ee rare STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION = PALM COURT NURSING AND REHABILIFATION CENTER Petitioner, vs. AHCA NO: 10-01-0056-NH RENDITION NO.: AHCA-02-0004-S-OLC AGENCY FOR HEALTH CARE ADMINISTRATION, NIV Respondent. / FINAL ORDER The Agency for Health Care Administration, having entered into a Joint Stipulation and Settlement Agreement with the parties to these proceedings, and being otherwise well advised in the premises, decides 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 that the parties hereto are directed to comply with terms of the Joint Stipulation and Settlement Agreement. . DONE and ORDERED this? /iay of LECE PNK , 2001, in Tallahassee, Leon - County, Florida. Se ae cada a or 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: Alba M. Rodriguez Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53” Street Miami, Fl 33166 (Inter-Office Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Inter-Office Mail) Linda Withers, Administrator Palm Court Nursing and Rehabilitation Center 2675 North Andrews Avenue Ft. Lauderdale, Florida 33311 (U. S. Certified Mail) . CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed.to the above-named - addressee on this Gtrotnes 4. 2002 ( Ws eer (i Yu os Spt Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, F132303 © - oak STATE OF FLORIDA! AGENCY FOR HEALTH CARE ADMINISTRATION PALM COURT NURSING AND REHABILITATION CENTER ; DOAH Case No. 01-3146 Petitioner, AHCA NO. 10-01-0056 vs. AGENCY FOR HEALTH CARE ADMINISTRATION Respondent. ST. IPULATION AND SETTLEMENT AGREEMENT Petitioner, Palm Court Nursing and Rehabilitation Center (hereinafter “Palm Court”) and Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through their undersigned representatives, pursuant to Sec. 120.57(4), Florida Statutes each individually, a “party”, collectively as “parties,” hereby. enter into this Stipulation and Settlement Agreement (hereinafter “Agreement”) and agree as follows: oo 1. Palm Court is a nursing home licensed pursuant to Chapter 400, Part Il, Florida Statutes (2001), and Chapter 59A-4, Florida Administrative Code, (2001 ). 2. The Agency has jurisdiction by virtue of being the regulatory and licensing authority over nursing homes pursuant to Chapter 400, Part II, Florida Statutes. 3. The Agency served Palm Court with a letter issued on July 3, 2001, notifying the party of its intent to impose a conditional licensure status effective June 8, 2001 for a a eee en eee ae Class Hf deficiency cited by the Agency during the survey of June 6-8, 2001. The alleged deficiency was.cited as a Class II, Scope and Severity of G (Tag 246). 4. Palm Court timely requested a formal administrative hearing in a petition to the Agency, which was referred to the Division of Administrative Hearings. , 5. 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. 6. The parties have negotiated and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and 7. In consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree that upon full execution of this Agreement: a. Palm Court agrees to a withdrawal of its Petition for Formal Administrative Proceedings: 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 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 (DOAH) of competent jurisdiction. b. The Agency will issue an amended Statement of Deficiency (Form 2567) reflecting that the deficiency described in Paragraph 3 of this agreement (Tag 246 cited on June 8, 2001) has been reduced from a Class II (Scope and Severity of G) to a Class II (Scope and Severity of D). Additionally, the Agency will issue an amended certificate to reflect that the nursing home license remained standard during the time period of June 8, 2001 through July 23, 2001. ce pt sey remem pee ook ae ne oc ee a i. ie ee bh 8. Upon full execution of this Agreement, Palm Court agrees that venue to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in the Circuit Court in Leon County, Florida, and shall be subject to all applicable provisions for interest, attomney’s fees, expenses, and costs for the prevailing party. 9. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement. 10. Each party shall bear its own costs and attorney fees. 11. This Agreement shall become effective on the date upon which it is fully executed by all the parties. | 12. Palm Court 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 Palm Court or related facilities. 13. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 14. This Agreement contains the entire understandings and agreements of the parties and supercedes any prior oral or written agreements between the parties and may not be amended except in writing. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Karen Goldsmith, Esq. Palm Court Nursing and Managed Care and Rehabilitation Center . Health Quality Assurance 2675 N. Andrews Ave. Agency for Health Care Ft. Lauderdale, Fl 33311 Administration DATED: WO DATED: _//- 42 -O/ “ William H. Roberts i Acting General Counsel Agency for Health Care Admin. 2727 Mahan Drive Tallahassee, FL 32308 DATED: Lily Seppe corer a meres ee oer 1) oe : STATE OF FLORIDA { : nea ABTA es | AGEHCYFOREALTN CARE ADMINISTRATION © ot JEB BUSH, G veknor’ al Ce pa rime nt 02 yh tala Nhvcer ACTING SECRETARY July 3, 2001 ; CERTIFIED. iE RETURN: RECEIPT REQUESTED Administrator #7099-3400-00 13-8446-0589 Palm Court Nursing & Rehabilitation Center 2675 North Andrews Avenue AHA S10-O1-COSENH Fort Lauderdale, Florida 33311 NOTICE OF INTENT TO ASSIGN CONDITIONAL LICENSURE STATUS Dear Administrator: In this case the imposition of a conditional licensure status is effective 6/8/01 and is issued Conditional as a result of the survey completed on 6/8/01. During this survey a Class II deficiency was cited due to the facility failure to ensure that a resident received the necessary services for a dental consult. The resident complained of a sore gum on 5/31/01 and an order was received for a dental consult. Nothing was done until 6/6/01 after the resident complained of jaw pain and had a swollen jaw. Resident was seen on 6/8/01 for dental services. This license reflects your current license status and must be displayed in a conspicuous place in your facility pursuant to section 400.062(5), F.S. ~ Pursuant to section 120.569, F.S., you have a right to request an administrative hearing. 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. . SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS Sincerely, Program Manager Long Term Care Health Facili ti e: acility Regulation maT Ai H : cc: West Palm Beach Field Office L Ms. Alba Rodriguez, Legal Dept., Miami Field Office . K. Munn, LTC Unit 2727 Mahan Drive « Mail Stop # 33 Tallahassee, FL 32308 - 4 | - i Visit AHCA Online at www. fdhe.state.fl.us

Docket for Case No: 01-003146