ASSISTED LIVING FACILITY -- Administrative...

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Date: 08/05/2011 ASSISTED LIVING FACILITY -- Administrative Fines Final Order Between: 07/01/2010 and 06/30/2011 Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imr Catalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat Page 1 File Nbr License # Provider Name County Current Lic Status Case # Case Type Final Order Imposed Fine Amt Deficiency Tag Class Desc 11965870 10183 1ZOURCE LIVING CARE BROWARD ACTIVE 2010007206 Survey Deficiency 04/27/2011 2250.00 A0417 Class 3 A0509 Class 3 A0511 Class 3 A0512 Class 3 A0518 Class 3 A0524 Class 3 11964002 8857 330 ASSISTED LIVING CORP. MIAMI-DADE ACTIVE 2010006418 Survey Deficiency 11/24/2010 200.00 A0527 Class 4 11967516 11516 A & M ASSISTED LIVING FACILITY II BREVARD ACTIVE 2010011442 Survey Deficiency 02/23/2011 1177.00 A0029 Class 2 11967791 11794 A BANYAN RESIDENCE SARASOTA ACTIVE 2011000382 Survey Deficiency 05/25/2011 2000.00 A0704 Class 2 A0718 Class 2 11942862 8337 A HOME AWAY FROM HOME SEMINOLE ACTIVE 2010009820 Survey Deficiency 01/26/2011 500.00 A0610 Class 3 11967480 11499 A PLACE LIKE HOME ALF, INC BREVARD ACTIVE 2010011009 Survey Deficiency 04/08/2011 750.00 A0700 Class 2 11963855 7618 A SAFE PLACE HILLSBOROUGH ACTIVE 2010003897 Survey Deficiency 07/15/2010 1500.00 A 706 Class 2 A0700 Class 2 11966240 10498 ABIGAIL (THE) HILLSBOROUGH ACTIVE 2010001035 Survey Deficiency 07/26/2010 1500.00 A0428 Class 2 2010003502 Survey Deficiency 05/11/2011 1941.92 A0323 Class 3 11965620 9985 ABSOLUTELY ASSISTED LIVING, INC. CLAY ACTIVE 2010010689 Survey Deficiency 04/01/2011 1015.00 58A-5.0185(7)(d) Class 3 11966962 11076 ABUELITOS FELICES ALF MIAMI-DADE ACTIVE 2009009274 Application 09/30/2010 3000.00 LF 11967562 11607 AGING IN GRACE LLC MIAMI-DADE LITIGATION 2011003818 Licensure Violation 05/17/2011 100.00 Fine 11910002 7228 AGUILA ADULT CARE CENTER HILLSBOROUGH ACTIVE 2010000798 Survey Deficiency 09/28/2010 2500.00 A0417 Class 2 A0718 Class 2 11911313 37 ALABAMA OAKS OF WINTER PARK ORANGE ACTIVE 2010013311 Survey Deficiency 03/21/2011 2560.00 A0505 Class 4 A0511 Class 3 A0512 Class 3 A0615 Class 3 A0718 Class 4 A0820 Class 3 A1101 Class 3 A1103 Class 3

Transcript of ASSISTED LIVING FACILITY -- Administrative...

Page 1: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 1

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965870 10183 1ZOURCE LIVING CARE BROWARD ACTIVE 2010007206 Survey Deficiency 04/27/2011 2250.00 A0417 Class 3

A0509 Class 3

A0511 Class 3

A0512 Class 3

A0518 Class 3

A0524 Class 311964002 8857 330 ASSISTED LIVING CORP. MIAMI-DADE ACTIVE 2010006418 Survey Deficiency 11/24/2010 200.00 A0527 Class 4

11967516 11516 A & M ASSISTED LIVING FACILITY II BREVARD ACTIVE 2010011442 Survey Deficiency 02/23/2011 1177.00 A0029 Class 2

11967791 11794 A BANYAN RESIDENCE SARASOTA ACTIVE 2011000382 Survey Deficiency 05/25/2011 2000.00 A0704 Class 2

A0718 Class 211942862 8337 A HOME AWAY FROM HOME SEMINOLE ACTIVE 2010009820 Survey Deficiency 01/26/2011 500.00 A0610 Class 3

11967480 11499 A PLACE LIKE HOME ALF, INC BREVARD ACTIVE 2010011009 Survey Deficiency 04/08/2011 750.00 A0700 Class 2

11963855 7618 A SAFE PLACE HILLSBOROUGH ACTIVE 2010003897 Survey Deficiency 07/15/2010 1500.00 A 706 Class 2

A0700 Class 211966240 10498 ABIGAIL (THE) HILLSBOROUGH ACTIVE 2010001035 Survey Deficiency 07/26/2010 1500.00 A0428 Class 2

2010003502 Survey Deficiency 05/11/2011 1941.92 A0323 Class 3

11965620 9985 ABSOLUTELY ASSISTED LIVING, INC. CLAY ACTIVE 2010010689 Survey Deficiency 04/01/2011 1015.00 58A-5.0185(7)(d) Class 3

11966962 11076 ABUELITOS FELICES ALF MIAMI-DADE ACTIVE 2009009274 Application 09/30/2010 3000.00 LF11967562 11607 AGING IN GRACE LLC MIAMI-DADE LITIGATION 2011003818 Licensure Violation 05/17/2011 100.00 Fine11910002 7228 AGUILA ADULT CARE CENTER HILLSBOROUGH ACTIVE 2010000798 Survey Deficiency 09/28/2010 2500.00 A0417 Class 2

A0718 Class 211911313 37 ALABAMA OAKS OF WINTER PARK ORANGE ACTIVE 2010013311 Survey Deficiency 03/21/2011 2560.00 A0505 Class 4

A0511 Class 3

A0512 Class 3

A0615 Class 3

A0718 Class 4

A0820 Class 3

A1101 Class 3

A1103 Class 3

Page 2: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 2

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965303 9774 ALBINA MANOR PINELLAS ACTIVE 2010003983 Survey Deficiency 01/13/2011 3500.00 A0522 Class 2

A0524 Class 2

A0700 Class 2

A701 Class 22010007538 Survey Deficiency 01/13/2011 750.00 A0626 Class 3

11964147 8838 ALPHA & OMEGA HOME CARE, INC. BROWARD ACTIVE 2010006193 Survey Deficiency 09/13/2010 1000.00 A0700 Class 2

11965004 9526 ALPHA & OMEGA RESIDENTIAL, INC MIAMI-DADE ACTIVE 2010009878 Survey Deficiency 04/04/2011 375.00 A1002 Class 3

11966961 11075 AMANECER HOME MIAMI-DADE DENIED 2010003212 Application 07/16/2010 5000.002010006293 Survey Deficiency 11/29/2010 500.00 A0901 Class 3

11967603 11662 AMAZING GRACE ALF HILLSBOROUGH ACTIVE 2010010819 Survey Deficiency 02/07/2011 375.00 A0707 Class 3

11967066 11183 AMISTADA 308 INC MIAMI-DADE ACTIVE 2010006267 Survey Deficiency 09/13/2010 1000.00 A008 Class 3

A0504 Class 311942708 8544 AMONET CARE HOME POLK ACTIVE 2010010367 Licensure Violation 11/24/2010 100.00 Class 4

2010012513 Survey Deficiency 02/23/2011 500.00 N0300 Class 3

2011003212 Survey Deficiency 06/09/2011 1500.00 A0504 Class 3

A0509 Class 3

A1004 Class 311967390 11429 AMOR SWEET HOME ALF MIAMI-DADE ACTIVE 2010009919 Survey Deficiency 12/16/2010 500.00 A0122 Class 3

11964527 9083 AMROSE CARE HILLSBOROUGH ACTIVE 2010010368 Licensure Violation 11/24/2010 100.00 Class 4

11967867 11873 ANA'S ELDERLY CARE MIAMI-DADE ACTIVE 2010010370 Licensure Violation 11/29/2010 100.00 Class 4

11966584 10771 ANDALUSIA ALF MIAMI-DADE ACTIVE 2010006319 Survey Deficiency 11/17/2010 200.00 A1003 Class 4

11967749 11734 ANGEL CARE ASSISTED LIVING FACILITY PINELLAS ACTIVE 2011000333 Survey Deficiency 04/04/2011 500.00 A0615 Class 3

11967125 11232 ANGELES SENIOR CARE, INC MIAMI-DADE ACTIVE 2010008391 Survey Deficiency 03/04/2011 700.00 A1103 Class 3

N0300 Class 42010010054 Survey Deficiency 05/04/2011 200.00 N0300 Class 4

11965085 9656 ANGELS (THE) MIAMI-DADE ACTIVE 2010010434 Licensure Violation 11/24/2010 100.00 Class 4

11966115 10378 ANGELS FOREVER, INC MIAMI-DADE ACTIVE 2010006427 Survey Deficiency 11/29/2010 375.00 A0509 Class 3

2010010435 Licensure Violation 12/17/2010 100.00 Class 4

11953224 8437 ANGELS GARDEN INC. HILLSBOROUGH ACTIVE 2010010439 Licensure Violation 11/15/2010 100.00 Class 4

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 3

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911068 5583 ANNETTE'S REST HOME SANTA ROSA ACTIVE 2010009737 Survey Deficiency 11/10/2010 500.00 A1103 Class 3

11966566 10751 ANNIE C HORNE ALF MIAMI-DADE ACTIVE 2010006357 Survey Deficiency 09/29/2010 500.00 L0500 Class 3

11967242 11313 ANOS DORADOS ALF INC MIAMI-DADE ACTIVE 2010006689 Survey Deficiency 12/13/2010 500.00 D0417 Class 3

11965667 9996 ARBOR OAKS @ GREENACRES PALM BEACH ACTIVE 2010010488 Licensure Violation 11/15/2010 100.00 Class 4

11932376 8042 ARISTOCRAT, THE COLLIER ACTIVE 2010010491 Licensure Violation 11/15/2010 100.00 Class 4

11967950 11962 ARK CENTER OF BREVARD II BREVARD ACTIVE 2010013236 Application 01/26/2011 366.002010013237 Licensure Violation 01/26/2011 1000.00 Unlicensed act. fine

11953381 5299 ARLINGTON GARDENS, LLC PINELLAS ACTIVE 2010010493 Licensure Violation 11/24/2010 100.00 Class 4

2010013464 Survey Deficiency 02/28/2011 1000.00 A0705 Class 2

11911160 7349 ARLINGTON HOUSE ACLF PUTNAM DENIED 2008014027 Survey Deficiency 07/02/2010 7500.00 A0705 Class 1

A0718 Class 12009002313 Survey Deficiency 07/02/2010 750.00 A0628 Class 2

2009002314 Survey Deficiency 07/02/2010 5000.00 A0119 Class 2

A0300 Class 2

A0602 Class 2

A0610 Class 2

A0631 Class 2

A0700 Class 2

A0718 Class 2

A0816 Class 22009007940 Survey Deficiency 07/02/2010 750.00 A0417 Class 3

A0500 Class 3

A1005 Class 311965761 10096 ASHTON PALMS ORANGE ACTIVE 2010006395 Survey Deficiency 09/10/2010 565.00 A0700 Class 3

11953701 8686 ASHTON PLACE SARASOTA ACTIVE 2010009924 Survey Deficiency 12/21/2010 500.00 A0417 Class 3

11953169 8466 ASSISTED LIVING WITH GRACE HILLSBOROUGH REVOKED 2010008734 Survey Deficiency 02/23/2011 1500.00 A0013 Class 3

A0211 Class 311912132 7352 ATRIUM AT BOCA RATON, THE PALM BEACH ACTIVE 2010009902 Survey Deficiency 05/11/2011 500.00 A0801 Class 3

11964082 8855 AUSTIN GROUP (THE) HILLSBOROUGH ACTIVE 2010010564 Licensure Violation 12/01/2010 100.00 Class 4

Page 4: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 4

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11966665 10813 AVALON'S ASSISTED LIVING ORANGE LITIGATION 2009009965 Survey Deficiency 03/09/2011 3000.00 A0029 Class 2

A0427 Class 2

A0700 Class 211966752 10887 AVERY COTTAGE, INC. PALM BEACH ACTIVE 2009004245 Survey Deficiency 05/25/2011 4500.00 A0004 Class 2

11911203 5390 AVERY'S HOME CARE DUVAL ACTIVE 2010010529 Licensure Violation 11/24/2010 100.0011953573 4839 AZALEA MANOR ORANGE ACTIVE 2010013291 Survey Deficiency 02/28/2011 1000.00 A0515 Class 3

A0700 Class 311967592 11630 AZALENE'S ALF BROWARD ACTIVE 2010010565 Licensure Violation 11/15/2010 100.00 Class 4

11966734 10946 B & B HOME CARE III MIAMI-DADE ACTIVE 2010010566 Licensure Violation 11/15/2010 100.00 Class 4

11953386 8542 BABY BOOMERS ADULT CARE FACILITY MIAMI-DADE ACTIVE 2010010567 Licensure Violation 11/24/2010 100.00 Class 4

11963788 8705 BALMY BEACH RETIREMENT HOME, INC SEMINOLE ACTIVE 2010008763 Survey Deficiency 01/12/2011 1500.00 E0712 Class 2

11910486 7218 BARKLEY PLACE LEE ACTIVE 2010003894 Survey Deficiency 08/09/2010 1000.00 A0718 Class 2

2010005422 Survey Deficiency 12/13/2010 1000.00 A1005 Class 3

A1103 Class 311965763 10100 BARRINGTON TERRACE - FT MYERS LEE ACTIVE 2010005731 Survey Deficiency 05/04/2011 4250.00 A0718 Class 1

2010010847 Licensure Violation 12/06/2010 100.00 Class 4

11942846 5651 BAY BREEZE NURSING & RETIREMENT CENTER SANTA ROSA ACTIVE 2010005251 Survey Deficiency 10/18/2010 500.00 A0417 Class 3

11963833 8721 BAYVIEW RETIREMENT CENTER DUVAL ACTIVE 2010013325 Survey Deficiency 02/23/2011 3500.00 A0511 Class 3

A0512 Class 3

A0513 Class 3

A0514 Class 3

A1106 Class 3

A1108 Class 3

A1115 Class 311966249 10497 BAYVIEW RETIREMENT HOME BROWARD REVOKED 2010005573 Survey Deficiency 12/16/2010 10000.00 A0700 Class 1

11911343 7695 BEEHIVE MANOR LLC HILLSBOROUGH CLOSED 2009013426 Survey Deficiency 12/03/2010 2500.00 A0514 Class 3

A0518 Class 3

A1115 Class 3

A1121 Class 3

Page 5: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 5

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911343 7695 BEEHIVE MANOR LLC HILLSBOROUGH CLOSED 2009013892 Survey Deficiency 12/03/2010 1000.00 A1115 Class 3

11967545 11593 BEIT ABOT, CORP MIAMI-DADE ACTIVE 2010010853 Licensure Violation 01/12/2011 100.00 Class 4

11964728 9241 BELLA LUNA RETIREMENT HOME MIAMI-DADE ACTIVE 2010005304 Survey Deficiency 12/15/2010 750.00 A0328 Class 4

D0504 Class 32010005970 Application 12/13/2010 356.00

11965472 9819 BELVEDERE COMMONS OF FORT WALTON BEACH OKALOOSA ACTIVE 2010001322 Application 09/21/2010 500.0011964842 9323 BELVEDERE COMMONS OF SUN CITY CENTER HILLSBOROUGH ACTIVE 2010001323 Application 09/21/2010 500.0011964056 8803 BELVEDERE COMMONS OF TAMPA HILLSBOROUGH ACTIVE 2010001316 Application 09/21/2010 500.0011965129 9519 BERRY HILL MANOR RETIREMENT CENTER SANTA ROSA ACTIVE 2010013596 Survey Deficiency 02/23/2011 3000.00 A0610 Class 2

A0615 Class 2

A0700 Class 211943161 8472 BEST CARE PINELLAS ACTIVE 2010010857 Licensure Violation 12/06/2010 100.00 Class 4

11911234 4788 BETHESDA ON TURKEY CREEK BREVARD ACTIVE 2011002121 Survey Deficiency 06/27/2011 1500.00 A0700 Class 2

11967513 11544 BETTER CARE FACILITY INC BROWARD CLOSED 2010010859 Licensure Violation 12/17/2010 100.00 Class 4

11965654 10031 BETTER CARE HOME MIAMI-DADE ACTIVE 2011004109 Survey Deficiency 06/27/2011 500.00 A0710 Class 3

11910655 5836 BILMAR GARDENS BROWARD REVOKED 2009008020 Survey Deficiency 11/03/2010 700.00 A0518 Class 3

2009011621 Survey Deficiency 12/22/2010 1800.00 A0418 Class 3

A0631 Class 22010008979 Survey Deficiency 10/27/2010 21000.00 A0500 Class 1

A0718 Class 1

A0801 Class 211966352 10566 BIMINI MANOR PINELLAS ACTIVE 2008011345 Survey Deficiency 07/16/2010 370.00 A0511 Class 3

2010010910 Licensure Violation 11/15/2010 100.00 Class 4

11910876 7258 BISCAYNE GARDENS COUNTRY ESTATE MIAMI-DADE ACTIVE 2010010924 Licensure Violation 11/24/2010 100.00 Class 4

11967417 11456 BLAKE AT GULF BREEZE (THE) SANTA ROSA ACTIVE 2010010974 Survey Deficiency 12/07/2010 500.00 A1101 Class 3

11964461 9063 BLAKE GLENN PINELLAS ACTIVE 2010010925 Licensure Violation 11/23/2010 100.00 Class 4

11910878 5156 BLUE SKY MIAMI-DADE ACTIVE 2010006255 Survey Deficiency 10/11/2010 700.00 A0503 Class 4

A0504 Class 311966990 11127 BRAYBROOK @ BAYONET POINT PASCO ACTIVE 2010011058 Licensure Violation 01/26/2011 100.00 Class 4

Page 6: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 6

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11932497 7478 BRIARWOOD MANOR BROWARD ACTIVE 2010002849 Survey Deficiency 08/26/2010 2000.00 A0700 Class 2

2010006190 Survey Deficiency 10/26/2010 1000.00 A0206 Class 3

A0711 Class 32010008961 Survey Deficiency 02/23/2011 2000.00 A0700 Class 2

2010010862 Survey Deficiency 05/04/2011 1000.00 A0500 Class 3

A0526 Class 311965603 9958 BRIDGE ASSISTED LIVING AT LIFE CARE CENT ORANGE ACTIVE 2010013257 Survey Deficiency 02/23/2011 1500.00 A0700 Class 2

11966866 10996 BRIDGE OF HOPE ALF DUVAL ACTIVE 2010010919 Licensure Violation 11/23/2010 100.00 ESS11932514 7354 BROOKSHIRE (THE) BREVARD LITIGATION 2010011020 Survey Deficiency 03/21/2011 1000.00 A0631 Class 3

2011001630 Survey Deficiency 05/25/2011 1400.00 A0631 Class 2

11965151 9555 BROWN'S HARBOR HOUSE WASHINGTON LITIGATION 2010010940 Licensure Violation 12/06/2010 100.00 ESS11967499 11540 BROWNSTONE WELLNESS OSCEOLA ACTIVE 2010013496 Survey Deficiency 06/08/2011 2958.00 A0205 Class 3

A0312 Class 4

A0610 Class 3

A0806 Class 3

A1104 Class 3

A1108 Class 3

A1109 Class 311910551 5856 BROXTON'S ACLF WASHINGTON ACTIVE 2010010964 Licensure Violation 11/29/2010 100.0011964934 9381 CABOT RESERVE ON THE GREEN SARASOTA ACTIVE 2010007730 Survey Deficiency 09/30/2010 500.00 A0610 Class 3

11965575 10003 CAMINO DE ESPERANZA MIAMI-DADE ACTIVE 2010010966 Licensure Violation 01/11/2011 100.0011967582 11599 CAMPHOR CORNER SEMINOLE FAILED TO

RENEW2010010969 Licensure Violation 12/17/2010 100.00

11966266 10506 CANTERBURY DREAMS PINELLAS ACTIVE 2010006893 Application 09/14/2010 355.0011912047 7892 CAPRICORN RETIREMENT HOME MIAMI-DADE ACTIVE 2010006177 Application 09/14/2010 183.0011932424 7919 CARDEN HOUSE PINELLAS ACTIVE 2010002171 Survey Deficiency 08/06/2010 2000.00 A0406 Class 2

A0801 Class 22010002172 Survey Deficiency 08/06/2010 1500.00 A1001 Class 3

A1004 Class 311965863 10283 CARELY HOME CARE MIAMI-DADE ACTIVE 2010011015 Licensure Violation 12/06/2010 100.00

Page 7: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 7

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965742 10083 CARING FOR YOU I-ALF, INC MIAMI-DADE ACTIVE 2010006372 Survey Deficiency 10/26/2010 200.00 A0417 Class 4

11967261 11366 CARING HOUSE ALF HILLSBOROUGH CLOSED 2010001902 Survey Deficiency 07/15/2010 20500.00 A0500 Class 1

A0700 Class 1

A0704 Class 1

A1011 Class 111966564 10753 CAROLINA CARE BREVARD ACTIVE 2010006356 Survey Deficiency 04/01/2011 500.00 A0429 Class 3

11966628 10800 CARRIAGE HOUSE ALF, LLC BREVARD ACTIVE 2010013506 Survey Deficiency 03/28/2011 1236.00 A0700 Class 2

11966581 10796 CARY'S ADULT CARE II, INC MIAMI-DADE ACTIVE 2010011017 Licensure Violation 12/06/2010 100.0011966535 10739 CASA BELLA ALF, INC. MIAMI-DADE ACTIVE 2010011042 Licensure Violation 12/06/2010 100.0011966160 10415 CELENA'S SENIOR CARE MIAMI-DADE ACTIVE 2010006301 Survey Deficiency 10/08/2010 500.00 A0209 Class 3

11966458 10691 CENTRAL TAMPA ASSISTED LIVING HILLSBOROUGH ACTIVE 2009006483 Survey Deficiency 12/13/2010 500.00 A0718 Class 2

2009006952 Survey Deficiency 12/13/2010 500.00 A0718 Class 2

11965784 10129 CENTURY ASSISTED LIVING FACILITY, INC MIAMI-DADE ACTIVE 2010006284 Survey Deficiency 10/28/2010 500.00 A0515 Class 3

11965743 10095 CENTURY OAKS BREVARD ACTIVE 2011002129 Survey Deficiency 05/23/2011 1500.00 A0700 Class 2

11910896 5853 CHRISTIAN HOME MIAMI-DADE ACTIVE 2010006338 Survey Deficiency 12/13/2010 500.00 A0209 Class 3

11964559 9071 CLARE BRIDGE OF VENICE SARASOTA ACTIVE 2009011059 Survey Deficiency 01/31/2011 1250.00 A0626 Class 3

Class 3

2009013443 Survey Deficiency 01/31/2011 1250.00 A0615 Class 3

A0626 Class 3

A0628 Class 311965191 9643 CLEARVIEW MANOR HILLSBOROUGH REVOKED 2010001957 Survey Deficiency 05/09/2011 10500.00 A0631 Class 2

A0700 Class 211965648 10082 CLERIA FAMILY HOME MIAMI-DADE ACTIVE 2010006426 Survey Deficiency 09/28/2010 1000.00 A0509 Class 3

A0511 Class 311953542 5315 CORNERSTONE AT LONGWOOD (THE) SEMINOLE ACTIVE 2010004338 Survey Deficiency 12/22/2010 500.00 A0727 Class 3

2010004344 Survey Deficiency 12/22/2010 750.002010009985 Survey Deficiency 04/15/2011 1625.00 A1110 Class 3

A1111 Class 3

A1112 Class 3

Page 8: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 8

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11953542 5315 CORNERSTONE AT LONGWOOD (THE) SEMINOLE ACTIVE 2010011450 Survey Deficiency 04/15/2011 2200.00 A0718 Class 2

2010011451 Survey Deficiency 04/15/2011 1350.00 A0700 Class 2

11964922 9409 COTTAGES OF GREENACRES (THE) PALM BEACH ACTIVE 2010005299 Survey Deficiency 10/08/2010 1500.00 A0615 Class 3

A0631 Class 3

A1121 Class 311910406 5649 CRESTVIEW MANOR OKALOOSA ACTIVE 2011003330 Survey Deficiency 06/27/2011 375.00 E0501 Class 3

11953194 7293 CRESTWOOD MANOR SARASOTA ACTIVE 2010000870 Survey Deficiency 08/18/2010 100.00 A0518 Class 4

2010002241 Survey Deficiency 03/23/2011 1125.00 A0510 Class 3

A1101 Class 3

A1119 Class 32010004508 Survey Deficiency 03/23/2011 750.00 A0700 Class 2

11965376 9756 CROWN POINTE OF SEBRING HIGHLANDS ACTIVE 2010013476 Survey Deficiency 03/28/2011 6064.80 A0323 Class 3

11965656 10011 DAISY CUIDADO DE ANCIANOS MIAMI-DADE ACTIVE 2009003998 Survey Deficiency 02/23/2011 500.00 A0504 Class 3

2009013814 Application 02/07/2011 3000.00 LF11964288 9140 DAYLIENS LIVING FACILITY MIAMI-DADE ACTIVE 2010009646 Survey Deficiency 02/23/2011 200.00 A1004 Class 3

11964272 8888 DAYSPRING RETIREMENT CENTER, INC. BAY ACTIVE 2010012289 Survey Deficiency 01/03/2011 1000.00 A0509 Class 2

2011001438 Survey Deficiency 04/11/2011 1000.00 A0505 Class 3

A1109 Class 311965825 10154 DE' BLANCA HOME II MIAMI-DADE ACTIVE 2010006251 Survey Deficiency 09/01/2010 2500.0011965837 10171 DE' BLANCA HOME IV MIAMI-DADE ACTIVE 2010006248 Survey Deficiency 08/26/2010 2000.00 A0328 Class 3

L 200 Class 3

L0101 Class 3

L0300 Class 311910846 5200 DOGWOOD INN HOLMES ACTIVE 2009011053 Survey Deficiency 08/09/2010 2000.00 A0509 Class 2

A1102 Class 211966350 10574 DR PHILLIPS ASSISTED LIVING FACILITY, IN ORANGE ACTIVE 2010012483 Survey Deficiency 02/07/2011 825.00 A0402 Class 4

A0724 Class 3

A1109 Class 311966480 10672 DULCE HOGAR II, INC MIAMI-DADE ACTIVE 2011005164 Application 06/16/2011 100.00 ess

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 9

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965865 10185 E & A PARADISE HOME MIAMI-DADE ACTIVE 2010008397 Survey Deficiency 03/11/2011 800.00 A0615 Class 3

A0707 Class 311966197 10439 EDEN MANOR ORANGE ACTIVE 2010004360 Survey Deficiency 10/18/2010 500.00 A0901 Class 3

11967531 11588 ELENA ASSISTED LIVING FACILITY MIAMI-DADE ACTIVE 2011003734 Application 05/17/2011 100.00 LF11967284 11430 ELITE ALF INC MIAMI-DADE ACTIVE 2010008399 Survey Deficiency 01/26/2011 700.00 A1103 Class 3

N0300 Class 411963752 8654 ELMINA'S ALF BROWARD ACTIVE 2010004491 Survey Deficiency 01/31/2011 900.00 A0718 Class 2

11943141 7280 ELZAIDA'S TENDER CARE PINELLAS ACTIVE 2007013791 Survey Deficiency 07/15/2010 1500.00 A0708 Class 3

A0718 Class 22008014414 Survey Deficiency 07/15/2010 500.00 A1004 Class 3

2008014418 Survey Deficiency 07/15/2010 3000.00 A0718 Class 2

A0802 Class 3

A0811 Class 311964990 9431 EMERALD PARK RETIREMENT LLC BROWARD ACTIVE 2010008768 Survey Deficiency 12/13/2010 500.00 A0113 Class 3

11910126 7103 EMERITUS AT ALTAMONTE SPRINGS SEMINOLE ACTIVE 2010011013 Survey Deficiency 02/24/2011 1500.00 A0705 Class 2

11963950 6563 EMERITUS AT BENEVA PARK SARASOTA ACTIVE 2010006873 Survey Deficiency 10/28/2010 500.00 N0200 Class 3

11964130 6670 EMERITUS AT CLEARWATER PINELLAS ACTIVE 2010011023 Survey Deficiency 12/22/2010 1000.00 A0718 Class 2

11964810 9286 EMERITUS AT CONWAY ORANGE ACTIVE 2010007099 Survey Deficiency 02/28/2011 5500.00 A0718 Class 2

2010007100 Survey Deficiency 02/28/2011 5500.00 A0029 Class 2

11963948 5491 EMERITUS AT CROSSING POINTE ORANGE CLOSED 2009011532 Survey Deficiency 08/03/2010 7500.00 A0427 Class 2

A0510 Class 2

A0718 Class 12009011536 Survey Deficiency 08/03/2010 5000.00 A0500 Class 1

2009011539 Survey Deficiency 08/03/2010 10500.00 A0029 Class 1

A0630 Class 12010004387 Survey Deficiency 08/03/2010 1000.00 A0705 Class 2

2010004392 Survey Deficiency 08/03/2010 1000.00 A0700 Class 2

2010004396 Survey Deficiency 08/03/2010 1000.00 A0500 Class 2

11953349 5096 EMERITUS AT FORT MYERS LEE ACTIVE 2010007578 Survey Deficiency 12/01/2010 2500.00 A0700 Class 2

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 10

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11953349 5096 EMERITUS AT FORT MYERS LEE ACTIVE 2010007578 Survey Deficiency 12/01/2010 2500.00 A0705 Class 2

11964882 9394 EMERITUS AT GAINESVILLE ALACHUA ACTIVE 2010013330 Survey Deficiency 05/04/2011 1000.00 A0726 Class 2

11964787 9294 EMERITUS AT JENSEN BEACH MARTIN ACTIVE 2010008917 Survey Deficiency 05/16/2011 2000.00 A0700 Class 2

A0705 Class 211965818 10162 EMERITUS AT LAKE MARY SEMINOLE ACTIVE 2010009817 Survey Deficiency 01/03/2011 1500.00 A0631 Class 2

2010013575 Survey Deficiency 04/04/2011 1500.00 A0700 Class 2

2011003324 Survey Deficiency 06/01/2011 1000.00 A0522 Class 3

11910091 6107 EMERITUS AT LAKELAND POLK ACTIVE 2010005260 Survey Deficiency 08/26/2010 774.19 A032311965054 9500 EMERITUS AT NORTHDALE HILLSBOROUGH ACTIVE 2010008374 Survey Deficiency 12/15/2010 4680.60 A0323 Class 3

11964969 9441 EMERITUS AT OCALA WEST MARION ACTIVE 2010013586 Survey Deficiency 05/04/2011 1000.00 A0610 Class 2

11965368 9731 EMERITUS AT OCOEE ORANGE ACTIVE 2010004362 Survey Deficiency 08/18/2010 1000.00 A0610 Class 3

A0727 Class 32010004364 Survey Deficiency 08/18/2010 1500.00 A0704 Class 2

2010006369 Survey Deficiency 09/10/2010 1500.00 58A-5.0182 Class 2

11911225 5501 EMERITUS AT RIVER OAKS SARASOTA ACTIVE 2010000864 Survey Deficiency 08/26/2010 1500.00 A0700 Class 2

2010000867 Survey Deficiency 09/28/2010 1000.00 0704 Class 3

A0304 Class 311965026 9430 EMERITUS AT THE LAKES LEE ACTIVE 2010002072 Survey Deficiency 10/05/2010 500.00 A0900 Class 3

11963877 5534 EMERITUS AT VENICE SARASOTA ACTIVE 2010006380 Survey Deficiency 12/21/2010 500.00 A0631 Class 3

11965647 9990 ENDLESS HOME CARE MIAMI-DADE ACTIVE 2010006269 Survey Deficiency 10/18/2010 200.00 A0503B Class 4

11910468 5153 ENON COUNTRY MANOR INC ESCAMBIA ACTIVE 2010004553 Survey Deficiency 08/02/2010 2550.00 A0213 Class 4

A0406 Class 3

A0505 Class 3

A0511 Class 3

A0710 Class 3

A0812 Class 3

A0900 Class 3

A0901 Class 3

A0902 Class 3

Page 11: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 11

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11910468 5153 ENON COUNTRY MANOR INC ESCAMBIA ACTIVE 2010004553 Survey Deficiency 08/02/2010 2550.00 A1102 Class 2

A1103 Class 3

A1115 Class 32010000644 Survey Deficiency 08/02/2010 2250.00 A0509 Class 2

A1102 Class 2

A1105 Class 211966681 10853 ESPERANZA'S ALF #2 MIAMI-DADE LITIGATION 2010006367 Survey Deficiency 11/19/2010 500.00 A0209 Class 3

2010010502 Licensure Violation 11/24/2010 100.0011966013 10290 ESSEX VILLAGE ALF INC MIAMI-DADE LITIGATION 2010010504 Licensure Violation 11/24/2010 100.0011932534 8151 ESTHER HOME CARE II MIAMI-DADE ACTIVE 2010006697 Survey Deficiency 01/11/2011 375.00 D0629 Class 2

11966594 10772 EUROPEAN MANOR CHARLOTTE ACTIVE 2010010505 Licensure Violation 11/24/2010 100.002010010863 Survey Deficiency 02/23/2011 965.63 A0613 Class 3

11967402 11449 EXCELSIOR OMEGA INC SARASOTA ACTIVE 2010010786 Licensure Violation 12/06/2010 100.0011964657 9277 EXECUTIVE GROUP HOME, INC MIAMI-DADE ACTIVE 2010006239 Survey Deficiency 09/03/2010 500.00 D1005 Class 3

11942801 8243 FAMILY CARE FREE HOUSE PINELLAS ACTIVE 2010008377 Survey Deficiency 01/19/2011 1000.00 A0504 Class 3

2010010788 Licensure Violation 12/17/2010 100.0011967571 11686 FAMILY COMFORT ALF MIAMI-DADE ACTIVE 2010010789 Licensure Violation 12/17/2010 100.0011966123 10394 FAMILY HOME CARE INC. (THE) MIAMI-DADE ACTIVE 2010010918 Licensure Violation 11/23/2010 100.00 ESS11953375 7569 FAMILY RETREAT PASCO ACTIVE 2009012862 Survey Deficiency 02/04/2011 9000.00 A0029 Class 2

A0119 Class 3

A0417 Class 3

A1100 Class 3

A1101 Class 3

A1103 Class 3

L0300 Class 3

L0500 Class 3

LF2009012865 Survey Deficiency 02/04/2011 1000.00 A1001 Class 3

A1034 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 12

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11967865 11861 FOR BETTER LIFE LLC LAKE ACTIVE 2010010947 Licensure Violation 11/15/2010 100.00 ESS11910473 5243 FOREST GLEN LODGES, INC. PASCO ACTIVE 2010000789 Survey Deficiency 07/22/2010 2500.00 A0409 Class 2

A0628 Class 22010002173 Survey Deficiency 07/22/2010 500.00 A0809 Class 3

11966775 10921 FOREST SPRINGS RETIREMENT RESIDENCE, INC BROWARD ACTIVE 2010010949 Licensure Violation 11/24/2010 100.00 ESS11967408 11774 FOUNTAIN MANOR FLAGLER ACTIVE 2010010952 Licensure Violation 11/24/2010 100.00 ESS11965786 10150 FOUR SEASONS ALF SEMINOLE ACTIVE 2010010954 Licensure Violation 12/06/2010 100.00 ESS11911587 828 FRONT PORCH MANOR PINELLAS ACTIVE 2010004412 Survey Deficiency 07/06/2010 1000.00 A1106 Class 3

A1107 Class 311966730 10883 GARDEN OF HOPE INC MIAMI-DADE ACTIVE 2010013549 Survey Deficiency 04/04/2011 500.00 A0209 Class 3

11964411 9014 GEORGE BLVD HOME LLC PINELLAS CLOSED 2009001712 Survey Deficiency 09/28/2010 1000.00 A0900 Class 3

A1103 Class 3

A1106 Class 3

A1107 Class 32009013900 Survey Deficiency 09/28/2010 3500.00 A0500 Class 2

A0802 Class 2

A0811 Class 311966850 11015 GOLDEN LIFE MANOR PINELLAS ACTIVE 2010010971 Licensure Violation 11/24/2010 100.0011963879 8756 GOLDEN MANOR ALF, INC. # 1 BROWARD ACTIVE 2010013560 Survey Deficiency 06/06/2011 1000.00 A0415 Class 2

11967595 11640 GOLDEN TOUCH HOME CARE #2 MIAMI-DADE ACTIVE 2010010972 Licensure Violation 12/06/2010 100.0011911284 7408 GRACE VILLA ORANGE ACTIVE 2010006373 Survey Deficiency 10/11/2010 1500.00 A0318 Class 3

A0517 Class 3

A1107 Class 32010009789 Survey Deficiency 02/09/2011 3029.50 A0304 Class 3

A0517

A0628

A0706

A0727

A0728

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 13

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911284 7408 GRACE VILLA ORANGE ACTIVE 2010011016 Survey Deficiency 05/09/2011 750.00 A0628 Class 3

L0300 Class 311965923 10274 GRACIOUS AGE SEMINOLE LITIGATION 2010011021 Survey Deficiency 01/19/2011 1500.00 A0704 Class 2

2010013504 Survey Deficiency 03/09/2011 1500.00 A0700 Class 2

11942934 5464 GRAND COURT VILLAGE I BROWARD ACTIVE 2009004030 Survey Deficiency 11/02/2010 4500.00 A0721 Class 3

A0800 Class 3

A0812 Class 3

A1102 Class 3

A1103 Class 3

A1106 Class 3

A1107 Class 3

A1117 Class 3

A1121 Class 32010010860 Survey Deficiency 12/16/2010 500.00 A0615 Class 3

11910247 7301 GRAND VILLA OF LARGO PINELLAS ACTIVE 2010001888 Survey Deficiency 09/28/2010 2250.00 A0522 Class 2

A0700 Class 2

A0718 Class 211967188 11321 HAMILTON ASSISTED LIVING PINELLAS ACTIVE 2010009784 Survey Deficiency 12/16/2010 1500.00 A0500 Class 2

A1105 Class 311964324 8961 HAMMOND HOUSE (THE) BROWARD ACTIVE 2010009898 Survey Deficiency 02/23/2011 1000.00 A0211 Class 3

A0215 Class 311965596 9965 HAMPTON COURT INDEPENDENT AND ASSISTED L POLK ACTIVE 2010004501 Survey Deficiency 07/26/2010 500.00 A1001 Class 3

2010004506 Survey Deficiency 07/26/2010 3500.00 A0201 Class 3

A0417 Class 3

A0514 Class 3

A0619 Class 3

A0700 Class 3

A1101 Class 3

A1103 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 14

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965596 9965 HAMPTON COURT INDEPENDENT AND ASSISTED L POLK ACTIVE 2010007151 Survey Deficiency 11/24/2010 1000.00 A0615 Class 3

A0631 Class 32010007539 Survey Deficiency 11/24/2010 5000.00 A0700 Class 3

2010008871 Survey Deficiency 11/04/2010 2000.00 A0615 Class 3

A0631 Class 311911084 5828 HAMPTON MANOR NORTH MARION ACTIVE 2011001439 Survey Deficiency 06/27/2011 800.00 A0706 Class 2

11965958 10268 HANDS OF GRACE LAFAYETTE ACTIVE 2011002549 Survey Deficiency 05/16/2011 1000.00 A0623 Class 2

11965695 10035 HARBOR PLACE AT PORT ST LUCIE, THE ST. LUCIE LITIGATION 2010005458 Survey Deficiency 01/19/2011 2000.00 A0700 Class 2

11965444 9815 HARBORCHASE OF GAINESVILLE ALACHUA ACTIVE 2010005256 Survey Deficiency 09/07/2010 3750.00 A0700 Class 1

11966380 10651 HARMONY HOMECARE SERVICE INC. ORANGE CLOSED 2008003381 Survey Deficiency 09/03/2010 4340.00 A0304 Class 3

A0308 Class 3

A0309 Class 4

A0322 Class 4

A0510 Class 3

A0615 Class 3

A1101 Class 3

A1103 Class 3

A1115 Class 3

L0500 Class 311964835 9289 HARMONY PLACE BROWARD ACTIVE 2010003918 Survey Deficiency 11/29/2010 2000.00 A0700 Class 2

A0718 Class 22010005300 Survey Deficiency 01/12/2011 750.00 A0417 Class 3

A1102 Class 311965936 10233 HERITAGE AT LAKE FOREST (THE) SEMINOLE ACTIVE 2010008873 Survey Deficiency 11/19/2010 1500.00 A0610 Class 2

11910622 5401 HERITAGE HOUSE RETIREMENT HOME PINELLAS ACTIVE 2010000772 Survey Deficiency 08/02/2010 1500.00 A0700 Class 2

11967259 11339 HERNANDEZ ALF HILLSBOROUGH ACTIVE 2010003005 Application 07/16/2010 3000.0011965739 10107 HERON CLUB AT PRESTANCIA (THE) SARASOTA ACTIVE 2010008388 Survey Deficiency 04/01/2011 2000.00 A0718 Class 2

A0724 Class 211964848 9345 HERON HOUSE SARASOTA ACTIVE 2011000765 Survey Deficiency 05/09/2011 1500.00 A0700 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 15

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11964848 9345 HERON HOUSE SARASOTA ACTIVE 2011000765 Survey Deficiency 05/09/2011 1500.00 A0707 Class 3

A0718 Class 311964467 8991 HIGHLAND TERRACE CITRUS ACTIVE 2010013334 Survey Deficiency 05/31/2011 2000.00 A0629 Class 2

A0631 Class 211910244 5389 HILCREST RETIREMENT RESIDENCE PINELLAS SUSPENDED 2009010095 Survey Deficiency 01/12/2011 1585.88 A0514 Class 3

A0718 Class 3

A1002 Class 3

A1101 Class 311964905 9528 HILDA HOME CARE MIAMI-DADE LITIGATION 2011003579 Licensure Violation 05/23/2011 50.00 LF11910597 5584 HOLMES CREEK ALF WASHINGTON ACTIVE 2009008097 Survey Deficiency 09/03/2010 2000.00 A0722 Class 2

A1013 Class 2

A1015 Class 211965248 9648 HOME FOR ANGELS MIAMI-DADE ACTIVE 2009001349 Application 09/03/2010 3000.00 LF11966570 10773 HOME SWEET HOME #2 MIAMI-DADE REVOKED 2010013037 Application 03/28/2011 500.0011953250 245 HOMESTEAD RETIREMENT OSCEOLA ACTIVE 2010006361 Survey Deficiency 03/09/2011 1500.00 A0218 Class 3

A0700 Class 311965516 9881 HOMEWOOD RESIDENCE AT DELRAY BEACH PALM BEACH ACTIVE 2010001995 Survey Deficiency 11/03/2010 7500.00 A1001 Class 1

2010011106 Licensure Violation 11/23/2010 100.0011965121 9584 HOMEWOOD RESIDENCE AT NAPLES COLLIER ACTIVE 2010000848 Survey Deficiency 11/02/2010 2500.00 A0705 Class 2

A0706 Class 22010001983 Survey Deficiency 11/10/2010 3000.00 A0615 Class 2

A0707 Class 2

A0718 Class 22010006399 Survey Deficiency 11/18/2010 500.00 A0705 Class 3

11966192 10428 HOPEWELL ASSISTED LIVING FACILITY, INC. BROWARD ACTIVE 2010008954 Survey Deficiency 11/23/2010 2000.00 A0700 Class 2

2010009999 Survey Deficiency 11/23/2010 1000.00 A0527 Class 3

A0615 Class 311965617 9953 HOWELL ALF # 2 WALTON ACTIVE 2010012240 Survey Deficiency 01/19/2011 2430.50 A0613 Class 2

A0629 Class 2

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 16

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11910251 6056 INDIAN OAKS MANOR PINELLAS ACTIVE 2010006241 Survey Deficiency 12/13/2010 1000.00 A0628 Class 3

A0631 Class 311911190 5576 INGLESIDE RETIREMENT DUVAL ACTIVE 2010002649 Survey Deficiency 05/20/2011 11000.00 A0011 Class 2

A0428 Class 2

A0631 Class 2

A0700 Class 22010005191 Survey Deficiency 05/20/2011 1000.00 A0209 Class 3

A0317 Class 32010009694 Survey Deficiency 05/20/2011 5000.00 A0500 Class 2

A0615 Class 211964828 9336 IONIE'S ASSISTED LIVING ORANGE ACTIVE 2010009788 Survey Deficiency 12/13/2010 1000.00 A0206 Class 3

A1106 Class 311966707 10871 IONIE'S ASSISTED LIVING II ORANGE ACTIVE 2010009787 Survey Deficiency 12/16/2010 1000.00 A0306 Class 3

A1101 Class 311967278 11448 J B S ASSISTED LIVING HOME BROWARD ACTIVE 2010009906 Survey Deficiency 12/22/2010 500.00 A1115 Class 3

11965438 9835 J R FAMILY CARE, INC MIAMI-DADE ACTIVE 2010006324 Survey Deficiency 12/13/2010 700.00 A0503 Class 4

A0619 Class 311910967 5564 JAS MANOR MIAMI-DADE ACTIVE 2010008030 Survey Deficiency 03/21/2011 500.00 A0629 Class 3

11910969 4911 JESUS OF NAZARETH HOME MIAMI-DADE ACTIVE 2010013546 Survey Deficiency 05/26/2011 3000.00 N0300 Class 2

N0303 Class 2

N302 Class 211967369 11443 JOSE YOANDRY ALF MIAMI-DADE ACTIVE 2010008875 Survey Deficiency 06/27/2011 1000.00 A0527 Class 3

A0819 Class 32010009875 Survey Deficiency 12/22/2010 500.00 A0504 Class 3

11966038 10307 JOSE' ROBERTO HOME CARE INC MIAMI-DADE ACTIVE 2010012279 Survey Deficiency 02/28/2011 1000.00 A0309 Class 3

A0504 Class 311967308 11378 JOZ-BRICK LUXURY VILLAS, CORP MIAMI-DADE ACTIVE 2010006178 Application 08/24/2010 365.0011965758 10088 JULIE'S RETIREMENT RESORT, INC. #2 ORANGE ACTIVE 2010006328 Survey Deficiency 01/14/2011 3207.00 A0704 Class 2

A0718 Class 2

Page 17: ASSISTED LIVING FACILITY -- Administrative Finesahca.myflorida.com/SCHS/ALWG/archived/docs/2011/2011-09-23/... · ASSISTED LIVING FACILITY -- Administrative Fines ... Nbr License

Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 17

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965758 10088 JULIE'S RETIREMENT RESORT, INC. #2 ORANGE ACTIVE 2010006328 Survey Deficiency 01/14/2011 3207.00 A0724 Class 2

11967532 11594 KENDALL ALF INC MIAMI-DADE ACTIVE 2010006294 Survey Deficiency 11/29/2010 400.00 A0615 Class 3

2011005173 Application 06/09/2011 100.0011911073 7285 KIPLING MANOR RETIREMENT CENTER ESCAMBIA ACTIVE 2008010733 Survey Deficiency 08/24/2010 12000.00 A0613 Class 1

A0615 Class 1

A0619 Class 2

A0631 Class 1

A0700 Class 1

A0706 Class 1

A0802 Class 2

A500 Class 1

A610 Class 12009009868 Survey Deficiency 08/24/2010 2500.00 A0406 Class 2

A0407 Class 2

A0429 Class 2

A0702 Class 2

A0812 Class 22009009928 Survey Deficiency 08/24/2010 3000.00 A0615 Class 3

A0802 Class 211966505 10727 LA PALOMA ALF SARASOTA ACTIVE 2009007751 Survey Deficiency 11/29/2010 6342.00 A0510 Class 3

A0511 Class 3

A0512 Class 3

A0513 Class 3

A0514 Class 3

A0516 Class 3

A0524 Class 3

A0609 Class 3

A1104 Class 3

A1106 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 18

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11966505 10727 LA PALOMA ALF SARASOTA ACTIVE 2009007751 Survey Deficiency 11/29/2010 6342.00 A1107 Class 3

A1108 Class 311965803 10145 LA ROSA ALF INC. MIAMI-DADE ACTIVE 2010006330 Survey Deficiency 12/22/2010 500.00 A0509 Class 3

11966217 10511 LAKE ALFRED ASSISTED LIVING AND RETIREME ORANGE ACTIVE 2010009777 Survey Deficiency 12/13/2010 1500.00 A052211966170 10423 LAUREL OAKS DUVAL ACTIVE 2010012293 Survey Deficiency 01/12/2011 1000.00 58A-5.023(1)(b) Class 2

11967093 11215 LEO HOMES, INC MIAMI-DADE ACTIVE 2011000463 Survey Deficiency 06/28/2011 500.00 N0300 Class 3

11966696 10836 LEORAY ALF, INC. BROWARD ACTIVE 2010001900 Survey Deficiency 04/04/2011 7500.00 A0500 Class 1

A0718 Class 1

A1000 Class 211964811 9356 LEXELLE ASSISTED LIVING FACILITY, INC FLAGLER ACTIVE 2010003198 Survey Deficiency 05/05/2011 6600.00 A0206 Class 3

A0223 Class 3

A0306 Class 3

A0417 Class 3

A0513 Class 3

A1102 Class 3

A1103 Class 3

A1104 Class 3

A1105 Class 3

A1106 Class 3

A1108 Class 311966343 10544 LIGHTHOUSE ALF (THE) ESCAMBIA DENIED

RENEWAL2009005968 Survey Deficiency 09/08/2010 6207.50 A0610 Class 2

A0613 Class 2

A0615 Class 2

A0626 Class 2

A0629 Class 2

A0631 Class 211943023 8339 LIGHTHOUSE INN NORTH BROWARD ACTIVE 2010003920 Survey Deficiency 08/18/2010 1000.00 A 801 Class 3

A1101 Class 311942965 7127 LIGHTHOUSE INN SOUTH BROWARD ACTIVE 2009011615 Survey Deficiency 12/13/2010 2000.00 A0211 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 19

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11942965 7127 LIGHTHOUSE INN SOUTH BROWARD ACTIVE 2009011615 Survey Deficiency 12/13/2010 2000.00 A0524 Class 3

A1001 Class 3

A1104 Class 32009013524 Survey Deficiency 11/17/2010 1400.00 A0211 Class 3

A1001 Class 32009014006 Survey Deficiency 11/17/2010 2000.00 A0119 Class 3

A0309 Class 3

A0705 Class 3

A0706 Class 311910699 4777 LIVING LEGENDS RETIREMENT CENTER BROWARD ACTIVE 2010001997 Survey Deficiency 08/24/2010 3212.12 A0323 Class 3

A0700 Class 311967323 11562 LONG LIFE CARE BROWARD LITIGATION 2010009855 Survey Deficiency 12/16/2010 1000.00 A0416 Class 3

A0523 Class 311910982 7548 LOVE VILLAGE MIAMI-DADE ACTIVE 2011000473 Survey Deficiency 04/20/2011 500.00 A509 Class 3

11967286 11357 LOVING CARE OF ST PETERSBURG PINELLAS ACTIVE 2010003083 Survey Deficiency 05/20/2011 5000.00 A0700 Class 2

2010003084 Survey Deficiency 05/20/2011 10000.00 A0615 Class 2

A0631 Class 22010009926 Survey Deficiency 05/23/2011 1000.00 A0631 Class 2

2010009970 Survey Deficiency 05/23/2011 500.00 A 615 Class 2

2010013466 Survey Deficiency 04/15/2011 750.00 A0615 Class 3

2010013467 Survey Deficiency 04/15/2011 500.00 A0707 Class 3

11967279 11364 LOVING ELDERLY CARE, INC MIAMI-DADE ACTIVE 2010006465 Survey Deficiency 11/29/2010 375.00 A0328 Class 3

11965443 9872 LYNMOORE ST LUCIE LAWNWOOD (THE) ST. LUCIE ACTIVE 2010005727 Survey Deficiency 06/06/2011 1500.00 A0700 Class 2

2010009912 Survey Deficiency 06/08/2011 500.00 A0616 Class 3

11967214 11336 M H TENDER CARE, INC #2 FLAGLER ACTIVE 2009012828 Survey Deficiency 12/13/2010 4500.00 Class 2

11912063 7978 MAGGIE'S RETIREMENT HOME #4 MIAMI-DADE ACTIVE 2011001608 Survey Deficiency 06/09/2011 500.00 D0304 Class 3

11942941 8366 MAGGIE'S RETIREMENT HOME #5 MIAMI-DADE ACTIVE 2010010050 Survey Deficiency 04/04/2011 500.00 A0328 Class 3

11964870 9346 MAGNOLIA COURT AT HEALTHPARK LEE ACTIVE 2010002426 Survey Deficiency 11/29/2010 375.00 E0801 Class 3

11911325 5886 MAGNOLIA HOUSE OF HPLS, INC ORANGE IN REVIEW 2010010724 Survey Deficiency 04/04/2011 5350.00 A0104 Class 4

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 20

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911325 5886 MAGNOLIA HOUSE OF HPLS, INC ORANGE IN REVIEW 2010010724 Survey Deficiency 04/04/2011 5350.00 A0206 Class 3

A0210 Class 4

A0319 Class 4

A0505 Class 3

A0511 Class 4

A0718 Class 3

A0724 Class 3

A0806 Class 4

A1103 Class 3

A1107 Class 3

A1109 Class 3

A1115 Class 32010013490 Survey Deficiency 03/11/2011 500.00 A0417 Class 3

11953416 8539 MAGNOLIA MANOR INC. PINELLAS ACTIVE 2008010610 Survey Deficiency 09/29/2010 375.00 A0418 Class 3

11965811 10165 MANATEE ASSISTED LIVING FACILITY, INC. MANATEE ACTIVE 2010003614 Application 09/10/2010 266.5011966124 10371 MARIA ADULT CARE #2 MIAMI-DADE ACTIVE 2010006277 Survey Deficiency 10/28/2010 500.00 A0209 Class 3

11966926 11054 MARIA HOME CARE CORP MIAMI-DADE ACTIVE 2010006384 Survey Deficiency 10/08/2010 500.00 A0615 Class 3

11967117 11210 MARLIN RETIREMENT ALF MIAMI-DADE CLOSED 2010010400 Licensure Violation 11/24/2010 100.0011910381 5201 MARRIOTT HOME CARE PALM BEACH ACTIVE 2010010408 Licensure Violation 11/15/2010 100.0011965799 10144 MARTIN ELDERLY CARE LIVING MIAMI-DADE ACTIVE 2010009921 Survey Deficiency 03/21/2011 2600.00 A0103 Class 4

A0223 Class 3

A0504 Class 3

A0513 Class 3

A1100 Class 4

A1101 Class 3

L 0203 Class 411966208 10440 MAUD'S PLACE MIAMI-DADE ACTIVE 2010009690 Survey Deficiency 03/21/2011 1000.00 1003 Class 3

1004 Class 311967829 11832 MAYDEL ALF CORP HILLSBOROUGH ACTIVE 2010010410 Licensure Violation 11/24/2010 100.00

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 21

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965775 10122 MAYRA'S ALF MIAMI-DADE ACTIVE 2010006300 Survey Deficiency 11/29/2010 500.00 A0509 Class 3

2010010625 Licensure Violation 11/24/2010 100.0011964474 9200 MAYRA'S ALF #3, INC. MIAMI-DADE ACTIVE 2010007629 Survey Deficiency 11/17/2010 500.00 A1106 Class 3

2010010627 Licensure Violation 11/24/2010 100.0011967252 11383 MCINTOSH MANOR SARASOTA ACTIVE 2010005423 Survey Deficiency 10/28/2010 500.00 A0628 Class 3

11966582 10798 MCSWEENEY ASSISTED LIVING FACILITY PASCO FAILED TO RENEW

2010000755 Survey Deficiency 09/10/2010 5500.00 A01115 Class 3

A0223 Class 3

A0418 Class 3

A0505 Class 3

A0509 Class 3

A0708 Class 3

A0710 Class 3

A0711 Class 3

A0810 Class 3

A0820 Class 3

A1105 Class 311967264 11324 MD HOME CARE #2 MIAMI-DADE ACTIVE 2010006703 Survey Deficiency 10/18/2010 500.00 D1034 Class 3

11967294 11340 MELBA COVE LLC BREVARD ACTIVE 2010013309 Survey Deficiency 03/03/2011 1000.00 A0615 Class 3

A1101 Class 311966979 11089 MERY ALF #2 CORP MIAMI-DADE ACTIVE 2010010671 Licensure Violation 11/24/2010 100.0011964602 9214 MI CASITA ALF MIAMI-DADE ACTIVE 2010006271 Survey Deficiency 10/18/2010 200.00 A0104 Class 4

11966030 10311 MI RETIRO ALF LLC MIAMI-DADE ACTIVE 2010007552 Survey Deficiency 04/11/2011 750.00 O0328 Class 3

O0402 Class 311967860 11869 MIAMI COMFORT COVE INC MIAMI-DADE ACTIVE 2010010674 Licensure Violation 01/31/2011 100.0011966644 10808 MIAMI LAKES ASSISTED LIVING FACILITY, IN MIAMI-DADE ACTIVE 2010010675 Licensure Violation 11/24/2010 100.0011910711 6508 MIDTOWN MANOR BROWARD ACTIVE 2010002000 Survey Deficiency 09/30/2010 1500.00 A0718 Class 2

A1011 Class 211911563 7498 MILLER RETIREMENT HOME MIAMI-DADE ACTIVE 2010006434 Survey Deficiency 05/20/2011 500.00 D0724 Class 3

2010010676 Licensure Violation 11/24/2010 100.00

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 22

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11967002 11121 MIRAMAR SENIOR LIVING V MIAMI-DADE ACTIVE 2010012283 Survey Deficiency 06/14/2011 500.00 A0304 Class 3

11967003 11120 MIRAMAR SENIOR LIVING VI MIAMI-DADE ACTIVE 2010010679 Licensure Violation 12/14/2010 100.0011967831 11808 MISSION OAKS SUMTER ACTIVE 2010010680 Licensure Violation 11/15/2010 100.0011953176 8493 MODEL RETREAT MIAMI-DADE IN REVIEW 2010010681 Licensure Violation 11/24/2010 100.0011965358 9698 MOLINA'S ADULT CARE MIAMI-DADE ACTIVE 2010006389 Survey Deficiency 11/02/2010 500.00 A0901 Class 3

2010010864 Survey Deficiency 04/04/2011 500.00 N0300 Class 3

11967210 11266 MOM & DAUGHTER HOME CARE, INC MIAMI-DADE ACTIVE 2010006385 Survey Deficiency 11/24/2010 500.00 A1103 Class 3

11967376 11485 MORE LIFE CARE INC DUVAL CLOSED 2010010755 Licensure Violation 11/24/2010 100.002010013595 Survey Deficiency 05/31/2011 16000.00 .429.52(4) Class 3

429.256 Class 3

429.275(2) Class 3

429.275(4) Class 3

429.28(1) Class 3

429.41(1)(a)3 Class 3

429.52(6) Class 3

429.52(9) Class 3

58A-5..0191(2)(f) Class 3

58A-5.0181(2)(b) Class 3

58A-5.0181(2)(c) Class 3

58A-5.0185(5)(b) Class 3

58A-5.0191(2)(a) Class 3

58A-5.0191(2)(b) Class 3

58A-5.0191(2)(c) Class 3

58A-5.0191(2)(d) Class 3

58A-5.0191(2)(e) Class 311953692 8604 MORRIS BRIDGE ADULT CARE FACILITY HILLSBOROUGH ACTIVE 2010004400 Survey Deficiency 08/26/2010 8000.00 A0323 Class 2

11911301 5053 MOTT FOSTER HOME ORANGE ACTIVE 2010004365 Survey Deficiency 04/06/2011 1950.00 A0210 Class 3

A0327 Class 4

A0900 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 23

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911301 5053 MOTT FOSTER HOME ORANGE ACTIVE 2010004365 Survey Deficiency 04/06/2011 1950.00 A1003 Class 3

A1103 Class 3

A1107 Class 311965005 9446 MUNNE CENTER, INC. MIAMI-DADE ACTIVE 2010007633 Survey Deficiency 01/26/2011 400.00 A0317 Class 4

A0322 Class 42010013246 Survey Deficiency 05/20/2011 1172.59 A0323 Class 3

11967406 11453 MY FAMILY ALF MIAMI-DADE ACTIVE 2010008884 Survey Deficiency 12/13/2010 100.00 A0503 Class 3

11953319 8570 MY HOME ALF, INC. MIAMI-DADE ACTIVE 2010006298 Survey Deficiency 10/18/2010 500.00 A1003 Class 3

11967061 11164 MY NEW HOME ALF, INC MIAMI-DADE ACTIVE 2010006283 Survey Deficiency 01/11/2011 1600.00 A0008 Class 3

Class 3

11943057 8528 MY SWEET HOME MIAMI-DADE ACTIVE 2010006352 Survey Deficiency 10/18/2010 1000.00 A0610 Class 3

A0619 Class 32010010821 Licensure Violation 12/06/2010 100.00

11910789 5685 NANCY B. BRUNO PINELLAS REVOKED 2009000695 Survey Deficiency 06/03/2011 3500.00 A0223 Class 3

A0511 Class 3

A0512 Class 3

A0513 Class 3

A0514 Class 3

A0820 Class 3

A1103 Class 32010003167 Survey Deficiency 06/03/2011 1000.00 A0415 Class 3

A0629 Class 311964613 9126 NATURE COAST LODGE, LLP CITRUS ACTIVE 2010001139 Survey Deficiency 11/10/2010 500.00 A0417 Class 3

11911062 8398 NELLIE'S RETIRED INN JEFFERSON LITIGATION 2010010906 Licensure Violation 11/24/2010 100.0011966773 10924 NENA'S ALF CARE CORP MIAMI-DADE ACTIVE 2010010907 Licensure Violation 11/15/2010 100.0011967482 11509 NEVIE'S CARING HANDS INC ORANGE ACTIVE 2010013493 Survey Deficiency 05/23/2011 1700.00 A0308 Class 4

A0322 Class 4

A0500 Class 3

A0527 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 24

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11967482 11509 NEVIE'S CARING HANDS INC ORANGE ACTIVE 2010013493 Survey Deficiency 05/23/2011 1700.00 A0729 Class 3

A1101 Class 311967665 11644 NEW BEGINNING BOARD & CARE HOME BREVARD ACTIVE 2010010931 Licensure Violation 11/24/2010 100.0011967862 11827 NEW BEGINNING CARE HOME BREVARD ACTIVE 2010010937 Licensure Violation 11/24/2010 100.0011967828 11804 NEW GREENVIEW II ALF MIAMI-DADE ACTIVE 2010010914 Licensure Violation 11/15/2010 100.0011965994 10263 NEW HORIZON NORTH BROWARD ACTIVE 2010010989 Licensure Violation 12/06/2010 100.0011910625 5778 NEW HORIZON SENIOR CITIZEN HOME CITRUS ACTIVE 2010010990 Licensure Violation 12/06/2010 100.0011964383 8982 NEW LIFE ASSISTED LIVING FACILITY ST. LUCIE ACTIVE 2010011242 Licensure Violation 12/07/2010 100.0011953540 7640 NEW MILLENNIUM ADULT CARE III MIAMI-DADE ACTIVE 2010009886 Survey Deficiency 03/02/2011 500.00 A0409 Class 3

2010012269 Survey Deficiency 04/01/2011 500.00 A0409 Class 3

11953464 6628 NEW RIVER VILLAS BROWARD ACTIVE 2010011279 Licensure Violation 12/07/2010 100.0011967807 11819 NEW VENTURES ALF LLC SUWANNEE CLOSED 2010011280 Licensure Violation 12/17/2010 100.0011967217 11311 NIRVANA BY BEACH ASSISTED LIVING FACILIT BROWARD CLOSED 2009009957 Survey Deficiency 06/03/2011 1500.00 A0417 Class 3

A0420 Class 3

A0718 Class 311967250 11344 NOEL SENIOR CARE INC MIAMI-DADE CLOSED 2010007606 Survey Deficiency 12/16/2010 700.00 58A-5.0191(1)(b)

A0504 Class 411910968 5934 NORTH MIAMI RETIREMENT LIVING MIAMI-DADE ACTIVE 2010011352 Licensure Violation 12/06/2010 100.0011912071 7860 NORTH PORT RETIREMENT CENTER SARASOTA ACTIVE 2010011353 Licensure Violation 12/06/2010 100.0011967089 11302 OASIS ADULT CARE MIAMI-DADE ACTIVE 2010007608 Survey Deficiency 11/17/2010 1100.00 A0509 Class 3

A0524 Class 3

A0527 Class 411967200 OASIS I MIAMI-DADE LITIGATION 2010011355 Licensure Violation 12/06/2010 100.0011966453 10631 OCEANVIEW RETIREMENT HOME BROWARD ACTIVE 2010011477 Licensure Violation 12/17/2010 100.0011964358 8918 OLIVINNE'S IN-HOME CARE, INC. BROWARD ACTIVE 2009008828 Survey Deficiency 05/25/2011 1000.00 A0412 Class 2

A0415 Class 211966464 10685 OPEN ARMS WITH LOVE INC. BREVARD CLOSED 2010011479 Licensure Violation 12/17/2010 100.0011911449 5120 ORANGE BLOSSOM MANOR BROWARD ACTIVE 2011000819 Survey Deficiency 04/06/2011 500.00 A0631 Class 3

11910373 4941 ORCHID ISLAND MANOR, LLC INDIAN RIVER ACTIVE 2010000945 Survey Deficiency 09/03/2010 1000.00 A0415 Class 2

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 25

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11964677 9199 ORCHID TERRACE COLLIER ACTIVE 2010011484 Licensure Violation 12/13/2010 100.0011967708 11692 ORLANDO FLORIDA ASSISTED LIVING FACILITI POLK ACTIVE 2010011487 Licensure Violation 01/26/2011 100.0011964948 9453 ORLANDO IVY COURT ORANGE ACTIVE 2010004373 Survey Deficiency 10/18/2010 2000.00 A0704 Class 2

A700 Class 22010013576 Survey Deficiency 03/09/2011 1500.00 A0700 Class 2

11965335 9737 OSPREY POINTE ON PALMER RANCH SARASOTA ACTIVE 2010007577 Survey Deficiency 11/02/2010 750.00 A0701 Class 2

11964501 9061 OUR HOUSE ALF, INC. BREVARD ACTIVE 2010004358 Survey Deficiency 11/19/2010 450.00 A0619 Class 3

11942937 8352 OUR LADY OF CHARITY MIAMI-DADE ACTIVE 2010013536 Survey Deficiency 04/04/2011 500.00 A0209 Class 3

11967328 11391 PALANI'S INC, ALF HILLSBOROUGH ACTIVE 2010006851 Application 08/24/2010 305.0011910386 7617 PALM BEACH ASSISTED LIVING FACILITY PALM BEACH ACTIVE 2010002003 Survey Deficiency 02/07/2011 3200.00 A0718 Class 2

A1011 Class 2

A1012 Class 211965658 9987 PALM COTTAGES OF ROCKLEDGE BREVARD ACTIVE 2010012480 Survey Deficiency 04/08/2011 1350.00 A0700 Class 2

11932469 7757 PALM GARDENS MANOR MIAMI-DADE ACTIVE 2010012276 Survey Deficiency 05/26/2011 1000.00 A0402 Class 3

A0408 Class 311966190 10407 PALM KREST MANOR POLK ACTIVE 2010003933 Survey Deficiency 07/26/2010 1500.00 A0415 Class 2

11942878 7269 PALMS OF FORT MYERS LEE ACTIVE 2010003196 Survey Deficiency 11/17/2010 500.00 A0610 Class 3

11953665 9176 PARADISE OF HIALEAH MIAMI-DADE ACTIVE 2010006276 Survey Deficiency 03/11/2011 1500.00 A0511 Class 3

A0512 Class 3

A0513 Class 3

A0514 Class 311922238 8065 PARADISE REST MANATEE ACTIVE 2008013897 Survey Deficiency 07/15/2010 250.00 A0509 Class 3

11911412 7169 PARK PLAZA RETIREMENT RESIDENCE MIAMI-DADE LITIGATION 2011000465 Survey Deficiency 05/20/2011 4200.00 A0201 Class 3

A0417 Class 4

A0503 Class 3

A0514 Class 3

A0615 Class 3

A0629 Class 3

A0724 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 26

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911412 7169 PARK PLAZA RETIREMENT RESIDENCE MIAMI-DADE LITIGATION 2011000465 Survey Deficiency 05/20/2011 4200.00 A1102 Class 3

A1103 Class 3

A1115 Class 32011002524 Survey Deficiency 06/27/2011 700.00 A0417 Class 4

A0724 Class 311953423 8521 PARRAMORE'S HOUSE LIBERTY REVOKED 2010000679 Survey Deficiency 09/28/2010 9000.00 A0416 Class 2

A0507 Class 2

A0524 Class 2

A0626 Class 2

A0629 Class 2

A0724 Class 2

A1101 Class 2

A1103 Class 2

A1115 Class 211966747 10897 PEACE ON EARTH ASSISTED LIVING FACILITY BROWARD ACTIVE 2010004414 Survey Deficiency 01/12/2011 1000.00 A0415 Class 3

A0615 Class 311910830 5195 PEACEKEEPERS DEN INC POLK LITIGATION 2011003398 Survey Deficiency 05/23/2011 500.00 A0615 Class 3

2011004127 Survey Deficiency 06/28/2011 3500.00 A0327 Class 3

A0510 Class 3

A0511 Class 3

A0514 Class 3

A0711 Class 3

A1115 Class 3

L0300 Class 32011005250 Survey Deficiency 06/27/2011 5000.00 A1002 Class 2

11966044 10295 PEACOCK CHATEAU MADISON ACTIVE 2010012284 Survey Deficiency 01/12/2011 2000.00 A1105 Class 2

A1116 Class 211966400 10598 PHOENIX SENIOR LIVING II, INC. BROWARD ACTIVE 2011001099 Survey Deficiency 05/16/2011 500.00 A0615 Class 3

11911632 7784 PLEADS FAMILY INC. MIAMI-DADE CLOSED 2010006286 Survey Deficiency 10/18/2010 4500.00 A0013 Class 4

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 27

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911632 7784 PLEADS FAMILY INC. MIAMI-DADE CLOSED 2010006286 Survey Deficiency 10/18/2010 4500.00 A0103 Class 4

A0104 Class 4

A0205 Class 3

A0217 Class 3

A0509 Class 3

A0819 Class 3

A0825 Class 4

A0900 Class 4

A1101 Class 311967142 11272 PM ADULT HOME CARE MIAMI-DADE ACTIVE 2010006296 Survey Deficiency 11/17/2010 500.00 A0819 Class 3

11910727 95 POMPANO RETIREMENT VILLAGE BROWARD ACTIVE 2010007907 Survey Deficiency 11/15/2010 1000.00 A0500 Class 3

A0718 Class 311965503 9921 PRESIDENTIAL PLACE BROWARD ACTIVE 2010002060 Survey Deficiency 07/19/2010 700.00 A1001 Class 2

11966716 10889 PRESTIGE MANOR III MARION ACTIVE 2011000770 Survey Deficiency 06/06/2011 500.00 A0417 Class 3

11963921 8807 PRINCE OF PEACE ELDERLY CARE FACILITY MIAMI-DADE ACTIVE 2009000472 Survey Deficiency 12/13/2010 1500.00 A0403 Class 3

A0509 Class 3

A0724 Class 311942762 8303 PRINCESS GARDENS ALF MIAMI-DADE ACTIVE 2010010691 Licensure Violation 11/24/2010 100.0011911409 91 PROFESSIONAL HOME CARE II MIAMI-DADE ACTIVE 2010010694 Licensure Violation 11/24/2010 100.0011912077 7375 PROSPERITY OAKS PALM BEACH ACTIVE 2010009905 Survey Deficiency 06/09/2011 1000.00 A 0631 Class 3

A0812 Class 311966138 10413 PROVIDENCE HOME ORANGE ACTIVE 2010010699 Licensure Violation 11/24/2010 100.0011967745 11777 QUIET WATERS PALM BEACH ACTIVE 2010010701 Licensure Violation 11/15/2010 100.0011965204 9688 RAFFA CORP MIAMI-DADE ACTIVE 2010010702 Licensure Violation 12/17/2010 100.0011965980 10271 RAFFA CORP II MIAMI-DADE ACTIVE 2010010722 Licensure Violation 11/24/2010 100.0011964521 9052 RAINBOW PLACE, INC. BROWARD ACTIVE 2010010736 Licensure Violation 11/24/2010 100.0011967393 11465 RAYMONDE JEAN BAPTISTE CENTER MIAMI-DADE ACTIVE 2010010867 Survey Deficiency 02/23/2011 500.00 N0301 Class 3

11964554 9135 REBA'S HOUSE MANATEE ACTIVE 2010010738 Licensure Violation 11/23/2010 100.0011910345 4879 REBECCA MANOR RETIREMENT HOME VOLUSIA ACTIVE 2010010742 Licensure Violation 12/06/2010 100.00

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 28

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11911223 5016 REGENTS CLUB, LLC CHARLOTTE ACTIVE 2010008948 Survey Deficiency 12/13/2010 3500.00 A0705 Class 2

A0706 Class 2

A0707 Class 211965466 9860 REMANSO ALF INC. MIAMI-DADE ACTIVE 2007008813 Survey Deficiency 07/19/2010 1365.00 A0205 Class 3

A0901 Class 311911393 6616 RENAISSANCE GARDENS MIAMI-DADE ACTIVE 2010007645 Survey Deficiency 05/16/2011 1000.00 A0403 Class 3

A0724 Class 311953426 5258 RENAISSANCE MANOR SARASOTA ACTIVE 2010010753 Licensure Violation 11/24/2010 100.0011922141 5815 RENAISSANCE RETIREMENT CENTER, LLC SEMINOLE ACTIVE 2010008889 Survey Deficiency 01/12/2011 1500.00 A0700 Class 2

2010012474 Survey Deficiency 02/23/2011 1500.00 A0700 Class 2

11911245 5556 RESIDENCE RETIREMENT CTR., INC. (THE) POLK ACTIVE 2010001965 Survey Deficiency 08/20/2010 1000.00 A1116 Class 2

11967626 11648 RESTORED LIVING FACILITY MIAMI-DADE ACTIVE 2010010827 Licensure Violation 01/26/2011 100.0011967815 11796 RETREAT AT ABINGDON (THE) ST. LUCIE ACTIVE 2010010831 Licensure Violation 12/06/2010 100.0011967587 11595 RETREAT AT WATERSONG (THE) BREVARD ACTIVE 2010013503 Survey Deficiency 06/03/2011 1400.00 A0705 Class 2

2011001616 Survey Deficiency 06/03/2011 2700.00 A0022 Class 4

A0511 Class 3

A0514 Class 3

A0617 Class 3

A0631 Class 3

A1101 Class 3

A1110 Class 3

E0309 Class 311965976 10267 REYES HOME CARE MIAMI-DADE ACTIVE 2010010839 Licensure Violation 12/06/2010 100.0011965030 9473 RIVIERA ASSISTED LIVING RESIDENCES VOLUSIA ACTIVE 2011001489 Survey Deficiency 06/03/2011 18500.00 58A-5.0191(2)(b)FAC11967183 11239 RODRIGUEZ ALF #1 MIAMI-DADE ACTIVE 2010006391 Survey Deficiency 02/23/2011 500.00 A0509 Class 3

11964689 9386 ROSAS A CREDIT ALF MIAMI-DADE ACTIVE 2010010053 Survey Deficiency 05/04/2011 900.00 A0306 Class 4

A0513 Class 3

A0615 Class 311910384 7462 ROYAL CARE A.C.L.F., INC. ST. LUCIE ACTIVE 2010008406 Survey Deficiency 12/16/2010 500.00 A1103 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 29

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11910140 5555 ROYAL GARDENS OF ST. CLOUD, LLC OSCEOLA ACTIVE 2010012206 Survey Deficiency 04/18/2011 1350.00 A0700 Class 2

11910074 7616 RUBY'S RESIDENTIAL CARE, INC. HILLSBOROUGH ACTIVE 2010002063 Survey Deficiency 08/10/2010 500.00 A9615 Class 3

11964394 8904 SALMO 23 ELDER CARE MIAMI-DADE ACTIVE 2010008111 Survey Deficiency 12/01/2010 1500.00 A0209 Class 3

A0619 Class 3

A1106 Class 311967551 11563 SAN JEAN FACILITY CARE, INC ORANGE ACTIVE 2011001614 Survey Deficiency 06/09/2011 1500.00 A0705 Class 2

11942761 7668 SAN JUDAS TADEO ALF MIAMI-DADE ACTIVE 2010006710 Survey Deficiency 05/23/2011 1875.00 A0529 Class 2

A0701 Class 211911315 5758 SAND POINT SENIOR LIVING BREVARD ACTIVE 2010004382 Survey Deficiency 05/09/2011 1400.00 A0700 Class 3

11911233 4789 SANFORD MANOR SEMINOLE ACTIVE 2010006397 Survey Deficiency 11/29/2010 1500.00 A0705 Class 2

11911404 6501 SANTANDER RETIREMENT HOME MIAMI-DADE ACTIVE 2010006281 Survey Deficiency 09/07/2010 200.00 A0309 Class 3

11967793 11803 SARAI HOME CARE INC MIAMI-DADE ACTIVE 2010009854 Survey Deficiency 03/09/2011 1000.00 A0509 Class 3

A1101 Class 311953284 8447 SAVANNAH COURT OF MAITLAND SEMINOLE ACTIVE 2010006313 Survey Deficiency 12/15/2010 1125.00 A0628 Class 3

A0631 Class 3

A0700 Class 32010013508 Survey Deficiency 04/15/2011 750.00 A0700 Class 2

11964749 9235 SAVANNAH COURT OF OVIEDO I BROWARD ACTIVE 2010008924 Survey Deficiency 04/15/2011 1250.00 A0626 Class 2

11965589 9917 SAVANNAH COURT OF ST CLOUD OSCEOLA ACTIVE 2010008943 Survey Deficiency 04/15/2011 1400.00 A0700 Class 2

11965595 9948 SEASONS BY RIVIERA VOLUSIA ACTIVE 2010009693 Survey Deficiency 11/10/2010 4000.00 A0631 Class 2

11966780 10994 SERAPHIM CARE MIAMI-DADE FAILED TO RENEW

2011002159 Survey Deficiency 06/06/2011 500.00 A0509 Class 3

11966794 10937 SERENITY PLACE ALF BREVARD ACTIVE 2010012488 Survey Deficiency 05/31/2011 200.00 A0324 Class 4

A1103 Class 311910220 7021 SERENITY VILLAGE PINELLAS CLOSED 2010007815 Survey Deficiency 11/29/2010 514.68 A0506 Class 3

A0509 Class 22010009779 Survey Deficiency 11/29/2010 1500.00 A1115 Class 3

A1116 Class 22010010650 Survey Deficiency 11/29/2010 3500.00 A1115 Class 1

11910736 5167 SHALOM MANOR BROWARD ACTIVE 2010008113 Survey Deficiency 09/10/2010 1000.00 A0718 Class 2

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 30

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11964562 9093 SHERIDAN MANOR BROWARD ACTIVE 2010008407 Survey Deficiency 12/22/2010 3000.00 A0209 Class 3

A0800 Class 3

A0801 Class 3

A0805 Class 3

A1002 Class 3

A1115 Class 311966573 10775 SHERWOOD HOUSE INC BREVARD ACTIVE 2010006315 Survey Deficiency 11/29/2010 750.00 A0629 Class 3

A0706 Class 311967319 11376 SILVER DAYS, ALF MIAMI-DADE ACTIVE 2010006432 Survey Deficiency 11/29/2010 500.00 D0328 Class 3

11965366 9775 SLOAN HOME OF CENTRAL FL INC ORANGE ACTIVE 2010013298 Survey Deficiency 03/21/2011 880.00 A0104 Class 4

A0308 Class 3

A0900 Class 311965499 9890 SOUTHERN LIVE-IN OF BRANDON HILLSBOROUGH ACTIVE 2010006857 Application 08/24/2010 488.0011910564 6020 SOUTHERN LIVING FOR SENIORS MADISON ACTIVE 2010006179 Survey Deficiency 03/21/2011 2000.00 A0008 Class 2

A1009 Class 211942830 7853 SOUTHERN OAKS ALF HARDEE ACTIVE 2010006871 Survey Deficiency 11/29/2010 5000.00 A0718 Class 2

A1000 Class 111965477 9847 SOUTHLAND SUITES OF LONGWOOD SEMINOLE ACTIVE 2008004947 Survey Deficiency 07/15/2010 525.00 A0206 Class 4

A0222 Class 4

A0617 Class 311965480 9858 SPRING HILLS HUNTER'S CREEK ORANGE ACTIVE 2010008945 Survey Deficiency 01/31/2011 1500.00 A0700 Class 2

11963882 7475 SPRINGWOOD COURT LEE ACTIVE 2010005298 Survey Deficiency 11/10/2010 1000.00 A0615 Class 3

A0629 Class 311965844 10323 ST PETER'S GARDEN ASSISTED LIVING FACILI INDIAN RIVER ACTIVE 2009007391 Survey Deficiency 12/23/2010 1500.00 A0309 Class 3

A0511 Class 3

A0615 Class 3

A1103 Class 3

A1104 Class 3

A1107 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 31

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11964709 9189 STERLING HOUSE OF BLUE WATER BAY OKALOOSA ACTIVE 2010000643 Survey Deficiency 09/10/2010 1250.00 A1101 Class 2

11964641 9182 STERLING HOUSE OF ENGLEWOOD CHARLOTTE ACTIVE 2010000832 Survey Deficiency 10/26/2010 1000.00 A0610 Class 3

A0812 Class 311966721 10861 STILLWATER ALF CORP BREVARD ACTIVE 2010009786 Survey Deficiency 01/19/2011 1200.00 A0104 Class 4

A0215 Class 4

A0307 Class 3

A0417 Class 311964933 9407 SULLIVAN HOUSE PASCO ACTIVE 2010013471 Survey Deficiency 05/09/2011 1219.35 A0323 Class 3

2011000372 Survey Deficiency 05/09/2011 2000.00 A0415 Class 2

11964377 9001 SUNNY HILLS OF SEBRING HIGHLANDS ACTIVE 2010005726 Survey Deficiency 11/19/2010 375.00 A0615 Class 3

11967698 11710 SUNNY'S ASSISTED LIVING, INC. PALM BEACH CLOSED 2010010728 Licensure Violation 11/24/2010 100.00 NO ESS11911106 5084 SUNRISE HOME CARE SERVICES BRADFORD LITIGATION 2010010732 Licensure Violation 11/24/2010 100.0011932456 8097 SUNRISE RETIREMENT HOME PINELLAS ACTIVE 2010010733 Licensure Violation 11/23/2010 100.0011964825 9325 SUNSET LAKE VILLAGE ACTIVE 2010010737 Licensure Violation 11/24/2010 100.0011967852 11833 SUNSET OAK 1, INC MIAMI-DADE ACTIVE 2010010740 Licensure Violation 12/06/2010 100.0011963891 5461 SUNSHINE ACRES LOVING CARE ASSISTED LIVI PINELLAS SUSPENDED 2010002869 Survey Deficiency 07/20/2010 500.00 A0629 Class 2

2010002873 Survey Deficiency 07/15/2010 1000.00 A1115 Class 2

A1116 Class 211964851 9300 SUNSHINE ASSISTED LIVING BROWARD ACTIVE 2010008408 Survey Deficiency 01/12/2011 500.00 A0211 Class 3

11967423 11457 SUNSHINE SENIOR CARE SERVICES BROWARD ACTIVE 2010009899 Survey Deficiency 11/30/2010 500.00 A0615 Class 3

11910951 7170 SUPERIOR LIVING OF HIALEAH, INC. MIAMI-DADE ACTIVE 2011000471 Survey Deficiency 04/20/2011 500.00 A1004 Class 3

11965363 9739 SUPERIOR RESIDENCES OF BRANDON MEMORY CA HILLSBOROUGH ACTIVE 2011002154 Survey Deficiency 05/17/2011 5500.00 A0700 Class 2

11966460 10656 SUPREME I ALF MIAMI-DADE ACTIVE 2010010777 Licensure Violation 11/24/2010 100.0011966943 11108 SURE CARE MANOR MARION ACTIVE 2009004554 Survey Deficiency 04/04/2011 5300.00 A0428 Class 1

A0500 Class 1

A0701 Class 12010010780 Licensure Violation 11/24/2010 100.00

11967059 11140 SWEET HOME AT LAST VOLUSIA ACTIVE 2010010781 Licensure Violation 11/24/2010 100.0011964985 9635 SWEET RESIDENCE, INC. II MIAMI-DADE IN REVIEW 2010011169 Licensure Violation 12/17/2010 100.00

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 32

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11966831 10969 TARA - FAITH MANOR BROWARD CLOSED 2010003524 Survey Deficiency 05/16/2011 500.00 A1115 Class 3

2010011172 Licensure Violation 12/06/2010 100.0011910101 1047 TENDER LOVING CARE RETIREMENT RESIDENCE POLK ACTIVE 2010013478 Survey Deficiency 05/04/2011 2500.00 A0700 Class 2

A0718 Class 211967483 11520 TOUCHED BY FAITH ASSISTED LIVING PINELLAS ACTIVE 2010009773 Survey Deficiency 02/28/2011 1500.00 A0718 Class 2

2011000462 Survey Deficiency 04/04/2011 500.00 A518 Class 3

11932535 8134 TOWN SQUARE AT VIERA, THE BREVARD ACTIVE 2010010527 Application 01/11/2011 7500.00 CHOW fine2010006317 Survey Deficiency 09/10/2010 1000.00 A0617 Class 3

A0700 Class 311963817 5522 TUSCANY VILLA OF NAPLES COLLIER ACTIVE 2010007566 Survey Deficiency 10/26/2010 500.00 A0631 Class 3

11910781 7309 TYRONE MANOR PINELLAS ACTIVE 2010000992 Survey Deficiency 09/10/2010 850.00 A0615 Class 3

A1107 Class 311911387 7284 VERONA'S RETIREMENT HOME II MIAMI-DADE ACTIVE 2010010047 Survey Deficiency 05/23/2011 2000.00 A0011 Class 3

A0104 Class 3

A0511 Class 3

A0615 Class 311963757 8646 VICTORIA VILLA BROWARD ACTIVE 2010004397 Survey Deficiency 07/21/2010 500.00 A1104 Class 3

2010004399 Survey Deficiency 09/02/2010 1000.00 A0524 Class 3

A1115 Class 311964837 9538 VILLA MARGO V MIAMI-DADE ACTIVE 2010009876 Survey Deficiency 05/25/2011 1125.00 A0416 Class 3

A0610 Class 3

A0619 Class 311965369 9947 VIOLETA'S HOME MIAMI-DADE ACTIVE 2010007562 Survey Deficiency 12/01/2010 2900.00 A0309 Class 3

A0418 Class 3

A0636 Class 1

A0901 Class 4

A1100 Class 4

L0200 Class 3

L0300 Class 3

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Date: 08/05/2011ASSISTED LIVING FACILITY -- Administrative Fines

Final Order Between: 07/01/2010 and 06/30/2011

Report: S:\IMPROMPTU\Internet Reports\ALF_Fines_Web.imrCatalog: L:\HQA_ENFORCEMENT\HQA_Enforcement_DM.cat

Page 33

File Nbr License # Provider Name County

Current Lic Status Case #

Case Type

Final Order

Imposed Fine Amt

Deficiency Tag

Class Desc

11965369 9947 VIOLETA'S HOME MIAMI-DADE ACTIVE 2010007736 Survey Deficiency 11/24/2010 500.00 A0636 Class 3

2010009865 Survey Deficiency 01/19/2011 500.00 A0615 Class 3

11922281 6061 WESTBROOKE MANOR PASCO ACTIVE 2010008380 Survey Deficiency 12/01/2010 1000.00 A0615 Class 3

11910628 4771 WHITEHALL BOCA RATON PALM BEACH ACTIVE 2010009643 Survey Deficiency 05/11/2011 750.00 A0700 Class 3

A0801 Class 311966216 10457 WILLOW HAVEN ALF, INC. MIAMI-DADE ACTIVE 2010009669 Survey Deficiency 05/11/2011 375.00 A0819 Class 3

11964578 9110 WIZE CHOICE PALM BEACH ACTIVE 2010002074 Survey Deficiency 07/16/2010 500.00 A0201 Class 3

A1103 Class 311932487 6601 WOODLANDS (THE) LEE ACTIVE 2010013525 Survey Deficiency 04/15/2011 3500.00 A0705 Class 2

A0718 Class 2

A0727 Class 211965267 9682 YAMILE'S HOME MIAMI-DADE ACTIVE 2010006268 Survey Deficiency 10/11/2010 1000.00 A0509 Class 3

A1101 Class 3