STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION PAULINE A. BLACK, d/b/a BROADVIEW RETIREMENT HOME #1, Petitioner, — os ~ Pros vs. DOAH NO: 00-1065 a RENDITION NO.: AHCA-00-Z58-S$30LC ~ AGENCY FOR HEALTH CARE = — ADMINISTRATION, Respondent. Hd LZ AON FINAL ORDER AL mi __ the Agency for Health, Care > Administration, having r received 2 an | Order * Closing | File » 1, The attached Joint Stipulation is approved and adopted as part of this Final Order. 2. The Order Closing File entered by Patricia H. Malono, Administrative Law Judge, dated October ui, 2000 closing the file that was opened i in this matter by the division of Administrative Hearings is attached and made a part of this Final Order. THEREFORE, it is ORDERED and ADJUDGED that the parties have to comply with the terms of the Joint Stipulation.. DONE and ORDERED this /? soy w Aeverabee, in Tallahassee, Leon County, Florida. “Ruben J) King-Shaw, Jr., Secretary. _Agenc for Health Care Administ bone 4 A PARTY WHO, is "ADVERSELY AFFECTED BY THIS ; FINAL O ORDER 1S ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF aay 7 ee ee eS me A NOTICE OF APPEAL WITH THE AGENCY CLERK AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: = ° Alba M. Rodriguez Assistant General Counsel Agency for Health Care Administration Manchester Building, 1st Floor 8355 NW 53rd Street Miami, Florida 33166 Hon. Patricia H. Malono Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Patricia Feeney, Field Office Manager Agency for Health Care Administration 1400 West Commercial Blvd., suite 100 Ft. Lauderdale, Florida 33309 ALF Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 James Curran, Esquire 633 Southeast 3 Avenue Suite 201 Ft. Lauderdale, Florida 33301 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the above R.S.. POWER, Agency Clerk Agency for Health Care _ Administration 2727 Mahan Drive Building #3 Tallahassee, Florida 32303 (850) 922-5865 aendk . ilk de. : STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS PAULINE A. BLACK, d/b/a BROADVIEW RETIREMENT HOME #1, Petitioner, : ; - DOAH-CASE NO: 00-1065 v. JUDGE: MALONO STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, : Respondent. : JOINT STIPULATION AND SETTLEMENT AGREEMENT This Joint Stipulation and Settlement Agreement ("Agreement") is made by and between the State of Florida Agency for Health Care Administration ("AHCA"), and Pauline A. Black, d/b/a Broadview Retirement Home #1, ("BROADVIEW") each individually, a "party," collectively, "parties." : WHEREAS, AHCA is the agency of the State of Florida responsible for assisted living facility licensure and inspection; and WHEREAS, BROADVIEW Retirement Home #1 ‘has submitted an application to operate as an assisted living facility at 1741 Southwest 70th Avenue, Pompano Beach, Broward County, Florida 33068; and WHEREAS, the parties desire to enter into this Agreement to settle their dispute with regard to the intended denial of Broadview Retirement Home's assisted living facility license and the $700.00 outstanding fine for AHCA Case No. 10-96-219ALF imposed by Final Order executed on February 20, 1997. NOW, THEREFORE, in consideration of the mutual promises herein, the parties, intending to be legally bound, agree as follows. 1. The foregoing recitals are true and correct and expressly incorporated herein. 2. AHCA and BROADVIEW hereby settle their disputes with respect to the intended denial of the initial assisted living facility license and the $700.00 outstanding fine against the facility. 3. This Agreement shall become efféctive on the date upon which it is signed by all parties (the "Effective Date"). 4. Covenants of AHCA. 4.1 AHCA shall issue a Provisional License, upon acceptance of this stipulation and upon completion ofa satisfactory initial survey by the Agency for Health Caré,Administration. 4.2 AHCA may conduct an inspection at the end of six (6) months to assure substantial compliance under Chapter 400 Part III, Florida Statutes and 58A-5, Florida Administrative Code. 4.3. If AHCA determines that BROADVIEW has taken any action listed as grounds for revocation in any of the provisions of Section 400.414(2), Florida Statutes or that BROADVIEW is not in substantial compliance with Florida Statute 400 Part III or the Florida Administrative Code, then the Provisional License may be revoked. : 4.4 Failure to substantially comply with the requirements of this Stipulation shall be sufficient. independent grounds for denial or revocation of the license of BROADVIEW RETIREMENT HOME #1 to operate as an assisted living facility, separate and apart from any other ground contained in Section 400.414(2) of the Florida Statutes. 5. Covenants of BROADVIEW RETIREMENT HOME #1. ; 5.1 BROADVIEW agrees to pay the Chines fine of Seven Hundred dollars ($700. 00) to AHCA within thirty (30) calendar days of issuance of the Provisional License. This payment shall be made payable to the Agency for Health Care Administration and shall be sent to Post Office Box 13749, Tallahassee, Florida 32317-3749 (the AHCA case number above and facility name should be referenced on the check). 5.2 BROADVIEW shall maintain compliance with all applicable Florida and federal laws, regulations and rules, including, but not limited to, Chapter 400, Part III, Florida Statutes (as amended), ~and ‘Chapter SBArS Florida Administrati e Code. 5.3 BROADVIEW shall, “within One Hundred Righty (180) days, be in substantial _compliance- to be able to obtain a Standard license. 6. This Agreement may not be ‘assigned by BROADVIEW. Any assignment, or attempted assignment of this Agreement by BROADVIEW shall be void. . 7. The waiver by AHCA of any breach of any provision of this Agreement shall not be construed to be a waiver of any other breach o -2- pene ie ge nee of such provision or of any breach of any other provision of this Agreement. 8. The provisions of this Stipulation may be enforced by either party subject to Florida Statute 120.69. 9. Each party shall bear its own attorney's fees and costs. 10. This Agreement supersedes any prior oral or written agreements between the ‘parties. 7 This Joint “stipulation ‘and Sett ement Agreement was signed by ‘petitioner on the 15th ,day of August, 2000 and was signed by the respondent on the 3 day of Cerwosem _, 2000. futur Bhp PAULINE A. BLACK Director, D&vision of Health Administrator Quality Assurance Broadview Retirement Home #1 Agency for Health Care 1741 Southwest 70th Avenue Administration Pompano Beach, Florida 33068 2727 Mahan Drive Tallahassee, Florida 32308 Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 we STATE OF FLORIDA DIVISTON OF ADMINISTRATIVE ‘HEARINGS PAULINE A. BLACK, d/b/a BROADVIEW RETIREMENT HOME #1, Petitioner, vs. Case No. 00-1065 AGENCY FOR HEALTH CARE ADMINISTRATION, : Respondent ORDER CLOSING FILE This cause having come before the undersigned on the parties' Joint Stipulation and Settlement Agreement. filed “October 5, 2000, and the undersigned being fully advised, it is, therefore, ORDERED that the file of the Division of Administrative Hearings in the above-captioned matter is hereby closed. DONE AND ORDERED this //¥Y€ day of October, 2000, in Tallahassee, Leon County, Florida. Dress al. PATRICIA H. MALONO Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 - re (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 OCT 13 a3 www.doah.state.fl.us pene eo

Docket for Case No: 00-001065