STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA Nos. 2020002214 License No, AL12511 v. HAPPY DAYS ASSISTED LIVING, LLC d/b/a HAPPY DAYS ASSISTED LIVING, Respondent. / ADMINISTRATIVE COMPLAINT The Petitioner, State of Florida, Agency for Health Care Administration (“the Agency”), files this Administrative Complaint against the Respondent, Happy Days Assisted Living, LLC d/b/a Happy Days Assisted Living (“the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine of $1,000.00 against an assisted living facility based upon two (2) Unclassified violations. PARTIES 1. The Agency is the licensure and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable state statutes and rules governing assisted living facilities. Ch. 408, Part II, Ch. 429, Part I, Fla. Stat. (2019), Ch. 59A-36, Fla. Admin. Code. The Agency may deny, revoke, and suspend any license issued to an assisted living facility and impose an administrative fine for a violation of the Health Care Licensing Procedures Act, the authorizing statutes or applicable rules. §§ 408.813, 408.815, 429.14, 429.19, Fla. Stat. (2019). In addition to licensure denial, revocation or suspension, or any administrative fine imposed, the Agency may asses a survey fee against an assisted living facility. § 429.19(7), Fla. Stat. (2019). 2. The Respondent was issued a license (AL12511) by the Agency to operate a 6 bed assisted living facility (hereinafter “Facility”) located at located at 23 Pepperdine Drive, Palm Coast, Florida 32164 and was at all material times required to comply with the applicable statutes and rules governing such facilities. 3. As the holder of such a license, the Respondent is a licensee. “Licensee” means “an individual, corporation, partnership, firm, association, or governmental entity that is issued a permit, registration, certificate, or license by the Agency.” § 408.803(9), Fla. Stat. (2019). “The licensee is legally responsible for all aspects of the provider operation.” § 408.803(9), Fla. Stat. (2019). “Provider” means “any activity, service, agency, or facility regulated by the Agency and listed in Section 408.802, Florida Statutes. § 408.803(11), Fla. Stat. (2019). Assisted living facilities are regulated by the Agency under Chapter 429, Part I, Florida Statutes, and listed in Section 408.802, Florida Statutes. § 408.802(13), Fla. Stat. (2019). Assisted living facility patients are thus clients. “Client” means “any person receiving services from a provider.” § 408.803(6), Fla. Stat. (2019). COUNTI Care Provider Background Screening Clearinghouse 4. Under Florida law, (2)(a) To ensure that the information in the clearinghouse is current, the fingerprints of an employee required to be screened by a specified agency and included in the clearinghouse must be: 1. Retained by the Department of Law Enforcement pursuant to s. 943.05(2)(g) and (h) and (3), and the Department of Law Enforcement must report the results of searching those fingerprints against state incoming arrest fingerprint submissions to the Agency for Health Care Administration for inclusion in the clearinghouse. 2. Retained by the Federal Bureau of Investigation in the national retained print arrest notification program as soon as_ the Department of Law Enforcement begins participation in such program. Arrest prints will be searched against retained prints at the Federal Bureau of Investigation and notification of arrests will be forwarded to the Florida Department of Law Enforcement and reported to the Agency for Health Care Administration for inclusion in the clearinghouse. 3. Resubmitted for a Federal Bureau of Investigation national criminal history check every 5 years until such time as the fingerprints are retained by the Federal Bureau of Investigation. 4. Subject to retention on a 5-year renewal basis with fees collected at the time of initial submission or resubmission of fingerprints. 5. Submitted with a photograph of the person taken at the time the fingerprints are submitted. (b) Until such time as the fingerprints are enrolled in the national retained print arrest notification program at the Federal Bureau of Investigation, an employee with a break in service of more than 90 days from a position that requires screening by a specified agency must submit to a national screening if the person returns to a position that requires screening by a specified agency. (c) An employer of persons subject to screening by a specified agency must register with the clearinghouse and maintain the employment status of all employees within the clearinghouse. Initial employment status and any changes in status must be reported within 10 business days. (d) An employer must register with and initiate all criminal history checks through the clearinghouse before referring an employee or potential employee for electronic fingerprint submission to the Department of Law Enforcement. The registration must include the employee’s full first name, middle initial, and last name; social security number; date of birth; mailing address; sex; and race. Individuals, persons, applicants, and controlling interests that cannot legally obtain a social security number must provide an individual taxpayer identification number. § 435.12(2), Fla. Stat. (2018) 5. The Agency conducted a Change of Ownership Licensure Survey on 03/26/2019. The Respondent Facility had deficiencies at the time of the survey. 6. Based on employee record review, staff schedule review and staff interview, the Facility failed to maintain an updated employee roster on the Agency for Health Care (AHCA) Provider Background Screening Clearinghouse website for one (Employee C) out of three sampled employees. 7. A review of the personnel file for Employee C revealed she had been re-hired by the Facility on 02/02/2019. 8. A review of the staff schedule dated for the month of February 2019 revealed Employee C worked on 02/02/2019. 9. A review of the online AHCA Provider Background Screening Clearinghouse website employee roster for the Facility revealed Employee C was not listed as an employce. 10. On 03/26/2019 at 2:00 P.M., an interview was conducted with the Administrator and the Owner, both confirmed that Employee C does work at this Facility on a part time basis. The Administrator and the Owner stated Employee C fills in when they need her to. Employee C was recently re-hired on 02/02/2019. The Administrator stated that she had not updated the AHCA Provider Background Screening Clearinghouse website employee roster when she re- hired Employee C. 11. The Facility’s actions and / or inactions constituted an Unclassified deficiency. Sanction 12. Under Florida law, regardless of the class of violation cited, instead of the fine amounts listed in paragraphs (a)-(d), the Agency shall impose an administrative fine of $500 if a facility is found not to be in compliance with the background screening requirements as provided in section 408.809, Florida Statutes (2018). § 429.19(2)(e), Fla. Stat. (2018). 13. Under Florida law, the Agency may impose an administrative fine for a violation that is not designated as a class I, class II, class II, 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. (2018). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to impose an administrative fine of $500.00 against the Respondent. COUNT II Background Screening — Prohibited Offenses 14. Under Florida law, Level 2 background screening pursuant to Chapter 435 must be conducted through the Agency on each of the following persons, who are considered 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. (e) 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. Evidence of contractor screening may be retained by the contractor’s employer or the licensee. § 408.809(1), Fla. Stat. (2018) 15; 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 2 background screening under chapter 435, each such person must submit to level 2 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 unless the person’s fingerprints are enrolled in the Federal Bureau of Investigation’s national retained print arrest notification program. If the fingerprints of such a person are not retained by the Department of Law Enforcement under s. 943.05(2)(g) and (h), the person must submit fingerprints electronically to the Department of Law Enforcement 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 shall be retained by the Department of Law Enforcement under s. 943.05(2)(g) and (h) and enrolled in the national retained print arrest notification program when the Department of Law Enforcement begins participation in the program. 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 a specified agency is fully implemented in the clearinghouse created under s. 435.12, the agency may accept as satisfying the requirements of this section proof of compliance with level 2 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 Families, 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 attestation of compliance with chapter 435 and this section using forms provided by the agency. § 408.809(2), Fla. Stat. (2018). 16. 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 s. 435.07. (b) 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. (c) 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 from disqualification pursuant to s. 435.07. (d) An employer may hire an employee to a position that requires background screening before the employee completes the screening process for training and orientation purposes. However, the employee may not have direct contact with vulnerable persons until the screening process is completed and the employee demonstrates that he or she exhibits no behaviors that warrant the denial or termination of employment. § 435.06(2)(a)-(d), Fla. Stat. (2018). 17. The Agency conducted a Change of Ownership Licensure Survey on 03/26/2019. The Respondent Facility had deficiencies identified at time of the survey. 18. Based on employee record review, review of the Agency for Health Care Administration Care Provider Background Screening Clearinghouse and staff interview, the Facility failed to conduct a Level II background screening for one (Employee C) out of three sampled employees. 19. During the Change of Ownership Licensure Survey on 03/26/2019, an employee record review was conducted for Employee C. Employee C had been re-hired on 02/02/2019. Review of the employee's application revealed no employment in a health-related field for over a year. Employee C's record did not contain evidence of a current Level II background screening. The last Level II background screening form in Employee C’s file was dated 04/20/2017. 20. A review of the Agency for Health Care Administration Provider Background Screening Clearinghouse website revealed no Level II background screening had been done since 04/20/2017. 21. On 03/26/2019 at 1:20 p.m., an interview was conducted with the Administrator and the Owner. The Administrator and the Owner confirmed Employee C was recently re-hired on 02/02/2019. The Owner stated Employee C had not worked in a health care related field in over a year. The Administrator confirmed there was a 90-day gap in service that would require a new Level II background screening and she had not done it. 22. The Facility’s actions and / or inactions constituted an Unclassified deficiency. Sanction 23. Under Florida law, regardless of the class of violation cited, instead of the fine amounts listed in paragraphs (a)-(d), the Agency shall impose an administrative fine of $500 if a facility is found not to be in compliance with the background screening requirements as provided ins. 408.809. § 429.19(2)(e), Fla. Stat. (2018). 24. 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. (2018). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to impose an administrative fine of $500.00 against the Respondent. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to enter a final order that: 1. Makes findings of fact and conclusions of law as set forth above. 2. Grants the relief set forth above. Respectfully Submitted, if J | - G Vivo Teresita A. Vivo, Senior Attorney Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Telephone: (850) 412-3690 Facsimile: (850) 922-6484 Teresita. Vivo(@ahca.myflorida.com NOTICE OF RIGHTS Pursuant to Section 120.569, F.S., any party has the right to request an administrative hearing by filing a request with the Agency Clerk. In order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), F.S., however, a party must file a request for an administrative hearing that complies with the requirements of Rule 28-106.2015, Florida Administrative Code. Specific options for administrative action are set out in the attached Election of Rights form. The Election of Rights form or request for hearing must be filed with the Agency Clerk for the Agency for Health Care Administration within 21 days of the day the Administrative Complaint was received. If the Election of Rights form or request for hearing is not timely received by the Agency Clerk by 5:00 p.m. Eastern Time on the 21st day, the right to a hearing will be waived. A copy of the Election of Rights form or request for hearing must also be sent to the attorney who issued the Administrative Complaint at his or her address. The Election of Rights form shall be addressed to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 412-3630, Facsimile (850) 921-0158. Any party who appears in any agency proceeding has the right, at his or her own expense, to be accompanied, represented, and advised by counsel or other qualified representative. Mediation under Section 120.573, F.S., is available if the Agency agrees, and if available, the pursuit of mediation will not adversely affect the right to administrative proceedings in the event mediation does not result in a settlement. THIS SPACE IS LEFT INTENTIONALLY BLANK 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 { ~ day of mM 2020. WV wa” Teresita A. Vivo, Senior Attorney Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Telephone: (850) 412-3690 Facsimile: (850) 922-6484 Teresita. Vivo@ahca.myflorida.com Keisha Woods, Unit Manager Assisted Living Unit Agency for Health Care Administration (Electronic Mail) Cathline Reid, Owner Happy Days Assisted Living, LLC d/b/a Happy Days Assisted Living 23 Pepperdine Drive Palm Coast, Florida 32164 (U.S. Certified Mail) 3489 0090 0027 £024 4705 40 Rob Dickson, Field Office Manager Agency Field Office Agency for Health Care Administration (Electronic Mail) Shaddrick A. Haston, Esquire Ullman Bursa Law Attorney for Happy Days Assisted Living, LLC d/b/a Happy Days Assisted Living 1618 Mahan Center Boulevard, Suite 103 Tallahassee, Florida 32308 (Electronic Mail) shad@shadhaston.com STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re: Happy Days Assisted Living, LLC d/b/a ACHA Nos. 2020002214 Happy Days Assisted Living ELECTION OF RIGHTS This Election of Rights form is attached to an Administrative Complaint. It may be returned by mail or facsimile transmission, but_must_be received by the Agency Clerk within 21 days, by 5:00 pm, Eastern Time, of the day you received the Administrative Complaint. If your Election of Rights form or request for hearing is not received by the Agency Clerk within 21 days of the day you received the Administrative Complaint, you will have waived your right to contest the proposed agency action and a Final Order will be issued imposing the sanction alleged in the Administrative Complaint. (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 form 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 fact and conclusions of law alleged in the Administrative Complaint and waive my right to object and to have a hearing. | understand that by giving up the right to object and have a hearing, a Final Order will be issued that adopts the allegations of fact and conclusions of law alleged in the Administrative Complaint and imposes the sanction alleged in the Administrative Complaint. OPTION TWO (2) I admit to the allegations of fact alleged in the Administrative Complaint, but 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 agency action is too severe or that the sanction should be reduced. OPTION THREE (3) I dispute the allegations of fact alleged in the Administrative Complaint and request a formal hearing (pursuant to Section 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. 11 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. 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 form to the Agency for Health Care Administration on behaif of the licensee referred to above. Signed: Date: Printed Name: Title: USPS Tracking® Tracking FAQs Track Another Package + Track Packages Anytime, Anywhere Get the free Informed Delivery® feature to receive automated notifications on your packages Learn More Remove Tracking Number: 9489009000276028670580 Your item was delivered to an individual at the address at 2:04 pm on March 20, 2020 in PALM COAST, FL 32164. Status: Delivered March 20, 2020 at 2:04 pm Delivered, Left with Individual PALM COAST, FL 32164 Get Updates Delivered

Docket for Case No: 20-001742

Orders for Case No: 20-001742