02/19/1992BAYSHORE MANOR
A/K/A MONROE COUNTY HOME
ADULT CONGREGATE LIVING FACILITY
FOR THE ELDERLY - LEVEL II
A G R E E M E N T
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This agreement entered into this 3RD day of � T
F EB RUARY
19 92, by and between the County �— of-, Mcwroe: b
0
State of Florida, hereinafter called "County" and
JORGE V. MARTINEZ
ROLANDO PUMAR
Party."
WITNESSETH:
, hereinafter called "Resident", and
, hereinafter called "Responsible
WHEREAS, the resident desires to use the facility of the
county known as the Monroe County Home, a/k/a Bayshore Manor, and
WHEREAS, the County has reviewed the application of the resi-
dent for admission to the Monroe County Home and has determined
that the resident is eligible for admission to said home, now
therefore,
In consideration of the mutual covenants, promises and premis-
es herein contained, the parties agree as follows:
A. BAYSHORE MANOR
1. To furnish room, board, linens, prescribed
medicines and general personal care.
2. To arrange for the transfer of the resident
to the hospital of the resident's choice when
ordered by the attending physician or the health
of the resident requires same, and to immediately
notify any responsible party (as designated herein)
of such transfer.
3. To make refunds on a per diem basis in accord
with date of discharge from the home. Refunds
cannot be made as long as personal belongings
remain in the resident's room. Refunds cannot
be made as long as there are outstanding
expenditures for services received by the resident.
4. In the event of closure of the facility for any
reason, a pro -rated per diem refund shall be made in
accord with date of closure within seven (7) days.
5. Residents will be notified in writing thirty (30)
days in advance of any basic rate change.
6. Bayshore Manor is not affiliated with any religious
organization.
7. Other: TO REIMBURSE RESIDENT $10.00 PER MONTH FOR PERSONAL
SPENDING MONEY.
B. THE RESIDENT OR RESPONSIBLE PARTY
1. To provide such personal clothing and effects as
needed or desired by the resident.
2. To pay the monthly rate agreed upon and such
charges as determined by the Monroe County
Home to be necessary for the operation of the
home.
3. That, upon certification by a physician or the
administrator of the home, the resident is no
longer capable of meeting the requirements
for occupancy in this facility, the resident,
next of kin, legal representative or agency acting
on the resident's behalf, will have to make
arrangements for the immediate transfer to an
appropriate facility. In the event a resident
has no person to represent him/her, this
facility shall assist resident in contracting
an appropriate Social Service Agency for place-
ment. Applicant agrees to vacate the facility
within forty-eight (48) hours after disquali-
fication.
4. To comply with all requirements as set forth
in the application made by the resident.
5. To comply with all rules and regulations esta-
blished by the County for operation and control
of said home.
6. Agrees, if not paying the maximum rate, to pay
any increase in income during the course of
residency, up to the maximum rate. The maximum
rate as established October 1, 1985, is $1,195.00
per month.
7. Individual monthly rents not to exceed the maximum
rate, will be established by evaluation of the
applicant's income, asset, resources and need.
8. Other:
C. FINANCIAL ARRANGEMENTS
The resident and/or responsible party agrees to pay
County $ igg np per month as rent for use of the
facilities.
PAYMENT WILL BE FROM THE FOLLOWING SOURCES:
1. Personal funds of resident $
2. Responsible party will pay $
3. Unearned income of resident
will pay:
Social Security $
Civil Service Annuity $
V.A. Pension $
Other $
388.00
2
D. STANDARD ADMISSION WAIVER
The County, through its employees, has agreed to exercise
such reasonable care toward the resident as his or her known
condition may require. However, this home is in no sense an
insurer of his or her safety or welfare and assumes no liability
as such.
The management of this home will not be responsible for any
valuables or money left in the possession of this person while he
or she is a resident of this home.
E. TERMINATION
If resident is absent from the home in excess of fourteen
(14) continuous days, such absence shall automatically terminate
this agreement and the resident shall remove all of his or her
property or belongings immediately. If resident fails to remove
same, the resident does hereby authorize the County to remove
said property or belongings and deliver same to responsible party.
F. MEDICAL SERVICES
The parties agree that Monroe County shall not be responsible
for or assume any responsibility for payment of any medical or
hospital services unless specifically agreed to by the parties or
their representatives at the time of the rendering of service.
G. DURATION OF AGREEMENT
Either party may terminate this agreement on thirty (30) days
written notice. Otherwise, it will remain in effect until a
different agreement is executed. However, this does not mean
that a resident will be forced to remain in the facility against
his/her will for any length of time. This agreement may be amend-
ed by written and executed approval of such amendment by both
parties or their representatives at the time of the amendment.
SES AS
IGNATURE OF RESIDENT
i
SIG ATURE OF RESPONSIBLE PARTY
,RTY
3
DATE:�-
APPROVED:
Signature of epresentative
of Monroe County Home a/k/a
Bayshore Man
Signature of Executive
Director - Monroe County
Social Services
S nature of County
Administrator
This is to certify that this Admission Agreement as approved by
the County Home and the County Administrator was ratified by the
Monroe County Board of C y Commissioners at their meeting held
on the day of hit 19.92
Signature of the Chairman
Monroe County Board of
County Commissioners
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
By
Deputy7 lerk
4
11ONROE COUNTY f C'•{E-U,VFLCRIVA
iCP COLLEGE KCAD KEY (VEST,
Ar,{ISSIC,V' CFITEPIA. AND POLICIES
The A{v►iAee County Home, Ar,'u�t Cc�tc�.-Leg--Late Liv-bcg Fac.iUtcf ,ju,'L the ELdclucl,
Levee II, heAeina6ten .,Le6&'LAcd to as the FaeiUtel, is Cicc;�sed thteugh ,the
State o5 F.eotcida Department c i Heath and Pehab.ieLtative Sehvice6, heAe.in-
at.te,'c tce6nAed .to as Ham, Lucd cpeAated by .the Board o6 Cout-ty CommZss.ionetv5
o6 Monn.oe County, Fea,,ida. The Faciuty -is goveAned in accondcuice with .the
tequ,i,temejtits os ChapteA 400, pa,-Lt II, Feotcida Statu" and the Ruees and Regu-
Qations as adopted by the Eoand 06 Moimoe County Comm.issioneAz heAetirca6tet
Aese/,fted to as County, ecataiaed he, -
Lein -
Resident o6 Monnc e County, Feo,,t i.da, sixty (60) yea'ts o6 age on o.ede,'c, ambueatoty,
in Aeasonabee heaUh, in need o' a home and having no lamiey abee to meet the.c,'e
needs, abee to cane 50n themseeve6 to a eeAtain degn.ee and not in need o6 nut6ing
cane, eoiivateseajtit ca'ce, tempo.,a'uy of emeAgency sheZteA •shade be eUg,ibee 6oA
adm.v5s.ion to the 6aci.City in aeeotdanee with .the tetcros and conditions contained
heu,bi.
AppZi.catiom ace accepted on a non-d,iactru,minatony basi's ,inceuding but not
e im.c ted to sex, coZot, Aace of c'ceed. The 6aeie.i.ty shaU ptay.ide a homeCike
atmosphene (room and boa'cd), personat seAv.ices and a eompnehekvs.ive ptogtam to
meet day to day needs o6 the ambueatony aged on an .indiv.iduae bas.i,s - conducive
to gtwup .Ci,ving. PeAzona,e SeAv i ces means s eAv.ice6 , in addition to houh,ing and
Good s etv.ice which include but ate not .Cim.i ted to: personae assistance with
bathing, dteJss.ing, ambueat.ion, housekeeping, supeLvi6ic►t, emot.ionae secuA ty,
and any other tetated se`cv.ices which the 5aciZity may de6ine. Petsonae .senv.ice
does not .inceude med.icat .seAvices.
ELIGIBILITY AND AMISSION POLICIES
The adm,v5s.ion o4 each tesidejit to this 5aci,Ci ty shaU be under the supet-
v.v5.i,on o5 the Adm.iniusttatot 06 the FacU ity within .the con6.ine/s 05 the bottocuing
g eneha,e, pozicie's .
(1) A Aes.ident/app-ticant must:
(a) Not have a comma icab ee disease -bi a -ttcu 5 -
5enabee stage.
(b) Have a ehnt x-Aay oA shbo test (TB) within
ninety (90) days ptcon to admission .to ,the
lac, eUty.
(c) Bea .esidcut el Monroe County, Femida 6on at feast
oRe (1) great and bun► ash vencl.ccatcv►1 vl same.
(d) Funnish 1,neol oA steed lot .the Aaeie,ity and .that there ,is
►to 6am.i,t y ON to meet their needs lot adequate cane.
(e) Fcc,-uush wnitten med.icae examination lnom a Licensed
physician (6onm wilt be 6ulc.nN& which shale. cent.i6y that
them medicae condition is such .that they w.iU meet the ne-
quvicements o6 .the 6a&Uty and .that setv.iees beyond .that
ate permitted in .the 6aci e ity ate not nequviced.
(6) Be ambueatoty - .that is the condition o f being phys.iea t y
and emotionaety We to anise 6nom a honitizon.tae on sitting
position, and in an emeng envy .to exit .the building ,to a point
06 sa6ety. This would inctude -those individuaes who may be
able .to ambutate with ,the assistance o6 ptos,thetie devices
such as etutehes, watkens on wheee chants.
(g) Be sixty (60) years o6 age on Men and 6unnish age veni6.i-
cation by either pnopen identi.6.ication, documents, on by
.in6onmation 6nom other public agencies such as .the Soci.ae
Sec.uni ty Adm.ini6t ation.
(h) Funn,ish pnoo6 o6 hos p.i tae.i.zation and me.dicae .i►vsunaice
which is equae to on better than eovetage o6 ued by Medicate.
(.i) Execute a wnitten eontnact with this 6aciUty at .the time o6
admission, on ption thereto, between .the. 6aciei,iy and .the
nes.ident on his designee on tegae representative. A copy
o6 cont&act to be executed is attached heneto and made a
pant th eneo 6 .
(2) THE ADMINISTRATOR SHALL:
(a) Maintain a written neeoad in .the nesident's personae
6iZe o6 ae.e 6.inanc%ae ave.angemen.ts with the nes.ident, his
next o6 Piro, on sponsor, with copies executed by and 6unktiushed
to each panty. This shaee .inceude detaieed neconds o6 ally
6unds on ponopenty heed lot the m ident bon sale peeping in
aeeondance with Cltap-ten 400 F.S. Pact II.
(1) The 6aeiUty my ON pemonat 4aKds lon the resident
not to exceed $100.00.
(2) The 6ac-ie.i y shale not accept our other 6uRds on
PAC!pe-ttl/ o-xcCpt BLS be,t 6otth 0t 1 above..
(b) ks-sess ito addit;i.u;iat changes, expenses of others
3.intanciaz i-iabU it es -in excess o 6 .the pnov is i.on5
intceuded .(')t the admission conitAact.
(c) Dctvm.ine- and -inceude as a minimum, the joUctoing
ptovZs.iont,s antd .s etv.icn in .the basic admission contAact
with each resident, next o6 hin of sponsor:
(1) The daiZu, weehey, of montthey -,Late, and te6und
p,tov-ision 'm unused portions theneo6.
(2) A e i,st.iag o6 s eAv,iees to be ptov,ided.
(3) Soeiae components apptoptt,i-ate to the neects o6 .the
Aes.idenits .
(d) App.-y the 6oUow.in2 rest)Lic t,ion z to ac',miz ion and
tetetti-an o6 .&I�esideytts:
1. A tes.ident who mani6est�s such degree o6 behay.iot that
he is a Bang eA to hims e e-6 or othexs , oA whose behay.iot
is so unacceptable oA d (is to tbing a5 to in teA6 eAe with
the adequate cafe or com6nt o6 otheA Aes idents in the
6aciUty shall not be admitted oA Aetained, and shade
be removed 6tom the 6aci.e ity.
2. No te1sideitt shaU po.5sess oA consume oecho.Pi.c beveAages
oA any eontAoited substance in the 6ac%ei,ty withowt Ila
physician's oAden.
3. No te.s.ide.nLt shaU be heed .in the 6acU-ity against his
wilt, uneess undeA Cotutt OAden.
4. No tes.idejit shade be admitted to of Aeta.i.ned in a 6acit'i'ty
who tequZtes s eAv-iee5 beyond ,those the 6aciUty .is -? i.eeis ed
to ptov.ide. This 6acie i ty may not provide nuts sing care ua-
tess Got a tempoAaAy ,iUne�ss, not to exceed seven (7) days.
5. A ttcsidentt absent 6rom this 6acieity in excess o6 6ounteen
(14) day.s,due to hospita izationt or abandontment shae.e be
tmnitiated as a resident in this 6ac- ,Uty. Such Aes-ident.t
may to-appey 6oA admission 6oMtv.inig .the -same pAoceduAe as
.that o6 a stew app.e.icant.
(3) The monthey Aate 6o:t appe,ieantt5/tte5.ide►Lt5 shae.e be ac justed to .the
ab.ii;ity o6 .the appUcatt,t/.tes.i,dcnt.t to patf. a,ppe-i-cantis/tes.idctts with
_Q_
cocomes Ins than the maximum mau be NOW to pay that
amount as their mon,thfy -rate_, th.i,swoued draude. any -increases
in thck Mcme duWng the course c6 thei�m mes-i.dcncy, up .to the
maxun((m -'rate.
(a) The mo►r.thf(I base mate sha-e be es.tabe shed at the
beginning o6 the 6iseat yeas and shaet pneva.i.e
thorough out the yeah.
(b) MonthTy mates ONE be mev.ioved and admeRded by the
$oamd of Anne County Comm.issionen.
(e) When Appt icant/ Resident teceiv a income and has
assets Zes,s ,than .the maximum month y hate, suppte-
mental suppoht rvLU be accepted 6mom .their. 6amity,
o.theA assistance s.ta.nce agencies ON. mepmel entativ es .
A 16 theme is no suppeementat suppoot avai,eabte, each
appticant/mes.ident co,,U ,then be ccnzidemed on an .in-
div.iduae basks .
(e) AR nwidents except .those paying .the maximum mate om
.those who do have o.thesc assets om ores ounces , wi i be
neimbuned .ten (10.00) doUa" pen month by .the County
6om .thew pewonae use.
(4) Upon cetti6.icat%on by ,the Adm.i► is.tmatom o6 the 6aci f i ty with ,the
concummanee of the Reeu,tive Dinecton of .the Monmoe County Depa t-
ment of Soc i.ae Sew ices , that At c i,tem.ia and nequivements set
6omth hemein have been complied with and/om met, the appe.i_cant shaU
be admitted to the 6acieity. Subject to adequate 6aci.f hies being
avaitake and execution of the admission agmeemeLt by .the mes.ident
and the County.
OPEPATIONAL STANDAP.DS
The 6aci ity AM 066eA Woe supemv.is,ion and .eiviHg conditions as -i's
necessary .to the cond,%tion o6 .the mes.i.der,t. This Aceudes supenvisioa of
diets as .to quaei.ty and quantity, watch6u.ene6s oven .the gniesae health,
safety and weft being of .�es-idc►(.ts. These shae.e be a daiey atva7enes6 of the
nes-idemts by designated sta66 of the 6acVlty as to the appa wt WE being
of the Adiv,iduaes with sub f.ici.ent pnov.is.ion An coNactAg .the mes,idatt'.s
- 5-
physician, ii the tcsident has not aeAeady done so, at a►u/ time tliene
appea'ts to be s.igai6icat,t deviation 6Aom htis jto.rmae appeahance O,t
state o6 heatth aitd weee being. Arptop.'t,i.ate notice 06 such ikl'5 tatcc,s
shaee. be recorded in .the penoaae AeeoAds o6 .the indiv.tduae.
W,tittet agteements between -the gaeiUty and each o6 its residents sha.ee
pAovide that, upon cMti icati.on by a physician .that .the tnident tis no
ZongeA capatbte o6
meeting
.the tequiAemen.ts (joA
occupancy in this
�acitity,
the tesid_ent, next
o6 Fun,
.eega.e Aeptesentat%ve,
or agency acting
on .the
resident's behae5, witi be noti6ied that .the tesident w%Le have to maize
a,'tAangemejis Got ,immediate t tans 6vL ,to an apptoptiate ease s etting . In
the evens a Aaident has no peuon .to teptesent him, this 6auei,ty shaU
be te/sponsibZe Got te6evtae to an appAopAi,ate sociat seAvice agency Got
ptaeement.
The admission o6 a resident to this 6acitity and his presence thmei.n shape
not con6eA on the 6ac t i tt1, its admin,is,t)tatoA, empto yees of tepAa en,tati.ves
any authot.ity to manage, use of dispose o6 any propehty o6 .the-Lnident;
not shaU such admission of ptesenee eon6er on any o6 such pmson/s any
authoAity ot te/spo►is.i,b.i,Q,i ty Sot the peltsonat a66ai,,ts o6 .the te,5idejLt,
except what may be necessary Got .the sa6e and otderey management o6 the
6acit. ty of gat the satiety og .the taident.
Th vs 6acitity, admin,i 6tt Latot, employee of AepAes en-tative .thereo 6, may
not act as the count appointed guaAdtan, tAus.tee, of consehvatot Sot any
taident o6 the 6aciUty oA any o6 such Aaideni's ptopettty.
This 6aciLUy shaU be oAgan,i.zed on a pro6e�ssionae basis eons.is,tejtt with
good business ptacti.ces.
Th-Es 6acit i ty shall be tesponzibte got p,,wv.tdi.ng s etvices 6oA Aesiden,ts as
nequi,ted consistent with the. eevee o6 services o66eAed.
This 6acit- ty shae.e emptoy or o-the)uv-ise aAAange Got the sekvice o6 such
pensonnee as ate AequiAed .to prwpeAey s-ta66 .the 6aci.Uty.
AMINISTRATIVE STMIrARtS
Th iz 6ac i Lity shaU be undeA .the eon.tAoe o6 an aomi;ii�s thatoA.
(1) The 6acUi ty of its duey des.igttated .'tepAnentattve shape
maun.tain the 6aeeow.ijtg WA tte►t ,'second-s ajtd any othe,'t .'second
AeouiAed by the Cotiaty o.'t HRH 61 0 peace, 6onm and .system
-u-
o icitiza .tUti Cmt ecacd 6z good bus (iic.ss 1).tact.(,cc,5.
(a) 1n ac3nissic ►t chid dischia. c -tcglc s te.'c t'.is.ti�ig
iicune.s (',j .tes.ideats mid date a6rIi.t.ted, i.de.►lt.i;)ijiklg
.61,so.tmation about each, the peace ,Strom which .the
nes.ident wcvs adrnZtted; .the date and -reason Son
c'lisehaAge, adequate .ident,i6icati.o►2 os the SaciUty
to which .the nes,iden t is digs chaAg ed on ,tAans S erred.
(b) A pets once 6iie Son each nes.iden t co" Zsti.ng o6
app,topt late data, ineeudino identc 6icat.ion o6 next
o6 loin, and ate data nequ ,-,ed Soh -the Hmida
Cett,i.s.ieate oS Death. PetaUs o6 ,the to,4eAAae,
adm. ss.ion, puLt-inent non-medi.cae and medicae .in-
Sotimati.on coneenn.ing .the -te,6 ident shaU be main-
tained with the g enenae S.cs eae . Aecond 06 each,
.ineeuciin_q copies o6 ate agreements on eon Aac t-s ,
account ,tecmcI6 and a cuAnent .inventoAy o6 pehsonat
pnopmty heed Son sa6 e- keep.ing .
(c) A Saci. ty accident/.incident record bite, eonta being
a eeean des en.iption o6 each accident/incident and
any o-thet -incident invotv.ing hazaAdous on de6iant
behay.ion o6 a resident on s.tass membeA with names
oS .indiv.iduaLs .invo.eved, dewctiption o6 mediea2 on
o-then seAvices pnov.ided and .the steps taken .i6 any
to pnev en i neeuhnalce.
(d) PeAsonnet neeond o6 each s.ta6' member. This record
wite be kept updated and contain otiginae emp.eoyment
app.eieation with neseAenees Sutwished.
(e) A necmd o6 peAsonnee poUci.es, inceuding statements
o6 poe.icies and work assignments Soh each po"s,i,tion.
(S) A neeond o6 montkey S.i)ce dtZUs , .indicating .the date,
hour and geneAat descA,i.ptiovt o6 each dtc te, .the extent
o6 .the s.ta66 -invoeved and .the name o6 peAson .in change.
(g) Financiae tcecotds which "ident,iSy ate .income o6 the
Sac.Ut ty by source and descnib.ing ate expenditures by
catecohy .in such a mannen as .to be auditab.ee by basic
accounting pnoceduAes .
FINANCIAL STANlAPVS
The a6n.(Jltst.latoA o6 this jac(.Uttl shay-e maCPLtI,C1l 6.i,scaE-te.cotds 6t
accordance with .the requirements o6 Chap.te�t. 400, F.S. Pa.tt II. Thene
shaf-e be a recog►iized system o6 accounting used to accunate.etf ne62ect
de.taiZs o6 the bu,si-tess. The 6aci.Uty shaU:
(1) Be administered on a .sound 6inanciae basis cons,is,tent
with good business practices.
(2) Speci'y its ,Le6und poZi..c,i.es as pa,,,t o6 .the admission
co nt.ta.c-t.
(3) Spec i.6y .that no adminZ5-tna ton, eonsuttan t, s-ta J 6 membeA
or repAesentatc:ve shate:
(a) Pay any eommiss,ioi,t, bonus, rebate oA gratuity
to any othga► ization, agency, physician, s.ta66
or other peAson bon re6erAai o6 anu tes.ideLt ,to
the 6ae i e.ity.
(b) Request oA accept any AenumeAation, rebate, g,i6.t
bene6it or advantage o6 any O`oAm 6Aom any vendor
or other suppei.er became o6 ,the pw-tehas e, re i tai
or Loan o6 equ,iJpme tt, suPPei.es or SeAvices 6oA the
6ac i e -ty or Aes.ide►Lt ;tot consistent with notunat'_
business proactice.
PERSONNEL STANDARDS
The adm.t.ni6t ator o6 this 6acc?ity shaf'e operate .the 6aciZity in accordance
with .the existing Afowwe County Peuonnee PoZi.cies and Procedures.
DI ETAPV STANDARDS
This 6acility shaU have wititten poZicies and procedures jot prov,idittg proper
nutALi.tionae care o6 its res.ide-nt6.
(1) The 6oteow.ing tequiA.ements shave be met:
(A) The adm.in swtnaton or a petsoa designated by .the
adminis,tAator shae-e be Ae.spoiisibte 6or .the .to.tae
dietary seAv-iee acid the day to day supeAv.is.ion o6
d.i.etaluj seAv-ice. The designated pehson shae.e be
Aesponsib.2e 6oncoond.irtati.;tg dietaAy s env.ices with
other-seAv.ices; deveeop.ing wo.'cf: asS-igtunejt.ts.
TVIC' f ca�l'Il atcci bill i;ic il('m(11-(.5t,at(1i S�larl
11(.Slhc' d1LtcCs 61 a SC(,jc a11d
111a{L1ic`(.
(B) Thc,tapeut.i.c diets as paesc.,ibed b1l the ph(fs.ic.ian
sha.E'-E' be .in .the nes.ident's teeond a11d .sewed ass
o,7dened.
(C) Pegui.at diets shall meet juLtrLitio►tak 1leeds 06
t.nide►i,ts in aeeondaiee 1c.ith .the cu.tnei-t recommended
Cietatcj A.teowance 06 the Fend. and Nattit.ion Boand,
Nationae Res eaneh Counc i t., adjusted ;ion age, sex,
and activity. Thenapeu,tic diets shcUt meet .these
nu tll,i bona. s-tandatds to .the extent .that Zs medieaUy
poss.ib.ee.
( C) The dieta,ty allowaiice shatt be met by the uses o6
s,tandati.zed neci.pes o66e,-Ling a vaA,iety o6 600d6
adapted ,to the Good habits, pne6 etelees and phys.ieae
abZ iti e/s o6 .the residents.
(F) An up ,to date manuae app.tev ed by HRS -s haU be used
as the standard te6 eAence tin ptann.ing negutvt. and
theh.apeu tie diets .
(F) Dated menus shaU be planned at teast one week in
advance bon tl.egu.ewL and .thetapeut.ic diets; and
eonteeted as setcved and kept on 6iZe bon -six months.
SuppZia o6 non-peA,&shab.ee Good .to meet nutti.tionae
needs o6 te/sidents bon one (1) week pehiod-sha.P..e be
on hand.
(G) Food shall be se)Lved attkoctiveecl at sa6e and
paeatab& tempehatutee s . AU fLes.ideits .s ha U be en-
eou,%ag ed to eat at tabtes .in dining areas. A, s uppty
06 app.7opA iate eating ware shall be on hold .to s etcv e
ace Aes-idekl.ts.
(H) AU mattms penta,inii1g .to 600d-se-tv.icc chat-e comptu
With the pnov.isions o6 C1lapte.t 10-13, Feo,tida Saiii,tcLty
Code.
FIGHT TO N.FARING
Any app.e,icant who Zs di6satis6.ied with .the decision rendered by .the
Depattmc3i,t 06 Monroe County Soci.a,- SeAvica, has .the night .to tequnt
a -Lev.iew o6 .thei,t case by .the Soeiae SeAv.ieers Fxecwtive Di�Lector. This
review shake be done cu.i,tlLi;i 6.ive (5) worhzi.ng days a6-tez..the request is
n.eee.ived Srom ,the app.ii.cazt. 16 the Di)Leetor'.s-tev.iew does not .'Lnoy-ve
,the appZi,can.t'.s comptai_nt, .the appYica►tit .then has .the Ai.gh,t .to 'teque's.t
a FaiA Heviing.
FAIR HEARING PROCFCURF
Within ,ten (10) woAiing days a6.te t a comp.eaint Zs received Srom an
appLiccuit, a heating w,iit be held .in .the o66.ice o6 the County Admini6t, zaton.
The purpose o6 .this heaA ing euiZt be .to a.Leow .the appi i.can t a 6a.uv opportunity
to voice hZs/her comp.taint be6ore a heaAing committee. Th.iscommittee wiU eorvs.ist
o6 the County Adm.inizttotoA, the Ctenh_ o6 .the Board o6 Montoe County Commissioners
mid one (1) County Commissioner. The 6.ina.e decision .shall be made by .the hea ing
committee within ten (10) days and a copy o6 same shaee be 6uscn.ished..to the
appZica t by United States Maii or pensonat deZivety.
As o6 .this date, I have read the Admission Criteria and Pot ie.ies :
cg nature o6 Resident
Wttn es s
�Ztness
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