STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

2015 NOV - 3 p 12: OW

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4196 FINE NO.: F0I 15-0745-001 LICENSE NO.: 1416096

INVOICE NO.: 0115-0745

PALM GARDEN OF WEST PALM BEACH, LLC,

Respondent.

                                                                                     I  

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

DOAH CASE NO.: 15-4187

Petitioner, FINE NO.: F0l 15-0735-001

LICENSE NO.: 1407096

vs. INVOICE NO.: 0115-0731

PALM GARDEN OF CLEARWATER, LLC,

Respondent.

                                                                                     I  

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

DOAH CASE NO.: 15-4188

Petitioner, FINE NO.: F0l 15-0736-001

LICENSE NO.: 1408096

vs. INVOICE NO.: 0115-0736

PALM GARDEN OF GAINESVILLE, LLC,

Respondent.

                                                                                     I

Filed November 9, 2015 2:08 PM Division of Adm1inistrative Hearings

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4189 FINE NO.: F0l 15-0737-001 LICENSE NO.: 1406096

INVOICE NO.: 0115-0737

PALM GARDEN OF JACKSONVILLE, LLC,

Respondent.

                                                                                     I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4190 FINE NO.: F0l 15-0739-001 LICENSE NO.: 1412096

INVOICE NO.: 0115-0739

PALM GARDEN OF ORLANDO, LLC,

Respondent.

                                                                                     I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4191 FINE NO.: F0l 15-0738-001 LICENSE NO.: 1409096

INVOICE NO.: 0115-0738

PALM GARDEN OF LARGO, LLC,

Respondent.

                                                                                     I

2

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4192 FINE NO.: F0l 15-0740-001 LICENSE NO.: 1418095

INVOICE NO.: 0115-0740

PALM GARDEN OF PINELLAS, LLC,

Respondent.

                                                                                     I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4193 FINE NO.: F0l 15-0741-001 LICENSE NO.: 1419096

INVOICE NO.: 0115-0740

PALM GARDEN OF PORT ST. LUCIE, LLC,

Respondent.

                                                                                     I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4194 FINE NO.: F0l 15-0742-001 LICENSE NO.: 1421096

INVOICE NO.: 0115-0742

PALM GARDEN OF SUN CITY, LLC,

Respondent.

                                                                                  I

3

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4195 FINE NO.: F0l 15-0743-001 LICENSE NO.: 1420095

INVOICE NO.: 0115-0743

PALM GARDEN OF TAMPA, LLC,

Respondent.

                                                                                     I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4197 FINE NO.: F0l 15-0746-001 LICENSE NO.: 1414096

INVOICE NO.: 0115-0746

PALM GARDEN OF WINTER HAVEN, LLC,

Respondent.

                                                                                  I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4198 FINE NO.: F0l 15-0747-001 LICENSE NO.: 1410096

INVOICE NO.: 0115-0747

PALM GARDEN OF AVENTURA, LLC,

Respondent.

                                                                                     I

4

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4199 FINE NO.: F0l 15-0748-001 LICENSE NO.: 1411096

INVOICE NO.: 0115-0748

PALM GARDEN OF OCALA, LLC,

Respondent.

                                                                                     I

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs.

DOAH CASE NO.: 15-4202 FINE NO.: F0l 15-0744-001 LICENSE NO.: 1415096

INVOICE NO.: 0115-0744

PALM GARDEN OF VERO BEACH, LLC,

Respondent.

                                                                                     I

FINAL ORDER

This matter involves Administrative Fine - Quality Assessment Fee letters issued by the Agency for Health Care Administration ("AHCA") on June 11, 2015, attached hereto as Exhibits "A" through "N," that imposed three thousand dollar ($3,000.00) fines on each of the above­ named facilities (each of the above-named facilities to be collectively referred to by the singular term, "Provider," hereinafter) for violations of Section 409.9082, Florida Statutes.

On June 22 and 23, 2015, Provider filed a Petition for Formal Administrative Hearing.

5

On July 24, 2015, the Agency Clerk issued a Notice advising the Division of Administrative Hearings ("DOAH") of Provider's Petition for Formal Administrative Hearing and requesting that an Administrative Law Judge be assigned to the matter.

On August 3, 2015, the Administrative Law Judge issued an Order of Consolidation, consolidating DOAH Case Nos. 15-4187, 15-4188, 15-4189, 15-4190, 15-4191, 15-4192, 15-

4193, 15-4194, 15-4195, 15-4196, 15-4197, 15-4198, 15-4199,and 15-4202pursuanttoRule28-

106.108 of the Florida Administrative Code .

On August 6, 2015, the Administrative Law Judge issued a Notice of Hearing, scheduling a hearing in this matter for October 8, 2015, in Tallahassee, Florida.

On August 28, 2015, Provider filed a Notice of Voluntary Dismissal.

On September 1, 2015, the Administrative Law Judge issued an Order Closing Files and Relinquishing Jurisdiction.

As Provider has voluntarily dismissed the Petitions in each of the above-named cases, Provider is required, pursuant to the June 11, 2015, Administrative Fine - Quality Assessment Fee letters (Exhibits "A" through "N") to pay AHCA fines in the amount of three thousand dollars ($3,000.00) per above-named facility for a total of forty-two thousand dollars ($42,000.00).

Based on the foregoing, this file is CLOSED.

DONE and ORDERED on this the Florida.

IL  

day of

NovlAi/l),( 2015 in Tallahassee,

DUDEK, SECRETA

Agency for Health Care Administration

6

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 via email to:

1. R. Terry Rigsby, Esquire Pennington, P.A. trigsby@penningtonlaw.com (Attorney for the Provider)

   
   

2. Bureau of Medicaid Program Finance

   
   

3. Bureau of Financial Services

   
   

4. Stuart Williams, Esquire (Office of the General Counsel)

   
   

5. Shena Grantham, Esquire (Office of the General Counsel)

6. Willis Melvin, Esquire (Office of the General Counsel)

   
   

7. Gregory Pitt, Esquire

(Office of the General Counsel)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and orre of t n furnished to the above named addressees by email on this the day of W 2015.

-                      

Richar . oop, Agency State of Florida, Agency for Health Care Administration 2727 Mahan Drive, MS #3

Tallahassee, Florida 32308-5403

(850) 412-3689/FAX (850) 921-0158

7

RKKSCOTT.

GOVERNOR

ELIZABETH DUDEK

SECRETARY

ADMINISTRATIVE FINE QU ALITY ASSESSMENT FEES

June ll, 2015

PG of West Palm Beach

300 EXECUTIVE Cb'NTER DRNE

West Palm Beach FL 33401

VIA CERTIFIBD MAIL

FINE TNVOICE#:

Invoice#:

Original Due Date:

F0J I 5-0745-001

0115-0745 -

2/15/2015

Our records indicate that payment for the above invoice was not received on its due elate.

As specified in 409.9082, Florida Statutes, states:

(2}Tbe assessment shall be payable to and collected by the agency on the 15th of the month following

the reporting month.

(7)(c) The agency shall impose an administrative fine, not to exceed $500 per day for the first occurrence and $1,000 per day for subsequent occurrences, not to exceed the amount of the assessment; for failure of any facility to pay its assessment by the 20th of the month.

See the attached statement for the administrath·e fme assessed.

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please return a copy of this letter with your payment to:

Agency for Health Care Administration Revenue Management Unit, Quality Assessments Post Office Box 13749, Mail Stop 14

Tallahassee, FL 32317•3749

Should you have any questions, please feel free to call Michael Mwphy at (850) 412-3829.

/mjc

Enclosure

2727 Mah11n Drive• Mail St()p 1114

Tallihassec. FL 32308 AllCA.MyFloridn.com

EXHIBIT A

Facebo<>k,tom/AHCAFlorida Youtube. com/AHCAFlorida Twitter .com/AHCA_FL S!ides ha re.net/ AHCAFlorlda

RARA - Provider Deu,ils (35-95036) Page I of l

AHCA-R.ARA

Dale: 05/13/2015 12:28:24

Usm FJ)I-IClcalnbrcm

Environment; Produclio11

PALM GARDEN OF WEST PALM Bl ACH

Provider Status

The status is Active as of06/08/20l0 05:00:07.

Provider Details

Provider ID 35-95036

License Number 1416096

Provider Type NURSING HOME

Audit Trail

Last Modified By

FDHC\RARA_ User

Last Modlfied On

06/08/20 IO 05:00:07

Physical Location

300 EXECUTIVE CENTER DRIVE

WEST PALM BEACH, FL 33401

Malllng Address

300 EXECUTIVE CENTER DRlVE

WEST PALM BEACH, FL 3340 I

Contact Info

Name Primary Contact

Phone Number {561)471-5566

Fax Number (561)471-5566 Other Number

Email Address

Active Receivables

Program FJlter: NFQA Exemption Status: NOT EXEMPT

Available Deferred Revenues

List of Deferred Revenues                                                                                                                                                              There is nodeferred revenue for the selected program.

Florida Agency for Health Care Administration

©2010

http://hq3netvip01/rara/Modu1es/EntitiesNendor/Default.aspx?ID=2441 5/13/2015

RICK SCOTT

GOVERNOR

EllZABETH DUDEK

SECRETARY

ADMlNISTRA TJVE FINE-QUALITY ASSESSMENT FEES

June J I , 2015

PG of Clearwater

3480 McMullen Booth Road Clearwater FL 33761

VIA CERTIFIED MAIL

FINE INVOICE/!:

Invoice#;

Original Due Date:

F0I 15-0735-001

0115-0731

2(15/2015

Our records indicate that payment for the above invoice was not received on its due date.

As specified in 409.9082, Flotida Statutes, states:

(2)The asseS!lment shall be payable to and collected by the agency on the 15t11 oftbe month following

the reporting month.

(7}(tJ The agency shall impose an administrative fine, not to exceed $500 per day for the first occurrence and $1,000 per day for subsequent occurrences, not to exceed the amount of the assessment; for failure of any facility to pay its assessment by the 20•11 of the month.

See the attached statement for the administrative fine assessed.

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please

return a copy of this letter with your payment to:

Agency for Health Care Administration Revenue Management Unit, Quality Assessments Post Office Box l3749t Mail Stop 14

Tallahassee, FL 32317•3749

Should you have any questions, please feel free to call Michael Murphy at (850) 412 3829.

/mjc

Enclosure

2727 Mahan Dri\'C • Mail Stop #14 Tallahassee. FL 32308 AllCA.MyFlorida.com

EXHIBIT B

Face b()olc.com/ AHCA Florid a Youtube.com/AHCAFlorid Twitter.(om/AHCA_FL SlideShare .net/ AtlCAFlo rid a

RARA - Provider Details (35-55262) Pagel of I

AHCA-RARA

Date: 05/1.312015 12:25:27

User: FDHC\c.labrcm

F.,nir'lnmcnl: l'toduction

PALM GARDEN OF CLEARWATER

Provider Status

The status is Active as of 06/08/2010 05:00:07.

Provider Details

Provider JD 35-55262

License Number 1407096

Provider Type NURSING HOME

Audi{ Trail

Last Modified By

FDHC\RARA_.User

Last Modified 011

06/08/20 l 0 05:00:07

Physical Location

3480 MCMULLEN BOOTH RD

CLEARWATER, FL 33761

Mniling Address

3480 MCMULLEN BOOTH RD CLEARWATER, FL 3376 I

Contact lnf-0

Name Primary Contact

Phone Number (727) 786-6697

Fax Number {i27) 786-6697

Other Number

Email Address

Active Receivables

Program Filter: NFQA Exemption Status: NOT EXEMPT

Available Deferred Revenues

List of Deferred Revenues

There is no deferred rc:venue for the selected program.

Florida Agency for Health Care Administration

©2010

http://hq3netvip0I /rara/Module.s/Entities!Vendor/Default .aspx?JD,..,,2179 5/13/2015

RICK SCOTT GOVERNOR

ELIZABETH DUDEK

SECRt'Tl,RY

ADMINISTRATIVE Fl E-Ql'ALlTV ASSESSMEI\T fEES

June 11, 1015

PG of Gainesville 227SW 62nd Boulevard Gainesville VL 32607

VIA CERTIFIED MA1L

FINE l'N'VOJCEt:

Invoke :

Original Due Date:

FOi 15-0736-001 0l lS-0736 -

211512(115

O n:.r c m!s jpqicc1J,JlJgJ p.arniem for tbe.abo\'e invoice was no1 received on its due date,

As specified in 409,9082, Florida Sta(utes, states:

( )The assessment shall be payable to and collected by the agcnc • on the 1S'h of tbe month following

the reporting month.

( 7 H(') The agenc ' shaU impose an administrad\'e fine, not to exceed $500 per day for the first occurrence and Sl tooo per da)' for subsequcnt occurrences, not to exceed the amount of the assessment; for failure of anr facility to pay its anessment b · the 20th of the month.

See the attacl1ed statement for the administrative fine assessed.

Please remit the fine payment upon receip1 of this Je11er. For prompt crediting to your account, please

retum a copy ofthis letter with your payment to:

Agcnc · for Health Care Administration Rc"enue Management Unil, Quality A!lsessments Post Office Box 13749, Mail Stop 14

Tallahassee, Fl, 323.17•3749

Shouid you have any questions, please feel free to call Michael Murphy nt (850) 412 3829.

imjc

Enclosure

:;27 M.ihun Onn· • Muil Swr t!]-1

Tullahass i·. FL 3 3(lt

A If(' A.M n1lf ii.le ((Ill!

EXHIBITC

F acebook.com/AHCAFloridii Yout ube.comlAHCAFlorida Twitter. co·m/ AHCA_ fl..

SlideShare.ne t/AHCAFlorid a

AHCA-RARA

Oak: 05il.•!WI I1:25:-1.•

her: IDIIC11:alahr 111 Ln, irnr,1111:111: Prod,1<-Ji!lll

PALM GARDEN OF GAINESVILLE

The st,11115 is Aclin a of06/08l2010 05:00:06,

Providt'I' Oe111ils

J'rorider rn 35-30106

Liceme Number 1-1080%

PrtH'id<'r 'I)·pt· NURSING 1101\1[

Audit Trnil

Losr Modified BJ

FDHC-.R:\RA Usc1

L11s1 Modified 011

06 •'08 1 20 IO 0 :00:0(,

Physic11l Location

227 SW 62ND Bl.VD GAINESVflJJ:,, Fl. 32(i07

Mniling Address

227 SW 62ND Bl.VD GAINESVILLE. Fl. 32607

Contnct Info

Num<- Primary {:m11.1l'I

PhoneNomhrr (352!3, 1-0601 Fin Numhl'r < 521]31-0()01

Other Numbi:r

I::mnil Addrc: s

Active Rectivablcs

Program Filter: NfQA

.

ExcmJ>tion Swtus: NOT EXEMPT

. . ----

Available Deferred Revenues

List of Deferred Rncnll<'$

liter.: is nu ucfcm:d r<.'\'i.!1111.: for the cketcd pmgram.

Florida Agency for Health Care Administrntion

.) 2010

http:l/hq3nt'tYip0 I 1 rnrn/M oduk s1Fntiti cs!Vcndorilkfoull.aspx'?I D""1875 5il 3/2015

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G0•!ERl OR

lUi:f..81;"."H DU::iEl<

SECRETAPV

ADMlNISTR.\.TIVE FINE Qt:AUTY ASSESSMENT FEES

June 11, 2015

PG of Jacksom·ille 5275 Spring Park Road Jacksonville FL 32216

VIA CERTrFIED MAIL

FINE INVOICE//:

Jnvoice#:

Original Due Date:

r·ol J 5-0737-001

OJ 15.0737

2115.'2015

Our records indicate that payment for the above invoice was not received on its due date

As specified in 409.9082, Florida Statutes, states:

f'.:iTbe assessment shall be payable to and collected by the agency on the 15th of the month foJJowing

the reporting nwuth.

(7)(c) The agency shall impose an administrative fine, not to exceed $500 per daJ for the fir 1 occurrence and $1,000 per day for subsequent occurrences, not to exceed the amount of the assessment; for failure of any facility to pay its assessment by the 20th of the month.

See the attached statement for the administrative fine assessed.

Please remit the fine payment upon receipt ofthls letter. For prompt crediting to your account, plt:ase return a c-0py of this letter with your payment to·

Agency for Health Care Administration Revenue Management Un.it, Quality Assessments Post Offke Box 13749, Mail Stop 14

Tallahassee, FL 32317-3749

Should you have any questions, please feel free t() call Michael Murphy.at (850) 412-3829.

!mjc

Enclosure

•

2727 Mahan Drive• Miil Stop #14

Talla\lassc , fl. 32308 1

A HC A.MyFlorida.com

'

F ac eboo1:. com/ AH CAFI orl da Youtube. com/AHCAFlori di Twitter .comJAHCA,. Ft.

Slides hare. net/AHCAFlorlda

EXHIBITD

AHCA RARA

Huie: 05'l:;.'2(J;5 J2.2S,5i

u cr HIHC,calat:wcn,

Eovtr,mment: Proriuctlo::

PALM GARDEN OF JACKSONVILLE

Provider Status

111e status is Activt a of 06/08/20!0 05:00:06

Provider Details

Pnwider ID 35-4 ! 625

l,icensc Numbe1 !406096

Pro,•ider Type NURS!NC HOMI

Audit Tr,iil

Last Modifi<-d By PDHC\RARA lJsr-r

Last Modified On 06/0&/2010 05:00:06

Physical Locatiori

5725SPRING PARK ROAD

JACKSONVILLE, fl 32216

Mailing ddress

5725 SPRrNG PARK ROAD

JACKSONVILLE, Fl 322 J 6

Contact Info

Name Primaiy Contact

Phone Number (904) 733-6954

Fax Number (904) 733-6954

Other Number

Email Address

Active Receivables

Program Filter: NF'QA Exemptio11 Status: NOT EXEMPT

Available Deferred Revenues

Lisr of Deferred Revenues                                                                                                                                               

There 1s no dcfc1Ted revenue forthe selected pmgram

Florida Agency for Health Care Adminisira1ioii

<Ci 20l0

http://hq3netvip0l/rara/Modulcs1Entities/Vendor/Default.aspx?ID::2057 5/l 3/2015

RICK SCOTT

GOVERNOR

ELIZABETH DUDEK

SECRETARY

June 11,201:5

ADMINISTRATIVE FINE-QUALITY ASSESSMENT FEES

PG of Orlando

654 East Econlockhatchee Trail Orlando PL 32825

VIA CERTIFIED MAIL

FINE INVOICE#:

Invoice#:

Origi.ial Due Date:

FOl 15-0739-00l 0115-0739

2115/2015

Our records indicate d1at payment for the above invoice was not rei::eh•ed on iis due-date.

As specified in 409.9082, Florida Statutes, states:

(2)The assessment shall be payable to and collected by the agency on the 15111 of tbe month foUowlng

the reporting month.

(7){c) 'fhe agcn y shall impose an admhllstratlve fme, not to exceed $500 per day for the first oc<:ummce and $1,000 per day for subsequent oceurr nces, not to exceed the amount of the assessment; for failure of a11y facility to pay its assessment by the 20'11 of the month,

See the attached statement for tbe admhtistt'1ttive fine assessed.

Please remit the fine payment upon receipt of this letter. For promp1 crediting to your account, please return a copy of this letter with your payment to:

Agency for HeaJtb CAre Administration Revenue Management Unit, Quality Assessmenb' Post Office Box 13749, MaU Stop 14

Taltahnssee, FL 32311 3749

Should you have any questions, please feel free lo call Michael Murphy at (850) 412-3829.

/mjc

Enclosure

2'127 Mahon Prive, Mllil Slop Fl4 Tallafu111sc:f. FL 32l{l!I AHCA.M.vfturida.cpm

EXHIBIT E

1'1ubook.com/AHC;\Ffo:rldl Voutube.corn/AHCAf'lo-rid1 Twitter.(Orn/A HCAFL SlideShart,,tet/ldfC Floridt

J\/\t\/\ - l'rov1uer uc1m1s (j_)- t4X I oJ Page 1 of l

AHCA-RARA

Par :{l l311tl/5 12:Z7:Di v cr: FIJI JC• tl:ibl\:,\l Emiroi1111c111: l'no<l:1 tion

PALM GARDEN OF ORLANDO

Provider Sh1tun

Tht status is Actlvr as of 06/08/2010 O:i:00:0i.

Provider Details

Provider ID 35- 74818

License Number 1412096

Provider Ty11e NURSING HOME

Ph)'SiNd Locution

654 N. ECONLOCKHATCH.rm 'IRAU,

◊RLANDO:FL 32825-6402 .. . ...

Mailing Address

654 N. ECONLOCKHATCHF.E TRAIL ORLANDO, FL 32825-6402

Contact lnfu

Name Primary Cont11ct

Plume Number (407}273-6 J 58

Fnx N11mbcr {407) 273-6158

Other Number

EmAil Address

I\Udll Trail

Last Mod!Oed By FDHC\R.ARA_User

Lnst Modlfied On

06!08/10}0 05:00:07

Active Receivables

-

Program Filler: NFQA ExcmpUcm Stutus: NOT EXEMPT -

Available Deferred Revenues

Th11rc is no dcfcrn:d 1cvc1111e for the selected pro!lmm,

Florida Agency for Hel¼llh Care Administration 02010

http://hq3 nctvi pO1/rara/Modulcs/Entitics/Vendor/Defaul(,aspx?TD,.,,2307 5/l 3/20J 5

ADMINJSTRATIYE FINE Ql!ALIT\' ASSESSMENT FEES

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A sprcificd in 409.91182. Florldn Stntutcs, lilntcs:

i 1Th1.1 nsst.•ssmcnt shnll b • r,nfnhk lo nnd rolll•ctrd hy the 11,:cnr · on tht• 151h of tbc month foliowin fhl' reporlin;: month.

, h H1·, Tlw n l.!11\')' shutl im1mst• 11n ndminii,trntin• fine. not to t•xcrcd $500 per dny for thr first

occurr·cnrt nnd Sl ,00(111cr dny for suh ec111c.•n1 occnrrc11ces, rmi to 4'X<'t• •d Ott nmounl of the

"

llM•t•ssnwnt: for fnilurc of nn, fm:ility to pnf its 11sscssme111 hy the 201 of 1hc mollfh,

Ser lhc nttnctwd stntcment for lhc m.hninistri1lh't• fim• ussrssNl.

Picas · remit the litw parmcJll upon rccei1,1 or thii. lc11cr. For pwmr1 cn:dilin!! Ill yom :H..'cnunt, please

n:1ur11 it •upy 111'1hi:- lclh:r ll'itli your payment w:

Al,!\'1t,· fur Ut•ulth Cure Administrntion Rc,·cmu• l\hum:,:cm,•111 linit, QuuUt, :\1,s,·ssmvnh J1 os1 Office Hoi 13749. Mail Stop 14

TnUnJtnss,•c. FL .32 17-374iJ

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mu: scon

GOVERNOR

£LIZABETH [)UDEK

5!:CRETAR\-

ADMINISTRATIVE FINF:-QUALITY ASSESSM1cN·1· t'li:Jl S

June 11, 2015

PG of Pinellas

200 16th Avenue Sb

Largo FL 33771

V1A CERTIFIED MAJ L FrNE INVOICE#:

invoice#:

Original Due Date:

FOJ 15-0740-001

0115-0740

2/15/2015

Our records indicate that payment for tbc above invoice was not received on its due date,

As specified in 409.9082, florid.fl Statutes, states:

(? 1The anessment sh11U be payable to and collected by the agency on the 15th of the month following the reporting month.

:Tl\;.:) The agency shall impose an administrative fine, not to exceed $500 per day for the first occurrence and $1,000 per day for subsequent occurrences, not to exceed the amount of the assessment; for failure of any facility to pay its assessment by the 20th of the month.

See the idtached statement for tbe administrative fme assessed.

Please rnm.it the fine payment upon receipt of this letter. For prompt crediting m your account, please

return a copy of this letter with your payment to:

Agency for Heidtb Care Administration Revenue Managewt:ot Unit, Quality Assessments Post Office Box 13749,MaUStop l4

Tallahassee, J<'L 32317-3749

Should you have any quesdons, please foe1 free to call 1v1ichae11"1.urphy at (850) 412w3829.

/mjc

Enclosure

2727 Mahoo Drive• Mail Stop ill'!

Tallahassee, Fl 32308

AIICA Myflor1d .COl11

EXHIBITG

F ;Jc el>o ok, com/ AH <AF lotida vo.lJtube.com.{AHCAl'lorida Twitter .com/AHCA_FL. Slides hare. net/AHCAFlorid;i

AHCA-RARA

flatc: 05,'J Y O 5 12? 7 i'

{lscr: f·D!l(\cnlabr,,rn

r ovinmnient, P,od11tti,•H'

PALM GARDEN O'F PINELLAS

Provider Status

The sta,us is Aclive as of06:'08/20IO 05:00:07.

Provider Details

Provider ID J.3·55269

License Number 14 !809.5

Provider Type M 1RSlN( i HOME

Audit Trail

Last Modified By

FDHC\RARA ..User

Last Modified On

06/08/2010 05:tlO:O?

Phy.sical Location

200 16TH AVE SE

J,,,\RQQ, FJ.., 3J77.l

Mailing Address

200 16TH AVE SE

LARGO, FL :mn

Contact .Jnfo

Name Primary Cvntact

Phone Number (727) 585-9377

Fax i'luwber ( n i) '>lb 9.P 1

Other Number f'mail Address

Active Receivables

Program Filter: NFQA F;xeruptio.o Status: NOT EXEMPT

-· ..

-·-••"'"

Available Deferred Revenues

List r,fl>eferrtd Revenues

IThere is no dt?furred revenue for the selected J)rugra.m.

Florida Agency for Health Care Administration

a:,2010

http://hq 3netvip0 I frara/rv!odule /Entitics/Vt>ndor/Default.aspx?JD, 2 l 86 5!1312015

RICK SCOTT

GOVERNOR

ELIZABETH DUDEK

SECRETARY

June 11, 2015

ADMINISTRATIVE FINE-QUALITY ASSESSMENT FEES

PG of Port St Lucie 1751 Hillmoor Drive Port St. Lucie FL 34952

VIA CERTIFIED MAIL

FINE INVOICE#:

Invoice#:

Original Due Date:

F0l 15-0741-001_ 0115-0740

2/15/2015

Oufrecord indicate that payment for the above invoice was not received on..its due date. As specified ln 409.9082, Florida Statutes, states:

(2)Tbe assessment shall be payable to and collected by the agency on the 15th of the month following

the reporting month.

(7)(c} The agency shall impose an administrative fine, not to exceed $500 per day for the first occurrence and $1,000 per day for subsequ nt occurrences, not to exceed the amount of the assessment; for failure of any facility to pay Its assessment by the zo•b of the month.

See the attached statement for the administrative fine 11ssessed,

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please return a copy of this letter with your payment to:

Agency for Health Care Admhustration Revenue Management Unit, Quality Assessments Post Office Box 13749, Mail Stop 14

Tallahassee, FL 32317-3749

Should you have any questions, please feel free to call Michael Murphy at (850) 412 3829.

/mjc

Enclosure

2727 Mah1111 Drive • Mail Stop #14 TaHahassee, FL 32308 AHCA.Myf'lorid11.com

EXHIBITH

Facf!book,,:om/AHCAFlorlda Vo1.1tv1>e.com/AHCAFlorld11 Twitter .i;om/AHCA_FL SlideSharf!,l'lf!t/AHCAFlorida

RARA • Provider Details (35-95606) Page 1 of l

AHCA-RARA

Date: 05/13/2015 12:2i:3l User: FDl·IC\ca!abrem Enl'irnnment: Production

PALM GARDEN OF PORT SAINT LUCIE

Provider Status

The status is Active as of06/08/l010 05;00:07.

Provider Details

Provider ID 35-95606

License Number 1419096

ProviderType NURSING HOME

Audit Trail

Last Modified By

FPHC\RARA_ User

Last Modified On

06/08/2010 05:00:07

Physical l,.,oeatio11

1751 SE HILLMOOR DRIVE PORT SA1NT LUCIE, FL 34952

Mailing Address

1751 SE HILLMOOR DR.JVE

PORTSAlNT LUCIE, FL 34952

Contact Info

Name Primary Comact Phone Number (772) 335-8844

Fax Number (772) 335-8844 Other Number

Email Address

Active Receivables

Program Filter: NFQA Exemption Status: NOT EXEMPT

Available Deferred Revenues

List of Deferred Revenues

Florida Agency for Health Care Administration

©2010

http://hq3netvip0I /rara/Modules/Entities/Vendor/Default.aspx?ID:::::2464 5/J 3/2015

r<10::&con

GOVERNOR

ELIZABETH DUDEK

SECRETARY

ADMII\lJSTRA TIVE FINE..QUALITY ASSESSMENT FEES

Jurte 11, 2015

PO of Sua eitr

!8.50 Upper Cmek Orive

Sun City Center PL 33513

VIA Clm:TlPJW MAIL

FINE lNVOieE#:

Invoice#:

Original Due Date:

FOl 15-074:2-001

0115-0742

2/15/2015

Our record$ indicate that payment for the above invoice was not rceeived on its due date. As specified io 409.9082, Florida Statutes, states:

(2)The asseSJmeut shall be payable to and collected by the agency on the 15th of the month following the reporting month.

(7)(c) Tbe agency shall impote an administrative fine, not to exceed BOO per day for the first occurrence and $1,000 per day for subsequent occurrences, not to exceed the amountof the assessment; for failure of any facility to pay its assessment by the10th of the month.

See the attached statement for the administrative fme assessed•

.Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please

return a copy of this letter with your payment to:

Agency for Health Care Administration Reven1te Maqagement Unit, Quality Assessments Post Office Box 13749, Mail Stop 14 Tallahassee, FL 32317-3749

Should you.have any questions, please feel free to call Michael Murphy at (850) 412-3829.

l.mjc

Bnelowrc

2727 Mahan Driv, • Mail Stop #14 Tallabau,,, .FL 3!?308 AHCA.Myflori(!a.eom

EXHIBIT I

Facebook,r:orr1IAHCAFlorida Vout\ll>e,um/AHCAFloridll Twltter,cem!AHCA_FL SlideShare.net/AHCAFlorida

AlICA.,RARA U,"r,

ij;.1"; 1),iilli!Jll! it:21:,ib FDHC\ilillobrtim

£1n·iu111mc11t: Production

PALM GARDEN OF SUN CITY

Provider Status

The status ii Aetlve as of06/08/20l0 05:00:07.

Provider Detail$

Provlder JD 35-62925

License Number 1421096

Provider Type NURSING HOME

Audit Trail

Last Modified By

FDHC\RARA_User

Last Modified On

06/08/20 IO 05:00:07

Physical LocQtion

3850 UPPER CREEK DR

SUN CITY ENTER, PL 33573

Mailing Addr-esJi

3850 UPPER CREEK DR

SUN CITY CENTER, FL 33573

••• _;;a :at.:e_   l,,lt .--

Contaet Info

Name J?rimary Coouict

Phone Number {813) 633-187$ Fax Number {SIS) 633-2875

Other Number Email Addreu

Active Receivables

Prosram FHtel': NFQA Exemption Status: NOT EXEMPT

Available Deferred Revenues

List of Deferred Revenues

There is no defem:d revenue for the sclcc1ed program.

Florida Agency for Health Care Administration C20l0

http:/lliqJnetvipO l lrara/Modules/E11tities/Vendor/Default.aspx?I1':;;:2229

Flied with AHCA Agency Clerk 6/23/2015 8:00:00 AM

S/13/2015

RICK SCOTT

GOVERNOR

ELIZABETH DUDEK

SECRETARY

ADMINISTRATIVE FINE-QUALITY ASSESSMENT FEES

June 11, 2015

PG of Tampa

3612 138th Avenue

Tampa FL 33613

VIA CERTIFIED MAIL

FINE INVOICE#:

Invoice#;

Original Due Date:

F0J 15-0743-00 I

0115-0743 -

2/1512015

Our records.indfoate that payment for the above invoice was not received on its due date.

As specified in 409.9082, Florida Statutes, states:

(2)The assessment shall be payable to and collected by the agency on the 151h of the month following the reporting month.

(7)(c) The agency shall impose an administrative fine, not to exceed $500 per day for the first occurrence and $1,000 per da)' for subsequent occurrences, not to exceed the amount of the assessment; for failure of any facility to pay its assessment by the 20111 of the month.

See the attached statement for the administrative fine assessed.

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please return a copy of this letter with your payment to:

Agency for Health Cttre Adnihdstration Revenue Management Unit, Qualft)• Assessments Post Office Box 13749, Mail Stop 14

Tallahassee, Fl,32317-3749

Should you have any questions, please feel free to call Michael Murphy at (850} 412-3829.

lmjc

Enclosure

2727 .Mohan Drive• M11il Stop #14

Tollaha.suc, Ft 32308

AHCA,M yflorida.com

EXHIBIT J

Fa(tbook.com/AHCAFlorlda Yo11tubc.com/AHCAflorlde Twitter ,tom/AHCA_FL SlideShue.net/AHCAFlorld11

RARA - Provider Details (35-62922) Page l of I

AHCA-RARA

Dntc: 05/13/2015 12:27:59

User: FDHC\calabrem

l n1·ironment: Production

PALM GARDEN OF TAMPA

Provider Status

The status is Active as of06/08/2010 05:00:07.

Provider Details

Provider ID 35,62922

License Number 1420095

Provider Type NURSING HOME

Audit Trail

Last Modified By FDHC\RA RA_User

Last Modified On

06/08/20 l O 05:00:07

Physical Location

3612E 138THAV£

TAMPA, FL 33613

Mamug Address

3612 E 138TH AVE

TAMPA, FL 33613

Contact Info

Name Primary Contact Phone Number (813)972-8775

Fax Number (813) 972-8775

Other Number

Email Address

Active Receivables

Program Filter: NFQA Exemption Status: NOT EXEMPT

Available Deferred Revenues

List.of Deferred Revenues

There is no !!cferred revenue for the selected program.

Florida Agency for Health Care Administration 02010

http://hq3netvip0l /rara/Modules/EntitiesNendor/Default.as.px?ID=2226 5/13/2015

ADMINISTRATIVE FINE-QUALITY ASSESSMENT FEES

June 11, 2015

PG of Winter Haven

1120 Cypress Garden Boulevard Winter Haven FL 33884

VIA CERTIFIED MAIL

RICK SCOTT

GOVERNOR

ELIZABETH DUDEK

SECRETARY

FINE INVOICE#:

Invoice#;

Original Due Date:

F0115-0746-00l_ 0115-0746

2/15/2015

Our records indicate that payment for the above invoice was not received on its due date.

As specified in 409.9082, Florida Statutes, states:

(2)The assessment shall be payable to and collected by the agencl' on the 151hof the month following the reporting month.

(7)(c) The agenc · shall impose an administrative fille, not to exceed $500 per day for the first occurrence and $1,000 per day for subsequent occurrences, not to exceed the amount of the assessment; for failure of any facility to pay its assessment by the 26th of the month.

See tbe attached statement for the administrative tine assessed.

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please return a copy of this letter with your payment to:

Agency for Health Care Administration Revenue Management Unit, Quality Assessments Post Office Box 13749, Mail Stop 14

Tallahassee., FL 32317-3749

Should you have any questions, please feel free to call Michael Murphy at (850) 412-3829.

/ntjc

Enclosure

2727 Mahan Drive• Mail Stop #14

Tallahassee, FL 32308 AHCA.MyFJorida.com

E•XHIBITK

Facebook.com/AHCAFlorida Youtube.com/AHCAFlorida Twitter.com/AHCA_Fl Slides ha re. net/AHCAl"lorida

RARA - Provider Details (35-653 J 4) Page l of l

AHCA-RARA

Date: 05/J3J2015 12:28:36

Oser: FDHC\calabrem

Environment: Production

PALM GARDEN OF WINTER HAVEN

Provider Status

The status is Active as of06/08/2010 05:00:07.

Provider Details

Provider JD 35--65314

License Number 1414096

Provider Type NURSfNG HOME

Audit Trail

Last Modified By

FDHC\RARA_User

Last Modified On

06/08/2010 05:00:07

Physical Location

1120 CYPRESS GARDENS BLVD WINTER HAVEN, FL 33884

Mailing Address

1120 CYPRESS GARDENS BLVD WINTER HA VEN, FL 33884

Contact Info

Name Primary Contact

Phone Number (863) 293-3 l 00

Fax Number (863) 293-3100

Other Number Email Address

Active Receivables

Program Filter: NFQA Exemption Status: NOT EXEMPT

Available Deferred Revenues

List of Deferred Revenues                                                                                                                       

There is no deferred revenue for the selected program.

Florida Agency for Health Care Administration

©2010

http://hq3netvip01/rara/Modules/EntitiesNendor/Defauit.aspx?ID==2264 5/13/2015

ADMINISTRATIVE FINE QUALITY ASSESSMENT FEES

June 11,2015

PG of North Miami

21251 East Dixie Highway Aventura PL 33180

VIA CERTIFJED MAIL

RICK SCOTT

GOVERNOR

ELIZABETH DUDEK

SECRETARY

FINE JNVOJCEr­

lnvoice!!:

Original Due Date:

F0IJ 5.0747-00 l

OJ 15-0747

11 5(2015

Our records indicate 1hat r,ay111e111 for the above invoice was rm1 rcce.ivcd on ils du!! Gl!t..

As specified in 409.9082, Florida Statutes, states:

'

12 )The assessment shall be payable to and collected b • the 11genc · on the 1511 of the month following

the reporting month.

f"i ,, c I The agency shall impose an administrative fine, not to exceed $500 per da · for the first occurrence and $1,000 pel' day for subsequent occurrences, not t-0 exceed the amount of the assessment for faUore of any facility to pay its assessment by the 20111 of the month.

Sec the attached statement for the administrative fine assessed.

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account. please return a copy of this letter With your paymen1 to:

Agenc,· for Health Care Administration Revcnm• Management Unit, Qualil)• Assessments Post Office Ben; 13749, Mall Stop 14

Tallahassee, FL 32317•3749

Should you have any questions, please feel free to call Michael Murphy at (850) 41:?-3829.

tmjc

Enclosure

7 7 Muh n Drive • Mpil Stnp t I 4

Tnllahns \'C. Fl. J:!JU A HC A.M)'Flvdllaxo.m

EXHIBIT L

Facebook .com/ AHCAFI o rid a Y out\fbt, com/AHCAFlofrda Twitter,com/AHCA_ FL SlideSha re,net/ AHC'.AFlorida

AHCA- RARA

lhllc: 05il.V20l5 J..!:,11,.:7

hu: l'Dl l('lcaiahr<ni

L111·inm111(•1J1; l',..d1H:111,n

PALM GARDEN OF AVENTlJRA

Provider Status

The status is Aclil'C as of 06/08/20HI 05:00:06.

Provider Details

Provider II) 3 5• l I 1346

License Numhcr 141()096

Pt<widct' Type NIJRSJNG HOME

Audit Trail

Last Modified By FDHC,RARA_ Us r

Last Modified 011

06108/2010 05:00:06

Physical Locnfion

21251 E DIXIE lfl(illWI\ Y

NORTFI Ml AM I BFACH.FL 33180

Mailing Addrc$S

21251 f: DIXIE HIGHWAY

NORTH MIAMI BEt\CH, l L 33180

Conlaet Info

Nilme Primar)' Contact

Phone Number (305) 935,4827

Fax Number 005) 935-4827

Other Numhcr

f:mail Address

Active Receivables

Program filter: NFQA facmptio11 Status: NOT EXEMPT

·····-· ---·-..--

-··--------...---'I,",......

Available Deferred Revenues

List of Deferred Rrvenues

Florida Agency for !lcalth C,m Adrninistrntion

, t:1 ::!0IO

ht1p://hq3netvipO l /rara/Modulcs/Entit ies/Vcndor/Dcfoult.aspx?I D=1799 5/13/2015

RICK scon

GOVERNOR

ELIZABETH DUDEK

SECRETARY

June 11, 2015

ADMINISTRATIVE FINE-QUALITY ASSESSMENT FEES

PG of Ocala

2700 SW 34th Street Ocala FL 34474

VIA CERTIFIED MAIL

HNE INVOICE#:

lnvoicefl:

Original Due Date:

FOl 15-0748-001_ 0115-0748

211512015

Ourrecords indicate that payment for the above invoice was not received otdts due date.·

As specified in 409.9082, Florida Statutes, states:

(2)The assessment shall be payable to and collected by the agencr on the 15th oftbe month following

the reporting month.

(7)(c) Tbe agency shall impose an administrative fine, not to exceed $500 per day for the first occurrence and $1,000 per day for subsequent occurrences, not to exceed the amount of tbe assessment; for failure of any factlity to pay Its assessment by the 20th of the month.

See the attached statement for the administrative fine assessed.

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please return a copy of this letter with your payment to:

Agency for Health Care Administration Revenue Management Unit, Quality Assessments Post Office Box 13749, Mall Stop 14

Tallahassee, FL 32317-3749

Should you have any questions, please feel free to call Michael Murphy at (850) 412-3829.

/mjc

Enclosure

27Z7 Mahan Drive• Mail Stop #14 Tallllhasiiee, Fl. 32308 AHCA.MyFJoridu.co111

EXHIBITM

Facebook,c;om/AHCAFlorida Voutube. cr,m/ AHCA Florid.a Twitter.comJAHCA_FL SlideShue,net/AHCAFIQrlda

RARA - Provider Details (3.'>-34105) /,age l 01 l

AHCA-RARA

DIiie: 05113/2015 12:26:44

li. cr: FDJK\i:nlabrcm

En\'ironmenl: Prm.luctio11

PALM GARDEN OF OCALA

Provider Stntus

111e status is Active as of06/08/2010 05:00:06.

Provider Details

Provider ID 35-34205

License Number 1411096

Pro\'ider Type NURSING HOME

Audit Trail

Last Modified By

FDHC\RARA_User

Lt\st Modified On

06/08/2010 05:00:06

Physical Location

2700SW34 STREET

OCALA, FL 34474

Mailing Address

2700 SW 34TH STREET

OCALA, FL 34474

Contact Info

Name Primary Contact

Phoue Number (352) 854-6262

Fax Number (352) 854-6262

Other Number

Email Address

Active Receivables

Program Filter: NFQA Exemptic>n Status: NOT EXEMPT

AvaHabJe Deferred Revenues

List of Deferred Revenues                                                                                                                   

Florida Agency for Health Care Administration

02010

http://hq3netvip01/rara/Modules/EntitiesNendor/Default.aspx?ro=1912 5/1312015

RICk SCOTT GOVERNOR

ELIZABETH DUDEK

SECRETARY

June 11> 2015

ADMINISTRATIVE FINE-QUALITY ASSESSMENT FEES

PG of Vero Beach 1755 37th Street Vero Beach FL 32960

VIA CERTlFIED MAlL

FINE INVOICE#:

Invoice#:

Original Due Date:

F0l 15-0744-001

0115-0744 -

2/15/2015

Our records indicatethatpayment fot the above invoice was not received on its due date,

As specified in 409.9082, Florida Statutes, states:

(2)Tbe assessment sbalJ be payable to and collected by the agency on the 151b of the month following the reporting month,

(7)(c) The agency shall impose an administrative tlnet not to exceed $500 per day for the first occurrence and Sl,000 per day for subsequent occurrences, not to exceed the amount of the assessment; for faflure of any facility to pay its assessment by the 20th of the month.

See the attached statement for the administrative fine assessed.

Please remit the fine payment upon receipt of this letter. For prompt crediting to your account, please retunt a copy of this letter with your payment to:

Agency for Health Care Administration Revenue Management Unit, Quality Assessments Post Office Box 13749, Mall Stop 14 Tallahassee, FL 32317-3749

Should YoU have any questions, please feel free to call Michael Murphy at (850) 412-3829,

/mjc

Enclosure

2727 Mahan Drive• Mail S101>/114 TallAhusee, FL 32308

AHCA, Myfloridn.com

XttlHl'l' N

Faoboolc.com/AHCAFlorida Youtube, Cf.Im/ AHCAFf orlda Twitter,<:om/AHCA_FL

SlidtShere •.net/ AHCAFlorida

, RARA - Provider Details (35-93105) Page 1 of 1

AHCA-RARA

D111c: 05/13/2015 12:28: 12

User: FDHC\calabrem

Environment: Production

PALM GARDEN O.F VERO BEACH

Provider Status

The status is Active as of06/08/20l0 05:00:07.

Provider Details

ProviderlD 35-93105

License Number 1415096

Provider Type NURSING HOME

Audit Trail

Last Modified By

PDHC\RARA_ User

Last Modified On

06/08/2010 05:00:07

Physical Location

1755 37TH STREET

VERO BEACH, FL 32960

Malling Address

1755 37TH STREET

VERO BEACH, FL 32960

Contact Info

Name Primary Contact Phone Number (772) 561-2443 Fax Number (772) 567·2443

Other Number

Email Address

Active Receivables

Program FIiter: NFQA Exemption Status: NOT EXEMPT

Available Deferred Revenues

List of Deferred Revenues                                                                                                                              

There is110 deferred revenue for the selected program.

Florida Agency for Health Care Administration

02()10

http://hq3netvip01/rara/Modules/EntitiesNendor/Default.aspx?fD=2398 5/13/2015

Docket for Case No: 15-004191

Orders for Case No: 15-004191