a ke ili oR HB ii la ees ta a ee le Als i sik, aa eres STATE OF FLORIDA __ AGENCY FOR HEALTH CARE ADMINISTRATION IHS AT GREENBRIAR, Petitioner, v. AHCA NO: 11-01-0155 NH CASENO: 01-3145 STATE OF FLORIDA, ae, AGENCY FOR HEALTH CARE ADMINISTRATION, soe a Respondent. ein / Choa os FINAL ORDER By letter, dated June 14, 2001, the Petitioner was notified of the Agency for Health Care Administration’s (AHCA) decision to change IHS at Greenbriar’s licensure status to “conditional” based on a Class III uncorrected deficiency cited on May 21, 2001. The Agency’s action letter, which explains the basis for the Class i deficiency, i is > attached hereto and incorporated herein. On July: 16, “2001, Petitioner served its Petition 1 for Formal Administrative Hearing, which disputed the factual basis of the Class III deficiency. The Petition was forwarded to the Division of Administrative Hearings (DOAH). On September 21, 2001, the Petitioner filed a Notice of Voluntary Dismissal with DOAH, which stated that it was dismissing, with prejudice, the above- captioned matter. On September 21, 2001, the administrative law judge closed the DOAH case and the jurisdiction reverted back to the Agency. Based on the foregoing, it is ORDERED: oo 4 ai fe 1 co er a oes ere sa ane Pry >) a a DONE and ORDERED this /3-day "Heats tig Tallahassee, Leon County, Florida, 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 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: Pury Lopez Santiago Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 (by inter-office mail) Diana Lopez Castillo Field Office Manager Agency for Health Care Administration 8355 N. W. 53” Street Miami, Florida 33166 (by inter-office mail) Long Term Care Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (by inter-office mail) ce eres a ars J.D. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (by U.S. mail) Jonathan Grout, Esquire Goldsmith & Grout, P.A. 2180 North Park Avenue, Suite 100 Post Office Box 2011 Winter Park, Florida 32790-2011 (by U.S. mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a tre 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 £8 day of G pbs (ney , 2002. lene Thue " SpCgency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865 PO mr CORE PRR IR FTE sapere Ieee ee allie ilk a, a renee ll Ttraueuh LOTo¥ FAA 3U5z735830 IES af GREENBR ran / . oo, 002 A RO FA ee 5 eo i . 1 ¥ Stare os Lona | ~AHCA LiuRs BRANKER, ACTING SECRETARY — JES BUSH, GOVERNCR 2001 CERTIFIED MAIL ime 14 20 RETURN RECEIPT REQUESTED Administrator #7085 3400 0013 $446 1494 THS at Greenbriar H- : 9820 North Kendall Drive Miami, FL 33176 Aye 4 A b. [[-C[~ C155 Mii NOTICE OF INTENT TO ASSIGN CONDITIONAL LICENSURE STATUS ‘ Dear Admmistrator: In this case, the imposition of a conditional Ijcensure stamis is effective May 21, 2001, and is issued Conditional as a result of the survey completed on May 21, 2001. During this survey, Class IT uncorrected deficiencies were cited for failure to keep resident free of restraints, and failure to maintain proper clinical records. This license teflects your curren: license status and maust be displayed in a conspicuous place in your facility pursuant to sectio:: 400.062(5), Florida Statutes, (F.S.). i to obtain a formal proceeding before the Division of Administrative Hearings under Section *° 120.57(1), F.S., your request for an administrative bearing must conform te the requirements in Section 28-106.201, Florida Administrative Code (-AC.), and must state the material facts you dispute. . : SEE ATTACHED EXPLANATION OF RIGHTS AND ELECTION Ge RIGHTS FORM Hesith Facility Regulation ‘ec: AHCA Area Office (11) E. Santiago, AHCA Attomcy eed UL Crider, LTC Unit 2727 Mahan Drive s Mf3i1 Stop #33 Tallahassee, FL 32308 0G) Viels AHCA Online at I www fdke.rigte/lus — EXHIBIT _/“"® . Poem cre cee reppe e arr an a oe ree eae ae eee wi i fb Pe Is py in] i] JUL 19 2001 2) L J ay STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION IHS AT GREENBRIAR, Petitioner, -vs- CASE NO. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / - — . PETITION FOR FORMAL ADMINISTRATIVE HEARIN G EEE AL ADMINISTRATIVE BEARING COMES NOW, IHS AT GREENBRIAR (“Greenbriar”), by and through its undersigned . counsel and files this, its Petition for Formal Administrative Hearing, pursuant to Chapter 120.57(1), Florida Statutes, and in support thereof, states the following: I. PARTIES 1. This is a Petition for Formal Administrative Hearing pursuant to Section 120.57(1), . Florida Statutes. . 2. Petitioner, Greenbriar, is a nursing home located at 9820 North Kendall Drive, Miami, Florida 33176, licensed by the State of Florida. 3. The agency affected is the Agency for Health Care Administration ("AHCA"), whose address is 2727 Mahan Drive, Tallahassee, Florida 32308, - 4. The office directly responsible for the action set out in this Petition is the Long Term Care Unit located at 2727 Mahan Drive, Tallahassee, Florida 32308. tnd rrr SSE Cm ere er oe a 5. Petitioner, Greenbriar, has standing to make this Petition because its substantial interests have been directly affected by the agency action complained of, as will more particularly be set forth below. Il. BACKGROUND 6. This Petition for Formal Administrative Hearing arises out of a decision by AHCA to change Greenbriar's licensure rating to conditional effective May 21, 2001. This is set out ina letter dated June 14, 2001 from Molly McKinstry, Long Term Care Unit, AHCA, a copy of which is attached hereto as Exhibit "A." 7. Greenbriar takes exception to the position taken by AHCA. It is the contention of Greenbriar that Greenbriar is entitled to a standard tating on its license for the year in question. Greenbriar did provide appropriate care to the residents cited, did maintain proper clinical records and did not have any uncorrected deficiencies. 8. The substantial interests of the Petitioner are affected by the Agency action taken. The community reputation is damaged by a conditional licensure rating. IU. CLAIM FOR RELIEF 9. The facts presented in the hearing will demonstrate that Greenbriar is entitled to a standard rating on its license. The position of AHCA is contrary to the facts and/or the law. WHEREFORE, Petitioner, Greenbriar, requests the following relief: a. That this matter be forwarded to the Division of Administrative Hearings pursuant to Section 120.57(1), Florida Statutes; | b. That a Recommended Order and a Final Order be entered finding that Greenbriar is entitled to a standard rating on its license; and © c. That attorneys' fees and costs be awarded to the Petitioner. core ses mE peE RptN ee fab liga a. RESPECTFULLY SUBMITTED this MF ay of July, 2001. I HEREBY CERTIFY that the original of the foregoing has been furnished by facsimile and overnight delivery to Pury Santiago, Senior Attorney, Agency for Health Care LL Administration, 8355 N.W. 53™ Street, Miami, Florida 33166, this VL. Z day of July, 2001. JONATHAN S. GROUT, ESQUIRE GOLDSMITH, GROUT & LEWIS, P.A. 2180 Park Avenue North, Suite 100 Post Office Box 2011 Winter Park, Florida 32790 407/740-0144 Attorneys for Petitioner Florida Bar No. 296066 PO A AO A TE omer coger ompeee STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS IHS AT GREENBRIAR, Petitioner, -vs- CASE NO. 01-3145 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. NOTICE OF VOLUNTARY DISMISSAL COMES NOW Petitioner, IHS AT GREENBRIAR, by and through its undersigned attorneys and hereby gives notice of its voluntary dismissal, with prejudice, of the above- captioned matter. RESPECTFULLY SUBMITTED this XY day of September, 2001. I HEREBY CERTIFY that the original of the foregoing has been furnished by facsimile to Administrative Law Judge J.D. Parrish, 850/921-6847, Division of Administrative Hearings, with a copy by mail delivery to Pury Lopez-Santiago, Esquire, Agency for Health Care Administration, 8355 N.W. 53" Street, Koger Center, First Floor, Miami, Florida 33166, thisc7/ day of EXHIBIT 3 cope wre ope opr September, 2001. JOMATHAN S. GROUT, ESQUIRE GOLDSMITH, GROUT & LEWIS, P.A. 2180 Park Avenue North, Suite 100 Post Office Box 2011 Winter Park, Florida 32790 407/740-0144 Attorneys for Petitioner Florida Bar No. 296066 Sore MEET Pe RR enn monger eee eee STATE OF FLORIDA - DIVISION OF ADMINISTRATIVE HEARINGS ‘| ps if l t . ame a Case No. 01-3145 IHS AT GREENBRIAR, Petitioner, vs. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ORDER CLOSING FILE This cause having come before the undersigned on Notice of Voluntary Dismissal, filed by Petitioner on September 21, 2001, and the undersigned being fully advised, it is, therefore, ORDERED that: 1. The final hearing in this cause scheduled for October 25, 2001, is hereby cancelled. 2. The file of the Division of Administrative Hearings in the above-captioned matter is hereby closed, and jurisdiction is hereby relinquished to the agency. EXHIBIT Poy “B ee eeges: Se gece .

Docket for Case No: 01-003145