STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, v. AHCA No. 2020000862 NORTH LAKE FACILITY, INC., d/b/a NORTH LAKE CARE CENTER, Respondent. / ADMINISTRATIVE COMPLAINT The Petitioner, State of Florida, Agency for Health Care Administration (“the Agency”), files this Administrative Complaint against the Respondent, North Lake Care Center (“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 $9,500.00 against a nursing home based upon criminal background screening violations. PARTIES 1. The Agency is the licensing and regulatory authority that oversees nursing homes in Florida and enforces the applicable state statutes and rules governing such facilities, Ch. 408, Part U1, Ch. 400, Part Il, Fla. Stat. (2019); Ch. 59A-4, Fla. Admin. Code. 2. The Respondent was issued a license by the Agency to operate a nursing home (‘the Facility”) and was at all times material required to comply with the applicable statutes and rules governing nursing homes. COUNT I Criminal Background Screening -- Clearinghouse 3s Under Florida law, the Agency shall require level 2 background screening for personnel as required in Section 408.809(1)(e), Florida Statutes, pursuant to Chapter 435 and Section 408.809. § 400.215, Fla. Stat. (2019). The criminal background screening results of such personnel shall be reviewed by the Agency and the qualifying or disqualifying status of the person named in the request shall be maintained in a database. § 408.809(3), Fla. Stat. (2019). The Care Provider Background Screening Clearinghouse was created and providers are required to register with the Clearinghouse and comply with its statutory and rule provisions. § 435.12, Fla. Stat (2019); Fla. Admin. Code R. 59A-35.090. Among other requirements, employers must 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. § 435.12(2)(c), Fla. Stat. (2019). 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. § 435.12(2)(d), Fla. Stat. (2019). 4. On or about 12/27/19 through 12/30/19 the Agency conducted a survey of the Facility. 5. Based on record review and staff interview, the Facility failed to ensure that initial employment or change in employment status was reported to the Care Provider Background Screening Clearinghouse employee roster within 10 days as required for 18 of 19 employees sampled (Employees #2 through #19). 6. Review of the personnel files beginning on 12/27/19, for the following employees, revealed these employees were not listed on the Background Screening Clearinghouse roster, until after surveyor intervention. 7. Employee #2, CNA (certified nursing assistant), rehired by facility on 09/20/19 - added to roster on 12/29/19. 8. Employee #3, CNA, hire date of 09/09/19 - declared 'eligible' on 08/29/19 - not on roster. 9. Employee #4, PT (physical therapy), hire date of 02/06/14 - not on roster. 10. Employee #5, CNA, hire date of 08/23/19 - added to roster 12/29/19. 11. Employee #6, Ward Clerk, hire date of 08/26/19 - added to roster 12/29/19 12. Employee #7, LPN (licensed practical nurse), hire date of 11/11/19 - added to roster 12/29/19. 13. Employee #8, CNA, hire date of 08/13/19 - added to roster 12/27/19. 14. Employee #9, CNA, hire date of 08/13/19 - added to roster 12/27/19. 15. Employee #10, CNA, hire date of 12/02/19 - added to roster12/29/19 16. Employee #11, Speech Pathologist, hire date of 07/05/19 added to roster - 12/29/19. 17. Employee #12, LPN, hire date of 05/08/19 - added to roster 12/29/19. 18. Employee #13, LPN, hire date of 07/07/12 - added to roster 12/29/19. 19. Employee #14, CNA - hire date of 08/27/19 - added to roster 12/29/19. 20. Employee #15, RN (registered nurse) hire date of 09/23/19 - added to roster 12/29/19. 21. Employee #16, CNA, hire date of 08/19/19 - added to roster 12/29/19. 22. Employee #17, CNA, hire date of 06/19/19 - added to roster 12/29/19. 23. Employee #18, CNA, hire date of 12/04/15 - added to roster 12/27/19. 24. | Employee #19, LPN, hire date of 04/26/19 - added to roster 12/27/19. 25. During an interview, on 12/30/19 at 12:14 PM, with the HR Director, she acknowledged the lack of employees on the Clearinghouse roster. Relief 26. Under Florida law, the Agency may impose an administrative fine against a nursing home, not to exceed $500 per violation per day for the violation of any provision of part II of chapter 400, part I of chapter 408, or the applicable rules. § 400.121, Fla. Stat. (2019). 27. 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. (2019). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to impose an administrative fine of $9,000.00 against the Respondent. COUNT II Criminal Background Screening 28. Under Florida law, the Agency shall require level 2 background screening for personnel as required in section 408.809(1)(e), Florida Statutes, pursuant to chapter 435, Florida Statutes, and section 408.809, Florida Statutes. § 400.215, Fla. Stat. (2019). 29. 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. (2019). 30. 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. (2019). 31. 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. (2019). 32. Facility. 33. On or about 12/27/19 through 12/30/19, the Agency conducted a survey of the Relief Under Florida law, the Agency may impose an administrative fine against a nursing home, not to exceed $500 per violation per day for the violation of any provision of part II of chapter 400, part II of chapter 408, or the applicable rules. § 400.121, Fla. Stat. (2019). 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 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. (2019). 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, respectfully seeks an order that: 1. Makes findings of fact and conclusions of law in favor of the Agency. 2: Imposes the relief set forth above. Respectfully Submitted, D. Carlton Enfinger II, Seftio orney Florida Bar No. 793450 Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 7 Tallahassee, Florida 32308 Telephone (850) 412-3658 Facsimile (850) 922-9634 Email: Carlton.Enfinger(@ahca.myflorida.com NOTICE 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. 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 a / day of February, 2020. . Carltohi Enfinger II, $ LAr Florida Bar No. 793451, Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 7 Tallahassee, Florida 32308 Telephone (850) 412-3658 Facsimile (850) 922-9634 Email: Carlton.Enfinger@ahca.myflorida.com | Administrator North Lake Care Center 750 Bayberry Drive Lake Park, FL 33403 (U.S. Certified Mail) 5489 0090 0027 bO48 45b& 44 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re: NORTH LAKE FACILITY, INC., d/b/a ACHA No. 2020000862 NORTH LAKE CARE CENTER 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. I 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. 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 form to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Printed Name: Title: 11 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: 9489009000276048956848 Your item was delivered to the front desk, reception area, or mail room at 3:37 pm on February 29, 2020 in WEST PALM BEACH, FL 33403. Status: Delivered February 29, 2020 at 3:37 pm Delivered, Front Desk/Reception/Mail Room WEST PALM BEACH, FL 33403 Get Updates Delivered

Docket for Case No: 20-002634