STATE OF FLORIDA FHLED AGENCY FOR HEALTH CARE ADMINISTRATION AUS IS 92 AGENCY FOR HEALTH CARE Saas ADMINISTRATION, wens fe A werem MEAT CLERM Petitioner, CASE No. 02-2560 AHCA No. 200202371 vs. TpP chal g ROYAL MANOR, So zm ° Me= GS wl. Respondent. Bao o ) / =a: cry FINAL ORDER SN wD a % The Agency for Health Care Administration, having entered into a Stipulation and Settlement Agreement with the party to these proceedings, and being otherwise well advised in the premises, decides as follows: The attached Stipulation and Settlement Agreement is approved and adopted as a part of this Final Order and the parties are directed to comply with the terms of the Stipulation and Settlement Agreement. THEREFORE, it is ORDERED and ADJUDGED that the parties hereto are directed to comply with terms of the Stipulation and Settlement Agreement. ' .DONE and ORDERED this Stay of Ju 02, in Tallahassee, Leon County, Florida. JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH AGENCY CLERK AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, IN 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. , 1 Copies furnished to: Ursula Eikman, Esq. Assistant General Counsel Agency for Health Care Administration Mail Stop #3 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Mail Stop #9 (Interoffice Mail) Gloria Collins Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop #14 (Interoffice Mail) Grace Achille, Administrator Royal Manor 600 Business Parkway Royal Palm Beach, Florida 33411 (U.S. Mail) Wendy Adams . Mail Stop #3 . (Interoffice Mail) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of this Final Order was served on the Auawt bth, of = , 2002. above-named person(s) by U.S. Mail, or the method designated, on this the je Leland McCharetf, Agency Clerk Agency for Health Care Administration UE/sr eo Nea pte STATE OF FLORIDA tug ~<&) AGENCY FOR HEALTH CARE ADMINISTRAT 19M, Ay Ong Ve 9: 2 AGENCY FOR HEALTH CARE Ke MS, Pipi St ADMINISTRATION, NG Petitioner, CASE No. 02-2560 AHCA No. 2002023711 VS. ROYAL MANOR, Respondent. / STIPULATION AND SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through their undersigned representatives, and Royal Manor (hereinafter “Respondent”) pursuant to Sec. 120.57(4), Florida Statutes (2001) each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Respondent is a Nursing Home licensed pursuant to Chapter 400, Part II, Florida Statutes (2001), and Chapter 59A, Florida Administrative Code, (2001); and ; WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent pursuant to Chapter 400, Part II, Florida Statutes; and WHEREAS, the Agency served Respondent with a Notice of Intent to Impose Fine, notifying the party of its intent to fine for $500, and; WHEREAS, Respondent requested a formal administrative hearing in a letter to the Agency dated April 19, 2002; and 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 recitals 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, Respondent agrees to a withdrawal of its Petition for Formal Administrative Proceedings; 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. 4. Upon full execution of this Agreement, Respondent agrees to pay $375 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. ‘s ' 3. Respondent neither admits nor denies the allegations raised in the notice of intent referenced herein. The Agency agrees that it will not impose any further penalty against Respondent as a result of the violation of s. 400.141(16), F.S. for the month of January 2002, however, no agreement made herein shall preclude the Agency from imposing a penalty against Respondent for any deficiency identified in a future survey of Respondent, which constitutes a “repeat” deficiency from the any future violations of this section. The parties agree that in such “repeat” case the deficiencies from the Notice of Intent to Impose Fine dated April 8, 2002, shall be deemed found without further proof. 6. 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. 7. Each party shall bear its own costs and attorney fees. 8. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 9. Respondent, for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attomeys 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 court or administrative forum, including any claims arising out of this agreement, by or on behalf of Respondent or related facilities. 10. This Agreement is binding upon all party’s herein and those identified -in the aforementioned paragraph (9) of this Agreement. Il, The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 12, This Agreement contains the entire understandings and agreements of the parties. 13. This Agreement supercedes any prior oral or written agreements between the parties. 14. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Agency for Health Care Administration © William H. Roberts Acting General Counsel Managed Care and Health Quality General Counsel’s Office Assurance Agency for Health Care Agency for Health Care Administration Administration DATED: S127 62. DATED: _ f/2 / 7~ Royal Manor Grace Achille, Administrator Royal Manor 600 Business Parkway Royal Palm Beach, Florida 33411 DATED: Cues [22

Docket for Case No: 02-002560