STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION gue ie 99 AGENCY FOR HEALTH CARE ADMINISTRATION, Ea oe Petitioner, DOAH No.: 02256 a ; AHCA No.: 2023541 9 vs. Cdr : ' TANDEM HEALTH CARE OF LAKE C edf PARKER, Respondent. FINAL ORDER . The Agency for Health Care Administration, having entered into a Stipulation and Settlement Agreement with the parties 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 Joint 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. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to this Case number, should be sent directly to Gloria Collins Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, Mail Stop Code # 14 Tallahassee, FI. 32308 DONE and ORDERED this JaAday of 002, in Tallahassee, Leon County, 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 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. Copies furnished to: Ursula Eikman, Esq. Assistant General Counsel AHCA, Mail Stop #3 (Interoffice Mail) Clark -Buurman, Administrator Tandem Health Care of Lake Parker 2020 W. Lake Parker Drive Lakeland, Florida 33805 (U.S. Mail) Gloria Collins Finance & Accounting AHCA, Mail Stop #14 (Interoffice Mail) Wendy Adams Regulatory Consultant AHCA, Mail Stop #3 (Interoffice Mail) Llizsoal, Delete Clinteeate.) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the fh August above-named addressees on this lé day of 2002, AliCcAuK Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 UE/sr STATE OF FLORIDA 02 ty os & a) AGENCY FOR HEALTH CARE ADMINISTRATION © ro Aplin. 9 AGENCY FOR HEALTH CARE MW! ys Oy ADMINISTRATION. Me Ap RG, aft “Vr Petitioner, DOAH CASE NO. 02-2565 vs. AHCANO: 2002023541 TANDEM HEALTH CARE OF LAKE . PARKER, Respondent. / SF, STIPULATION AND SETTLEMENT AGREEMENT —— ET EL ELEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through their undersigned representatives, and Tandem Health Care of Lake Parker (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 I, Florida Statutes (2001), and Chapter 59A, Florida Administrative Code, (2001); and te - WHEREAS, the Agency has Jurisdiction by virtue of being the regulatory and licensing authority over Respondent pursuant to Chapter 400, Part I, 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 petition to the Agency dated May 1, 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 THEREF ORE, 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 120.5 7(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. 5. 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 8. This Agreement shall become effective on the date upon which it is fully executed 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. te. - 10. This Agreement is binding upon all party’s herein and those identified in the 11. The undersigned have Tead and understand this Agreement and have authority to 12. This Agreement contains the entire understandings and agreements of the parties, parties. 14. This Agreement may not be amended except in writing, Any attempted assignment of this Agreement shall be void. The following Tepresentatives hereby acknowledge that they are duly authorized to enter into this Agreement. Agency for Health Care Administration YZ, Elizabeth Rudek William H. Roberts Deputy Secfetary Acting General Counsel ManagedCare and Health Quali General Counsel’s Office Assurance Agency for Health Care Agency for Health Care Administration Administration DATED: Ses On DATED:_{V6/ gy. Tandem Health Care at Lake Parker C Clark Buurma, Administrator Tandem Health Care at Lake Parker 2020 W. Lake Parker Drive Lakeland, Florida 33805 DATED: / /; 8 [oe

Docket for Case No: 02-002565