STATE OF FLORIDA _ AGENCY FOR HEALTH CARE ADMINISTRATION’: en GUIZE CHERISOL, AFCH, Petitioner, AHCA NO. 2004005514 2004006539 vs. DOAH NO. 05-0805 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER ea Having reviewed the administrative complaint dated July 29, 2004, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Stipulation and Settlement Agreement (Ex. 2) with the parties to these proceedings, and being otherwise well advised in the premises, finds and concludes as follows: 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 fine of $1,875.00 is hereby imposed upon the Petitioner. This amount is due and payable within thirty (30) days of the date of rendition of this Order. 3. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to these case numbers, should be sent directly to: Jean Lombardi Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308. 4. The Petitioner’s petitions for formal and informal administrative proceedings are héreby dismissed. S. The Petitioner’s license renewal application received by the Agency on or about April 5, 2004 is hereby denied. 6. The Petitioner shall not apply for a new license, license renewal, or attempt to acquire an existing license to operate any health care facility, including an Adult Family-Care Home in the State of Florida for a period of two (2) years commencing on the date of the entry of the Final Order in this matter. 7. Unpaid fines will be subject to statutory interest, and may be collected by all methods legally available. The Remainder of This Page Intentionally Left Blank 8. Each party shall bear its own costs and attorney’s fees. 9. The above-styled cause is hereby dismissed. DONE and ORDERED this — 7 day of Masry _, 2005, in Tallahassee, Leon County, Florida. Alan Levine, Secretary Agency for Health Care’Administration 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 THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Guize Cherisol Gerald L. Pickett Owner Senior Attorney Guize Cherisol, AFCH Agency for Health Care Admin. 13601 Northwest 2"? Avenue 525 Mirror Lake Drive N., # Miami, Florida 33168 St. Petersburg, Florida 33701 (U. S. Mail) (Interoffice Mail) 7 Jean Lombardi Elizabeth Dudek Finance & Accounting Deputy Secretary Agency for Health Care Agency for Health Care Administration Administration 2727 Mahan Drive, MS #14 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 Tallahassee, Florida 32308 (Interoffice Mail) (Interoffice Mail) ; _ Wendy Adams John G. Van Laningham Agency for Health Care Administrative Law Judge Administration Division of Administrative Hearings 2727 Mahan Drive, Bldg #3, MS #3 The DeSoto Building Tallahassee, Florida 32308 1230 Apalachee Parkway | (Interoffice Mail) Tallahassee, Florida 32399-3060 (U.S. Mail) ; 7 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the method designated, on this the LO* day of —ee— , 2005. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 FROM t” FAX NO. : May. @3 2885 @5:@9PM P1 ' STATE OF : FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION GUIZE CHERISOL, AFCH, _ Petitioner, . CASE Nos: AHCA 2004005514 vs AHCA 2004006539 . _DOAH 05-0805 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, ___ Respondent. . / STIPULATION AND SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through their undersigned representatives, and GUIZE CHERISOL (hereinafter “Petitioner”) 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, Petitioner is an Adult Family-Care Home licensed pursuant to Chapter 400 Part VII, Florida Statutes (2003), and Rule 58A-14, Florida Administrative Code, (2003); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Petitioner pursuant to Chapter 400, Florida Statutes; and WHEREAS, the Agency served Petitioner with an Administrative Complaint on August 2, 2004, notifying the party of its intent to impose an administrative fine in the amount of $2,500.00 and deny license renewal and; . WHEREAS, the Petitioner requested an Informal Administrative Proceeding by returning the Election of Rights form choosing Option 2; and WHEREAS, the cause was referred to the Division of Administrative Hearings for resolution of material disputed facts, and EXHIBIT Za tabbles’ ; FROM: FAX NO. : May. @3 2085 @5:1@Pm P2 WHEREAS, the parties have agreed thata fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and WHEREAS, the partes have negotiated and agreed thatthe best interest ofall the parties wil 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, Petitioner agrees to a withdrawal of its Petition for Formal and Informal Administrative Proceedings; agrees to waive any and all eppeals 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 (DOAR) of competent jurisdiction. 4, Upon full execution of this Agreement, Petitioner agrees to pay $1,875.00 (One Thousand Eight Hundred Seventy Five Dollars) in administrative fines 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. Guize Cherisol, AFCH, and Guize Cherisol, individually, agree: a. The license renewal application received by the Agency on or about April 5, 2004, will be denied, | “b. Not to apply for anew license, license renewal, or attempt to acquire an existing license, FROM: FAX NO. : May. @3 2885 @5:11PM P3 to operate any health care facility, including an Adult Family-Care Home, in the State of Florida for a period of two (2) years commencing on the date of the entry of the Final Order in this matter. 6. Petitioner does not dispute and admits the allegations of facts raised in the administrative complaint referenced herein. The Agency agrees that it will not impose any further penalty against Petitioner as a result of the 06/10/04 survey, however, no agreement made herein shall preclude the Agency from imposing a penalty against Petitioner for any deficiency/violation of statute or rule identified in a future survey of Petitioner. ; 7. 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. 8. 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. Petitioner 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 any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Petitioner or related facilities. il. This Agreement is binding upon all party's herein, | 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. FROM > FAX NO. : May. @3 2005 @5:11PM Pa 14. This Agreement supercedes any prior oral of written agreements between the parties. 15. ‘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 - Sai I 13601 Northwest 2nd AVenne, Miami, Florida 33168 Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 DATED: _Sf2?1/ Os . patep:_ 5 /3 [0S Agency for Health Care Administration 2727 Mahan Drive ; Tallahassee, Florida 32308 DATED: __&

Docket for Case No: 05-000805