STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

SHARON NARRIMAN ALLY,

FILED

.ts.HCA AGDiCY CLERK

znaq JUL - s P 3= ob

vs.

Petitioner,

DOAH CASE NO.: 09-3155 FRAES NO.: 2009005797

RENDITION NO.: AHCA-09- 50 -5-0LC

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

FINAL ORDER

Having reviewed the Notice of Intent to Deny dated May 20, 2009, 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. The Notice of Intent to Deny, as to the Petitioner's initial application for licensure of the Facility, is deemed superseded by the Settlement Agreement.

   
   

   Filed July 10, 2009 2:22 PM Division of Administra1tive Hearings.

   
   

3. The Petitioner's petition for a formal administrative proceeding is hereby dismissed.

4. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner's application.

5. Each party shall bear its own costs and attorney fees.

   
   

6. The above-styled case is hereby closed.

DONE and ORDERED this _f!_day of d£4j

in Tallahassee, Leon County, Florida.

, 2009,

Holly Ben n, Secretary

Agency for ealth 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:

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

ts-­

method designated, on this the _K_ day of _--= =-=--7----' 2009.

Richard Shoop, Agency Clerk

Agency for Health Care Administration 2727 Mahan Drive, Building #3

Tallahassee, Florida 32308-5403

(850) 922-5873

'

CHARLIE CRIST GOVERNOR

Better Health Care for all Floridians

HOLLY BENSON

SECRETARY

CERTIFIED MAIL RETURN

RECEIPT REQUESTED

May 20,-2009

Sharon Narriman Ally

9709 Crenshaw Circle

Clermont, FL 34711

RE: CC# 2009005797

Dear Ms. Ally:

NOTICE OF INTENT TO DENY

It is the decision of this Agency that Sharon Narriman Ally's initial application for an adult family care home (AFCH) license be DENIED.

The Specific Basis for this determination is:

Failure -to live in the Adult Family Care Home pursuant to Section 429.63(2), 429.65(2)(a), 429.67(2),.Floric:la Statutes (F.S.) and Chapter 58A-14.008(2)(a)2, Florida Administrative Code (F.A.C.). The applicant noted on page 1 of the AFCH license application that she does not live in the AFCH located at 9718 Crenshaw Circle, Clermont, FL 35711. Documentation submitted with the application indicates that the provider lives at 9709 Crenshaw Circle, Clermont, FL 35711; therefoi"e your application is being denied.

EXPLANATION OF RIGHTS

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( I),. F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201; Florida Administrative Code (F.A.C.), and must state the material facts you dispute.

EXHIBIT

1

2727 Mahan Drive, MS#30 Tallahassee, Florida 32308

Vl!llt AHCA onllne at http://ahca.myflorlda.com

·; Sharon Narriman Ally

May 20, 2009

Page #2

SEE ATTACHED ELECTION OF RIGHTS FORM

s4 Jc.,dL

Bemaro E. Hudson, Manager ·

Assisted Living Unit

Bureau· of Long Term Care Services BEM/lrm

Copy to: Alachua Field Office - 03

LTCOC Withlacoochee Jan Mills, Mail Stop #3

'l

STATE OF FLORIDA FIL.ED

AGENcv FOR HEALTH cARE ADMINisTRATioN AGElc'f'tLERK

RE: Sharon Narriman Uy

CASE NO: 2009005797

2ooq JUN - 2 P 1.J: 2 I ·

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed Notice of Intent to Deny of the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Deny or some other notice of intended action by AHCA.

An .Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Notice of Intent to Deny or any other proposed action by AH CA.

If an Election of Rights with your selected option is not received by AHCA within twenty­ one (21) days from the date you received this notice of proposed action, you will have given up your right to contest the Agency's proposed action and a final order will be issued.

--- -(Please reply using this ElectionofRi&hts.form unlessyou,.your attorney...QQ:our re r e=se=n=ta=ti ·v e-----

prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

Please return your ELECTION OF RIGHTS to:

·Agency for Health Care Administration Attention: Agency Clerk.

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308

Phone: (850) 922-5873 Fax: (850) 921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS:

OPTION ONE (1) I admit to the allegations of facts and law contained in Jhe

Notice of Intent to Deny, or other notice of intended action by AHCA and I waive my right to object and have a bearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the proposed penalty, fine or action.

OPTION TWO (2) I admit to the allegations of facts contained in .the Notice of

Intent to Deny, or other proposed action by AHCA, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or

that the fine should be reduced.

OPTION THREE (3) L I dispute the allegatio s of fact contained in the Notic_e of

Intent to Deny or other proposed action by AHCA, and I request a formal hearing

(pursuant to Section 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Subsection 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.201, Florida Administrative Code, which reguires that it contain: ·

1. The name and address of each agency affected and each agency's file or identification number, if known;

2. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any;

3. An explanation of how your substantial interests will be affected by the Agency's proposed action;

4. A statement of when and how you received notice of the Agency's proposed action;

5. A statement of all disputed issues of material fact. If there are none, you must state that there are none;

6. A concise statement of the ultimate facts alleged, including the specific facts you contend warrant reversal or modification of the Agency's proposed action;

7. . A statement of the specific rules or statutes you claim reQuire reversal or modification of the Agency's proposed action; and

8. A statement of the relief you are seeking, stating exactly what action you wish the Agency to take with respect to its proposed action.

   (Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.)

   License type: adult family care home Licensee Name: Sharon Narriman Ally

   Contact person: S Ji11 I{ 0 ,J Al fl l<./Zt IY'J fl ,J flJv1,_V ( O tiI ]) £ I( )

   <t?

   Name Title

   Address: q7, 8 CA€AISfiRw et llE C G morJI FL 3 I/

   Street and number City Zip Code

   8 5"'2. 2.4-1 '3 b I 3 s 2-- 'i 8 i rs-o cg 4

   Telephone No. Fax No. Email (optional) _

   o 3S2S3bb003

   • I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the lice see referred to above.

     
     

     
     

     Signed:

     ,dt0,tV6Vv

     
     

     Date:

     1

     Print Name: 81-f RR.orJ AU--'/

     Title:----'f-R..;.;0....U;. I D!Sf-<_ .,; ---

     
     

     USPS Track & Confirm Page 1 of 1

     
     

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     Search Results

     Label/Receipt Number: 7160 390198482819 2134 Servlce(s): Certified Mau™

     Status: Delivered

     
     

     Your Item was delivered at 11:41 AM on May 26, 2009 in CLERMONT, FL 34711.

     Track & Confirm

     
     

     Track & Confirm ,J.fll!JilJ

     Enter Label/l3ecelpt Numb r_.-···--- -··--.

     
     

     Detailed Results:

     • Delivered, May 26, 2009, 11:41 am, CLERMONT, FL 34711

     • Notice Left, May 23, 2009, 2:51 pm, CLERMONT, FL 34711

   
   

   Notification (!ptiotts .......... -... _._.._.. _........... .............. ..............---·--·..·-·................... ····-·········•··-··•····--..•·•·········-·--···········-·

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   PAGE 01

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   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATION

   SHARON NARRIMAN ALLY,

   
   

   
   

   vs.

   Petitioner,

   
   

   Case No: 09-3155

   FRAES: 2009005797

   STATE OF FLORIDA, AGENCY FOR

   HEALTH CARE ADMINISTRATION,

   
   

   Respondent,

   
   

   I

   smLEHE!tI A§RiEMENI

   Responde"t State of Florida; Agency for Health care Administration (the "Agency"), through its undersigned representatives, and Petitioner, Sharon Narrlman Ally ("Petitioner''), pursuant to Section 120.57(4), Florida Statutes, each Individually, a \\party," collectively as '\parties," hereby enter Into this Settlement Agreement ("Agreementu) and agree as follows:

   WHl!REAS, the Petitioner is an appllcarit for an adult family-care

   home license pursuant to pursuant to Chapters 408, Part u, and 429, Part 11, Florida Statutes, Section 20.42, Florida Statutes and Chapter 58A-14,

   Florida Administrative Code; and

   WHEREAS, the Agency h s jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to Chapter Chaptera 408, Part 11, and 429, Part II, Florida Statutes, Section 20.42, Florida Statutes and Chapter SBA-14, Florida Administrative Code; and

   
   

   EXHIBIT

   
   

   2

   
   

   :;, to-

   04/01/2005 16:36 3523949956

   IO'::j \:l:$: :lb tiHU'I-A. H, l; A 727 5521440

   PAGE 02

   T-365 P004/J10 F-583

   
   

   WHl!REAS, the Agency has jurisdiction by virtue of being the

   regulatory and llcenslng uthorlty over the license sought by Petitioner; and

   
   

   WHEREAS, the Agency served the Petitioner with a Notice of Intent to Deny on May 20, 2009, notifying the Petitioner of Its intent to deny Petitioner's applicatlon for an adult family-care home license; and

   WHEREAsf the parties have agreed that a fair, efficient, and cost

   
   

   effective resolution oft.his dispute would avoid the expenditure of substantial sums to litigate the dispute; and

   WHERl!AS, the parties stipulate to the adequacy of considerations

   exchanged; and

   WHEREAS, the parties hijve negotiated In good faith 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 lncorpon1ted

herein are binding findings of the parties.

3, Upon full execution of this Agreement, Petitioner agrees to waive any and all proceedings and appeals to which It may be entitled Including, but not limited to, an Informal proceeding under Subsection 120.57(2), a

04/01/2005 16:36 3523949956

'j-·,:o-· (i9 08:26 FR(t1- .H.C.A 727 5521440

PAGE 03

T-306 ?005/ 10 F 583

tormal proceeding under Subsection 120.57(1), appeals under section 1,20,68, Florida Statutes; and declaratory and all writs of relief In any court or quasi-court {OOAH) of competent jurisdiction; and further agrees to waive compliance with the form of the Flnai 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 or this Agreement.

1. Upon full execution of this Agreement, the parties agree to the following:

   1. The Notice of Intent to Deny is deemed superseded by this

      agreement.

   2. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner's application.

   3. Petitioner's request for a formal hearing Is withdrawn, and

      the case will be closed.

   4. Nothing in this Agreement shall prohibit the Agency from denying Petitioner's appllcatlon for llcensure based upon any statutory or regulatory provision, including, but not

      limited to, the failure. or Petitioner to s tlsfactorily

      complete a survey reflecting compliance with all statutory and rule provisions as required by law.

      
      

      PAGE 04

      T-3 S ? )310 F~583

      
      

2. Venue for any action brougtit to Interpret, challenge or enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie solely in the Clrcu.lt Court In Leon County, Fiorida.

3. By executing this Agreement, the Petitioner neither admits nor denies the allegations raised In the Notice of Intent to Deny referenced herein.

4. 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,

5. Each party shall bear its own costs and attorney's fees.

6. This Agreement shall become effective on the date upon which 1t

   Is fully executed by all the parties.

7. The Petitioner for itself and for Its related or resulting organi ations, Its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the Agency and its agents, representatives, and attorneys of all claims, demands, actions, causes of action, suits, damages, losses, and e)(penses, of any and every nature

   whatsoever, arising out of or In any way related to this mijtter and the Agency's actions, 1ncludlng, but not limited to, any claims that were or may be asserted In any federal or state court or administrative forum, including

   any clalms arising out of this Agreement, by or on behalf of the Petitioner or

   related or resulting organizations.

   
   

   r!U'\- .\\.c.

   04/01/2005 16:36 3523949956

   i1:1-·t. -' ':l 0i·. '27 A

   
   

   PAGE 05

   T-306 P007/010 F-583

   
   

8. This Agreement is binding upon all parties herein and those

   Identified In the aforementioned paragraph of this Agreement.

   
   

   1

9. In the event that Petitioner is or was a Medicaid provider, this settlement does not prevent the Agency from seeking Medicaid overpayments or from Imposing any sanctions pursuant to Rule 59G..9.070

   Florlda Administrative Code. This agreement does not prohibit the Agency

   
   

   from taking action regarding Respondent's Medicaid provider status,

   conditions, requirements or contract.

10. The undersigned have read and understand his Agreement and have authority to bind their respective principals to It. Petitioner has the capacity to execute this Agreement. Petitioner understands that it has the right to consult with counsel and has knowingly and freely entered into this Agreement without exercising Its right to consult with counsel. Petitioner

    affirms that Petitioner u·nderstands that counsel for the Agency represents solely the Agency, and Agency counsel has not provided legal advice to or innuenced PetltiOner In Its decision to enter Into this Agreement.

11. Thl5 Agreement contains the entire understandings and

    
    

    agreements of the parties.

    
    

12. This Agreement supersedes any prior oral or written agreements between the parties. This Agreement may not be amended except in writing, Any attempted assignment of this Agreement shaII be void.

H.C

04/01/2005 16:36 3523949956

ltlti-Lb-· 1&1 1.1 . ,{I rn.Jll-..

PAGE 06

l6. All parties agree that a facsimile signature suffices for an original

signature.

17. The followlng representatives hereby acknowledge that they are

duly authorized to enter Into this Agreement.

Age

272

Tall

/'11,1 Justin M. Senior, ene

l,11 Florida Bar No. 79741

Agency for Health Care Admln.

2727 Mahan Drive, Mall Stop #3

Tallahassee, Flortda 32308

J4/ !lb j;J (J_lj&

r

Sharon Narrlman Ally

9718 Crenshaw Circle

Clermont, Florida 34711

'l_ .z.F

DATEO; b -26 - OC,

stant General Counsel Florida Bar No. 817775 Agency for Health Care Administration

525 Mirror Lake Drive, North

2,

st. Petersburg, Florida 33701

DATED: J 2001

Docket for Case No: 09-003155

Orders for Case No: 09-003155