issue and stated she was not aware there was no staff and the owner had been working alone for the past month. The administrator stated to the owner, "I told you that you had to have a written schedule. ".. The administrator was not aware of any staff who applied for a position and she has not seen any applications or files. She was shown the file of the woman who. the. owner stated she left in the sole care of the residents. . The administrator stated she had never seen this file or met this woman. The administrator stated she has not ‘trained any new staff. The administrator stated she was not able to give any. answers about the 3 residents admitted until she could get some information about them. 39. Employee Record Review conducted on 1/31/14 at 2:45 PM for staff #A. She © was not officially hired by the owner or administrator and was allowed to. be the sole caretaker of the residents, The review did not reveal any -documentation of completion of Infection Control in-service training. Employee Record Review did not reveal any. documentation of completion of cardiopulmonary resuscitation (CPR) or First Aid courses. . Employee Record Review did not reveal any documentation that a background screening was conducted prior to. being left in the sole care of the residents. 40. In an interview conducted on 1/30/14. at 2:15. PM with the owner, she stated she was thinking of hiring staff #A and left her with the residents. alone. while. she. went to the drug store to see if staff #A could handle being alone with the residents. Owner stated that Staff A told her she has all the paper work regarding background screening, First Aid, cardiopulmonary e ° resuscitation (CPR) and Communicable Disease Statement including tuberculosis (TB). The owner stated she did not have.a job application or references for staff #A. . 41, In an interview conducted on 1/30/14 at 4 PM with the administrator, she stated she was not aware that any staff was interviewed. She had no knowledge that owner was leaving the residents in the sole care of staff #A, who is not actually employed. 42, In an interview conducted on 1/30/14. at 2:15 PM with the owner, she was asked to. produce the Monthly Fire Drill documentation and the Admission Discharge Log. The owner stated she did not have documentation of fire drills. The owner stated that the Admission Discharge Log is not up to date. The three residents admitted since 1/02/14 were not added to the Log.. 43. In an interview conducted on 1/30/14 at 4 PM with administrator, she stated she has informed the owner repeatedly that she must have an up to date Log for Fire and Elopement Drills as well as have the Admission and_Discharge Log up to date... The administrator stated she was not aware that two. of the residents were not able to self-evacuate and needed assistance. 44, Record Review conducted on 1/30/14 for resident #1, admitted on 1/29/14, resident #2, admitted on 1/02/14 and resident #3, admitted on 1/23/14 did not reveal any contracts for any of the residents admitted since 1/02/14. 45. In. an interview conducted on 1/30/14 at 2:15. PM with the owner, she stated that she has not had time to have contracts signed by the residents or their representatives. 46. In an interview conducted on 1/30/14 at 4 PM with the administrator, she stated that she was not aware of any residents admitted. 47. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines present an e ° imminent danger to the clients of the provider or a substantial probability that death or serious physical or emotional harm would result therefrom. The condition or practice constituting a class I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by. the agency, is required for correction. The agency. shall impose an administrative fine as provided by. law for a cited class I violation. A fine shall be levied notwithstanding the correction of the violation.§ 408.813(2)(a), Fla. Stat. (2013). 48. Under Florida law, the Agency shall impose an administrative fine for a cited class I violation in an amount not less than $1,000 and not exceeding $5,000 for each violation. § 429.19(2)(b), Fla. Stat. (2013). . Wherefore the Petitioner, State of Florida, Agency for Health Care Administration, seeks an administrative fine against the Respondent in the amount of $4,500.00. Count IV Revocation 49, Pursuant to 429.14, Florida Statutes in addition to the requirements of part II of chapter 408, the agency may deny, revoke, and suspend any license issued under this part and impose an administrative fine in the manner provided in chapter 120 against a licensee for a violation of any provision of this part, part II of chapter 408, or applicable rules, or for any of the following actions by a licensee, for the actions of any. person subject to level 2 background screening under s. 408.809, or for the actions of any facility employee: (a) An intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility;(b) The determination by. the agency that the owner lacks the financial ability. to. provide continuing adequate care to residents;(c) Misappropriation or conversion of the property. of a resident of the facility;(d) Failure to follow the criteria and procedures provided under part lof chapter 394 relating to the transportation, voluntary admission, and invohintary examination of a facility e @ 2? ) resident;(e) _A citation of any of the following deficiencies as specified in s, 429.19: 1. One or more cited class I deficiencies.2, Three or more cited class II deficiencies.3. Five or more cited class III deficiencies that have been cited on a single survey and have not been corrected within the times specified.(f) Failure to comply with the background screening standards of this part, s. 408.809(1), or chapter 435. 50. The Agency re-alleges and incorporates Counts (1) through (3) of this Complaint as if fully recited herein. . 51. | WHEREFORE, pursuant to. section 429.14(1)(a)(e)(f), Florida Statutes (2013) the Agency seeks the revocation of Respondent’s assisted living facility license. /s/John Bradle . . John E. Bradley Assistant General Counsel Florida Bar No. 92277 Office of the General Counsel . Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3, MS3. Telephone: (850) 412-3658 Facsimile: (850) 921-0158 John.Bradley@ahca.myflorida.com NOTICE The Respondent is notified that it/he/she has the right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. If the Respondent wants to hire an attorney, it/he/she has the right to be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights form. The Respondent is further. notified if the Election of Rights form 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. The Election of Rights form shall be made to the Agency for Health Care Administration . —__—and-deliveredto: Agency Clerk, Agency for Health Care Administration, 2727 Mahan: Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 412-3630. 18 e } CERTIFICATE OF SERVICE I HEREBY CERTIFY. that a true and correct copy. of the Administrative Complaint and Election of Rights form were served to the below named persons/entities by the method designated on this 20th day of February 2014, . Theresa DeCanio, Field Office Manager Local Field Office Agency for Health Care Administration (Electronic Mail). Shaddrick Haston, Unit Manager. Licensure Unit Agency for Health Care Administration (Electronic Mail). isJohn Bradley John E.. Bradley Assistant General Counsel Florida Bar No. 92277 Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3, MS3 Telephone: (850) 412-3658 Facsimile: (850) 921-0158 John.Bradley@ahca.myflorida.com Trene Omega Administrator. Yan Yan Health Care, Inc. 585 Allen drive Merritt Island, Florida 32952. Certified Mail — 7011. 1570 0000 3003 2114 19 e , STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re:. Yan Yan Healthcare, Inc. . AHCA No. 2014001640 ELECTION OF RIGHTS This Election of Rights form is attached to a proposed agency 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. Your Election of Rights may. be returned by mail or by facsimile transmission, but must be filed within 21 days of the day. that you receive the attached proposed agency action. If your Election of Rights with your selected option is not received by AHCA within 21 days of the day that you received this proposed agency action, you will have waived your right to contest the proposed agency. 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, and Chapter 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. . Telephone: 850-412-3630... Facsimile: 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 Fee, Notice of Intent to Impose a Late Fine, or Administrative Complaint and I waive my right to object and to have a hearing. . | 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) I admit to the allegations of facts contained_in the Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine, or Administrative 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, Notice of Intent to. Impose a Late Fine, or Administrative - Complaint, and I request a formal hearing (pursuant to Section 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. 20 . ° 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. It must be received by the Agency. Clerk at the address above within 21 days of your receipt of this proposed agency 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. The name, address, telephone number, and facsimile number (if any) of the Respondent, 2. The name, address, telephone number and facsimile number of the attorney or qualified representative of the Respondent (if any) upon whom service of pleadings and other papers shall be made. . 3. A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. 4. A statement of when the respondent received notice of the administrative complaint. 5. A statement including the file number to the administrative complaint. Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency. _ agrees. Licensee Name: Contact Person: . Title: , Address: . . . . Number and Street . City. . Zip Code Telephone No. Fax No.., E-Mail (optional) I hereby. certify that I am duly. authorized to submit this Election of Rights to the Agency. for Health Care Administration on behalf of the licensee referred to above. Signed: . _ Date: . Print Name:- . . Fitle: 21 oer cet ee SE1.. Rs. COMPLETE THIS SEC sai TION ee "Ls tE FHIS:SECTION peli ai ea

Docket for Case No: 14-004715