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. STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTHA TION February 3, 1993 Jeffery Ward Administrator serenity West 37815 15th Avenue Zephyrhills, Florida 33541 Dear Mr. Ward: A follow-up survey visits and desk review for Licensure of your Adult Congregate Living Facility (ACLF) was completed on January 20, 22, & 27, by Diane Cruz, Janet Mills, and Robert Scharnweber, all representing this office. The resident census on the date of the visit was none. The enclosed provider copy of the annotated Classification of Deficiencies for ACLF Licensure Requirements (HRS Form 553 D) indicates the status of corrective action observed on the date of this visit for those deficiencies identified during the survey of 12/17/92. A follow-up visit will be conducted to ensure correction for any deficiencies found not corrected at the time of this visit. The enclosed HRS Form 553 D may be used as a summa~y of this follow-up survey and review to replace any previously provided summary of the annual survey. This document is required to be prominently posted in the facility so as to be accessible to all residents and to the general public, in accordance with Chapter 400.435(3), Florida statutes. Documents relating to state Licensure requirements will be made available for public disclosure as required by Florida Law. A recommendation for a provisional license has been submit.ted to our Central Office in Tallahassee for a capacity of 43. This license when approved will be forwarded to you under separate cover. A recommendation a standard license cannot be made until aft.er the deficiencies listed have been corrected and a follow-up visit conducted. 877 EXECUTIVE CENTER DRIVE WEST, ST. PETERSBURG, FLORIDA 33702 (813) 570-5181 FAX (813) 570-5164- LAWTON CHILES. GOVEaNOR