STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

2015 MAY 19 A IQ: 1-lO

DOAH No. 14-5849

vs.

TIKI R. STAFFORD d/b/a DIVERSITY ME,

Respondent.

                                                                                        /

AHCA Nos. 2014007637

2015001509

License No. 11951

File No. 11967998

Provider Type: Assisted Living Facilitv

RENDITION NO.: AHCA- 15 ·QJ.°11 -S-OLC

FINAL ORDER

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

1. The Agency has jurisdiction over the above-named Provider pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions.

   
   

2. The Agency issued the attached Administrative Complaint and Election of Rights forms to the Provider. (Ex. 1) The Agency also issued the attached Notice of Intent to Deny Renewal Application and Election of Rights form to the Provider. (Ex. 2) 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. 3) Based upon the foregoing, it is ORDERED:

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

   
   

5. The Provider shall contract with a consultant and fulfill its contractual obligations under the Settlement Agreement. The Provider's Administrator shall complete the ALF training for Limited Mental Health Licensure certification course.

   
   

6. The Provider shall pay the Agency $2,500.00. 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:

   
   

   Filed May 20, 2015 1:28 PM Division of Administra1tive Hearings

   
   

   Central Intake Unit

   Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61

   Tallahassee, Florida 32308

   
   

7. Counts II and III of the Administrative Complaint are withdrawn.

   
   

8. The Notice of Intent to Deny is withdrawn.

ORDERED at Tallahassee, Florida, on this_{_ _ day of _,_ -        -         -         -         -         -         -         -         -             ' 2015.

1

cretary

are 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 CERTIFY that a true and correct--9WY of this Final Orde was served on the below-named persons by the method designated on this J.E_ day of                    -+-4------"c.;,c ' 2015.

Richard J. Shoop, Agency Clerk Agency for Health Care Administration

2727 Mahan Drive, Bldg. #3, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone: (850) 412-3630

Docket for Case No: 14-005849

Orders for Case No: 14-005849