ABCA AGE STATE OF FLORIDA NOY CLERK AGENCY FOR HEALTH CARE ADMINISTRAT#ONAR = A 9; 22: WARD TOWER ASSISTED LIVING AND SENIOR SOCIAL CENTER, Petitioner, AHCA No.: 2008013434 DOAH No.: 09-0198 vs. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, B eyes Cae ae BO Aes rN a Mah on eth HOS en Respondent. Eee, yp & / Oat eh FINAL ORDER Having reviewed the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated December 3, 2008, attached hereto and incorporated herein (Exhibit 1), and all other matters of record, the Agency for Health Care Administration (“Agency”), being otherwise well- advised in the premises, finds and concludes as follows: FINDINGS OF FACT 1. The Agency issued a Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review against Petitioner, Ward Tower Assisted Living and Senior Social Center, an assisted living facility. This Notice of Intent charged the following: failure to submit a satisfactory sanitation inspection within the last year; failure to submit page 4 of the ALF license application; failure to clarify and submit appropriate deed or lease agreement; failure to submit a complete healthcare licensing application; and failure to submit a complete healthcare licensing application addendum. 2. The Petitioner was served the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review on December 5, 2008 by Certified U.S. Mail, Return Receipt Requested. The U.S. Postal Service’s Track and Confirm Record is attached hereto and incorporated herein (Exhibit 2), Enclosed with the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review was an Election of Rights form which advised Respondent of its right to a hearing pursuant to Section 120.57(1) or Section 120.57(2), Florida Statutes (2008). 3. Respondent selected Option Three (3) within the Election of Rights (Exhibit 3), disputing the allegations of fact contained in the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review and requested a Formal Hearing. 4. On January 21, 2009, Petitioner withdrew its Petition for Formal Hearing (Exhibit 4). 5. On January 22, 2009, Administrative Law Judge Claude B. Arrington issued an Order Closing the File (Exhibit 5). 6. The facts, as alleged and found, establish that Petitioner failed to submit a satisfactory sanitation inspection within the last year; failed to submit page 4 of the ALF license application; failed to Clarify and submit appropriate deed or lease agreement; failed to submit a complete healthcare licensing application; and failed to submit a complete healthcare licensing application addendum, violating Section 408.806(3)(b), Florida Statutes (2008). Petitioner’s application is withdrawn from further review. CONCLUSIONS OF LAW 1. Petitioner is an assisted living facility over which the Agency has jurisdiction pursuant to the provisions of Chapter 429, Part I, Florida Statutes (2008), Section 20.42, Florida Statutes (2008), Chapter 408, Part II, Florida Statutes (2008), Chapter 58A-5, Florida Administrative Code. 2. As alleged in the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review, Petitioner is in violation of Section 408.806(3)(b), Florida Statutes (2008). 3. By withdrawing its Petition for a Formal Hearing, Petitioner expressly waived its right to a hearing and consented to the entry of a Final Order adopting the allegations and conclusions set forth in the Notice of Intent to Deem Application Incomplete and Withdrawn from. Further Review. The sanction sought in this Notice of Intent is upheld. Based on the foregoing findings of fact and conclusions of law, it is ORDERED: 1. The Agency’s Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review is upheld. 2. Petitioner’s application is withdrawn from further review. 3. The above-styled case is hereby closed. DONE and ORDERED this 82 day of “SAAtCA_ __ 2009, in Tallahassee, Leon County, Florida. Holly Benson, Secretary Agency for Hgalth 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 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: Gus Suarez, Esq. Lourdes A. Naranjo, Esq. Gus Suarez, P. A. Assistant General Counsel 5201 Blue Lagoon Drive Agency for Health Care Suite 270 Administration Miami, Florida 33126-2065 8350 N. W. 52 Terrace -— Suite 103 (U. S. Mail) Miami, Florida 33166 (Interoffice Mail) Jan Mills Elizabeth Dudek Agency for Health Care Deputy Secretary Administration Agency for Health Care 2727 Mahan Drive, Bldg #3, MS #3 Administration Tallahassee, Florida 32308 2727 Mahan Drive, Bldg #1, MS #9 (Interoffice Mail) Tallahassee, Florida 32308 (Interoffice Mail) | Claude B. Arrington Administrative Law Judge Division of Administrative hearing 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. 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 LP aay of J arch , 2009. : —— > a Richard J. Shoop Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308 (850) 922-5873

Docket for Case No: 09-000198