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22332 VICK STREET
PORT CHARLOTTE, FL 33980
Phone: (941) 627-5388
County: Charlotte

Mailing Address

22332 VICK STREET
PORT CHARLOTTE, FL 33980
County: Charlotte

Emergency Actions:

None
Facility/Provider Type: Assisted Living Facility
Administrator: KATIE WADSWORTH
Financial Officer: BETTY RODRIGUEZ
Owner/Licensee: FAMILY EXTENDED CARE OF PUNTA GORDA INC
Owner/Licensee Since: 12/16/2010
Profit Status: Not-For-Profit
Licensed Beds: 98
Bed Types:
Extended Congregate Care : 0
Private : 98
Optional State Supplement : 0
AHCA Number (File Number): 11911223
AHCA Field Office: 08
License Number: 5016
Current License Effective: 12/16/2018
Expires: 12/15/2020
License Status: LICENSED

Services/Characteristics:

Medicaid Services :  Assistive Care Services, Assisted Living Waiver
Specialty License :  Limited Mental Health
Bed Hold Policy :  Facility will hold beds during a temporary absence
Occupancy/Occupancy Rate :  98 / 100.00 %
Continuing Care Retirement Community :  No
Adult Day Care Services :  Yes
Activities :  Arts and Crafts, Cooking Classes, Dancing, Exercise Classes, Games/Cards, Gardening, Music Programs, Shopping, Social Events/Outings, Theater and Movies, Yoga
Languages Spoken :  English, Spanish
Nurse Availability :  3rd Party Part-Time
Payment Forms Accepted :  Insurance and/or HMO, Medicaid, VA, Workers Compensation
Special Programs and Services :  Memory Care, Occupational Therapy, Pet Therapy, Physical Therapy, Speech Therapy

Emergency Power Plan Summary:

Onsite Alternate Power Source :  Fixed Generator
Emergency Power Supports :  Refrigeration
Plan Approval :  Sep 24, 2018
Implementation Date :  Jul 25, 2018
Implementation Extended Until :  Jan 01, 2019
Cooling Method :  Air Conditioner, Fans, ice maker, portable lights
Areas Cooled :  Common Areas, Dining Room, Hallway
Areas Cooled Location :  Within Facility
Square Footage Cooled :  2,400
Number of People to use Cooled Space :  85

Legal Actions

Date InitiatedCase #Case TypeViolationFine AmountDate Imposed
04/05/2013 2013003734 FineSurvey $750.00 09/06/2013
01/25/2012 2012000986 FineSurvey $1,000.00 04/05/2012
Change of ownership occurred 12/20/2010
08/09/2010 2010008948 FineSurvey $3,500.00 12/13/2010
12/30/2008 2009000699 FineSurvey $500.00 06/15/2009
02/05/2007 2007002092 FineSurvey $4,000.00 03/19/2008
08/17/2005 2005007584 FineSurvey $18,000.00 02/24/2006
05/16/2005 2005004165 FineSurvey $1,500.00 08/04/2005
05/04/2005 2005004132 FineSurvey $3,000.00 08/04/2005
Please note the legal actions above may have been issued to a prior owner. The Final Order displays the name of the licensee responsible for the legal action that was taken.

Consumer Guides:



Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.
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