STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

SENIOR CARE GROUP, INC, d/b/a LAKESHORE VILLAS HEALTH CARE CENTER,

Petitioner,

AGHICY CLERK

2014 HAR 31 /\ !!: 22

VS.

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION,

Case No. 13-395PH AHCA No. 2013005471

RENDITION NO.: AHCA- /4 -DJ.15 -S-OLC

Respondent.

--------------------'/

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

VS. ACHA No. 2013006461

SENIOR CARE GROUP, INC. d/b/a LAKESHORE VILLAS HEALTH CARE CENTER,

Respondent.

                                                                            I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

VS. ACHA No. 2013006462

SENIOR CARE GROUP, INC. d/b/a LAKESHORE VILLAS HEALTH CARE CENTER,

Respondent.

                                                                               I

1

Filed April 16, 2014 11:18 AM Division of Administrative Hearings

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH No. 14-248

ACHA No. 2013006534

SENIOR CARE GROUP, INC. d/b/a LAKESHORE VILLAS HEALTH CARE CENTER,

Respondent.

./

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH No. 14-528

ACHA No. 2013007612

SENIOR CARE GROUP, INC. d/b/a LAKESHORE VILLAS HEALTH CARE CENTER,

Respondent.

!

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

vs.

Petitioner,

DOAH No. 14-521

ACHA No. 2013010196

SENIOR CARE GROUP, INC. d/b/a LAKESHORE VILLAS HEALTH CARE CENTER,

Respondent.

                                                                            I

FINAL ORDER

Having reviewed the Administrative Complaints and Notices of Intent to Deny, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows:

2

1. The Agency has jurisdiction over Senior Care Group, Inc. d/b/a Lakeshore Villas Health Care Center pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions.

   
   

2. The Agency issued the attached Administrative Complaints and Notices of Intent to Deny and Election of Rights forms to Senior Care Group, Inc. d/b/a Lakeshore Villas Health Care Center. (Ex. 1) The Election of Rights forms advised of the right to an administrative hearing.

   
   

3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) Based upon the foregoing, it is ORDERED:

1. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement.

   
   

2. The Notice of Intent to Deny is superseded by this Agreement.

   
   

3. Senior Care Group, Inc. d/b/a Lakeshore Villas Health Care Center shall pay the Agency

   $25,500.00. 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:

   
   

   Office of Finance and Accounting Revenue Management Unit

   Agency for Health Care Administration 2727 Mahan Drive, MS 14

   Tallahassee, Florida 32308

   
   

4. Conditional licensure status is imposed on Senior Care Group, Inc. d/b/a Lakeshore Villas Health Care Center beginning on April 12, 2013.

ORDERED at Tallahassee, Florida, on this z.J day of fA._l>l./'4... , 2014.

Eli retary

Agency for Health Care Administration

3

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 CERTIFY that true and co_rrect .£912Y of this Final as      served on the below-named persons by the method designated on this 5/ ay of    .re ( · , 2014.

Richard Shoop, Agency Clerk

Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone: (850) 412-3630

4

RICK SCOTT GOVERNOR

May 22, 2013

dkA#ICA

FLORIDA AGENCY FOR HEAlJH CARE ADMlN!STRATION

Better Health Care for all Floridians

Certified Article Number

719b 9008 9111 8922 9925

SENDERS RECORD

ELIZABETH DUDEK SECRETARY

ADMINISTRATOR /. ';p ttECErvr;u

LAKESHORE VILLAS HEALTH CARE CENTE1f-CtLITY fNTAKE UNiTLICENSE NUMBER: 1282096

16002 LAKESHORE VILLA DR FILE NUMBER: 62921

TAMPA, FL 33613 MAY 2 3 20f3 CASE#: 2013005471

Dear Ms. Johnson:

It is the decision of this Agency that Lakeshore Villas Health Care Center's license renewal application for a nursing home be DENIED.

The specific basis for the Agency's decision is based on the following grounds:

• Pursuant to section 400.121(3)(d), F.S., the Agency shall revoke or deny a nursing home license for two class I deficiencies arising from separate surveys within a 30 month period. Lakeshore Villas Health Care Center was cited for Class I deficiencies on October 13, 2011 and November 14, 2012.

  
  

• Section 408.815(1), F.S., states that in addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest: (a) a violation of this part, authorizing statutes, or applicable rules; and (d) a demonstrated pattern of deficient performance.

EXPLANATION OF RIGHTS

Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute.

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS.

Manager Long Term Care Unit

cc: Agency Clerk, Mail Stop 3

EXHIBIT 1

2727 Mahan Drive,MS#33

Tallahassee, Florida 32308

Visit AHCA online at ahca.myflori da.com

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: LAKESHORE VILLAS HEALTH CARE CENTER CASE NUMBER: 2013005471

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed Notice of Intent to Deny of the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Fine, Administrative Complaint, or some other notice of intended action by AHCA.

An Election of Rights must be returned by mail or by fax within twenty-one (21) days of the day you receive the attached Notice of Intent to lmpo.se a Fine, Administrative Complaint or any other proposed action by AHCA.

If an Election of Rights with your selected option is not received by AHCA within twenty­ one (21) days from the date you received this notice of proposed action, you will have given up your right to contest the Agency's proposed action and a final order will be issued.

(Please reply using this Election of Rights form unless you, your attorney or your representative prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

Please return your ELECTION OF RIGHTS to:

Agency for Health Care Administration Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308

Phone: (850) 412-3630 Fax: (850) 921-0158

PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS:

OPTION ONE (1)      I admit to the allegations of facts and law contained in the

Notice of Intent to Impose a Fine, Administrative Complaint, or other notice of intended action by AHCA and I waive my right to object and have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the proposed penalty, fine or action.

OPTION TWO (2) I admit to the allegations of facts and law contained in the

Notice of Intent to Impose a Fine, Administrative Complaint, or other proposed action by AHCA, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced.

OPTION THREE (3) I dispute the allegations of facts and law contained in the

Notice of Intent to Impose a Fine, Administrative Complaint, or other proposed action by AHCA, and I request a formal hearing (pursuant to Section 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within twenty-one (21) days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it contain:

1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any.

2. The file number of the proposed action.

3. A statement of when you received notice of the Agency's proposed action.

4. A statement of all disputed issues of material fact. If there are none, you must state that there are none.

Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.

License type: Nursing Home License number: 1282096

Applicant Name: SENIOR CARE GROUP INC. d/b/a LAKESHORE VILLAS HEALTH CARE CENTER

Contact person:                                                                                                                                    Name Title

Address:

Street and number City Telephone No.                                                 _

Zip Code

Fax No.                                                        _

Email (optional)                                                            _

Ihereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.

Signed: Date:                                                  

Print Name:                                                                                  Title:                      _

RICK SCOTT GOVERNOR

FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

  ICA

ELIZABETH DUDEK SECRETARY

July 8, 2013

LAKESHORE VILLAS HEALTH CARE CENTER 16002 LAKESHORE VILLA DR

TAMPA, FL 336_13

RECEIVED GENERAL COUNSEL

JUL 12 2013

Agency for Health Care Administration

Dear Administrator:

The attached license with Certificate #18248 is being issued for the operation of your facility. Please review it thoroughly to ensure that all information is correct and consistent with your records. If errors or omissions are noted, please make corrections on a copy and mail to:

Agency for Health Care Administration Long Term Care Section, Mail Stop #33 2727 Mahan Drive, Building 3

Tallahassee, Florida 32308

Issued for status change to Conditional. Sincerely,

5 meet/ W pocn

Kathy Munn

Agency for Health Care Administration Division of Health Qu_ality Assurance

Enclosure

cc: Medicaid Contract Management

2727 Mahan Drive, MS#33 Tallahassee, Florida 32308

Visit AHCA online at ahca. myflorida.com

CERTIFICATE#: 18248

State of Florida

LICENSE#: SNF1282096

AGENCY FOR HEALTH CARE ADMINISTRATION

DIVISION OFHEALTH QUALITY ASSURANCE

NURSING HOME

CONDITIONAL

This is to confirm that SENIOR CARE GROUP, INC. has complied with the rules and regulations adopted by the State of Florida, Agency For Health Care Administration, authorized in Chapter 400, Paii II, Florida Statutes, and as the licensee is authorized to operate the following:

LAKESHORE VILLAS HEALTH CARE CENTER 16002 LAKESHORE VILLA DR

TAMPA, FL 33613

TOTAL: 179 BEDS

STATUS CHANGE EFFECTNE DATE: 06/04/2013

EXPIRATION DATE: 06/29/2013

Docket for Case No: 14-000521

Orders for Case No: 14-000521