STATE OF FLORIDA ace _ AGENCY FOR HEALTH CARE ADMINISTRATION ~~~ 07> 7h A828 fu A Sup BAY PINES MANOR, aad Petitioner, CASE Nos: 05-4659 2005010285 vs. STATE OF FLORIDA Bo = AGENCY FOR HEALTH CARE mse 5 “td ADMINISTRATION, resp D = a= Pl Respondent. ALS DP pe / od my Lad Qo FINAL ORDER Having reviewed the Notice of Intent to Deny dated December 6, 2005, 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 Agreement with the parties to these proceedings, and being otherwise well advised in the premises, finds and concludes as follows: ORDERED: 7 1. The attached Stipulation Agreement (Ex. 2) is approved and adopted as part of this Final Order and the parties are directed to comply with the terms of the Stipulation Agreement. 2. The Agency’s Notice of Intent to Deny is hereby withdrawn. 3. The Petitioner’s Petition for Formal Administrative Proceedings is hereby withdrawn. 4. Each party shall bear its own costs and attorney’s fees. 5. The above styled case is hereby dismissed. DONE and ORDERED this &O day of tnatc&A_ , 2006, in Tallahassee, Leon County, Florida. Alan Levine, Secretary Agency for Héalth 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: | Gerald L. Pickett Michael T. Grady Senior Attorney Bay Pines Manor Agency for Health Care Admin. 10591 Bay Pines Boulevard 525 Mirror Lake Drive N., #330K St, Petersburg, Florida 33708 St. Petersburg, Florida 33701 (U.S. Mail) (Interoffice Mail) Jan Mills Elizabeth Dudek Agency for Health Care Deputy Secretary Administration Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 | 2727 Mahan Drive, Bldg #1, MS 9 Tallahassee, Florida 32308 Tallahassee, Florida 32308 (Interoffice Mail) (Interoffice Mail) . _| __| T. Kent Wetherell, II Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. Mail) | 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 /¥ Gay of ¥ 6. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308-5403 (850) 922-5873 PAGE 42 92/88/2086 11:32 —_ ) aan ’ FLORIDVAGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR . ALAN LEVINE, SECRETARY Certified Article Number CERTIFIED MAILRETURN . ‘RECEIPT REQUESTED 21b0 390% 4859 PANN: EDad . SENDERS RECORD December 6, 2005 Michael T Grady Bay Pines Manor 10591 Bay Pines Blvd Saint Petersburg, FL 33708 RE: CC# 2005010285 NOTICE OF INTENT TO DENY Dear Mr.Grady: ‘ Itis the decision of this Agency that Bay Pines Manor renewal application for an assisted living facility be DENIED. ; . . The Specific Basis for this determination is: The applicant’s failure to pay all outstanding fines, liens, or overpayments assessed by final order of the agency pursuant to Section 400.831(1)(a) & (2) and 400.417(3), Florida Statutes (F.S.). The fine assessed are as follows: A one thousand five thousand dollar ($1,500.00) administrative fine pursuant to AHCA Clase . No. 2004005425 ALF rendered on September 28, 2004, 2 The applicant's failure to meet minimum licensure standards which includes, proof of liabili insurance, proof of compliance with background screening and page 9 of the application pursuant to Section 400.411(6)( 11) and Section 400.411 (3)(a) FS. and Section 58A4-5.014 (1)(a)1,5 and 11 Florida Administrative Code (F .A.C,), Therefore, the renewal application is being denied pursuant to Section 400,414(1)G) and (a), F.S. : af " EXPLANATION OF RIGHTS ~ Pursuant to Section 120.569, Florida Statutes, (F.S.) you have the tight to request an _ administrative hearing. In order to ‘obtain a formal proceeding before the Division of Vistt AHCA Onitne at + thea mttaeiaa an EXHIBIT AL » 2727 Mahda Drive ¢ Mail Stop 430 Tallahassee,'FL 32308 . AHCA PAGE ® 4 62/68/2986 11:32 a ‘ . , 7 Bay Pines Manor DBeceniber 6, 2005 Page 2° . hearing must conform to the: requirements in Section 28-106,201, Florida Administrative Coile’ . @.A.C), and.noust state the material facts you dispute. ; . ‘ : SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS ‘ : ” . Siticetély, . Lyry () : Wha * AGicc Copy to: Saint Petersburg Field Office -05 rs Administrator, District 05, Dept. of Children and Families me LTCOC District 05 an ' ‘ Jan Mills, General Counsel Office “ . a3 (@2/88/2686 11:32 wow AHCA 3 Ty . . @ J ) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES. (To be used with Election of Rights for NOt to Deny form ~ attached) In response to the allegations set forth In the Administrative Complaint issued-by the Agency for Health Care Administration (“AHCA" or “Agency"), Respondent must make one.of forrn. . “OPTION 1, If Respondent does not dispute the allegations In the- Administrative Complaint -and-Respondent elects to waive the right to be heard, Responcient should select’ OPTION 4 of. the election of rights form. A final order will be entered finding you gullty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. cos y : OPTION 2, If Respondent does not dispute any material fact alleged in the Administrative Complaint (Respondent admits: all the material facts alleged in the Administrative Complaint), Respondent may request an Informal hearing pursuant to Section 120.67(2), Florida Statutes before tha’ Ageney. At the informal hearing, Respondent will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the’ ‘Complaint. For an informal hearing, Respondent should salect OPTION 2 on the- Election 6? Rights’ forrn; ‘ ; OPTIONS. | If the Respondent disputes, the allegations set forth in the Administrative Compiaint (you do nat admit thern) you may request a formal hearing pursuant to Section 120.57(1), Florida . ” : Statutes. To obtain a formal hearing, Respondent should select OPTION 3 on the Election of. Rights fortn. ; : tn order to, obtain a formal proceeding before the Division of Administrative Hearligs under Section 120.57(1), F.S., Respondent's request for an administrative hearing must conform to ” the requirements in Section 28-106,201, Florida Administrative Code (F.A.C), and must state the. material facts disputed, . , option Is ‘not received by AHCA within twenty-one (21) days from the. date of’. Respondent's receipt of the Administratlva Complaint, a final order will be Issued finding’ | * « “! . the deficlancles and/or violations charged and imposing the penalty sought In the : Compiatnt. . PAGE 85 02/88/2086 11:32 a) AHA @ Pot ) STATE. OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: Bay Pines Manor - +" GASE NO: 2008010285." ELECTION OF RIGHTS FOR NOI TO DENY PLEASE SELECT ONLY 1 OF THE 3 OPTIONS - “An: Explanation of Rights is attached, ‘OPTION ONE (1) ___ Respondent does not dispute the allegations of fact contained In the Administrative Complaint and waives Respondent's right ta object or to be heard. Respondent understands that by waiving Respondent's rights, a tinal ‘order will be issued that adopts the Administrative Complaint and imposes the sanctions. Sought. , . OPTION TWO (2) * Respondent does not dispute and Respondent admits the allegations of fact in the Administrative Complaint, but Respondent does wish to. be 4fforded an informal Proceeding, pursuant to Section 120.57(2), Florida Statutes, at which - time ‘Respondent will be permitted to submit oral and/or written evidence to:the Agency in thitigation of the penalty imposed, ‘ : OPTION THREE.(3)___ Respondent does dispute the allegations of fact contained in’ the Administrative Complaint and Respondent requests a formal hearing, pursuant to. ‘Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the’ Division of Administrative Hearings. Cok lf Respondent chooses OPTION THREE (3), in order to obtain a formal proceeding: before thé Division of Administrative Hearings under Section 120.57(1), Florida Statutes.. - Respondent's request for an administrative hearing must conform to the requirements in’. * Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material” facts you dispute. ; In order to preserve Respondent's right to a hearing, Respondent's Election of ” Rights in this matter must be recelved by AHCA within twenty-one (21) days from: the date Respondent recelves the Notlce of Intent. If the election-of rights form ; with Respondent’s selected option Is not received by AHCA within twenty-one - (21) days from-the date of the Respondent’s receipt of the Administrative: ' Complaint, a final order will be issued findIng the deficlencies and/or violations: ' charged and Imposing the Penalty sought in the Complaint. , i or THREE (3) above. and if”. _ Respondent is:interested in discussing a settlement of this matter with the Agency, please ° al8o mark and check this black, O .o ‘ P 82/88/2086 11:32 i i. AHCA @ PAGE 66 . wvestatasnescnensnennenentendetnrtirtrertesantiahnbaedii mat nn FRO SR ABUT BAND BORA Deda ory addneas different from hen t? HYES, enter dallvery addraza balow; . : . i : MICHAEL T GRADY -. . . ts _ BAY PINES MANOR , eo “uel 30 cote 10591 BAY PINES'BEVD"""" ° i" ue SAINT PETERSBURG, FL 33708 HEALTH FACILITY COMPLIANCE . : RE: 11932380 SBINDEK; 14, 05, MS #30 . . : rt Zy4 PS Form S817, January 2008 “Dareate Rau Receipt ~ : ay yretos tt rere sek Seta e ie, wo : STATE OF FLORIDA ra 83 AGENCY FOR HEALTH CARE ADMINISTRATION F i tl. E PD 1006 APR IT A I 3g BAY PINES MANOR, ) nivis) ) OW OF Petitioner, ) ADIT aR ATIVE vs. ) DOAH Case No. 05-4659 NGS ) AHCA Case No. 2005010285 STATE OF FLORIDA ) AGENCY FOR HEALTH ) CARE ADMINISTRATION, ) ) Respondent. __) STIPULATION AND SETTLEMENT AGREEMENT - Petitioner, Bay Pines Manor (hereinafter Bay Pines), and the Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through their undersigned representatives, pursuant to Sec. 120.57(4), Florida Statutes (2005) each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Bay Pines is an assisted living facility, licensed pursuant to Chapter 400 Part III, Florida Statutes, and Rule 58A-5, Florida Administrative Code; and - WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing ~ authority over Bay Pines pursuant to Chapter 400, Part TI, Florida Statutes; and WHEREAS, the Agency served Bay Pines with a Notice of Intent to Deny its licensure on, or about, December 9, 2005; 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 EXHIBIT Zz. WHEREAS, Bay Pines has complied with all omissions for licensure described in the Notice of Intent to Deny, 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, Bay Pines agrees to a withdrawal of its Petition for a Formal Administrative Proceeding; 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 § 120.57(2), Fla. Stat. (2005), a formal proceeding under § 120.57(1), Fla. Stat. (2005), appeals under § 120.68, Fla. Stat. (2005); and agrees to waive declaratory and all writs of relief in any court or quasi-court (Division of Administrative Hearings) of competent jurisdiction. 4. Bay Pines, by executing this stipulation, admits the validity of the allegations raised in the Notice of Intent to Deny license referenced herein. 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. The Agency agrees to withdraw the said Notice of Intent to Deny and that it will not impose any further penalty against Bay Pines as a result of the omissions described in the December 6, 2005 Notice of Intent to Deny. However, no agreement made herein shall preclude the Agency from imposing a penalty against Bay Pines for any future deficiency/violation of statute or rule by Bay Pines. 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 shail 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. Bay Pines 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 Bay Pines or related facilities. 10. This Agreement is binding upon all party’s herein and those identified in the aforementioned paragraph nine of this Agreement. 11. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. : . 12. This Agreement contains the entire understandings and agreements of the parties. 13. This Agreement supercedes any prior oral or written agreements between the parties. 14. 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. abEL ET dele Elizabeth Dudek Deputy Sefretary, Health Qyélity Assurance Agenc¥ for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Yl [ence DATED: He Mr. Michael T. Grady Bay Pines Manor 10591 Bay Pines Blvd. St. Petersburg, Florida 33708 DATED: 3/6/0G vA wurrtrC lana Christa Calamas General Counsel, Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 patep: “i 7 da

Docket for Case No: 05-004659