STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION THE TERRACE OF DAYTONA ey gute 27 BEACH, LLC, Petitioner, vs. AHCA No. 2004002919 DOAH No. 04-1260 STATE OF FLORIDA, AGENCY FOR HEALTH CARE 3B ADMINISTRATION, > a) ae to Respondent. Fan ee / Z wo FINAL ORDER ga | rw o v ‘ao nr The Agency for Health Care Administration, having entered into a Joint s Stipulation and Settlement Agreement, and being othemise fully advised in the premises, determines 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: 1. That the parties hereto are directed to comply with the terms of the Joint Stipulation and Settlement Agreement. 2. A fine of THREE THOUSAND SEVEN HUNDRED FIFTY AND 00/100 DOLLARS ($3,750.00) is hereby imposed upon THE TERRACE OF DAYTONA BEACH, LLC. The fine is due and payable within 30 days of the date of rendition of this Order. AHCA No. 2004002919 Page 1 of 3 Final Order 3. Checks should be made payable to the “Agency for Heaith Care Administration.” The check, along with a reference to this case number, should be sent directly to: Jean Lombardi, Office of Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, FL 32308. 4, Unpaid fines will be subject to statutory interest, and may be collected by all methods legally available. DONE and ORDERED this ray of a 2005, in Tallahassee, Leon County, Florida. \ oft Alan Levine, Secretar Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER !S 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: Ella Jane P. Davis, Theodore E. Mack, Esquire Administrative Law Judge Powell & Mack Division of Administrative Hearings 803 North Calhoun Street The DeSoto Building Tallahassee, FL 32303-6211 4230 Apalachee Parkway Tallahassee, FL 32399-3060 AHCA No. 2004002919 Page 2 of 3 Final Order Elizabeth Dudek, Deputy Secretary Agency for Health Care Administration (Interoffice Mail) Janis L. Rosenthal Assistant Genera! Counsel Agency for Health Care Administration (Interoffice Mail) Wendy Adams, Regulatory Consultant Agency for Health Care Administration Jean Lombardi, Office of Finance & Accounting Agency for Health Care Administration (Interoffice Mail) CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true copy of the foregoing was delivered by U.S. Mail ett or other method designated to the persons listed above on this 2’_ day of "Te 2005. Richard Shoop, Agency : erk Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, MS #3 Tallahassee, FL 32308 AHCA No. 2004002919 Page 3 of 3 Final Order STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION THE TERRACE OF DAYTONA BEACH, LLC. Petitioner, vs. AHCA No. 2004002919 CASE No. DOAH 04-1260 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent / JOINT STIPULATION AND SETTLEMENT AGREEMENT Respondent, Agency for Health Care Administration (hereinafter the "Agency”) through their undersigned representatives, and THE TERRACE OF DAYTONA BEACH, LLC. (hereinafter "Petitioner") pursuant to Sec. 120.57(4), Florida Statutes each individually, a "party", collectively as "parties," hereby enter into this Joint Stipulation and Settlement Agreement ("Agreement") and agree as follows: WHEREAS, THE TERRACE OF DAYTONA BEACH, LLC., operates a nursing home facility licensed pursuant to Chapter 400 Part Il, Florida Statutes (2003), and Chapter 59A-5 Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over THE TERRACE OF DAYTONA BEACH, LLC. pursuant to Chapter 400, II, Florida Statutes; and Chapter 59A-5; WHEREAS, the Agency served THE TERRACE OF DAYTONA BEACH, LLC. a notice of intent to impose late fine on April 5, 2004, notifying the party of its intent to impose an administrative fine for FIVE THOUSAND AND 00/100 DOLLARS ($5,000.00), and; AHCA # 2004002919 Page 1 of 5 Case # DOAH 04-1260 WHEREAS, THE TERRACE OF DAYTONA BEACH, LLC. requested 2 formal administrative hearing in documentation received by the Agency on April 7, 2004; 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, THE TERRACE OF DAYTONA BEACH, LLC. agrees to a withdrawal of its Request for formal Hearing; 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 (DOAN) of competent jurisdiction. Provided, however, that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this stipulation. 4. Upon full execution of this Agreement, THE TERRACE OF DAYTONA BEACH, LLC. agrees to pay THREE THOUSAND SEVEN HUNDRED FIFTY AND AHCA # 2004002919 Page 2 of 5 Case # DOAH 04-1260 00/100 DOLLARS ($3,750.00), 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. By executing this stipulation, THE TERRACE OF DAYTONA BEACH, LLC. does not admit, and the Agency asserts the validity of the allegations raised in the notice of intent letter or administrative complaint referenced herein. The Agency agrees that it will not impose any further penalty against THE TERRACE OF DAYTONA BEACH, LLC. a result of the receipt of the application that was received on December 2, 2004. 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. THE TERRACE OF DAYTONA BEACH, LLC. 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 THE TERRACE OF DAYTONA BEACH, LLC. or related facilities. AHCA # 2004002919 Page 3 of 5 Case # DOAH 04-1260 10. The Agency for Health Care Administration, does hereby discharge THE TERRACE OF DAYTONA BEACH, LLC.., 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 the Agency for Health Care Administration. 11. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph nine (9) of this Agreement. 12. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 13. | This Agreement contains the entire understandings and agreements of the parties. 14, | This Agreement supercedes any prior oral or written agreements between the parties. 45. A facsimile signature contained herein shall be as valid and binding as an original signature thereof. THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK AHCA # 2004002919 Page 4 of 5 Case # DOAH 04-1260 16. | 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. Seta Mapgelp — Llane ELA. ELIZABETH DUDE DEPUTY SECRETARY, DIVISION OF HEALTH QUALITY FOR ASSURANCE THE TERRACE OF DAYTONA BEACH, AGENCY FOR HEALTH CARE LLC. ADMINISTRATION 2727 MAHAN DR MAIL STOP 9 TALLAHASSEE, FL 32308 ; ofaios _/,/ DATED: 0 saves: 4S d Y/ 04 o a va ZO) “ vA _ LP ASL RISTIAN- 207 cc ei (QBS GENERAL COUNSEL AGENCY FOR HEALTH CARE ADMINISTRATION 2727 MAHAN DRIVE MAIL STOP 3 TALLAHASSEE, FL 32308 DATED: AHCA # 2004002919 Page 5 of 5 Case # DOAH 04-1260

Docket for Case No: 04-001260