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STATE OF FLORIDA 2019 JM l - 2 P 12: 8
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
Petitioner,
V.
Case No.: 18-5514
AHCA No.: 2018004972
Provider Type: Assisted Living
RENDITION NO.: AHC.4 19 - oo 17 • -S-OLC
AN EXCELLENT CARE ALF, LLC,
Respondent.
I
Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows:
The Agency issued the attached Administrative Complaint and Election of Rights form to the Respondent. (Ex. 1) The parties have since entered into the attached Settlement Agreement, which is adopted and incorporated by reference into this Final Order. (Ex. 2).
The Respondent shall pay the Agency an administrative fine of four thousand three hundred six dollars ninety-two cents ($4,306.92) plus survey fees of one hundred ninety-three dollars eighty-seven cents ($193.87), for a total sum of four thousand five hundred dollars ($4,500.00). If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within 120 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the "Agency for Health Care Administration" and containing the AHCA ten-digit case number should be sent to:
Central Intake Unit
Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61
Tallahassee, Florida 32308
ORDERED at Tallahassee, Florida, on this _L day of J9"= , 201f.
retary
Agency for Health Care Administration
Filed January 14, 2019 4:08 PM Division of Administrative Hearings
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.
I CERTIFY that a true and correct copy ofj:}Hj; Final Order was served on the below
named persons by the method designated on this ay of
201JI-
CERTIFICATE OF SERVICE
=7 ,
Ric ar . Shoop, ency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3
Tallahassee, Florida 32308
Telephone: (850) 412-3630
Facilities Intake Unit Agency for Health Care Administration (Electronic Mail) | Central Intake Unit Agency for Health Care Administration (Electronic Mail) |
Nicola L. C. Brown, Senior Attorney | Ketlie Moise |
Office of the General Counsel Agency for Health Care Administration (Electronic Mail) | Owner/Administrator An Excellent Care ALF, LLC 15477 S.W. 1515t Terrace |
Miami, FL 33196 | |
(US Mail) |
2
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION,
vs.
Petitioner,
ARCA Case Nos. 2018004972
License No. 12933
File No. 11969108
Provider Type: Assisted Living Facility
AN EXCELLENT CARE ALF, LLC,
Respondent.
/
ADMINISTRATIVE COMPLAINT
COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter "the Agency"), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, An Excellent Care ALF, LLC, (hereinafter "the Respondent"), pursuant to Sections 120.569 and 120.57, Florida Statutes (2017), and alleges as follows:
NATURE OF THE ACTION
This is an action to impose an administrative of five thousand six hundred ninety-three dollars and eighty-seven cents ($5,693.87) based upon one (1) Class II deficiency, one (1) unclassified criminal background screening deficiencies, and survey fees.
PARTIES
The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida. Ch. 408, Part II, and Ch. 429, Part I, Fla. Stat. (2015); Ch. 59A-35, Ch. 58A- 5, Fla. Admin. Code. The Agency may deny, revoke, and suspend any license issued to an assisted living facility and impose an administrative fine for a violation of the Health Care Licensing Procedures Act, the authorizing statutes or applicable ru]es. §§ 408.812, 408.813, 408.815, 429.14, 429.19, Fla. Stat. (2017). In addition to licensure denial, revocation or suspension, or any
EXHIBIT 1
administrative fine imposed, the Agency may assess a survey fee against an assisted living facility.
§ 429.19(7), Fla. Stat. (2017).
The Agency issued the Respondent a license to operate an assisted living facility ('1be facility'') located at 16251 SW 248th Street, Homestead, FL 33031, and the Respondent was at all times material required to comply with the applicable statutes and rules governing assisted living facilities.
COUNT I (A002SJ
Resident Care - Supervision
Under Florida Law,
(7) The facility must notify a licensed physician when a resident exhibits signs of dementia or cognitive impairment or has a change of condition in order to rule out the presence of an underlying physiological condition that may be contributing to such dementia or impainnent. The notification must occur within 30 days after the acknowledgment of such signs by facility staff. If an underlying condition is determined to exist, the facility shall arrange, with the appropriate health care provider, the necessary care and services to treat the condition.
§ 435.12(2), Fla. Stat. (2017).
Under Florida Law,
An assisted living facility must provide care and services appropriate to the needs of residents accepted for admission to the facility.
SUPERVISION. Facilities must offer personal supervision as appropriate
for each resident, including the following:
Monitoring of the quantity and quality of resident diets in accordance with Rule 58A-5.020, F.A.C.
Daily observation by designated staff of the activities of the resident while
on the premises, and awareness of the general health, safety, and physical and emotional well-being of the resident.
Maintaining a general awareness of the resident's whereabouts. The resident may travel independently in the community.
Contacting the resident's health care provider and other appropriate party such as the resident's family, guardian, health care surrogate, or case manager if the resident is discharged or moves out.
Maintaining a written record, updated as needed, of any significant changes,
any illnesse that resulted in medical attention, changes in the method of medication
administration, or other changes that resulted in the provision of additional services.
Fla. Adm.in. Code R. 58A-5.0l 82 (2017).
Facts
On or about and between December 4, 2017 and December 13, 2017, the Agency conducted a Complaint Survey of the Respondent's facility.
Based on observation, record review, and interview, the Respondent facility failed to ensure that two (2) out of seven (7) sampled residents received medical provide care and services appropriate to their needs.
Resident#!
During phone interview on or about December 1, 2017, Resident "#6's family revealed that Resident #6 was admitted to the hospital due to low blood sugar, and remained admitted to the hospital for an extended period of time.
Review of Resident #6's hospital records revealed that on September 24, 2017 fire
rescue responded to the Respondent facility and found Resident #6 with blood sugar level of 20mg/dl. Nonna! blood sugar range for an adult is 70-100 mgldl.
Review of Resident #6's hospital records revealed the Resident anived at the hospital at or about 1:22 P.M. on September 24, 2017, stated they had not eaten breakfast that morning. The hospital administered glucose and glucagon, and the resident's glucose level went up to 40 mgldl. A second dose of glucagon was administered and the resident's glucose level went up to 60 mg/dl. According to hospital records, Resident #6 remained hospitalized until September 29, 2017.
Review of Resident #61s facility records found no progress notes from September 24, 2017 relating to Resident #6's significant change in blood sugar levels that resulted in the need
for medical attention and subsequent hospitalization.
During interview on or about December 4, 2017, the facility's Administrator asserted she did not know why Resident #6' s blood sugar lowered, and that it was part of the change in Resident #6's condition.
Review of Resident #6's Health Assessment (AHCA Form 1823), dated January 11, 2017, showed medical history and diagnoses of diabetes, chronic kidney disease, anemia, major depression, dyslipidemia, Vitamin D Deficiency, Hypertension, Congestive Heart Failure, GERD, Peripheral Neuropathy, and alerted to special precautions due to the residents Hypoglycemia (low blood sugar).
During interview on or about December 12, 2016, the facility's Administrator stated she called 911 for Resident #6 because the residents showed signs of blood sugar, and asserted the resident had only received one can of Glucema that morning and no other food.
Resident#4
During intereview on or about December 4, 2017, the facility's Administrator revealed that Resident #4, a diabetic resident with insulin dependency, had not been admitted by the home health agency yet although she had called the home health agency the night before.
Review of the facility's admission and discharge log showed Resident #4's
admission date as December I. 2017.
Review of Resident #4's records revealed a prescription, dated November 14, 2017, for a sliding scare of lispro {Humalog) 100 units/ml subcutaneous solution before meals and at bedtime.
Review of Resident #4's records showed no documentation that any facility staff
was checking Resident #4's blood sugar level or injecting the insulin, and there was no
documentation that Resident #4 received insulin injections between December I, 2017 and December 4, 2017.
Review of Resident #4's Medication Observation Records (MORs) revealed an order for Novolog Mix 70/30, inject subcutaneously twice a day according to sliding scale, but the MORs were not initialed on any day by facility staff between December 1, 2017 and December 4, 2017.
Review of Resident #4's MORs revealed no documentation or notation that a home health agency or the facility's registered nurse was checking Resident #4's blood sugar levels.
Review of the facility's personnel records found the facility's Administrator was a registered nurse. During interview on or about December 4, 2017, the Administrator stated she did not know she could check the residents' blood sugar levels because she was told she couldn't use her nurse's license in the facility.
During interview on or about December 13, 2017, the Administrator stated she had checked Resident's blood sugar levels twice a day and administered the insulin, but said no during the December 4, 2017 interview because she did not was to get her registered nurse license in trouble.
Based on the above findings, the Agency cited the Respondent facility with a Class
II volation.
Sanction
The Respondent's actions, or inactions, constitute a Class II violation of Section 429.26, Florida Statutes (2017), and Rule 58A-5.0182(1), F.A.C. (2017).
Class "II" violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency detennines directly
threaten the physical or emotional health, safety, or security of the clients, other than class I violations. The agency shalJ impose an administrative fine as provided by law for a cited class II violation. A fine shall be levied notwithstanding the correction of the violation. § 408.813(2)(b), Fla. Stat. (2017).
Under Florida law,
In addition to the requirements of part II of chapter 408, the agency may deny, revoke, and suspend any license issued under this part and impose an administrative fine in the manner provided in chapter 120 against a licensee for a violation of any provision of this part, part II of chapter 408, or applicable rules, or for any of the following actions by a licensee, for the actions of any person subject to level 2 background screening under s. 408.809, or for the actions of any facility employee: an intentional or negligent act seriously affecting the health, safety, or welfare of a resident of the facility.
§ 429.14(1)(a}, Fla. Stat. (2017).
Under Florida law,
Violations of this part, authorizing statutes, or applicable rules shall be classified according to the nature of the violation and the gravity of its probable effect on clients. Violations shall be classified on the written notice as follows: ... Class "II" violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. The agency shall impose an administrative fine as provided by law for a cited class II violation. A fine shall be levied notwithstanding the correction of the violation.
§ 408.813(2)(b), Fla. Stat. (2017).
Under Florida law, the Agency shall impose an administrative fine for a cited Class II violation in an amount not less than $1,000 and not exceeding $5,000 for each violation. § 429.19(2)(b), Fla. Stat. (2017).
The Agency cited the Respondent for a Class II violation in accordance with applicable statutes and authorizing rules.
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
seeks to impose an administrative fme of five thousand dollars ($5,000.00) against the Respondent
COUNT IT 1AZ814J
Background Screening Clearinghouse
Under Florida Law,
Until such a time as the fingerprints are enrolled in the national retained print arrest notification program at the Federal Bureau of Investigation, an employee with a break in service of more than 90 days from a position that requires screening by a specified agency must submit to a national screening if the person returns to a position that requires screening by a specified agency.
An employer of persons subject to screening by a specified agency must register with the clearinghouse and maintain the employment status of all employees within the clearinghouse. Initial employment status and any changes in status must be reported within 10 business days.
An employer must register with and initiate all criminal history checks through the clearinghouse before referring an employee or potential employee for electronic fingerprint submission to the Department of Law Enforcement. The registration must include the employee's full first name, middle initial, and last name; social security number; date of birth; mailing address; sex; and race. Individuals, persons, appJicants, and controlling interests that cannot legally obtain a social security number must provide an individual taxpayer identification number.
§ 435.12(2), Fla. Stat. (2016)
On or about and between December 4, 2017 and December 13, 2017, the Agency conducted a Complaint Survey of the Respondent's facility.
Based on interview and record review, the Respondent facility failed to maintain the employment status of all employees on its roster within the Agency's Backgound Screening CJearinhouse Database.
Review of the Agency's Backgrmmd Screening Clearinghouse Database for
providers on or about December 12, 2017 showed the Respondent facility's employee roster was empty
During phone interview on or about December 12, 2017, the facility's Administrator stated she had not updated the facility roster yet because she thought it was something new and she had more time to do it.
Based on the above findings, the Agency cited the Respondent facility with an unclassified criminal background screening violation.
Sanction
The Respondent's actions, or inactions, constitute an unclassified violation of the criminal background screening statute, specifically§ 435.12(2), Fla. Stat. (2017).
Under Florida law, in addition to the requirements of part II of Chapter 408, the Agency may deny, revoke, and suspend any license issued under this part and impose an administrative fine in the manner provided in Chapter 120 against a licensee for a violation of any provision of Part I or Chapter 429, Part II of Chapter 408, or applicable rules, or for any of the following actions by a licensee, for the actions of any person subject to level 2 background screening under Section 408.809, Florida Statutes, or for the actions of any facility employee: (f) failure to comply with the background screening standards of Chapter 429, Part I, Section 408.809(1), or Chapter 435, Florida Statutes. § 429.14(I)(t), Fla. Stat. (2017).
Under Florida law, the Agency may impose an administrative fine for a violation that is not designated as a class I, class II, class III, or class IV violation. Unless otherwise specified by law, the amount of the fine may not exceed $500 for each violation. Unclassified violations include: (b) violating any provision of this part, authorizing statutes, or applicable rules. § 408.813(3)(b), Fla. Stat. (2017).
Under Florida law, the Agency shall impose an adminsitrative fine of $500.00 if a facility is found not to be in compliance with the backgr01md screening requirements as provided
in section 408.809, Florida Statutes. § 429.12(2)(e), Fla. Stat. (2017).
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to impose an administrative fine of five hundred ($500.00) against the Respondent.
COUNTIII
Survey Fee
Under Florida law,
(7) 1n addition to any administrative fines imposed, the agency may assess a survey fee, equal to the lesser of one half of the facility's biennial license and bed fee or $500, to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visjts conducted m1der s. 429.28(3)(c) to verify the correction of the violations.
§ 429.19(7), Fla. Stat. (2017).
On or about and between December 4, 2017 and December 13,2017, the Agency conducted a Complaint Survey of the Respondent's facility.
The Agency conducted a complaint investigation resulting in the finding of
violations. These violations were the subject of the complaint or monitoring visits conducted to verify the correction of the complaint.
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration,
seeks to assess a survey fee of one hundred ninety-three dollars and eighty-seven cents ($193.87)
against the Respondent.
CLAIM FOR RELIEF
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to enter a final order that:
Renders findings offact and conclusions of law as set forth above.
Grants the relief set forth above.
Respectfully Submi!,ted,
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K9--<iian S. Oldham, Assistant General Counsel Frorida Bar No. 105448
Office of the General Counsel
Agency for Health Care Administration 2727 Mahan Drive, MS #7
Tallahassee, Florida 32303
Telephone: 850-412-3696
Facsimile: 850-922-6484
Jgistian.Oldhamuliahca.mvflorida.co111
NOTICE OF RIGHTS
Pursuant to Section 120.569, F.S., any party has the right to request an administrative hearing by filing a request with the Agency Clerk. In order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.S7{1), F.S., however, a party must file a request for an administrative hearing that complies with the requirements of Rule 28- 106.2015, Florida Administrative Code. Specific options for administrative action are set out in the attached Election of Rights form.
The Election of Rights form or request for hearing must be filed with the Agency Clerk for the Agency for Health Care Administration within 21 days of the day the Administrative Complaint was received. If the Election of Rights form or request for hearing is not timely received by the Agency Clerk by 5:00 p.m. Eastern Time on the 21st day, the right to a hearing will be waived. A copy of the Election of Rights form or request for hearing must also be sent to the attorney who issued the Administrative Complaint at his or her address. The Election of Rights form shall be addressed to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 3, Tallahassee., FL 32308; Telephone {850)
412-3630, Facsimile (850) 921-0158.
Any party who appears in any agency proceeding bas the right, at his or her own expense, to be accompanied, represented, and advised by counsel or other qualified representative. Mediation under Section 120.573, F.S., is available if the Agency agrees, and ff available, the pursuit of mediation will not adversely affect the right to administrative proceedings in the event mediation does not result in a settlement.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to the below named persons/entities by the method
designated on this Jff,l,. day of _ _f.f){(( •"-- " , 2018.
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Kri:-1ian s. Oldham, Assistant G eral Counsel Florida Bar No. 105448
Office of the General Counsel
Agency for Health Care Administration 2727 Mahan Drive, MS #7
Tallahassee, Florida 32303
Telephone: 850-412-3696
Facsimile: 850-922-6484 Krjstian.Oldham(,l1a4. a.mytlor:i col_!l
· Arlene Mayo-Davis, Field Office Manager
I Field Office- Region 11
'. Agency for Health Care Administration
: (Electronic Mail)
I
I Keisha Woods-, Unit Manager
1 Assisted Living Unit
Agency for Health Care Administration (Electronic Mail)
Administrator
i An Excellent Care ALF, LLC
i 16251 SW 248th Street ' Homestead, FL 33031
. (Certified Mail - )
7012 1010 00D3 2493 8155
I I
STATE OF FLORIDA
AGENCY FOR REALTH CARE ADMINISTRATION
RE: An Excellent Care ALF, LLC AHCA No(s).: 2018004972
ELECTION OF RIGHTS
This Election of Rights form is attached to an Administrative Complaint. It may be returned by maU or facsimile transmission, but must be received b,, the Agencv Clerk within 21 davs. bv 5:00 pm. Eastern Time. of the dav \'OU received the Administrative Complaint. If your Election of Rights form or request for hearing is not received by the Agency Clerk wjthJn 21 days of the day you received the Administratjve Complaint, you will have waived your right to contest the proposed agency action and a Final Order will be issued imposing the sanction alleged in the Administrative Complaint.
(Please use this fonn unless you, your attorney or your representative prefer to rep]y according to Chapter120. Florida Statutes. and Chapter 28, Florida Administrative Code.)
Please return your Election of Rights fonn to this address: Agency for Health Care Administration
Attention: Agency Clerk
2727 Mahan Drive, Mail Stop #3
Tallahassee, Florida 32308
Telephone: 850-412-3630 Facsimile: 850-921-0158
PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS
OPTION ONE (1) Iadmit to the allegations of fact and conclusions of law alleged In the Administrative Complaint and waive my right to object and to have a hearing. 1 understand that by giving up the right to object and have a hearing, a Final Order will be issued that adopts the allegations offact and conclusions oflaw alleged in the Administrative Complaint and imposes the sanction alleged in the Administrative Complaint.
OPTION TWO (2) I admit to the allegations of fact alleged in the Administrative
Complaint, but 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 agency action is too severe or that the sanction should be reduced.
OPTION THREE (3) I dispute the allegations of fact alleged in the Administrative
Complaint and 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 Section 120.57(1), Florida Statutes. It must be
received by the Agency Clerk at the address above within 21 da\'S of your receipt of this proposed agency action. The request for fonnal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain:
The name, address, telephone number, and facsimile number (if any) of the Respondent.
The name, address, telephone number and facsimile nwnber of the attorney or qualified representative of the Respondent (if any) upon whom seivice of pleadings and other papers shall be made.
A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate.
A statement of when the respondent received notice of the administrative complaint.
A statement including the file number to th administrative complaint.
Mediation under Section 120.573; Florida Statutes, may be available in this matter if the Agency agrees.
Licensee Name: |
|
|
Contact Person: | Title: | |
Address: Number and Street | City Zip Code |
Telephone No. _ Fax No.
E-Mail (optional) . _
I hereby certify that I am duly authorized to submit this Election of Rights fonn to the Agency for Health Care Administration on behalf of the licensee referred to above.
Date:
Printed Name: Title:
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
Petitioner,
V.
Case No.: 18-5514
AHCA No.: 2018004972
Facility Type: Assisted Living
AN EXCELLENT CARE ALF, LLC,
Respondent.
./
SETTLEMENT AGREEMENT
The Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), and the Respondent, An Excellent Care ALF, LLC ("the Respondent"), pursuant to Section 120.57(4), Florida Statutes, enter into this Settlement Agreement ("Agreement") and agree as follows:
WHEREAS, the Respondent is an assisted living facility licensed pursuant to Chapter 408, Part II, and Chapter 429, Part I, Florida Statutes, and Chapter 58A-5, Florida Administrative Code, and
WHEREAS, the Agency has jurisdiction by virtue of being the licensing and regulatory authority over the Respondent; and
WHEREAS, the Agency conducted a survey of Respondent's assisted living facility
between December 4, 2017 through December 13, 2017, and later issued the Respondent an Administrative Complaint on May 21, 2018, notifying Respondent of the Agency's intent to impose an administrative fine in the amount of five thousand five hundred dollars ($5,500.00) plus survey fees of one hundred ninety-three dollars eighty-seven cents ($193.87) for a total sum of five thousand six hundred ninety-three dollars eighty-seven cents ($5,693.87); and
Page 1 of 5
EXHIBIT 2
WHEREAS, the Respondent requested a formal hearing by filing an election of rights form; and
WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and
WHEREAS, the parties stipulate to the adequacy of considerations exchanged; and
WHEREAS, the parties have 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:
All recitals herein are true and correct and are expressly incorporated herein.
All parties agree that the above "whereas" clauses incorporated herein are binding findings of the parties.
Upon full execution of this Agreement, the Respondent agrees to waive service of an administrative complaint, any and all appeals and proceedings to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), Florida Statutes, a formal proceeding under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court of competent jurisdiction; and agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled, provided, however, that this agreement shall not be deemed a waiver by either party of its right to judicial enforcement of this Agreement.
Upon full execution of this Agreement, the Respondent agrees to pay the Agency an administrative fine of four thousand three hundred six dollars ninety-two cents ($4,306.92) plus survey fees of one hundred ninety-three dollars eighty-seven cents ($193.87) for a total sum of four thousand five hundred dollars ($4,500.00) within 120 days of the entry of the Final Order as
full and final payment required under this Agreement.
Venue for any action brought to interpret, enforce or challenge the terms of this Agreement and its corresponding Final Order shall lie solely in the Circuit Court of Florida, in and for Leon County, Florida.
By executing this Agreement, the Respondent denies the facts and legal conclusions raised in the Administrative Complaint referenced herein, and the Agency asserts the validity thereof. Nothing in this Agreement shall be deemed to preclude the Agency from using this assessment of fines in weighing future administrative actions regarding the Respondent including, but not limited to, decisions regarding the licensure of Respondent, including, but not limited to, licensure for limited mental health, limited nursing services, or extended congregate care. The Agency is not precluded from using the subject events for any purpose within the jurisdiction of the Agency. Further, Respondent acknowledges and agrees that this Agreement shall not preclude or estop any other federal, state or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the Administrative Complaint.
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.
Each party shall bear its own costs and attorney's fees.
This Agreement shall become effective on the date upon which it is fully executed by all parties.
The Respondent, for itself and its related or resulting organizations, successors, transferees, attorneys, heirs, and executors or administrators, discharges the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys, of and from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and
every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of the Respondent or its related or resulting organizations.
This Agreement is binding upon all parties and those persons and entities that are identified in the above paragraph.
In the event that the Respondent was a Medicaid provider at the time of the occurrences alleged in the Administrative Complaint, this Agreement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any further sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not settle any pending or potential federal issues against the Respondent. This Agreement does not prohibit the Agency from taking any action regarding the Respondent's Medicaid provider status, conditions, requirements or contract, if applicable.
The Respondent agrees that if any funds to be paid under this Agreement to the Agency are not timely paid as set forth in this Agreement, the Agency may deduct the amounts assessed against the Respondent in the Final Order, or any portion thereof, owed by the Respondent to the Agency from any present or future funds owed to the Respondent by the Agency, and that the Agency shall hold a lien against present and future funds owed to the Respondent by the Agency for said amounts until paid.
The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. The Respondent has the legal capacity to execute this Agreement. The Respondent understands that it has the right to consult with its own independent counsel and has knowingly and freely entered into this Agreement. The Respondent understands that Agency counsel represents only the Agency and that Agency counsel has not provided any
Nov 28 18, 21:28 p.2
legal advice to, or influenced, the Respondent in i djision toenter into this Agreement.
ttl
This Agreement contains the entire derstandings and agreements of the parties.
iy
This Agreement supersedes any prior oral or agreements between the parties. This
Agreement may not be amended except in writing. attempted assignment of this Agreement
shall be void. I
All parties agree that a facsimile si ale suffices for an original signature.
The following representatives acknowledge that they are duly authorized to enter into this
Agreement.
Health Quality Assurance
Agency for Health Care Administration 2727 Mahan Drive, Bldg. #1
Tallahassee, Florida 32308
DATED: _/_}_2-/_!_'1
I
-Adm-
lKetlie Moise, owner/Administ
Excellent Care ALF, LLC 15477 S.W. 15l5t Terrace
. i , Florida 33196
ma:riemoise541a!yahoo.com
>
l1TED: "/I/;; g;.2£1/'[5"
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Stefan R Gr §eneral Counsel Office of the General Counsel
Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3
Tallahassee, Florida 32308 DATED: _1 Z·+--1'-(_1lj, [_
Page 5 ofS
t N1 icola L. C. Brown sistant General Counsel
gchicy for Health Care Administration 25 Mirror Lake Drive North, Ste. 330H St. Petersburg, Florida 33701
\
LrED: 11 \ ':I\ l9
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| Issue Date | Document | Summary |
|---|---|---|
| Jan. 02, 2019 | Agency Final Order |
