STATE OF FLORIDA 2 FEED . _. AGENCY FOR HEALTH CARE ADMINISTRATION Rebs “> ClPART ENE ep ANGEL WINGS OF LAKE COUNTY, INC., Petitioner, vs. Case No. 00-4330 6 I AHCA No. 03-00-021-ALF STATE OF FLORIDA, RENDITION NO.: AHCA-01-030-S-OLC AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / ’ FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement on January 26, 2001, which is incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the 2? -aay of February, 2001, in Tallahassee, Florida. aes —1 AA TKS i Secretay Agency fof Gi A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A 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 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. Copies furnished to: Tracey S. Cottle, Esquire Agency for Health Care Administration (Interoffice Mail) Mater D. Alcubilla, Administrator Angel Wings of Lake County 6333 S.E. Babb Road Belleview, Florida 34420 ALF Unit (Interoffice Mail) Cora Kurtz, Area 3 Office (Interoffice Mail) Gloria Collins, Finance and Accounting _WA H CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this th 2001. .S¥ Po A Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865 AGENCY FOR HEALTH CARE AD 858 413 9313 P.@2 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ANGEL WINGS OF LAKE COUNTY, INC., Petitioner, vs. CASE NO. 00-4330 AGENCY FOR HEALTH CARE ADMINISTRATION Respondent. STIPULATION AND SETTLEMENT AGREEMENT Angel Wings of Lake County, Inc. (hereinafter “Angel Wings”), and State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through their undersigned representatives, and pursuant to Sec. 120.57(4), Florida Statutes (2000) each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Angel Wings is an assisted living facility licensed pursuant to Chapter 400, Part II, Florida Statutes (2000), and Chapter 58A-5, Florida Administrative Code, (2000) . and is located at 6333 S,E. Babb Road, Belleview, FL 34420;° and a NriO-2801 12:58 AGENCY FOR HEALTH CARE AD 858 413 9313 P83 WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over assisted living facilities pursuant to Chapter 400, Part ITI, Florida Statutes; and WHEREAS, the Agency issued a provisional license (license no. AL8820; certificate no. 7089) to Angel Wings with an effective date of January 21, 2000 and an expiration date of June 20, 2000; and WHEREAS, the Agency conducted a change of ownership licensure survey on March 3, 2000 where upon thirteen deficiencies were cited. A follow-up survey was conducted on June 8, 2000 resulting in the citation of ten deficiencies. Seven of these deficiencies were uncorrected deficiencies. After the June 8, 2000 survey the Agency imposed a $2,100 fine against the facility. | WHEREAS, the Agency notified Angel Wings in a letter dated August 3, of their Notice of Intent to Deny Angel Wings’ change of ownership license. WHEREAS, Angel Wings requested a formal hearing in a letter dated August 24, 2000. WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and we WHEREAS, the parties have negotiated and agreed that the best. interest-of all the parties will be served by a settlement of this proceeding; and ) NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All xvecitals are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. 3. Upon full execution of this Agreement, Angel Wings agrees toa withdrawal of its Petition for Formal Administrative Proceedings now pending in the Division of Administrative Hearings (hereinafter “DOAH”) case no. 00-4330; agrees toa dismissal and remand of the proceedings now pending in the Division of Administrative Hearings case no. 00-4330; agrees to. waive any and all appeals and proceedings; agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120,57(2), a formal proceeding under Subsection 120,57(1), appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court (DOAH) of competent jurisdiction; and ¥ ~O8-2001 12:59 AGENCY FOR HEALTH CARE AD 858 413 9313 oP. gs 4. Upon full execution of this Agreement, Angel Wings agrees to pay two thousand one hundred ($2,100) in civil fines to the Agency within 30 days of the entry of the Final Order. venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in the Circuit Court in Leon County, Florida, and shall be subject to all applicable provisions for interest, attorney’s fees and costs. 5. This Agreement resolves the issue of an outstanding $2,100 fine against Angel Wings arising from the Agency’s June 8, 2000 survey. This Agreement does not resolve or limit any other fines, penalties or other actions by the Agency against Angel Wings relating to or resulting from subsequent charges, violations or surveys, including repeat violations that may arise or relate to the March 3, 2000 or June 8, 2000 survey in any way whatsoever, or any future actions that may be taken by the Agency. 6. Upon full execution of this Agreement and the receipt of the $2,100 fine imposed, the Agency shall issue Angel Wings a standard license with an effective date of June 21, 2000 and an expiration date of January 20, 2002. _7, Upon full execution of this Agreement, the Agency “shall enter a Final Order adopting and incorporating the-terms - of this Agreement and dismissing the above-styled case; and J TANTES SIL 1S Be AGENCY FOR HEALTH CARE AD 858 413 9313 P.665 8. In the event that Angel Wings fails to pay the fine within the time allotted herein, then in addition to the outstanding fine, Angel Wings voluntarily agrees to be bound by the issuance of a Final order constituting an admission of noncompliance with the state regulatory and statutory requirements pursuant to Section 400.414 (1) (e), Florida Statutes, and Angel Wings shall voluntarily and immediately relinquish rights to its assisted living facility license, By this, Angel Wings’ License shall be considered null and void, whether the license is in Angel Wings’ possession or not. . 9. Each party shall bear its own costs and attorney fees, 10. This Agreement shall become effective on the date upon i which it is fully executed by all the parties. il. Angel Wings, for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby Fa discharge the state of Florida, Ageney for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency’s actions, including, but not limited to, any claims that were or may be asserted in any federal or State ° ‘ JAN-@8-2001 13:08 AGENCY FOR HEALTH CARE AD 858 413 9513 court or administrative forum, including any claims arising out of this agréement, by or on behalf of Angel Wings. 12. Each party shall bear its own attorney fees and costs. 13. This Agreement is binding upon all party’s herein and those identified in the aforementioned paragraph eleven (11) of this Agreement. 14. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 15. This Agreement contains the entire understandings and agreements of the parties. 16. This Agreement supercedes any prior oral or written agreements between the parties, 17. This Agreement may not be amended except in writing, assigned, by Angel Wings, its successor, or any resulting organization. Any attempted assignment of this Agreement by Angel Wings shall be void. The following representatives hereby acknowledge that they are duly authorized to enter inte this Agreement. J. i Mater. D, Alcubilla Director, Owrer/Administrator Managed Care and , Angel Wings of Lake Health Quality Assurance County, Inc. Agency for Health Care 6333 S.E. Babb Road Administration Belleview, FL 34420 DATED; | ) upd Tracey S. Cottle Assistant General DATED; eral Counsel Agency for Health Care Counsel Administration Agency for Health 2727 Mahan Drive Care Administration Tallahassee, FL 32308 2727 Mahan Drive Mail Stop Code #3 Tallahassee, FL 32308 Fax (850) 413-9313 Phone (850) 923-5873 DATED: : DATED: ee TOTAL P.@S

Docket for Case No: 00-004330