Conclusions 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 has jurisdiction over the above-named Respondent pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaint and Election of Rights form to the Respondent. (Ex. 1) The Election of Rights form advised of the right to an administrative hearing. 3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) Based upon the foregoing, it is ORDERED: 1, The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 2. The Respondent shall pay the Agency $14,500. 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: Office of Finance and Accounting Revenue Management Unit Agency for Health Care Administration 2727 Mahan Drive, MS 14 Tallahassee, Florida 32308 Filed January 28, 2014 3:22 PM Division of Admitlistrative Hearings 3. Conditional licensure status is imposed on the Respondent beginning on August 30, 2012 and ending on September 4, 2012. 4. The references in the Statement of Deficiencies for the August 28-30, 2012 survey of Springwood Care and Rehabilitation Center relating to Resident #2 being on thickened liquids is deleted. ORDERED at Tallahassee, Florida, on this 2-4 day of eee , 2014. i Le ek, Secretary y for Nealfh Care Administration
Other Judicial Opinions 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. CERTIFICATE OF SERVICE I CERTIFY that a true and correct opt this Final Order was served on the below-named persons by the method designated on this ZY. ay of eauary , 2014. Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Finance & Accounting Facilities Intake Unit Revenue Management Unit (Electronic Mail) (Electronic Mail) Andrea M. Lang Thomas W. Caufman, Esq. Office of the General Counsel Quitairos, Prieto, Wood & Boyer, P.A. Agency for Health Care Administration Attorney for Respondent (Electronic Mail) 4905 West Laurel Street, 2"! Floor Tampa, Florida 33607 (U.S. Mail) Lynne A. Quimby-Pennock Administrative Law Judge Division of Administrative Hearings (Electronic Mail) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2012009469 4602 NORTHGATE COURT, LLC d/b/a SPRINGWOOD CARE AND REHABILITATION CENTER, Respondent. / ADMINISTRATIVE COMPLAINT. COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against 4602 NORTHGATE COURT, LLC d/b/a SPRINGWOOD CARE AND REHABILITATION CENTER (hereinafter “Respondent”), pursuant to Sections 120.569 and 120.57 Florida Statutes (2012), and alleges: NATURE OF THE ACTION This is an action against a nursing home to impose an administrative fine of TEN THOUSAND DOLLARS ($10,000.00) pursuant to Section 400.23(8)(a), Florida Statutes (2012), based upon one (1) Class I deficiency; to assess a survey fee in the amount of SIX THOUSAND DOLLARS ($6,000.00) based upon Respondent being cited for one (1) Class I deficiency pursuant to Section 400.19(3), Florida Statutes (2012), and to assign conditional licensure status beginning on August 30, 2012, pursuant to Section 400.23(7)(b), Florida Statutes (2012). The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference. EXHIBIT 1 JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2012). 2. The Agency has jurisdiction over the Respondent pursuant to Section 20.42, Chapter 120, and Chapter 400, Part II, Florida Statutes (2012). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the regulatory authority responsible for the licensure of nursing homes and the enforcement of all applicable federal and state statutes, regulations and rules governing nursing homes pursuant to Chapter 400, Part Il, Florida Statutes (2012) and Chapter 59A-4, Florida Administrative Code. The Agency is authorized to deny, suspend, or revoke a license, and impose administrative fines pursuant to Sections 400.121 and 400.23, Florida Statutes (2012); assign a conditional license pursuant to Section 400.23(7), Florida Statutes (2012); and assess costs related to the investigation and prosecution of this case pursuant to Section 400.121, Florida Statutes (2012). 5. Respondent operates a 120-bed nursing home, located at 4602 Northgate Court, Sarasota, Florida 34234, and is licensed as a nursing home, license number 15130962. Respondent was at all times material hereto, a licensed nursing home under the licensing authority of the Agency, and was required to comply with all applicable state rules, regulations and statutes. COUNTI The Respondent Failed To Ensure Residents The Right To Receive Adequate And Appropriate Protective And Support Services In Violation Of Section 400.022(1)(), Florida Statutes (2012) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, all licensees of nursing home facilities shall adopt and make public a statement of the rights and responsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement shall assure each resident the following: The right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the Agency. Section 400.022(1)(1), Florida Statutes (2012). 8. On or about August 28, 2012 through August 30, 2012, the Agency conducted a Complaint Investigation (CCR# 2012009348 and CCR# 2012008938) of the Respondent’s facility. 9. Based on record review, interview and observation, the facility failed to prevent the abuse, neglect and mistreatment of one (1) of three (3) sampled residents, specifically Resident number two (2). This resulted from the willful spraying of water in the facial area of Resident number two (2), who had an order to receive only thickened liquids, palliative care and was known to be resistive to activities of daily living, including showering. The facility's failure with Resident number two (2) and their failure to identify the need to retrain staff on procedures to appropriately shower residents with similar conditions placed all residents with those conditions at risk for serious injury, harm, impairment, or death. 10. On August 28, 2012, a review of Resident number two’s (2) record containing a Nursing Progress note dated August 25, 2012 at 5:30 a.m. which documented, “Resident number two (2) moaning loudly (and) then screaming... Visible signs of pain on Resident’s face (fear and grimacing)." Morphine 5 mg/0.25 cc SL (11:00 p.m. and 5 a.m.) and back rubbing, both had positive calming effect. 11. The progress note also documented, "Took 80 cc of water during the night shift. Pulse 78, respirations 16; unlabored while awake, dyspnea noticed while sleeping. Resting with cycs closed. Will monitor." 12. A nursing note at 12:20 p.m. documented MS04 (Morphine Sulfate) 0.25 cc was administered "with minimal effect" to Resident number two (2), who was "very anxious and moaning loudly." The note states at approximately 11:50 a.m., Certified Nursing Assistants called the nurse into the shower room where Resident number two (2) was found unresponsive with a faint pulse. Resident number two (2) was returned to bed immediately with a board under him/her. Cardio Pulmonary Resuscitation was administered and oxygen was placed over Resident number two’s (2) face. No pulse was felt. The paramedics arrived and continued Cardio Pulmonary Resuscitation. At 12:10 p.m., paramedics stated Resident number two (2) had passed away. The nursing note documented, the "Director of Nursing notified and family was being contacted by Director of Nursing. Westside funeral home called." 13. On August 29, 2012 at 12:45 p.m. during an interview regarding the event on August 25, 2012, Employee F stated, "I asked another Certified Nursing Assistant (Employee G) to help me give Resident number two (2) a shower." During the shower, when Employee G sprayed water in the resident's face, Employee F said, "Do not do that, he/she is on thickened liquids." Employee G said, “Resident number two (2) had soap in his/her eyes." After that, Employee F got the nurse because Resident number two (2)"was not acting normal." 14. During this interview, Employee F stated, "I am CPR certified, (but) did not assist with it." When asked when the last training on abuse was received, Employee F said, “I do the modules on the computer; | believe last month." Regarding the facility staff to notify in a case of abuse, Employee F stated, "You notify the Abuse Coordinator, the Director of Nursing, her name is on my badge." The incident was reported via phone call to Employee M, the Unit Manager, who was at home on August 25, 2012, by Employees J and F. 15. Inn interview on August 29, 2012, at 10:30 a.m., Employee M reported receiving a call at home on August 25, 2012 at approximately 1:10 p.m. regarding Resident number two (2). Employees I and F reported that while giving Resident number two (2) a shower, Employee G sprayed Resident number two (2) in the face and the mouth. Employee I did not see the action, but Employee F witnessed Employee G spray Resident number two (2). 16. During interviews on August 29, 2012, Employees B, D, N and H stated they received training about abuse after August 25, 2012. Employee H stated the instruction provided during training regarding getting shampoo out of a resident’s hair included "have them hold their head back and rinse it out." When asked if a resident had mucous coming out of their nose and going into their mouth, can you spray it off with the shower head, Employee H answered, “It is okay to spray it (face) to get it (mucous) out." 17. On August 28, 2012, a record review of Resident number two’s (2) Minimum Data Set Kardex Report for 2880 noted the resident as "Moderately Impaired" to make Activities of Daily Living, but made no mention of bathing or behavior issues. Also, there was no indication Resident number two (2) was receiving thickened liquids. The Kardex report is used by staff as a quick review of resident information. 18. On August 28, 2012, a review of the shower schedule used by the Certified Nursing Assistants, last updated on June 14, 2012 for Resident number two (2), revealed the resident due "Saturday" by the "11:00 p.m. to 7:00 a.m. shift." The shower schedule notes no change can be made without the Unit Manager’s approval. Resident number two (2) was given a shower on August 25, 2012 during the 7:00 a.m. to 3:00 p.m. shift. 19. On August 28, 2012, a review of Resident number two’s (2) Medication Administration Record dated August 25, 2012 revealed a physician order for palliative care to start on August 23, 2012. There was no indication the nursing staff knew to provide the palliative care on August 23, 2012, August 24, 2012 and August 25, 2012 as no nurse initialed those dates. 20. A record review on August 28, 2012 revealed Resident number two (2) was admitted to the facility on July 20, 2012. On August 23, 2012, Resident number two (2) was documented with a "Medical Diagnosis of Dysphasia," and was to receive "Palliative Care Only." 21. During an interview on August 29, 2012 at 2:25p.m., the administrator stated, "We are pretty much concluding with the investigation. We are unable to substantiate abuse.” 22. Regarding training provided since August 25, 2012, the administrator said, "We have done education on the Abuse and Neglect policy; what it means, how it is reported, with examples specifically of the scenario of Resident number two (2). If staff has an understanding of what abuse is, they are more aware of how they are interacting with residents. I am comfortable with what has taken place so far." During the interview, the administrator did not report any training was provided regarding the appropriateness of residents receiving showers, who are on palliative care, do not like showers, and have behavior issues." 23. \ The facility had failed to prevent abuse, neglect or the mistreatment of Resident number two (2) and other similarly-effected residents. Interviews and record reviews revealed staff failed to implement current standard of practice showering procedures with a resident that was on palliative care; had identified issues with exhibiting difficult behaviors, including while being showered and was on thickened liquids. On August 28, 2012, August 29, 2012 and August 30, 2012, the facility administrative staff failed to retrain and monitor adequately direct care staff administering showers to residents. 24. The facility has failed to ensure the critical incident will not be repeated. 25. The Agency determined that this deficient practice presented a situation in which immediate corrective action was necessary because Respondent’s non-compliance had caused, or was likely to cause, serious injury, harm, impairment, or death to a resident receiving care in Respondent's facility. The Agency cited Respondent for an isolated Class I deficiency as set forth in Section 400.23(8)(a), Florida Statutes (2012). WHEREFORE, the Agency intends to impose an administrative fine in the amount of TEN THOUSAND DOLLARS ($10,000.00) against Respondent, a nursing home in the State of Florida, pursuant to Sections 400.23(8)(a), Florida Statutes (2012). COUNT I Assignment Of Conditional Licensure Status Pursuant To Section 400.23(7)(b), Florida Statutes (2012) 26. The Agency re-alleges and incorporates by reference the allegations in Count I. 27. The Agency is authorized to assign a conditional licensure status to nursing homes pursuant to Section 400.23(7), Florida Statutes (2012). 28. Due to the presence of one (1) Class I deficiency, the Respondent was not in substantial compliance at the time of the survey with criteria established under Chapter 400, Part II, Florida Statutes (2012), or the rules adopted by the Agency. 29. The Agency assigned the Respondent conditional licensure status with an action effective date of August 30, 2012. The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the Respondent conditional licensure status for the period beginning on August 30, 2012, pursuant to Section 400.23(7)(b), Florida Statutes (2012). COUNT OI Assessment Of Fine Pursuant To Section 400.19(3), Florida Statutes (2012) 30. The Agency re-alleges and incorporates by reference the allegations in Count I and Count II. 31. The Respondent has been cited for one (1) Class I deficiency and therefore is subject to a six (6) month survey cycle for a period of two (2) years and a fine of SIX THOUSAND DOLLARS ($6,000.00) pursuant to Section 400.19(3), Florida Statutes (2012). WHEREFORE, the Agency intends to impose a six (6) month survey cycle for a period of two (2) years and assess a fine in the amount of SIX THOUSAND DOLLARS ($6,000.00) against Respondent, a nursing home in the State of Florida, pursuant to Section 400.19(3), Florida Statutes (2012). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief against the Respondent as follows: 1. Make findings of fact and conclusions of law in favor of the Agency on Count I through Count III. 2. Impose an administrative fine against the Respondent in the amount of TEN THOUSAND DOLLARS ($10,000.00) pursuant to Section 400.23(8)(a), Florida Statutes (2012), and assess a survey fee in the amount of SIX THOUSAND DOLLARS ($6,000.00), pursuant to Section 400.19(3), Florida Statutes (2012), for a total of SIXTEEN THOUSAND DOLLARS ($16,000.00). 3. Assign a conditional license to the Respondent beginning on August 30, 2012. 4. Assess costs related to the investigation and prosecution of this case. 5. Enter any other relief that this Court deems just and appropriate. Respectfully submitted this i144 day of Sewer , 2012. tug a ae Co oN, YJ wane Andrea M. Lang, Assistant General Cournsel Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 335-1253 NOTICE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO RETAIN AND BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS. ALL REQUESTS FOR HEARING SHALL BE MADE AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 412-3630. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to: Corporation Service Company, Registered Agent for 4602 Northgate Court, LLC d/b/a Springwood Care and Rehabilitation Center, 1201 Hays Street, Tallahassee, Florida 32301, by United States Certified Mail, Return Receipt No. 7011 2000 0001 4884 9195 and to Susan Ritchie, Administrator, 4602 Northgate Court, LLC d/b/a Springwood Care and Rehabilitation Center, 4602 Northgate Court, Sarasota, Florida 34234, by United States Certified Mail, Return Receipt No. 7011 2000 0001 4884 9195 on this is Onis day of Segoe mbec . 2012. Qt 1M, Nowe Andrea M. Lang, Assistant General Counsel Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 335-1253 Copies furnished to: Susan Ritchie, Administrator 4602 Northgate Court , LLC d/b/a Springwood Care and Rehabilitation Center 4602 Northgate Court Sarasota, Florida 34234 (U.S. Certified Mail) Andrea M. Lang, Assistant General Counsel Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Electronic Mail) Corporation Service Company Registered Agent for 4602 Northgate Court, LLC d/b/a Springwood Care and Rehabilitation Center 1201 Hays Street Tallahassee, Florida 32301 (U.S. Certified Mail) Bernard Hudson, Health Services and Facilities Consultant Supervisor Bureau of Long Term Care Services Long Term Care Unit Agency for Health Care Administration 2727 Mahan Drive, Building #3, Room 1213B Tallahassee, Florida 32308 (Electronic Mail) Harold Williams Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Electronic Mail) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2012009469 4602 NORTHGATE COURT, LLC d/b/a SPRINGWOOD CARE AND REHABILITATION CENTER, Respondents. ELECTION OF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be an Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. Your Election of Rights must be returned by mail or by fax within twenty-one (21) days of the date you receive the attached Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. If your Election of Rights with your elected Option is not received by AHCA within twenty-one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a Final Order will be issued. Please use this form unless you, your attorney or your representative prefer to reply in accordance with Chapter 120, Florida Statutes (2012) and Rule 28, Florida Administrative Code. PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Phone: 850-412-3630 Fax: 850-921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) ___ I admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a Final Order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) ___ I admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint, but I 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 administrative action is too severe or that the fine should be reduced. OPTION THREE (3)__ I dispute the allegations of fact and law contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 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 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain: 1. Your name, address, telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4. A statement of all disputed issues of material fact. If there are none, you must state that there are none. Mediation under Section 120.573, Florida Statutes may be available in this matter if the Agency agrees. License Type: (Assisted Living Facility, Nursing Home, Medical Equipment, Other) Licensee Name: License Number: Contact Person: Name Title Address: Street and Number City State Zip Code Telephone No. Fax No. E-Mail (optional) I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the above licensee. Signature: Date: Title: Print Name: FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RICK SCOTT ELIZABETH DUDEK GOVERNOR SECRETARY September 11, 2012 SPRINGWOOD CARE AND REHABILITATION CENTER 4602 NORTHGATE COURT SARASOTA, FL 34234 Dear Administrator: The attached license with Certificate #17737 is being issued for the operation of your facility. Please review it thoroughly to ensure that all information is correct and consistent with your records. If errors or omissions are noted, please make corrections on a copy and mail to: Agency for Health Care Administration Long Term Care Section, Mail Stop #33 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 Issued for a Status Change to Conditional Sincerely, Pp bbe O aco Agency for Health Care Administration Division of Health Quality Assurance Enclosure ce: Medicaid Contract Management Visit AHCA online at 2727 Mahan Drive, MS#33 ahca.myflorida.com Tallahassee, Florida 32308 Exhibit A Original Certificate of Conditional License 4602 Northgate Court, LLC d/b/a Springwood Care and Rehabilitation Center Certificate No. 17737 License No. SNF15130962 CLOC/TE/OT ‘-ALVG NOLLVaId Xd CLOC/0E/80 “HLVd AALLOSAda HONVHD SN.LV.LS Sddd Oct “IVLOL vETvE Td ‘VLOSVUVS Land ALVOHLYON 709P YALNYO NOLLVITTEVHAY GNV FAVOD GOOMONIadS :3UIMOTI[OJ oy} oyeIado 0} PEZHOYINE ST sosudo!] BY] SB puB ‘saynyels epLOLy ‘[] Weg ‘OOp JeideyD ur paezuoyjne ‘uoneNsTUTUpY sed Wop 10,4 Aouesy ‘epuopy Jo areig am Aq paidope suone[ngar pur sani oy) ym porto sey OTT ‘LUNOD ALVOHLYON 7209p Jeu} WEFUOD 0} St SY, TVNOILIGNOD HINOH ONISHON FONVANSSV ALITWNO HLTWIH AO NOISIAIC NOLLVULSININGYV FaVO HLTVAaH YOd AONADV BPLIOLy JO 93e)S STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No(s): 2012009469 13-1617 4602 NORTHGATE COURT, LLC d/b/a SPRINGWOOD CARE AND REHABILITATION CENTER, Respondent. SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “A gency”), through its undersigned representatives, and Respondent, 4602 Northgate Court, LLC d/b/a Springwood Care and Rehabilitation Center (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: WHEREAS, Respondent is a Nursing Home licensed pursuant to Chapters 400, Part II, and 408, Part II, Florida Statutes, Section 20.42, Florida Statutes and Chapter 59A-4, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to Chapter 400, Florida Statutes; and WHEREAS, the Agency served Respondent with an administrative complaint on or about September 17, 2012, notifying the Respondent of its intent to impose administrative fines EXHIBIT 2 in the amount of $10,000 and a survey fee of $6,000 and assign a conditional licensure status commencing August 30, 2012 and ending September 4, 2012; and WHEREAS, Respondent requested a formal administrative proceeding by filing a Petition for Formal Administrative Hearing; 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, 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 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, Respondent agrees to pay $8,500 in administrative fines and a survey fee in the amount of $6,000 in accord with law. Respondent accepts the assignment of conditional licensure status commencing August 30, 2012 and ending September 4, 2012. In addition, the references in the Statement of Deficiencies relating to Resident #2 being on thickened liquids will be deleted. 5. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in Circuit Court in Leon County, Florida. . 6. By executing this Agreement, Respondent neither admits nor denies, 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 Respondent for any deficiency/violation of statute or rule identified in a future survey of Respondent, which constitutes a “repeat” or “uncorrected” deficiency from surveys identified in the administrative complaint. The parties agree that in such a “repeat” or “uncorrected” case, the deficiencies from the surveys identified in the administrative complaint shall be deemed found without further proof. 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, licensure for limited mental health, limited nursing services, extended congregate care, or 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 administrative complaint. 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 terms of this Agreement and closing the above-styled case. 9. Each party shall bear its own costs and attorney’s fees. 10. | This Agreement shall become effective on the date upon which it is fully executed by all the parties. 11. Respondent for itself and for its related or resulting organizations, its 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. 12. This Agreement is binding upon all parties herein and those identified in paragraph eleven (11) of this Agreement. 13. ‘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. 14. Respondent agrees that if any funds to be paid under this agreement to the Agency are not paid within thirty-one (31) days of entry 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. 15. The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. 16. This Agreement contains and incorporates the entire understandings and agreements of the parties. 17. This Agreement supersedes any prior oral or written agreements between the parties. 18. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 19. All parties agree that a facsimile signature suffices for an original signature. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. / | ia Susan Ritchie, Administrator 4602 Northgate Court, LLC Agency for Health Care Administration d/b/a Springwood Care and 2727 Mahan Drive, Bldg #1 Rehabilitation Center Tallahassee, Florida 32308 4602 Northgate Court Sarasota, Florida 34234 DATED: { | DANY DATED: _/2-6-73 Stuért F.“Williafns, General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: /; al/ [7 Andrea M. Lang, Senior Attorney Agency for Health Care Administration 2295 Victoria Avenue Fort Myers, Florida 33901 DATED: 1 [4/1 Loh: Thomas W. Caufinar, Esq. Quitairos, Prieto, Wood & Boyer, P.A. 4905 West Laurel Street, 2™ floor Tampa, Florida 33607 Attorney for Respondent patep:_/2 - #-/3
Conclusions THE PARTIES resolved all disputed issues and executed a settlement agreement, which is attached and incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is hereby CLOSED. DONE AND ORDERED on this the -I' }- day of J , 20J..Q_, in Tallahassee, Florida. Thomas W. Arnold, Sec Agency for Health Care Administration AHCA v. Abdul Salman, M.D., Gulf Coast Walk-In Clinic Final Order - Page I of 3 Filed January 11, 2010 4:26 PM Division of Administrative Hearings. AP ARTY 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 BYLAW, 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 to: Abdul R. Salman, M.D. Gulf Coast Walk-In Clinic 3228 East 15th Street Panama City, FL 32405 (Via U.S. Mail) Justin M. Senior, General Counsel Agency for Health Care Administration 2727 Mahan Drive Building 3, Mail Station 3 Tallahassee, Florida 32308 (Interoffice Mail) Kim Kellum, Chief Medicaid Counsel Agency for Health Care Administration 2727 Mahan Drive Building 3, Mail Station 3 Tallahassee, Florida 32308 (Interoffice Mail) William M. Blocker, II Esquire Agency for Health Care Administration 2727 Mahan Drive Building 3, Mail Station 3 Tallahassee, Florida 32308 (Interoffice Mail) Ken Yon, Bureau Chief Medicaid Program Integrity 2727 Mahan Drive Building 2, Mail Station 6 Tallahassee, Florida 32308 (Interoffice Mail) Peter Williams, Inspector General Medicaid Program Integrity 2727 Mahan Drive Building 2, Mail Station 6 Tallahassee, Florida 32308 (Interoffice Mail) Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Via U.S. Mail) Agency for Health Care Administration Bureau of Finance and Accounting 2727 Mahan Drive Building 2, Mail Station 14 Tallahassee, Florida 32308 (Interoffice Mail) Department of Health (License #ME0049602) (Email) ARCA v. Abdul Salman, M.D., Gulf Coast Walk-In Clinic Final Order - Page 2 of 4 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail, or the method designated, on this the 7 ay of - \_w.._)/_cA;-_l.t_C r Y , 20/0 . Richard Shoop, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 AHCA v. Abdul Salman, M.D., Gulf Coast Walk-In Clinic Final Order - Page 3 of 3
Conclusions THIS CAUSE comes before the AGENCY FOR HEALTH CARE ADMINISTRATION (the "Agency"”) concerning co-batched Certificate of Need ("CON") Application Nos. 10069 - 10072 seeking to establish a new hospice program in Orange County, District 7/B. ODYSSEY HEALTHCARE OF COLLIER COUNTY, INC. d/b/a ODYSSEY HEALTHCARE OF CENTRAL FLORIDA (hereinafter “Odyssey Healthcare”) filed CON Application No. 10071 in the Second Batching Cycle of 2009. The application was denied. Thereafter, Odyssey Healthcare timely filed a Petition for Formal Administrative Hearing with respect to its denial. The Petition was Filed August 27, 2010 3:01 PM Division of Administrative Hearings. forwarded by the Agency Clerk to the Division of Administrative Hearing (“DOAH"). On June 8, 2010, Odyssey Healthcare filed its voluntary dismissal of the DOAH Case No. 10-1681CON (Ex. 1). On June 9, 2010, an Order Severing DOAH Case No. 10-1681CON (Ex. 2) and an Order Closing file (Ex. 3) were issued by DOAH as a result of Odyssey Healthcare’s voluntary dismissal. It is therefore ORDERED and ADJUDGED: 1. The voluntary dismissal by Odyssey Healthcare is hereby acknowledged and accepted. 2. CON Application No. 10071 is hereby denied. 3. The above-styled case is hereby closed. DONE and ORDERED this 2) day of August, 2010, in Tallahassee, _y W. ARNOLD, Secretary AGENCY FOR HEALTH CARE ADMINISTRATION Florida. ae eeeneeeeeaeneneneenmmnenneneeennnaaneneieemnenenamemenenneE mat a
The Issue The issue for disposition is whether Petitioner's application for a certificate of need (CON) was properly rejected by Respondent for failure to file the application by the deadline established in rules 59C-1.008(k)1. and 2. and 59C-1.008(4), F.A.C. The parties have stipulated that if the rules are determined valid in the companion case, 93-7094RX, the agency was authorized to reject the application.
Findings Of Fact Manatee Hospitals and Health Systems, Inc. d/b/a Manatee Memorial Hospital (Manatee) is a nonprofit corporation which operates a short-term general acute care hospital in Manatee County, Florida. On November 1, 1993, Manatee timely and properly submitted a letter of intent to the Agency for Health Care Administration (Agency) seeking authority to convert up to 11 substance abuse beds and/or up to 28 acute care beds to 28 skilled nursing beds for review in the Nursing Home Batch Cycle, 2nd Cycle, 1993. On December 1, 1993, Manatee submitted a CON application to the agency seeking authority to convert up to 11 adult substance abuse beds and/or up to 28 acute care beds to 28 skilled nursing beds for review in the nursing home batch cycle, 2nd cycle, 1993. The application included the appropriate filing fee. Manatee failed to submit a copy of its CON application to the local health council by 5:00 p.m. on the application due date of December 1, 1993. Instead, the application was submitted to the local health council on December 2, 1993. By correspondence from Liz Dudek, Chief, Certificate of Need and Budget Review Section, dated December 7, 1993, the agency advised Manatee that its CON application was not accepted and was being returned to Manatee because Manatee failed to submit a copy of its application to the health council by 5:00 p.m. on the application due date of December 1, 1993, as required by rules 59C- 1.008(1)(k)1., and 2., and 59C-1.008(4), F.A.C.
Recommendation Based on the foregoing, it is, hereby, RECOMMENDED: That Petitioner's request that the agency accept its application for comparative review in the Nursing Home Cycle, 2nd cycle be DENIED. DONE AND RECOMMENDED this 21st day of February, 1994, in Tallahassee, Leon County, Florida. MARY CLARK Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904)488-9675 Filed with the Clerk of the Division of Administrative Hearings this 21st day of February, 1994. COPIES FURNISHED: John M. Knight, Esquire The Perkins House, Suite 200 118 North Gadsden Street Tallahassee, Florida 32301 J. Robert Griffin, Esquire Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303 Robert L. Powell, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Kim Tucker, General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Conclusions Having reviewed the administrative complaint dated July 16, 2008, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration ("Agency") has entered into a Settlement Agreement (Ex. 2) with the other party to these proceedings, and being otherwise well-advised in the premises, finds and concludes as follows: ORDERED: The. att ached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. Filed June 30, 2009 1:59 PM Division of Administrative Hearings. Respondent shall pay an administrative fine in the amount of One Thousand Dollars ($1000.00). The administrative fine is due and payable within thirty (30) days of the date of rendition of this Order. Checks should be made payable to the "Agency for Health Care Administration." The check, along with a reference to these case numbers, should be sent directly to: Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308 Unpaid amounts pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. Respondent's petition for formal administrative proceedings is hereby dismissed. Each party shall bear its own costs and attorney's fees. The above-styled case is hereby closed. DONE and ORDERED this du, day of- =---' 2009, in Tallahassee, Leon County, Florida. Holly Ben on, Secretary Agency fo Health Care Administration 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. Copies furnished to: David C. Ashburn Attorney for the Respondent Greenberg Traurig, P.A. 101 East College Avenue Tallahassee, Florida 32302 (U. S. Mail) Mary Daley Jacobs Assistant General Counsel Agency for Health Care Administration 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) Finance & Accounting Agency for Health Care Admin. Revenue Management Unit 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (Interoffice Mail) Daniel Manry Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the <?s = method designated, on this the Z f C J , 2009. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA
Conclusions THIS CAUSE came before the State of Florida, Agency for Health Care Administration (“the Agency") for the issuance of a final order. 1. On March 10, 2014, Greystone Hospice of District 7B, LLC, (“Greystone”) requested a formal administrative hearing to contest the preliminary denial of Certificate of Need (“CON”) Application No. 10209, which it submitted to establish a hospice program in the Agency Health Planning Service District 7, Hospice Service Area 7B, and to contest the preliminary approval of Halifax Hospice, Inc.’s (“Halifax”) CON Application No. 10210, to Filed May 15, 2014 4:20 PM Division of Administrative Hearings establish a hospice program in Hospice Service Area 7B. 2. The matter was referred to the Division of Administrative Hearings (CDOAH”) where it was assigned Case No. 14-1368CON. 3. On April 1, 2014, Halifax requested a formal administrative hearing challenging the co-batched applications and supporting the Agency’s preliminary approval of Halifax’s CON Application No. 10210, to establish a hospice program in Service Area 7B, and to support the Agency’s preliminary denial of the co-batched application filed by Greystone. 4. The request was referred to DOAH where it was assigned Case No. 14-1472CON. 5. On April 2, 2014, DOAH issued an Order of Consolidation. 6. On April 18, 2014, Greystone filed a Notice of Voluntary Dismissal. It is therefore ORDERED: 7. The denial of Greystone’s CON Application No. 10209 is upheld. 8. The approval of Halifax’s CON Application No. 10210 is upheld subject to the conditions noted in the State Agency Action Report. ORDERED in Taliahassee, Florida, on this ee day of [hae , 2014. ab hb Ductere Elizabeth Dudek, Secretary Agency for Hegfth Care Administration
Other Judicial Opinions 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. Page 2 of 3 CERTIFICATE OF SERVICE I CERTIFY that a true and correct copy of this Final Order was served on the below- —~—” named persons by the method designated on this [Pine Les , 2014. Richard J. Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 (850) 412-3630 W. David Watkins Administrative Law Judge Division of Administrative Hearings (Electronic Mail) Lorraine M. Novak, Esquire Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Stephen A. Ecenia, Esquire Rutledge, Ecenia and Purnell, P.A. Post Office Box 551 Tallahassee, Florida 32302-0551 Steve@reuphlaw.com (Electronic Mail) Seann M. Frazier, Esquire Parker, Hudson, Rainer and Dobbs, LLP 215 South Monroe Street, Suite 750 Tallahassee, Florida 32301 Sfrazier@phrd.com (Electronic Mail) R. David Prescott, Esquire Rutledge, Ecenia and Purnell, P.A. Jonathan L. Rue, Esquire Parker, Hudson, Rainer and Dobbs, LLP Post Office Box 551 285 Peachtree Center Avenue, Suite 1500 Tallahassee, Florida 32302-0551 Atlanta, Georgia 30303 David@reuphlaw.com jrue@phrd.com (Electronic Mail) (Electronic Mail) | Gabriel F.V. Warren, Esquire James McLemore, Supervisor Rutledge, Ecenia and Purnell, P.A. Certificate of Need Unit Post Office Box 551 Agency for Health Care Administration Tallahassee, Florida 32302-0551 (Electronic Mail) Gabriel@reuphlaw.com (Electronic Mail) Page 3 of 3
Conclusions 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 has jurisdiction over the above-named Respondent pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaint and Election of Rights form to the Respondent. (Ex. 1) The Election of Rights form advised of the right to an administrative hearing. 3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) Based upon the foregoing, it is ORDERED: 1. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 2. The Administrative Complaint is withdrawn. ORDERED at Tallahassee, Florida, on this 21 day of Oe bu 2013. en ~N Elizabe udek, Seg an Agency for Health Care 1 Filed October 31, 2013 3:15 PM Division of Administrative Hearings
Other Judicial Opinions 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. CERTIFICATE OF SERVICE I CERTIFY that a true and corre: of this Final Order was served on the below-named persons by the method designated on this Pty of Z eobne fT , 2013. Pp Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Arlene Sanchez, Administrator Facilities Intake Unit Royal Gardens Villa (Electronic Mail) 1270 Northeast 112" Street Miami, Florida 33161 | Nelson E. Rodney Robert E. Meale Office of the General Counsel Administrative Law Judge Agency for Health Care Administration Division of Administrative Hearings (Electronic Mail) (Electronic Mai!)
