STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ~ PK 16 CEC 23 Pp: 42 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, — DOAH Case No. 05-3544 Vv. AHCA Case Nos. ’ 2005005459 o 2005006179 o AVSNF, LLC, d/b/a ARBOR VILLAGE . - 53) NURSING CENTER, f/k/a WECARE NURSING CENTER, Respondent. / FINAL ORDER The Agency for Health Care Administration, having entered into a Stipulation and Settlement Agreement, and being otherwise well-advised in the premises, finds as follows: It is ORDERED that: | 1. The Stipulation and Settlement Agreement is attached hereto and made a part hereof. The parties are directed to comply with its terms. 2. Respondent shall pay Petitioner one thousand eight hundred seventy-five ($1,875.00) dollars in administrative fines. This amount is due and payable within thirty (30) days of the rendition of this Order. 3. The conditional license is effective June 2, 2005 through June 26, 2005. 4, Any payment by check or money order shall be made payable to the “Agency for Health Care Administration,” with a reference to this case number, and shall be sent directly to: 1 Jean Lombardi Agency for Health Care Administration Office of Finance & Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, FL 32308 5. Unpaid amounts will be subject to statutory interest and may be collected by all methods legally available. 6. The above-styled case is hereby dismissed. mo _—" DONE and ORDERED this CAO day of eee mbiono 26 , in Tallahassee, Leon County, Florida. Alan Levine, Secretary Agency for Health Care Administration Wipe 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 AND A SECOND COPY, ALONG WITH THE FILING FEE 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 APELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Donna La Plante, Esq. 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) Jan Mills Regulatory Consultant Agency for Health Care Administration 2727 Mahan Drive, M.S. #3 Tallahassee, Florida 32308 (Inter-office Mail) Jonathan S. Grout, Esq. ; Goldsmith, Grout & Lewis, P.A. 2180 Park Avenue North, Suite 100 P.O. Box 2011 : ' Winter Park, Florida 32790-2011 (U.S. Mail) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true copy of the foregoing was mailed to the above-named addressees on this ZEisy of. L ex Ce 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, CASENO.: 05-3544 2005005459 AVSNF, LLC, d/b/a ARBOR VILLAGE 2005006179 NURSING CENTER, f/k/a WECARE NURSING CENTER, Vv. r t Respondent. us / STIPULATION AND SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (“Agency”) through their undersigned representatives, and AVSNF, LLC, d/b/a ARBOR VILLAGE NURSING CENTER, f/k/a WECARE NURSING CENTER (“Arbor”), pursuant to Section 120.57(4), Florida Statites (2005) each individually, a “party”, collectively as “parties”, hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Arbor is a licensed skilled nursing facility pursuant to Chapter 400, Part 18 located at 490 South Old Wire Road, Wildwood, Florida.34875; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over skilled nursing facilities pursuant to Chapter 400, Part II, Florida Statutes; and WHEREAS, the Agency served Arbor with an Administrative Complaint notifying the party of its intent to impose a fine of $2,500.00 and a conditional licensure rating; and WHEREAS, Arbor requested a formal administrative hearing in a petition to the Agency; and ay 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 interests 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, Arbor agrees to a withdrawal of its Petition For Formal Administrative Hearing; 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. Upon full execution of this Agreement, Arbor agrees to pay One Thousand Eight Hundred Seventy-Five ($1,875.00) Dollars in administrative fines to the Agency within 30 days of entry of the Final Order. | The conditional licensure rating will be effective June 2, 2005 through June 26, 2005. 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. Arbor neither admits nor denies the allegations raised in the Administrative Complaint referenced herein. The Agency agrees that it will not impose any further penalty against Arbor as a result of the survey conducted on June 2, 2005. However, no agreement made herein shall preclude the Agency from imposing a penalty against Arbor for any deficiency/violation of a statute or rule identified in a future survey of Arbor, which constitutes a cumulative or uncorrected deficiency from the survey completed June 2, 2005. ‘ | 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. Eacli party shall bear its own costs and attorney’s fees. 9. This Agreement shall become effective on the date upon which it is fully executed by all the parties. | ‘ 10Arbor, 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 Arbor or related facilities. 11. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph ten (10) 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. 15. 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: DEP SECRETARY AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Tallahassee, FL 32308 Date signed: / a 1PFO/ D — CHRISTA CALAMAS, ESQUIRE GENERAL COUNSEL AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive Tallahassee, FL 32308 Ie 17/06 Date signed: het GROUT, {7 ‘GOLDSMITH, GROUT & LEWIS, P.A. 2180 Park Avenue North, Suite 100 Post Office Box 2011 Winter Park, FL 32790-2011 ' 407/740-0144 Attorneys for Respondent Florida Bar No. 296066 Date signed: hin [f-OS

Docket for Case No: 05-003544