ST ATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

GARDEN OF ROSES ASSISTED LIVING, LLC, 201◄ OCT I O P 2: I b

Petitioner,

V.

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

AHCA No. 2014006024

RENDITION NO.: AHCA- 14 · Q Lf -S-OLC

./

FINAL ORDER

THIS CAUSE came on for consideration before the Agency for Health Care Administration ("the Agency"), which finds and concludes as follows:

1. The Agency issued the Petitioner the attached Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review (Ex. 1). The parties entered into the attached Settlement Agreement (Ex. 2), which is adopted and incorporated by reference.

   
   

2. The parties shall comply with the terms of the Settlement Agreement. The Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review is rescinded and the Agency shall resume the review of the application if it has not already done so.

ORDERED in Tallahassee, Florida, on this _j_ day of _U_cb - - - - - - ' 2014.

, ecretary

Care Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party that is adversely affected by this Final Order is entitled to seek 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.

Page 1 of 2

Filed November 14, 2014 2:20 PM Division of Administrative Hearings

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct cop is Final Order was served on the below- named persons/entities by the method designated on this of                             , 2014.

Richard Shoop, Agency Cler

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone (850)'412-3630

Page 2 of 2

RfCKSCOTT

fl0RltJ.y,CfN0' tO/iH!W.Ttt C'ARl:ftl'.WINISTAATION

ELIZABETH DUDEK

GOVERNOR Certified Article Number

June 19, 2014

SENDERS RECORD

SECRETARY

CERTIFIED MAIL

ROSE MARIE WONG, ADMINISTRATOR GARDEN OF ROSES

3629 SE 2ND ST

BOYNTON BEACH, FL 33435

License Number: 12067

Case Number: 2014006024

FAc1u ,i iYEU

TAf(F, llNfT

J N 19 2014

NOTICE OF INTENT TO DEEM APPLICATION INCOMPLETK: UJ'n ?r_Hearth

WITHDRAWN FROM FURTHER REVIEW m,Sfration

Dear Administrator:

Your application for license is deemed incomplete and withdrawn from further consideration pursuant to Section 408.806(3}(b), Florida Statutes (F.S.), which states that "Requested information omitted from an application for licensure, license renewal, or change of ownership, other than an inspection, must be filed with the agency within a specified time period after the agency;s request for omitted information or the application shall be deemed incomplete and shall be withdrawn from further consideration and the fees shall be forfeited''.

Your assisted living facility license has a status of "In Review". We are reviewing the license to determine if it will be approved. The Agency was notified on April 14, 2014 that the facility had to

evacuate 6 residents due to a court order issued by Palm Beach County Sheriff's Office because the mortgage had not been pftld. The Agency received a temporary lease agreement on April 17, 2014 which expired 05/15/2014. The Agency requested proof of financial ability to operate due to the

facility's apparent financial distress on April 21, 2014. The facilitis financial records were reviewed on June 2, 20f 4 and had deficiencies.

You were notified by corre pondence dated June 4, 2014 to provide further information addressing identified apparent errors or omissions within ten days from the receipt of the Agency;s·· correspondence. Our records indicate you received this correspondence by certified mail on June 7, 2014. As this requested information was not timely received by the Agency, your application is deemed incomplete and withdrawn from further consideration. The outstanding issues remaining for licensure are:·.

Proof of Financial Ability To Operate EXHIBIT

OMISSIONS:

Notification of Financial Distress by Landlord

-"1"

The ALF's lease agreement contains a provision that the landlord notify the lessee of any certain or potential situation of any kind that may have an effect on the lease agreement. Please explain and provide any available supporting documentation by the lessor regarding how the lessor notified the ALF of the events affecting property and the risk that the tenants may be evicted. In addition, explain how the ALF management responded to such notification in the best interest of the patients and the ALF as a going concern1

2727 Mahan Drive,MS#30

Tallahassee, Florida 32308

Visit AHCA onlina at

ahca.myflorida.com

Ms. Wong

GARDEN OF ROSES

Page2

06/19/2014

Purchase of Property-General Omissions

As noted below, the agency is attempting to purchase the property it is currently housed in. Staff notes the following:

1. The projections do not indicate a purchase price for the facility, nor did the facility

   provide proof of the purchase price or ability to fund the purchase (discussed below).

   
   

2. The projections also do not reflect the result of any financing on the balance sheet, income statement, or cash flow statement.

Please explain:or correct the above.

Purchase Price and Proof of Funding

Documentation provided indicates the ALF will be purchasing the facility; however, the ALF did not provide documentation of the purchase (purchase agreement, bill of sale, etc.) and did not provide proof of ava.ilable funding to complete the purchase transaction. Please provide supporting documentation indicating the availability of funds to complete the purchase. Proof may include account statements of the purchaser prior to purchase. If the purchase has already been completed (an executed bill of sale exists) please provide documentation of the transfer of funds including canceled checks, and or electronic funds transfer recelpts. If the applicant borrowed any of the funds for the purchase from an institution or individual, please disclose the a

mount borrowed, the identity of the lender, and documentation supporting the loan.

This is a review of flnancial stability. As such, in addition to the above, provide copies of the operating account:

1. Bank statements,

2. Bank statement reconciliations, and

3. Check register, and

4. A copy of the detailed profit and loss statement

for the first quarter (January through March), 2014.

Failure to pro;vide proof of ability to fund the minimum funding requirement will result in denial of

the application.

Pursuant to Schedule 1 instructions, please provide independent, certifiable documentation of the existence and availability of these funds. Examples of documents that support funding indude:

!

• copie of current bank statements for accounts owned by the proposed agency, :

• letters of commitment from a bank or other independent lending source,

• or a copy of a line of credit agreement indicating credit line and available c·redit and any restrictions,

• parent company audited financial statements (Note: unaudited financial statements will not be considered as proof of funding ability).

Also, if submitting more than one document as support for funding, attach a separate schedule that clearly lists each item, including:

• Name of the financial institution

• Cutoff (balance) date

• Last four digits of the account/identification number

• Ending balance

• For a line of credit, along with the above, provide total credit line and available credit

Ms. Wong

GARDEN OF ROSES

Page 3

f

06/19/2014

;

Staff will not attempt to analyze and recap multiple funding documents and statements in order to reconcile to funding claimed on Schedule 1. As a result, in if multiple supporting documents are submitted without a lead recap schedule listing each item of funding and reconciling to Schedule 1, staff will consider the funding claimed on Schedule 1 unsupported, resulting in denial of the application.

Note: any pa ent company or personal funds pledged to the applicant must meet the above criteria and the owner of the funds must provide a binding letter of financial commitment pledging the funds to the applicant, along with the above documentation of existence and availability of the funds.

All proof of funding documentation must be dated no later than ten (10) days prior to the date the application is received by AHCA. All proof of funding should be as of the same date.

All proof of funding must be as of the same cutoff date.

Please note, response to the below questions and omissions may change the amount of start-up cost, working capital, and contingency funding requirement on Schedule 1. The applicant must provide sufficient supporting documentation for any additional funding required.

Other:

Explain Changes to Projections

When financial statements are reviewed for an application, staff assumes that a great de'al of time and effort have b;een expended to produce the most accurate projections possible. Revised financial statements cdntaining significant changes, other than correcting the errors identified in the omissions noted above, require detailed explanations of the changes. Failure to fully explain these changes may result in denial of the application.

CPA

While this application is not required to be prepared by a CPA, staff notes the schedules are complex and 'require detailed knowledge of accounting methods. Staff highly recommends the applicant retain the services of a CPA in preparing the forms.

IMPORTANT NOTE

Please note that Section 408.8065(3) states in part "...any person who knowingly flies a false or misleading license or license renewal application or who submits false or misleading information related to such application, and any person who violates or conspires to violate this section, commits a felony of the third degree, punishable as provided ins. 775.082, s. 775.083, ors. 775.084."

Please remember to revise any schedules that may be affected by changes to schedules associated with responses to the above questions and omissions, particularly any changes that may be made to Schedules 2, 3, and 4 since these schedules are the basis for expense, revenue, and cash flow projections ory Schedules 5, 6, and 7. Any changes that affect cash flow may change the amount of funding need d for contingency and working capital. (Note: any additional funding needed must be supported).

Ms. Wong . GARDEN OF ROSES

Page 4

06/19/2014

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(1), 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.

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS.

Sinc (2 p_

Catherine Avery, Manager 0 Assisted Living Unit

SH/Pottere

STATE OF FLORIDA

AGENCY FOR BEALfl CARE ADMINISTRATION

GARDEN OF ROSES ASSISTED LIVING, LLC,

Petitioner,

1. DOAH No. 14-3724

   AHCA No.: 2014006024

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Respondent.

   
   

   
   

   SETTLEMENT AGREEMENT

   
   

   The Petitioner (''the Applicant") and the Respondent (''the Agency'') voluntarily enter into this Settlement Agreement ("Agreement") and agree as follows:

   
   

   1. Parties/Background. The Applicant filed an application seeking licensure within the jurisdiction of the Agency. After initial review, the Agency issued the Applicant an omissions letter and thereafter a Notice of Intent to Deem Renewal Application Inoomplete and Withdrawn From Further Review ('"NOf'). The Applicant has since tendered to the Agency additional information and/or documentation in support of the application, which the Agency is willing to review.

      
      

   2. Purpose and Effect of Settlement. Both parties wish to resolve this case without further litigation and recognize that by entering into this Agreement, both are expressly waiving their right to any legal proceeding they are entitled; including, but not limited to, fonnal and informal proceedings under Section 120.57, Florida Statutes, and appellate review. Both parties consent to the withdrawal of any request for formal or informal hearing if such a request has been made, as well as the relinquishment of jurisdiction of the informal hearing officer or administrative law judge.

      
      

   3. Resumption of Application Review. The parties agree that this Agreement shall supersede the NO! and that the application will no longer be deemed to be incomplete and withdrawn from further review. If the Agency has not already completed its review of the application, it shall resume its review of the application upon entry of the Final Order adopting this Agreement Nothing in tbis Agreement, however, shall prohibit the Agency from denying the application based upon any statute, rule, or regulation, and, if applicable, an unsatisfactory licensure survey.

   4. Administrative Action. The Agency agrees to rescind the NOI

      
      

   5. Release. The Applicant releases and forever discharges the Agency, its employees and agents, both past and current, from any and all claims, including, but not limited to, damages, attorney's fees and costs, arising from or relating to the issuance or litigation of this NOI.

      
      

   6. Costs and Attorney's Fees. Each party shall bear their own costs and attorney's fees.

      Page 1 of3 EXHIBIT

      -"2"

      ··----------

      
      

      
      

   7. Right to Counsel. The Applicant acknowledges the right to retain independent counsel and has either obtained its own counsel or voluntarily waived the right to counsel. The Applicant further acknowledges that Agency counsel represents solely the Agency and that Agency counsel has not provided any legal advice to, or influenced, the Applicant in the voluntary decision to enter into this Agreement.

      
      

   8. Entire Agreement. This Agreement contains the entire understandings of both parties. This Agreement supersedes any prior oral or written agreements that may have existed between the parties. This Agreement may not be amended by either party except in writing.

      
      

   9. Execution of Agreement. Both parties agree that an electronic signa e suffices for an original signature, that an electronic or facsimile copy suffices for an original document, and that this Agreement may be executed in counterparts. This Agreement shall be effective upon full execution by all parties and adoption into a Final Order. After full execution of this Agreement, the Agency will enter a Final Order adopting this Agreement and closing the case.

The following representatives have read and understand this Agreement, are signing it freely and voluntarily, and acknowledge that they are authorized to enter into this Agreement.

2727M

Tallahas

dministration

3

Rose

Owner

Gardens of Roses Assisted Living Facility 3629 SE 2nd Street

Boynton Beach, Florida 33435

DATED: /0- J- '2..0!Lf

a

Stuart F. Williams, General Counsel

Office of the General Counsel . Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308

J Counsel

of

Agency for dministration

525 Mirror Lake Drive

St. Petersburg, Florida 33701

t r

DATED: /P/4/2?1//

DATED:

/12 - I Z{)tl(

Page2 of3

Theodore E. Mack, Esquire Counsel for Petitioner Powell & Mack

700 Bellwood Drive

M'/

allahassee, Florida 32303

• ATED: / tJ

l

Page3 of3

Docket for Case No: 14-003724

Orders for Case No: 14-003724