19-003125 Agency For Health Care Administration vs. Alex Bellamy Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, October 22, 2019.

accrediting, third party billing including but not limited to the Florida Medicaid program, and private

contracts.

8. The Respondent shall pay the Agency $2,250.00. If full payment has been made, the

cancelled check acts as receipt of payment and no further payment is required. If full payment has not

been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory

interest and may be referred to collections. A check made payable to the "Agency for Health Care

Administration" and containing the AHCA ten-digit case number should be sent to:

Central Intake Unit

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 61

Tallahassee, Florida 32308

ORDERED in Tallahassee, Florida, on this k_ day of "S (»L '2020.

Mary C. Ma w,

Agency For Health Care Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted

by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with

filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency

maintains its headquarters or where a party resides. Review of proceedings shall be conducted in

accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of

rendition of the order to be reviewed.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and of the furnished to the below

named persons by the method designated on this of , 2020.

7

Richar oop, Ag

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

[phone]

Facilities Intake Unit Keisha Woods, Unit Manager

Agency for Health Care Administration Assisted Living Facility Licensure Unit

(Electronic Mail) Agency for Health Care Administration

(Electronic Mail)

Central Intake Unit Karla Beasley, Field Office Manager

Agency for Health Care Administration Field Office #2

(Electronic Mail) Agency for Health Care Administration

(Electronic Mail)

Katrina Derico-Harris Katie Jackson, Assistant General Counsel

Medicaid Accounts Receivable Office of the General Counsel

Agency for Health Care Administration Agency for Health Care Administration

(Electronic Mail) (Electronic Mail)

Nicholas Constantino Alex Bellamy

Medicaid Contract Management Adult Family Care Home

Agency for Health Care Administration 1671 Monroe Sheffielq Road

(Electronic Mail) Chipley, FL 32428

(U.S. Mail)

G.W. Chisenhall, Presiding Officer John E. Terrel, Attorney for Petitioner

Division of Administrative Hearings 1700 North Monroe Street, Suite 11-116

The DeSoto Building Tallahassee, Fl. 32303

1230 Apalachee Parkway (U.S. Mail)

Tallahassee, FL 32399-3060

(Electronic Mail)

NOTICE OF FLORIDA LAW

408.804 License required; display.--

(1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers

or provides services that require licensure, without first obtaining from the agency a license authorizing

the provision of such services or the operation or maintenance of such provider.

(2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address

that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not

be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the

licensee, provider, and location for which the license is issued.

408.812 Unlicensed activity.--

( 1) A person or entity may not offer or advertise services that require licensure as defined by this part,

authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency.

A licenseholder may not advertise or hold out to the public that he or she holds a license for other than

that for which he or she actually holds the license.

(2) The operation or maintenance of an unlicensed provider or the performance of any services that require

licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity

constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state

attorney may, in addition to other remedies provided in this part, bring an action for an injunction to

restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the

performance of any services in violation of this part and authorizing statutes, until compliance with this

part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency.

(3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after

receiving notification from the agency, such person or entity fails to cease operation and apply for a license

under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by

authorizing statutes and applicable rules. Each day of continued operation is a separate offense.

( 4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for

each day of noncompliance.

(5) When a controlling interest or licensee has an interest in more than one provider and fails to license a

provider rendering services that require licensure, the agency may revoke all licenses and impose actions

under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against

each licensee until such time as the appropriate license is obtained for the unlicensed operation.

(6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a

person or entity is operating or maintaining a provider without obtaining a license and determines that a

condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person

or entity is subject to the same actions and fines imposed against a licensee as specified in this part,

authorizing statutes, and agency rules.

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

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner,

DOAH No. /1-/9/f

v. AHCA No. 2018015626

ALEX BELLAMY,

_____________________________ Respondent. ./

AFFIDAVIT OF MARQUITTA FRANKLIN

STATE OF FLORIDA

COUNTY OF LEON

Before me, the undersigned authority appeared, Marquita Franklin, who having been first

sworn, says:

1. My name is Marquitta Franklin. I am over 18 years of age and have personal

knowledge of the facts and information provided in this affidavit.

2. I am currently employed by the State of Florida, Agency for Health Care

Administration. My employment began Juh 6. 2018.

3. I am the property owner of739 East Blvd., Chipley, Florida 32428.

4. In August 2017, ALEX BELLAMY, began to reside at the property located at 739

East Blvd., Chipley, Florida 32428.

5. ALEX BELLAMY and I established a verbal agreement for a $520 rent payment

to be made every month on the 3rd. There was an additional agreement that when the betterment

of his circumstances occurred, that we would revisit his rent obligations. The agreement was that

rent would increase within a year.

EXHIBIT A

6. ALEX BELLAMY initially made payment with cash, and then payments were

made through Cash App, a mobile phone application used for monetary transfers.

7. On or about October 9, 201 7, during the course of my employment with the

Agency, Keisha Woods, my supervisor at that time approached me regarding my role as a property

owner. She inquired as to the status of my ownership at the property located at 739 East Blvd.,

Chipley, Florida 32428.

8.. I confirmed my status as a property owner of 739 East Blvd., Chipley, Florida

32428.

9. At that time, I stated that I was unaware of the operation of an adult family care at

the property located at 739 East Blvd., Chipley, Florida 32428.

10. After this denial, Ms. Woods presented a copy of a lease agreement (s) submitted

by ALEX BELLAMY that I allegedly signed.

11. At that time, I denied signing a lease agreement (s) regarding my property located

at 739 East Blvd., Chipley, Florida 32428.

FURTHER AFFIANT SA YETH NOT.

-

STATE OF FLORIDA

COUNTY OF LEON

The foregoing instrument was acknowledged before me on this of

" _ _._?\\_· ..w.\\-")uX_jl'--l_\\ __ , 2019, by Marquitta Franklin, who is(personally known t<'j me="" or="" who="">

--- as identification.

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Notary Public, State of DESHARIATKINS

* ._'W ,. MY COMMISSION# GG 038269

If EXPIRES: Oclobe/12. 2020

°F Bonded 111111 )lotary Services

Print, Type, or Stamp Name ofNotary Public

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May 9, 2019

Alex Bellamy (Tenant)

739 East Blvd

Chipley, FL 32428

Marquitta Franklin, Landlord, herby give you Alex Bellamy, Tenant, and all other

occupants on the agreed upon month-to month rental agreement, thirty (30) days' notice

to vacate the dwelling located at 739 East Blvd, Chipley, FL, 32428.

Listed below are the reasons for the eviction:

1. Falsified Lease

2. Amount agreed upon $900.00 (month·to-month) has never been paid. Landlord

has only received rent in the amount of $520.00 every month. This amount was

never agreed upon.

YOU MUST VACATE THE PREMISES BY: June gth, 2019.

If you remain in the dwelling on or after June 9 1 h, 2019, I will proceed with legal actions

to have you removed from the property.

EXHIBIT B

.·. · ·n · • • • · · ••

lVIA.tiJ!!l RECEIPT

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STATE OF FLORIDA

DIVISION OF ADMlNISTRA TIVE HEARINGS

STATE. OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner,

DOAH Nos. 19-1918

v. 19-3125

ALEX BELLAMY,

Respondent.

AFFIDAVIT OF MARQUITTA FRANKLIN

'STATE OF FLORIDA

COUNTY OF LEON

Before me, the undersigned authority appeared, Marquitta Frank:Jin, who having been first

sworn, says:

1. My name is Marquitta Franklin. I am over 18 years of age and have personal

knowledge of the facts and information provided in this affidavit.

2. I am the sole owner of the property located at 739 East Blvd., Chipley, Florida

32428.

3. In August 2017, ALEX BELLAMY, began to reside at the above-referenced

property.

4. On or about May 9, 2019, I mailed a certified Notice to Vacate (hereinafter

"Notice") letter to ALEX BELLAMY. See Exhibit A.

5. Pursuant to this Notice, ALEX BELLAMY was provided thirty (30) days, from the

date of the letter, to vacate the premises located at 739 East Blvd., Chipley, FL 32428.

EXHIBIT C

6. ALEX BELLAMY has since vacated the property and the locks were changed.

FURTHER AFFIANT SA YETH NOT.

STATE OF FLORIDA

COUNTY OF LEON

The foregoing instrument was acknowledged before me on this day of

. , 2019, by Marquitta Franklin, who is€onally known J.oine or who produced

as identification.

1 /-\\ r r I

L .:J \\

Notary Pubhc,

* &f * LN COMMISSION N GG 038268

Bonded EXPIRES: Tlvu Budge! October Notllty 12, 2020 Selvict$

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Print, Type, or Star.ilp Name of Notary Public

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My Commission Expires