STATE OF FLORIDA _ AGENCY FOR HEALTH CARE ADMINISTRATION MCT 17 Q2 AHCA CENTER, EXTENDED CARE loaf AEPARTHMENT CLERK YP Ml Petitioner, DOAH de NO, 01-0026 AHCA NO. 2000050561 Vv. oO th AGENCY FOR HEALTH CARE nee BOF ADMINISTRATION, ae ~ Respondent. ea a ft J ~ wo oe FINAL ORDER — The Agency for Health Care Administration, having entered into a Settlement Agreement with the parties to these proceedings, and being otherwise well advised in the premises, decides as follows: The attached 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 Settlement Agreement. THEREFORE, it is ORDERED and ADJUDGED that the parties hereto are directed to comply with terms of the Settlement Agreement. 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 Gloria Collins, Agency for Health Care Administration, 2727 Mahan Drive, Mall Stop #14, Tallahassee, Florida 32308. Unpaid fines will be subject to statutory interest,.and may be collected by all methods legally available. DONE and ORDERED this 22> day of 2002 in Tallahassee, Leon County, Florida. Rhonda M.)Medows, MD, Secreta 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: Theodore E. Mack, Esq. Powell & Mack, P.A. 803 North Calhoun Street Tallahassee, Florida 32308 (U.S. Mail) John F. Gilroy, Esq. Senior Counsel Mail Stop #3 (Interoffice Mail) Gloria Collins Finance & Accounting Mail Stop #14 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Mail Stop #9 (Interoffice Mail) Wendy Adams Mail Stop #3 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named persons and entities by U.S. Mail, or the method designated, on this | tay of (4.2002. Gyfatei Them ison Sstealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850)-922-5873 JFG/sr aan ee per ee ey 2727 Mahan Drive « Mail Stup #33 EXHIBIT ce , . FILED ot JAN“ PH E49 RUBEN J. XING-GHAW, JI OF AGUIMISTRATIVE FLED/RETURN RECEIPT REQUESTER ES JEB BUSH, GOVERNOR, November 9, 2000 iCER’ Ms. Renev Steen | Lake City Extended Care Center if 1001 S. Ermine Street | Lake City, Morida 32055 \, j NOTICE OF Dear Ms. Steca: A fine of $5,000 is hereby imposed duc toftl renewal for Lake City Extended Care Cer The: upplication for license renowal wus die to the gency for Health Caro Administration by October 2, 2000. Lowever, the applicatics ur received on November 6, 2000, thirty-four (34) days late. Pursuant to Section 400.111, Flp pda Sustutes, (F.S.) the Agency must assess a finc for license renewal applications that are not reel ved af least 90 days prior to the license expiration date. A fee af one half the total facility Ligbrise ix abvessed for each day beyond the license duc date, up to a maximum of $5,000. | | | | (Pleaxe include a copy of this Notice of 1 gat} PAYMENT SHOULD BE SENT TO: Agency for Health Care Administration Long Terra Care Unit, MS-33 2727 Mahan Drive Tallahassee, FL 32308 Pursuant to Section 120.569, P.S., you hay q bike fight to request un administrative hearing. Jn order to obtain a formal proceeding before the Divitoa of Administrative Hearings under Visit ANCA Online ot ° Valblahassee, Fl. 32308 www Sdewatare fl. us Page 2 Section 120, S71), FS., your request for 4 administrative hearing must conlonm to > the requirements in Section 28-106.201, Flori : Adm istrative Code (i.A.C), and must state the material facts you dispute. opportunity to present both written and o violations set out in the Notice of {ntent. {n this matter, jation under Section 120.573, F.S., Is not available All requests for hearings shall be filed with the Ag acy for Health Care Administration within twenty-one (21) days of receipt of this letd ay ‘gilre to submit either payment or a request for hearing will result in the cniry ofa final 9: ie impésing the flac sought. Any request shall bc sent to; | Agency for Health Care Administration Tracey Cottle, Esq., Senior Attorney | 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32368 (Plcase include a copy of this Notice of Th : Sincerely, Molly McXinstry, Program et Long Term Care Unit co: = Ms. Tracey Cottle, MS #3 Ms. Cora Kurz, AO3 K. Munn, LTC unit _EXHIBIT Zz STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: CASE NAME CASE NO. ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE (1) 8 1 do not dispute the allegations of fact contained in the Administrative Complaint and waive my right to object or to be heard. | understand that by waiving my rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) 8 { do not dispute and | admit the allegations of fact in the Administrative Complaint, but do wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time | will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) @ {do dispute the allegations of fact contained in the Administrative Complaint and request a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. If you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your 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 your right to any hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. if you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. 0 Mediation under Section 120.573, Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW - REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL YOU RECEIVE A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your current address.) Respondent (Licensee) Address: License. No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: [INSERT AREA ATTORNEY NAME AND INFO]], Agency for Health Care Administration, (Note: Overnight Deliveries to , FL 32308-5403.) Telephone Number: > FAX + TDD 1-800-955-8771. EXHIBIT 4 4 flys ms 13 EILED SEM STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINS TRATIONS 49 pivistOl OF zeae! 1 “ Many 2 :) fn LAKE CITY EXTENDED ADMINIS) RAY CARE CENTER, HEARINGS Petitioner, - 2 ve. casENO, ©! OCzz.4o 3 AGENCY FOR HEALTH ~ CARE ADMINISTRATION, Respondent. PETITION FOR FORMAL ADMINISTRATIVE HEARING Petitioner, Lake City Extended Care Center ("Lake City"), by and through undersigned counsel, hereby petitions the Agency for Health Care Administration ("Agency") for a formal administrative hearing pursuant to Section 120.57(1), Florida Statutes. In compliance with Chapter 28-5.201, Florida Administrative Code, Lake City alleges: 1. The agency affected is the Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308. 2. The petitioner is Lake City Extended Care Center. For purposes of these proceedings, Lake City's address is that of undersigned counsel. 3. Lake City's substantial interests are affected by the Agency's determination that it is subject to a $5,000.00 fine. Specifically, AHCA has alleged that Lake City was not in compliance with Section 400.111 for failure to file its license renewal application in a timely manner. fo | 4. Official notice of the Agency's action was given Lake City through letter dated November 9, 2000. (Copy attached) 5. The disputed issues of material fact involve the Agency’s decision to impose the maximum fine prior to the date of license renewal. In addition, the Agency has arbitrarily issued the maximum fine without considering any mitigating circumstances. The Agency's imposition of a maximum fine under these circumstances is also discriminatory in that the Agency issues lesser fines to other health care providers for similar infractions. 6. Through prior final order, the Agency has recognized that mitigating circumstances are to be taken into account when issuing such fines. See, Home Nursing Services, Inc. v, AHCA, Case No. 98-96 PH, Rendition No. AHCA-98-396FOI-OLC. 7. Lake City asserts that, among other things, the Agency should have considered as mitigation the fact that the renewal is merely a formality, since ownership of the facility has not changed. As such, there was no potential harm to the public, and any inconvenience to the Agency was minimal. 8. Lake City is entitled to relief pursuant to Chapter 120, Florida Statutes and Titles 28 and 59, Florida Administrative Code. WHEREFORE, Lake City requests: (a) That The Agency for Health Care Administration refer this matter to the Division of Administrative Hearings to conduct a formal administrative hearing pursuant to Section 120.57, Florida Statutes if the issues cannot be first resolved through settlement or mediation. (b) That recommended and final orders be issued reducing the penalty to Lake City based upon the Agency’s treatment of other health care providers and in consideration of mitigating circumstances. Submitted this 27th day of November, 2000. Theodore E. Mack Powell & Mack 803 North Calhoun Street Tallahassee, Florida 32303 (850) 224-1452 Attorney for Lake City CERTIFICATE OF SERVICE | HEREBY CERTIFY that the original of the foregoing has been furnished by hand delivery to Sam Power, Agency Clerk, Agency for Health Care Administration, Fart Knox Executive Center, 2727 Mahan Drive, Building 3, Room 3426A, Tallahassee, Florida 32308 and a copy furnished by U.S. Mail to Tracy Cottle, Esquire, Senior Attorney, AHCA, 2727 Mahan Drive, Mail Stop #3, Tallahassee, FL 32308, this 27th day of November, 2000, Theodore E. Mac!

Docket for Case No: 01-000026