STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, au 4 etitioner Ps few 3 vs. AHCA No.: 2002046628 09750 © DOREEN T. ADAM, d/b/a THE MAYFLOWER, ~ “oO ‘ 7 Respondent. Rendition No.: ABCA G95C\ ic 25- OFS) / - = FINAL ORDER ao 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 <2 day of “_, 2003, in Tallahassee, Leon County, Florida. OE sage he Rhonda M. Medows, , Secretary 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. Copies furnished to: Joanna Daniels, Esq. Assistant General Counsel Agency for Health Care Administration 2727 Mahan Dr., Suite 3808-D Tallahassee, Florida (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 & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308 (Interoffice Mail) James M. Stewart, Sr., Esq. Stewart & Bellefeuille 212 North Marion Avenue Lake City, Florida 32025-3917 Barbara J. Staros Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Wendy Adams (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 Zz] day of \ feneus Cu , 2003. -o@.Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA 9 pe A) DIVISION OF ADMINISTRATIVE HEARINGS “2 29 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH Case No: 02-4750 v. AHCA Case No: 2002046628 DOREEN T. ADAM, d/b/a THE MAYFLOWER Respondent. / esses STIPULATION AND SETTLEMENT AGREEMENT SERRA IVR AND SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through their undersigned representatives, and DOREEN T. ADAM, d/b/a THE MAYFLOWER, (hereinafter referred to as RESPONDENT), 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 (“Agreement”) and agree as follows: WHEREAS, Respondent is an assisted living facility licensed pursuant to Chapter 400 Part III, Florida Statutes and Section 58 A-5, Florida Administrative Code, 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 WHEREAS, the Agency served Respondent with an Amended Administrative Complaint on October 29, 2002, notifying the party of its intent to Impose a fine for One Thousand Dollars ($1000.00); 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. The Parties agree that this matter should be remanded. The PETITIONER agrees to present no evidence on the Amended Administrative Complaint served on October 29, 2002 and agrees to submit the matter to final order for dismissal. 5. 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. 6. 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 April 15, 2002 and May 7, 2002. However, no agreement made herein shall preclude the Agency from imposing a penaity against Respondent for any deficiency identified in a future survey of Respondent, which constitutes a “repeat” deficiency from the April 15, 2002 and May 7, 2002 survey(s). The parties agree that in such ‘repeat” case the deficiencies from the April 15, 2002 and May 7, 2002, survey(s) shall be deemed found without further proof. 7. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement. 8. Each party shall bear its own costs and attorney fees. 9. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 10. 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. 11. 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. 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 attempted 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. We 7a DATED_2/ 7/03 ames M. Stewaft, Sr., Esquire STEWART & BELLEFEUILLE 212 North Marion Avenue Lake City, Florida 32025-3917 Florida Bar No. 113727 Attorney for Respondent DOREEN T. ADAM, d/b/a THE MAYFLOWER Achaea fig fs DATED fees (el Elizabeth Dudek Deputy Secretary, Managed Care and Health Quality Assurance Agency for Health Care Administration MO ste pagl) oe Oily Khe DATED ee KS Valda Clark Christian General Counsel, Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 “9 Cp ff oanna Daniels Assistant General Counsel Agency for Heaith Care Administration 2727 Mahan Drive Bldg. #3 Mail Stop #3 Tallahassee, Florida 32308 Snnnnelieittieheemmmemmmmneenninie ee

Docket for Case No: 02-004750