STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR oy Dt HEALTH CARE ADMINISTRATION, No 24 Case No. 04-0397 Petitioner, AHCA No. 2003003766 2003004453 vs. EMERALD SHORES HEALTH CARE ASSOCIATES, LLC, d/b/a EMERALD SHORES HEALTH AND REHABILITATION, i: Respondent. FINAL ORDER Sow 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 that: 1. The parties hereto are directed to comply with the terms of the Joint Stipulation and Settlement Agreement. 2. A fine of $2,000.00 is hereby imposed upon the Respondent. This amount is due and payable within thirty (30) days of the clate of rendition of this Order. 3. The Agency shall uphold Emerald Shores Health and Rehabilitation conditional license for the period of May 15, 2003 through June 14, 2003. 4. 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 5. Unpaid fines will be subject to statutory interest and may be collected by all methods legally available. 6. Other than the executory features of this final order, the request for hearing is deemed withdrawn and this case and file deemed closed. DONE and ORDERED this /5 day of Legos I , 2005, in Tallahassee, Leon County, Florida. . IN , Alan Levine, Secretary } Agency fot 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: Michael O. Mathis, 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 Mai! 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) Jay Adams, Esquire Broad and Cassel, P.A. 215 S. Monroe Street, Ste. 400 Tallahassee, FL 32301 (U.S. Mail) P. Michael Ruff Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-3060 (Inter-office Mail) Wendy Adams (Inter-office Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed to the above-named addressees on this day of ___, 2005. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ) ADMINISTRATION, ) ) Petitioner, ) ) vs. ) Case No. 04-0397 ) AHCA # 2003003766 EMERALD SHORES HEALTH CARE ) # 2003004453 ASSOCIATES, LLC, d/b/a EMERALD SHORES ) HEALTH AND REHABILITATION, ) ) Respondent. ) ___) STIPULATION AND SETTLEMENT AGREEMENT Petitioner, Agency for Health Care Administration (hereinafter the "Agency") by and through its undersigned representatives, and Emerald Shores Health Care Associates, LLC, d/b/a Emeraid Shores Health and Rehabilitation (hereinafter "Respondent", by and through its undersigned attorney, each individually a "party" and collectively "parties," hereby enter into this Stipulation and Settlement Agreement ("Agreement") pursuant to Sec. 120.57(4), Florida Statutes, and agree as follows: WHEREAS, Respondent is the licensee of a skilled nursing facility (the Facility) licensed pursuant to Chapter 400, Part Il, Florida Statutes (2003), and Rule 59A-4, Florida Administrative Code (2003); and, WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent pursuant to Chapter 400, Part Il, Florida Statutes; and, TLH HEA THO6247.1 30636/0005 8/4/2005 9:53 AM WHEREAS, the Agency conducted a survey of Respondent on May 15, 2003, and asa result of that survey served Respondent with an Administrative Complaint (AHCA No. 2003003766) notifying Respondent of the Agency’s assignment of conditional licensure status to Respondent’s Facility beginning on May 15, 2003 and of the Agency’s intent to impose upon Respondent an administrative fine of $3,000, based upon 3 uncorrected class III deficiencies identified during that survey; and, WHEREAS, Respondent timely requested a formal administrative hearing on these matters in its Petition for Formal Administrative Hearing (Case No. 04-0397); and, WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of these disputes would avoid the expenditure of substantial sums to litigate the disputes; 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. NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All recitals in the whereas clauses above are true and correct, expressly incorporated herein, and are binding findings of the parties. 2. Upon full execution of this Agreement, Respondent agrees to a withdrawal of its petitions for formal administrative proceedings, agrees to waive any objection to the form of the Final Order (findings of fact and conclusions of law) to which it otherwise may be entitled, and to waive any further state administrative action in these matters, including but not limited to, any informal proceeding under Subsection 120.57(2), Florida Statutes, any formal proceeding under Subsection 120.57(1), Florida Statutes, any appeal under Section 120.68, Florida Statutes; and any action for declaratory or other relief in any court or quasi-court (DOAH) of competent TLH1\HEALTHW96247.1 30638/0005 8/4/2005 9:53 AM jurisdiction; provided however, no agreement herein shall be deemed to be a waiver by either party of its right to judicial enforcement of this stipulation. 3. The Parties agree that Respondent's licensure rating is Conditional from May 15, 2003, through June 14, 2003. 4. Respondent agrees to pay the Agency fines in the amount of $2,000.00 (Two Thousand Dollars) within thirty days of the full execution of this Agreement by all parties. 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 and Settlement Agreement, Respondent does not admit the validity of the allegations raised in the Administrative Complaint referenced herein. By executing this Stipulation and Settlement Agreement, the Agency asserts the validity of the allegations raised in the Administrative Complaint. The Agency agrees it will not impose any further penalty against Respondent as a consequence of the survey conducted on May 15, 2003, 2004; however no agreement made herein shall preclude the Agency from using deficiencies from that survey to impose any penalty authorized under Chapter 400.121(1)(b), Florida Statutes. or from doubling a future fine pursuant to Chapter 400.23(8)(b7. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreeraent and dismissing the above-styled case. 7. Each party shall bear its own costs and attorney’s fees in this matter. 8. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 9. Respondent, for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the to TLHANHEALTH\96247.1 30638/0005 8/4/2005 9:53 AM 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 Emerald Shores Health Care Associates, LLC, or related facilities. 10. The Agency for Health Care Administration, does hereby discharge Emerald Shores Health Care Associates, LLC, 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, excepting possible future penalties that the Agency may impose using the May 15, 2003, survey as more particularly set forth in paragraph 6 herein, 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. 11. This Agreement is binding upon all parties herein and those identified in the two previous paragraphs 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 the entire understandings and agreements of the parties. 14. This Agreement supercedes any prior oral or written agreements between the parties. TLH1\HEAL ~“H196247.1 30638/000E 3/4/2005 9:53 AM 15, This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. The representatives below hereby acknowledge that they are duly authorized to enter into this Agreement. eh Chom s Elizabeth Nudek Deputy Secketary, Health Quality Assurance Agency for Health Care Administration DATED: i S/o Ss Clute Cole CValantar Christa Calamas Genera] Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee FL 32308 DATED: Z [13fos TLHI\HEALTH96247.1 30638/0005 8/4/2005 9:53 AM is Aish 4d Cassel 215 S. Monroe Street, Ste. 400 Tallahassee, FL 32301 DATED: 5S B3:OS

Docket for Case No: 04-000397