STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH No. 21-0082 AHCA Nos. (ESO) 2020013184

2020014304

License No. 8022

VILLA SERENA I, INC.,

Respondent.

/

ST ATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

File No. 11912024

Facility Type: ALF

VS.

Petitioner,

DOAH No. 20-5129 AHCA Nos. (ESO) 2020013185

2020014305

License No. 8518

VILLA SERENA II, INC,

Respondent.

I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

File No. 11953233

Facility Type: ALF

vs.

Petitioner,

DOAH No.: 20-5128

AHCA Nos. 2020016306

2020019759

License No. 10792

VILLA SERENA III, INC., d/b/a VILLA SERENA III,

Respondent.

I

File No. 119666 I 5

Facility Type: ALF

HtNUI I IUN NU.: AH A- )... \ - u., \ c:, ·S-UL

Filed May 17, 2021 9:51 AM Division of Administrative Hearings

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner, DOAH No. 20-5120

AHCA No. 2019015653

SANTA BARBARA BH, INC., d/b/a VILLA SERENA VII,

f/k/a SANTA BARBARA HOME I,

Respondent.

/

VILLA SERENA III, INC., d/b/a VILLA SERENA III,

Petitioner,

V. AHCA No. 2021002529

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent,

./

VILLA SERENA IV, INC., d/b/a VILLA SERENA IV,

Petitioner,

V. AHCA No. 2021002532

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent,

I

SAN THELMO INVESTMENT GROUP, INC., d/b/a VILLA SERENA VI,

Petitioner,

V. AHC'A No. 2021002517

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent,

;/

FINAL ORDER

THIS CAUSE came on for consideration before the Agency for Health Care Administration ("the Agency"), which finds and concludes as follows:

1. The Agency issued the Respondents, Villa Serena 1, Inc, Villa Serena II, Inc., and Villa Serena III, Inc., d/b/a Villa Serena III, and Santa Barbara BH, Inc., d/b/a Villa Serena VII, f/k/a Santa Barbara Home I, the attached Administrative Complaints and Election of Rights Forms (Exs. l, 2, 3, and 4).

   
   

2. The Agency issued the Petitioners Villa Serena III, Inc. d/b/a Vdla Serena Ill, Villa Serena IV, Inc., d/b/a Villa Serena IV and San Thelmo Investment Group, Inc. d/b/a Villa Serena VI, the attached Notices of Intent to Deny the Renewal Application for an Assisted Living Facility (Exs. 5, 6, and 7).

   
   

3. The parties have since entered into the attached Settlement Agreement (Ex. 8), which is adopted and incorporated by reference.

   
   

4. Count III of the Complaint against Villa Serena III, Inc. d/b/a Villa Serena III which seeks revocation of that facility's assisted living facility licensure is withdrawn.

   
   

5. In accordance with Florida law, Respondents Villa Serena 1, Inc. and Villa Serena II, Inc. are responsible for retaining and appropriately distributing all client records within the timeframes prescribed in the authorizing statutes and applicable administrative code provisions. Respondents Villa Serena 1, Inc. and Villa Serena II, Inc.are advised of Section 408.810, Florida Statutes.

   
   

6. In accordance with Florida law, Respondents Villa Serena 1, Inc., and Villa Serena II, Inc. are responsible for any refunds that may have to be made to the clients.

   
   

7. Respondents Villa Serena 1, Inc. and Villa Serena II, Inc. are given notice of Florida law regarding unlicensed activity. Respondents Villa Serena 1, Inc. and Villa Serena II, Inc. are advised of Section 408.804 and Section 408.812, Florida Statutes. Respondents Villa Serena 1, Inc. and Villa Serena II, Inc. should also consult the applicable authorizing statutes and administrative code provisions. Respondents Villa Serena 1, Inc. and Villa Serena II, Inc. are notified that the cancellation of an Agency

   license may have ramifications potentially affecting accrediting, third party billing including but not limited to the Florida Medicaid program, and private contracts.

   
   

8. Respondents Villa Serena 1, Inc., Villa Serena II, Inc., Villa Serena III, Inc., d/b/a Villa Serena III, and Santa Barbara BH, Inc., d/b/a Villa Serena VII, f/k/a Santa Barbara Home I shall pay an administrative fine in the total amount of $23,500.00 within 180 days of the date of the Final Order or prior to the issuance of change of ownership licensure, whichever shall first occur. The fines shall be assessed as $8,000.00 for Villa Serena 1, Inc.; $5,000.00 for Villa Serena It Inc.; $10,000.00 for Villa Serena III, Inc., d/b/a Villa Serena III; and $500.00 for Santa Barbara BH, Inc., d/b/a Villa Serena VII, f/k/a Santa Barbara Home I. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within 180 days of the Final Order or prior to the issuance of change of ownership licensure, ,,,vhichever shall first occur. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the "Agency for Health Care Administration" and containing the AHCA ten-digit case numbers should be sent to:

   
   

   Central Intake Unit

   Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61

   Tallahassee, Florida 32308

   
   

9. The Parties shall comply with the remaining terms of the Agreement.

ORDERED at Tallahassee, Florida, on this.2b .\-}day of '{\ n\

------

, 2021.

ak, Acting Deputy Secretary Care Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed.

I CERTIFY that a true and correct lhis Final Order

ser.\'ed on the below-named

CERTIFICATE OF SERVICE 1'

persons by the method designated on this day of r 1 '/ , 2021.

op, cy Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

Telephone: (850) 412-3630

------------------- ----------·---------

The Honorable Mary Li Creasy Administrative Law Judge

Division of Administrative Law Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060 Electronic Filin

The Honorable Brittany 0. Finkbeiner Administrative Law Judge

Division of Administrative Law Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060 Electronic Filin

NOTICE OF FLORIDA LAW

408.804 License required; display.--

(}) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider.

(2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued.

408.812 Unlicensed activity. --

1. A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she hollds a license for other than that for which he or she actually holds the license.

   
   

2. The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfadion of the agency.

   
   

3. It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense.

   
   

4. Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance.

   
   

5. When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require Iicensure, the agency may revoke all Ii censes and impose actions

   under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation.

   
   

6. In addition to granting injunctive relief pursuant to subsection (2), if the agency detennines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules.

   
   

7. Any person aware of the operation of an unlicensed provider must report that provider to the agency.

   
   

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATrON

   
   

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   
   

   vs.

   
   

   VILLA SERENA 1, INC.,

   
   

   Respondent.

   I

   ADMINISTRATIVE COMPLAINT

   
   

   Case No.: 2020014304

   License No.: 8022 Facility Type: ALF

   
   

   COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Villa Serena 1, Inc. ("Respondent"), pursuant to § 120.569 and 120.57, Florida Statutes (2020), and alleges:

   NATURE OF THE ACTION

   
   

   This is an action against an assisted living facility to revoke Respondent's assisted living facility license pursuant to §§ 408.815 and 429.14, Florida Statutes (2020); and to impose an administrative fine of sixteen thousand dollars ($16,000.00) based upon one (I) Class I, one (I) Class II, and two (2) unclassified deficient practices.

   JURISDICTION AND VENUE

   
   

   1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2020).

1. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code,

   
   

   PARTIES

   
   

2. The Agency 1s the regulatory authority responsible for licensure of assisted living

   
   

   EXHIBIT 1

   facilities and enforcement of all applicable federal regulations, state statutes, and rules governing assisted living facilities pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes, and Chapter 59A-36, Florida Administrative Code, respectively.

3. Respondent operates a fourteen (14) bed assisted living facility located at 1200 Southwest 22 Terrace, Miami, Florida 33145, and is licensed as an assisted living facility, license number 8022.

4. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

   COUNT I

   
   

5. The Agency re-alleges and incorporates paragraphs (1) througt1 ( 5) as if fully set forth herein.

6. Under Florida law, the Agency shall require level 2 background screening for personnel as required in Section 408.809(l)(e) pursuant to Chapter 435 and Section 408.809. § 429.174, Florida Statutes (2020).

7. Florida law provides that 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.

   1. 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. (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 licc11see or provider whose responsibilities require him or her to provide personal care or personal services directly to clients, or contracting with a licensee or provider to work 20 hours a week or more who will have access to client funds, personal property, or living areas. Evidence of contractor screening may be retained by the contractor's employer or the licensee. § 408.S09(1 ), Florida Statutes (2020).

8. Florida law also provides that every 5 years following his or her licensure, employment, or entry into a contract in a capacity that under subsection (I) 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), Florida Statutes (2020).

I 0. Under Florida law, m addition to the offenses listed in Sectwn 435.04, all persons required to undergo background screening pursuant to this part or authc,,nzing statutes must not have 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 or any similar offense of another jurisdiction listed in Section 408.809(4). § 408.809(4), Florida Statutes (2020).

1. Also 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 ), Florida Statutes (2020).

2. Florida law provides that: (a) an employer may not hire, selec:1. 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 tennination 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 wou1d 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. (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.

   1. 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 Section 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 dknial or tennination of employment. § 435.06(2)(a)-(d), Florida Statutes (2020).

3. Under Florida law, any employee who refuses to cooperate in such screening or refuses to timely submit the information necessary to complete the screening, mcluding fingerprints if required, must be disqualified for employment in such position or, if employed, must be dismissed. § 435.06(3), Florida Statutes (2020).

4. Also under Florida law, level 2 background screening must he conducted for staff, including staff contracted by the facility to provide services to residents, pursuant to §§ 408.809 and 429.174, Florida Statutes; Rule 59A-36.0l 0(2)(f), Florida Administrative Code.

5. Florida law also provides that a person who serves as a controlling interest of, is employed by, or contracts with a licensee on July 31, 2010, who has been screened and qualified according to standards specified ins. 435.03 ors. 435.04 must be rescreened by July 31, 2015, in compliance with the following schedule. If, upon rescreening, such pers1m has a disqualifying offense that was not a disqualifying offense at the time of the last screening, but is a current disqualifying offense and was committed before the last screening, he or she may apply for an exemption from the appropriate licensing agency and, if agreed to by the employer, may

   continue to perform his or her duties until the licensing agency renders a decision on the

   
   

   application for exemption if the person is eligible to apply for an exemption and the exemption request is received by the agency within 30 days after receipt of the rescreening results by the person. The rescreening schedule shall be: (a) Individuals for whom the last screening was conducted on or before December 31, 2004, must be rescreened by July 31, 2013. (b) Individuals for whom the last screening conducted was between January 1. 2005, and December 31, 2008, must be rescreened by July 31, 2014. (c) Individuals for whom the last screening

   
   

   conducted was between January I, 2009, through July 31, 2011, must b, rescreened by July 31, 2015. § 408.809(5), Florida Statutes (2020).

6. Under Florida law, "Staff'' means any individual employed by a facility, contracting with a facility to provide direct or indirect services to residents, or employed hy a firm under contract with a facility to provide direct or indirect services to residents when present in the facility. The tenn includes volunteers performing any service that counts toward meeting any staffing requirement of this rule chapter. Rule 59A-36.002(37), Florida Administrative Code.

7. Under Florida law, "Employee" means any person required by law to be screened pursuant to this chapter, including, but not limited to, persons who are contractors, licensees, or volunteers. § 435.02(2), Florida Statutes (2020).

8. On or about August 5, 2020, the Agency completed a survey of Respondent's facility.

   
   

9. Based upon observation, interviews and the review of records, Respondent failed to ensure that its staff had the required background screening or exemption for one (I) of ten (I 0) sampled staff (Staff H) whose responsibilities required providing personal care or who had access to residents' personal property or their living areas, the same being contrary to law.

10. Staff H was observed walking into Respondent's facility on July 30, 2020 at 11:49 a.m.

    
    

    On July 30, 2020 at 12:27 p.m., Staff H was observed testing the carbon monoxide detector in the living room of Respondent's facility and at 12:28 p.m., Staff H tested the detector in the family room where Residents #5, #6 and #7 sat watching television.

11. On July 30, 2020 at 12:59p.m., Staff H was searching for gloves and face mask supplies in the kitchen drawers and in the cabinets of one of the facility's bathrooms.

12. Respondent's Administrator was interviewed on July 30, 2020 at I :26 p.m. The Administrator stated that Staff H went to the facility at least every month.

    
    

13. A review of the Agency's Care Provider Background Screening database showed that Staff H completed a level 2 background screening on July 2, 2019. Ho1i\ ever, the results showed that StaffH was "not eligible."

14. Staff H clearly had access to residents and their property.

    
    

15. Providers are required to obtain and maintain such records as criminal history background screenings for Agency review in personnel records. See, Rule 59A-36.0I 5(2)(a)(3), Florida Administrative Code.

16. Respondent allowed an individual, in an employment or volunteer role, access to residents, their records, and property, without having first obtained a criminal history background check on the individual.

17. The above reflects that Respondent failed to ensure that its staff had the required background screening or exemption for one (I) of ten (I 0) sampled staff (Staff H) whose responsibilities required providing personal care or who had access to residents' personal property or their living areas, the same being contrary to law.

18. The Respondent's actions or inactions constituted a violation of§§ 429.174 and 408.809, Florida Statutes (2020).

19. 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 2 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 )(t), Florida Statutes (2020).

20. Florida law also provides that regardless of the class of violation i.:ited, instead of the fine amounts listed in paragraphs (a)-(d), the Agency shall impose an administrative fine of $500.00 if a facility is found not to be in compliance with the background screening requirements as provided in § 408.809. § 429.19(2)( e), Florida Statutes (2020).

21. 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 $500.00 for each violation. Unclassified violations include: Violating any provision of this part, authorizing statutes, or applicable rules. § 408.813(3)(b), Florida Statutes (2020).

    WHEREFORE, the Agency seeks to impose an administrative fine of five hundred dollars ($500.00) against the Respondent.

    COUNT II

    
    

22. The Agency re-alleges and incorporates paragraphs (I) through f 5) as if fully set forth herein.

23. 7. Florida law provides:

    
    

    1. The Agency for Health Care Administration in consultation with the Department of Law Enforcement shall create a secure web-based system, which shall be known as the "Care Provider Background Screening Clearinghouse" or "clearinghouse," and which shall be implemented to the full extent practicable no later than September 30, 2013, subject to the specified agencies being funded and equipped to participate in such program. The clearinghouse shall allow the results of criminal history checks provided to the specified agencies for screening of persons qualified as care providers under s. 943.0542 to be shared among the specified agencies when a person has applied to volunteer, be employed, be licensed, or enter into a contract that requires a state and national fingerprint-based criminal history check. The Agency for Health Care Administration and the Department of Law Enforcement may adopt rules to create forms or implement procedures needed to carry out this section.

       
       

       (2)(a) To ensure that the infonnation 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:

       I. 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 subm1ssions to the Agency for Health Care Administration for inclusion in the clearinghouse.

       1. 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 pnnts 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.

       2. Resubmitted for a Federal Bureau oflnvestigation national criminal history check every 5 years until such time as the fingerprints are retained by the Federal Bureau of Investigation.

       3. Subject to retention on a 5-year renewal basis with fees collected at the time of initial submission or resubmission of fingerprints.

       4. Submitted with a photograph of the person taken at the time the fingerprints are submitted.

       1. 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.

       2. 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 IO business days.

       3. An employer must register with and initiate all criminal hi tory 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(1 )-(2), Florida Statutes (2020).

       
       

24. On or about August 5, 2020, the Agency completed a survey of Respondent's facility.

    
    

25. Based upon observation, interviews, and the review of records, Respondent failed to maintain an up-to-date employee roster in the Care Provider Background Screening Clearinghouse for one (I) of ten (I 0) sampled staff (Staff F), the same being contrary to law.

    
    

26. During an interview on July 30, 2020 at 12:06 p.m., Respondent' ;, Administrator stated that Staff F was in training.

27. On July 30, 2020 at 12:11 p.m., StaffF was observed inside Resident #3's room by herself, cleaning and organizing. Further observation on July 30, 2020 m I :25 p.m. showed that StaffF served lunch to Residents #8, #10, and #13.

28. A review of Respondent's employee roster on the Care Provider Background Screening Clearinghouse database showed that Staff F was not listed on Responden1's employee roster.

29. During an interview on July 30, 2020 at 5:05 p.m., Staff F stated she started working at Respondent's facility on July 20, 2020.

30. The above reflects that Respondent failed to maintain an up-to-date employee roster in the Care Provider Background Screening Clearinghouse for one (1) of ten (10) sampled staff (Staff F), the same being contrary to law.

31. The Respondent's actions or inactions constituted a violation of§ ,B5.12, Florida Statutes (2020).

32. 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 2 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), Florida Statutes (2020).

    
    

33. Florida law provides that 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 $500.00 if a facility is found not to be in compliance with the background screening requirements as provided ins. 408.809. § 429.19(2)(e), Florida Statutes (2020).

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 $500.00 for each violation. Unclassified violations include: Violating any provision of this part, authorizing statutes, or applicable rules. § 408.813(3)(b), Florida Statutes (2020).

    WHEREFORE, the Agency intends to impose an administrati\·e fine in the amount of five hundred dollars ($500.00) against Respondent.

    COUNT III

    
    

35. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth

    
    

36. Florida law provides:

    
    

    (I) No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to:

    1. Live in a safe and decent living environment, free from abuse and neglect.

    2. Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy.

    3. Retain and use his or her own clothes and other personal property in his or her immediate living quarters, so as to maintain individuality and personal dignity, except when the facility can demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other residents.

    4. Unrestricted private communication, including receiving and sending unopened correspondence, access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar situations.

       
       

    5. Freedom to participate in and benefit from community ser11ces and activities and to pursue the highest possible level of independence, autonomy, ,111d interaction within the community.

    6. Manage his or her financial affairs unless the resident or, if applicable, the resident's representative, designee, surrogate, guardian, or attorney 111 fact authorizes the administrator of the facility to provide safekeeping for funds as p11wided ins. 429.27.

    7. Share a room with his or her spouse if both are residents of the facility.

    8. Reasonable opportunity for regular exercise several times a week and to be outdoors at regular and frequent intervals except when prevented by inclement weather.

    9. Exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, nor any attendance at religious services, shall be imposed upon any resident.

    10. Assistance with obtaining access to adequate and appropriate health care. For purposes of this paragraph, the term "adequate and appropriate health care" means the management of medications, assistance in making appointments for health care services, the provision of or arrangement of transportation to health care appointments, and the performance of health care services in accordance with s. 429.2' 55 which are consistent with established and recognized standards within the community.

    11. At least 45 days' notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a pl1ysician to require an emergency relocation to a facility providing a more skilled level of care or the resident engages in a pattern of conduct that is harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days' notice of a nonemergency relocation or residency termination. Reasons for relocation must be set forth in writing and provided to the resident or the resident's legal representative. The notice must state that the resident may contact the State Long-Tenn Care Ombudsman Program for assistance with relocation and must include the statewide toll-free telephone number of the program. In order for a facility to terminate the residency of an individual without notice as provided herein, the facility shall show good cause in a court of competent jurisdiction.

        1. Present grievances and recommend changes in policies, procedures, and services to the staff of the facility, governing officials, or any other person without restraint, interference, coercion, discrimination, or reprisal. Each facility shall establish a grievance procedure to facilitate the residents' exercise of this right. This right includes access to ombudsman volunteers and advocates and the right to be a member of, to be active in, and to associate with advocacy or special interest groups.

        2. The administrator of a facility shall ensure that a written notice of the rights, obligations, and prohibitions set forth in this part is posted in a prominent place in each facility and read or explained to residents who cannot read. The notice must include the statewide toll-free telephone number and e-mail address of the State Long-Term Care Ombudsman Program and the telephone number of the local ombudsman council, the Elder Abuse Hotline operated by the Department of Children and Families, and, if applicable, Disability Rights Florida, where complaints may be lodged. The notice must state that a complaint made to the Office of State Long-Term Care Ombudsman or a local long-term care ombudsman council, the names and identities of the residents involved in the complaint, and the identity of complainants are kept confidential pursuant to s.

    
    

    400.0077 and that retaliatory action cannot be taken against a resident for presenting grievances or for exercising any other resident right. The facility must ensure a resident's access to a telephone to call the State Long-Term Care Ombudsman Program or local ombudsman council, the Elder Abuse Hotline operated by tht Department of Children and Families, and Disability Rights Florida.

    § 429.28(1) and (2), Florida Statutes (2020).

    
    

37. Florida law further provides:

    
    

    (I )(a) A resident shall be given the option of using his or her ":>wn belongings, as space pennits; choosing his or her roommate; and, whenever possible, unless the resident is adjudicated incompetent or incapacitated under state law, managing his or her own affairs.

    (b) The admission of a resident to a facility and his or her presence therein shall not confer on the facility or its owner, administrator, employees, or representatives any authority to manage, use, or dispose of any property of the resident; nor shall such admission or presence confer on any of such persons any autho1ity or responsibility for the personal affairs of the resident, except that which may be necessary for the safe management of the facility or for the safety of the resident.

    § 429.27(1 ), Florida Statutes (2020).

    
    

38. Florida law also states:

    
    

    (6) RESIDENT RIGHTS AND FACILITY PROCEDURES.

    1. A copy of the Resident Bill of Rights as described in section 429.28, F.S., or a summary provided by the Long-Term Care Ombudsman Program must be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to rule 59A-36.006, F.A.C.

    2. In accordance with section 429.28, F.S., the facility must have a written grievance procedure for receiving and responding to resident complaints and a written procedure to allow residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint.

    3. The telephone number for lodging complaints against a facility or facility staff must be posted in full view in a common area accessible to all residents. The telephone numbers are: the Long-Term Care Ombudsman Program, l (888)831-0404; Disability Rights Florida, l (800)342-0823; the Agency Consumer Hotline l (888)419-3456, and the statewide toll-free telephone number of the Florida Abuse Hotline, l (800)96-ABUSE or l (800)962-2873. The telephone numbers must be posted in close proximity to a telephone accessible by residents and the text must be a minimum of 14-point font.

    4. The facility must have a written statement of its house rules and procedures that must be included in the admission package provided pursuant to rule 59A-36.006, F.A.C. The rules and procedures must at a minimum address the facility's policies regarding:

       l. Resident responsibilities;

       1. Alcohol and tobacco use;

       2. Medication storage;

          
          

       3. Resident elopement;

       4. Reporting resident abuse, neglect, and exploitation;

       5. Administrative and housekeeping schedules and requirements:

       6. Infection control, sanitation, and universal precautions; and,

       7. The requirements for coordinating the delivery of services to residents by third party providers.

    5. Residents may not be required to perform any work in the facility without compensation. Residents may be required to clean their own sleeping areas or apartments if the facility rules or the facility contract includes such a requirement. If a resident is employed by the facility, the resident must be compensated in compliance with state and federal wage laws.

    6. The facility must provide residents with convenient access to a telephone to facilitate the resident's right to unrestricted and private communication, pursuant to section 429.28(l)(d), F.S. The facility must allow unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there must be, at a minimum, a readily accessible telephone on each floor of each building where residents reside.

    7. In addition to the requirements of section 429.41(I )(k), F.S., the use of physical restraints by a facility on a resident must be reviewed by the resident's physician annually. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint.

    Rule 59A-36.007(6), Florida Administrative Code.

    
    

39. On or about August 5, 2020, the Agency completed a survey of Respondent's facility.

    
    

40. Based upon observation, interviews, and the review ofrecords, Respondent failed to ensure that residents lived in a safe and decent living environment, free from abuse and neglect, and were treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy, the same being contrary to the mandates of law. Specifically, Respondent's staff did not follow infection control precautions recommended by the Center for Disease Control and Prevention and the Florida Governor's emergency order, DEM Order, dated March 15, 2020 thereby failing to safeguard thirteen (13) of fifteen (15) sampled residents (Residents #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #13, and #14) who tested positive for COVID-19 after being exposed by three (3) of Respondent's staff (Staff B, C, and D). Respondent also failed to protect fourteen (14) of fifteen (15) resid, nts (Residents #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #13, #14 and #15) from exposure to four (4) of nine (9) staff

    
    

    (Staff B, C, D, and I) who worked with COVID-19 positive cases wearing inadequate personal protective equipment (PPE). Respondent further failed to place four (4) uf nine (9) sampled staff (Staff A, B, I and F) on quarantine for the recommended ten (10) days and continued to allow them to work and care for residents. Respondent's staff who were nega1ive for COVID-19 (Staff A and F) provided care and services to positive and negative COVID-19 residents (Residents# 1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #13, #14 and #15). Those staff members did not wear appropriate personal protective equipment to prevent cross-infection. Respondent also allowed two (2) of nine (9) sampled staff with unknown COVID-19 status (Staff G and H) inside its facility without that staff wearing the appropriate personal protective equipment.

41. The novel coronavirus SARS-co V-2/ COVID-19 is a transmissible respiratory infection that presents severe risk to persons who are aged, infinn, or suffer from co-morbidities including, but not limited to, immune system deficiency, respiratory disease, diabetes, and obesity. See generally, Publications of the Centers for Disease Control.

42. On March 1, 2020, the Governor of the State of Florida issued Executive Order 20-51 designating a Public Health Emergency as a result of COVID-19 and its impact. Pursuant to that authority, emergency orders have been issued by the Florida Division of Emergency Management to implement the protections necessary to assure the health, safety, and well-being of Florida's citizenry, including those most vulnerable to the effects of infoction.

43. The Agency for Health Care Administration (AHCA) has issued guidance and clarification on DEM Order 20-006 to providers, and on March 18, 2020, issued an alert notifying all homes that all staff or other individuals admitted to a residential facility must don face masks and that caregivers must wear gloves when providing resident care. While the treatment and management of residents with infectious disease and the implementation of

    
    

    isolation precautions for such events are a long-standing health care i rnes faced by residential facilities, the ease of contagion and the effects of infection presented by COVID-19 mandate that providers exert meticulous practice and procedure to identify resident symptoms and take immediate prophylactic procedures to both assure appropriate treatment of a potentially infected resident and protect the remainder of a facility's population from the risk of spread of the infection.

44. A review of recommendations from the Centers for Disease Control (CDC) dated April 13, 2020 showed that if COVID-19 was identified or suspected in a resident of an assisted living facility, the resident should immediately be isolated in his/her room and the health department notified. The recommendations further stated that, "For situations where close contact between any (symptomatic or asymptomatic) resident cannot be avoided, personr1cl should at a minimum, wear eye protection (goggles or face shield) and an N95 or higher-level respirator (or a facemask if respirators are not available or personnel are not fit tested). Cloth face coverings are not PPE and should not be used when a respirator or facemask is indicated. l f personnel have direct contact with the resident, they should also wear gloves. If available, gowns are also recommended but should be prioritized for activities where splashes or sprays are anticipated or high-contact resident-care activities that provide opportunities for transfer to pathogens to hands and clothing of personnel (e.g., dressing, bathing/showering, transfernng, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, wound care).

45. On July 30, 2020 at 11:40 a.m., Staff G and H (both wearing surgical masks and gloves) were observed exiting their vehicle and walking into Respondent's facility. The Administrator did not take their temperatures and did not complete the screening questionnaire.

    
    

46. At 12:28 p.m., Staff H was observed testing the carbon monoxide detectors in the family room where Residents #5, #6, and #7 sat watching television. The residents were observed sitting less than six (6) feet apart and not wearing any face cove1ings.

47. In an interview with Respondent's Administrator on July 30, : 020 at 12:09 p.m., she stated that she did not screen the staff due to Agency representatives being at the facility. She further stated Staff G was not tested for COVID-19 because she does not work at the facility and that Staff H gave her a ride after completing her fingerprinting.

48. On July 30, 2020 at 4:59 p.m., the Administrator said that Staff H had been tested for COVID-19 and that she would provide the results. However, there was no documentation provided to the Agency of Staff H's COVID-19 test results.

49. On July 30, 2020 at 11:41 a.m., Residents #8 and #10 were observed sitting less than six

    
    

    (6) 6 feet from one another on the front porch without wearing masks.

    
    

50. On July 30, 2020 at 12:00 p.m., the Administrator stated that on .July 27, 2020, the state agency came and tested the residents but she had not yet received the n::sults. She further stated that she expected some residents to have positive results.

51. A review ofCOVID-19 test results for residents showed that on July 28, 2020, Residents #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #13, and #14 tested positive for COVID-19. Resident #15 tested negative for COYID- I 9.

52. During an interview on July 30, 2020 at 12:01 p.m., the Administrator stated it was a challenge to have residents comply with social distancing. At 12:31 run., the Administrator further stated that "each time we give them a mask, 2 seconds later, it's on the floor." A review of the residents' progress notes showed no documentation that Respondent contacted the residents' medical providers for assistance to have the residents comply with the CDC guidelines.

    
    

53. A review of Respondent's facility's hospitalization log showed that on July 26, 2020 that Resident#l l was sent to the hospital with a fever, elevated heart rate and body aches.

54. On July 30, 2020 at 1:32 p.m., the Administrator stated t1rnt Respondent did not document in Resident#l l's records why the resident went to the hc,spital. At 1:38 p.m., the Administrator stated that Resident #11 went to the hospital because thf resident's blood pressure was elevated and the resident had body aches but not because of COVID-19.

55. Resident #l's health assessment (AHCA Fonn 1823) dated November 17, 2019 showed a medical history and diagnoses of schizophrenia, dementia, hypercholesteremia, hypothyroidism, and benign essential hypertension.

56. Resident #1's COVID-19 test result showed the resident tested positive on July 28, 2020.

    
    

57. Resident #2's health assessment (AHCA Form 1823) showed a medical history and diagnoses of coronary artery disease, chronic obstructive pulmonary disease, prostate cancer, anemia, memory loss, and anxiety.

58. Resident #2's COVID-19 test result showed the resident tested positive on July 28, 2020.

    
    

59. Resident #3's health assessment (AHCA Fonn 1823) dated June 3, 2020, showed a medical history and diagnoses of unspecified cirrhosis of the liver and end stage liver disease.

60. Resident #3's COVID-19 test result showed the resident tested positive on July 28, 2020.

    
    

61. Resident #4's health assessment (AHCA Form 1823) dated June 2, 2020 showed a medical history and diagnoses of high blood pressure and hepatic lipase .

62. Resident #4's COVID-19 test result showed the resident tested positive on July 28, 2020.

    
    

63. Resident #S's health assessment (AHCA Fonn 1823) dated April 20, 2020 showed a medical history and diagnoses of chronic kidney injury, dementia, and high blood pressure.

64. Resident #S's COVID-19 test result showed the resident tested positive on July 28, 2020.

    
    

65. Resident #6's health assessment (AHCA Form l 823) dated December l 8, 2019 showed a medical history and diagnoses of chronic kidney disease - stage \ high blood pressure, congestive heart failure, and dementia.

66. Resident #6's COVID-19 test result showed the resident tested pc, itive on July 28, 2020.

    
    

67. Resident #7's health assessment (AHCA Form 1823) dated January 23, 2020 showed a medical history and diagnoses of high blood pressure, iron deficiency anemia, schizophrenia, urinary tract infection, and Huntington's disease.

68. Resident #7's COVID-19 test result showed the resident tested positive on July 28. 2020.

    
    

69. Resident #S's health assessment (AHCA Form 1823) dated April 8, 2019 showed a medical history and diagnoses of hypothyroidism, insomnia, and anemia.

70. Resident #S's COVID-19 test result showed the resident tested positive on July 28, 2020.

81, Resident #9's health assessment (AHCA Form 1823) dated Octnber 2, 2018 showed a medical history and diagnoses of osteoporosis, anemia, high blood pressure, dementia, ethanol abuse, and diabetes mellitus.

1. Resident #9's COVID-19 test result showed the resident tested positive on July 28, 2020.

   
   

2. Resident #lO's health assessment (AHCA Form 1823) dated July 21, 2020 showed a medical history and diagnoses of diabetes mellitus, gastroesophageal reflux disease, vitamin deficiency, hypersensitivity lung disease, and congestive heart failure.

3. Resident #1O's COVID-19 test result showed the resident tested positive on July 28, 2020.

4. Resident #ll's health assessment (AHCA Form 1823) dated July 12, 2020 showed a medical history and diagnoses of high blood pressure, gastroesophagcal reflux disease, and dementia.

   
   

5. Resident #12's health assessment (AHCA Fonn 1823) dated May 23, 2019 showed a medical history and diagnoses of high blood pressure, diabetes type :'... hyperlipidemia, gastro­ esophageal reflux disease, and anemia.

6. Resident #I 2's COVID-19 test result showed the resident tested positive on July 28, 2020.

7. Resident #13's health assessment (AHCA Fonn 1823) dated July 22, 2020 showed a medical history and diagnoses of Alzheimer's disease, osteoarthritis, chronic anxiety disorder, and chronic constipation.

8. Resident #13's COVID-19 test result showed the resident tested positive on July 28, 2020.

9. A review of "independent living" Resident #14's health assessment (AHCA Fonn 1823) dated October I 0, 2019 showed a medical history and diagnoses of hypertension, depression, chronic constipation, osteoarthritis, schizoaffective disorder, coronary artery disease, and diabetes mellitus type 2.

10. Resident #14's COVID-19 test result showed the resident tested positive on July 28, 2020.

11. A review of "independent living" Resident #15's health assessmt:,nt (AHCA Fonn 1823) dated November 21, 2019 showed a medical history and diagnoses of high blood pressure, anxiety, gastritis, osteoarthritis, and hypocomplementemia.

12. Resident #I S's COVID-19 test result showed the resident tested negative on July 28, 2020.

13. On 07/30/2020 at 12:27 p.m., it was observed that Residents #2, #3, #4, and #15 occupied

    
    

    21

    
    

    bedrooms on the second floor. Further observation showed the only bathroom on the second floor was not stocked with soap and paper towels.

14. On July 30, 2020 at 12:27 p.m., the Administrator stated that all the residents occupying the second floor share the bathroom on that floor.

15. On July 30, 2020 at 12:39 p.m., the home health nurse was observed wearing a surgical mask and gloves to enter Respondent's facility and walk to Resident# 12\ room.

16. During an interview on July 30, 2020 at 12:39 p.m., the home health nurse stated the agency sent her to administer Resident#l 2's insulin.

17. On August 5, 2020 at 3:31 p.m., Staff F was observed walking into multiple resident rooms while sweeping the floor and wearing a cloth mask.

18. A review of recommendations from the CDC show that cloth face coverings are NOT personal protective equipment and should not be worn for the care of patients with suspected or confirmed COVID-19 or other situations where use of a respirator or facemask is recommended. The recommendations further state facemasks are preferred over cloth face coverings for healthcare personnel as facemasks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others.

I 00. Further observation at 4:01 p.m. that day showed Resident#l pass Staff F the telephone and state that Staff A wanted to talk to her. Resident#l was not wearing a mask. Review of Resident #l's test results show that the resident tested positive for COVID-19 on July 28, 2020.

1. On July 30, 2020 at 1 :30 pm., the Administrator stated she hired new staff, Staff F, to relieve staff that was positive for COVID-19.

2. On 07/30/2020 at 5:09 PM, during a phone interview, Staff F stated that Staff I trained

   
   

   and worked alongside her caring for residents at the facility the week of .I uly 20, 2020. A review of staff test results show that Staff I tested positive for COVID-19 on Ju, y 25, 2020.

3. A review of recommendation from the CDC showed that health,.:are personnel who had prolonged close contact with a healthcare personnel confinned witl1 COVID-19 should be excluded from work fourteen (14) days after last exposure.

1. A review of the facility's record showed no documentation that the home health agency nurses who provided services at Respondent's facility were tested for CO\'ID-19.

2. On July 30, 2020 at 12:47 p.m., the Administrator stated that she had no physical documentation of the home health agency's staff test results.

3. On July 30, 2020 at 12:55 p.m., the Administrator was asked about the amount of personal protective equipment in stock at the facility. The Administrator stated she did not know. She further stated she would have to call the house manager to get the infotmation.

4. On July 30, 2020 at 12:56 p.m., the Administrator presented a bm of one hundred (100) count gloves and a sixty (60) ounce bottle of hand sanitizer. Further observation at 12:58 p.m., showed the Administrator call out to Staff H, the maintenance person, to assist her in finding the personal protective equipment. Staff H opened a drawer in the kitchen and pulled out two (2) packages of twenty-five (25) count surgical masks. Respondent did not have any face shields, N95 masks, or gowns in stock during the onsite inspection.

5. In an interview on July 30, 2020 at I :40 p.m., the Administrator stated that the facility cooked and served meals for the independent residents and that all r,esidents, including the independent residents, ate in the common dining area. The Administrator added that the residents at the facility required assistance or supervision with the activities of daily living. All the residents at the facility needed assistance with self-administration of medications.

   
   

6. The above reflects that Respondent failed to ensure that residents lived in a safe and decent living environment, free from abuse and neglect, and were treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy, the same being contrary to the mandates of law. Specifically, Respondent's staff did not follow infection control precautions recommended by the Center for Disease Control and Prevention and the Florida Governor's emergency order, DEM Order, dated March 15, 2020 thereby failing to safeguard thirteen (13) of fifteen (15) sampled residents (Residents #1. #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #13, and #14) who tested positive for COVID-19 after being exposed by three

1. of Respondent's staff (Staff B, C, and D). Respondent also failed to protect fourteen (14) of fifteen (15) residents (Residents #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, tq2, #13, #14 and #15) from exposure to four (4) of nine (9) staff(StaffB, C, D, and I) who ,.,orked with COVID-19 positive cases wearing inadequate personal protective equipment (PPE). Respondent further failed to place four (4) of nine (9) sampled staff (Staff A, B, I and F) on quarantine for the recommended ten (10) days and continued to allow them to work and care for residents. Respondent's staff who were negative for COVID-19 (Staff A and F) pro\ ided care and services to positive and negative COVID-19 residents (Residents #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #13, #14 and #15). Those staff members did not wear appropriate personal protective equipment to prevent cross-infection. Respondent also allowed two (2) of nine (9) sampled staff with unknown COVID-19 status (Staff G and H) inside its facility without that staff wearing the appropriate personal protective equipment.

   I 09. The Agency determined that this deficient practice was a condition or occurrence 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.

   1. The Agency cited the Respondent for a Class I violation in accurdance with applicable statutes and authorizing rules.

   2. That the same constitutes a Class I offense as defined in § 408.8 I :l(2)(a), Florida Statutes (2020).

      WHEREFORE, the Agency intends to impose an administrative fine in the amount of ten thousand dollars ($10,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to § 429. l 9(2)(a), Florida Statutes (2020).

      COUNT IV

      
      

   3. The Agency re-alleges and incorporates paragraphs (1) througr, (5) and Counts I - III above as if fully set forth herein.

   4. Florida law provides

      
      

      Notice of change of administrator.-If, during the period for which a license is issued, the owner changes administrators, the owner must notify the agency of the change within 10 days and provide documentation within 90 days that the new administrator meets educational requirements and has completed the applicable core educational requirements under s. 429.52. A facility may not be operated for more than 120 consecutive days without an administrator who has completed the core educational requirements.

      § 429.176, Florida Statutes (2020).

      
      

   5. Florida law also provides:

      
      

2. A new facility administrator must complete the required core training, including the competency test, within 90 days after the date of employment as an administrator. Failure to do so is a violation of this part and subjects the violator to an administrative fine as prescribed in s. 429.19. Administrators licensed in accordance with part II of chapter 468 are exempt from this requirement. Other licensed professionals may be exempted, as determined by the department by rule.

3. Administrators are required to participate in continuing education for a minimum of 12 contact hours every 2 years.

§ 429.52(4)-(5), Florida Statutes (2020).

..

Florida further states:

(I) ADMINISTRATORS. Every facility must 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 appropriate care to all residents as required by chapters 408, part II, 429, part I, F.S., and rule chapter 59A-35, F.A.C., and this rule chapter.

1. An administrator must:

   1. Be at least 21 years of age;

   2. If employed on or after October 30, 1995, have, at a minimum, a high school diploma orG.E.D.;

   3. Be in compliance with Level 2 background screening requirements pursuant to sections 408.809 and 429.174, F.S.;

   4. Complete the core training and core competency test requirements pursuant to rule 59A-36.0l l, F.A.C., no later than 90 days after becoming employed as a facility administrator. Administrators who attended core training prior to .I uly 1, 1997, are not required to take the competency test unless specified elsewhere in this rule; and,

   5. Satisfy the continuing education requirements pursuant to rule 59A-36.0l 1, F.A.C. Administrators who are not in compliance with these requirements must retake the core training and core competency test requirements in effect on the date the non-compliance is discovered by the agency or the department.

2. In the event of extenuating circumstances, such as the death of a facility administrator, the agency may permit an individual who otherwise has not satisfied the training requirements of subparagraph (l)(a)4. of this rule, to temporarily serve as the facility administrator for a period not to exceed 90 days. During the 90 day period, the individual temporarily serving as facility administrator must:

   1. Complete the core training and core competency test requirements pursuant to rule 59A-36.011, F.A.C.; and,

   2. Complete all additional training requirements if the facility maintains licensure as an extended congregate care or limited mental health facility.

3. Administrators may supervise a maximum of either three assisted living facilities or a group of facilities on a single campus providing housing and health care Administrators who supervise more than one facility must appoint in writing a separate manager for each facility. However, an administrator supervising a maximum of three assisted living facilities, each licensed for 16 or fewer beds and all within a 15 mile radius of each other, is only required to appoint two managers to assist in the operation and maintenance of those facilities.

4. An individual serving as a manager must satisfy the same qualifications, background screening, core training and competency test requirements, and continuing education requirements as an administrator pursuant to paragraph (l)(a) of this rule. Managers who attended the core training program prior to April 20, 1998, are not required to take the competency test unless specified elsewhere in this rule. In addition, a manager may not serve as a manager of more than a single facility, except as provided in paragraph (1)(c) of this rule, and may not simultaneously serve as an administrator of any other facility.

5. Pursuant to section 429.176, F.S., facility owners must notify the Agency Central Office within 10 days of a change in facility administrator on the Notification of Change

   
   

   of Administrator fonn, AHCA Form 3180-1006, June 2016, which is incorporated by reference and available online at: http://www.flrules.org/Gateway reference.asp?No=Ref- 09393.

   Rule 59A-36.010(1), Florida Administrative Code.

   
   

   116. On or about August 5, 2020, the Agency completed a survey of Respondent's facility.

   
   

   117 Based upon observation, interviews, and the review of records, Respondent failed to have an administrator capable of handling the operation and maintenance of the facility, including the management of all staff and the residents, the same being contrary to the mandates of law.

   1. A review of the Agency's Care Provider Background Screening Clearinghouse database showed that Staff A was Respondent's administrator since February 17, 2017.

   2. On July 30, 2020 at 11:40 a.m., the Administrator allowed Staff G and H to enter into Respondent's facility without taking their temperatures and without completing the screening questionnaire.

   3. In an interview with the Administrator on July 30, 2020 at 12:17 p.m., she stated that she did not screen the staff due to Agency representatives being at the facility.

   4. On July 30, 2020 at 11:41 a.m., Residents #8 and #10 were observed sitting on the front porch of Respondent's facility. At 11:42 a.m., the Administrator asked these residents what their names were.

   5. On July 30, 2020 at 12:16 p.m., Residents #5, #6, and #7 were observed sitting in the living room area of the facility watching television. The Administrator stated that she did not know the names of the residents and would have to ask them their names. The Administrator then approached Residents #5, #6, and #7 and asked them their names.

   6. On July 30, 2020 at 12:16 p.m., the Administrator said that Resident #14 shared a room with Resident # 11.

      
      

   7. On July 30, 2020 at 12:39 p.m., Staff J was observed entering Respondent's facility. Staff J was wearing a surgical mask and gloves.

   8. Staff J was interviewed on July 30, 2020 at 12:39 p.m., Staff J slated that she was a home health agency nurse providing services to Resident #12.

   9. On July 30, 2020 at 12:47 p.m., the Administrator stated that she did not have documentation of COVID-19 results for Staff J.

   10. On July 30, 2020 at 11:50 a.m., the Administrator was observed cleaning the facility.

       
       

       Staff F was observed at 12:11 p.m., that same day, cleaning residents' rooms. At 1 :25 p.m., Staff F was also observed preparing and serving lunch to Residents #8, #10, and #13. Both staff members were observed wearing surgical masks and gloves.

   11. In an interview with the Administrator on July 30, 2020 at 12:00 p.m., the Administrator stated that the residents were tested for COVID-19 on July 27, 2020 and she expected some of the residents to test positive.

   12. The Administrator also stated on July 30, 2020 at 12:55 p.m., thal she did not know the amount and location of Respondent's personal protective equipment.

   13. At 12:58 p.m. on July 30, 2020, the Administrator called out to Staff H, the maintenance person, to assist her in finding the personal protective equipment. Staff H was seen opening a drawer in the kitchen and pulling out two (2) packages of twenty-five (25) count surgical masks.

   14. As set forth in Count I, the Administrator also failed to ensure that all staff personnel who have access to client funds, personal property, or living areas had an eligible level 2 background screemng.

   15. As set forth in Count II, the Administrator failed to maintain an updated employee roster on the Background Screening Clearinghouse database.

   
   

   I 33. As set forth in Count III, Respondent's Administrator also failed to ensure that residents lived in a safe and decent living environment, free from abuse and negkd, and were treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy, the same being contrary to the mandates of law. Specifically, infection control precautions required for COVID-19 were not followed.

   134. The above reflects that Respondent failed to have an administratcir capable of handling the operation and maintenance of the facility, including the management of all staff and the residents, the same being contrary to the mandates oflaw.

   I 35. The Agency determined that this deficient practice involved conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the Agency determines directly threatens the physical or emotional health, safety, or security of the clients, other than class I violations.

   I 36. That the same constitutes a Class II violation pursuant to § 429.:I 9(2)(b), Florida Statutes (2020).

   1. The Agency cited the Respondent for a Class II violation in accordance with applicable

      
      

      statutes and authorizing rules.

      
      

      WHEREFORE, the Agency intends to impose an administrative fine in the amount of five thousand dollars ($5,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to § 429. l 9(2)(b), Florida Statutes (2018).

      COUNTY

      
      

   2. The Agency re-alleges and incorporates paragraphs (I) through (5) and Counts I - IV above as if fully set forth herein.

   3. Under Florida law:

      
      

      1. 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 vwlation of any provision of this part, part II of chapter 408, or applicable rules, or for any of the following actions by a licensee, any person subject to level 2 background screening under s. 408.809, or any facility staff:

         1. An intentional or negligent act seriously affecting the health.. safety, or welfare of a resident of the facility ...

            1. A citation for any of the following violations as specified in s. 429.19:

               1. One or more cited class I violations.

               2. Three or more cited class II violations.

               3. Five or more cited class III violations that have been cited ,Jn a single survey and have not been corrected within the times specified.

            2. Failure to comply with the background screening standards of this part, s. 408.809(1 ), or chapter 435 ...

            (h) Failure of the license applicant, the licensee during relicensure, or a licensee that holds a provisional license to meet the minimum license requirements of this part, or related rules, at the time of license application or renewal ...

            (k) Any act constituting a ground upon which application for a license may be denied.

            § 429.14(1 )(a), (e), (f), (h), and (k), Florida Statutes (2020).

            
            

   4. Florida law also provides that:

      
      

      1. In addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest:

         1. False representation of a material fact in the license application or omission of any material fact from the application.

         2. An intentional or negligent act materially affecting the health or safety of a client of the provider.

         3. A violation of this part, authorizing statutes, or applicable rules...

      § 408.815(l)(a)-(c), Florida Statutes (2020).

      
      

   5. That Respondent has been cited with one (I) Class I violation ofla,:v on a single survey as set forth in Count III which constitutes independent grounds for the revocation of Respondent's Iicensure as an assisted living facility pursuant to § 429.14(1)(e)(I), Florida Statutes (2020).

   6. Respondent has also been cited for failure to comply with background screening

      
      

      standards of Chapter 429, Part I, s. 408.809 (1), or Chapter 435 as set forth in Count I by failing to have eligible level 2 background screenings for all staff and as set forth in Count II by failing to maintain an updated employee roster on the Care Provider Background Screening

      
      

      Clearinghouse database. The foregoing violations reflecting Responde::11's failure to comply with the background screening standards of Chapter 429, Part I, s. 408.809 (I), or chapter 435, each constitute independent grounds for the revocation of Respondent· s licensure as an assisted living facility.

   7. That Respondent has engaged in intentional or negligent acts seri()usly and/or materially affecting the health, safety or welfare of a resident of the facility which establishes grounds upon which an application for a license may be denied as set forth in §§ 429.14(1 )(a) and 408.815(1 )(b) Florida Statutes (2020).

   8. That Respondent's actions and/or inactions as set forth above constitute a ground upon which application for a license may be denied under§ 429.14(1 )(k), Florida Statutes (2020).

   9. That Respondent has violated the minimum requirements of law of Chapters 429, Part II; Chapter 408, part II (including§ 408.815(l)(b) and (c), Florida Statutes (2020); and Chapter 59A-36, Florida Administrative Code as described with particularity within this complaint.

   10. That Respondent has a duty to maintain its operations in accord with the minimum requirements of law and to provide care and services at mandated mi mmum standards. That based thereon, individually and collectively, the Agency seeks the revocation of the Respondent's licensure.

   WHEREFORE, the Agency intends to revoke the license of the Respondent to operate an assisted living facility in the State of Florida.

   
   

   Respectfully submitted this2;il_ day of August, 2020.

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE Al>\1INISTRATION

   
   

   '1 /

   By: -+------#-IC/,(--"--'--'../'<--,f7"-"'' ""'-,--':; -(E;l

   Gisela I es1. s, sq.

   
   

   ...k:. 61,-

   Fla. fNo·. 21010 / .

   Ageq.6y for Health Care Adfoinistration 525iv1irror Lake Drive N DOH

   St. Petersburg, FL 33701 727.552.1945 (office) Gisela.Iglesias@ahca.myflDJida.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) daJs 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 delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (8SO) 412-3630.

   
   

   CERTIFICATE OF SERVICE

   
   

   I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by

   U.S. Certified Mail, Return Receipt No. 7019 2970 0001 3240 66q(,7on August2.5_, 2020 to Roxana Solano, Administrator, Villa Serena 1, Inc., 1200 Southwest 22 Terrace, Miami, Florida 33145 and by Regular U.S. Mail to Santos Rafael Munoz, Registered Agent, Villa Serena 1, Inc., 8365 Northwest 157th Terrace, Miami Lakes, Florida 33016.

   
   

   V

   32 ii I

   
   

   Copy furnished to Arlene Mayo Davis Field Office Manager

   Agency for Health Care Administration

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATION

   
   

   Re: Villa Serena 1, Inc.

   AHCA No. 2020014304

   
   

   ELECTION OF RIGHTS

   
   

   This Election of Rights form is attached to an Administrative Complaint. The Election of Rights form may be returned by mail or by facsimile transmission, but must be filed with the Agency Clerk within 21 days by 5:00 p.m., Eastern Time, of the day that you received the Administrative Complaint. If your Election of Rights form with your selected option (or request for hearing) is not timely received by the Agency C'Jerk, the right to an administrative hearing to contest the proposed agency action will be waived and an adverse Final Order will be issued. In addition, please send a copy of this form to the attorney of record who issued the Administrative Complaint.

   
   

   (Please use this form unless you, your attorney or your qualified representative prefer to reply according to Chapter120, Florida Statutes, and Chapter 28, Florida Administrative Code.) The address for the Agency Clerk is:

   
   

   Agency Clerk

   Agency for Health Care Administration

   2727 Mahan Drive, Building #3, Mail Stop #3

   Tallahassee, Florida 32308

   Telephone: 850-412-3630 Facsimile: 850-921-0158

   
   

   PLEASE SELECT ONLY l OF THESE 3 OPTIONS

   
   

   OPTION ONE (1) Iwaive the right to a hearing to contest the allegations of fact and conclusions of law contained in the Administrative Complaint. I 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 fine, sanction or other agency action.

   
   

   OPTION TWO (2) I admit the allegations of fact contained in the Administrative

   Complaint, but I wish to be heard at an informal hearing (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, sanction or other agency action should be reduced.

   
   

   OPTION THREE (3) I dispute the allegations of fact contained 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 conforrn to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it contain:

   
   

   I. The name, address, telephone number, and facsimile number (if any) of the Respondent.

   1. The name, address, telephone number and facsimile number of the attomey or qualified representative of the Respondent (if any) upon whom service of pleading and other papers shall be made.

   2. A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate.

   3. A statement of when the respondent received notice of the administrative complaint.

   4. 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 to the Agency for Health Care Administration on behalf of the licensee referred to above.

   
   

   Signed: Date:

   
   

   Print Name: Title:

   
   

   STATE OF FLORIDA

   
   

   AGENCY FOR HEALTH CARE ADMINISTRATION

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   
   

   vs.

   
   

   VILLA SERENA II INC,

   
   

   Respondent.

   I

   ADMINISTRATIVE COMPLAINT

   
   

   Case No.: 2020014305

   License No.: 8518 Facility Type: ALF

   
   

   COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Villa Serena II Inc ("Respondent"), pursuant to §§ 120.569 and 120.57, Florida Statutes (2020), and alleges:

   NATURE OF THE ACTION

   
   

   This is an action against an assisted living facility to revoke Respondent's assisted living facility license pursuant to §§ 408.815 and 429.14, Florida Statutes (2020), and to impose an administrative fine of ten thousand five hundred dollars ($10,500.00) based on one (1) Class I and one (1) unclassified deficient practices.

   JURISDICTION AND VENUE

   
   

   I. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2020).

   1. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code,

      
      

      EXHIBIT 2

      
      

      PARTIES

      
      

   2. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes, and rules governing assisted living facilities pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes, and Chapter 59A-36, Florida Administrative Code, respectively.

   3. Respondent operates a fourteen (14) bed assisted living facility located at 60 Northwest 33rd Avenue, Miami, Florida 33125-4921, and is licensed as an assis1ed living facility, license number 8518.

   4. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

      COUNTI

      
      

   5. The Agency re-alleges and incorporates paragraphs (1) through I 5) as if fully set forth herein.

   6. Under Florida law, the Agency shall require level 2 background screening for personnel as required in Section 408.809(1 )(e) pursuant to Chapter 435 and Section 408.809. § 429.174, Florida Statutes (2020).

   7. Florida law provides that 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.

      1. 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. (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 lic nsee or provider whose responsibilities require him or her to provide personal care or personal services directly to clients, or contracting with a licensee or provider to work 20 hours a week or more who will have access to client funds, personal property, or living areas. Evidence of contractor screening may be retained by the contractor's employer or the licensee. § 40ls.809(1 ), Florida Statutes (2020).

   8. Florida law also provides that 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. I 2, 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 65I, 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) fhe 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), Florida Statutes (2020).

   9. Under Florida law, m addition to the offenses listed in Section 435.04, all persons

      
      

      required to undergo background screening pursuant to this part or authori,;:ing statutes must not have 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 or any similar offense of another jurisdiction listed in Section 408.809(4). § 408.809(4), Florida Statutes (2020).

   10. Also 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 exemptinn from disqualification. The only basis for contesting the disqualification is proof of mistaken identity. § 435.06(1 ), Florida Statutes (2020).

   11. Florida law provides that: (a) 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 tennination 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. (b) If an employer becomes aware that an employee has been arrested for a dis4ualifying 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.

       1. 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 Section 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 screenmg process is completed and the employee demonstrates that he or she exhibits no behaviors that warrant the denial or tennination of employment. § 435.06(2)(a)-(d), Florida Statutes (2020).

   12. Under Florida law, any employee who refuses to cooperate in such screening or refuses to timely submit the information necessary to complete the screening,. mcluding fingerprints if required, must be disqualified for employment in such position or. if employed, must be dismissed. § 435.06(3), Florida Statutes (2020).

   13. Also under Florida law, level 2 background screenmg must be conducted for staff, including staff contracted by the facility to provide services to residents, pursuant to §§ 408.809 and 429.174, Florida Statutes; Rule 59A-36.0l 0(2)(f), Florida Administrative Code.

   14. Florida law also provides that a person who serves as a cc,ntrolling interest of, is employed by, or contracts with a licensee on July 31, 2010, who has been screened and qualified according to standards specified ins. 435.03 ors. 435.04 must be rescreened by July 31, 2015, in compliance with the following schedule. If, upon rescreening, such per:--on has a disqualifying offense that was not a disqualifying offense at the time of the last scr, ening, but is a current disqualifying offense and was committed before the last screening, he c,r she may apply for an exemption from the appropriate licensing agency and, if agreed to by the employer, may continue to perform his or her duties until the licensing agency renders a decision on the application for exemption if the person is eligible to apply for an exemption and the exemption request is received by the agency within 30 days after receipt of the rescreening results by the person. The rescreening schedule shall be: (a) Individuals for whom the last screening was conducted on or before December 31, 2004, must be rescreened by July 31, 2013. (b) Individuals for whom the last screening conducted was between January l, 2005, and December

       
       

       31, 2008, must be rescreened by July 31, 2014. (c) Individuals for whom the last screening conducted was between January 1, 2009, through July 31, 2011, must be rescreened by July 31,

       2015. § 408.809(5), Florida Statutes (2020).

       
       

   15. Under Florida law, "Staff' means any individual employed by a facility, contracting with a facility to provide direct or indirect services to residents, or employed hy a firm under contract with a facility to provide direct or indirect services to residents when present in the facility. The term includes volunteers perfonning any service that counts toward meeting any staffing requirement of this rule chapter. Rule 59A-36.002(37), Florida Administrative Code.

   16. Under Florida law, "Employee" means any person required by law to be screened pursuant to this chapter, including, but not limited to, persons who are contractors, licensees, or volunteers. § 435.02(2), Florida Statutes (2020).

   17. On or about August 11, 2020, the Agency completed a survey of Respondent's facility.

       
       

   18. Based upon observation, interviews and the review of records.. Respondent failed to ensure that its staff had the required background screening or exemption for one (1) of eight (8) sampled staff (Staff E) whose responsibilities required providing personal care or who had access to residents' personal property or their living areas, the same being contrary to law.

   19. On August 3, 2020 at 12:08 p.m., maintenance tools were observed outside of Residents #10 and #11's room at Respondent's facility. There was an electronic miter saw in the kitchen next to the sliding door.

   20. During an interview on August 3, 3030 at 12:16 p.m., Staff B stated that Staff D and E did maintenance jobs at Respondent's facility but they also worked at other facilities owned by the same owner as that of Respondent's facility. Staff D and E moved between the facilities as needed.

       
       

   21. A review of the Agency's Background Screening Clearingho1.1,;e database showed that Staff E completed a level 2 background screening on July 2, 2019. Th results of that screening stated that Staff E was "not eligible."

   22. Staff E clearly had access to residents and their property.

       
       

   23. Providers are required to obtain and maintain such records as criminal history background screenings for Agency review in personnel records. See, Rule 59A-36.015(2)(a)(3), Florida Administrative Code.

   24. Respondent allowed an individual, in an employment or volunteer role, access to residents, their records, and property, without having first obtained a criminal history background check on the individual.

   25. The above reflects that Respondent failed to ensure that its staff had the required background screening or exemption for one (1) of eight (8) sampled staff (Staff E) whose responsibilities required providing personal care or who had acces , to residents' personal property or their living areas, the same being contrary to law.

   26. The Respondent's actions or inactions constituted a violation of§ 429.174 and 408.809, Florida Statutes (2020).

   27. 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 2 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, Pan .I, Section 408.809(1 ), or Chapter 435, Florida Statutes. § 429.14( 1 )(f), Florida Statutes (2020).

   28. Florida law also provides that 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 $500.00 if a facility is found not to be in compliance with the background screening requirements as provided in§ 408.809. § 429.19(2)(e), Florida Statutes (2020).

   29. 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. Unles otherwise specified by law, the amount of the fine may not exceed $500.00 for each violation. Unclassified violations include: Violating any provision of this part, authorizing statutes, or applicable rules. § 408.813(3 )(b), Florida Statutes (2020).

       WHEREFORE, the Agency seeks to impose an administrative fine of five hundred dollars ($500.00) against the Respondent.

       COUNT II

       
       

   30. The Agency re-alleges and incorporates paragraphs (I) through (:5) as if fully set forth herein.

   31. Florida law provides:

       
       

       1. No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to:

          1. Live in a safe and decent living environment, free from abuse and neglect.

          2. Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy.

          3. Retain and use his or her own clothes and other personal property in his or her immediate living quarters, so as to maintain individuality and personal dignity, except when the facility can demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other residents.

             
             

          4. Unrestricted private communication, including rece1vmg and sending unopened correspondence, access to a telephone, and visiting with any per ,on of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar situations.

          5. Freedom to participate in and benefit from community sennces and activities and to pursue the highest possible level of independence, autonomy, and interaction within the community.

          6. Manage his or her financial affairs unless the resident or, if applicable, the resident's representative, designee, surrogate, guardian, or attorney in fact authorizes the administrator of the facility to provide safekeeping for funds as prnvided ins. 429.27.

          7. Share a room with his or her spouse if both are residents of the facility.

          8. Reasonable opportunity for regular exercise several times a week and to be outdoors at regular and frequent intervals except when prevented by inclement weather.

          9. Exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, nor any attendance at religious services, shall be imposed upon any resident.

          (i) Assistance with obtaining access to adequate and appropriate health care. For purposes of this paragraph, the term "adequate and appropriate health care" means the management of medications, assistance in making appointments for health care services, the provision of or arrangement of transportation to health care appointments, and the perfonnance of health care services in accordance with s. 429.255 which are consistent with established and recognized standards within the community.

          1. At least 45 days' notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a _physician to require an emergency relocation to a facility providing a more skilled level of care or the resident engages in a pattern of conduct that is harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days' notice of a nonemergency relocation or residency termination. Reasons for relocation must be set forth in writing and provided to the resident or the resident's legal representative. The notice must state that the re ident may contact the State Long-Tenn Care Ombudsman Program for assistance with relocation and must include the statewide toll-free telephone number of the program. In order for a facility to terminate the residency of an individual without notice as prov11ded herein, the facility shall show good cause in a court of competent jurisdiction.

             1. Present grievances and recommend changes in policies, procedures, and services to the staff of the facility, governing officials, or any other person without restraint, interference, coercion, discrimination, or reprisal. Each facility shall establish a grievance procedure to facilitate the residents' exercise of this right. This right includes access to ombudsman volunteers and advocates and the right to be a member of, to be active in, and to associate with advocacy or special interest groups.

       2. The administrator of a facility shall ensure that a written notice of the rights, obligations, and prohibitions set forth in this part is posted in a prominent place in each facility and read or explained to residents who cannot read. The notice must include the statewide toll-free telephone number and e-mail address of the State Long-Term Care Ombudsman Program and the telephone number of the local ombudsman council, the

          
          

          Elder Abuse Hotline operated by the Department of Children and Families, and, if applicable, Disability Rights Florida, where complaints may be .lodged. The notice must state that a complaint made to the Office of State Long-Term Care Ombudsman or a local long-term care ombudsman council, the names and identities of the residents involved in the complaint, and the identity of complainants are kept confidential pursuant to s. 400.0077 and that retaliatory action cannot be taken against a resident for presenting grievances or for exercising any other resident right. The facility must ensure a resident's access to a telephone to call the State Long-Term Care Ombudsman Program or local ombudsman council, the Elder Abuse Hotline operated by the Department of Children and Families, and Disability Rights Florida.

          § 429.28(1) and (2), Florida Statutes (2020).

          
          

   32. Florida law further provides:

       
       

       (I )(a) A resident shall be given the option of using his or her own belongings, as space permits; choosing his or her roommate; and, whenever possible, unless the resident is adjudicated incompetent or incapacitated under state law, managing his or her own affairs.

       (b) The admission of a resident to a facility and his or her presence therein shall not confer on the facility or its owner, administrator, employees, or representatives any authority to manage, use, or dispose of any property of the resident; nor shall such admission or presence confer on any of such persons any authority or responsibility for the personal affairs of the resident, except that which may be necessary for the safe management of the facility or for the safety of the resident.

       § 429.27(1), Florida Statutes (2020).

       
       

   33. Florida law also states:

       
       

       (6) RESIDENT RIGHTS AND FACILITY PROCEDURES.

       1. A copy of the Resident Bill of Rights as described in section 429.28, F.S., or a summary provided by the Long-Term Care Ombudsman Program must be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to rule 59A-36.006, F.A.C.

       2. In accordance with section 429.28, F.S., the facility must have a written grievance procedure for receiving and responding to resident complaints and a written procedure to allow residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint.

       3. The telephone number for lodging complaints against a facility or facility staff must be posted in full view in a common area accessible to all residents. The telephone numbers are: the Long-Term Care Ombudsman Program, 1(888)831-0404; Disability Rights Florida, 1(800)342-0823; the Agency Consumer Hotline 1(888)419-3456, and the statewide toll-free telephone number of the Florida Abuse Hotline, 1(800)96-ABUSE or 1(800)962-2873. The telephone numbers must be posted in close proximity to a telephone accessible by residents and the text must be a minimum of 14-point font.

       4. The facility must have a written statement of its house rules and procedures that must

          
          

          be included in the admission package provided pursuant to rule 5,(JA-36.006, F.A.C. The rules and procedures must at a minimum address the facility's policies regarding:

          I. Resident responsibilities;

          1. Alcohol and tobacco use;

          2. Medication storage;

          3. Resident elopement;

          4. Reporting resident abuse, neglect, and exploitation;

          5. Administrative and housekeeping schedules and requirements...

          6. Infection control, sanitation, and universal precautions; and,

          7. The requirements for coordinating the delivery of services to residents by third party providers.

       5. Residents may not be required to perform any work in the facility without

          compensation. Residents may be required to clean their own sleepmg areas or apartments if the facility rules or the facility contract includes such a requirement. If a resident is employed by the facility, the resident must be compensated in compliance with state and federal wage laws.

       6. The facility must provide residents with convenient access to a telephone to facilitate the resident's right to unrestricted and private communication, pursuant to section 429.28(1 )(d), F.S. The facility must allow unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there must be, at a minimum, a readily access1 hie telephone on each floor of each building where residents reside.

       7. In addition to the requirements of section 429.4l(l)(k), F.S., the use of physical restraints by a facility on a resident must be reviewed by the resident's physician annually. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint.

       Rule 59A-36.007(6), Florida Administrative Code.

       
       

   34. On or about August 11, 2020, the Agency completed a survey of Respondent's facility.

       
       

   35. Based upon observation, interviews, and the review of records, Respondent failed to ensure that residents lived in a safe and decent living enviromnent, free from abuse and neglect, and were treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy, the same being contrary to the mandates of law. Specifically, Respondent's staff did not follow infection control precautions recommended by the Center for Disease Control and Prevention and the Florida Governor's emergency order, DEM Order, dated March 15, 2020 thereby failing to safeguard fifteen (15) of fifteen (15) sampled residents (Residents #1 - #15). Ten (10) residents were positive for COVID-19 (Residents #1, #2,

       
       

       #3, #4, #7, #8, #9, #10, #11, and #15) and were not isolated in the facility. Two (2) other residents (Residents #4 and #13) were hospitalized with symptoms of C OVID-19. Respondent's staff who were positive for COVID-19 provided care and services tc1 positive and negative COVID- I 9 residents and those staff members did not wear appropn ate personal protective equipment (PPE) to prevent cross-infection.

   36. The novel coronavirus SARS-coV-2/ COVID-19 is a transmissihle respiratory infection that presents severe risk to persons who are aged, infirm, or suffer from co-morbidities including, but not limited to, immune system deficiency, respiratory disease, diabetes, and obesity. See general(v, Publications of the Centers for Disease Control.

   37. On March I, 2020, the Governor of the State of Florida issued Executive Order 20-51 designating a Public Health Emergency as a result of COVID-19 and its impact. Pursuant to that authority, emergency orders have been issued by the Florida Division of Emergency Management to implement the protections necessary to assure the health, safety, and well-being of Florida's citizenry, including those most vulnerable to the effects of infection.

   38. The Agency for Health Care Administration (AHCA) has issued guidance and clarification on DEM Order 20-006 to providers, and on March 18, 2020, issued an alert notifying all homes that all staff or other individuals admitted to a residential facility must don face masks and that caregivers must wear gloves when providing re ident care. While the treatment and management of residents with infectious disease and the implementation of isolation precautions for such events are a long-standing health care issues faced by residential facilities, the ease of contagion and the effects of infection presented by COVID-19 mandate that providers exert meticulous practice and procedure to identify resident symptoms and take immediate prophylactic procedures to both assure appropriate treatment of a potentially infected

       
       

       resident and protect the remainder of a facility's population from th, risk of spread of the infection.

   39. A review of recommendations from the Centers for Disease Control (CDC) dated April 13, 2020 showed that if COVID-19 was identified or suspected in a resHlent of an assisted living facility, the resident should immediately be isolated in his/her room and the health department notified. The recommendations further stated that, "For situations where close contact between any (symptomatic or asymptomatic) resident cannot be avoided, personnel should at a minimum, wear eye protection (goggles or face shield) and an N95 or higher-level respirator (or a facemask if respirators are not available or personnel are not fit tested). Cloth face coverings are not PPE and should not be used when a respirator or facemask is indicated. personnel have direct contact with the resident, they should also wear gloves. If avai !able, gowns are also recommended but should be prioritized for activities where splashes or sprays are anticipated or high-contact resident-care activities that provide opportunities for transfi:r to pathogens to hands and clothing of personnel (e.g., dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, wound care).

   40. On July 31, 2020 at 8:00 a.m., Staff B greeted the Agency's representatives upon entering Respondent's facility. After being asked, Staff B stated she had tested positive for COVID-19 on July 14, 2020, and isolated for three (3) to four (4) days and then returned to work pursuant to the instructions of Respondent's Administrator. Staff B had not been tested again to confirm whether or not she was still positive prior to returning to work. Staff B was observed not wearing proper personal protective equipment. She was only wearing a surgical fr1ce mask and medical uniform. Staff B also mentioned that Staff C was assisting residents with self-administration of

       
       

       medication and preparing and serving breakfast to residents. She statc1i that residents who were positive and negative with COVID-19 shared the same dining table.

   41. On July 31, 2020 at 8:00 a.m., Staff B was observed providing care to residents that were both positive and negative for COVID-19. Further observation revealed that Staff C, who had also tested positive for COVID-19, was also providing care to residents. Despite Staff B and Staff C both being positive for COVID-19, they were providing assistance with activities of daily living (ADL) such as bathing, grooming, meal preparation, and assistance with self­ administration of medications.

   42. During the survey, residents were observed not maintaining social distancing of at least six (6) feet apart, and were not wearing any personal protective equipment.

   43. On July 31, 2020 at 8:05 a.m., Staff B stated she knew there were residents who had tested positive for COVID-19 but she did not know who those residents were. Staff B also said that there was no documentation in residents' files identifying which res:ident had tested positive since the results had not been received yet. Staff B admitted that even though she had provided assistance to the residents, she did not know which ones were positive for COVID-19.

   44. On July 31, 2020 at 9:05 a.m., COVID-19 test results were received via fax. A review of these records revealed that the "result" portion of the tests had been blocked out. Further review of the records indicated that there was no way to confirm which residents were positive or negative for COVID-19.

   45. During a telephone interview with Respondent's Administrator on July 31, 2020 at 9:05 a.m., she stated that the COVID-19 "results" portion of the test were blocked out due to how they were submitted by the State Health Department. In addition, the Administrator said that

       
       

       residents who tested positive had been isolated although she was nor able to identify those residents.

   46. On July 31, 2020 at approximately 9:45 a.m., a home health agency registered nurse arrived at Respondent's facility to administer the morning insulin to Resident #1. During the screening process, Staff B informed the nurse that the resident was COVID-19 positive. The nurse stated he did not know beforehand that the resident was positive. He told Staff B that he needed to call his home health agency about the situation, and he the11 proceeded to leave the facility. The nurse was only wearing a face mask.

   47. On August 3, 2020 at 11 :33 a.m., Staff B was observed opening the facility's door wearing a blue disposable face mask and gloves.

   48. During an interview on August 3, 2020 at 11:33 a.m., Staff B stated the facility's census was fifteen (15) residents but two (2) residents were at the hospital. Staff B added that nine (9) residents at the facility and two (2) staff members on duty tested positive to COVID-19. During a later interview on August 3, 2020 at 11:51 a.m., Staff B stated that she ,.i. ore a face shield when bathing the residents. She stated that she used a gown when she had to provide first aid care if someone bled, and during baths.

   49. On August 3, 2020 at 12:58 p.m., StaffB was observed putting on a face shield.

       
       

   50. On August 3, 3030 at 11 :39 a.m., three (3) face shields and two (2) packages of fifty (50) units each of blue disposable face masks were observed in the staffroom. There was one (1) box of one hundred (I 00) gloves in the living room. Later that same day at I :03 p.m., one (1) box with an original quantity of one hundred (100) gloves which was less than half full was observed on the wall next to the kitchen.

       
       

   51. During an interview on August 3, 2020 at 1:03 p.m., Staff C stakd she didn't know where more gloves were kept.

   52. A review of COVID-19 test results for residents showed that the laboratory detected COVID-19 in Residents #1, #3, #4, #7, #9, and #11 on July 28, 2020.

   53. Resident #1's health assessment (AHCA Fonn 1823) completed on January 17, 2019, showed a history and diagnoses of hypertension, cerebrovascular accident, muscle weakness, diabetes mellitus type II, and hyperlipidemia.

   54. Resident #1's subsequent COVID-19 test result showed the resident again tested positive on August 3, 2020.

   55. Resident #2's health assessment (AHCA Form 1823) completed on January 28, 2020, showed a medical history and diagnoses of coronary artery disease, hypertension, non-insulin dependent diabetes mellitus, and gastritis. The resident required fall precautions.

   56. Resident #2's COVID-19 test result showed the resident tested positive on August 3, 2020.

   57. Resident #3's health assessment (AHCA Form 1823) completed on October 7, 2019, showed a medical history and diagnoses of heart failure, gastroesophageal reflux disease, and chronic obstructive pulmonary disease.

   58. Resident #3's subsequent COVID-19 test result showed the resident again tested positive on August 3, 2020.

   59. Resident #4's health assessment (AHCA Form 1823) completed on an unknown date, showed a medical history and diagnoses of schizoaffective disorder, severe neurocognitive impairment, hypertension, and hypothyroidism.

       
       

   60. Resident #4's COVID-19 test result showed the resident tested p,:)sitive on July 28, 2020.

       
       

       Resident #4 was subsequently sent to a local hospital on August 2, 202U because the resident did not want to eat and had shortness of breath.

   61. Resident #S's COVID-19 test result showed the resident tested negative on August 3, 2020.

   62. Resident #6's health assessment (AHCA Form 1823) completed on May 13, 2020, showed a medical history and diagnoses of chronic obstructive pulmonary disease, diabetes mellitus, hypertension, seizures, anxiety, chronic embolism and thrombosis. The resident required seizure precautions.

   63. Resident #6's COVID-19 test result showed the resident tested negative on August 3, 2020.

   64. Resident #7's health assessment (AHCA Fonn 1823) showed ,1 medical history and diagnoses of cutaneous B-cell lymphoma; hypertension; diabetes m::l litus; end stage renal disease; anemia of chronic disease; diabetic retinopathy; legally blind right eye; and septic embolic brain, lungs and pancreas. The resident received dialysis three (3) times a week and needed assistance with ambulation, bathing, dressing, and transferring.

   65. Resident #7's subsequent COVID-19 test result showed the res11dent tested positive on August 3, 2020.

   66. Resident #8's health assessment (AHCA Form 1823) completed on December 18, 2019, showed a medical history and diagnoses of hypothyroidism, glaucoma, hypertension, osteoarthritis, and schizophrenia. Resident #8 required assistance with self-administration of medication and suffered from behavior changes and loss of memory. The resident tested positive for COVID-19 on June 3, 2020.

       
       

   67. Resident #S's COVID-19 test result showed the resident tested positive on August 3, 2020.

   68. Resident #9's health assessment (AHCA Form 1823) completed on July 18, 2019, showed a medical history and diagnoses of acute gastroenteritis, hypertension, seizure, and dementia. The resident required total care for bathing and dressing and supervision for ambulation, eating, self-care, and toileting.

   69. A review of Resident #9's COVID-19 test result showed the resident tested positive on July 28, 2020. Resident #9's subsequent COVID-19 test result showed the resident again tested positive on August 3, 2020.

   70. Resident #lO's COVID-19 test result showed the resident tested positive on August 3, 2020.

   71. Resident #11 's health assessment (AHCA Form 1823) completed on March 28, 2017, showed a medical history and diagnoses of cardiomyopathy, hypertension, hyperlipidemia, dermatitis and dementia.

   72. Resident #11's subsequent COVID-19 test result showed the resident tested positive on August 3, 2020.

   73. Resident #12's health assessment (AHCA Form 1823) completed on November 14, 2017, showed a medical history and diagnoses of schizophrenia, hypertension, leukocytosis, circumstantial delusions, and limited insight.

   74. Resident #l 2's COVID-19 test result showed the resident tested negative on August 3, 2020.

   75. Resident #13's health assessment (AHCA Form 1823) completed on July 8, 2020, showed a medical history and diagnoses of major neurocognitive disorder, hyperlipidemia,

       
       

       seizures, type 2 diabetes, history of alcohol use disorder, and hypertension. Respondent sent Resident #13 to a local hospital July 25, 2020 after the resident had symptoms of shaking and diarrhea for five (5) days.

   76. Resident #14's health assessment (AHCA Form 1823) completed on March 22, 2018, showed a medical history and diagnoses of with hypertension, seizure disorder, major depression, anxiety, history of cardiovascular accident, impulse control disorder, hyperlipidemia, dementia, and right side hemiparesis. The resident required fall precaution: .

   77. Resident #l 4's COVID-19 test result showed the resident tested negative on August 3, 2020.

   78. Resident #l 5's health assessment (AHCA Form 1823) completed on December 3, 2018, showed a medical history and diagnoses of hypertension, benign prostatic hyperplasia, thyroid disease, Alzheimer's disease, depression, insomnia, chronic obstructi,e pulmonary disease, gastroesophageal reflux disease, seizure, and hyperlipidemia.

   79. Resident #l 5's COVID-19 test result showed the resident testedl positive on August 3, 2020.

   80. During an interview on August 3, 2020 at 11:36 a.m., Staff B stated that Residents #5, #6, #12, and #14 tested negative for COVID-19. Staff B added that Respondent's staff helped Residents #12 and #14 with bathing and medications and Resident #6 received assistance with self-administration of medications. Resident #5 was an "independent living" resident and Respondent's staff cooked and served that resident's food. Staff B later slated that Staff B and C provided care and services to all the residents as they needed and also assisted the residents with their medications.

       
       

   81. On August 3, 2020 at 11:33 a.m. and again at 11:52 a.m., Resident #2 was observed walking down the hallway from the back of the facility to Room #1 wlllle wearing a face mask covering the resident's mouth and chin.

   82. On August 3, 2020 at 12:03 p.m., Residents #9 and #12 were observed sitting less than six (6) feet apart from each other while watching television in the TV room. Resident #9 did not wear a face mask and the resident's mouth and nose were exposed. Resident #12 wore a face mask that covered the mouth and chin.

   83. During an interview on August 3, 2020 at 11:38 a.m., Staff B stated that Respondent's staff did their best to disinfect bathrooms after someone used it. At 11:50 a.m., Staff B added that the residents and staff who were positive and negative for COVID-19 shared the same bathrooms.

   84. On August 3, 2020 at 11:52 a.m., Resident #5 was observed walking into one of the bathrooms across from room #3. Resident #5 exited the bathroom at 11:5J a.m. Staff B emptied into the toilet a half-full urinal that the resident had brought, then rinsed the urinal in the sink. Further observation revealed that no one cleaned or disinfected the bathroom after the resident used it. Staff B was not observed changing her gloves or washing her hands. Staff B continued walking throughout the facility with visitors while Staff C was in the kitchen area.

   85. During an interview on August 3, 2020 at 11:54 a.m., Staff B stated Residents #6 and #7 used to share room #4. Residents #5 and #6 tested negative for COVID-19 while Resident #7 tested positive for COVID-19 during the last round of tests. The facility decided to leave Resident #7 sleeping alone in room #4 while Resident #6 shared room #3 with Resident #5 during sleeping times. Resident #6's personal belongings remained in the room occupied by

       
       

       Resident #7. Staff B collected what Resident #6 needed and brought tr1cm to the resident's new sleeping room.

   86. During an interview on August 3, 2020 at 12:21 p.m., Staff B stated that Staff F gave her COVID-19. Staff F informed Staff B that the method of transmission of COVID-19 was through saliva and contact. Staff B later added that she had a runny nose and body pain around one (I) week before she had the COVID-19 test done but she continued working At 1 :07 p.m. that same day, Staff B added she knew she was positive for COVID-19 on a Suncl a y and did not work the following Monday, Tuesday, and Wednesday and then returned to work on Thursday. At 3:31

       p.m. that day, Staff B also stated she returned to worked after three (3) days off because Respondent's Administrator called her and asked her to return to work. The staff did not see her doctor (health care provider) after testing positive for COVID-19. Staff B also stated she did not have a negative COVID-19 test after testing positive. Staff B stated she checked the residents' temperature. She did not feel comfortable delegating the temperature checks to Staff C because Staff C was new working at the facility. Staff B revealed that the Administrator and Staff F provided her infection control training and COVID-19 training. She was instructed that if someone had a fever, the temperature was 40 or higher degrees Celsius c,r 104 or higher degrees Fahrenheit.

   87. During an interview on August 3, 2020 at 12:23 p.m., Staff C stated she knew and learned from the news on the television what to check for in residents as possible symptoms of COVID-19. Staff C started to work at Respondent's facility around July 8, 2020 and had a negative COVID-19 test at that time. Her duties included preparing and serving food, doing the laundry, and providing housekeeping to the residents and the "independent living" residents.

       Staff C added that she assisted all the residents with self-assistance of m1:dication at bedtime and with ambulation and transferring, as needed.

   88. Staff C said she was extremely tired around July 10, 2020 whil c working at the facility and this was around one (I) week before staff were tested for COVID- l 9. Staff C said that she continued working and caring for the residents at the facility while she felt sick. During a subsequent interview on August 3, 2020 at 3:34 p.m., Staff C stated she did not work for approximately four (4) days after finding out that she tested positive for COVID-19. She said that after that, Staff H called her and asked her to return to work becaust:: the facility did not have staff. Staff C further stated that she felt extremely tired during the interview.

   89. During an interview on August 3, 3030 at 1:05 p.m., Staff B stated that Residents #1 and #7 received nursing services from at least three (3) different nurses from two (2) different home health agencies. Staff B further stated that the regularly assigned home health agency registered nurse for Resident #1 (Registered Nurse A) had a sick family member and a different nurse provided services to that resident.

   90. A review of Respondent's records showed there was no documentation indicating that Respondent screened any of the home health agency nurses after July 31, 1020.

   91. During an interview on August 3, 2020 at 11:47 a.m., Staff B stated the facility sent Resident #4 to a local hospital the previous afternoon (August 2, 2020) because the resident did not want to eat and had shortness of breath. At 12:02 p.m., Staff B said that Respondent sent Resident #13 to a local hospital July 25, 2020 after the resident had been shaking and having diarrhea for five (5) days.

   92. Respondent's records showed there was no documentation indicating the facility continuously monitored residents for signs and/or symptoms of COVID-19. Respondent's

       facility documented the residents' temperature on June 26, 2020, July S, 2020, July 19, 2020,

       
       

       July 30, 2020, July 31, 2020, and August 3, 2020.

       
       

   93. During an interview on August 3, 2020 at 12:10 p.m., Staff B stat d she did not work on Saturday or Sunday (August 1 and 2, 2020). Staff B added she checked the residents' temperature for the rest of missing dates, but she forgot to document them.

   94. During an interview on August 4, 2020 at 1:27 p.m., the Admirnstrator stated that staff received COVID-19 training and infection control training. She stated that Staff G, who had been sick with COVID-19 for three (3) weeks, provided this "extensive training." The Administrator stated that staff at the facility had plenty of supplies.

   95. During an interview on August 4, 2020 at 1:31 p.m., the Administrator stated she had the missing temperature logs and screening logs with her at her house. The Administrator took them with her because the facility was disorganized. She would find out about the missing logs.

   96. During a telephone interview on August 4, 2020 at 4:16 p.m., Rtgistered Nurse A stated that she took care of one (1) resident, and that she was informed of the resident's COVID -19 positive status on August 1, 2020 by the manager. She further stated tha1 when she took care of COVID-19 positive residents, she wore the following personal protective equipment: face shield, mask, and gloves. She also stated that she provided nursing services at ·villa Serena 1, 3, 4, and 6.

   97. On August 5, 2020 at 3:45 p.m., Staff B stated that the resident census was thirteen (I 3),

       
       

       and she was the only staff at the facility that was assisting with the residents' needs. She stated that Staff C, who had been experiencing symptoms of exhaustion related to her COVID-19 positive status during the survey on August 3, 2020, had become worse and could not come to work. Staff B further stated that residents did not like to wear their face masks.

   98. On August 5, 2020 at 3:45 p.m., two (2) residents were observed in the hallway.

       
       

       Resident #1, who was positive for COVID-19, was sitting in a wheelchair and requested assistance with a bath. The resident was wearing a surgical face mask below the chin; it was not covering the resident's mouth and nose. Resident #12 was observed pushing Resident #l's wheelchair. Resident #12 had tested negative for COVID-19. Resident #12 was not wearing a face mask. Also, residents #9 and #11 were observed in the television area sitting next to each other. Resident #9 was not wearing a face mask and Resident #11 was wearing a surgical face mask.

   99. The above reflects that Respondent failed to ensure that residents lived in a safe and decent living environment, free from abuse and neglect, and were treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy, the same being contrary to the mandates of law. Specifically, Respondent's staff did not follow infection control precautions recommended by the Center for Disease Control and Prevention and the Florida Governor's emergency order, DEM Order, dated March 15, 2020 thereby failing to safeguard fifteen (15) of fifteen (15) sampled residents (Residents #1 - #15). Ten (10) residents were positive for COVID-19 (Residents #1, #2, #3, #4, #7, #8, #9, #10, #11, and #15) and were not isolated in the facility. Two (2) other residents (Residents #4 and #13) were hospitalized with symptoms of COVID-19. Respondent's staff who were positive for COVID-19 provided care and services to positive and negative COVID-19 residents and those staff members did not wear appropriate personal protective equipment to prevent cross-infection.

   IO I. The Agency determined that this deficient practice was a condition or occurrence 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.

   
   

   1. The Agency cited the Respondent for a Class I violation in accurdance with applicable statutes and authorizing rules.

   2. That the same constitutes a Class I offense as defined in § 408.8 l 3(2)(a), Florida Statutes (2020).

      WHEREFORE, the Agency intends to impose an administrati vc fine in the amount of ten thousand dollars ($10,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to§ 429. l 9(2)(a), Florida Statutes (2020).

      COUNT III

      
      

   3. The Agency re-alleges and incorporates paragraphs (1) through ( 5) and Counts I and II above as if fully set forth herein.

   4. Under Florida law:

      
      

      1. 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 v:1olation of any provision of this part, part II of chapter 408, or applicable rules, or for any of the following actions by a licensee, any person subject to level 2 background screenmg under s. 408.809, or any facility staff:

         (a) An intentional or negligent act seriously affecting the health. safety, or welfare of a resident of the facility ...

         (e) A citation for any of the following violations as specified in s. 429.19:

         1. One or more cited class I violations.

         2. Three or more cited class II violations.

         3. Five or more cited class III violations that have been cited on a single survey and have not been corrected within the times specified.

         (t) Failure to comply with the background screening standards of this part, s. 408.809(1), or chapter 435 ...

         (h) Failure of the license applicant, the licensee during relicensure, or a licensee that holds a provisional license to meet the minimum license requirements of this part, or related rules, at the time of license application or renewal ...

         (k) Any act constituting a ground upon which application for a license may be denied.

         § 429.14(l)(a), (e), (t), (h), and (k), Florida Statutes (2020).

         
         

   5. Florida law also provides that:

   1. In addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest:

      1. False representation of a material fact in the license application or omission of any material fact from the application.

      2. An intentional or negligent act materially affecting the health or safety of a client of the provider.

      3. A violation of this part, authorizing statutes, or applicable rnks ...

   § 408.815(l)(a)-(c), Florida Statutes (2020).

   
   

   I 07. That Respondent has been cited with one (1) Class I violation of law on a single survey as set forth in Count II which constitutes independent grounds for the revocation of Respondent's licensure as an assisted living facility pursuant to § 429.14(1 )(e)(1), Florida Statutes (2020).

   108. Respondent has also been cited for failure to comply with background screening standards of Chapter 429, Part I, s. 408.809 (1), or Chapter 435 as set fonh in Count I by failing to have eligible level 2 background screenings for all staff. The foregoing violation reflecting Respondent's failure to comply with the background screening standards of Chapter 429, Part I,

   1. 408.809 (I), or chapter 435, constitutes independent grounds for the revocation of Respondent's licensure as an assisted living facility.

      I 09. That Respondent has engaged in intentional or negligent acts seriously and/or materially affecting the health, safety or welfare of a resident of the facility which establishes grounds upon which an application for a license may be denied as set forth in§§ 429.14(l)(a) and 408.815(1 )(b) Florida Statutes (2020).

      1. That Respondent's actions and/or inactions as set forth above constitute a ground upon which application for a license may be denied under § 429.14(1)(k), Flonda Statutes (2020).

      2. That Respondent has violated the minimum requirements of law of Chapters 429, Part II; Chapter 408, part II (including § 408.815(l)(b) and (c), Florida Statutes (2020); and Chapter 59A-36, Florida Administrative Code as described with particularity within this complaint.

      3. That Respondent has a duty to maintain its operations in accc,rd with the minimum requirements of law and to provide care and services at mandated minimum standards. That based thereon, individually and collectively, the Agency seeks the revocation of the Respondent's licensure.

      WHEREFORE, the Agency intends to revoke the license of the Respondent to operate an assisted living facility in the State of Florida.

      Respectfully submitted this"2.5#xJa;i of August 2020.

      
      

      STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      
      

      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 delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 412-3630.

      CERTIFICATE OF SERVICE

      
      

      I HEREBY CERTIFY that a true and correct copy of the foregrn ng has been served by

      U.S. Certified Mail, Return Receipt No. 7019 2970 0001 3240 6689 on August..<$11 2020 to Roxana Solano, Administrator and Registered Agent, Villa Serena II Inc, 60 Northwest 33rd Avenue, Miami, Florida 33125-492 I.

      
      

      Copy furnished to Arlene Mayo Davis Field Office Manager

      Agency for Health Care Administration

      STATE OF FLORIDA

      AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      Re: Villa Serena II Inc

      AHCA No. 2020014305

      
      

      ELECTION OF RIGHTS

      
      

      This Election of Rights form is attached to an Administrative Complaint. The Election of Rights form may be returned by mail or by facsimile transmission, but must be filed with the Agency Clerk within 21 days by 5:00 p.m., Eastern Time, of thE' day that you received the Administrative Complaint. If your Election of Rights form with your selected option (or request for hearing) is not timely received by the Agency Clerk, the right to an administrative hearing to contest the proposed agency action will be waived and an adverse Final Order will be issued. In addition, please send a copy of this form to the attorney of record who issued the Administrative Complaint.

      
      

      (Please use this form unless you, your attorney or your qualified representative prefer to reply according to Chapter120, Florida Statutes, and Chapter 28, Florida Administrative Code.) The address for the Agency Clerk is:

      
      

      Agency Clerk

      Agency for Health Care Administration

      2727 Mahan Drive, Building #3, Mail Stop #3

      Tallahassee, Florida 32308

      Telephone: 850-412-3630 Facsimile: 850-921-0158

      
      

      PLEASE SELECT ONLY 1 OF THESE 3 OPTIO S

      
      

      OPTION ONE (1) Iwaive the right to a hearing to contest the allegations of fact and conclusions of law contained in the Administrative Complaint. I 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 fine, sanction or other agency action.

      
      

      OPTION TWO (2) I admit the allegations of fact contained in the Administrative

      Complaint, but I wish to be heard at an informal hearing (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, sanction or other agency action should be reduced.

      
      

      OPTION THREE (3) I dispute the allegations of fact contained 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 No1: 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 (1 f your receipt of this proposed agency action. The request for fonnal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it co main:

      
      

      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 R1.ghts to the Agency for Health Care Administration on behalf of the licensee referred to above.

      
      

      Signed: Date:

      
      

      Print Name: Title: _

      
      

      STATE OF FLORIDA

      AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

      
      

      Petitioner,

      
      

      vs.

      
      

      VILLA SERENA III, INC.

      d/b/a VILLA SERENA Ill

      
      

      Respondent.

      I

      ADMINISTRATIVE COMPLAINT

      
      

      Case No.: 2020016306

      License No.: 10792 Facility Type: ALF

      
      

      COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Villa Serena IIJ, Inc. d/b/a Villa Serena III ("Respondent"), pursuant to

      §§ 120.569 and 120.57, Florida Statutes (2020), and alleges:

      
      

      NATURE OF THE ACTION

      
      

      This is an action against an assisted living facility to revoke Respondent's assisted living facility license pursuant to §§ 408.815 and 429.14, Florida Statutes (2020), and to impose an administrative fine of twenty thousand dollars ($20,000.00) based on two (2) Class I deficient practices.

      JURISDICTION AND VENUE

      
      

      1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2020).

      2. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code.

         
         

         EXHIBIT 3

         
         

         PARTIES

         
         

      3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes, and rules governing assisted living facilities pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes, and Chapter 59A-36, Florida Administrative Code, respectively.

      4. Respondent operates a thirteen (13) bed assisted living facility located at 1777 NW 30 Street, Miami, Florida 33142 and is licensed as an assisted living facility, license number I 0792.

      5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

         COUNTI

         
         

      6. The Agency re-alleges and incorporates paragraphs (I) through ( 5) as if fully set forth herein.

      7. Florida law provides:

         
         

         1. No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Fl01ida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to:

            1. Live in a safe and decent living environment, free from abuse and neglect.

            2. Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy.

            3. Retain and use his or her own clothes and other personal property in his or her immediate living quarters, so as to maintain individuality and personal dignity, except when the facility can demonstrate that such would be unsafe. impractical, or an infringement upon the rights of other residents.

            4. Unrestricted private communication, including receiving arid sending unopened correspondence, access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar situations.

            5. Freedom to participate in and benefit from community services and activities and to pursue the highest possible level of independence, autonomy, and interaction within the community.

               
               

            6. Manage his or her financial affairs unless the resident or, if applicable, the resident's representative, designee, surrogate, guardian, or attorney in fact authorizes the administrator of the facility to provide safekeeping for funds as provided ins. 429.27.

            7. Share a room with his or her spouse if both are residents of the facility.

            8. Reasonable opportunity for regular exercise several times a week and to be outdoors at regular and frequent intervals except when prevented by inclement weather.

            9. Exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, nor any attendance at religious services, shall be imposed upon any resident.

            10. Assistance with obtaining access to adequate and appropriate health care. For purposes of this paragraph, the term "adequate and appropria1 c health care" means the management of medications, assistance in making appointments for health care services, the provision of or arrangement of transportation to health care appointments, and the performance of health care services in accordance with s. 429.255 which are consistent with established and recognized standards within the community.

            11. At least 45 days' notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a physician to require an emergency relocation to a facility providing a more skilled level of care or the resident engages in a pattern of conduct that is harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days' notice of a nonemergency relocation or residency termination. Reasons for relocation must be set forth in writing and provided to the resident or the resident's legal representative. The notice must state that the resident may contact the State Long-Term Care Ombudsman Program for assistance wilh relocation and must include the statewide toll-free telephone number of the program. In order for a facility to tenninate the residency of an individual without notice as provided herein, the facility shall show good cause in a court of competent jurisdiction.

                1. Present grievances and recommend changes in policies, procedures, and services to the staff of the facility, governing officials, or any other pc:rson without restraint, interference, coercion, discrimination, or reprisal. Each facility shall establish a grievance procedure to facilitate the residents' exercise of this right. This right includes access to ombudsman volunteers and advocates and the right to be a member of, to be active in, and to associate with advocacy or special interest groups.

                2. The administrator of a facility shall ensure that a written notice of the rights, obligations, and prohibitions set forth in this part is posted in a prominent place in each facility and read or explained to residents who cannot read. The notice must include the statewide toll-free telephone number and e-mail address of the State Long-Term Care Ombudsman Program and the telephone number of the local ombudsman council, the Elder Abuse Hotline operated by the Department of Children and Families, and, if applicable, Disability Rights Florida, where complaints may be lodged. The notice must state that a complaint made to the Office of State Long-Term Care Ombudsman or a local long-term care ombudsman council, the names and identities of the residents involved in the complaint, and the identity of complainants are kept confidential pursuant to s. 400.0077 and that retaliatory action cannot be taken against a resident for presenting grievances or for exercising any other resident right. The facility must ensure a resident's access to a telephone to call the State Long-Term Care Ombudsman Program or local

                   
                   

                   ombudsman council, the Elder Abuse Hotline operated by tht Department of Children and Families, and Disability Rights Florida.

                   § 429.28(1) and (2), Florida Statutes (2020).

                   
                   

      8. Florida law further provides:

         
         

         (1)(a) A resident shall be given the option of using his or her own belongings, as space permits; choosing his or her roommate; and, whenever possible, unless the resident is adjudicated incompetent or incapacitated under state law, managing his or her own affairs.

         (b) The admission of a resident to a facility and his or her presence therein shall not confer on the facility or its owner, administrator, employees, or representatives any authority to manage, use, or dispose of any property of the resident; nor shall such admission or presence confer on any of such persons any authority or responsibility for the personal affairs of the resident, except that which may be necessary for the safe management of the facility or for the safety of the resident.

         § 429.27{1 ), Florida Statutes (2020).

         
         

      9. Florida law also states:

      
      

      (6) RESIDENT RIGHTS AND FACILITY PROCEDURES.

      1. A copy of the Resident Bill of Rights as described in section 429.28, F.S., or a summary provided by the Long-Term Care Ombudsman Program must be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to rule 59A-36.006, F.A.C.

      2. In accordance with section 429.28, F.S., the facility must have a written grievance procedure for receiving and responding to resident complaints and a written procedure to allow residents to recommend changes to facility policies and procedures. The facility must be able to demonstrate that such procedure is implemented upon receipt of a complaint.

      3. The telephone number for lodging complaints against a facility or facility staff must be posted in full view in a common area accessible to all residents. The telephone numbers are: the Long-Term Care Ombudsman Program, 1(888)831-0404; Disability Rights Florida, 1(800)342-0823; the Agency Consumer Hotline 1(888)419-3456, and the statewide toll-free telephone number of the Florida Abuse Hotline, I (800)96-ABUSE or 1(800)962-2873. The telephone numbers must be posted in close proximity to a telephone accessible by residents and the text must be a minimum of 14-point font.

      4. The facility must have a written statement of its house rules and procedures that must be included in the admission package provided pursuant to rule 59.A-36.006, F.A.C. The rules and procedures must at a minimum address the facility's policies regarding:

         1. Resident responsibilities;

         2. Alcohol and tobacco use;

         3. Medication storage;

         4. Resident elopement;

         5. Reporting resident abuse, neglect, and exploitation;

         6. Administrative and housekeeping schedules and requirements;

            
            

         7. Infection control, sanitation, and universal precautions; and,

         8. The requirements for coordinating the delivery of services to residents by third party providers.

      5. Residents may not be required to perform any work in the facility without compensation. Residents may be required to clean their own sleeping areas or apartments if the facility rules or the facility contract includes such a requirement. If a resident is employed by the facility, the resident must be compensated in compliance with state and federal wage laws.

      6. The facility must provide residents with convenient access to a telephone to facilitate the resident's right to unrestricted and private communication, pursuant to section 429.28(1 )(d), F.S. The facility must allow unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there must be, at a minimum, a readily accessible telephone on each floor of each building where residents reside.

      7. In addition to the requirements of section 429.41(1)(k), F.S., the use of physical restraints by a facility on a resident must be reviewed by the resident's physician annually. Any device, including half-bed rails, which the resident hooses to use and can remove or avoid without assistance, is not considered a physical restraint.

      Rule 59A-36.007(6), Florida Administrative Code.

      
      

      I 0. On or about September 15, 2020, the Agency completed a survey of Respondent's facility.

      1. Based upon observation, interviews, and the review of records.. Respondent failed to ensure that residents lived in a safe and decent living environment, free from abuse and neglect, and were treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy, the same being contrary to the mandates of law. Specifically, Respondent failed to follow current infection control standards from the Centers for Disease Control and Prevention (CDC) related to COVID-19 (Coronavirus Disease 2019) and Florida Governor's emergency orders DEM Order 20-006, dated March 15, 2020. Seven (7) residents tested positive for the COVID-19 disease (Residents #1, #2, #3. #4, #5, #6, and #7) following Staff A testing positive. Respondent further placed residents at risk of exposure to the COVID-19 virus by having positive Staff A caring for negative COVID-19 residents (Residents #8, #9, #10, #11, and #12). Respondent also failed to regard the privacy needs of two (2) of

         
         

         seven (7) sampled residents (Resident #IO and #11). Emergency supplies for the facility were stored in these residents' room, and Resident #IO used a bedside urinal in full view of Resident #11.

      2. The novel coronavirus SARS-coV-2/ COVID-19 is a transmissible respiratory infection that presents severe risk to persons who are aged, infinn, or suffer from Lo-morbidities including, but not limited to, immune system deficiency, respiratory disease, diabetes, and obesity. See generally, Publications of the Centers for Disease Control and Prevention.

      3. On March 1, 2020, the Governor of the State of Florida issued Executive Order 20-51 designating a Public Health Emergency as a result of COVID-19 and its 11npact. Pursuant to that authority, emergency orders have been issued by the Florida Division of Emergency Management to implement the protections necessary to assure the health. safety, and well-being of Florida's citizenry, including those most vulnerable to the effects of infection. Among those emergency orders was DEM Order 20-006, dated March 15, 2020, delineating minimum screening standards for persons entering identified residential facilities.

      4. The Agency for Health Care Administration (AHCA) has issued guidance and clarification on DEM Order 20-006 to providers, and on March 18, 2020, issued an alert notifying all homes that all staff or other individuals admitted to a residential facility must don face masks and that caregivers must wear gloves when providing res11dent care. While the treatment and management of residents with infectious disease and 1!he implementation of isolation precautions for such events are a long-standing health care issues faced by residential facilities, the ease of contagion and the effects of infection presented by COVID-19 mandate that providers exert meticulous practice and procedure to identify resident symptoms and take immediate prophylactic procedures to both assure appropriate treatment of a potentially infected

         
         

         resident and protect the remainder of a facility's population from the risk of spread of the infection.

      5. The Centers for Disease Control and Prevention referred to the high risk of COVID-19 spread to residents of assisted living facilities and stated: "Given their congregate nature and population served, assisted living facilities (ALF) are at high risk of COVID-19 spreading and affecting their residents. If infected with SARS-CoV-2 (Severe Acu1c Respiratory Syndrome Coronavirus 2), the virus that causes COVID-19, assisted living residenb-often older adults with underlying chronic medical conditions-are at increased risk of serious illness."

      6. A review of recommendations from the Centers for Disease Control and Prevention dated April 13, 2020 showed that if COVID-19 was identified or suspected in a resident of an assisted living facility, the resident should immediately be isolated in his/her room and the health department notified. The recommendations further stated that, "For situations where close contact between any (symptomatic or asymptomatic) resident cannot he avoided, personnel should at a minimum, wear eye protection (goggles or face shield) and an N95 or higher-level respirator (or a facemask if respirators are not available or personnel are not fit tested). Cloth face coverings are not PPE and should not be used when a respirator or f1cemask is indicated. If personnel have direct contact with the resident, they should also wear gloves. If available, gowns are also recommended but should be prioritized for activities where splashes or sprays are anticipated or high-contact resident-care activities that provide opportunities for transfer to pathogens to hands and clothing of personnel (e.g., dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, wound care).

         
         

      7. On September 15, 2020 at 7:10 a.m., Staff A and Staff B were observed wearing surgical masks and gloves.

      8. On September 15, 2020 at 7:10 a.m. Staff A, the House Manager, stated that seven (7) residents were at an isolation center due to being positive for COVID-19. Staff A further stated the virus fl got into the facility through the staff, fl but said there were: no positive or suspected cases of COVID-19 with staff or residents at this time.

      9. A review of the House Manager's job description showed that the House Manager was responsible for "making sure that things were done correctly" ,vith regard to cleaning, organizing, maintenance and medications, including reordering, documenting, receiving and organizing medications. The House Manager was also required to ensure that "all processes from DOH [the Department of Health] are being followed'" and that Respondent complied with regulations from the Agency and the Department of Health. The House Manager was responsible for establishing and implementing residents' care plans.

      10. Staff A was observed on September 15, 2020 from 7:30 a.rn. to around 10:30 a.m. assisting residents with medication, ambulation, and meals, and also cleaning the facility.

      11. During an interview on September 15, 2020 at 9:50 a.m., the Compliance Manager stated that all resident rooms were professionally disinfected and sanitized on August 23, 2020.

      12. A review of COVID-19 test results of Respondent's staff showed tl1at Staff B and Staff D tested positive for COVID-19 on August 23, 2020. Further review revealed that Staff A tested positive for COVID-19 on August 24, 2020.

      13. During an interview on September 15, 2020 at 8:03 a.m., Staff A stated that she returned to work on August 31, 2020, six (6) days after her positive diagnosis for COVID-19. Further review of Respondent's staffs COVID-19 test results showed that Staff A was listed as "on

          
          

          vacation" from August 24, 2020 through August 30, 2020. Starting on August 31, 2020, Staff A signed in for work and documented her absence of symptoms.

      14. The Centers for Disease Control and Prevention on Septe1nber 15, 2020, provides guidelines for healthcare professionals to return to work. Specifically, ''healthcare professionals who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test."

      15. During an interview on September 15, 2020 at 8:03 a.m., Staff A stated that "if you are asymptomatic you can come back to work. You don't have to wait 10 days.11

      16. During an interview on September 15, 2020 at 8:42 a.m., the Compliance Manager stated that Staff A cared for all of the residents in the facility. The Compliance Vianager further stated that Staff A worked Monday through Saturday from 7:00 a.m. to 5:30 p.m.

      17. A review of Respondent's COVID-19 binder revealed Staff A had a handwritten document dated August 15, 2020 or August 25, 20202 that appeared to be a negative IGG and IGM Antibody test result. The document was not signed by a physician or laboratory personnel. The dates appeared to be changed and the numbers were written over. Printed material on the test result stated, "The form documents these rapid results are part of a clinical study and are for research purposes only. You should not use these results as an indication of your current state of health. If you have or suspect you may have SARS-COVID 19 please follow up with your primary care provider.11 There was no documentation that Staff A followed up with her primary care provider.

      18. Further review of Respondent's COVID-19 binder revealed that seven (7) residents,

          
          

          Resident #1, #2, #3, #4, #5, #6, and #7 tested positive for COVID-19 on August 27, 2020, three

          
          

          1. days after Staff A received a positive test result.

          
          

      19. During an interview on September 15, 2020 at 9:36 a.m., Respondent's Compliance Manager stated that Residents #1, #2, #3, #4, #5, #6, and #7 tested positive for COVID-19 on August 27, 2020 and were sent to Miami Care Center-Isolation to quarantine on August 28, 2020.

      20. The certificate of disinfection and sanitization produced by Respondent had an effective date of August 23, 2020, and an expiration of August 30, 2020. There was no documentation of the disinfection of Respondent's facility after August 27, 2020 when Residents #1 through #7 tested positive for COVID-19.

      21. During an interview on September 15, 2020 at 9:45 a.m., the Compliance Manager stated that after Staff A tested positive, she provided a negative result, so she thought Staff A could return to work. The Compliance Manager further stated that she was confused about when the staff could return to work.

      22. On September 15, 2020 at 7:30 a.m., Staff B was observed prepanng and servmg breakfast to Residents #8, #9, and #12.

      23. On September 15, 2020 at 7:42 a.m., Staff B was observed assisting Resident #11 to ambulate to the bathroom. Staff B was not observed changing her gloves after preparing and serving food to the residents.

      24. On September 15, 2020 at 7:42 a.m., Staff B stated she was going to bathe Resident #11.

          
          

          Staff B did not change her gloves before or after bathing Resident #11. Later that same day at 7:52 a.m., Staff B was observed preparing and serving breakfast to Residents #10 and #11.

          
          

      25. On September 15, 2020 at 8:23 a.m., Staff A received a phone call. After the phone call, Staff A and Staff B put on gowns and face shields. Staff B was then observed changing her gloves for the first time since 7:30 am. Staff B did not perfonn hand hygiene in between these multiple tasks.

      26. The Centers for Disease Control and Prevention recommends everyone should wash their hands often. CDC.gov addresses hand hygiene in healthcare settings and provides that:

          Hand hygiene is an important part of the U.S. response to 1he international emergence of COVID-19. Practicing hand hygiene, which includes the use of alcohol-based hand rub (ABHR ., or handwashing, is a simple yet effective way to prevent the spread of pathogens and infections in healthcare settings. CDC recommendations reflect this important role.

          
          

      27. During an interview on September 15, 2020 at 8:47 a.m., Staff A stated that all staff wore gowns and face shields when they were cleaning the facility.

      28. During an interview on September 15, 2020 at 9:05 a.m., the Compliance Manager stated that it was facility policy for all staff to wear a face shield, mask, and gloves while working at the facility. She further stated this was the recommendation given to herb:,., the Department of Health.

      29. On September 15, 2020 at 10:40 a.m., Resident #10 was observed seated in the living room of Respondent's facility with Resident #12 without properly using hi saber face mask. The resident had the face mask around his/her chin.

      30. During the survey on September 15, 2020 from 7:15 a.m. through I 0:40 a.m., Resident #10 and Resident #11 were observed walking throughout Respondent's facility, including the dining area and hallways, without wearing face masks. Resident #11 was observed with his/her face mask on the arm of his/her walker.

          
          

      31. On September 15, 2020 at 7:45 a.m., it was observed that Resr,,ondent's emergency food supply was stored inside of room six which housed Resident #10 and Rc ident #11.

      32. During an interview on September 15, 2020 at 10:10 a.m., the Compliance Manager stated there was no other space in the facility to store the emergency food supply and that is why they it was stored in room 6 with Residents #10 and #11.

      33. Observation on September 15, 2020 at 8:00 a.m., revealed an open urinal container in room six near Resident #1O's bedside.

      34. On September 15, 2020 at 10:24 a.m., the Compliance Manager stated that Resident #10 did not want to get up in the middle of the night to use the bathroom, so he/she used the urinal.

      35. On September 15, 2020 at 10:27 a.m., Staff A was observed erecting a room divider in room 6 between Resident #10 and Resident #11.

      36. The above reflects that Respondent failed to ensure that residents lived in a safe and decent living environment, free from abuse and neglect, and were treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy, the same being contrary to the mandates of law. Specifically, Respondent failed to follow current infection control standards from the Centers for Disease Control and Prevention related to COVID-19 (Coronavirus Disease 2019) and Florida Governor's emergency orders DEM Order 20-006, dated March 15, 2020. Seven (7) residents tested positive for the COVID-19 disease (Residents #1, #2, #3, #4, #5, #6, and #7) following Staff A testing positive. Respondent further placed residents at risk of exposure to the COVID-19 virus by having positive Staff A caring for negative COVID-19 residents (Residents #8, #9, #10, #11, and #12). Respondent also failed to regard the privacy needs of two (2) of seven (7) sampled residents (Resident #10 and #11). Emergency supplies for the facility were stored in these residents' room, and Resident #10 used a

          
          

          bedside urinal in full view of Resident #11.

          
          

      37. The Agency determined that this deficient practice was a condition or occurrence related to the operation and maintenance of a provider or to the care of dients which the Agency detennines present an imminent danger to the clients of the provider c,r a substantial probability that death or serious physical or emotional hann would result therefrom

      102. The Agency cited the Respondent for a Class I violation in accordance with applicable statutes and authorizing rules.

      1. That the same constitutes a Class I offense as defined in § 408.8 l 3(2)(a), Florida Statutes (2020).

         WHEREFORE, the Agency intends to impose an administrat:1 ve fine in the amount of ten thousand dollars ($10,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to§ 429. l 9(2)(a), Florida Statutes (2020).

         COUNT II

         
         

      2. The Agency re-alleges and incorporates paragraphs (1) through ( 5) as if fully set forth herein.

      3. That Florida law provides:

         
         

         (2) STAFF.

         1. Within 30 days after beginning employment, newly hired staff must submit a written statement from a health care provider documenting that the individual does not have any signs or symptoms of communicable disease. The examination performed by the health care provider must have been conducted no earlier than 6 months before submission of the statement. Newly hired staff does not include an employee transferring without a break in service from one facility to another when the facility is under the same management or ownership.

            1. Evidence of a negative tuberculosis examination must be documented on an annual basis. Documentation provided by the Florida Department of Health or a licensed health care provider certifying that there is a shortage of tuberculosis testing materials satisfies the annual tuberculosis examination requirement. An individual with a positive tuberculosis test must submit a health care provider's statement that the individual does not constitute a risk of communicating tuberculosis.

               
               

            2. If any staff member has, or is suspected of having, a communicable disease, such individual must be immediately removed from duties unt,I a written statement is submitted from a health care provider indicating that the individual does not constitute a risk of transmitting a communicable disease.

         2. Staff must be qualified to perfonn their assigned duties consistent with their level of education, training, preparation, and experience. Staff providing services requiring licensing or certification must be appropriately licensed or certified. All staff must exercise their responsibilities, consistent with their qualification:-.. to observe residents, to document observations on the appropriate resident's record, and to report the observations to the resident's health care provider in accordance with this rule chapter.

         3. All staff must comply with the training requirements of rule 5SA-5.0191, F.A.C.

         4. An assisted living facility contracting to provide services to residents must ensure that individuals providing services are qualified to perform their assigned duties in accordance with this rule chapter. The contract between the facility and the staffing agency or contractor must specifically describe the services the staffing agency or contractor will provide to residents.

         5. For facilities with a licensed capacity of 17 or more residents, the facility must:

         I. Develop a written job description for each staff position and provide a copy of the job description to each staff member; and,

         2. Maintain time sheets for all staff.

         (t) Level 2 background screening must be conducted for staff, including staff contracted by the facility to provide services to residents, pursuant to sections 408.809 and 429.174, F.S.

         Rule 59A-36.0l 0(2), Florida Administrative Code.

      4. That Florida law also provides: ((2) STAFF RECORDS.

         1. Personnel records for each staff member must contain, at a minimum, a copy of the employment application, with references furnished, and documentation verifying freedom from signs or symptoms of communicable disease. In addition, records must contain the following, as applicable:

            1. Documentation of compliance with all staff training and continuing education required by rule 59A-36.0l 1, F.A.C.,

            2. Copies of all licenses or certifications for all staff providing services that require licensing or certification,

            3. Documentation of compliance with level 2 background screening for all staff subject to screening requirements as specified in section 429.174, F.S., and rule 59A-36.010, F.A.C.,

            4. For facilities with a licensed capacity of 17 or more residents, a copy of the job description given to each staff member pursuant to rule 59A-36.010, F.A.C.,

            5. Documentation verifying direct care staff and administrator participation in resident elopement drills pursuant to paragraph 59A-36.007(8)(c), F.A.C.

         2. The facility is not required to maintain personnel records for staff provided by a licensed staffing agency or staff employed by an entity contracting to provide direct or indirect services to residents and the facility. However, the facility must maintain a copy

            
            

            of the contract between the facility and the staffing agency or C(lntractor as described in rule 59A-36.010, F.A.C.

         3. The facility must maintain the written work schedules and staff time sheets for the most current 6 months as required by rule 59A-36.010, F.A.C.

            (c) The facility must maintain the written work schedules and •:tafftime sheets for the most current 6 months as required by Rule 58A-5.0l 9, F.A.C.

            Rule 59A-36.0l 5(2), Florida Administrative Code.

            
            

      5. On or about September 15, 2020, the Agency completed a survey of Respondent's facility.

      6. Based on observation, interviews and the review of records, Respondent failed to ensure that three (3) of four (4) sampled staff (Staff A, Staff B, and Staff DI had a written statement from a healthcare provider indicating that they did not constitute cl risk of transmitting a communicable disease after testing positive for COVID- I 9, the same being contrary to the mandates of law.

      7. The COVID-19 virus is a transmissible respiratory infection that presents severe risk to persons who are aged, infirm, or suffer from co-morbidities including, but not limited to, immune system deficiency, respiratory disease, diabetes, and obesity. See generally, Publications of the Centers for Disease Control and Prevention (CDC).

      8. The Centers for Disease Control and Prevention referred to the high risk of COVID-19 spread to residents of assisted living facilities and stated: "Given their congregate nature and population served, assisted living facilities (ALF) are at high risk of COVID-19 spreading and affecting their residents. If infected with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), the virus that causes COVID-19, assisted living residents-•often older adults with underlying chronic medical conditions-are at increased risk of serious illness."

      9. On September 15, 2020, Staff A and Staff B were observed at Respondent's facility caring for five (5) residents.

         
         

      10. A review of records revealed that Staff B and Staff D tested pnsitive for COVID-19 on August 24, 2020 and returned to work on September 3, 2020.

      11. Records also showed that Staff A tested positive for COVID-19 on August 25, 2020 and returned to work on August 31, 2020.

      12. During an interview on September 15, 2020 at 9:36 a.m., Respondent's Compliance Manager stated that Resident #1, #2, #3, #4, #5, #6, and #7 tested positive for COVID-19 on August 27, 2020 and were sent to Miami Care Center-Isolation to quarantine on August 28, 2020. The Compliance Manager further stated that she was confused about when the staff could return to work after testing positive for COVID-19.

      13. During the survey, Respondent failed to produce written proof from a health care provider documenting that Staff A, B, or D did not constitute a risk of transmitting a communicable disease.

      14. Respondent's staffing schedule showed that Staff A was scheduled to work Monday through Saturday from 7:00 a.m. to 5:30 p.m. Staff B was scheduled to work Monday, Tuesday, Wednesday and Saturday from 6:00 a.m. to 6:00 a.m. Staff D was scheduled to work Thursday, Friday, and Sunday from 6:00 a.m. to 6:00 p.m. and on Saturday from 7:00 a.m. to 5:00 p.m.

      15. On September 15, 2020 at 8:42 a.m., the Compliance Manager confirmed Respondent's staffing schedule.

      16. On September 15, 2020 at 9:45 a.m., the Compliance Manager acknowledged that Staff A, Staff B, and Staff D did not have a written statement from a health care provider documenting that they did not constitute a risk of transmitting a communicable disease.

      17. The above reflects that Respondent failed to ensure that three (3) of four (4) sampled staff (Staff A, Staff B, and Staff D) had a written statement from a healthcare provider indicating

          that they did not constitute a risk of transmitting a communicable disease after testing positive for COVID-19, the same being contrary to the mandates of Jaw.

      18. The Agency detennined that this deficient practice was a conditwn or occurrence related to the operation and maintenance of a provider or to the care of c1ients vvhich the Agency determines present an imminent danger to the clients of the provider or a substantial probability that death or serious physical or emotional hann would result therefrom.

      19. The Agency cited the Respondent for a Class I violation in accordance with applicable statutes and authorizing rules.

      20. That the same constitutes a Class I offense as defined in § 429.:I 9(2)(a), Florida Statutes (2020).

          WHEREFORE, the Agency intends to impose an administrative fine in the amount of ten thousand dollars ($10,000.00) against Respondent, an assisted Jiving facility in the State of Florida, pursuant to § 429.19(2)(a), Florida Statutes (2020).

          COUNT III

          
          

      21. The Agency re-alleges and incorporates paragraphs (I) through { 5) and Counts I and II above as if fully set forth herein.

      22. Under Florida Jaw:

          
          

          1) 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, any person subject to level 2 background screening under s. 408.809, or any facility staff:

          (a) An intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility ...

          1. A citation for any of the following violations as specified ins. 429.19:

             1. One or more cited c1ass I violations.

             2. Three or more cited cJass II violations.

                
                

             3. Five or more cited class III violations that have been cited on a single survey and have not been corrected within the times specified.

          2. Failure to comply with the background screening standards of this part, s. 408.809(1 ), or chapter 435 ...

          (h) Failure of the license applicant, the licensee during reliccnsure, or a licensee that holds a provisional license to meet the minimum license requirements of this part, or related rules, at the time of license application or renewal ...

          (k) Any act constituting a ground upon which application for a license may be denied.

          § 429.14(l)(a), (e), (f), (h), and (k), Florida Statutes (2020).

          
          

      23. Florida law also provides that:

          
          

          1. In addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest:

             1. False representation of a material fact in the license applicai:ion or omission of any material fact from the application.

             2. An intentional or negligent act materially affecting the health or safety of a client of the provider.

             3. A violation of this part, authorizing statutes, or applicable rnles ...

                § 408.815(1)(a)-(c), Florida Statutes (2020).

                
                

      24. That Respondent has been cited with two (2) Class I violations oflaw on a single survey as set forth in Counts I and II which each separately constitutes independent grounds for the revocation of Respondent's licensure as an assisted living facility pursuan1! to§ 429.14(1)(e)(l), Florida Statutes (2020).

      25. That Respondent has engaged in intentional or negligent acts seriously and/or materially affecting the health, safety or welfare of a resident of the facility which establishes grounds upon which an application for a license may be denied as set forth in §§ 429.14(1 )(a) and 408.815( 1)(b) Florida Statutes (2020).

      26. That Respondent's actions and/or inactions as set forth above constitute a ground upon which application for a license may be denied under § 429.14(1 )(k), Florida Statutes (2020).

      27. That Respondent has violated the minimum requirements of law of Chapters 429, Part II; Chapter 408, Part II (including § 408.815(1 )(b) and (c), Florida Statutes (2020); and Chapter

          
          

          59A-36, Florida Administrative Code as described with particularity W!fhin this complaint.

          
          

      28. That Respondent has a duty to maintain its operations in accord with the minimum requirements of law and to provide care and services at mandated mrnimum standards. That based thereon, individually and collectively, the Agency seeks the revocation of the Respondent's licensure.

      WHEREFORE, the Agency intends to revoke the license of the Respondent to operate an assisted living facility in the State of Florida.

      
      

      Respectfully submitted this L2-!J1 day of October 2020.

      
      

      STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      /i)

      By:,------#h'-"'---'-,f--/::U42

      Gi

      Fl . 2101

      Age y for Health Car Administration

      52. irror Lake Ori: N., 330H St.' etersburg, FL 33701 727.552.1945 (office)

      Gisela.Iglesias@ahca.myfl01ida.com

      NOTICE

      
      

      The Respondent is notified that it/he/she has the right to request a1n 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 delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 412-3630.

      
      

      CERTIFICATE OF SERVICE

      
      

      I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by

      U.S. Certified Mail, Return Receipt No. 7019 2970 0001 3240 7310 on October /2-- , 2020

      to Shaddrick A. Haston, Counsel for Villa Serena III, Inc. d/b/a Villa Serena III, at Ullman Bursa Law, 3812 Coconut Palm Drive, Tampa, Florida 33619.

      
      

      Copy furnished to Arlene Mayo Davis Field Office Manager

      Agency for Health Care Administration

      
      

      Shad Haston via email at shaston@ublawoffices.com

      STATE OF FLORIDA

      AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      Re: Villa Serena III, Inc. d/b/a Villa Serena III

      AHCA No. 22020016306

      
      

      ELECTION OF RIGHTS

      
      

      This Election of Rights form is attached to an Administrative Complaint. The Election of Rights form may be returned by mail or by facsimile transmission, but must be filed with the Agency Clerk within 21 days by 5:00 p.m., Eastern Time, of the day that you received the Administrative Complaint. If your Election of Rights form with our selected option (or request for hearing) is not timely received by the Agency Clerk, the right to an administrative hearing to contest the proposed agency action will be waived and an adverse Final Order will be issued. In addition, please send a copy of this form to the attorney of record who issued the Administrative Complaint.

      
      

      (Please use this fonn unless you, your attorney or your qualified representative prefer to reply according to Chapterl 20, Florida Statutes, and Chapter 28, Florida Administrative Code.) The address for the Agency Clerk is:

      
      

      Agency Clerk

      Agency for Health Care Administration

      2727 Mahan Drive, Building #3, Mail Stop #3

      Tallahassee, Florida 32308

      Telephone: 850-412-3630 Facsimile: 850-921-0158

      
      

      PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS

      
      

      OPTION ONE (l) I waive the right to a hearing to contest the allegations of fact and conclusions of law contained in the Administrative Complain1t. I understand that by giving up my right to a hearing, a final order will be issued that adopls the proposed agency action and imposes the fine, sanction or other agency action.

      
      

      OPTION TWO (2) I admit the allegations of fact contained in the Administrative

      Complaint, but I wish to be heard at an informal hearing (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, sanction or other agency action should be reduced.

      
      

      OPTION THREE (3) I dispute the allegations of fact contained 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 NOI 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( I), Flo1ida Statutes. It must be received by the Agency Clerk at the address above within 21 day 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 compfriint.

      
      

      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: Title:

      STATE OF FLORIDA

      AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

      
      

      Petitioner,

      
      

      VS.

      
      

      SANTA BARBARA BH INC., d/b/a VILLA SERENA VII,

      f/k/a SANTA BARBARA HOME I,

      
      

      Respondent.

      I

      
      

      Case No.: 2019015653

      License No.: 5058 Facility Type: ALF

      
      

      ADMINISTRATIVE COMPLAINT

      
      

      COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent Santa Barbara BH Inc., d/b/a Villa Serena VII, f/k/a Santa Barbara Home I (hereinafter "Respondent"), p\msuant to§§ 120.569 and 120.57, Florida Statutes (2018), and alleges:

      NATURE OF THE ACTION

      
      

      This is an action against an assisted living facility to impose an administrative fine in the amount of five hundred dollars ($500.00) based upon one (I) uncorrected Class III deficient practice.

      JURISDICTION AND VENUE

      
      

      1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2018).

      2. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code.

         
         

         EXHIBIT+

         PARTIES

         
         

      3. The Agency is the regulatory authority responsible for Iicensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes ancl rules governing assisted living facilities pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes, and Chapter 59A-36, Florida Administrative Code, respectively.

      4. Respondent operates a twelve (12) bed assisted living facility k,cated at 3317 SW 24th Terrace #19, Miami, Florida 33145-3139, and is licensed as an assisted living facility, license number 5058.

      5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

         COUNTI

         
         

      6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.

      7. That Florida law provides:

         
         

         The facility must notify a licensed physician when a resident exhibits signs of dementia or cognitive impairment or has a change of condition in order to rule out the presence of an underlying physiological condition that may be contributing to such dementia or impairment. The notification must occur within 30 days after the acknowledgment of such signs by facility staff. If an underlying condition is determined to exist, the facility shall arrange, with the appropriate health care provider, the necessary care and services to treat the condition.

         § 429.26(7), Florida Statutes (2018). 1

         
         

      8. Florida law also provides:

         An assisted living facility must provide care and services appropriate to the needs of residents accepted for admission to the facility.

         1. SUPERVISION. Facilities must offer personal supervision as appropriate for each resident, including the following:

            1. Monitoring of the quantity and quality of resident diets in accordance with rule 58A- 5.020, F.A.C.

               
               

               1 This subsection remained unchanged in the 2019 version of the statute.

            2. Daily observation by designated staff of the activities of tl:.e resident while on the premises, and awareness of the general health, safety, and phyi:i ,:al and emotional well­ being of the resident.

            3. Maintaining a general awareness of the resident's whereabouts The resident may travel independently in the community.

            4. 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.

            5. Contacting the resident's family, guardian, health care surrogate, or case manager if the resident is discharged or moves out.

            6. Maintaining a written record, updated as needed, of any significant changes, any illnesses that resulted in medical attention, changes in the method of medication administration, or other changes that resulted in the provision of additional services.

               Rule 58A-5.0182 (l)(a)-(f), Fla. Admin. Code. 2

               
               

      9. That the Agency completed a survey of Respondent's facility on May 21, 2019.

      
      

      I 0. Based upon the review of records, observation, and interviews, Respondent failed to maintain a written record, updated as needed, of any significant changes and notify the healthcare provider and emergency contact person for one (I) out of nine (9) sampled residents (Resident #1), contrary to the mandates of law.

      1. A review of Resident #1's records showed the resident was admitted to Respondent's facility on October 13, 2017. The resident's Health Assessment dated December 26, 2018, reflected a diagnosis of dementia by the physician. A hospitalization log showed Resident #1 was hospitalized from April 25, 2019 to April 27, 2019.

      2. StaffB was interviewed by the Agency's representative on May 21, 2019 at 11:45 a.m.

         
         

         Staff B stated that Resident #1 tripped and fell on April 25, 2019, outside the facility. She called Miami Dade Fire Rescue and they transferred the resident to the hospital. Resident #1 was released from the hospital and returned to Respondent's facility on April 27, 2019.

      3. Resident #1's records did not have documentation that the resident's primary physician and

         
         

         2 Effective July 1, 2019, this Rule was renumbered and transferred to Rule 59A-36.007, Florida Administrative Code without substantive change.

         
         

         family members were notified of the foregoing.

         
         

      4. The above reflects that Respondent failed to maintain a written rewrd, updated as needed, of any significant changes and notify the healthcare provider and emergency contact person for one (I) out of nine (9) sampled residents (Resident #1), contrary to the mandates oflaw.

      5. The Agency determined that this deficient practice was a condition or occurrence related to the operation and maintenance of a provider or to the care of clients which indirectly or potentially threatens the physical or emotional health, safety, or security of clients, other than class I or class II violations.

      6. That the Agency cited Respondent for a class III violation.

         
         

      7. That a provider must correct a deficient practice within thirty (30) days. See,§ 408.811(4), Florida Statutes (2018).

      8. That on September 6, 2019, the Agency completed a revisit to the survey of May 21, 2019.

         
         

      9. Based upon the review of records, observation, and interviews, Respondent failed to provide proof of written documentation, care and services, and personal supervision appropriate to the needs of one (1) out of seven (7) sampled residents (Residents #4) who sustained falls at its facility, contrary to the mandates oflaw.

      10. On September 6, 2019 at 10:05 a.m., the Agency's representative observed Resident #4 sitting in a wheelchair in the patio located in the front of Respondent's facility.

      11. A review of Resident #4 's records revealed that the resident was admitted to Respondent's facility on October 31, 2014. The Health Assessment dated January 16, 2017, indicated the resident was diagnosed with diabetes mellitus type 2, cerebrovascular accident (CVA), hypertension (HTN), coronary artery disease (CADS), acute right leg deep vein thrombosis (DVT), osteoarthritis, and right paresis. The Health Assessment also showed the resident had right side

          
          

          hemiparesis, required a low sodium diet, required supervision with eal Ing and transferring and assistance with the rest of activities of daily living. There was no documentation that the resident fell at any time.

      12. Respondent's owner and Compliance Officer were asked if someone fell at the facility recently and they denied this until they were asked about the incident that occurred at the facility when Resident #4 fell and the staff called emergency rescue services. Jin response thereto, they brought Respondent's incident daily log which was reviewed by the Agency's representative. The incident daily log showed that on Wednesday, September 4, 2019, Resident #4 went to stand up from his/her bed and fell. The emergency rescue service was called because the staff could not lift the resident. When the emergency rescue service arrived, the resident ,vas asked if he/she hit his/her head or any part of the body and the resident answered "no."

      13. Respondent's owner was interviewed on September 6, 2019 at 1 :04 p.m. The owner stated that Resident #4 fell last Wednesday, September 3, 2019. The emergency rescue service was called because the staff was unable to put the resident back in his/her bed. The owner said she did not say anything about the incident earlier due to an oversight and because the resident was not a fall risk.

      14. Respondent's records failed to document what steps or interventions were taken after Resident #4 fell in its facility. The records also failed to contain proof that Respondent had developed a plan to avoid other falls in the future.

      15. The above reflects that Respondent failed to provide proof of written documentation, care and services, and personal supervision appropriate to the needs of one (1) out of seven (7) sampled residents (Residents #4) who sustained falls at its facility, contrary to the mandates of law.

      16. The Agency determined that this deficient practice was a condition or occurrence related to the operation and maintenance of a provider or to the care of clients which indirectly or

          
          

          potentially threatens the physical or emotional health, safety, or security uf clients, other than class I or class II violations.

      17. That the Agency cited Respondent for a class III violation.

          
          

      18. That the same constitutes an uncorrected class III deficiency.

      
      

      WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00) against Respondent, an assisted living facility in the State of Florida, pursuant to§ 429.19(2)(c), Florida Statutes (2019).

      
      

      Respectfully submitted this 51/1day ofNo\'ember, 2019.

      
      

      STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      u

      ,.. · .,.,.... -..-, -""-,.\

      ;1 / _,/ /J

      l ;•-· /., , :

      By: 1 /? _,,1

      --,''-------, t:,,- ....

      Gis a esias, Esq.

      Fla. Ba/.r' . No. 21010 /l/

      Ageqty for Health Care Administration 52iMirror Lake Dr. N., Suite 330

      St. Petersburg, Florida 33701 Telephone: (727) 552-1945

      Fax:(727)552- 1440

      Gisela.Iglesias@ahca.myflorlda.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 imal order will be entered.

      
      

      The Election of Rights form shall be made to the Agency for Health Care Administration and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 412-3630.

      
      

      CERTIFICATE OF SERVICE

      
      

      I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by

      U.S. Certified Mail, Return Receipt No. 7019 1120 0000 9811 3498 on November -5 , 2019, to Adriana Molina, Administrator, Santa Barbara BH Inc., d/b/a Villa Serena VII, f/k/a Santa Barbara Home I, 3317 SW 24th Terrace #19, Miami, Florida 33145-3139, and by U.S. Regular Mail to Roxana Solano, Registered Agent, , Santa Barbara BH Inc., d/b/a Villa Serena VII, 3317 SW 24th Terrace #19, Miami, Florida 33145-3139.

      '11

      i_/.

      
      

      
      

      Copy furnished to: Arlene Mayo Davis Field Office Manager

      .,,G

      / I I

      I

      j

      STATE OF FLORIDA

      AGENCY FOR HEALTH CARE ADMINISTRA lf'ION

      
      

      Re: SANTA BARBARA BH INC., d/b/a VILLA SERENA VII, f/k/a SANTA BARBARA HOME I

      
      

      AHCA No. 2019015653

      
      

      ELECTION OF RIGHTS

      
      

      This Election of Rights form is attached to an Administrative Complaint. The Election of Rights form may be returned by mail or by facsimile transmission, but must be filed with the Agency Clerk within 21 days by 5:00 p.m., Eastern Time, of the day that you received the Administrative Complaint. If your Election of Rights form with your selected option (or request for hearing) is not timely received by the Agency Clerk, the rig:ht to an administrative hearing to contest the proposed agency action will be waived and an adverse Final Order will be issued. In addition, please send a copy of this form to the attorney of record who issued the Administrative Complaint.

      
      

      (Please use this form unless you, your attorney or your qualified representative prefer to reply according to Chapter120, Florida Statutes, and Chapter 28, Florida Administrative Code.) The address for the Agency Clerk is:

      
      

      Agency Clerk

      Agency for Health Care Administration

      2727 Mahan Drive, Building #3, Mail Stop #3

      Tallahassee, Florida 32308

      Telephone: 850-412-3630 Facsimile: 850-921-0158

      
      

      PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS

      
      

      OPTION ONE (l) I waive the right to a hearing to contest the allegations of fact

      and conclusions oflaw contained in the Administrative Complaint. I 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 fine, sanction or other agency action.

      
      

      OPTION TWO (2) I admit the allegations of fact contained in the Administrative

      Complaint, but I wish to be heard at an informal hearing (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, sanction or other agency action should be reduced.

      
      

      OPTION THREE (3) I dispute the allegations of fact contained 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 NO.I 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 ), Flc,nda 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 re4uirements 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 to the Agency for Health Care Administration on behalf of the licensee referred to above.

      
      

      Signed: Date: _

      
      

      Print Name: Title:

      
      

      • &-?Ji11n · i1ta¾.. 1v1hit!iit

      · ..;:::.,,/ ·..,_-:... ·: . ·:..:..:....:..:1 -J -:.f_r ·-t·, 4,.<

      9ij}q 72bb 99aq 2160 b299 91

      ..• . ..·.·,;1§}JD_;Ji :nt f2 !) ,.·

      
      

      RON DESANTIS GOVERNOR

      
      

      SHEVAUN L. HARRIS

      ACTING SECRETARY

      -- -- ·-· -- < , , .

      - : ; _·::., ,.:_ ----- ""'-- ,.... ,4-,

      
      

      February 16, 2021 CERTIFIED

      
      

      Ms. Roxana Solano, Administrator Villa Serena ID

      1777 NW 30 Street

      Miami, FL 33142

      File Number: 11966615

      Application Number: 77539

      Provider Type: Assisted Living Facility

      
      

      RE: Complaint Number 2021002529, 1777 NW 30 Street, Miami

      
      

      
      

      Notice of Intent to Den,· the Renewal Application for an Assisted Living Facility

      Dear Ms. Solano:

      
      

      It is the decision of this Agency that Villa Serena ID renewal application for an Assisted Living Facility

      license be DENIED.

      
      

      The Specific Basis for this determination is:

      
      

      On November 3, 2020, Living Well A.C.L.F., Inc., the licensee for Villa Serena II, was terminated from participation in the Florida Medicaid according to the Suspension Final Order (MPI Case No. 2020- 0018822-Exhibit I). Currently, Roxana Solano is the 100% controlling interest of Living Well A.C.L.F., Inc., licensee of Villa Serena II. Ms. Solano also serves as the common controlling interest of Villa Serena III, Inc., the licensee of Villa Serena III.

      
      

      Due to the fact, that Ms. Solano is the common controlling interest in both Living Well A.C.L.F., Inc. and Villa Serena ID, Inc., the renewal application for Villa Serena ill is denied pursuant to Sections 408.810

      1. and 408.815 (1) (e), Florida Statutes (F.S.).

      
      

      
      

      EXPLANATION OF RIGHTS

      
      

      Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must confonn to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispme_

      
      

      SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS.

      
      

      2727 Mahan Drive• MS#30 Tallahassee, FL 32308 AHCA. MyFlorida .com

      Fa cebook .com/AHCAFlorida Y c, ut ube .com/AHCAFlorida Twitter. co m/AHCA_F L

      
      

      EXHIBIT 5

      Villa Serena III February 16, 2021 Page2

      
      

      r

      If you have any questions or need further assistance, please call the General Counsel's Office at (850)

      412-3630.

      I._,,,,,·\

      ( ..)

      Keisha Woods, MPH

      Health Administration Services Manager Assisted Living Unit

      Division of Health Quality Assurance cc: Legal Intake Unit, MS# 3 Enclosure

      Villa Serena III February 16, 2021

      
      

      STATE OF FLORIDA

      AGENCY FOR HEALTH CARE ADMINISTRATION

      
      

      RE: Villa Serena III

      
      

      Case Number: 2021002529

      
      

      ELECTION OF RIGHTS

      
      

      This Election of Rights form is attached to a proposed Notice of Intent to Deem Incomplete and Withdraw from Further Review of the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Deem Incomplete and Withdraw from Further Review or some other notice of intended action by AHCA.

      
      

      An Election of Rights must be returned b,· mail orb,· fax within 21 da\S of the da, you receive the attached Notice of Intent to Deem Incomplete and Withdraw from Further Review or an, other proposed action b, ABCA.

      
      

      If an Election of Rights with your selected option is not received by AHCA within twenty-one (21) days from the date you received this notice of proposed action, you will have given up your right to contest the Agency's proposed action and a final order will be issued.

      
      

      (Please reply using this Election of Ri!!hts fonn unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrativt Code.)

      
      

      Please return your ELECTION OF RJGHTS to:

      
      

      Agency for Health Care Administration Attention: Agency Clerk

      2727 Mahan Drive, Mail Stop #3

      Tallahassee, Florida 32308

      Phone: (850) 412-3630 Fax: (850) 921-0158

      
      

      OPTION ONE (I) I admit to the allegations of facts and law contained in the Notice of Intent to Deem

      Incomplete and Withdraw from Further Review, or other notice of intended action by AHCA and I waive my right to object and have a hearing. I 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 proposed penalty, fine or action.

      
      

      OPTION TWO (2) I admit to the allegations of facts contained in tbe Notice of Intent to Deem

      Incomplete and Withdraw from Further Review, or other proposed action by AIICA, 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 Deem

      Incomplete and Withdraw from Further Review or other proposed action by ARCA, 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.

      Villa Serena III February 16, 2021 Page2

      
      

      PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must ftle a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Subsection 120.57(1), Florida Statutes. It must be received by the Agency Ckrk at the address above within 21 days of receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.201, Florida Administrative Code, which requires that it contain:

      1. The name and address of each agency affected and each agency's file or identification number, if known;

      2. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any;

      3. An explanation of how your substantial interests will be affected by the Agency's proposed action;

      4. A statement of when and how you received notice of the Agency's proposed action;

      5. A statement of all disputed issues of material fact. If there are none, you must state that there are none;

      6. A concise statement of the ultimate facts alleged, including the specific facts you contend warrant reversal or modification of the Agency's proposed action;

      7. A statement of the specific rules or statutes you claim require reversal or modification of the Agency's proposed action; and

      8. A statement of the relief you are seeking, stating exactly what action y·ou wish the Agency to take with respect to its proposed action.

         (Mediation under Section 120.573, Florida Statutes, may be available in this matter if :he Agency agrees.)

         
         

         License Type: Assisted Living Facility Licensee Name: Villa Serena Iii

         License Number: 10792

         
         

         -····

         Contact Person: Name Title

         Address:

         Street and number City Telephone Nbr.:

         Email (optional ):

         
         

         Zip Code

         
         

         Fax Nbr.:-------

         
         

         Ihereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.

         
         

         Signed.,_: _ Date:

         
         

         Print Name:-------- Title:-------

         
         

         
         

         STATE OF FLORIDA,

         STATE OF FLORIDA

         AGENCY FOR HEALTH CARE ADMINISTRA TIOI._.

         
         

         212D NOV - 3 A 11: I i

         AGENCY FOR HEALTH CARE ADMINISTRATION,

         
         

         VS,

         Petitioner,

         MPI Case No.: 2020-0018822

         Providor No.: 001676700

         Licens1t No.: 8518

         LIVING WELL D/8/A VILLA SERENA 11,

         Respondent. /

         NPI Nc1.. NIA

         
         

         SUSPENSION FINAL ORDER

         THIS CAUSE is before me for issuance of a Final Order. In a letter dated August 26, 2020, (Ex.1) Living Well d/b/a Villa Serena II (Respondent), was informed that the State of Florida, Agency for Health Care Administration (Agency) applied a sanction of suspension from participation in the Florida Medicaid program pursuant to Section 409.913, Florida Statutes (F.S..), and Rule 59G-9.070,

         Florida Administrative Code (F.A.C.). The respondent is prohibited from performing any action that results in a claim for payment to the Medicaid program as a result of furnishing, supervising a person who is furnishing, or causing a person to fumish goods or services.

         
         

         The letter contained full disclosure and notice regarding the Respi:mdent's administrative hearing and due process rights and was sent to the address last shown on the provider's provider enrollment file in compliance with Section 409.913(6), F.S., which specifies thert it is "the responsibility of the provider to furnish and keep the agency informed of the provider's current address. United States Postal Service proof of mailing or certified or registered mailing of such notice to the provider at the address shown on the provider enrollment file constitutes sufficient proof of notice." The certified mail receipt is attached hereto and incorporated herein as Ex. 2. To date. ttte Respondent has not requested a hearing to dispute the facts contained in the letter, and the limeframe within which Respondent had to request a hearing has expired.

         
         

         FINDINGS OF FACTS

         1. The letter disclosed the Respondent's administrative and due proo ss rights and was sent via certified mail to the address last shown on the provider's provider enrollment file. See Ex. 2.

         2. The Respondent has not disputed imposition of the sanction as set forth in the letter.

      CONCLUSIONS OF LAW

      1. The Agency incorporates and adopts the statements and conclusic,ns of law as set forth in the aforementioned letter.

      2. The sanction as set forth in the letter is final.

      
      

      ORDER

      BASED on the foregoing, it is ORDERED and ADJUDGED that the Respondent is SUSPENDED from participation in the Florida Medicaid program pursuant to Section 409.913. F.S.. and Rule 59G-9.070, F.A.C. 'l ,,.1,. _ L-

      DONE AND ORDERED this- - day of _,ff!_.::. • 2020, in Tallahassee, Florida.

      
      

      cKi st , Deputy Secretary Di· · n of alth Quality Assurance

      Agency for Health Care Administration

      
      

      A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS E tHTLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTIC,E OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRIC:l WHERE THE AGENCY rAAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SKALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE Rlll.ES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAVS OF RENDITION OF THE ORDER 10 BE REVIEWED.

      Copies furnished to:

      
      

      Living Well d/b/a Villa Serena II 60-62 NW 33 Avenue

      Miami, FL 33125 (U.S. Mail)

      
      

      Kelly Bennett, Chief

      Division of Health Quality Assurance Medicaid Program Integrity Kellv.Bennett@ahca.mvflorida.com (Electronic Mail)

      
      

      Laura Maclafferty, Chief

      Division of Health Quality Assurance Bt1reau of Health Facility Regulation BHFR@ahca.my8orfda.c:om (Electronic Mail)

      
      

      William H. Roberts, Esquire Acting General Counsel Office of the General Counsel

      William.Roberts@ahca.myflorida.com

      (Electronic Mail)

      
      

      Michael Murphy, Revenue Financial Administrator Bureau of Financial Services Michael.Murphy@ahca.mvflorida.com

      (Electronic Mail)

      
      

      Eunice Medina, Chief

      Bureau of Plan Management Operations Eunice.Medina@ahca.myfiorida.com (Electronic Mail)

      
      

      Gay Munyon, Chief

      Bureau of Medicaid Fiscal Agent Operations Gay.Munyon@ahc,a.myftorida.com (Electronic Mail)

      Final Orders lnbox

      finalorders@ahca.mvflorida. C(fill

      {Electronic Mail)

      
      

      Ryan Fitch, Chief

      Division of Heaffh Quality Assurance

      Bureau of Central Services

      CSMU-86@ahca.myflQrida.com

      {Electronic Mail)

      
      

      Shena L. Grantham, Esquire MAL & MPI Chief Counsel Office of the General Counsf1I

      Shena.Grantham@ahca.myflorida.com

      {Electronic Mail)

      
      

      Katrina Derico-Harris, Unit Manager Medicaid Accounts Receivables Unit Bureau of Financial Services Katrina.Derico-Harris@ahq;i.m\lflorida.com (Electronic Mail)

      
      

      Erica Baker, Government An,alyst II Bureau of Plan Management Operations Erfca.Baker@ahca.myflorida.com (Electronic Maft)

      
      

      CERTIFICATE OF SERVICE

      I HEREBY CERTIFY that a true and corred copy of the foregoing has been served o above­ named perso U.S. Mail or other designated method as indicated ori this the 3 ay of

      npl, 4 ,20QO

      
      

      
      

      Agency Clerk State of Florida

      Agency for Health Care Administration

      2727 Mahan Drive, MS #3

      Tallahassee, FL 32308-5403

      (850) 412-3689

      
      

      
      

      . GG'rtltf:?tl:J\l1li'.Jf }_t(mfo l"

      ' ·- ---• •, ;,.J,;;;:;,..•_•:.l:.: },-.,.-,.-A,"• : •,

      9414 7 bb 90 21 0 b;oo 03

      . nV Jl;r t1QJT0

      RON DESANTIS GOVERNOR

      
      

      SHEVAUN L. HARRIS ACTING SECRETARY

      February 16, 2021 CERTIFIED

      
      

      Ms. Roxana Solano, Administrator Villa Serena IV

      754 NW 22nd Ct Miami, FL 33125-3309

      File Number: 11966710

      Application Number: 80200

      Provider Type: Assisted Living Facility

      
      

      RE: Complaint Number 2021002532, 754 NW 22nd Ct, Miami, FL

      
      

      Notice of Intent To Deny the Renewal Application for an Assisted Living Facilih'

      Dear Ms. Solano:

      
      

      It is the decision of this Agency that Villa Serena IV application for an Assisted Living Facility license be DENIED.

      
      

      The Specific Basis for this determination is:

      
      

      On November 3, 2020, Living Well A.C.L.F., Inc., the licensee for Villa Serena ll, was terminated from participation in the Florida Medicaid according to the Suspension Final Order (MPI Case No. 2020- 0018822 - Exhibit 1). Currently, Roxana Solano is the 100% controlling interest of Living Well A.C.L.F., Inc., licensee of ViJla Serena Il. Ms. Solano also serves as the common controlling interest of Villa Serena IV, Inc., the licensee of Villa Serena IV.

      
      

      Due to the fact, that Ms. Solano is the common controlling interest in both Living Well A.C.L.F., Inc. and Villa Serena IV, Inc., the renewal application for Villa Serena IV is denied pursuant to Sections 408.810

      1. and 408.815 (1) (e), Florida Statutes (F.S.).

         
         

         
         

         EXPLANATION OF RIGHTS

         
         

         Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in S1;:lCtion 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute.

         
         

         SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS.

         
         

         2727 Mahan Drive• MS#30 Tallahassee, FL 32308 AHCA. MyFlorida.com

         Fac:e book .com/AHCAFlorida Yo utube.com/ A HCA Florida Twitter. com/AHCA_FL

         
         

         EXHIBIT 6

         Villa Serena IV February 16, 2021 Page2

         
         

         If you have any questions or need further assistance, please call the General Counsel's Office at (850) 412-3630.

         
         

         Keisha Woods, MPH

         Health Administration Services Manager Assisted Living Unit

         Division of Health Quality Assurance cc: Legal Intake Unit, MS# 3 Enclosure

         Villa Serena IV February 16, 2021

         
         

         STATE OF FLORIDA

         AGENCY FOR HEALTH CARE ADMINISTRATION

         
         

         RE: Villa Serena Iv

         
         

         Case Number: 2021002532

         
         

         ELECTION OF RIGHTS

         
         

         This Election of Rights form is attached to a proposed Notice of Intent to Deem Incomplete and Withdraw from Further Review of the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Deem IncompJete and Withdraw from Further Review or some other notice of intended action by AHCA.

         
         

         An Election of Rights must be returned bv mail orb, fax within 21 davs of the da, }OU receive the attached Notice of Intent to Deem Incomplete and Withdraw from Further Review or an, other proposed action b\' AHCA.

         
         

         If an Election of Rights with your selected option is not received by AHCA within twenty-one (21) days from the date you received this notice of proposed action, you will have given up your right to contest the Agency's proposed action and a final order will be issued.

         
         

         (Please reply using this Election of Ril!hts form unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

         
         

         Please return your ELECTION OF RIGHTS to:

         
         

         Agency for Health Care Administration Attention: Agency Clerk

         2727 Mahan Drive, Mail Stop #3

         Tallahassee, Florida 32308

         Phone: (850) 412-3630 Fax: (850) 921-0158

         
         

         PLEASE SELECT ONLY 1 OP THESE 3_OPTIONS:

         
         

         OPTION ONE (1) I admit to the allegations of facts and law contained in the Notice of Intent to Deem

         Incomplete and Withdraw from Further Review, or other notice of intended action by ARCA and I waive my right to object and have a hearing. I 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 proposed penalty, fine or action.

         
         

         OPTION TWO (2) I admit to the allegations of facts contained in the Notice of Intent to Deem

         Incomplete and Withdraw from Further Review, or other proposed action b r AHCA, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Stallltes) 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 Deem

         Incomplete and Withdraw from Further Review or other proposed action by ARCA, 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.

         • Villa Serena IV February 16, 2021 Page 2

PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain 1t formal hearing. You also must file a written petition in order to obtain a formal hearing before 11J1e Division of Administrative Hearings under Subsection 120.57(] ), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.201, Florida Administrative Code, which requires that it contain:

1. The name and address of each agency affected and each agency's foe or identification number, if known;

1. Your name, address, and telephone number, and the name, address, rnd telephone number of your representative or lawyer, if any;

2. An explanation of how your substantial interests will be affectu. hy the Agency's proposed action;

3. A statement of when and how you received notice of the Agency's proposed action;

4. A statement of all disputed issues of material fact. If there are none, you must state that there are none;

5. A concise statement of the ultimate facts alleged, including the specific facts you contend warrant reversal or modification of the Agency's proposed action;

6. A statement of the specific rules or statutes you claim require reversal or modification of the Agency's proposed action; and

7. A statement of the relief you are seeking, stating exactly what action :.rou wish the Agency to take with respect to its proposed action.

(Mediation under Section 120.573, Florida Statutes, may be available in this matter if ·.he Agency agrees.)

License Type: Assisted Living Facility Licensee Name: Villa Serena Iv

License Number: 10868

Contact Person:

Name

Title

Address: ---- -

Street and number

Telephone Nbr.: Email (optional):

City Zip Code

Fax Nbr.:

I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.

Signed.;..: _ Date:

Print Name:

STATE OF FLORIDA

AGENCY FOR HEALTH CAREADMINISTRATIOfl

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

r.. \ :LJ

-\Hi·:/\

//}: ;_;y LL[ :-{

2828 NOV - 3 A II: I R

vs.

Petitioner,

MPI Case No.: 2020-0018822

Provider No.: 001676700

UcenSE No.: 8518

LIVING WELL D/B/A VILLA SERENA 11,

Respondent.

I

SUSPENSION FINAL ORDER

NPI No.: NIA

THIS CAUSE is before me for issuance ot a Final Order. In a letter dated August 26, 2020, (Ex.1) Living Well d/b/a Villa Serena II (Respondent), was informed that the State of Florida, Agency for Health Care Administration (Agency) applied a sanction of suspension from participation in the Florida Medicaid program pursuant to Section 409.913, Florida Statutes (F.S.), and Rule 59G-9.070, Florida Administrative Code (F.A.C.). The respondent is prohibited from per1forming any action that results In a claim for payment to the Medicaid program as a result offumishin1 ,, supervising a person who is furnishing, or causing a person to fumish goods or services.

The letter contained full disclosure and notice regarding the Respondent's administrative hearing and due process rights and was sent to the address last shown on the provider's provider enrollment file in compliance with Section 409.913(6), F.S., which specifies that it is "the responsibility of the provider to furnish and keep the agency informed of the provider's c1Jrrent address. United States Postal Service proof of mailing or certified or registered mailing of sucll notice to the provider at the address shown on the provider enrollment file constitutes sufficient proof of notice." The certified mail receipt is attached hereto and incorporated herein as Ex. 2. To date. the Respondent has not requested a hearing to dispute the facts contained in the letter, and the timeframe within which Respondent had to request a hearing has expired.

FINDINGS OF FACTS

1. The letter disclosed the Respondent's administrative and due process rights and was sent via certified mail to the address last shown on the provider's provider enrollment file. See Ex. 2.

2. The Respondent has not disputed imposition of the sanction as set forth in the letter.

CONCLUSIONS OF LAW

1. The Agency incorporates and adopts the statements and conclusions of law as set forth in the aforementioned letter.

2. The sanction as set forth in the letter is final.

ORDER

1

BASED on the foregoing, it is ORDERED and ADJUDGED that the Respondent is SUSPENDED from participation in the Florida Medicaid program pursuant to Section 409.913, F.S., and Rule 59G-9.070, F.A.C. '.> ,. _ _ L _

DONE AND ORDERED this_.::;_ day of_.(f!--'-f!'I ._ ,2020, in Tallahassee, Florida.

cKi st , Deputy Secretary Di· · n of Ith Quality Assurance

Agency for Health Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTfCE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RIJLES. THE NOTICE OF

APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER iro BE REVIEWED.

Copies furnished to:

Living Well dlbla Villa Serena ii

60-62 NW 33 Avenue

Miami, FL 33125 (U.S. Mail)

Kelly Bennett, Chief

Division of Health Quality Assurance Medicaid Program Integrity Kelly.Bennett@ahca.myfiorida.com (Electronic Mail)

Laura Maclafferty, Chief

Division of Health Quality Assurance Bureau of Health Facility Regulation BHFR@ahca.myflorfda.com (Electronic Mail)

William H. Roberts, Esquire Acting General Counsel Office of the General Counsel

William.Roberts@ahga.mvflorjda,com

(Electronic Mail)

Michael Murphy, Revenue Financial Administrator Bureau of Financial Services Michael.Murphv@ahca.myflorjda.com

(Electronic Mail)

Eunice Medina, Chief

Bureau of Plan Management Operations Eunice.Medina@ahca.myflorida.com (Electronic Mail)

Gay Munyon, Chief

Bureau of Medicaid Fiscal Agent Operations Gay.Munyon@ahca.myflorida.com (Electronie Mail)

Final Orders lnbox finatorders@ahca,mvflorida.&.QID (Electronic Mail)

Ryan F'ltch, Chief

Division of Health Quality AE,suranc:e Bureau of Central Services

CSMU-86@ahca.myflorida.c:Q'!! (Electronic Mail)

Shena L. Grantham, Esquire MAL & MPI Chief Counsel Office of the General Couns.!I

Shena.Grantham@ahca.mvflorida.com (Electronic Mail)

Katrina Derico-Hanis, Uni1Manager Medicaid Accounts Receivables Unit Bureau of Financial Services Katrina.Derico-Harris@ahca.myflorida.com (Electronic Mail)

Erica Baker, Government An1alyst ii Bureau of Plan Management Operations Erica.Baker@ahca.my1lorida.eom (Electronic Mail)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been served o above­ named persoyu.s. Mail or other designated method as indicated on this the ay of

/61•4 .WO.

rd J o , uire Agency Clerk

State of Florida

Agency for Health Care Administration 2727 Mahan Drive, MS #3

Tallahassee, FL 32308-5403

(850) 412-3689

1:i{'t! 1t11f1 d1,/nt}r -H1';nt;;N

RON DESANTIS GOVERNOR

SHEVAUN L. HARRIS

--. "- t,. - .. < .,o· · :'!.,. - ,_.:;•::_....: _ ,, •'-,a •• · •

414 72bb 990 21&0 b3DO 10

ACTING SECRETARY

February 16, 2021 CERTIFIED

Ms. Valeria Dejesus-Abreu, Administrator Villa Serena VJ

754 NW 22nd Ct

Miami, FL 33125

File Number: 11969112

Application Number: 81898

Provider Type: Assisted Living Facility

RE: Complaint Number 2021002517, 2120 NW 18th Terr, Miami, FL

Notice of Intent To Den\' the Renewal Application for an Assisted Living Facility

Dear Ms. Dejesus-Abreu:

It is the decision of this Agency that Villa Serena VI renewal application for an Assisted Living Facility license be DENIED.

The Specific Basis for this determination is:

On November 3, 2020, Living Well A.C.L.F., Inc., the licensee for Villa Serena n, was terminated from participation in the Florida Medicaid according to the Suspension Final Order (MPI Case No. 2020- 0018822 - Exhibit 1). Currently, Roxana Solano is the 100% controlling interest of Living Well A.C.L.F., Inc., licensee of Villa Serena II. Ms. Solano also serves as the common controlling interest of San Thelmo Investment Group, Inc. the licensee of Villa Serena VI.

Due to the fact, that Ms. Solano is the common controlling interest in both Living Well A.C.L.F., Inc. and San Thelmo Investment Group, Inc., the renewal application for Villa Serena VI is denied pursuant to Sections 408.810 (2) and 408.815 (1) (e), Florida Statutes (F.S.).

EXPLANATION OF RIGHTS

Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute.

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHfS FORMS.

2727 Mahan Drive• MS#30 Tallahassee, FL 32308 AHCA. MyFlorida .com

Face book .com/AHCA Florida Youtube .com/AHCA Florida Twitter.com/AHCA_FL

EXHIBIT 7

Villa Serena VI February 16, 2021 Page2

If you have any questions or need further assistance, please call the General Counsel's Office at

(850) 412-3630.

Keisha Woods, MPH

Health Administration Services Manager Assisted Living Unit

Division of Health Quality Assurance cc: Legal Intake Unit, MS# 3 Enclosure

Villa Serena VI

February 16, 2021

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: Villa Serena VI

Case Number: 2021002517

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed Notice of Intent to Deem htcomplete and Withdraw from Further Review of the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Deem Incomplete and Withdraw from Further Review or some other notice of intended action by AHCA.

An Election of Rights must be returned b\' mail orb,· fax within 21 da,s of the da, ,ou receive the attached Notice of Intent to Deem Incomplete and Withdraw from Further Review or am· other proposed action b, AHCA.

If an Election of Rights with your selected option is not received by AHCA within twenty-one (21) days fron1 the date you received this notice of proposed action, you will have given up your right to contest the Agency's proposed action and a final order will be issued.

(Please reply using this Election of Ri_g!11s form unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

Please return your ELECTION_Qf RIGHTS to:

Agency for Health Care Administration Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308

Phone: (850) 412-3630 Fax: (850) 921-0158

PLEASE SELECT ONLY _l_QEJHES 3 OPTION.S;

OPTION ONE (1) I admit to the allegations of facts and Jaw contained in tlhe Notice of Intent to Deem

Incomplete and Withdraw from Further Review, or other notice of intended adion by AHCA and I waive my right to object and have a hearing. I 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 proposed penalty, fine or action.

OPTION TWO (2) I admit to the allegations of facts contained in tbe Notice of Intent to Deem

Incomplete and Withdraw from Further Review, or other proposed action by AHCA, 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 th«i Notice of Intent to Deem

Incomplete and Withdraw from Further Review or other proposed action by ABCA, 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.

Villa Serena VI February 16, 2021 Page2

PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficiemt to obtain a formaJ hearing.

You also must me a written petition in order to obtain a fonnal hearing before the Division of Administrative

Hearings under Subsection 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.201, Florida Administrative Code, whi:.:h @!!!f that it contain:

1. The name and address of each agency affected and each agency's file or identification number, if known;

1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any;

2. An explanation of how your substantial interests will be affeck <1 by the Agency's proposed

   action;

3. A statement of when and how you received notice of the Agency's proposed action;

4. A statement of all disputed issues of material fact. If there are none, you must state that there are none;

5. A concise statement of the ultimate facts alleged, including the spec i fie facts you contend warrant reversal or modification of the Agency's proposed action;

6. A statement of the specific rules or statutes you claim require re\crsal or modification of the

   Agency's proposed action; and

7. A statement of the relief you are seeking, stating exactly what actioll :,,ou wish the Agency to take with respect to its proposed action.

(Mediation under Section 120.573, Florida Statutes, may be available in this matter if :he Agency agrees.)

License Type: Assisted Living Facility Licensee Name: Villa Serena Vi

License Number: 12947

Contact Person:

Name Title

Address: ·

Street and number

Telephone Nbr.: _ Email (optional ): .

.

City Zip Code

FaxNbr.:

I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health

Care Administration on behalf of the licensee referred to above.

Signed"'-: Date:

Print Name:

STATE OF FLORIDA,

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRA TIOf

.!.,!-t;::t,

l : t(., Y LL[ :

212D NOV - 3 A II: I

AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner.

MPI Case No.: 2020-0018822

Provide,r No.: 001676700

UcenSE• No.: 8518

LIVING WELL D/8/A VILLA SERENA 11,

Respondent.

/

NPI No.: NIA

SUSPENSION FINAL ORDER

THIS CAUSE is before me for issuance of a Final Order. In a letter dated August 26, 2020, (Ex.1) Living Well d/b/a Villa Serena II (Respondent), was informed that the State of Florida, Agency for Health Care Administration (Agency) applied a sanction of suspension from participation in the Florida Medicaid program pursuant to Section 409.913, Florida Statutes (F.S.), and Rule 59G-9.070, Florida Administrative Code (F.AC.}. The respondent is prohibited from performing any action that results in a claim for payment to the Medicaid program as a result of fumishinu, supervising a person

who is furnishing, or causing a person to furnish goods or services.

The letter contained full disclosure and notice regarding the Respc.ndent's administrative hearing and due process rights and was sent to the address last shown on the provider's provider enrollment file in compliance with Section 409.913(6). F.S., which specifies that it Is qthe responsibility of the provider to furnish and keep the agency informed of the provider's current address. United States Postal Service proof of mailing or certified or registered mailing of suct1 notice to the provider at the address shown on the provider enrollment file constitutes sufficient proof c>f notice." The certified mail receipt is attached hereto and incorporated herein as Ex. 2. To date, the Respondent has not requested a hearing to dispute the racts contained In the letter, and the timeframe within which Respondent had to request a hearing has expired.

FINDINGS OF FACTS

1. The letter disclosed the Respondent's administrative and due process rights and was sent via certified mail to the address last shown on the provider's provider enrollment file. See Ex. 2.

2. The Respondent has not disputed imposition of the sanction as set forth in the letter.

CONCLUSIONS OF LAW

1. The Agency incorporates and adopts the statements and conclusions of law as set forth in the aforementioned letter.

2. The sanction as set forth in the letter is final.

ORDER

BASED on the foregoing, it is ORDERED and ADJUDGED that the Respondent is

SUSPENDED from participation in the Florida Medicaid program pursuant to Section 409.913, F.S.,

and Rule 59G-9.070, F.A.C. , , L _

DONE AND ORDERED this_..:>_ day of , 2020, in Tallahassee, Florida.

, Deputy Secretary

D Quality Assurance Agency for Health Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS E'.NTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTM:E OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, Willi THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.

Copies furnished to:

Living Well d/b/a Villa Serena II 60-62 NW 33 Avenue

Miami, FL 33125

(U.S. Mail)

Kelly Bennett, Chief

Division of Health Quality Assurance Medicaid Program Integrity K!Jlly.Bennett@ahca.myflorida.com (Electronic Mail)

Laura Maclafferty, Chief

Division of Health Quality Assurance Bureau of Health Facility Regulation BHFR@ahca.myftorida.com (Electronic Mai

VViUiam H. Roberts, Esquire Acting General Counsel Office of the General Counsel

VVilliam.Roberts@ahca.myflorid@.QOm

(Electronic Mail)

Michael Murphy, Revenue Financial Administrator Bureau of Financial Services Michael.Murphy@ahca.myflorida.com

(Electronic MaiQ

Eunice Medina, Chief

Bureau of Plan Management Operations Eunice.Medina@ahca.mvflorlda.com (Electronic Mail)

Gay Munyon, Chief

Bureau of Medicaid Fiscal Agent Operations Gav.Munyon@ahca.mvftorida.com (Electronic Mail)

Final Orders lnbox finalordem@ahca,mvfloridt1. (Eleclronic Mail)

Ryan Fitch, Chief

DMsion of Health Quality A:ssuranc:e Bureau of Central Services

CSMU-86@ahca,myflorida.,i;;mn

(Electronic Mail)

Shena L. Grantham, Esqulro MAL & MPI Chief Counsel Office of the General Counsel

Shena.Grambam@ahca.myfiorida.com

(Electronic MaD)

Katrina Derico-Harris, Unit Manager Medicaid Aooounts Receivables Unit Bureau of Financial Services: Katrina.Derico-Harris@ahca.myflorida.com (Electronic Mail)

Erica Baker, Government Analyst II Bureau of Plan Management OperatiOns Erica.Baker@ahca.myflorida.com (Electronic MaH)

2

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been served o above­

named persoyu.s. Mail or other designated method as indicated 011 this the 3 ay of

/16-t« I,, ,20QO

Agency Clerk

State of Florida

Agency for Health Care Administration 2727 Mahan Drive, MS #3

Tallahassee, FL 32308-5403

(850) 412-3689

3

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH No. 21-0082 ARCA Nos. (ESO) 2020013184

2020014304

License No. 8022

VILLA SERENA 1, INC.,

Respondent.

_;!

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

File No. 11912024

Facility Type: ALF

vs.

Petitioner,

DOAH No. 20-5129

AHCA Nos. 2020013185

2020014305

License No. 8518

VILLA SERENA II, INC,

Respondent.

!

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

VILLA SERENA III, INC., d/b/a

VILLA SERENA 111,

File No. 11953233

Facility Type: ALF

DOAH No.: 20-5128

ARCA Nos. 2020016306

2020019759

License No. 10792

File No. 11966615

facility Type: ALF

Respondent.

/

1

EXHIBIT 8

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner, DOAH No. 20-5120

ARCA No. 2019015653

VS.

SANTA BARBARA BH, INC., d/b/a VILLA SERENA VII,

f/k/a SANTA BARBARA HOME I,

Respondent.

!

VILLA SERENA III, INC., d/b/a VILLA SERENA III,

Petitioner,

v. AHCA No. 2021002529

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent,

/

VILLA SERENA IV, INC., d/b/a VILLA SERENA IV,

Petitioner,

V. AHCA No. 2021002532

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent,

I

SAN THELMO INVESTMENT GROUP, INC., d/b/a VILLA SERENA VI,

Petitioner,

V. ARCA No. 2021002517

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent,

_.;/

SETTLEMENT AGREEMENT

The State of Florida, Agency for Health Care Administration (hereinafter "the Agency"), Villa Serena 1, Inc. (hereinafter "VS I"), Villa Serena II, Inc. (hereinafter "VS2''), Villa Serena III, Inc. d/b/a Villa Serena III (hereinafter "VS3"), Villa Serena IV, Inc. d/bia Villa Serena IV (hereinafter "VS4"), Villa Serena V, Inc d/b/a Villa Serena V (hereinafter wvS5"), San Thelma Investment Group, Inc. d/b/a Villa Serena VI (hereinafter "VS6"), Santa Barbara BH, Inc., d/b/a Villa Serena VII, f/k/a Santa Barbara Horne I (hereinafter "VS7"), (collectively "the Villa Serena facilities") and Roxana Solano, Individually, by and through their representatives, pursuant to Section 120.57(4), Florida Statutes, enter into this Settlement Agreement ("Agreement") and agree as follows:

WI IE REAS, the Agency issued an emergency suspension order on 'VS1, and

WHEREAS, the Agency issued an Administrative Complaint (hereinafter Complaint I") (DOAH No. 21-0082/AHCA No. 2020014304) dated August 25, 2020, seektng the revocation of VSl's assisted living facility license and the imposition of administrative fines totaling sixteen thousand dollars ($16,000.00) based upon one (1) Class I, one (1) Class II, and two (2) unclassified deficient practices; and

\VHEREAS, VSl filed a petition for a formal hearing contesting 1he allegations in Complaint 1; and

WHEREAS, the Agency issued an emergency suspension order on VS2, and

WHEREAS, the Agency issued an Administrative Complaint (hereinafter "Complaint 2") (DOAH No. 20-5129/AHCA No. 2020014305) dated August 25, 2020, seeking the revocation of VS2's assisted living facility license and the imposition of administrative fines totaling ten thousand five hundred dollars ($10,500.00) based upon one (1) Class I and one (1) unclassified deficient practices; and

WHEREAS, VS2 filed a petition for a formal hearing contesting the allegations in Complaint 2; and

WHEREAS, the Agency issued an Administrative Complaint (hereinafter "Complaint 3") (DOAH No. 20-5128/AHCA No. 2020016306) dated October 12, 2020, seekmg the revocation of VS3's assisted living facility license and the imposition of administrative fines totaling twenty thousand dollars ($20,000.00) based upon two (2) Class I deficient practices; and

WHEREAS; VS3 filed a petition for a fonnal hearing contesting the allegations in Complaint 3; and

WHEREAS; the Agency completed surveys ofVS3 on September 15, 2020 and November 2, 2020 (hereinafter "Surveys'') (AHCA No. 2020019759) during which deficient practices were cited; and

WHEREAS, the citation of the above referenced deficient practices subjects VS3 to fines in the amount of five hundred dollars ($500.00);

WHEREAS, the Agency issued an Administrative Complaint (hereinafter "Complaint 4")

(DOAH No. 20-5120/AHCA No. 2019015653) dated November 5, 2019, seeki:1g the imposition of an administrative fine of five hundred dollars ($500.00) against VS7 based upon one (1) uncorrected Class III deficient practice; and

WHEREAS, VS7 filed a petition for a formal hearing contesting tile allegations in Complaint 4; and

"'HEREAS, the Agency filed a Notice oflntent to Deny the license rcr:ewal applications of VS3 (hereinafter "NOID 1") (AHCA No. 2021002529), VS4 (hereinafter "NOID 2") (ARCA No. 2021002532) and VS6 (hereinafter "NOID 3") (ARCA No. 2021002517'1, seeking to deny their respective license renewal applications: and

WHEREAS, Roxana Solano is the controlling interest of the Villa Serena facilities, all of which are assisted living facilities licensed and regulated by the Agency; and

NOW THEREFORE, for good and valuable consideration, the sufficiency of which is

confinned, the Villa Serena facilities, Roxana Solano, Individually, and th Agency agree as follows:

1. All of the above recitals are true and correct and are expressly incorporated into the

   
   

   Agreement.

   
   

2. The Parties agree that the above recitals are binding findings on the Parties.

   
   

3. Upon full execution of this Agreement, the Villa Serena facilities and Roxana Solana waive any and all appeals and proceedings to which they may be entitled, including but not limited to, an informal proceeding under Subsection 120.57(2), Florid:1 Statutes, a formal proceeding under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court of competent jur.sdiction; and agree to

   
   

   waive compliance with the form of the Final Order (findings of fact and couc lusions of law) to which they may be entitled. Provided, however, that this Agreement shall not be deemed a waiver by any party of its right to judicial enforcement of this Agreement. VS3 waives the issuance of an Administrative Complaint for the relief based the surveys of VS3 on September 15, 2020, and November 2, 2020 (ARCA No. 2020019759).

4. Upon full execution of the Agreement:

   
   

   CHOW Requirement for VS1 and VS2

   
   

   1. For VS1 and VS2, the Agency must receive from an independent third-party bona fide purchaser for value a change of ownership (CHOW") application by no later than one hundred eighty (180) days from the date of the Final Order adopting this Agreement for VSl and VS2. The change of ownerships must be an ann's length transaction, and under no circumstances whatsoever, may the CHOW applicant be a relative of Roxana Solano or any person (including current or former officers or employees) that is in any way connected to any of the Villa Serena facilities. The Agency reserves the right to contest the history, background and qualification of the CHOW applicant to determine whether the controlling interest is in fact a bona fide purchaser for value. The CHOW applications must contain the required information and supporting documentation required by law for a CHOW applicant, including but not limited to, documents reflecting the effective date of any closing, leasehold, or purchase agreements between VS 1 and VS2 and their respective CHOW applicants.

   2. Should a CHOW application not be timely submitted to the Agency for the respective licenses ofVSl or VS2 within one hundred eighty (180) days of the entry of the Final Order as set forth above, the respective license of VS1 and VS2 shall be sun-endered effective as

      
      

      of the 180th day of the entry of the Final Order. In such case, the respective licenses of VS I and VS2 shall be canceled without any further agency action as of the 180th day of the entry of the Final Order. During this 180-day period, and until any provisional license is issued to a CHOW applicant, the emergency suspension orders for VSI and VS2 shall remain in full force and effect. If the Agency approves a CHOW application for VS I or VS2 and issues a provisional license to the CHOW applicant, the provisional license shall lift the emergency suspension order upon issuance of the provisional license.

      Fine Payments and Licensure Prohibitions

      
      

   3. VSI, VS2, VS3, and VS7 shall pay an administrative fine in the total amount of twenty-three thousand five hundred dollars ($23,500.00) within one hundred eighty (180) days of the date of the Final Order or prior to the issuance of change of ownership licensure, whichever shall first occur. The fines shall be assessed as $8,000.00 for VS I, $5,000.00 for VS2, $10,000.00 for VS3 and $500.00 for VS7.

   4. Count III of Complaint 3 which seeks license revocation of VS3's assisted living facility licensure is withdrawn.

   5. The Villa Serena facilities and Roxana Solano further agree that they and any business entity in which they hold an interest, shall not apply for any future license regulated by

      the Agency nor shall they obtain any interest in any business entity which holds licensure or Medicaid provider contracts administered by law by the Agency until after June 11, 2025. For the purposes of this paragraph, the term ''business entity" shall not include any business entity publicly traded on a recognized stock exchange. Should any of them apply for a license regulated by the Agency, the application shall be summarily denied by the Agency. The Villa Serena facilities and

      
      

      Roxana Solano specifically waive any and all rights provided by law, including but not limited to, administrative review under Chapter 120, Florida Statutes, appellate rights, or i.njunctive or other actions in law or equity in any court or forum to challenge such denial action.

   6. The restrictions in above subparagraph above shall not apply to any application seeking the renewal of the licensure ofVS3 located at 1777 NW 30th Street, Miami, Florida 33142, License Number 10792; VS4 located at 754 NW 22nd Court, Miami, Florida 33 l 25-3309, License Number 10868; VS5 located at 2750 NW 6 Street, Miami, Florida 33125, License Number 11694; VS6 located at 2120 NW 18th Terrace, Miami, Florida 33125, License Number 12947; and VS7 located at 3317 SW 24th Terrace #19, Miami, Florida 33145-3139, License Number 5058, to operate their respective assisted living facilities identified above (VS3, VS4, VS5, VS6, and VS? (hereinafter collectively referred to as "VS3-VS7").

      Professional Management Consultant

      
      

   7. VS3-VS7 shall retain the services of a professional management consultant for a period of two (2) years commencing from the date of the entry of the Final Order adopting this Settlement Agreement. For each assisted living facility, the consultant shall conduct and supervise staff training; maintain personnel records to ensure that staff training records, background screening and other documents are updated and accessible at the respective facility locations; prepare and maintain staffing schedules; and develop and implement a quality assurance program. The consultant shall also visit each assisted living facility no less than monthly and complete a written report identifying, at a minimum, activities completed by the consultant, recommended interventions or improvements, and an assessment of implementations of prior recommendations or interventions of the consultant. The monthly reports shall be made available for inspection by

      
      

      the Agency upon request.

      
      

      Dismissal of NOID 1, NOID 2 and NOID 3

      
      

   8. NOID 1, NOID 2, and NOID 3 shall be withdrawn. lfthe Agency has not already completed its review of the applications of VS3, VS4, and VS6, it shall resume its review of the applications upon entry of the Final Order adopting this Agreement. Nothing in this Agreement, however, shall prohibit the Agency from denying the applications based upon any regulation, and if applicable, an unsatisfactory licensure survey other than that respectively addressed in NOID 1, NOID 2 and NOID 3.

   Non-Use of Medicaid Termination

   
   

   1. The Agency agrees that it will not use the pending Medicaid termination of VS2 for any future licensure decision of the remaining Villa Serena facilities.

5. Venue for any action brought to enforce the terms of this Agreement or the adopting Final Order shall lie solely in the State Circuit Court in Leon County, Florida.

6. By executing this Agreement, the Villa Serena facilities deuy the allegations set forth in the Administrative Complaints and NOIDs, but recognize that the Agency continues in good faith to assert the validity of the allegations. This Agreement shall not preclude the Agency from imposing a penalty against the remaining Villa Serena facilities for any deficiency/violation of statute or rule identified in any other survey unrelated to the above surveys. In such an event, the Villa Serena facilities retain the right to challenge the factual allegations related to the deficient practices/violations alleged in any such cause.

7. This Agreement does not preclude the Agency from using deficiencies from surveys involving VSl, VS2, VS3 and VS7 regarding the licensure of VSl, VS2, VS3 and VS7,

   
   

   including, but not limited to, licensure for limited mental health, limited nursing services, extended congregate care, or a demonstrated pattern of deficient performance. This Agreement does not preclude the Agency from using the subject events for any purpose within the: jurisdiction of the Agency. This Agreement does not preclude or estop any other federal, state, or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the above referenced in the Administrative Complaints and the surveys. This Agreement does not prohibit the Agency from taking action regarding Medicaid provider status, conditions, requirements or contract of VS1, VS2, VS3, and VS7 related to the allegations of the Administrative Complaints and the surveys.

8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above--styled case.

9. Each party shall bear its own costs and attorney's fees.

   
   

10. This Agreement shall become effective on the date upon which it is fully executed by all the parties.

11. The Villa Serena facilities and Roxana Solano, for themselves and for their related

    
    

    or resulting organizations, their successors or transferees, attorneys, heirs, and executors or administrators, discharge the Agency, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, including, but not limited to, any claims that were or may be asserted in any foderal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of the Villa Serena facilities and Roxana Solano and any of their related facilities.

    
    

12. This Agreement is binding upon all parties and those iden1ified in the above paragraph of this Agreement.

13. In the event that VSl, VS2, VS3, and VS7 were Medicaid providers at the subject time of the occurrences alleged in the complaints, this Agreement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any sanctions pursuant to Rule 590-9.070, Florida Administrative Code.

14. VSI, VS2, VS3 and VS7 agree that if any funds to be paid under this Agreement to the Agency are not paid within the time set forth in the Final Order adopting this Agreement or prior to a change of ownership, whichever shall first occur, the Agency may 1foduct the amounts assessed against VS1, VS2, VS3, and VS7 in the Final Order, or any portion thereof, owed by VS1, VS2, VS3, and VS7 to the Agency from any present or future funds owed to VS1, VS2, VS3, and VS7 by the Agency, and that the Agency shall hold a lien against present and future funds owed to VSI, VS2, VS3, and VS7 by the Agency for said amounts until paid.

15. The undersigned have read and understand this Agreement and have the authority to bind their respective principals. The Villa Serena facilities and Roxana Solano have the legal capacity to execute this Agreement.

16. This Agreement contains and incorporates the entire understandings and agreements of the parties. This Agreement supersedes any prior oral or \Vritten agreements between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void.

17. All parties agree that a facsimile signature suffices for an original signature.

    
    

18. The following representatives acknowledge that they are duly authorized to enter

into this Agreement.

-"-1' -M rv, Deputy ecretary

ty Assurance

Agency fo Health Care Administration 2727 Mahan Drive, MS #3

Tallahassee, Florida 32308

JamesD. Va General Cou

Office of the , eneral Counsel

Agency for Health Care Administration 2727 Mahan Drive, MS #3

Tallahassee, Florid, 32 P8

SJ

Shaddrick A Haston, Esquire Ullman Bursa Law

3812 Coconut Palm Drivt:

Tampa, Florida 33619

Counsel for the Villa Sere:na facilities and Roxana Solano, Individually

DATED: 3-12-2021

4,CLW

Title: C 1::-,0

Villa Serena 1, Inc. Villa Serena, II, Inc.

Villa Serena, III, Inc. d/b/a Villa Serena III

Villa Serena, IV, Inc. d/b/a Villa Serena IV Villa Serena V, Inc. d/b/a Villa Serena V

DATED:

J...Sl ().,\

San Thelmo Investment Group, Inc., dba d/b/a Villa Serena VI

Santa Barbara BH Inc. d/b/a

Villa Serena VII f/k/a Santa Barbara Home I DATED: 03/12/21

Gi'se Iglesias, Senior. tomey Of e of the Genera C unsel

ncy for Health e Administration

5 Mirror Lake D·· e, North, Suite 3300

1. Petersburg, Florida 33701

Roxana Solano, Individually DATED: 03/12121

Docket for Case No: 20-005120

Orders for Case No: 20-005120