STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION BEVERLY HEALTH AND REHAB feiss nur 12 09 CENTER ENGLEWOOD POL ep Petitioner, CASE NO. 02-1583 Loy) Ey AHCA No.: 2002021491 clonaech vs. Oo ~ ay AGENCY FOR HEALTH CARE Be Ble ADMINISTRATION, Es - “ ot Respondent. E & _/ FINAL ORDER D = ay ah on ne The Agency for Health Care Administration, having entered into a Joint Stipulation Agreement with the parties to these proceedings, and being otherwise well advised in the premises, decides as follows The attached Joint Stipulation Agreement (Ex.. 1) 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 Agreement THEREFORE, it is ORDERED and ADJUDGED that the parties hereto are directed to comply with terms of the Joint Stipulation Agreement DONE and ORDERED this day of Tallahassee, Leon County, Florida hake , 2002, in 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: Dennis L. Godfrey, Esq. Administrative Law Judge Senior Attorney DOAH ~ The DeSoto Building a . 1230 Apalachee Parkway Agency for Health Care Administration Tallahassee, FL 32399-3060 525 Mirror Lake Drive, #330L St. Petersburg, FL 33701 (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) Gloria Collins Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308 (Interoffice Mail) R, Davis Thomas Broad and Cassel P.O. Drawer 11300 Tallahassee, FL 32302 Wendy Adams Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #3 Tallahassee, Florida 32308 (Inter-office 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) by U.S. Mail, or the method designated, on this the 1Q day of , 2002. ag ha McCharen, tray faby Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 921-8177 ‘ P 87/89/2802 14:11 7275521440 . .',__AHCA AGE a2 © 87/08/2802 13:99 7275521 dag ee | EXHIBIT | F State or FLORIDA AGERCY FoR HRALTE CARR fc arencrom ! ! BL, i wt BRVERLY MRALTE AND REHAB i y rm) a XNGLENCOD, ' Se Bott : | cee OL om _ 2 va, Pebitdoner, ANCA wo: 2002922491, ee a om i _e ae AONNCY YOR WHITH canE @ Ne) ADMINIRTRATIOR, ' Oe. on ! Sm t ! m n Respondent. 1 . pe / | ! ' Str: ON Respondent, Strate of Florida, Agency for Health Care Admindetration (hereinafter the “agency”) through their undqrsigned representative, and Beverly Health and Rehab Center Englawooa, Pdt itioner (hereinafrar “Beverly | Health and Rehab Center Englawosa” or “Pati tidoner”) pursuant to Sac, I . 120.574), Plorida Statutes (2001) each individually, &@ “party”, collectively | a8 “parties,” hereby enter anto this Sepalasien Agreement (“Agreement”) and agree 46 follows: j ; WHEREAS, Petitionar, Bavarly Healty and Rahab Center Rnglewoaa, ig a nuraing home facility licensed Purauant to ctlapter 400, part IZ, Florida Statutes (2001), and Chapter S9A-4, Plorida Aaninistracive Code, (2001); and WHERRAA, the Agency bas jurisdiction by virtue of being the regulatory and licensing authority over Peedtionar pursdant to Chaptex 400, Part ZZ, { Florida Statutes, and H WHEREAS, tha Agenoy on auguee 24, 2002 lsent the Petitioner a orice of | Tatent to Asaign a Conditional Ligengura Statue indicating that the agency H i was jeguing a Conditional rating te the Petitioner ettecedve April 21, 2061; . t and WHEREAS, Petitioner timely requested a [Poxmat adminiatraeive hearing in t & peeition to the Agency dated march 20, 2007 (AHA No. 20090224915; and 20d 80:ST z00z 6 Inc Ov29-28p~0S8:xe4 SoTLUNOCYSH/OH 8 IH sa ste PAGE @3 87/89/2882 14:11 7275521449 “ V BHCA rn ' 87/99/2002 13:33 7275821449 Arica} | PAGE a3 i i t WHEREAS, the parties have greed chat & fair, efficient, and coat i effective rasolution of this digpute would apold the expenditure of Substantial guma to litigate the Alegute, J WOW TREREVORE, in Consideration of the! meual promisea and racitais herein, the parties intending to be legally hound, agree as follows: I 1. All recitals are txue and sorreet and are expressly incorporatad ! herein. i i 2. RBOtN parties 49teeq that tha “whereas” Glauses incorporated herein t are binding findings af the partion, | 3.) Upen rua Qxecution of this Agreetant, Beverly Health and rehab | Center Bnglewood agrees to a withdrawal of ith romeat for formal administrative Proceeding, 4, The parties further aqree as follows; (a) As a result of the Informal Diopite Rerolution (IDR) meeting fondusted on §/11/01, the Agency reclassified deficiencies previously described under Tage ¥282 and Tagr 514 as ond deficiency under F426; as a Foault of the reclagwificarion of these aericleneies, there is no legal justification ar the dawuance af a Conditionda license on 4/24/02. Upon full execution of thig Agreement, the Agency agreds to rescing the Notice of Intent te Assign Conditional Licensure Statud a6 stated in the Agency’ a letter dated Auguer 28, 2003, and reseind en Conditional rating it Previously issued to the Petitioner; the Agerey further agvees to ra-lague a standard license and amend any list thar is qreated or maintained by the Ag@ncy that indicates that the faeiiity had ‘ conditional license during the period at iague, including, the list commonly know ag the watch list. 5. Upon #441 execution of thig Agreqment,, the Agency shall enter a Pinal Oxder adopting and incorporating the edrma Of Chit Agreement, and diemissing the above-styled case. 6. Bach party shall beax ite own costa and acgorney faag. i I 2 £0'd 80:ST Z00Z 6 Inc Ot29-28p~0gg: xe 4 SAT LUENOAYFH/0H 8 OW _O @7/09/28@2 14:11 _ 7275521449 . AHCA PAGE 94 * 87/89/2062 13:33 7275801448 AHCA PAGE 4 | | 7, ‘Thiw Agreement shal become ottedtive on the date wpen which tt ds fully oxecucea by 412 the parties, i 8. Beverly Health and Rehab Center aglewsed fer iewelé and for ite related or ramulting Organizations, ito succdasors or transferees, attorneys, beixa, and sxecutors or administrators, does 'hereny Shacharge the stare of Florida, Agendy foY Health Care Adminiatration, and ite agents, represenkativas, and attorneys of and from alt Cladma, demanda, actions, causes Of action, puite, Qamages, Lloseag, and expenses, of any and every nature whatsoever, ariaing owe of om in any dey related to thin matter and the Agenay's actions, including, but not limited to, any cladma that were or Way be anserted in any federal or atata coure of administrative forum, dnehuding any claims arising out of thing agrdenent, by or on hehalf of Reverly Health and Rehab Center Englewood or irenaced faciiities, a. This Agreement is binding upon alt party's herein and those identified dn tha aforementioned paragraph nine (9) of this agreement. 1@, The underaigned have read and sndocrta thin Agreement and have authority to bind thetr reepsdtive principale fe ir. Al. This agreament Oottaings the entite underatandings and agraements of the parties, : 12, 9 This Agreement supercedes any prior oral ox written agreements between the parties. 23.0 Thi Agreenient may not be amended except in writing, Any attempted asaignment of thie Agreement skall Ine void, WO'd 60:61 zZ00zZ 6 inc OVZS-28V-068: x84 — SYA AIUNOGUSH/OH 3 OW OO ie 87/89/2802 14:11 727552144a ~ «* AHCA PAGE @5 arves/2ee2 13:49 versa.) gal ge ch Dugex Deputy ecret ary, Managed) Care and Broad and Caage Tallahasnee, Florida 23401 Healttr’ Quality Ageurance 850-691-6810 Agency for Hamlth Carg Abtorney for Petitioner Adminisrratjon, ' 1 \ . DATED; (2p DATED: July 9 , 2002 william #H. Roberta Acting General Counsel, i Agency for Health Care : Admini atration ' 4747 Mahan Drive | Tallahassee, PL, 32300 ‘ i t ! DATED ; Lap D~ , S0'd 60:ST 2002 6 Inc OFCS-28¥-058: XE SUA LAENOLEH/OH 3 OW

Docket for Case No: 02-001583