STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION®*-3 22 (2 Pind ph CA WUESTHOFF PROGRESSIVE CARE KOOLERWI CENTER, INC. d/b/a WUESTHOFF PROGRESSIVE CARE CENTER, es TT Petitioner, = vs. AHCA NO. 2002069981 CASE NO. 02-1425 AGENCY FOR HEALTH CARE . ADMINISTRATION, pmk C ’beaecd Respondent. oe / FINAL ORDER The Respondent, AGENCY FOR HEALTH CARE ADMINISTRATION (“Agency”), issued to Petitioner, Wuesthoff Progressive Care Center, Inc. d/b/a Wuesthoff Progressive Care Center (“Wuesthoff”), a notice of intent to impose fine letter dated February 19, 2002 (the “Notice of Intent”). The Notice of Intent notified Wuesthoff of the Agency’s intent to impose an administrative fine in the amount of $5,000.00 for Wuesthoff's failure to file timely’ with the Agency an application for change of ownership. On March 15, 2002, the Agency received Wuesthoff’s Election of Rights form. Wuesthoff selected Option “3” on the Election of Rights form disputing the allegations of fact contained in the Notice of Intent and requesting a formal proceeding pursuant to Section 120.57(1), Florida Statutes. Subsequently, Wuesthoff withdrew it’s petition for formal administrative proceedings dated April 12, 2002, and submitted a check made payable to “AHCA" in the amount of $5,000.00. Based on the foregoing, it is hereby ORDERED: 1) An administrative fine in the amount of $5,00.00 is hereby paid in full; and 2) The above-styled case shall be and is hereby, CLOSED. DONE and ORDERED on this the _& day of ~2002, in Tallahassee, Florida. 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. Copies furnished to: John F. Gilroy, Senior Counsel Agency for Health Care Administration Mail Stop #3 (Interoffice Mail) Agency for Heaith Care Aaministracion Mail Stop #9 (Interoffice Mail) Gloria Collins, Finance & Accounting Agency for Heaith Care Administration Mail Stop #14 (Interoffice Mail) Karen L. Davila, Esquire Wuesthoff Progressive Care Center, Inc. 110 Longwood Avenue Rockledge, Florida 32955 (U.S. Mail) State of Florida Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) ERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) by U.S. Mail, or the method designated, on this tne22hay of us"2002. Li (AA Lealand McCharen, Agency Clerk “2 Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 JFG/sr 93/14/2002 THU 14:17 FAT 321 690 6643 WUESTHOFF NURSING ADMIN. Boog alto STATE OF FLORIOA ’ EXHIBIT A ~IAHCA SAIUA AGCHCT FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR RHONOA M. MEQOWS, MD, FAAFP, SECRETARY February 19, 2002 CERTIFIED/RETURN RECEIPT REQUESTED (#7000 0600 0026 7842 979%: Administrator Bs Wuesthoff Progressive Care Center Inc. 8050 Spyglass Hill Road . Vierra, Florida 32940 o? NOTICE OF INTENT TO IMPOSE LATE FINE 4200200998 mr Dear Administrator: A fine of $5,000 is hereby imposed due to the late filing of an application for change of ownership for Wuesthoff Progressive Care Center by Wuesthoff Progressive Care Center, Inc. The application for the change of ownership was due to the Agency for Health Care Administration by October 3, 2001. However, the application was received on November 21, 2001, 49 days late, as the effective date for the change in ownership was January 1, 2002. Pursuant to sections 400.179, 400.102, 400.121, Florida Statutes (F.S.), the Agency must assess a fine for change of ownership applications that are not received at least ninety (90) days prior to the effective date of the transfer. A fee of $500 is assessed for cach day beyond the application due date, up to a maximum of $5,000. : PAYMENT SHOULD BE SENT TO: (if paid within 21 days of receipt of notice) Agency for Health Care Administration Long Term Care Unit, MS-33 2727 Mahan Drive ‘ . Tallahassee, FL 32308 - (Please include a copy of this Notice of Intent) 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 _ EXHIBIT i EF 2727 Mahan Drive « Mail Stop # 33 Visit AHCA Ontine at Tallahassee, FL 32303 www fohe stare fi, us . x. - 3/14/2002 THU 14:17 FAX 321 690 6643 WUESTHOFF NURSING ADYT Boor Page 2 section 120. S7(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 EXPLAN ATION OF RIGHTS FORMS Sincerely; wd, Mhest Molly Fag a . Program Manager Long Term Care Unit Health Faciliry Regulation ce: Field Office Supervisor Jim Kemp, LTC Unit a File, LTC Unit SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY & Complete items 1, 2, and 3. Also complete item 4 if Restricted Oelivery is desired, @ Print your name and address on the reverse so that we can return the card to you. ® Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: O. Is delivery address different from item 17 CI Yes RECEIVED ™~ | FEB 2 5 2002 Administrator Wuésthoff Progressive Care 8050 Spyglass Hill Road 2. Sd .* Vierra, FL 32940 ERONGTERM CARE UNIT , ” O Registered Return Receipt for Merchandise ! O insured Mail ~=— 6.0.0. 4. Restricted Oalivery? (Extra Fee) 2. Articta Number {Copy from service labep) 6 OnfA2e PEA $997. PS Form 3811, July 1999 Domestic Return Receipt 102895-00-M.0952 EXHIBIT 2. tabbies" : N. OS eee 03/14/2002 THU 14:15 Fat 321 690 6643 WESTHOFF NURSING aDMI3 “4 Booz ¢ < J rr rr STATE OF FroRMA Doe STE oe. AGENCY FOR HEALTH CARE ADMINISTRATION ae RE: Wuesthoff Progressive Care Center Enforcement 4200200998 ELECTION OF RIGHTS FOR NOTICE OF INTENT 0 8 EP PLEASE SELECT ONLY | OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE(1) G Ido not dispute the allegations of fact contained in the Notice of Intent and waive my right to object or to be heard. I understand that by waiving my rights, a final order will be ‘~ " “Ggsued that adopts the Notice of Intent and imposes the sanctions sought. . .. OPTION TWO (2) Q Ido not dispute and I admit the allegations of fact in the Notice of Intent, bur do wish to be afforded an informal proceeding, Pursuant to Section 120.57(2}, Florida Stauutes, ar which time [ will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) XX Ydo dispute the allegations of fact contained in the Notice of Intent and request a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. sot In order to preserve your right to any hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Notice of Intent. If you do not respond at all within twenty-one (21) days from receipt of the Notice of Intent, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Notice of Totent. If you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. . Mediation under Section 120.573, Florida Statutes, is not available in this matter. (Please sign and tii! in your current address.) FF PROGRESSIVE CARE CENTER, INC. Re / Addrss;__110 LONGWOOD, AVENUE, ROCKIES "py! UaRiS License No, and facility type: __ SNF 16320961 Phone No__ 321-636-2211 ext. 1509 ae reel ext. 15 PLEASE RETURN YOUR COMPLETED FORM TO: Molly McKiastry, Unit Manager Long Term Care Unit, MS 33 Agency for Health Care Administration 2727 Mahan Drive, Tallahassee, Florida 32308 (Phone #850-483-5861, fax #850-414-5416, TDD 1-800-955-8771) EXHIBIT Poe STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION EXPLANATION OF RIGHTS UNDER SFC. 120.569, FLORIDA STATUTES (To be used with Election of Rights for Administrative Complaint form — attached) In response to the allegations set forth in the Administrative Complaint issued by the Agency for Health Care Administration (“AHCA” or “Agency”), you must make one of the following elections within twenty- one (21) days from the date of receipt of the Administrative Complaint. Please make your election of the attached Election of Rights form and retum it fully executed to the address listed on the form. OPTION 1. If you da not dispute the allegations in the Administrative Complaint and waive your right to be heard, you should select OPTION 1 on the election of rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. OPTION 2. If you donot dispute any material fact alleged in the Administrative Complaint (you admit each of them), you may request an informal hearing pursuant to Section 120.57(2), Florida Statutes before the Agency. At the informal hearing, you will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, you should select OPTION 2 on the Election of Rights form. QPTION 3. If you dispute the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal hearing, select OPTION 3 on the Election of Rights form. 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., In order to preserve your right.to a hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty- one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. EXHIBIT _— O4518/2002 09:37 FAX 850 410 1512 LTC , aca * . gaynoy2ga2 13:41 © 321-698” 35 RISK MGT ot PAGE 03/18 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Wuesthoff Progressive Care Center, Inc., Petitioner, v. CASENO..02:1427 A oad State of Florida, poop TSt Agency for Health Care Administration, <0 Ae) o \ Respondent. se / PETITION TO WITHDRAW PETITION FOR FORMAL ADMINISTRATIVE PROCEEDINGS * © Petitioner, Wuesthoff Progressive Care Center, Inc., (hereinafter “Petitioner”), hereby withdraws its Petition for Formal Administrative Proceedings pursuant to Section 120.569 and Section 120.57(1), Florida Statutes (1999) and Rule 28-106.201, Florida Administrative Code. Respectfully submitted this 12th day of April, 2002. WUESTHOFF PROGRESSIVE CARE CENTER, INC. KAREN L. DAVILA, General Counsel Florida Bar L.D. No, 283850 EXHIBIT 14

Docket for Case No: 02-001425