STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2019-38841 SAMANTHA L. GRAF, C.N.A,, RESPONDENT. / ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Nursing against Respondent, Samantha L. Graf, C.N.A., and in support thereof alleges: 1. Petitioner is the state agency charged with regulating the practice of nursing assistance pursuant to section 20.43, Florida Statutes; chapter 456, Florida Statutes; and chapter 464, Florida Statutes. 2. At all times material to this Administrative Complaint, Respondent was a certified nursing assistant (C.N.A.) within the state of Florida, having been issued certificate number CNA 220502. 3. Respondent’s address of record is 2189 Park Road, Venice, Florida 34293. 4. Respondent may also be located at 913 Acadia Road, Venice, Florida 34293. 5. Onor about August 20, 2019, in the Circuit Court of the Twelfth Judicial Circuit in and for Sarasota County, Florida, Respondent entered a plea of no contest to one count of Neglect of a Child Without Great Bodily Harm, a third-degree felony in violation of section 827.03(2)(d), Florida Statutes (2019). 6. Section 464.204(1)(b), Florida Statutes (2019), provides that intentionally violating any provision of this chapter, chapter 456, or the rules adopted by the board constitutes grounds for disciplinary action. 7. Section 464.018(1)(d)(6), Florida Statutes (2019), provides that being convicted or found guilty of, or entering a plea of guilty or nolo contendere to, regardless of adjudication, a violation of chapter 827, relating to child abuse, constitutes grounds for disciplinary action. 8. As set forth above, on or about August 20, 2019, in the Circuit Court of the Twelfth Judicial Circuit in and for Sarasota County, Florida, Respondent entered a plea of no contest to one count of Neglect of a Child Without Great Bodily Harm, a third-degree felony in violation of section 827.03(2)(d), Florida Statutes (2019). 9. Based on the foregoing, Respondent violated section 464.204(1)(b), Florida Statutes (2019), by intentionally violating section 464.018(1)(d}(6), Florida Statutes (2019), by being convicted or found guilty of, or entering a plea of guilty or nolo contendere to, regardless of adjudication, a violation of chapter 827, relating to child abuse. WHEREFORE, the Petitioner respectfully requests that the Board of Nursing enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's certificate, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. [signature page follows] SIGNED this __ 25 day of November , 2019. Scott A. Rivkees, MD State Surgeon General FILED Ja] Dbibiy. A. Cresuford DEPART OEHEALTH Pili A. Crawford | ssistant General Counse’ CLERK: (rare Moxud — Fla, Bar No. 91378 pate:___NOV_2 5 2019. Florida Department of Health Prosecution Services Unit 4052 Bald Cypress Way, Bin #C65 Tallahassee, FL 32399-3265 Telephone: (850) 558-9829 Facsimile: (850) 245-4662 Email: Philip.Crawford@flhealth.gov /PAC PCP: November 22, 2019 PCP Members: Habgood & Forst NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to rule 28-106.111(2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to rule 28-106.2015(5), Florida Administrative Code. Mediation under section 120.573, Florida Statutes, is not available to resolve this Administrative Complaint. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed.

Docket for Case No: 20-000188PL