STATE OF FLORIDA . CD, Se, AGENCY FOR HEALTH CARE ADMINISTRATION ; AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2001052131 vs. AHCA No.: 2002002881 DOAH No.: 02-0673 , FLR PREMIER OP, L.L.C. d/b/a CS0-cls RENOVA HEALTH CENTER, RENDITION NO.: AHCA-03-C BC 2 -s-01€ 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, finds and concludes 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. 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 total fine of $7,500.00 is hereby imposed upon Renova Health Center. The fine is due and payable within thirty (30) days of the date of rendition of this Order. The conditional licensure status is upheld. 3. 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: Jean Lombardi Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, Mail Stop # 14 Tallahassee, Florida 32308. 4. Unpaid fines will be subject to statutory interest and may be collected by all methcds legally available. DONE and ORDERED this D aay of Seekes , 2003, in Tallahassee, Leon County, Florida. Rhonda N. Medows, MD, Secret Agency-for Health Care Adminis 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, 2 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 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive - Mail Stop # 14 Tallahassee, Florida 32308 (Interoffice Mail) Wendy Adams Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Florence Snyder Rivas Administrative Law Judge Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. Mail) Jonathan S. Grout, Esq. Goldsmith, Grout & Lewis, P.A. 2180 Park Avenue North, Suite 100 Winter Park, Florida 32790 (U.S. Certified Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the above-named addressees on this lO day of _ ( ‘ nya , 2003. Clee TiiteaSs 4©€ Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 4 AGENCY FOR HEALTH CARE a) ADMINISTRATION, Petitioner, AHCA No.: 2001052131 AHCA No.: 2002002881 v. DOAH No.: 02-0673 FLR PREMIER OP, L.L.C. @/b/a RENOVA HEALTH CENTER, Respondent. STIPULATION AND SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) by and through their undersigned representatives, and FLR Premier Op, L.L.C., d/b/a Renova Health Center, hereinafter (“Renova Health Center”) pursuant to Section. 120.57(4), Florida Statutes (2002) each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement. Agreement (“Agreement”) and agree as follows: WHEREAS, Renova Health Center is a licensed skilled nursing facility pursuant to Chapter 400, Part II located at 750 Bayberry Drive, Lake Park, Florida 33403; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over nursing homes pursuart to Chapter 400, Part II, Florida Statutes; and Page 1 of 5 d WHEREAS, the Agency served Renova Health Center with an administrative complaint notifying the party of its intent to impose an administrative fine of $10,000.00 [AHCA No.: 2001052131 and impose a conditional licensure status (AHCA No.: 2002002881] for four (4) Class II deficiencies. WHEREAS, Renova Health Center requested a formal administrative hearing in a petition to the Agency dated September 10,2001; 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 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, Renova Health Center agrees to a withdrawal of its Petition for Formal Administrative Proceedings; agrees to waive any and all appeals and Page 2 of 5 a 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. Upon full execution cf this Agreement, Renova Health nos Center agrees to pay $7,500.00 in administrative fines to the Agency within thirty (30) days of the entry of the Final Order. The conditional licensure status is upheld. 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. Renova Health Center neither admits nor denies the allegations raised in the administrative complaint referenced herein. The Agency agrees that it will not impose any further penalty against Renova Health Center as a result of the survey conducted on August 8, 2001, however, no agreement made herein shall preclude the Agency from imposing a penalty against Renova Health Center for any deficiency identified in a future survey of Renova Health Center, which constitutes a “repeat” deficiency from the survey conducted on August 8, 2001. Page 3 of 5 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. Rach party shall 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. Renova Health Center for itself and for its related or successers or wn resulting organizations, it 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, demancs, 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 Renova Health Center or related facilities. 10. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph nine (9) of this Agreement. 11. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. Page 4 of 5 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. The following representatives hereby acknowledge duly authorized to enter into this Agreement. ie LMD : HL Jo Me TE— “Tad — Elizabgth Dudek Deputy/Secretary Attorney for Respondent Managed Care and Goldsmith, Grout & Lewis, P.A. Health Quality Assurance 2180 Park Avenue North Agency for Health Care Suite 100 Administracion Winter Park, Florida 32790 2727 Mahan Drive Tallahassee, Florida 32308 Dated: Sitkiy Si Lz 3 Dated: S-AOQZ am) : felts (edi EE ~ Vaida Clark Christian General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Dated: Abe § 20% Page 5 of 5

Docket for Case No: 02-000673