Findings Of Fact Respondent corporation owns and operates The Ambrosia Home (the Home), a nursing home in Tampa, Florida. Ella Mae Smith, the sole stockholder and the chief executive officer of the corporation, worked as nursing home administrator for the Home from January 1, 1976, through April 21, 1976. Ms. Smith, who is a registered nurse, has been associated with the Home since 1962. On April 22, 1976, Willard Roth began as the Home's administrator, a job he kept through December 31, 1976. In January of 1976, respondent opened a 23 bed addition. Until Mr. Roth's arrival, Ms. Smith worked every day from seven in the morning till seven in the evening, except Saturdays and Sundays when she worked from seven in the morning till three in the afternoon. After Mr. Roth took over as nursing home administrator, Ms. Smith only worked eight hour days although she came back nights occasionally to look in on patients; she stopped going to get supplies for the Home herself and began sharing with Mr. Roth responsibilities for hiring and firing and for finances. For the first three quarters of 1976, respondent employed Judith Irene Roberson as a bookkeeper and secretary at the rate of three dollars an hour. Ms. Roberson is Ella Mae Smith's daughter. For the final thirteen weeks of 1976, Ms. Roberson worked as activities' director for respondent at the rate of three and a half dollars an hour. In both positions, Ms. Roberson worked overtime without pay. Because of this and because of her work for respondent in various capacities in 1970, 197, 1972, 1973, 1974 and 1975, she received a nine thousand dollar ($9,000.00) bonus in 1976. Ms. Roberson began working for respondent in July of 1970. In January of 1976, respondent received payments from petitioner for November and December of the preceding year. This money was used, in March of 1976, to open a savings account at First Federal of Tarpon Springs. In October of 1976, part of the money in the First Federal account was used to open a savings account at the Barnett Bank of Tampa. At no time during 1976, did the balance in the First Federal account fall below thirty-nine thousand, three hundred ninety-four dollars and seventy-six cents ($39,394.76). At no time during 1976, did the balance in the Barnett account fall below twelve thousand nine hundred sixty-four dollars and fifty-one cents ($12,964.51). The following year respondent used the money to pay back taxes, to pay bonuses and for other business purposes. On April 1, 1975, Ms. Smith acquired from respondent corporation the property on which the Home is located. During the year 1976, Ms. Smith leased the property back to the corporation at an annual rent of sixty-thousand dollars ($60,000.00). Rental payments under this agreement were subject to a four percent sales tax. At the close of 1976, there remained owing to Ms. Smith accrued bit unpaid rent. The corporations held a note from Ms. Smith during the year 1976, which she had given as partial payment for the property. In addition, Ms. Smith was indebted to the corporation for mortgage payments it had made on her behalf, aggregating thirty-five thousand six hundred ninety-seven dollars ($35,697.00). During the year 1976, Ms. Smith drove a 1975 Buick to and from work and used the car for other personal purposes. In addition to the personal use she made of the car, she used it to take resident of the Home on picnics, to entertain them in other ways, to transport them to a doctor's office and sometimes to take them to buy clothes. In operating the Home, she used the car for other errands: taking curtains to be cleaned and retrieving them; going shopping for fabric; and weekly trips to a Kwik-Chek store for housekeeping and other supplies. Fuel and maintenance expenses in the approximate amount of eleven hundred dollars ($1,100.00) were incurred in the operation of the automobile during 1976. No records were kept to reflect what fraction of the car's use was personal to Ms. Smith, however. Whenever Ms. Smith purchased supplies for the Home at the Kwik-Chek store, she paid with a check drawn on a Home account. In addition to housekeeping supplies, she sometimes bought Band-Aids and food on these trips. No records were kept to reflect just what was acquired on each trip. According to respondent's records, housekeeping supply expenses aggregated four thousand five hundred sixty-four dollars ($4,564.00) for 1976, and approximately forty- five hundred dollars ($4,500.00) for 1975. During 1976, six hundred dollars ($600.00) were reported stolen from petty cash in two accounts of which respondent had control. Respondent incurred certain legal and advertising expenses aggregating nine hundred fifty dollars ($950.00) in i976. Petitioner reimburses medicaid providers like respondent for a portion of certain expenses they incur in caring for eligible patients. In addition, petitioner's payments to medicaid providers include a return of approximately ten percent to medicaid providers on net assets devoted to the care of eligible patients. Respondent was slated to be audited by petitioner during 1977, in accordance with federal regulations prescribing such audits for each medicaid provider at lease once every three years. Petitioner performed its audit of respondent for the year 1976 earlier in 1977 than it would have otherwise, at the request "of HRS counsel because of a lawsuit that Ambrosia Home" (T48) brought against petitioner. Jesus A. Martinez, an auditor II in petitioner's employ, performed the audit of respondent, which was subsequently reviewed by Messrs. Roark and Conners, and possibly by Mr. Powell, all of whom are also employees of petitioner. As a result of the audit, petitioner proposes to disallow certain expenses claimed by respondent. These include sales tax on rent paid by respondent to Ms. Smith; portions of salaries respondent paid Ms. Smith and Ms. Roberson; petty cash reported stolen; checks to Kwik-Chek in excess of fifty dollars ($50.00), aggregating two thousand five hundred sixty-seven dollars and seventy-eight cents ($2567.78); and expenses related to the 1975 Buick, viz., interest on money borrowed to acquire it, an allowance for depreciation, insurance, taxes, licenses and operating expenses. Petitioner originally proposed to disallow certain professional fees, but indicated after the hearing that it would allow them. On advice that has since been rejected, respondent did not originally claim depreciation and operating expenses for the automobile. Similarly, respondent did not originally include the value of the automobile in computing the equity on which its return should be calculated, but took the contrary position in these proceedings. Petitioner proposes to disallow the value of the automobile and, as a result of the audit, to disallow certain other items respondent included in computing its equity capital. These include funds drawing interest in saving accounts far more than six months and Ms. Smith's obligations to respondent. On the other hand, petitioner included in equity capital the unpaid rent respondent owed Ms. Smith, even though respondent failed to include this item in its equity calculations. The foregoing findings of fact should be read in conjunction with the statement required by Stuckey's of Eastman, Georgia v. Department of Transportation, 340 So.2d 119 (Fla. 1st DCA 1976), which is attached as an appendix to the recommended order.
Recommendation Upon consideration of the foregoing, it is RECOMMENDED: That petitioner allow the entire salary respondent paid Ms. Smith in 1976, as a reasonable cost. That petitioner allow the salary respondent paid Ms. Roberson in 1976, as a reasonable cost, less and except seven thousand three hundred seventy dollars ($7,370.00). That petitioner disallow and exclude all other disputed items. DONE and ENTERED this 16th day of October, 1978, in Tallahassee, Florida. ROBERT T. BENTON, II Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 APPENDIX Paragraph one of petitioner's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraph two of petitioner's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraphs three and four of petitioner's proposed findings of fact are consistent with the evidence adduced at the hearing but are not strictly relevant. Paragraph five of petitioner's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraphs six and seven of petitioner's proposed findings of fact are actually proposed conclusions of law. Paragraph one of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant, except that the evidence did not establish when cost reports for the year 1976 were submitted. Paragraph two of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant, except for the last clause thereof which was not established by the evidence. Paragraph three of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant. Paragraphs four and five of respondent's proposed findings of fact are consistent with the evidence adduced at the hearing but are not strictly relevant. Paragraph six of respondent's proposed findings of fact has been adopted, in substance, insofar as relevant, except for the final sentence thereof, which is not supported by the evidence. Paragraphs seven and eight of respondent's proposed findings of fact have been adopted, in substance, insofar as relevant. Paragraphs nine and ten of respondent's proposed findings of fact are actually proposed conclusions of law. COPIES FURNISHED: Ellen Ostman, Esquire Department of HRS 4000 West Buffalo Avenue Tampa, Florida 33614 Allan M. Dabrow, Esquire Suite 1300 1845 Walnut Street Philadelphia, Pennsylvania 19103 Mr. David Ganley Supervisor of Nursing Home Receivables Department of HRS 1317 Winewood Boulevard Tallahassee, Florida 32301 Mr. Carl McBride Department of Accounting Department of HRS 1317 Winewood Boulevard Tallahassee, Florida 32301 The Ambrosia Home 1709 Tallaferro Road Tampa, Florida 33609 W. Kirk Brown, Esquire 313 Williams Street Suite 10 Post Office Box 4075 Tallahassee, Florida 32303
Findings Of Fact The Agency for Health Care Administration (AHCA) is the State Agency with responsibility for administration of the Certificate of Need (CON) program in the State of Florida, including CON review of Medicare certified home health agencies. Principal Nursing Services, Inc., is a Florida Corporation engaged in the business of providing home health services to consumers in AHCA District XI, Dade County, Florida. It is currently licensed to provide non-Medicare and Medicaid reimbursed home health services and it has applied for a certificate of need (CON) to provide Medicare certified home health services in District XI. Petitioner's CON application for District XI was denied by AHCA. The denial is currently being challenged in another case. Pursuant to Section 408.034(3), Florida Statutes (1992), AHCA is required to: . . . establish, by rule, uniform need methodologies for health services and health facilities. In developing uniform need methodologies, the department shall at a minimum, consider the demographic characteristics of the population, service use patterns, standards and trends, geographic accessibility, and market economics. The certificate of need review criteria in Section 408.035, Florida Statutes, further requires AHCA to consider factors such as efficiency, the impact projects will have on the costs of health care, and the extent to which projects will foster competition. In response to Section 408.034(3), Florida Statutes (1992), and after two failed attempts at rulemaking in 1983 and 1986, AHCA embarked upon a third attempt at establishing a need methodology to project the need for Medicare certified home health agencies. During the process of developing a third rule, the Agency consulted representatives of the home health industry. The agency also contracted and paid for a study by Dr. Elton Scott, an associate professor of economics and finance at FSU, to develop and recommend appropriate methodologies to calculate need for Medicare home health agencies. The Scott study proposed three methods for calculating "need" for Medicare home health agencies utilizing various types of data and statistical formulae. The methodologies proposed by the Scott study were: Check for changes in the cost efficient firm size (CEAS) of 18,000 visits per year by analyzing firm size to average cost per visit data. Calculate various use rates by utilizing data based on Medicare hospital admissions and Medicare vists on a regional and district level multiplied by the ratio of historical population over 65 to projected population over 65. Project the gross number of agencies in a district by dividing the projected number of Medicare home health visits by the cost efficient firm size (CEAS). Finally, subtract the number of existing and approved home health care firms in a district from the gross number of agencies needed for that district to yield the number of home health agencies needed in the future. The second method proposed by the Scott study is simpler than method A above because Method B requires less complex data with fewer complex steps. Essentially, data representing Medicare hospital admissions is not required for Method B. Method B again requires that the cost efficient firm size of 18,000 visits per year be checked for accuracy. Then the regional use rate is calculated by dividing the total number of home health visits by the regional historical population over 65. Next compute the projected gross number of Medicare home health visits for a district by multiplying the regional medicare use rate by the projected district population over 65. Divide the projected gross number of Medicare home health visits by the cost efficient firm size to yield the gross number of home health agencies needed in the future. Finally subtract the current number of existing and approved home health agencies from the gross number of needed agencies to yield the net number of home health agencies needed in the future. Method C would use data based on the total number of home health visits and two groups of projected population over 65 in a statistical formula based on regression analysis. However, this approach was not recommended because the results were inconclusive and much of the data for calculating regression coefficients was not available or was unreliable. In 1988, Rule 59C-1.031, Florida Administrative Code, the rule at issue in this proceeding, was adopted by the Department of Health and Rehabilitative Services, now the Agency for Health Care Administration (AHCA). The methodology set forth in Rule 59C-1.031, Florida Administrative Code, requires, in part, that AHCA project the net need for new Medicare certified home health agencies. This net need is based on the "projected number of home health agency visits" (PHHV) and an estimate of a "cost effective agency size" (CEAS). The Rule, as adopted, states, in part: (3) Need Methodology (c) The net need for new Medicare home health agencies in each district is calculated as follows: HHNN = (PHHV - AHHV)/CEAS) - AHH Where: HHNN equals the Medicare certified home health agency net need. PHHV equals the projected number of home health agency visits for the respective district and planning horizon . . . AHHV equals the actual number of home health agency visits provided by all Medicare certified home health agencies in the district . . . CEAS is the cost efficient agency size in number of visits at which economy of scale is achieved . . . CEAS shall be updated by the agency annually and shall be determined by the agency according to the following methodology: Rank all agencies by visit size, excluding hospital-based agencies. Calculate the average cost for all visits for each remaining agency. Calculate the mean visit cost for all agencies, excluding hospital-based agencies, and two standard deviations from the mean for the remaining agencies. Eliminate agencies with average costs at or exceeding two standard deviations above and below the mean visit cost from further calculations. Array remaining agencies by visit size from low to high, and sort agencies into 4 groupings by visit size containing an equal or similar number of agencies, and calculate the mean cost for each grouping. Calculate the percentage reduction, if any, in mean visit cost for each grouping as compared to the previous grouping. Identify the agency size groupings which have a mean visit cost reduction of 5 percent or more compared to the mean visit cost of the previous grouping. Select the agency size grouping for which the last 5 percent or more reduction in mean visit cost is achieved prior to a grouping for which a less than 5 percent reduction is achieved as compared to the previous grouping and determine the median agency size for this grouping rounded to the nearest thousand. This agency size is defined as CEAS. Specifically, Rule 59C-1.031(3)(c), Florida Administrative Code, delineates a formula to calculate net need for home health agencies in batching cycles. The formula contained in the rule is HHN=((PHHV-AHHV)/CEAS)-AHH. As indicated above, HHN is the measure of home health agency net need. PHHV is the projected number of home health agency visits per district calculated by multiplying the number of visits by the projected population over age 65 expected for that particular one year of the planning horizon. CEAS is an estimate of the cost efficient agency size. The most recent number of Medicare visits and costs incurred by Medicare home health agencies are based on cost reports available to the AHCA from Medicare intermediaries. The source for the projected population is the Executive Office of the Governor. The data sources are reasonable sources for such information. The Rule, as adopted, differed from the Scott study recommendations in several significant respects. 1/ Specifically, the Scott study's methodologies would not have subtracted actual home health visits (AHHV) from the projected number of home health visits (PHHV) before dividing by cost effective agency size (CEAS), and the Scott study's methodologies would have provided a reliable determination of CEAS. The Scott study never recommended subtracting the actual number of home health visits from any quantity since to follow such a formula has the effect of locking in and protecting the existing market and existing home health agencies and newly admitted home health agencies from competition from home health agencies desiring to be admitted to the market. The effect is particularly significant when home health agencies are involved because there is no inherent capacity limit for any home health agency. That is, in theory the capacity or ability to perform home health visits of any home health agency is infinite. The agency can quickly and easily add more and more nursing and other health provider personnel to meet the service demand. Because home health agencies are free to expand ad infinitum, current CON holders have the ability to limit the participation of new agencies in the market or the number of new participants allowed into the Medicare home health market for any given batching cycle. In fact, the number of new agencies permitted into the Dade County market over the years demonstrates the limit to competition imposed by the Rule since larger and larger agencies are increasing and not even moderate growth is being allowed. Currently for the Dade County District, nine of 31 existing home health agencies operate at above 100,000 visits per year. 4,113,228 visits are projected to be needed for the 1995 planning horizon. However, only two new agencies were deemed to be needed for the 1995 home health agency planning horizon. In short, the Rule prohibits the entry of providers who could efficiently and effectively provide services to Medicare patients in part by artificially protecting existing providers from competition. The rationale of AHCA for subtracting out the actual number of visits is the assumption that existing agencies have the capacity to provide services to existing case load since growth in visits is mathematically allotted to new agencies. Under the evidence the assumption is accurate given a home health agency's ability to expand. Indeed good need planning requires that at least some of the current visits be subtracted from the projected number of Medicare home health visits. Such planning is inherent in the certificate of need program. However, the evidence did demonstrate that by subtracting all the current visits over the CEAS amount the rule unnecessarily protects existing providers from competition. Therefore, AHCA's rationale cannot serve to authorize a rule which acts in such an extreme anticompetitive manner. Beyond subtraction of the actual number of Medicare home health visits, the most significant departure of the Rule from the Scott study is in the calculation of cost efficient agency size (CEAS). The purpose of CEAS is to establish the visit size at which a new agency can obtain cost efficiency. The concept of CEAS is based on the generally accepted principle that the greater the number of home health visits performed by a home health agency the less costly is each unit of service, up to a threshold beyond which no greater economies of scale are realized. Generally, a newly approved agency which has recently begun operations has a very high cost per visit which diminishes as the agency achieves a larger number of visits. Further, the purpose is not merely to find the initial economy of scale, but the point at which there are no significant additional economies of scale to be realized. "Economy of scale" is defined as: The behavior pattern of costs where gains in operating efficiencies act to reduce costs per unit to a certain point (economies of scale) and that as the level of production continues to increase operating inefficiencies take effect (diminishing returns). The Scott study recommended that CEAS be calculated based on six groups of firms ranging in size from 0-6,000 visits per year, 6,000-9,000 visits per year, 9,000-12,000 visits per year, 12,000-15,000 visits per year, 15,000- 20,000 visits per year, 20,000-30,000 visits per year and 30,000+ visits per year. These six sizes were selected by the Scott study as the most informative group sizes after comparison to alternative grouping schemes. Cost data for each firm in each group was then averaged separately for skilled nursing vists and for home health aide visits. Finally the average of the per-visit cost for each group was analyzed, using the analysis of variance model to determine whether statistically significant differences in per-visit costs occurred between the groups. The rule calculates CEAS by grouping and ranking all existing certified home health agencies with respect to total numbers of visits. Four groupings are created and then the average cost per visit is calculated for each group, based on the average cost per visit for each home health agency within the group. 2/ The rule provides that the agency size grouping for which the last 5 percent or more reduction in mean visit cost is achieved prior to a grouping for which a less than 5 percent reduction is achieved as compared to the previous grouping will be the group upon which the CEAS is based. The agency uses the last five percent break. However, the Rule does not compel AHCA to select the group with the lowest average cost, and based on the language in the methodology, the agency intended that Group "1" never be selected as the CEAS, although AHCA did select this group in one recent case. The rule provides also for the elimination from the calculation of any agency with a cost per visit more than two standard deviations from the mean cost of the group and for elimination from the calculation for hospital based agencies. Hospitals were eliminated from the data after careful consideration because, at the time the Rule was promulgated, analysis of the data indicated that hospital cost per visit was significantly higher than nonhospital based agencies and it was determined that inclusion of the hospital data would skew and distort the cost efficiency data for the nonhospital based agencies. In 1987, all parties agreed that hospital based home health agencies would skew the determination of CEAS and should be omitted from the CEAS calculation. However, the reasons for eliminating hospital based home health agencies from consideration are no longer valid. Significantly, AHCA admits that consideration of these agencies must again be reviewed. In fact, the Agency recalculated the July 1994 fixed need pool projection of two additional home health agencies in District XI utilizing hospital data and the need projection did not change for the batching cycle. Given these facts, the factual basis for the rule's exclusion of hospital based home health agencies no longer exists and the Rule is now an invalid exercise of delegated legislative authority. Pursuant to AHCA's determination, CEAS has been calculated as follows, for the indicated planning horizons: Planning Horizon CEAS Avg. Cost per Visit 7/91 21,000 $51.25 1/92 12,000 $51.25 7/92 12,000 $46.80 1/93 5,000 3/ $46.81 7/93 64,000 $46.81 1/94 87,000 $46.41 7/94 88,000 $49.24 1/95 119,000 $51.88 As can be seen CEAS as calculated by AHCA has generally increased, however, there have not been large increases in the costs of delivering home benefit services, and thus there appears no justification for the wide fluctuation in CEAS produced by application of the rule's formula. AHCA had no explanation for the disparity. It appears the rationale behind regulating home health agencies is the premise that cost savings are realized as the number of agency visits increases. However, AHCA has, in fact, detected a decreasing correspondence between the size of a home health agency and its number of visits and average cost per visit, as agency costs migrate toward the Medicare ceiling for reimbursement. In fact, two contradictory intentions emerge from close study of the rule. Even more evident is that the rule intends to restrict market access without substantial regard to the principle of cost containment. The rule reflects a bias toward restricting market entry by home health agencies without regard to cost efficiency. As noted above, the rule precludes the possibility that the group with the lowest number of visits (and thus generating the largest fixed need pool) could ever be selected as the CEAS. Also as noted above, the rule's preference for later reductions of at least five percent, without regard to comparing average costs or even percentage reductions, again encourages the selection as the CEAS of the group with the larger number of visits (thus generating the smallest fixed need pool). Third, Rule 59C-1.031, Florida Administrative Code, cannot be interpreted to require Respondent to select the CEAS based on the group with the lowest average cost per visit. Further, in determining CEAS, the Rule does not distinguish between the "types" of visits performed by each home health agency in the calculation of average costs. Specifically, the Rule does not consider the cost difference between skilled nursing visits and visits by home health aides. Because the cost of an average skilled nursing visit can be twice as much as the cost for a home health aide visit, and because larger agencies tend to do more home health aide visits, the Rule's determination of average cost does not truly reflect the actual cost of producing those services. As a result, CEAS is weighted toward an agency size larger than where true economy of scale is achieved and actually encourages one service to subsidize another. However, probably the most serious flaw in the rule's CEAS calculation involves the five percent reduction between the four groups. Apparently, the five percent figure was simply chosen by the agency as an appropriate point of demarcation. However, AHCA pointed to no studies or other information which justifies or rationalizes the use of five percent as the spread factor between groups in the need formula. Indeed the need formula contains no method for analyzing whether the five percent figure is even a significant difference between any one group since no analysis of variance between groups is performed on the data used by AHCA in the calculation of CEAS. Without such an analysis of variance neither the five percent figure nor any other number can be said to be a significant variation in average cost between groups. In short, unless the five percent reduction is a significant variation between the groups it is a meaningless figure on which to base the selection of efficient firm size since the data can vary by that amount at any given point in time. Since there is no factual basis for the five percent spread and there is no analysis of variation contained in the CEAS calculation in the rule, the portion of the rule setting forth the CEAS calculation has no basis in fact or logic and is therefore an invalid exercise of delegated legislative authority. The agency would argue the record does not contain substantive evidence that the addition of significant numbers of additional home health agencies in any area of the state would reduce the cost of service or improve the quality of care or access to care. However, the argument misses the point that the CON statute is intended to limit market access by new businesses only to the extent necessary to maintain quality of care and prevent overutilization. Moreover, the argument does not go to the issue of whether the rule is valid under its statutory authority. Costs of service and quality of care issues may certainly be one reason underlying a given rule. However, the fact that the evidence did not disclose such problems does not serve as a basis for validating a rule which is not within the scope of delegated legislative authority. On the other hand, AHCA did not demonstrate that if large numbers of new agencies were admitted to the market that there would inevitably result a large number of agencies operating below any cost efficiency. AHCA's argument in that regard is full of "ifs", and was not shown to have any basis in fact. Indeed, it is just as likely that market economics will force inefficient providers out of the home health agency market. Respondent's interpretation of the rule, which stresses the intention to restrict market access without substantial regard for the principle of cost containment, fails to account adequately for the fact that diminishing returns or diseconomies of scale may actually have already begun before the second group is considered. The intent of the rule is to find the cost efficient agency size at which economies of scale are achieved. If the economies of scale are only encountered within the first group (i.e., the group with the agencies with the smallest number of visits), then it is impossible to justify the rule and the rule is therefore invalid.
Findings Of Fact Petitioner, Indigo Manor, is a Florida licensed nursing home and Medicaid provider. Petitioner is a long term provider, and the successor in interest in the facility originally built by Health Care and Retirement Corporation of America (HCRC). Petitioner's address is 595 Williamson Boulevard, Daytona Beach, Florida. Respondent is the single state agency responsible for administering the Florida Medicaid program pursuant to Section 409.913, Florida Statutes, and rules promulgated thereunder. Reimbursement to nursing homes is governed by the Florida Title XIX Long-Term Care Reimbursement Plan (the Plan). The Plan is adopted by reference by Rule 10C-7.0482, Florida Administrative Code. Under the Plan, long-term care providers are reimbursed under a prospective reimbursement methodology. Rates are projected for a rate semester based on historical cost data. The provider is either reimbursed for depreciation and interest or is reimbursed under the Fair Rental Value System ("FRVS") for the property cost component of the provider's rate. Under FRVS, reimbursement is based on the acquisition costs of a capital asset. These acquisition costs are indexed forward based on a portion of the rate of increase in the Dodge Construction Index. (See Long-Term Care Reimbursement Plan at Section V.E.I.a.) Nursing homes participating in the Medicaid program on October 1, 1985, when the FRVS was implemented, were allowed to base their reimbursement on depreciation of actual property and interest costs. Most facilities entering the program after October 1, 1985, were put on FRVS. To prevent any facility from receiving lower reimbursement under the FRVS method as opposed to the depreciation plus interest method, there was a transition period during which some facilities continued to be paid depreciation plus interest payments until the FRVS payments exceeded the depreciation and interest payments as specified in Section V.E.1.h. of the Plan. At that time, a facility would receive reimbursement under the FRVS method. (See Long-Term Care Reimbursement Plan at Section IV.D.) Frank D. Hughes, an expert in Medicaid reimbursement to nursing homes, testified in behalf of the Department. He identified a chart, Respondent's Exhibit 1, which shows that costs reimbursement to a provider may start at a higher reimbursement per diem than FRVS, but that component of the provider's total reimbursement rate will decline over time; and FRVS will start a provider at a lower initial rate, but the property component of the total reimbursement rate will increase over time. Section IV.D. of the Department's Plan limits applicability of the hold harmless/payback clause to facilities entering the Medicaid program after October 1, 1985, which had committed to construction or purchase loans prior to October 1, 1985. The Department's witness clarified that the Department interpreted the language "committed to construction or purchase loans" in the disjunctive, i.e., "committed to construction" or "committed to purchase loans" prior to October 1, 1985. Further, the witness clarified that the Department interpreted the language "committed to construction" to be limited to providers who were subject to legally enforceable agreements for construction or financing. The Department's rationale was that only those providers who were subject to legally enforceable agreements would be adversely effected by the Plan's new method, and needed that protection of the hold harmless/payback clause. Mr. Hughes clarified that, if enforceable commitments had been made for loans, the Department would consider the entity to have met the "commitment" requirement. Mr. Hughes also clarified that, if a provider was able to finance a construction project without loans and accomplish the construction itself, the Department would consider the provider "committed" to construction at the point it entered into subcontracts for the project, or alternatively, at the point actual construction of the facility was begun. A stated intent to build a nursing home or nonbinding preparation prior to October 1, 1985 was insufficient to establish a commitment to construction. In September through November 1985, Health Care and Retirement Corporation of America (HCRC) began the permitting process to construct the subject nursing home on property it owned in Daytona Beach, Volusia County, Florida. The Department conceded that HCRC, the predecessor of Indigo Manor, had taken certain actions towards constructing the facility to include purchasing the property, architectural and engineering drawings and plans, obtaining building permits, and obtaining a Certificate of Need. In November 1985, construction on the project actually began. On November 25, 1985, HCRC entered into a construction contract with a subsidiary of HCRC to construct the nursing home. Funds for construction were obtained through internal transfers at HCRC via lines of credit available to HCRC. It was conceded by Petitioner that there were no loans obtained for the construction of the facility. The facility was completed and enrolled in the Medicaid program in July 1987. At that time, it was placed on the FRVS for its property costs. Subsequently, in December of 1987, the facility was transferred to the cost reimbursement system, effective retroactively to its date of entry in July. There is no documentation in the Department's files to indicate the reason the change was made, and no documentation to indicate additional or revised information was submitted to the Department to justify the change. The facility remained on the cost basis until February 1992, when the Department reviewed the audits in the facility's reimbursement file and determined the facility should not have been changed to cost, but instead should have remained on FRVS. Revised rate sheets dated February 20, 1992, covering all rate setting periods since July 22, 1987, were provided to the Petitioner that advised Petitioner would have its rate recalculated using the FRVS method and indicated the amended rates. On June 1, 1992, Petitioner's accounting firm sent a letter to the Department's Medicaid Cost reimbursement Administrator stating the facility believed the Department made a mistake by recalculating the rates. The letter asked that the matter be reviewed and the "error" corrected. On June 22, 1992, Petitioner was advised that the Department had determined the amount of overpayment received by Indigo Manor based upon the recalculated rates. Petitioner was directed to repay $250,935.46 which represented the difference between the actual rate paid which used the cost reimbursement method, and the rate that should have been paid using the correct FRVS method. By letter dated June 23, 1992, Mr. Hughes explained that, based on the Florida Title XIX Long-Term Care Reimbursement Plan, facilities entering the Medicaid program after October 1, 1985, would have their property costs recognized under the FRVS method. The letter pointed out that the Plan held harmless only those new facilities that had committed to facility construction or purchase loans prior to October 1, 1985. The letter, Petitioner Exhibit 1-B, also stated: The Department has consistently interpreted "committed" to mean enforceable agreements regarding facility construction or purchase loans specific to the facility in question, e.g. a contract for construction or an agreement for purchase loans specific to the facility in question. Based on the Department's June 23, 1992 letter, Petitioner filed a request for formal proceedings pursuant to Section 120.57(1), Florida Statutes, to challenge the Department's determination it should be on FRVS. Subsequent to the filing of that petition, Indigo Manor filed the instant petition alleging the Department is relying on non-rule policy. As of the date of the hearing, the Department had not initiated rulemaking regarding its challenged statement of policy, and the Department offered no evidence showing that rulemaking was not feasible or practicable. Petitioner conceded the phrase "committed to construction or purchase loans" is found within 109C-7.0482, Section IV, D., Florida Administrative Code. Petitioner does not allege that 10C-7.0482, Florida Administrative Code, is not a validly promulgated rule. Petitioner further concedes that contracts were not executed for construction of the facility, and actual construction was not begun until after October 1, 1985. At the formal hearing, the Department did not dispute that Petitioner was substantially affected by the Department's action. The Department did argue, however, that Petitioner did not have standing to bring the instant action as it did not actually own the property or facility at issue, nor did it have a contract in effect with the owner, Health Care and Retirement Corporation (HCRC), prior to October 1, 1985. While the Petitioner did not own the facility, the Department recognizes that Petitioner is the successor in interest to HCRC and is the entity impacted by the Department's rule and Department's policy of construing the term "committed to construction" to be limited to enforceable contracts for construction or purchase loans. HCRC has no present interest in the facility, and the Department's action.
Findings Of Fact On February 15, 1977, Petitioner was employed by the City of Clearwater as a full-time firefighter. He became certified as a firefighter on April 21, 1977, and was issued certificate number 5374. After receiving an associate's degree from St. Petersburg Junior College, Petitioner became eligible to receive firefighters' supplemental compensation benefits on July 1, 1981. After receiving a bachelor's degree from Eckerd College, Petitioner became eligible to receive additional firefighters' supplemental compensation benefits on May 1, 1984. Until July 2, 1986, Petitioner received his supplemental compensation benefits according to the appropriate level. On July 2, 1986, a hearing was held before the City of Clearwater Pension Advisory Committee as to whether Petitioner was entitled to a job- connected disability pension for injuries that he received in firefighting related activity. Following a finding by the Clearwater Pension Advisory Committee that Petitioner was entitled to the disability, the City of Clearwater forwarded to Respondent a Notice of Ineligibility for Supplemental Compensation Benefits, reflecting an ineligibility date for Petitioner of July 2, 1986. Based upon the Notice of Ineligibility, as well as the fact that Petitioner had received a disability that could not be corrected to the satisfaction of the Respondent, Respondent voided Petitioner's certification as a firefighter and terminated his supplemental compensation benefits as of July 2, 1986. Petitioner elected a retirement plan option offered by the City of Clearwater under which he extended his termination of employment date by the amount of time due him for vacation, holiday pay, and one-half of his accrued sick leave. By utilizing the vacation and sick leave time to which he was entitled, Petitioner extended his termination of employment date to October 8, 1987. Between July 2, 1986 and October 8, 1987 Petitioner occupied the status of an employee on vacation or on sick leave, i.e., he was on leave with pay. He received a paycheck at the same time that other employees of the City of Clearwater received theirs, and his paycheck carried the same deductions that other employees would have in their checks. It is uncontroverted that although Petitioner received his disability on July 2, 1986, Petitioner has received compensation from the City of Clearwater on an uninterrupted basis encompassing the period from July 2, 1986 through October 8, 1987 for duties that he performed as a full-time firefighter for the City of Clearwater Fire Departments his employing agency.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED that a Final Order be entered reinstating Petitioner's supplemental compensation benefits from July 2, 1986 through October 8, 1987 and directing that those benefits be paid to Petitioner forthwith. DONE and RECOMMENDED this 23rd day of October, 1987, at Tallahassee, Florida. LINDA M. RIGOT, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 23rd day of October, 1987. COPIES FURNISHED: William Gunter State Treasurer and Insurance Commissioner The Capitol, Plaza Level Tallahassee, Florida 32399-0300 Fredric S. Zinober, Esquire Village Office Park, Suite 107 2475 Enterprise Road Clearwater, Florida 33575 Lisa S. Santucci, Esquire Department of Insurance 413-B Larson Building Tallahassee, Florida 32399-0300 =================================================================
Findings Of Fact The Petitioner is an elderly lady who is the recipient of benefits pursuant to the "Home Care for the Elderly" program administered by the Respondent pursuant to Section 410.035, Florida Statutes. The subject program is designed to be an alternative to institutionalized care in a nursing home for such elderly, physically disabled citizens as the petitioner, Mrs. Sapp. The program's purpose is to enable such persons to remain in a physically and emotionally wholesome family environment, if at all possible, rather than being forced to reside in a nursing home institution when they are no longer able to care for themselves. In the Petitioner's case, a family member, Mrs. Taylor, is able to provide round-the-clock care for the Petitioner in return for which the Respondent (Department) pays the Petitioner a home care subsidy based upon a flat rate schedule in some way related to the recipient's income (See Exhibit No. 1). The State benefits by such a program since a recipient such as the Petitioner, who qualifies fully for subsidized care in a nursing home, with its substantially greater expense, can be maintained much less expensively at home. On or about July 1, 1980, the petitioner received notice from the Federal social Security Administration that her Supplemental Security Income benefits would be increased due to an increase in the cost of living during the past year. Because of this and because the petitioner had no other "countable income" for the purposes of the Social Security Act benefits, her Supplemental Security Income (551) was raised to $238.00 per month. Upon learning of the increase in the Petitioner's 551 benefits, the Respondent, apparently following the subsidy schedule contained in Exhibit No. 1, reduced the benefits paid to the Petitioner from $96.00 per month to $72.00 per month. The subsidy schedule contained in Exhibit No. 1 makes no allowance for increase in the cost of living, but rather, is apparently based on the "institutional care policy" or based (pursuant to Section 410.035, Florida Statutes) on the minimum payment the recipient would be entitled to for full institutional nursing home care. The State subsidy amounts depicted on Exhibit No. 1 may be within the range of less then 45 percent and more than ten percent of the minimum institutional nursing home care payment pursuant to Section 409.266, Florida Statutes, but there is no showing of the amount of such institutional care benefits. The Respondent described the income received from the federal program and other sources as a dollar-for-dollar "set off" against the income she receives from the home care subsidy program. That contention is not accurate, however, inasmuch as the State subsidy benefit reduction involved herein was not a reduction in the same sum as the subject increase in the federal 551 payment, and additionally, once the State benefits were reduced to the disputed amount of $72.00 per month, then they would remain at $72.00 per month oven if the federal benefits ultimately increased by several hundred dollars. Thus, it is obvious that the federal benefits do not operate as a dollar-per-dollar "set off" against the State benefits normally due. The Respondent's position that the federal benefits are fully countable income in calculating the amount of benefits due in order to provide such a recipient as the Petitioner with her fully allowable income under this Home Nursing Care program, is not an accurate description of the State policy nor the means by which the State benefits are calculated. It is undeterminable how the benefits are calculated or why and in what manner the federal benefits under the SSI program are considered in large part to be "countable income" in determining the Petitioner's financial status and entitlement under the State program. The Respondent apparently arrived at the $24.00 per month reduction in benefits under the Section 410.035 program by applying the Petitioner's new increased income under the federal program to the corresponding chart of State benefits contained in Exhibit No. 1, the origin or derivation of which was not shown. There was no definitive showing of the amount of relevant nursing home care payments which the Petitioner would be entitled to if she were confined in a nursing home, and thus no means to calculate the fractional portion thereof due the Petitioner as a subsidy for home nursing care pursuant to the program under discussion.
Recommendation Having considered the competent, substantial evidence of record, the foregoing Findings of Fact and the Conclusions of Law, it is concluded that competent, substantial evidence has not been presented which will sustain the Respondent's burden of proving adequate justification for its reduction of the Petitioner's Home Care for the Elderly benefits. It is, therefore, RECOMMENDED that the Petitioner continue to receive the benefits in the amount of $96.00 per month which she was receiving prior to the agency action herein involved and that Home Care for the Elderly benefits withheld from her pursuant to the agency's action be restored. DONE and ENTERED this 6th day of November, 1980, in Tallahassee, Leon County, Florida. P. MICHAEL RUFF, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 10th day of November, 1980. COPIES FURNISHED: Mrs. Ada Sapp Route 3, Box 137 Cottondale, Florida 32431 John L. Pearce, Esquire District II Legal Counsel Department of Health and Rehabilitative Services 2639 North Monroe Street Suite 200-A Tallahassee, Florida 32303
The Issue The issue in this proceeding is whether the Department of Children and Family Services should revoke the family day care license of Respondents.
Findings Of Fact Respondent has been registered with the Department as a family home day care provider since September of 2001. A registered family home day care does not have to meet all of the requirements that a licensed day care home must meet. However, the same background screening and training requirements must be met. Registered family day care homes are not inspected as often as licensed homes. Each year, the registered provider must complete a renewal application that, among other things, identifies household members and substitute care-givers. The operator of the home and all household members are required to pass a Level 2 background screening. Additionally, registered family home applicants must pass a 30-hour family day care home training, a five-hour early literacy course, and each year, complete 10 hours of in-service of continuing education. Operators of the registered homes must designate a substitute care provider who is also required to go through the background screening. Ms. Huewitt designated Teresa Clary as her substitute care provider on her 2007, 2008, and 2009 applications. Previous Disciplinary Action On three occasions in the fall of 2008 and on one occasion in February 2009, Respondent was found to be out of compliance with ratio requirements, i.e., caring for more children than allowed. Additionally, in November 2008, the Family Services Counselor from the Department called the home and the phone was answered by one of Ms. Huewitt’s adult daughters. That daughter informed the Family Services Counselor that Ms. Huewitt was not home and would be back shortly. The Department then determined that this violated the substitute care requirement as Teresa Clary was designated as the substitute care provider. As a result, the Department issued an Administrative Complaint on January 12, 2009, regarding two incidents of being out-of-ratio and for violation of “listed substitute requirements.” A $300 fine was imposed and the registration was placed on probationary status in February 2009. In a letter dated August 27, 2009, the Department informed Ms. Huewitt that the Probationary Registration was lifted effective August 9, 2009, because “the Operator has been in compliance with ratio and capacity requirements during periodic monitoring/inspections while on probationary registration.”2/ Facts concerning the Amended Notice of Administrative Action Ms. Huewitt has three adult children: Jennifer Oliver, Stephanie Oliver, and Anthony Oliver. Jennifer Oliver was listed as an “other family/household member” on the 2007, 2008, and 2009 applications. As a result, a background screening was conducted on Jennifer. The background screening revealed a disqualifying offense. Jennifer requested an exemption from disqualification, but was denied. Consequently, Jennifer Oliver was not permitted to be in the home during the operational hours of the day care. On February 2, 2009, Ms. Huewitt entered into a safety plan in which she agreed not to allow her daughter, Jennifer, to supervise the children while in her care, or even to allow Jennifer to be in the residence while children are in her care during business hours. Despite this, on August 11, 2009, at approximately 9:25 a.m., the Family Services Counselor, Miatta Jalaber, went to Ms. Huewitt’s home and saw Jennifer in the home. Jennifer exited the home as Ms. Jalaber did her walk-through. As a result, Ms. Jalaber called her supervisor, who instructed Ms. Jalaber to write another safety plan for Ms. Huewitt. The August 11, 2009, safety plan was hand-written by Ms. Jalaber while at Ms. Huewitt’s home day care and states, “I Alisa Huewitt understand that my daughter, Jennifer Oliver, must not be present in my residence [address] during operating hours 7:30 a.m.-6:00 p.m. M-F while I have children in care.” The safety plan was signed by both Ms. Jalaber and Ms. Huewitt. Ms. Jalaber made subsequent visits to Ms. Huewitt’s home on October 30, 2009, December 29, 2009, January 29, 2010, February 5, 2010, February 19, 2010, and March 30, 2010. No other persons were present and Ms. Huewitt’s home was in ratio during those visits. She did observe Jennifer in the home on April 16, 2010, but the day care was closed that day. Stephanie Oliver is not listed on any of the applications as a person residing in the home, but has been seen at Ms. Huewitt’s during hours when the day care is open. While there was some testimony that both Stephanie and Ms. Huewitt’s son Anthony have some sort of criminal background and that they have been seen at the day care during business hours, the record is insufficient to establish that their criminal records contain disqualifying offenses, or that they actually live in the home. What is clear is that Ms. Huewitt is of the belief that it is not necessary to list persons who do not actually reside in the home, but who frequently visit the home, on her applications under the category “Other Family/Household Members.” There were instances in which Ms. Jalaber went to the day care home and was led to believe that Jennifer Oliver was Stephanie Oliver. Ms. Jalaber only learned that the daughter she saw and spoke to at the home was Jennifer, who was not supposed to be there during working hours, when she attended Jennifer’s exemption from disqualifying fact-finding meeting. While the record is insufficient to clearly support a finding that Ms. Huewitt lied to Ms. Jalaber about her daughter’s identity, she was not forthcoming with clarifying the confusion. In July 2009, the Department received an abuse report that Ms. Huewitt’s grandson, Kory Hill, Jr., sustained a skull fracture in her residence during business hours. Ms. Jalaber went to Ms. Huewitt’s home, not to investigate the abuse report, but because there was concern that Kory Hill, Sr., who reportedly was taking care of Kory Hill, Jr., on the day of the incident, was residing in the home. Kory Hill, Jr., is Jennifer’s son. Ms. Jalaber addressed her concerns with Ms. Huewitt.3/ During this visit, Ms. Jalaber learned that there was a separate structure in back of Ms. Huewitt’s house. Ms. Jalaber describes it as being just three steps in back of the main house. The structure contains a large room, a closet, and a bathroom and will hereinafter be referred to as “the apartment.” Ms. Jalaber observed clothes in the apartment’s closet and throughout the apartment, and sofa cushions on the floor. It appeared to Ms. Jalaber that someone was residing in the apartment. Ms. Huewitt denies that Mr. Hill, Sr., resided in her home. However, Ms. Huewitt acknowledges that her infant grandson, Kory Hill, Jr., was injured while in the care of his father, Kory Hill, Sr., and that the injury took place in the apartment in back of her house. The injury took place during the day while children were in her care in the main part of her house. Jhaismen Collins is a Child Protective Investigator with the Department. She was assigned to investigate the abuse report regarding this incident. Her investigation began July 1, 2009, at the emergency room where Kory Hill, Jr., had been taken. While there, she spoke to Ms. Huewitt and other family members present in the emergency room. She then made several visits to Ms. Huewitt’s home to follow-up, after the baby was discharged from the hospital. During the follow-up visits, Ms. Collins observed Stephanie in the home and observed Kory Hill, Sr., packing his belongings to leave the home. While the evidence is inconclusive as to whether Mr. Hill actually resided in the apartment behind Ms. Huewitt’s home, it is clear that he frequented the home and the apartment behind the home to visit his son. His son, Kory, Jr., and another son, Kentavious, who is also Ms. Huewitt's grandson, are now attending Ms. Huewitt’s day care. Ayuana Hale is a Dependency Case manager for the Department. Her job is to provide needed services to the child and family in the case of a verified finding of abuse, neglect, or abandonment. She was assigned to the case involving Kory Hill, Jr., after the abuse investigation was closed as verified. Ms. Hale testified that Mr. Hill is currently incarcerated. She has knowledge of this because she is obligated to try to offer Mr. Hill services while he is incarcerated. Parents of children who attend Ms. Huewitt’s home day care are extremely complimentary of the care their children receive, and are not concerned with the safety of their children while there.
Recommendation Based upon the Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Department of Children and Family Services enter a final order placing the license on probation, requiring Respondent to attend further training in the requirements of applicable statutes and rules regarding who must be listed on her applications, requiring those listed to undergo background screening, and requiring successful completion of such training, with no further incidents, prior to approval of Respondent's application for renewal of her registration. DONE AND ENTERED this 24th day of June, 2010, in Tallahassee, Leon County, Florida. S BARBARA J. STAROS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 24th day of June, 2010
Conclusions Having reviewed the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review (hereinafter " NOIW") , and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: The Agency has jurisdiction over the above-named Petitioner pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing status and administrative code provisions. The Agency issued the attached NOIW and Elections of Rights form to the Petitioner with respect to its change of ownership (hereinafter "CHOW") application. (Ex. A) The Election of Rights form advised of the right to an administrative hearing. The Petitioner received the NOIW and timely filed the Election of Rights form with the Agency Clerk. (Ex. B) On September 30, 2011, the Agency filed a motion to dismiss with the Agency Clerk, citing the mootness of the NOIW due to the revocation of the underlying assisted living facility license. (Ex. C) The Agency Clerk granted the motion and directed the entry of a final order. (Ex. D) Based upon the foregoing, it is ORDERED: 1. The Agency's NOIW is withdrawn as moot due to the revocation of the underlying license to operate the assisted living facility in question. ORDERED in Tallahassee, Florida, on this -1![ day of Eliza Agency for retary are Administration Filed February 21, 2012 1:56 PM Division of Administrative Hearings
Other Judicial Opinions A party that is adversely affected by this Final Order is entitled to seek 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct co is Final Order was served on the below- named persons/entities by the method designated on this ay of ---/ ,2012. 7 Richard Shoop, Agen Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone (850) 412-3630 Jan Mills Facilities Intake Unit Agency for Health Care Administration (Interoffice Mail) Shaddrick Haston, Unit Manager Assisted Living Facility Unit Agency for Health Care Administration (Interoffice Mail) Tria Lawton-Russell Office of the General Counsel Agency for Health Care Administration (Interoffice Mail) John D.C. Newton, II Administrative Law Judge Division of Administrative Hearings (Electronic Mail) Lawrence Bessser, Esquire Samek and Besser 1200 Brickell Avenue, No. 1950 Miami, Florida 33131 (U.S. Mail) 2
The Issue The issue is whether Petitioner proved by clear and convincing evidence allegations contained in its Proposed Revocation of Respondent's Family Day Care License No. 907 dated January 21, 2004.
Findings Of Fact Based upon observation of the witnesses and their demeanor while testifying, exhibits admitted into evidence, stipulations and arguments of the parties, evidentiary rulings made pursuant to Section 120.57, Florida Statutes (2003), and the entire record compiled herein, the following relevant and material facts are determined: The Parties Petitioner is the state agency responsible for licensing and regulating child care facilities, including family day care homes. Petitioner routinely conducts inspections of licensed family day care homes to determine whether the home is in compliance with the applicable statutes and rules. Any problems found during the inspections are noted on a report, which is provided to the home’s operator immediately following the inspection. When appropriate, the inspection report provides a time frame within which the problems must be corrected. Regular inspections are conducted approximately twice a year. More frequent inspections--monthly or every six weeks-- are conducted on family day care homes that have a provisional license rather than a standard license. Petitioner also conducts inspections in response to complaints it receives, and it has the authority to inspect family day care homes at any time without notice. Respondent is the provider and licensed owner of a licensed family day care home located at 965 Waldon Avenue in Bartow, Florida (hereinafter “Respondent’s facility” or “the facility”). Respondent’s facility consists of a family residence with a connecting door to the converted garage. The number of children Respondent may have in “care” each day depends upon: (1) the ages of the children in care and (2) the number of qualified caregivers available to supervise the children in various age groups. This restrictive requirement, referred to as the “child care ratio,” is mandated by statute, the violation of which creates a dangerous situation and a dangerous condition for the safety and well-being of the children in care. The Inspection and violations On March 12, 2003, Respondent’s facility was inspected by Gloria Mathews (Ms. Mathews) and Tricia Step (Ms. Step), and several areas of non-compliance were identified during this inspection. The following non-compliant items were noted on Petitioner’s Family Child Care Home Inspection Checklist: unsafe storage of materials dangerous to children was observed in the bathroom drawers, litter was observed in areas where children play, equipment or plumbing not in working order (item was a baby crib and toilet with tissue the children had not flushed), no operable smoke detector or fire extinguisher, the surface of the diaper changing area was not impermeable, no record of fire drills for the past six months, and an up-to-date and age-appropriate immunization record was missing for one child. Two other non-compliant items, Ipecac not labeled with poison control phone number and seven pre-school age children ages 12 months and older were in the facility. Respondent may provide care to only six children in this age group. The extra child was taken home, and this item was corrected at the time of inspection. On December 18, 2003, Respondent’s facility was inspected by Ms. Mathews and Ms. Step, and the following non- compliant items were noted on the Family Child Care Home Complaint: Respondent had 18 children in the facility three of which were infants. Respondent was not present at the time of inspection, and the substitute caregiver was in charge. Petitioner could not determine whether screening of the substitute caregiver, Elizabeth Ricks, had been completed. Ms. Mathews and Ms. Step remained at Respondent’s facility until the parents picked up their children. James Hayes (Mr. Hayes), Respondent’s husband, took one child home. On January 21, 2004, Petitioner informed Respondent by certified mail of the proposed revocation of her family day care license initially issued in March 2002. Petitioner alleged that the decision to revoke Respondent’s license to operate a family child care facility was based on her failure to ensure that the children' substitute caregivers were adequately screened and because Respondent's home was over capacity and out of ratio. The notice stated: On December 18, 2003, there were eighteen (18) children in your day care home. Three (3) of the children were under the age of twelve (12) months. With 3 infants in your care, your license permits you to care for a maximum of six (6) children. The number of children in your home far exceeds the number of children allowed. During an inspection on March 12, 2003, seven (7) preschool age children ages 12 months and older were observed in your home. You are permitted six (6) children in this age group. This violates section 402.302(7), F.S. You also failed to insure [sic] that the substitute care persons in your home caring for children were properly screened in accordance with section 402.313, Florida Statutes. At the final hearing, Petitioner’s inspectors, Ms. Mathews and Ms. Step testified that when they arrived at Respondent’s facility on December 18, 2003, Mr. Hayes was in the facility. Based upon the testimony of the inspectors, Petitioner argued in its post-hearing submittal that Mr. Hayes had not been screened and that he had a criminal record. Petitioner presented no evidence to substantiate the claim that Mr. Hayes had a criminal record. The testimony and argument regarding this issue is hearsay without corroboration and disregarded. Respondent's Evidence Respondent testified that she was out of town on December 18, 2003, and that her substitute caregiver had begun training classes, but apparently had not completed the course and, therefore, had no background check performed. According to Respondent, non-compliant items identified by Petitioner’s inspectors were corrected as soon thereafter as possible. Respondent testified that she was confused regarding the infant and pre-school child-to-caregiver ratio because it was never explained to her in the manner testified to by both Ms. Mathews and Ms. Step. Continuing, Respondent testified that her substitute caregiver(s) had completed the required training and are now qualified to assist her. She contended that submission of the names and certification of training completion had been provided to Petitioner and that she was awaiting Petitioner's response. This testimony was not disputed by Petitioner. Respondent, to counter allegations that her facility and personnel presented a significant or potential risk of harm to the children, provided four testimonial letters from parents who were regular patrons of her facility. Each of the four parents expressed confidence in the assurance of safety and the ready necessity of Respondent’s child care services during the work week and often times during the weekend. Respondent presented photographs of her facility evidencing the facility’s configuration, carpeting, equipment, beds, and other furniture. Respondent testified that Mr. Hayes does not enter the facility during the time children are present. To ensure separation between the family’s living area and the attached rooms used for child care, Respondent installed a door between the room leading from the family’s living area to the anteroom and the garage. Respondent corrected every non-compliant item identified by Petitioner during their two inspections of her facility. Many, if not all, corrections were made when identified; i.e., the clogged toilet was flushed. The non- compliant items, individually or collectively, were minor and did not directly create an unsafe situation for the children in care. These efforts demonstrated a sincere intent and desire to comply with Petitioner's rules and regulations and to continue to provide a safe and necessary family day care home for working parents in her immediate neighborhood. Violations Proven by Petitioner Petitioner proved by clear and convincing evidence that on March 12, 2003, there were seven preschool children ages 12 months and older in the facility, Family Day Care License No. 907 permits a maximum of six children in care, an amount in violation of Subsection 402.302(7)(c), Florida Statutes (2003). Petitioner proved by clear and convincing evidence that on December 18, 2003, there were 18 children in Respondent's facility in violation of Subsection 402.302(7)(b), Florida Statutes (2003).
Recommendation Based upon the foregoing Finding of Facts and Conclusions of Law, it is RECOMMENDED that the Department of Children and Family Services issue a final order as follows: Finding Petitioner guilty of violating Subsection 402.302(7), Florida Statutes (2003), twice. Finding Petitioner not guilty of violating Section 402.313(3), Florida Statutes (2003). Setting aside the revocation of Respondent's family day care home license. Suspending Respondent's family day care home license until such time that the following conditions are met to the satisfaction of the Department: Respondent's substitute caregivers are identified, trained, qualified, and approved by Petitioner. Respondent demonstrates an understanding of the required child-to-child caregiver ratios. Respondent has trained each of her substitute caregivers on the child-to-child caregiver ratios and provides written instructions to be followed by her caregivers each day when the children in care in a specific age group are out of ratio to the number of caregivers present. That all conditions hereinabove are completed to the satisfaction of Petitioner as the condition for lifting the suspension. DONE AND ENTERED this 17th day of September 2004, in Tallahassee, Leon County, Florida. S FRED L. BUCKINE Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 17th day of September, 2004. COPIES FURNISHED: Jack Emory Farley, Esquire Department of Children and Family Services 4720 Old Highway 37 Lakeland, Florida 33813-2030 Theresa Hayes Arielle's Angel Care 965 Waldon Avenue Bartow, Florida 33830 Paul F. Flounlacker, Agency Clerk Department of Children and Family Services 1317 Winewood Boulevard Building 2, Room 204B Tallahassee, Florida 32399-0700 Josie Tomayo, General Counsel Department of Children and Family Services 1317 Winewood Boulevard Building 2, Room 204 Tallahassee, Florida 32399-0700
