t FILED AGENCY FOR STATE OF FLORIDA HEALTH CARE ADMINISTRATION 1 AGENCY FOR HEALTH CARE ADMINISTRATIONDEPUuTY CLERK CLERK LAKEVIEW TERRACE HEALTH CARE Of. CENTER, INC., d/b/a TERRACE SKILLED pate__“)} a — NURSING FACILITY, ao - MG AIS: li Erle Petitioner, AHCA NO. 2003008109'\ ' on ee, vs. ; ° Pe % 4, % ; “8 STATE OF FLORIDA, AGENCY FOR ; wag ad HEALTH CARE ADMINISTRATION, | ane , “os Respondent. ~ / FINAL ORDER The Agency for Health Care Administration, having entered into q Joint , Stipulation and Settlement Agreement with LAKEVIEW TERRACE HEALTH | CARE CENTER, INC. d/b/a TERRACE SKILLED NURSING FACILITY 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 aré directed to comply with the terms of the Joint Stipulation and Settlement Agreement. THEREFORE, it is ORDERED and ADJUDGED that: 1. The parties hereto are directed to comply with terms of the Joint Stipulation and Settlement Agreement; 2. An administrative fine in the amount of $3,750.00 (representing a 25% reduction of the original amount of the fine) is imposed; and 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 & Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, FL 32308 4. Unpaid fines will be subject to Statutory interest, and may be collected by all: methods legally available. DONE and ORDERED this bey of ety , 2004, in Tallahassee, Leon County, Florida. Alan Levine, sa He é Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUFED 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: .Gary J. Clarke, Esquire ‘Wendy Adams Attorney for Petitioner AHCA Sternstein, Rainer & Clarke, P.a. 2727 Mahan Drive Building #3 Mail 101 North Gadsden Street Stop #3 Tallahassee, FL 32301-7606 Tallahassee, Florida 32308 (U.S. Mail) ‘(Interoffice Mail) Elizdbeth Dudek Donna Riselli, Esquire Deputy Secretary Senior Attorney AHCA ' Agency for Health Care 2727 Mahan Drive Building 3 MS Administration Building #3 Mail Stop #3 2727 Mahan Dr. Bldg #1 Mail Stop Tallahassee, Florida 32308 Code #9 ', (Interoffice Mail) 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) t CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to! the above individuals on this 1G day of Gui , 2004. if _ = Can gl ups oh | 10 Sana nctnaten, Agency Clerk ‘ Agency for Health Care Administration’ 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 May-14-2084 11:41 AGENCY HEALTH CARE ADMIN CEN esa 921 @158 P28 a STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ; t LAKEVIEW TERRACE HEALTH CARE | CENTER, INC., d/b/a TERRACE SKILLED NURSING FACILITY, Petitioner, AHCA NO. 2003008109 vs, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, ; Respondent. i STIPULATION AND SET TLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through their undersigned representatives, and LAKEVIEW TERRACE HEALTH CARE CENTER, INC. d/ofa TERRACE SKILLED NURSING FACILITY, hereinafter referred to as Petitioner). through their undersigned representatives, 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, Petitioner 's a facility licensed pursuant to Chapter 400, Florida Statutes ' (2002), and Florida Administrative Code, (2002); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Petitioner pursuant to sections 120.569 and 120.57, Florida Statutes; and . WHEREAS, the Agency served Petitioner with a Notice of Intent to Impose Late Fine on October 31, 2003, notifying Petitioner of its intent to Impose a late fine of Five Thousand Dollars 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: Mey-14-2904 11:42 AGENCY HEALTH CARE ADMIN 52 921 8152 P24 . aN 4. 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, Petitioner, agrees to waive any and aif 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 120.67(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. Petitioner agrees io pay the sum of Three Thousand Seven Hundred Dollars ($3,750.00) to the Agency within thirty (30) days of execution of the Final Order {representing 75% of the fine of $5,000.00). Payment shall be made to AHCA c/o Jaan Lombardi, Finance & Accounting, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop Code #14, Tallahassee, Florida 32308. 5. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall vest in the Circult Caurt in Leon County, Florida. ‘ 6, Upon full execution of this Agreement, the Agency shail enter a Final Order adopting and incorporating the terms of this Agreement. 7. Each 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. Petitioner for itself and for its related or resulting organizations, Its successors or transferees, attomeys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attomeys 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 facieral or state court or administrative forum, including any claims arising out of this Agreement, by or on behalf of Petitioner or related facilities. 40. This Agreement is binding upon all party's herein and those identified in the aforamentioned paragraph (9) of this Agreement. 44, The undersigned have read and understand this Agreement and have authority to bind their raspective principals to it: hay-14-2094 11:42 AGENCY HEALTH CARE ADMIN a5@ 921 @158 P.a5 co ent contains and incorporates the entire understandings and 42. This Agreem i} agreements of the parties. _ 43. This Agreement supercedes any prio oral or written agreements between the ' parties. | 44, | This Agreement may not be amended except in individuals signing below and any attempted assignment of this Agreement shall be void. 15. ’ The partles agree that AHCA is authorized to and shall submit a final order adopting and incorporating the terms and conditions of this Seftlement Agreement without nt Agreement shall be attached ta the Final Order. writing executed by all the notice of hearing and that this Settleme 16. The following representatives hereby acknowledge that they are duly . authorized to enter into this Agreement on behalf of the respective parties. f paTeD. 5 /A7/O Gary J. , Esquire ; Petitioner Lakeview Terrace Health Care Center, Inc. dib/a Terrace Skilled Nursing Facility | | : Ase Pigg pateo__ V4 ol Elizabeth Dudek a Deputy Secretary, Managed Care and Health Quality Assurance Agency for Health Care Administration “yy ea ca j : a oa . Ck DATED ee [3 200P General Counsel, Agency for Health Care Administration TOTAL P.@5

Docket for Case No: 03-004688