STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION 2Dl1 MAR 23 P f2: I 2

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

Petitioner,

V.

GRACE MANOR AT LAKE MORTON, LLC,

Respondent.

I

FINAL ORDER

DOAH No. 21-0037

AHCA Nos. 2020010517

(Moratorium) 2020009686

License No. 5217

File No. 11910053

Provider Type: Assisted Living Facility

RENDITION NO.: AHCA- 2-l - Ll,Co -S-OLC

Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows:

1. 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).

   
   

2. The action seeking license revocation is withdrawn. The Respondent shall pay the Agency

   $10,500.00. 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 30 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

   
   

3. The Immediate Moratorium on Admissions is lifted.

ORDERED at Tallahassee, Florida, on this ''J,,,2-ctay of_,

"d, ,2021.

c · stry, Deputy Secretary

c for Health Care Administration

Filed March 31, 2021 1:54 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 he filed within 30 days of rendition of the order to be reviewed.

CERTIFICATE OF SERVICE

I CERTIFY that a true and correct C.9PY)Jf this Final.Jtr was served on the below-named

persons by the method designated on this .2Z_ y of

, rc...i , 2021.

't"fl--1--"'<rnoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

Telephone: (850) 412-3630

2

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

V. Case No: 2020010517

Facility Type: Assisted Living

License No. 5217

GRACE MANOR AT LAKE MORTON, LLC,

Respondent.

/

SETTLEMENT AGREEMENT

Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the "Agency"), through its undersigned representatives, and Grace Manor at Lake Morton, LLC (hereinafter "Respondent"), pursuant to Section 120.57(4), Florida Statutes, each individually, a "party," collectively as "parties," hereby enter into this Settlement Agreement ("Agreement") and agree as follows:

\VHEREAS, Respondent is an assisted living facility licensed pursuant to Chapters 429, Part I, and 408, Part II, Florida Statutes, Section 20.42, Florida Statutes and Chapter 59A-36, Florida Administrative Code; and

WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to Chapters 429, Part I, and 408, Part II, Florida Statutes; and

WHEREAS, the Agency served Respondent with an Administrative Complaint on or about June 18, 2020, notifying Respondent of the Agency's intent to revoke Respondent's licensure to operate an assisted living facility in the State of Florida and to impose administrative

EXHIBIT 2

fines in the sum of ten thousand dollars ($10,000.00) and a survey fee of five hundred dollars ($500.00) for a total assessment of ten thousand five hundred dollars ($10,500.00); and

WHEREAS, Respondent has timely filed a Petition for Fonnal Administrative Hearing as to the Complaint, and

WHEREAS, the parties have negotiated 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:

1. All recitals herein are true and correct and are expressly incorporated herein.

   
   

2. Both parties agree that the "whereas" clauses incorporated herein are binding findings of the parties.

3. Upon full execution of this Agreement, Respondent agrees to waive any and all appeals and proceedings to which it may be entitled including, but not limited to, informal proceedings under Subsection 120.57(2), Florida Statutes, fonnal proceedings 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 no agreement herein shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement.

4. Upon full execution of this Agreement:

   
   

   1. Respondent shall pay ten thousand five hundred dollars ($10,500.00) in administrative fines and survey fees within thirty (30) days of the entry of the Final Order; and

      
      

   2. Count III of the Complaint seeking revocation of Respondent's licensure to operate an assisted living facility in the State of Florida, shall be deemed dismissed.

5. Venue for any action brought to enforce the terms of this Agreement or the Final

   
   

   Order entered pursuant hereto shall lie in Circuit Comt in Leon County, Florida.

   
   

6. By executing this Agreement, Respondent denies the allegations raised in the Administrative Complaint referenced herein, and the Agency asserts the validity of the allegations raised in the Administrative Complaint referenced herein. No agreement made herein shall preclude the Agency from imposing a penalty against Alafia Village for any deficiency/violation of statute or rule identified in a future survey of Alafia Village, which constitutes a "repeat" or "uncoITected" deficiency from surveys identified in the administrative complaints referenced herein.

7. No agreement made herein shall preclude the Agency from using the deficiencies from the surveys identified in the administrative complaint in any decision regarding licensure of Respondent, including, but not limited to, a demonstrated pattern of deficient performance. 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 Survey. This agreement does not prohibit the Agency from taking action regarding Respondent's Medicaid provider status, conditions, requirements or contract.

8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the tenns of this Agreement and closing the above-styled case.

9. Each party shall bear its own costs and attorney's fees.

I 0. This Agreement shall become effective on the date upon which it ts fully executed by all the patties.

1. Respondent for itself and for its related or resulting organizations, successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge 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 Respondent or related facilities.

2. This Agreement is binding upon all parties herein and those identified m paragraph eleven (11) of this Agreement.

3. In the event that Respondent was a Medicaid provider at the subject time of the occurrences alleged in the complaint herein, this settlement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code.

4. Respondent agrees that if any funds to be paid under this agreement to the Agency are not paid within thitiy-one (31) days of ently of the Final Order in this matter, the Agency may deduct the amounts assessed against Respondent in the Final Order, or any portion thereof, owed by Respondent to the Agency from any present or future funds owed to Respondent by the Agency, and that the Agency shall hold a lien against present and future funds owed to Respondent by the Agency for said amounts until paid.

5. The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. Respondent has the capacity to execute this Agreement.

   
   

6. This Agreement contains and incorporates the entire understandings and agreements of the parties.

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

   
   

   parties.

   
   

8. This Agreement may not be amended except m writing. Any attempted assignment of this Agreement shall be void.

9. All parties agree that a facsimile signature suffices for an original signature.

   
   

10. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement.

cKi t , Deputy Secretary ual ty ssurance

Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32308

DATED: J_/_.A_;.. J- _(_

.V

/s/ Shaddrick A. Haston

Shaddrick A. Haston, Esq. Counsel for Respondent Ulman Bursa Law

3812 Coconut Palm Drive Tampa, Florida 33619 Florida Bar No. 31067

DATED: 03102121

3,u(,/it C :s=? .c 1 /2

JamesD.Vamado ·.el Name: 2;u7)"'F. ".._r Jt:::

General Counsel Title: .@aA.IA:j, ,· .1'11tc, Agency for Health Care Administration Grace Manor at LakiMdfton, LLC 2727 Mahan Drive, MS #3

Tallahassee, Florida 32308

Tallahassee, Florida 32308 Florida Bar No. 586617

DATED: _ DATED: _

a tl, Seni r Attorney

alth Care Administration 525 Mirror ake Drive North, Suite 330 St. Petersburg, Florida 33701

Florida Bar No. 69097

DATED:_,;;.........,../....,..,. 2/ _\_

Docket for Case No: 21-000037

Orders for Case No: 21-000037