STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, V. CASE NO. 2019-41177 TIFFANY SIELAFF, C.N.A., RESPONDENT. / ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health (Department), by and through its undersigned counsel, and files this Administrative Complaint before the Board of Nursing against Respondent, Tiffany Sielaff, C.N.A., and in support thereof alleges: 1. Petitioner is the state agency charged with regulating the practice of nursing 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 license number CNA 240223. 3. | Respondent's address of record is 3603 38th Avenue West, Bradenton, Florida 3420. 4. Petitioner has reason to believe Respondent may be located at 4300 18th Street West Apt. E207, Bradenton, Florida 34205. 5. Respondent is licensed pursuant to chapter 464, Florida Statutes, and is a health care practitioner as defined in section 456.001(4), Florida Statutes (2019). 6. Onor about November 17, 2016, in the Circuit Court, in Manatee County, Florida, Respondent entered a plea of nolo contendere to one felony count of Dealing in Stolen Property, in violation of chapter 812.019(1), Florida Statutes. 7. Section 464.204(1)(b), Florida Statutes (2016), provides that intentionally violating any provision of chapter 464, chapter 456, or the rules adopted by the board, constitutes grounds for disciplinary action. 8. Section 464.018(1)(e), Florida Statutes (2016), subjects a licensee to discipline for having been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under section 435.04 or similar statute of another jurisdiction; or DOH v. Tiffany Sielaff, C.N.A.; Case No. 2019-41177 2of5 having committed an act which constitutes domestic violence as defined in section 741.28. 9. Section 435.04(2)(cc), Florida Statutes (2016), includes any offense prohibited under chapter 812, relating to theft, robbery, and related crimes, if the offense is a felony. 10. Respondent violated section 464.018(1)(e), Florida Statutes (2016), by entering a plea of nolo contendere to one felony count of Dealing in Stolen Property, in violation of chapter 812.019(1), Florida Statutes, on or about November 17, 2016. 11. Based on the foregoing, Respondent has violated section 464.204(1)(b), by intentionally violating section 464.018(1)(e), by having been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, an offense prohibited by section 435.04, Florida Statues, which prohibits violations of chapter 812, relating to theft, robbery, and related crimes, if the offense is a felony. DOH v. Tiffany Sielaff, C.N.A.; Case No, 2019-41177 30f 5 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 license, 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. SIGNED this _9th_ day of _January_, 2020. Scott A. Rivkees, MD State Surgeon General /s/ Logan A. White Logan A. White Assistant General Counsel Fla. Bar No. 112281 Florida Department of Health Prosecution Services Unit 4052 Bald Cypress Way, Bin #C65 DEPARTHENTGEEALTH =——Tallahassee, FL 32399-3265 A venal a brtueftees Telephone: (850) 558-9913 ATTY CAE 1 ~ Facsimile: (850) 245-4662 “JAN 0.9 2020 Email: logan.white@flhealth.gov PCP: 1/9/2020 PCP Members: McDonough, Glymph DOH v. Tiffany Sielaff, C.N.A.; Case No. 2019-41177 4o0f5 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. DOH v. Tiffany Sielaff, C.N.A.; Case No, 2019-41177 50f5

Docket for Case No: 20-001906PL