ee ae ‘ Sg STATEOF FLORIDA ?-» FILED AGENCY FOR HEALTH CARE ADMINISTRATION - ».5 53 STATE OF FLORIDA ASDA AGENCY FOR HEALTH CARE DESARTMEM” CLERM ADMINISTRATION, Petitioner, AHCA NO. 2002049149 2003000068 _. vs. DOAH NO. 03-1536 Ek KW bored 03-1603 cee DOKL THE HEALTH CENTER OF ORLANDO, INC., Rendition fo) HCA d/b/a THE HEALTH CENTER OF WINDERMERE, — 8 Respondent. mo, 8 an / ° co FINAL ORDER ce pO oy Having reviewed the administrative complaints dated January 21, 2003, attached hereto and incorporated herein (Ex. 1 & 2), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a 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 Stipulation and Settlement Agreement (Ex. 3), 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. 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, DONE and ORDERED this —day of ecpese , 2003, in Tallahassee, Leon County, Florida. Lbs tb hehe Rhonda Medows, MD, Secretary Agency foy Health Care Administrati A 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 THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Donna Holshouser Stinson, Esq. Broad and Cassel 215 S. Monroe St. Suite 400 Tallahassee, FL 32301 (U. S. Mail) Katrina D. Lacy, Esq. AHCA, Senior Attorney 525 Mirror Lake Dr. N. #330G St. Petersburg, FL 33701 (Interoffice Mail) Jean Lombardi AHCA, Finance & Accounting 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308 (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) Wendy Adams Agency for Health Care Administration 2727 Mahan Drive, Bldg #3 MS #3 Tallahassee, FL 32308 (Interoffice Mail) William Roberts AHCA, Hearing Officer 2727 Mahan Drive, Bldg #3 MS #3 Tallahassee, FL 32308 (interoffice Mail) T. Kent Wetherell, II, AU Div. Administrative Hearings 1230 Apalachee Parkway Tallahassee, FL 32399-3060 (U.S. 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) and entities by U.S. Mail, or the method designated, on this theQ7 day of « ALG ust _, 2003. fLealand McCharen, Agency rk S 4 Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 921-8177 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION EXHIBIT 5 tabbies” AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2002049149 THE HEALTH CENTER OF ORLANDO, INC., d/b/a THE HEALTH CENTER OF WINDERMERE Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against THE HEALTH CENTER OF CRLANDO, INC, d/b/a THE HEALTH CENTER OF WINDERMERE, (hereinafter referred Respondent), pursuant to Section 120.569, and 120.57, Florida Statutes, (2002), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Respondent, pursuant to Section 400.102, Florida Statutes (2002) and assess costs related to the investigation and prosecution of this case, pursuant to Section 400.121(10), Florida Statutes (2002). JURISDICTION AND VENUE 2. Venue lies in Orange County, Division of Administrative Hearings, pursuant to Sections 120.569 and Pa 120.57, Florida Statutes (2002). 3. Venue ve__s pursuant to’ Rule 28-106.-7, Florida Administrative Code. PARTIES 4. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended); Chapter 400, Part II, Florida Statutes (2002), and; Chapter 59A-4 Fla. Admin. Code, respectively. 5. RESPONDENT is a nursing facility whose 120-bed nursing home is located at 4875 Cason Cove Dr., Orlando, FL 32811. RESPONDENT is licensed to operate a skilled nursing facility pursuant to license #SNF130470967. At all relevant times, RESPONDENT was a licensed facility required to comply with all applicable regulations, statutes and rules under the licensing authority of AHCA. COUNT I RESPONDENT FAILED TO ENSURE THAT EACH RESIDENT RECEIVED THE NECESSARY CARE AND SERVICES IN VIOLATION OF 42 CFR §483.25, VIA Fla. Admin. Code R.59A-4.1288 UNCORRECTED CLASS III DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. { 7. On or abou. October 7, 2002, AHCA co...ucted a survey at Respondent’s facility. 8. Based on record review and interview, Respondent failed to ensure that each resident received the necessary care and services for one of twenty-two sampled residents (#2). The findings include: Based on record review, it was documented that an order for Clonidine (Catapres), a medication used for the control of high blood pressure (BP), was written on 09/06/02. The order documented: Clonidine 0.1 mg, 1 tab P.O. (by mouth) every § hours prn. (as needed) for a systolic blood pressure greater than 160 and diastolic blood pressure greater than 90. Documentation on the vital signs record, documented the following blood pressures as follows: 09/15/02, BP 169/72, 09/22/02, BP 178/78, 09/30/02, BP 170/69, 10/01/02, BP 179/70, 10/03/02, BP 163/68, 10/06/02, BP 170/72, and a second time on 10/06/02, BP 67/69. Record review of documentation in the clinical record and the nurse’s notes confirmed that the medication was not administered on these dates. The facility failed to notify the physician of the blood pressure reading and that the medication was not administered as per physician's orders dated 09/06/02. Review of the documentation on the medication administration record (MAR) documented that the medication was not administered on these dates. The resident had a diagnosis of Cerebral vascular accident (CVA). An interview with the Director of Nursing (DON) was conducted on 10/10/02. He/she stated "if the medication was given, it would be recorded in the resident's clinical record". 9. Respondent was provided a mandated correction date of November 1, 2002. 10. On or about November 18, 2002, a follow-up survey was conducted at Respondent’s facility. 11. Based on record review and interview, Respondent failed to ensure that each resident received the necessary care and services for one of thirteen sampled residents (#2). The findings include: Record review revealed resident (#2) with diagnoses of cerebral vascular accident (CVA), high blood pressure (HTN) and bilateral subdural hematomas. On 7/7/01, the physician ordered.Clonidine (Catapres), a medication used for the control of high blood pressure. Clonidine 0.3 milligrams (mg), 1 tab p.o. (by mouth) every 8 hours was ordered as needed for diastolic blood pressure greater than 100. Review of the medication administration record (MAR) revealed the following: on 11/12/02 at 6 AM Clonidine 0.3 mg. was administered with a diastolic blood pressure of 89, on 11/16/02 at 2 AM Clonidine 0.3 mg. was administered with a diastolic blood pressure of 80, on 11/16/02 at 10 PM, Clonidine 0.3 mg. was administered with a diastolic blood pressure of 82, on 11/17/02 at 9 PM, Clonidine 0.3 mg. was administered with a diastolic blood pressure reading of 80. Clonidine was administered four times when the diastolic blood pressure did not exceed the parameter of 100 according to the physician's order. Further review of the clinical record revealed a physician's order on 7/7/01 for Labetalol (Trandate), a medication used for the control of high blood pressure. The order read: Labetalol 100 mg., 1 tab p.o. every 6 hours as needed for systolic blood pressure greater than 189 or diastolic blood pressure greater than 110. Review of the MAR on the following days revealed: on 11/12/02 at 6 AM the systolic blood pressure was 193, and on 11/17/02 at 9 PM the systolic blood pressure was 190. Labetalol was not administered on 11/12/02 and 11/17/02, as ordered by the physician. Review of the nurse’s notes revealed no documentation regarding the blood pressures, administration of medications or resident assessment. Review of the nurse’s notes revealed no documentation regarding the blood pressures, administration of medications or resident assessment. An interview with the Director of Nursing (DON) was conducted and the DON stated that the attending physician was notified of the identified discrepancies. ‘12. The above actions or inactions are a violation of 42 CFR 483.25, which requires the facility to provide the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being, in accordance with Pa the comprehensive assessment and plan of care. 4 13. Pursuant to Section 400.23(8) (c), Florida Statutes, the foregoing is an “isolated” class III deficiency and as such, results in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental or psychosocial well - being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class III deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more Class I or Class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A citation for a class III deficiency must specify the time within which the deficiency is required to be corrected. If a Class III deficiency is corrected within the time specified, no civil penalty shall be imposed. 14. A civil penalty is authorized and warranted in the amount of $1,000, as this violation constitutes an uncorrected Class III deficiency. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care ‘Administration requests the Court to order the following: a. Make factual and legal findings in favor of the Agency on Count I; b. Impose a fine and survey fee in the amount of one thousand dollars ($1,000) for the violation cited in Count I against the Respondent, pursuant to Sections 400.419(1)(c), Florida Statutes (2002); and c. Assess costs related to the investigation and prosecution of this case pursuant to Section 400.121(10), Florida Statutes (2002); and d. Grant any other general and equitable relief as deemed appropriate. NOTICE THE HEALTH CENTER OF ORLANDO, INC. D/B/A THE HEALTH CENTER OF WINDERMERE hereby is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care fa Administration, and delivered to Katrina D. Lacy, Esquire, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr. No., Suite 330G, St. Petersburg, Florida, 33701. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Katrina D. Lacy, Senior Attorney Fla. Bar. No. 0277200 Counsel for Petitioner Agency for Health Care Administration 525-Mirror Lake Dr. No., Suite 330G St. Petersburg, FL 33701 (727) 552-1525 (office) (727) 552-1440 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail Return Receipt No. 7002 2030 0002 7109 5769, to Corporation Service Company, 1201 Hays Street, Tallahassee, FL 32301 dated on / i} “an UL AC a Katrina D. Lacy, psaylre January ©/ 1 2003. Copies furnished to: Corporation Service Company Registered Agent for The Health Center of Windermere 1201 Hays Street Tallahassee, FL 32301 (U.S. Certified Mail) Stephen A. Rykiel, Administrator The Health Center of Windermere 4875 Cason Cove Drive Orlando, FL 32811 (U.S. Mail) ~ Katrina D. Lacy AHCA —- Senior Attorney 525 Mirror Lake Drive, Suite 330G St. Petersburg, FL 33701 EXHIBIT a STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA NO: 2003000068 vs. THE HEALTH CENTER OF ORLANDO, INC., d/b/a THE HEALTH CENTER OF WINDERMERE Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against THE HEALTH CENTER OF ORLANDO, INC., d/b/a THE HEALTH CENTER OF WINDERMERE, (hereinafter “Respondent”) and alleges: Nature of the Action 1. This is an action to impose a conditional licensure status effective November 19, 2002 through September 30, 2003, pursuant to Sections 400.102(1) (a) and (dad), 400.23(7) (b), and 400.23(8) (c), Florida Statutes. 2. The Respondent was originally cited for the deficiency during the survey conducted on or about November 18, 2002. Jurisdiction and Venue 3. The Agency has jurisdiction over the Respondent pursuant to chapter 400, Part II, Florida Statutes. 4. venue lies in Orange County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28, Florida Administrative Code. Parties 5. AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 6. Respondent is a nursing home located at 4875 Cason Cove Dr., Orlando, FL 32811. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter S9A-4, Florida Administrative Code, having been issued license number #SNF130470967. COUNT I RESPONDENT FAILED TO ENSURE THAT EACH RESIDENT RECEIVED THE NECESSARY CARE AND SERVICES IN VIOLATION OF 42 CFR §483.25, VIA Fla. Admin. Code R.59A-4.1288 UNCORRECTED CLASS III DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. On or about October 7, 2002, a survey was conducted at Respondent’s facility. 9. Based on record review and interview, Respondent failed to ensure that each resident received the necessary care and services for one cf twenty-two sampled residents (#2). The findings include: Based on record review, it was documented that an order for Clonidine (Catapres), a medication used for the control of high blood pressure (BP), was written on 09/06/02. The order documented: Clonidine 0.1 mg, 1 tab P.O. (by mouth) every § hours prn. (as needed) for a systolic blood pressure greater than 160 and diastolic blood pressure greater than 90. Documentation on the vital signs record, documented the following blood pressures as follows: 09/15/02, BP 169/72, 09/22/02, BP 178/78, 09/30/02, BP 170/69, 10/01/02, BP 179/70, 10/03/02, BP 163/68, 10/06/02, BP 170/72, and a second time on 10/06/02, BP 67/69. Record review of documentation in the clinical record and the nurse’s notes confirmed that the medication was not administered on these dates. The facility failed to notify the physician of the blood pressure reading and that the medication was not administered as per physician's orders dated 09/06/02. Review of the documentation on the medication administration record (MAR) documented that the medication was not administered on these dates. The resident had a diagnosis of Cerebral vascular accident (CVA). An interview with the Director of Nursing (DON) was conducted on 10/10/02. He/she stated "if the medication was given, it would be recorded in the resident's clinical record". 10. Respondent was provided a mandated correction date of November 1, 2002. 11. On or about November 18, 2002, a follow-up survey was conducted at Respondent’s facility. 12. Based on record review and interview, Respondent failed to ensure that each resident received the necessary care and services for one of thirteen sampled residents (#2). The findings include: Record review revealed resident (#2) with diagnoses of cerebral vascular accident (CVA), high blood pressure (HTN) and bilateral subdural hematomas. On 7/7/01, the physician ordered Clonidine (Catapres), a medication used for the control of high blood pressure. Clonidine 0.3 milligrams (mg), 1 tab p.o. (by mouth) every 8 hours was ordered as needed for diastolic blood pressure greater than 100. Review of the medication administration record (MAR) revealed the following: on 11/12/02 at 6 AM Clonidine 0.3 mg. was administered with a diastolic blood pressure of 89, on 11/16/02 at 2 AM Clonidine 0.3 mg. was administered with a diastolic blood pressure of 80, on 11/16/02 at 10 PM, Clonidine 0.3 mg. was administered with a diastolic blood pressure of 82, on 11/17/02 at 9 PM, Clonidine 0.3 mg. was administered with a diastolic blood pressure reading of 80. Clonidine was administered four times when the diastolic blood pressure did not exceed the parameter of 100 according to the physician's order. Further review of the clinical record revealed a physician's order on 7/7/01 for Labetalol (Trandate), a medication used for the control of high blood pressure. The order read: Labetalol 100 mg., 1 tab p.o. every 6 hours as needed for systolic blood pressure greater than 180 or diastolic blood pressure greater than 110. Review of the MAR on the following days revealed: on 11/12/02 at 6 AM the systolic blood pressure was 193, and on 11/17/02 at 9 PM the systolic blood pressure was 190. Labetalol was not administered on 11/12/02 and 11/17/02, as ordered by the physician. Review of the nurse’s notes revealed no documentation regarding the blood pressures, administration of medications or resident assessment. An interview with the Director of Nursing (DON) was conducted and the DON stated that the attending physician was notified of the identified discrepancies. 13. The above actions or inactions are a violation of 42 CFR 483.25, which requires the facility to provide the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. 14. The above referenced violation therefore, constitutes the grounds for the imposed uncorrected Class III deficiency authorized pursuant to Sections 400.102(1) (a) and (d), and 400.23(8) (c), Florida Statutes. 15. The Agency seeks to impose a Conditional Licensure Status effective November 19, 2002 through September 30, 2003, based on the Class III deficiency, as authorized under Sections 400.102(1) (a) and (a), 400.23(7) (b), and 400.23(8)(c), Florida Statutes. WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I; B. Recommend that the change of licensure status effective November 19, 2002 through September 30, 2003, from Standard to Conditional be upheld; Cc. Reasonable attorney’s fees and costs; and D. All other general and equitable relief allowed by law. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and~« Election of Rights (one page). All requests for hearing shall be made to the attention of Katrina D. Lacy, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr. N., Suite 330G, St. Petersburg, Florida, 33701. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Katrina D. Lacy, Florida Bar No. 0277400 Senior Attorney Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, 330G St. Petersburg, Florida 33701 OFFICE: (727) 552-1525 FAX: (727) 552-1440 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail Return ‘ Receipt No. 7002 2030 0002 7109 5752, Company, 1201 Hays Street, January Al, 2003. Tallahassee, to Corporation Service 32301 dated on FL Copies furnished to: Corporation Service Company Registered Agent for The Health Center of Windermere 1201 Hays Street Tallahassee, FL 32301 (U.S. Certified Mail) Stephen A. Rykiel, Administrator The Health Center of Windermere 4875 Cason Cove Drive Orlando, FL 32811 (U.S. Mail) Katrina D. Lacy AHCA - Senior Attorney 525 Mirror Lake Drive, Suite 330G St. Petersburg, FL 33701 Katrina D. Lacy, Mi squire i 5 ; a Ai BS Ais GS Se ‘i Ee GPM GF GS hae i OF i ae Sun oe 4 , Yat ; Ya ae Ps TAA UAT ail a HALA, ME State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION DIVISION OF HEALTH QUALITY ASSURANCE SKILLED NURSING FACILITY CONDITIONAL ‘ This is to confirm that HEALTH CENTER OF ORLANDO, INC., THE has complied with the rules and regulations adopted by the State of Florida, Agency For Health Care Administration, authorized in Chapter 400, Part II, Florida Statutes, and as the licensee is authorized to operate the following: : HEALTH CENTER OF WINDERMERE, THE 4875 CASON COVE DRIVE ORLANDO, FL 32811 with 120 beds. STATUS CHANGE ACTION EFFECTIVE DATE: 11/19/2002 ch ttre Quality. Ps un eae + a 7 ry BA is 4 Ws se ay OR OOO EXHIBIT 3 tabbies" STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No.: 2002049149 Petitioner, 2003000068 DOAH No.: 03-1536 03-1603 vs. THE HEALTH CENTER OF ORLANDO, INC., d/b/a THE HEALTH CENTER OF WINDERMERE, Respondent. STIPULATION AND SETTLEMENT AGREEMENT Petitioner, Agency for Health Care Administration (hereinafter the "Agency") through their undersigned representatives, and The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere (hereinafter “Respondent") pursuant to Sec. 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, The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere, is a nursing home licensed pursuant to Chapter 400 Part II, Florida Statutes (2002), and Rule 59A-4, Florida Administrative Code, (2002); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over The Health Center of Windermere pursuant to Chapter 400, Part I, F lorida Statutes; and WHEREAS, the Agency served Corporation Service Company, registered agent for The Health Center of Windermere, two (2) Administrative Complaints on January 21, 2003, notifying 1 TLHI\HEALTH\65830. 1 31789/0001 DMA 8/13/2003 the party of its intent to impose a civil penalty for $1,000.00, and the imposition of a conditional license effective November 19, 2002 through September 30, 2003, and; WHEREAS, The Health Center of Windermere requested a formal administrative hearing in an Amended Petition for Formal Administrative Hearing filed by Donna H. Stinson, Esquire and received by the Agency on April 24, 2003; 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, The Health Center of Orlando, Inc. d/b/a The Health Center of Windermere agrees to a withdrawal of its Request for Formal Hearing; 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. Provided, however, that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this stipulation. TLUHI\HEALTH'65830 1 31789/0001 DMA 8/13/2003 4. The parties agree to the following: (a) Count I-Tag F309 will be changed from an uncorrected Class III , deficiency to a Class IV deficiency; (b) The assessed fine, in the amount of $1,000, for Count I-Tag F309 will be eliminated; (c) The Conditional License will be withdrawn by the Agency; (d) The Health Center of Windermere will withdraw its Petition for Formal Hearing upon execution of the agreement. 5. 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. 6. By executing this stipulation, The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere does not admit, and the Agency asserts the validity of the allegations raised in the administrative complaint referenced herein. The Agency agrees that it will not impose any further penalty against The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere, as a result of the Follow-Up Survey completed November 18, 2002. However, no agreement made herein shall preclude the Agency from imposing a penalty against The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere for any deficiency/violation of statute or rule identified in a future survey of The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere, which constitutes a cumulative fine or uncorrected deficiency from the Follow-Up Survey completed November 18, 2002. Provided, however, that if the Agency hereafter imposes such a penalty, the facility reserves the right to challenge that penalty and any deficiency from the November 18, 2002 survey, supporting it in an administrative appeal. TLH1\HEAL TH\65830.1 31789/3001 DMA 8/13/2003 7. 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. 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. The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere, for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the 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 The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere or related facilities. 11. The Agency for Health Care Administration, does hereby discharge The Health Center of Orlando, Inc., d/b/a The Health Center of Windermere, 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 the Agency for Health Care Administration, excepting actions based on an uncorrected deficiency or cumulative fine, as referenced in paragraph six (6). 12. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph ten (10) of this Agreement. 4 TLHTHEALTHI65830.1 . 31789/0001 DMA 8/13/2003 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. 15. | This Agreement supercedes any prior oral or written agreements between the parties. 16. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. ( hoe athe OVcb ele Diena Helsl im gel Shh Elizabeth Dudek Donna Holshouser Stinson Deputy Secretary, Broad and Cassel Managéd Care and 215 S. Monroe Street, Ste. 400 Health Quality Assurance Tallahassee, FL 32301 Agency for Health Care Administration DATED: DATED: 8/13/0S — Valda Clark Christian General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee FL 32308 DATED: TLH1\HEALTH\65830. + 31789/3001 OMA 8/13/2003

Docket for Case No: 03-001536