A A = STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, ane oN 7 pe OO? Petitioner, S me vs. AHCA No: 2003007421- 2003008283 ~ -, HAVEN OF OUR LADY OF PEACE, INC., DOAH No: 64-0088 Respondent. / FINAL ORDER The Agency for Health Care Administration, having entered into a Joint Stipulation and Settlement Agreement with the parties to these proceedings, and being otherwise well advised in the premises, decides as follows: The attached Joint 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 Joint Stipulation and Settlement Agreement. ORDERED: 1. That the deficiency cited against Haven of Our Lady of Peace, as a result of the survey conducted on September 9, 2003 is hereby amended to a Class Ill deficiency. Haven of Our Lady of Peace, Inc. agrees to pay a fine of $750.00 to the Agency within 30 rye - days of the entry of the Final Order. The payment is due and payable within thirty (30) days of the date of rendition of this Order. 2. The Conditional License imposed by the Agency on November 22, 2003 is hereby rescinded. 3.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 & Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, FL 32308 4. The $750.00 fine will be subject to statutory interest, and may be collected by all methods legally available if unpaid within the 30-day time frame. DONE and ORDERED this / day of Aoperwloer, 2004, in Tallahassee, Leon County, Florida. , Secretary ™ Agency foy Health Care Administrati 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: 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 Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308 (Interoffice Mail) Stephen C. Emmanuel, Esq. Ausley & McMullen 227 South Calhoun Street Tallahassee, Florida 32301 (U.S. Certified mail) Hon. Diane Cleavinger Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, 3299-3060 (U.S. Mail) Nelson E. Rodney, Esq. Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52™ Street, Suite 103 Miami, Florida 33166 (Interoffice Mail) Wendy Adams Intake Mail Stop #3 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the above-named addressees on _ this dt aay of ria vere , 2004. Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, - vs. DOAH CASE NO. 04-0086 <* AHCANO.: 2003007421 HAVEN OF OUR LADY OF PEACE, 2003008283 INC., Respondent. | STIPULATION AND SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through their undersigned representatives, and HAVEN OF OUR LADY OF PEACE, ING. (hereinafter “HAVEN’”), pursuant to Sec. 120.57(4), Florida Statutes, each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, HAVEN operates a Nursing Home located at 1900 Summitt Boulevard, Pensacola, FL 32503, and licensed pursuant to Chapter 400 Part Il, Florida Statutes, and Rule 58A-4, Florida Administrative Code, (the “Facility”); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent pursuant to Chapter 400, Florida Statutes; and WHEREAS, the Agency served HAVEN with a Notice of Assignment of Conditional Licensure on November 22, 2003; and WHEREAS, the Agency cited HAVEN with an isolated Class II deficiency and notified HAVEN of its intent to impose an administrative fine in the amount of $2,500 as a result of the survey conducted on September 8, 2003; and WHEREAS, the Haven timely filed an administrative petition challenging the alleged deficiency and the Notice of Assignment of Conditional Licensyre; 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 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, HAVEN agrees, subject to entry by the Agency of a Final Order consistent with the terms of this Agreement, to a withdrawal of its request for a Formal Administrative Proceeding; agrees to waive any and all state 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, the Agency agrees to: a. Reduce the citation identified as Tag 324 in the September 8-9, 2003 survey from a state Class II deficiency to a state Class III deficiency. b. Withdraw the Notice of Assignment of Conditional licensure status, which resulted from the citation identified in paragraph 4a above. C. Reduce the administrative fine from $2,500 to $750 [representing 75% of the fine amount applicable to an isolated Class III deficiency]. © d. The Agency further agrees that the deficiency cited against the Haven was corrected in the time specified by the Agency, and that the Agency's files will be changed to reflect that the Haven's license was never assigned a conditional rating as a result of the survey conducted on September 8, 2003. 5. Within 30 days of the entry by the Agency of a Final Order fully adopting the terrns of this Agreement, HAVEN agrees to pay $750.00 (Seven Hundred Fifty and no/100 Dollars) to the Agency. 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. 6. HAVEN does not admit the allegations of facts raised in the 2567s generated as a result of the survey conducted on September 8-9, 2003. The Agency continues to assert the validity of those allegations, but after further review agrees that a Class II deficiency is not warranted under the circumstances. The Agency agrees that the terms of this Agreement constitute the full and final resolution of all state issues that were raised or could have been raised as a result of the surveys referenced in the Notice of Assignment of Conditional Licensure. 7. Upon full execution of this Agreement, the Agency shall enter a Final Order fully adopting and incorporating the terms of this Agreement and dismissing the above-styled case. &. Each party shall bear its own costs and attorney fees. 9. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 10. HAVEN 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 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 state court or state administrative forum, by or on behalf of HAVEN or related facilities. Provided, however, that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this stipulation, and further provided that the Haven does not waive its right to challenge any actions that have or may be taken by any federal agency as a result of the survey. 11. The Agency, for itself and for itself and all successor State agencies, does hereby discharge HAVEN and its related or resulting organizations, its successors, transferees, 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, by or on behalf of the Agency or any successor State agencies. 12. This Agreement is binding upon all parties herein and those identified in paragraph ten of this Agreement. Notwithstanding the foregoing, nothing in the 2567s generated in conjunction with the survey conducted on September 8, 2003, this Agreement or the Final Order entered pursuant to this Agreement, shall be used or relied upon by the Agency as a basis for any sanctions or any other action adverse to any person or entity other than HAVEN or its subsidiaries or corporate affiliates. 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 shall be void. All parties agree that a facsimile signature suffices for an original signature. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. 4 \ Elizabeth Dudek Robert Granger, Member Deputy Spcretary Board of Directofs Health Quality Assurance Haven of Our l/ady of Peace, Inc. Agency for Health Care Admin. 1900 Summit Boulevard 2727 Mahan Drive Pensacola, FL 32503 Tallahassee, FL 32308 DATED: Wh 4 ho DATED: Seo DOAH No. 04-0086 AHCA No. 2003007421 & 2003008283 (i thé p— Valda Clark Christian General Counsel Agency for Health Care Admin. 2727 Mahan Drive Tallahassee, Florida 32308

Docket for Case No: 04-000086