STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

FfLEO

AHCA

AGENCY CLERK

1013 JUL 2 A q: 42 .

Petitioner,

vs.

OLD CUTLER RETIREMENT HOME

Respondent.

                                                                                /

CASE NO. 12-2245MPI PROVIDER NO. 140645100 LICENSE NO. AL8238

C.I. NO. 12-2514-000

RENDITION NO.: AHCA-/3- '?/I -5-MDO

FINAL ORDER

THE PARTIES resolved all disputed issues and executed a Stipulation and Agreement. The parties are directed to comply with the terms of the attached Stipulation and Agreement. Based on the foregoing, this file is CLOSED.

DONE AND ORDERED this day

re Administration

20JJ , in Tallahassee, Leon County,

Page 1 of 3

Filed July 26, 2013 10:19 AM Division of Administrative Hearings

CASE NO.

C.I. No.

12-2245MPI

12-2514-000

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A 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 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:

Old Cutler Retirement Home ATTN: Pamela Berryman

151 SE 15th Road, Apt #1201 Miami, Florida 33129-1246

Email: pamelaaberryman@hotmail.com

June C. McKinney Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

Agency for Health Care Administration

Debora E. Fridie, Assistant General Counsel, MS #3

Agency for Health Care Administration Division of Health Quality Assurance

Agency for Health Care Administration Home Care Unit, MS #34

Agency for Health Care Administration Bureau of Finance and Accounting, MS #14

Agency for Health Care Administration Bureau of Medicaid Program Integrity, MS#6 ATTN: Rick Zenuch, Bureau Chief

Florida Department of Health

CASE NO.

C.I. No.

12-2245MPI

12 2514-000

CERTIFICATE OF SERVICE

=

I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order was furnished by United States Mail, interoffice mail, or email transmission to the above-referenced

addressees this Z f             )C{ y , 20}3       .

Clerk

Agency for Administration

2727 Mahan Drive, MS #3

Tallahassee, Florida 32308

Telephone No. (850)-412-3630

Fax No. (850)-921-0158

Docket for Case No: 12-002245

Orders for Case No: 12-002245