FILS State of Florida Division of Administrative Hearings STATE OF FLORIDA, to Fe AGENCY FOR HEALTH CARE OCT IS &2 AYOA DEP ATHENT CLERK ADMINISTRATION, Ava! Petitioner, . vs. DOAH Case No: 02-3141 LPS QB, ACHA Case No: 2001053041/2002038491 | SARDONYX ASSOCIATES LIMITED PARTNERSHIP D/B/A PERIDOT PLACE/THE WOODLANDS Respondent. _/ FINAL ORDER The Agency for Health Care Administration, having entered into a Joint Stipulation and Settlement Agreement with SARDONYX ASSOCIATES LIMITED PARTNERSHIP D/B/A PERIDOT PLACE/THE WOODLANDS and the parties being otherwise fully advised in the premises, determines 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. Agreement. THEREFORE, it is ORDERED and ADJUDGED that the parties hereto are directed to comply with terms of the Joint Stipulation and Settlement apt DONE and ORDERED this wy day of Tallahassee, Leon County, Florida. “, 2002, in Rhonda M. Meadows cretary 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 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the following on this (é ) day of ¢ x ke oes , 2002. Jonathan S. Grout Esquire Goldsmith & Grout PA 2180 North Park Ave Suite 100 P O Box 2011 Winter Park, Fl 32790-2011 Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bidg #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) Wendy Adams Agency for Health Care Administration 2727 Mahan Drive Building #3 Mail Stop #3 Tallahassee, Florida 32308 interoffice mail Richard Joseph Saliba, Esquire-Senior Attorney AHCA 2727 Mahan Drive Building 3 MS Building #3 Mail Stop #3 Tallahassee, Florida 32308 (Interoffice Mail) Sa 4ptleland McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 STATE OF FLORIDA 9 fhe gs DIVISION OF ADMINISTRATIVE HEARINGS; Ip. nd ' A STATE OF FLORIDA, AGENCY FOR NOpgy hes. 4. HEALTH CARE ADMINISTRATION, Hees je eo fey wiveyRAyS ifdine fup Petitioner, DOAH Case No: 02-3141 AHCA Case No: 2001053041/2002038491 vs. SARDONYX ASSOCIATES LIMITED PARTNERSHIP D/B/A PERIDOT PLACE/THE WOODLANDS Respondent. STIPULATION AND § EMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the "Agency”) through their undersigned representatives, and SARDONYX ASSOCIATES LIMITED PARTNERSHIP D/B/A PERIDOT PLACE/THE WOODLANDS (hereinafter referred to as RESPONDENT), through their undersigned representatives, pursuant to Sec. 120.57(4), Florida Statutes (2001) each individually, a "party", collectively as "parties," hereby enter into this Stipulation and Settlement Agreement ("Agreement") and agree as follows: WHEREAS, Respondent is an assisted living facility licensed pursuant to Chapter 400 Part Il, Florida Statutes (2001), and Section 58 A-5, Florida Administrative Code, (2002); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent pursuant to sections 120,569 and 120.57, Florida Statutes; and Gd 288° ON Wdle-9 000e /7 “Oe 3ny WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent pursuant to sections 120.569 and 120.57, Florida Statutes; and . | WHEREAS, the Agency served Respondent with an Amended Administrative Complaint on June 10, 2002, notifying the party of its intent to Impose a fine for One Thousand Seven Hundred Fifty Dollars ($1750.00), and survey fee of Five Hundred Dollars (3500) 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, RESPONDENT, 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. 4. AHCA and Respondent agree that the Administrative Complaint consists of two counts. Count I purports to be an action alleging a Class II deficiency and 9d c18b° ON WdlE:3 C002 “Oe Sn¥ Count IT alleges an action for a Class III deficiency. AHCA agrees that Count Tis herein modified to allege a Class III deficiency rather than a Class II deficiency. ) 5. Respondent agrees to pay in full settlement of the disputed matter the sum of sum Two Thousand Two Hundred Fifty Dollars ($2,250) to the Agency within thirty (30) days of the rendition of the Final Order. Such payment shall not be construed as an admission ofa sanction by the Respondent, Payment shall be made to AHCA c/o Gloria Collins Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308. 6. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall vest in the Circuit ‘Court in Leon County, Florida. 7. Respondent neither admits nor denies the allegations set forth within the administrative complaint filed in the above referenced matter. The Agency agrees that it will not impose any further penalty against Respondent as a result of the survey that took place on or about August 23, 2001 and relative to the survey on or about date of May 20, 2002. However, no agreement made herein shall preclude the Agency from imposing a penalty against Respondent for any deficiency identified in a future survey of Respondent, which constitutes a "repeat" deficiency from the August 23, 2001 survey(s) and from the May 20, 2002 survey(s). The parties agree that in such 'repeat" Lid 7188" ON WdlE:9 C00 “GE any g ‘d case the deficiencies from the August 23 2001, survey(s) and from the May 20, 2002, survey shall be deemed found without further proof, 8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement. 9. Each party shall bear its own costs and attorney fees. 10. This Agreement shall become effective on the date upon which it is fully executed by all the parties, 11, Respondent 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 Respondent or related facilities. This Agreement is binding upon all party's herein and those identified in the aforementioned paragraph (1) of this Agreement. 12, The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 13. This Agreement contains and incorporates the entire understandings and agreements of the parties, 188° ON WdbE:9 = 200c "Qe say 14. This Agreement supercedes any prior oral or written agreements between the parties, 15. This Agreement may not be amended except in writing executed by all the individuals signing below and any attempied assignment of this Agreement shall be void. 16. The parties agree that AHCA is authorized to and shall submit a final order adopting and incorporating the terms and conditions of this settlement agreement without notice of hearing and that this settlement agreement shall be attached to the Final Order. 17. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement on behalf of the respective parties. Goldsmith, Grout & Lewis, P.A. Hx F, aren (8/3/02 Jonathan S. Grout Esquire Alex Finch, Esquire 2180 North Park Ave Suite 100 P O Box 2011 Winter Park, Fl 32790-2011 Deputy Setretary, Managed Care and Health Quality Assurance Agency for Health Care Administration 6d 2188'ON WdbE:9 2002 “De any patep_ GZ /b2 it ; / lola LWA Hy span Aeting General Counsel, ; Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 Kewl LZ paren 413} g% Ric eph Saliba, Esquire Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive Bldg. #3 Mail Stop #3 Tallahassee, Florida 32308 Ol “d 2188°ON WdBE?9 7002 “OE any

Docket for Case No: 02-003141