‘ FILED STATE OF FLORIDA NOV 193 AGENCY FOR HEALTH CARE ADMINISTRATION Oe le artas A H e AY AGENCY FOR HEALTH CARE OPER HAA ADMINISTRATION, ; 4 (A boarof Petitioner, AHCA No.: 2003006425 vs. DOAH No.: 03-3812 CREST MANOR ASSISTED LIVING Ic AHCA No.: 2003006692 d/b/a CREST MANOR, DOAH No.: 03-3865 Respondent. RENDITION NO.: AHCA-03-C'133-S-OLC 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, finds and concludes 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. ORDERED: 1. The attached Stipulation and Settlement Agreement is approved and adopted as part of this Final Order and the parties are directed to comply with the terms of the Stipulation and Settlement Agreement. 2. A total fine of $1,250.00 ($750.00 administrative fine + $500.00 survey fee) is hereby imposed upon Crest Manor. The fine is due and payable within thirty (30) days of the date of rendition of this Order. Additionally, the Agency withdraws its pending intent to deny the facility’s CHOW as an ALF license and will schedule and conduct another survey of the facility. Upon finding the facility in substantial compliance, the Agency will approve the CHOW license at subject in this case. The Agency reserves the right to issue another intent to deny license notice should the facility be found not to be in compliance at the rescheduled survey. 3. 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: Jean Lombardi Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, Mail Stop # 14 Tallahassee, Florida 32308. 4. Unpaid fines will be subject to statutory interest and may be collected by all methods legally available. DONE and ORDERED this _/¢/day of hoverrboc,, 2003, in Tallahassee, Leon County, Florida. Rhonda M.)Medows, MD, Secretary Agency fof Health Care Administra 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: Kathryn F. Fenske, Esq. Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53% Street Miami, Fl 33166 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) ~ Jean Lombardi ~~ oo ee Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive - Mail Stop # 14 Tallahassee, Florida 32308 (Interoffice Mail) Wendy Adams Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Errol! H. Powell Administrative Law Judge Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. Mail) Claude B. Arrington Administrative Law Judge Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. Mail) Jonathan S. Grout, Esq. Goldsmith, Grout & Lewis, P.A. 2180 Park Avenue North - Suite 100 Winter park, Florida 32790 (U.S. Certified Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the above-named addressees on this_/9 day sr cay 2003. Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION. Petitioner, 2003006692 CREST MANOR ASSISTED LIVING, INC., d/b/a CREST MANOR Respondent. / ey STIPULATION AND SETTLEMENT AGREEMENT —_—_—_— OS EEE LEMENT AGREEMENT Petitioner, Agency for Health Care Administration (“Agency”) through their undersigned ) ) ) ) ) ~Vs.- ) AHCA No: 2003006425 ) ) ) ) ) representatives and CREST MANOR ASSISTED LIVING, INC., d/b/a CREST MANOR (“CREST MANOR”), pursuant to Section 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, Crest Manor is an assisted living facility licensed pursuant to Chapter 400, Part Ill, Florida Statutes (2002) and Chapter 58A-5, Florida Administrative Code (2002); and WHEREAS, the Agency has Jurisdiction by virtue of being the regulatory and licensing authority over assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes; and WHEREAS, the Agency served Crest Manor with a Notice of Intent to Deny letter on September 8, 2003, notifying the party of its intent to deny the facility’s change of ownership (CHOW) application as an assisted living facility (ALF) license, due to the applicant’s failure to meet minimum license standards, as the Agency found uncorrected deficiencies, pursuant to surveys conducted on February 25, 2003, April 10, 2003, May 19, 2003, and August 26, 2003: and WHEREAS, Crest Manor requested a formal administrative proceeding as to the denial in a petition to the Agency dated September 16, 2003; and WHEREAS, the Agency served Crest Manor with an Administrative Complaint dated September 22, 2003, seeking to impose a One Thousand Dollar ($1,000.00) administrative fine; and WHEREAS, Crest Manor requested a Formal Administrative Proceeding as to the administrative fine in a petition to the Agency dated September 25, 2003; and 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 WHEREAS, the parties have negotiated and agreed that the best interests 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, Crest Manor agrees to a withdrawal of its Petition for a Formal Administrative Hearing; agrees to waive any and ail 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 Telief in any court or quasi-court (DOAH) of competent jurisdiction. 4. Crest Manor shall pay the Agency Seven Hundred Fifty ($750.00) Dollars within thirty (30) days of rendition of the Final Order. Crest Manor shall also pay the Agency Five Hundred ($500.00) Dollars for a survey fee within thirty (30) days of the rendition of the Final Order. 5. Crest Manor believes that it has corrected all cited deficiencies at issue in this case. Crest Manor and the Agency have settled the administrative fine case that resulted from the February 25, 2003, April 10, 2003, May 19, 2003, and August 26, 2003 surveys. The Agency withdraws its pending intent to deny the facility’s CHOW as an ALF license and will schedule and conduct another survey of the facility; and upon finding the facility in substantial compliance, the Agency will approve the CHOW license at subject in this case. The Agency reserves the right to issue another intent to deny license notice should the facility be found not to be in compliance at the rescheduled survey, due to any deficiencies found at the rescheduled survey. 6. 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. 7. Crest Manor neither admits nor denies the allegations in the Administrative Complaint and the Notice of Intent to Deny letter referenced herein. The Agency agrees that it will not impose any further penalty or sanction against Crest Manor as a result of the surveys conducted on February 25, 2003, April 10, 2003, May 19, 2003, and August 26, 2003, however, no agreement made herein shall preclude the Agency from imposing a penalty against Crest Manor for any deficiency/violation of statute or rule identified in a future survey of Crest Manor, which constitutes a “repeat” deficiency from the surveys conducted on February 25, 2003, April 10, 2003, May 19, 2003, and August 26, 2003. 8. 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. 9. Each party shall bear its own costs and attorneys’ fees. 10. This Agreement shall become effective on the date upon which it is fully executed by all the parties. I]. Crest Manor, for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs and executors or administrators, does hereby discharge the Agency 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 court or administrative forum, including any claims arising out of this Agreement, by or on behalf of Crest Manor or related facilities, 12. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph eleven (11) of this Agreement. 13. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 14. This Agreement contains the entire understandings and agreements of the parties. 15, This Agreement supercedes any prior oral or written agreements between the parties. 16. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement by Crest Manor or related facilities, its successor or any resulting organization shall be void. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement: brew 2. Fn f 7 JONATHAN S. GROUT, eels GOLDSMITH, GROUT & LEWIS, P.A. 2180 Park Avenue North, #100 ADMINISTRATION Post Office Box 2011 2727 Mahan Drive Winter Park, FL 32790-2011] Tallahassee, FL 32308 407/740-0144 Attorneys for Respondent Florida Bar No. 296066 Date signed: Y “ib o Ss Date signed: LZ A, Cer / Z Bey Ls ie Cc. eed Lig SIRE GENERAL COUNSEL AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Tallahassee, FL 32308 Date signed: Lf LOS

Docket for Case No: 03-003812