STATE OF FLORIDA 07 Oe FIRED AGENCY FOR HEALTH CARE ADMINISTRATION Pcl yax B23 AM: 29 its aS ive HOME FOR THE ANGELS, INC, a Petitioner, DOAH No: 07-2305 ve AHCA No: 2007004845 , RENDITION NO.: AHCA-07-O73O -s-o1LC STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ee FINAL ORDER Having reviewed the Notice of Intent to Impose Late Fine, dated April 30, 2007, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a 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 Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. Petitioner shall pay an administrative fine in the amount of $3,000.00. The administrative fine is due and payable within thirty (30) days of the date of rendition of this Order. 3. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to these case numbers, should be sent directly to: Karen Davis Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308 4. Unpaid fines pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. 5. Petitioner’s petition for formal administrative proceedings is hereby dismissed. 6. Each party shall bear its own costs and attorney’s fees. 7. The above-styled case is hereby closed. DONE and ORDERED this =77 day of Aoverrher, 2007 in Tallahassee, Leon County, Florida. Andrew C.\Agwunobi, M.D., Secretary Agency for Health Care Administratio 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: A. Koss, Esquire Attorney for Petitioner 782 N.W. 42"? Avenue-Suite 448 Miami, Florida 33126 (U.S. Certified Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Karen Davis Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (Interoffice mail) Hon. J.D. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail} Tria Lawton-Russell Assistant General Counsel Agency for Health Care Administration 8350 NW 52™ Terrace, S-103 Miami, Florida 33166 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 {Interoffice 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 the sy day of sl SD Richard Shoop, Agency Cle —<——> rp Agency for Heaith Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 : : : ANDREW G. AGWUNOBI, M.D. CO RAVERNOR r « SECRETARY April 30, 2007 Ms. Jean O. Acosta, Administrator Home For The Angels 9270 S.W. 42 ‘Terrace Miami, FL 33165 RE: CC# 2007004845 e . NOTICE G MPOSE Dear Ms. Acosta: “ : A fine of $5,000 is hereby imposed pursuant to Section 429,19(1), Florida Statutes (F.S.) due to Home for the Angels fate filing of the Change of Ownership application for Home For The Angels, an Assisted Living Facility. The SPECIFIC BASIS for the decision to impose a fine is: . The applicant's failure to submit 4 change of ownership application to the Agency for a new license at least 60 days before the date of transfer of ownership in accordance with Section 429,12(1), F.S. Your change of ownership application was received on January 22, 2007, and showed that the transfer of ownership was to take place on March 22, 2007. Huwevet, the Bill of Sale you submitted in response to the Agency's letter dated February 13, 2007, shows the transfer of ownership date as January 22. 2 TO PAY NOW: aa ~ PAYMENT SHOULD BE MAD} TO: AGENCY FOR HEALTH CARE ADMINISTRATION, AND SENT TO THE ASSISTED LIVING UNIT, 2727 MAHAN DR RE RAL LAHASSEE, FLORIDA 32308, ALONG WITH A COPY OF THIS NOTICE % LORIBA ae a 2727 Mahen Drive, MSA3O ‘ Visit AHCA online at Tallahassee, Florida 34306 COMPARE GARE hitp://ahcm.myflorids.com Wh. a wrew.FlericaCompereCare.gor @5-84-2087 12:19 JERN 2658200335 PeG.1 OSSY B Ogooye Wd9e?zZ 4002 TE FEW a) Aane_acc_ene Homie For The Angels April 30, 2007 Page 2 L, OF TS Pursuant to Section 120,569, F.S:, you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, F.A.C., and must state the material facts you dispute. If you do not dispute any issues af material fact (you admit them), you will be afforded an informal hearing under Section 120.57(2), F.S. At an informa] hearing, you will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the viclations set out in the Notice of:Intent. All requests for hearings shall be:filed with the Agency within twenty-one (21) days of receipt of this letter. Failure to submit cither payment or a request for hearing will result in the entry of a fina] order imposing the fine sought. Any request shall be sent to Alberta Granger, Unit Manager, Assisted Living Unit, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL 32308, Please include a copy of this Notice of Intent with the request. . Sincerely, akc. Assisted Living Unit 3 Bureau of Long Term Care Services AGAT 05-@4-2087 12:08 JEAN 3458288335 ° PaG.c TT : ° wae beaaneen mp oadmnanue rhsaar2 ANF TH Rew STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION HOME FOR THE ANGELS, INC., Petitioner, vs. AHCA No: 2007004845 DOAH No: 07-2305 STATE OF FLORIDA, AGENCY FOR HEALTH CARE AMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Respondent, State of F lorida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Petitioner, Home for the Angels, Inc. (hereinafter “Petitioner”), pursuant to Section 120.57(4), Florida Statutes each individually, a “party,” collectively as “parties,” hereby enter into this Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, the Petitioner is an assisted living facility licensed pursuant to Chapter 429, Part I, Florida Statutes, Section 20.42, Florida Statutes, and Chapter 58A-5, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over licensure of assisted living facilities pursuant to Chapter 429, Part I, Florida Statutes; and WHEREAS, the Agency issued Petitioner with a Notice of Intent to Impose Late Fine on or about April 30, 2007, notifying the Petitioner of its intent to impose an administrative fine in the sum of five thousand dollars ($5,000.00); and WHEREAS, the Petitioner requested a formal administrative hearing by petition filed with the Agency on May 11, 2007; 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 stipulate to the adequacy of considerations to be exchanged; 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, Petitioner agrees to a withdrawal of its Petition for a formal administrative proceeding; agrees to waive any and all appeals and proceedings 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; and agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled. Provided, however, ‘that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this settlement agreement. 4. Upon full execution of this agreement, Petitioner agrees to pay the sum of three thousand dollars ($3,000.00) in administrative fines to the Agency within thirty (30) days of the entry of the Final Order adopting this Agreement. 5. Venue for any action brought to interpret, challenge, or enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie solely in the Circuit Court in Leon County, Florida. 6. By executing this Agreement, the Petitioner admits the facts and legal conclusions raised in the Notice of Intent referenced herein. The Agency agrees that it will not impose any further penalty against the Petitioner as a result of the allegations of its Notice of Intent. Nothing in this Agreement shall be deemed to preclude the Agency from using this assessment of fines in weighing future administrative actions regarding the Petitioner including, but not limited to, decisions regarding the licensure of Petitioner, including, but not limited to, licensure for limited mental health, limited nursing services, or extended congregate care. The Agency is not precluded from using the subject events 7. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case. 8. Each 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. 10. The Petitioner 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 Petitioner or related facilities. 11. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph ten of this Agreement. 12, The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 13. In the event that Petitioner was a Medicaid provider at the subject time of the actions alleged in the Notice of Intent referenced herein, this settlement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues. 14. Petitioner agrees that if any funds to be paid under this agreement to the Agency are not paid within thirty-one (31) days of entry of the Final Order in this matter, the Agency may deduct the amounts assessed against Petitioner in the Final Order, or any portion thereof, owed by Petitioner to the Agency from any present or future funds owed to Petitioner by the Agency, and that the Agency shall hold a lien against present and future funds owed to Petitioner by the Agency for said amounts until paid. 15. | This Agreement contains the entire understandings and agreements of the parties. 16. | This Agreement supersedes any prior oral or written agreements between the parties. 17. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. All parties agree that a facsimile signature suffices for an original signature. 18. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Elizabeth\Dudek HQA, Deputy Secretary Agency Tor Health Care Administration 2727 Mahan Drive, Bldg #1 Tallahassee, Florida 32308 DATED: / W4 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: _ ft 6 (KY Abe Koss, Esquire Attorney for Home for the Angels, Inc 782 NW 42" Avenue, Suite 448 Miami, Florida 33126 ria Lawton Russell Assistant General Counsel Agency for Health Care Administration 8350 NW 52™ Terrace, Suite 103 Miami, Florida 33166 DATED: 11 ~ 6-0)

Docket for Case No: 07-002305