STATE OF FLORIDA / Ji[ . '( :_, ET:;{

AGENCY FOR HEALTH CARE ADMINISTRATION 'O I l

2016 jlJL 2 I A 1 :

ASSISTED LIVING FACILITY OF DUNEDIN, LLC d/b/a DUNEDIN ASSISTED LIVING FACILITY,

Petitioner,

V.

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

AHCA No. 2016001105

License No. 7292

File No. 11910826

Provider Type: Assisted Living Facility

RENDITION NO.: AHCA- \ ·o \,.\\A -S-0LC

/

FINAL ORDER

Having reviewed the Notice of Intent to Deny Change of Ownership Application and all other matters of record, the Agency for Health Care Administration finds and concludes as follows:

1. The Agency issued the Petitioner, a change of ownership applicant for licensure, the attached Notice of Intent and Election of Rights form. (Ex. 1) The Election of Rights form advised of the right to an administrative hearing pursuant to Sections 120.57(1) and 120.57(2), Florida Statutes. The Petitioner received the Notice of Intent and Election of Rights form and later voluntarily withdrew the application for licensure pursuant to the terms of the attached settlement agreement. (Ex. 2)

   
   

   Based upon the foregoing, it is ORDERED:

   
   

2. The Petitioner's change of ownership application for licensure is withdrawn and the provisional license issued to the Petitioner shall be cancelled 45 days from the date of the date of this Final Order without any further action by the Agency. The Petitioner shall proceed to discharge the residents in a safe and orderly manner. At the conclusion of 45 days or upon the discontinuance of operations, whichever is first in time, the Petitioner shall immediately return the license certificate for the license which is the subject of this action to the appropriate licensure unit in Tallahassee, Florida.

   
   

3. The Notice oflntent is withdrawn.

   
   

4. The Petitioner is responsible for any refunds that may be due to any clients.

   
   

5. The Petitioner shall remain responsible for retaining and appropriately distributing client records as prescribed by Florida law. The Petitioner is advised of Section 408.810, Florida Statutes. The Petitioner should also consult the applicable authorizing statutes and administrative code provisions as well as any other statute that may apply to health care practitioners regarding client records.

   
   

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   Filed August 15, 2016 12:09 PM Division of Administrative Hearings

6. The Petitioner is given notice of Florida law regarding unlicensed activity. The Petitioner is advised of Section 408.804 and Section 408.812, Florida Statutes. The Petitioner should also consult the applicable authorizing statutes and administrative code provisions. The Petitioner is notified that the cancellation of an Agency license may have ramifications potentially affecting accrediting, third party billing including but not limited to the Florida Medicaid program, and private contracts.

ORDERED at Tallahassee, Florida, on this .     ( 1 day of_ (:/-r_ _·---¥_,         , 2016.

Elizabeth

Agency for are Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

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.

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CERTIFICATE OF SERVICE

I CERTIFY that a true and correct !Jhis Final Order was served on the below-named

persons by the method designated on this f                          2016.

/

Richard J. Shoop, Agenc

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

Tallahassee, Florida 32308

Telephone: (850) 412-3630

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NOTICE OF FLORIDA LAW

408.804 License required; display.--

1. It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider.

   
   

2. A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued.

408.812 Unlicensed activity.--

1. A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license.

   
   

2. The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency.

   
   

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3. It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense.

   
   

4. Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance.

   
   

5. When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation.

   
   

6. In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules.

   
   

7. Any person aware of the operation of an unlicensed provider must report that provider to the agency.

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Certified Article Number SENDERS RECORD

Qolbaol!oS

RICK SCOTT GOVERNOR

ELIZABETH DUDEK

SECRETARY

Pebruary 4, 2016 CERTIFIED

Maryla B Hawekotte, Administrator and Owner Dunedin Assisted Living Facility

14605 Coffey Lane

Hudson, FL 34667

File Number: 11910826

License Number: 7292

Provider Type: ussiMed hvmg fm;1l1L)

1u:n:1v1m

f',\Cll,ITY l"TAIO: !,MT

RE: Complaint Number 20J600U0S 534 Howell Street, Dunedin

04

Notice of Intent to Deny for Change of Ownec&urt;tiilli ;tnnlon

Dear Ms. Hewekoue,

It is the decision of this Agency that Dunedin Assisted Living Facility Change of Ownership application for (an/the) assisted living facility license be DBN[ED.

The Specific Basis for this determination is; The applicant failed to meet minimum licensure requirements pursuant to Section 408, Par1 II, Florida Suitutes (f:.s.) and Section 429. Part 1, F.S.

On December 2, 2015 a change of ownership survey was conducted in conjunction with a complaint investigation and two class III deficiencies were cited. The deficiencies were in the areas of Staffing Sumdards and Training.

Two complaint investigations were completed on January 8, 2016 and eight deficiencies were cited. The deficiencies included; one class two in the a1·ea of Rc:-idcni Cure, une .mdussilkd defidt'Hc} m th;. ,t.\:a of Background Screening, and six class lII deficiencies in the areas of: Medkation, Staffing Standards, Food service, Fiscal, and Resident Contracts.

Therefore, pursuant to Sections 408.810 F.S., 408.809 F.S., and 429.14{1) (f)

Ownership Application has been denied.

your Change of

EXPLANATION OF RIGHTS

Pursuant to Section 120.569, F.S., )'OU 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 Admit istrative Code (F.A.C). and must state the material facts you dispute.

SEE ATI ACfIED ELECTION AND EXPLANATlON OP RIGHTS FORMS.

If you have any questions or need further assistance, please call Keanna Green at (850) 412•4419 ore­ mail at Keanna.Green@ahca.myflorida.com.

EXHIBIT 1

271.7 Mahan Orlpe • MS#30 Tallahassee, FL 32308 AHCA .MyFlor!da.com

Faubook.torll/AHCAF!orldil Yout vbe.com/AHCAFlorida rwitte r.tom/MICA_F L

Sl!d eS hare.Mt/A HC AFll;irlda

Dunedin Assisted Living Facility

February 4, 2016

Page #2

c~ {

IJ,n

Assisted Living Unit

Agency for Health Care Administration cc: Legal Intake Unit, MS# 3

STAT! or l<'LORIDA

DlVXSION OF f\.))MINISTRATM HEARINGS

ASSISTED LrVlNO FACILITY

Of DUNDEXN, LLC

d/b/a DUNEDIN ASSISTED LIVJNG FACILITY

Petitioner,

STATE OF FLOR!DA

AGENCY fOR HBALTH CARE At>MlNISTRATION,, ·

Respondent.

CASE. No. 16-1448

ARCA No.: 2016001105

$lT.XLtMENTAGREEMENJ

Respondent, State of Florida. Aiency for Health Ca.i-e Administiation (hi::reinafter the "Agency'), through its1.mcletslg11ed representatives. and '.Petitioner, Assisted Livine facility of Durtedin, LLC d/b/a Dunedin Assisted Livln :facilify (herein:rl't.$r 1Ll' rovid '). pursuant to

S tioll 120.:57(4), Florida Statutes, each individually, a "pru:ty." coUectivcly as parties... hereby

tmter imo thLs Settlerne:nt Agreem ("Agreement") and agree ag follows:

W&E'.REAS, Petitioner, at all times relevBJlt, were assisttd living facilities licensl"ld pur$utnt tO Ch pters 408, l'art Il and 429, Part I. Florida Statutes, and Chapter 58A-5, Florida Administrative Code And

wtmrutAS, the A cy has jurisdiction by virtLle of being the regulatory and licensing authority over RespQndents, pursuant to Chapters 408, Part U and 4.29, .Part l, Florida Statutes.; and

EXHIBIT 2

WlOtREAB, tho Agency iisued a Notice of Intent to Deny tho PJ:9vider's change of ownei..hip application on Febnia,:y 4, 201ti, lieensi, nwnbeir 7292; and

WHEREAS, F'etitioner requeeted a fonnal proceeding by selecting OptiQil "1" on the Election of Rights fonn and by the filing of a Pt!tition; and

WHEREAS, the parties have negotiated a:nd 11greed that the bos-t int.erest of all 'Che parties

will be served b:y a 8ettle:ment of this procer!ding; ano

NOW THEREFORE. in consideration ofth.e -mutual promises and citals herein, the

parties intending to be legally bound, agree as follows:

1. AU recitals h axe truo and comet and are xpreasly in orporeted herein.

2. Both pa.mes agree that the "whereas)) clauses incnrporated h rein ano bindin

   fmdin.gs of the parties.

3. Upon full execution 4)f this Agretinent, Respondent agrees to waive any and all appeals an.d pro'"eed.ings to which it ms.y be entitled including, but not limited to, m infonnal proceeding under Subeecti n l:Z0.57(2), Florida St\tutes1 a formal proceeding undt'Jr Subsection 120.57(1). Florida Statutes, appeal!; under Section 120.68, Florida SUJ.tute3; and declaratory and all writs ofr1tlief ll'l &'l)' court Pr quasi-court of oompe ent judsdiction; and agrees to waive complianco with the form of the Final Order (findings of fact and conclU$lons of law) to whfoh it may be entitled, provided., however, that no agr ement herein shall be deemed a wa.ivr;r by either party of its right to judici enforcernent of this Agreement.

4. Upon full exeoution of this Agreem nt1 the parties agr e ttS follows:

   1. EffectiVe inunedia. ly the Pi;-ovidllll' gre-es not to a.chnit an:y tl.u:thcr

      residents t.c;, th facility.

      
      

   2. Contingent upon the Provider's voluntary withdrawal of its change of ownership application for lic::ensute with the Agl/lll.Cy, the Agoncy agrees to rescind the NOI identified as AHCA Case No. 2016001105.

      
      

      b. The parti s agree that this Agreement shall upt,rs de the NOL

      1,. All residents residing in the facility shall be di:.lcharged pl,lr$uant to Florida

      !Aw, within (4S) days of issuance of the Fin.al 01:'d.er in this ctSE!,

      
      

      1. Effective 5:00 pm on the (45) day from the date a Final Order is is11ued incorporating the terms of this agreeml'lnt license no. #7292 shall be deemed. reHnquished, cancelled, and legally nonexistent.

         
         

      2. lne Provider shall not attempt to transfer ownmhip of the facility in any way prior to thi, effectivB date of cancellation of license no, #729'2. The (45) days a;ranted are expressly and solely for the purpose of f itiwting the orderly transfer o,; dlschargo of residents,

      
      

      f, Execution of this went by Marla. HawelcQtte, as owner and administrator of 'the Provider, Uc<:n c: no. #7292, will t l!til Qffirm;t;ive withdl'a.wal of the change: of own hip appllcatfo,:i 1:Qr li nse no. #7292

      -il.l\imitted to the Agency. No further act will be required for withdra.wa1 of the

      application.

      
      

5. Venue for any e,.ction brought to challenge, interpret o.- enforee the temu of this Agreement or its Final Order shall He solely in the Circuit Court of Leon County, Florida.

7. The Petitioner's cution of'this Agx ertt isnot an admi.Bsion of.my ru1epti¢u or wrongt!Qing against the Provider. However, thb Agreertleti.t shall not preclude the Agency from imposing a. p alty :against any other faclUry licon$ed by the Provider for any d.effoiency or vio!ation of any st.atut.e or rule identified irt a future r.urvey of licerui d facility of the Provider.

9. Upon full execution ofthls Agrei;ment, ihe Agency shall enter a l;linal Order

ado-ptl andincorporating the tenn:5 of this Agreement and closing the above-i,tyled o e.

10, Each party shall hear its own costs and attorney's fee$.

11. This Agreement shall become e ctive on the date upon which it is fully executed

by all 1he parties,

I 2. The Provider, and Ma 1a Hawekotte, indiVidually, for thetnselvoi, and for their

related or res1.1ltin orgs:nizations. successors or trausfei:ees, attome;,s, heh-sf and executors o:r

3

adminilltmtors, do hereby dis.charge the State of Florida, Agen<,y for Health CareAdministrationi and its agents. r esent:atives, and orneys of and from ti.11 clauns1 demands, actions, causes of action, suits, damaaes, losscss, and expenses:, of any and evecy nature whatsoev1;1,, arising 01,1t of or in anyway related t-0 this matter attd the Agency's actions, ini::ludlng, 'out !'lot limited to, any claims that were or may be asserted in any fed ral or state court or administrative fomnl.

Including any claims arising out of this agreement, by or on behalf of t{espontlont Qr rel11.ted

facilities.

13, This Agreemeru is binding upon all parties herein and those identif d U1

paragraph twelve (12) Qfthis Agr ent.

14, ln the event that Petrtioner was Medic.aid providar at the subject time of the occurrcncos alleged in the complaint herein, this settlement does noi: prevent the Agency from seeking Medieaid ove ym nts related to the subject fa1;ue.s or from lmposil'lg t111y sllnotions pursttan't :Rule 590--9.070, Fknida Administrative Code.

1. Petitioner agrees that if any fun(!& -i:o be paid under thi.:! agreement to the Agency e not J?ak! within thirty--one (30 days of entry of the Final Order in this matter; the Agency may deduct the o.mot.1nts assessed against Respondent in the Final Order, or any portion thereof, owed by Respondent ·tc the Aa;ency ftom any pl.'esent or futun, funds owed to Ras-.pondent by the Agency, and that the A2:ency shall hold a. lien against present and future fimds owed to Respondent by tht Agency for said amoU11.t& until paid.

2. The midersigned have read and understand this Agt ement and have the authority

   
   

   to bind their rospocti.vn principals. to it. Ill:.Hawekott . lrtdlvidually, has the capacity to e te this A eement.

   
   

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3. This AgJ:eemcnt contains and lni:o;rporates the entire understandings Md

   
   

   agreemen.ts of the parties.

4. This Agreement supersedes any prior oral or written agreements between the

   
   

   parties,

5. This Agreement may not be a.m<inded except in writing. Any itti:entpted

   assigrunCQt of this Agrtement shall ha v()id,

6. All partiei agree that a. fa.osimile sign"'wre suffices for tln original signature.

The following repro:ien tivee hereby 11-Cknowledge that they are duly authorized to enter

tnto thi$ Agreement

Tall

s

Owner of Assisted Living of Dunedin, LLC

534 Howell Stre

Dunedin, Florida 34696

DATED:

/) Stuart F. • s, General Counsel

U-t,Offii,e of the Oenera.J Cowsel

Agency for Health Care Admlnisll'a.tion 2727 Mahan Drive, MS #3

Tallahassee, Florid& 3 308

  c.pgQ_u, Q2_ 1d      /-O"L:

Thomas Cauftnan, fug -:. \_)

Counsel for PQtitioner

Quint!iros, Prieto, Wood & :Boyiir, P.A. 4905 West laurel Street, Suite 200

Tampa, Florida 33607

DATED:                            

Bradley, Senfor Att.o

J.

Ageno:y for Health C&re .N mini,tration

,.25 Mirror Lak Drive, Suite 3300

St. Perersburg, Florida 33701

DATED;-1JJ5_1I Ca

6

Docket for Case No: 16-001448

Orders for Case No: 16-001448