STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ORLANDO LIVING CENTER, t Petitioner, vs. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. oe / mS FINAL ORDER Having reviewed the Notice of Intent to Deny License Renewal dated January 15,. 2004, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Stipulation and Settlement Agreement (Ex. 2) with the parties to these proceedings, and being otherwise well advised in the premises, finds and concludes as follows: 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. 2. The Petitioner’s petition for formal administrative proceedings is hereby dismissed. 3. Each party shail bear its own costs and attorney's fees. 4. The above-styled case is hereby dismissed. DONE and ORDERED this 23 day of QeberplBLA_, 2005, in Tallahassee, Leon County, Florida. Alan Levine, wn Agency for ab tbl. Puce . ecretary alth 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 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 HEADQUART| REVIEW @F PROCEEDINGS SHALL BE ERS OR WHERE A PARTY RESIDES. 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: Irwin N. Sperling, Esq. 1212 East Ridgewood Street Orlando, FL 32803 (U. S. Mail) Brian T. Mulligan, Esq. Agency for Health Care Admin. 525 Mirror Lake Drive N., #330L St. Petersburg, Florida 33701 (interoffice Mail) Jean Lombardi Finance & Accounting Agency for Health Care Admin. 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 | (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Admin. 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 | (Interoffice Mail) Jan Mills Agency for Health Care Admin. 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 | (Interoffice Mail) Daniel M. Kilbride, ALJ Div. of Admin. Hearings 1230 Apalachee Parkway Tallahassee, FL 32399-3060 (Interoffice Mail) CERTIFICATE OF SERVICE 7 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 method designated, on this the 29" day of Lace be , 2005. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 the STATE OF FLORIDA . AGENCY FOR HEALTH CARE ADMINISTRATION . ORLANDO LIVING CENTER, ' Petitioner; c \ DOAH No. 05-1537 vs. AHCANo. 2004000381 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / eel STIPULATION AND SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration, (hereinafter “A gency”) by and through its undersigned representatives, and Orlando Living Center (hereiniafter-*Petitioner”), by and through its undersigned representatives, pursuant to Section 120.57(4), Florida Statutes (2005), each individually a “party,” collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Petitioner was an assisted living facility licensed pursuant to Chapter 400, Part Hf, Florida Statutes (2003), and Chapter 58A-5, Florida Administrative Code (2003); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Petitioner pursuant to Chapter 400, Part Il, Florida Statutes (2005), and Chapter 58A-5, Florida Administrative Code (2005); and WHEREAS, on or about March 14, 2003, the Petitioner submitted to the Agency an Assisted Living Facilities License Renewal Application (hereinafter “License Renewal Application”); and EXHIBIT _ WHEREAS, the Agency issued to the Petitioner multiple conditional licenses pursuant to Section 400.417(5), Florida Statutes (2003), thereby granting Petitioner additional time come into compliance with all applicable statutes and regulations; and WHEREAS, the Agency subsequently served Petitioner with a Notice of Intent to Deny (#2004000381) (hereinafter “Notice of Intent”) dated January 15, 2004, notifying the Petitioner of the Agency’s intent to deny Petitioner’s License Renewal Application; and WHEREAS, Petitioner answered the Notice of Intent by submitting to the Agency (1) an the Election of Rights for Notice of Intent form, on which the Petitioner selected Option Three, thereby requesting a formal administrative proceeding, and (2) a Petition for Formal Hearing, both of which were received by the Agency on or about February 5, 2004; and WHEREAS, the Petitioner has continued to operate an assisted living facility during the protracted formal administrative hearing process; 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. The parties agree that all recitals above are true and correct, expressly incorporated herein, and binding findings of the parties. 2. Following signature by all parties designated below as signatories, the Agency shall send to the Petitioner via U.S. Certified Mail (Return Receipt Requested) a copy of this fully executed Agreement. 3. The Petitioner shall be deemed to have received a copy of this fully executed Agreement on the “Date of Delivery” indicated on the U.S. Certified Mail Return Receipt. Ifno date has been recorded under the heading “Date of Delivery” on the U.S. Certified Mail Return Receipt, the Petitioner shall be deemed to have received a copy of this fully executed Agreement on the date reflected on the Track & Confirm service available on the United States Postal Service’s website. ‘4. Upon full execution of this Agreement, Petitioner agrees to: a) forego any th ‘ administrative review of the referenced Notice of Intent and including, but not limited to, any request, petition, or election under Section 120.569, Florida Statutes (2005), for an formal proceeding ‘tuider Section 120.57(1), Florida Statutes (2005), or for a informal proceeding under Section 120. 572), Florida Statutes (2005), any appeal under Section 120.68, Florida Statutes (2005), and any declaratory relief or relief sought through any writ, of or from any court or administrative tribunal of competent jurisdiction; b) waive any and all appeals or further proceedings regarding this matter; c) waive any objections as to the form of the Final-Order (e.g., regarding the presentation of findings of fact and conclusions of law). Provided, however, that no agreement made herein shall be deemed a waiver by either party of its right to judicial fete enforcement of this Agreement. 5. Within one (1) day following Petitioner’s receipt of the fully executed Agreement, as described i in Paragraph Three (3) above, Petitioner agrees to provide to all residents at Petitioner’s facility written notice of termination of residency as required by Section 400.428(1)(k), Florida Statutes (2005). Copies of all such notices shall be provided to the Agency within two (2) days following Petitioner’s receipt of the fully executed Agreement. Such written notice shall provide that termination of residency shall be effective forty-five (45) days following the date of the notice of termination. However, if Section 400.428(1)(k) requires a shorter notice period for any resident, the written notice provided to such resident shall specify a shorter notice period. Furthermore, any and all residents who can be placed at another licensed facility, and who request or do not object to such placement, shall be transferred to such facility at the earliest practicable date possible for such transfer. However, any such transfer shall occur prior to the expiration of the 45-day period described above. 6. Nothing in this Agreement shall prohibit any current resident from continuing residency, or other individual from initiating residency, at the physical structure currently maintained by the Petitioner or Elias J. Samaan, who serves as the President, Secretary, and Treasurer of Orlando Living Center, Inc., and as Administrator of Petitioner. Provided however, that any such resident shall not receive, and the Petitioner, Elias J. Samaan, and/or any agent or employee thereof, shall not provide any services that would require an Agency-issued license to lawfully operate. 7. Petitioner and Elias J. Samaan agree to'comply with any and all applicable statutes, rules, and regulations concerning Medicaid participation and reimbursement. Nothing in this Agreement shall in any way absolve or relieve the Petitioner or Elias J. Samaan for a failure to comply with such statutes, rules, and regulations. ' 8. Upon full execution of this Agreement, Petitioner agrees to withdraw in its entirety the Petitioner's previously submitted License Renewal Application. By virtue of such: withdrawal, the Petitioner’s license to operate as an assisted living facility shall be deemed to expire one (1) day after the 45-day period set forth in Paragraphs Five (5) and Nine (9) of this Agreement. 9. Upon full execution of this Agreement, at which time Petitioner’s withdrawal of License Renewal Application shall be deemed effective, the Agency agrees not to sanction or fine the Petitioner or Elias J. Samaan for the unlicensed operation of an assisted living facility unless and until such time as the Petitioner or Elias J. Samaan continue to operate as an assisted living facility beyond the 45-day termination of residency date established pursuant to Paragraph Five (5) of this Agreement. 10.‘ Petitioner and Elias J. Samaan agree to comply with, and the Agency shall retain the authority to enforce, any and all applicable refund provisions, including but not limited to those set forth in Section 400.424(3)(b), Florida Statutes (2005). Should the Petitioner, Elias J. Samaan, or any agent or employee thereof, fail to comply with applicable refund provisions, the Mw t . Petitioner and Elias J. Samaan shall be subject to any and all penalties and sanctions permitted and/or authorized by law. 11.«.» Nothing in this Agreement shall be deemed a waiver by the Agency of its duty and obligation to enforce any and all statutory and regulatory provisions concerning the unlicensed operation of a health care facility over which the Agency the maintains jurisdiction. Should the Petitioner, Elias J. Samaan, or any agent or employee thereof, engage in any such unlicensed activity subsequent to the 45-day termination of residency date established pursuant to Paragraph Five (5) of this Agreement, the Petitioner and Elias J. Samaan shall be subject to any and ail penalties and sanctions permitted and/or authorized by law. ( 4 meyer 12. Nothing in this Agreement shall be deemed a waiver by the Agency of its duty and obligation to enforce any and all statutory and regulatory provisions concerning the operation of a licensed or unlicensed assisted living facility. Until such time as the Petitioner’s license to operate an assited living facility is deemed expired, as detailed in Paragraph Nine (9) above, the Petitioner and Elias J. Samaan shall be subject to all laws governing assisted living facilities. 13. Petitioner and Elias J. Samaan further agree that such party and individual: a. Shall not apply for a new license, or attempt to acquire an existing license to operate any health care facility, including an assisted living facility, in the State of Florida for a period of two (2) years, commencing on the date a Final Order is rendered in this matter. b. Shall not be involved or employed, directly or indirectly, as an administrator of any nursing home, skilled nursing facility, assisted living facility, adult family care home, or any other health care facility in the State of Florida for a period of two (2) years, commencing on the date a Final Order is rendered in this matter. t 14. Ifeither the Petitioner or Elias J, Samaan, subsequent to the two (2) year exclusion period described in Paragraph Thirteen (13) above, apply for licensure to operate any health care facility in the State of Florida, the Agency may deny such license application if the Petitioner, or Elias J. Samaan, as an officer, director, agent, or managing employee of the Petitioner or as an affiliated person, partner, or shareholder having an ownership interest equal’ to 5 percent or greater in the Petitioner, has failed to pay all outstanding fines, liens, or overpayments assessed by final order of the Agency or final order of the Centers for Medicare and Medicaid Services, not subject to further appeal. Such fines shall include, but shall not be limited to: a. The Final Order in Agency Case No. 2003006161, by which the. Agency imposed upon Petitioner a ONE THOUSAND AND NO/100 DOLLAR ($1000.00) fine that was due and payable within thirty (30) days of February 6, 2004. b. The Final Order in Agency Case No. 2003008414, by which the Agency imposed upon Petitioner a SEVEN HUNDRED FIFTY AND NO/100 DOLLAR ($750.00) fine that was due and payable within thirty (30) days of February 6, 2004. 15. Forso long as the Petitioner and Elias J. Samaan refrain engaging in unlicensed operation of any type of health care facility regulated by the Agency, the Agency agrees to waive its right to impose any fines against Petitioner for violations cited during surveys of Petitioner’s facility on or about July 14, 2005, and August 11, 2005. However, no Agreement made herein shall preclude the Agency from seeking imposition of fines upon the Petitioner for the violations cited during the aforementioned surveys should the Petitioner engage in any unlicensed activity subsequent to the 45-day termination of residency date established pursuant to Paragraph Five (5) of this Agreement. 16. No agreement made herein shall preclude the Agency from denying Petitioner or its principals, including Elias J. Samaan, licensure or renewal of a license that allows, or is necessary, for the operation of a health care facility in State of Florida. The Agency shall be authorized to » base such denial upon any applicable provision in law. fi 17, 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. 18. ";'Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement. ' . 19. Each party shall bear its own costs and attorney’s fees. 20. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 21. _’'’Petitioner, for itself and for its related or resulting organizations; its successors or * weeine transferees, attorneys, heirs, and executors or administrators, and Elias J. Samaan do hereby wnt discharge the Agency 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 Petitioner or related facilities, or by or on behalf of Elias J. Samaan. 22. This Agreement is binding upon all parties herein and those identified in Paragraph Twenty-One (21) of this Agreement. 23. The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. 24. This Agreement contains the entire understandings and agreements of the parties. 4 25. This Agreement supersedes any prior oral or written agreements between the parties. ‘ 26. This Agreement may not be amended except in writing. Any attempted assignment. of this Agreement shall be void. binding as an original signature. 28. The following representatives hereby acknowledge that they are du. to enter into this Agreement. P Health Quality Assurance Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 42 35d «al nD: 1212 East Ridgewood Street Orlando, Florida 32803 Attomey for Petitioner lor General Counsel Agency for Health Care Administration 2721 Mahan Drive Tallahassee, Florida 32308 Dated: (2fatl 1s Dated: Dated: in f ( Lccotcl-on( VAC ams chamnexcun AS. Mees, 56C, + THeee. Christa Calamas lias J. Samaan President, Secretary, and Treasurer of Orlando Living Center, Inc. Administrator of Orlando Living Center 2721 Uintah Avenue Orlando, Florida 32805 Dated: _ // lie lo ks) L 27. All parties agree that a facsimile signature contained herein shall be as valid and ly authorized

Docket for Case No: 05-001537