21-000037 Agency For Health Care Administration vs. Grace Manor At Lake Morton, Llc Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, February 2, 2021.

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 C9-PY)Jf this Final.2tr was served on the below-named

persons by the method designated on this of , ...--c ... , 2021.

'rfl-.._....rnoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

Telephone: [phone]

Facilities Intake Unit Central Intake Unit

Agency for Health Care Administration Agency for Health Care Administration

(Electronic Mail) (Electronic Mail)

Mary J. Howard, Senior Attorney Keisha Woods, Unit Ma nager

Office of the General Counsel Licensure Unit

Agency for Health Care Administration Agency for Health Care Administration

(Electronic Mail) (Electronic Mail)

Thomas M. Hoeler, ChiefFacilities Counsel Patricia Caufman, Field Office Manager

Office of the General Counsel Shantina Hardie, ALF S uperv1sor

Agency for Health Care Administration Local Field Office

(Electronic Mail) Agency for Health Care Administration

(Electronic Mail)

Division of Administrative Hearings Shaddrick A. Haston, E sqmre

(Electronic Filing) Counsel for Respondent

Ullman Bursa Law

3812 Coconut Palm Dri ve

Tampa, Florida 33619

shaston@ublawoffices.c ,om

(Electronic Mail)

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 ($1 0,000.00) and a survey fee of five hundred dollars

($500.00) for a total assessment of ten thousand five hundred dollars ($1 0,500.00); and

WHEREAS, Respondent has timely filed a Petition for Formal 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, formal 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:

a. Respondent shall pay ten thousand five hundred dollars ($1 0,500.00) in

administrative tines and survey fees within thirty (30) days of the entry of the

Final Order; and

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b. 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.

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

executed by all the patties.

11. Respondent for itself and for its related or resulting organizations, successors or

transferees, attomeys, 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 m

paragraph eleven (II) 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 thitiy-one (31) days of entty 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. Respondent has the capacity to execute this Agreement.

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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 m writing. Any attempted

assignment of this Agreement shall be void.

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

20. The following representatives hereby acknowledge that they are duly authorized

to enter into this Agreement.

/s/ Shaddrick A. Haston

cKi t , Deputy Secretary Shaddrick A. Haston, Esq.

ual ty ssurance Counsel for Respondent

Agency for Health Care Administration Ulman Bursa Law

2727 Mahan Drive 3812 Coconut Palm Drive

Tallahassee, Florida 32308 Tampa, Florida 33619

Florida Bar No. 31067

DA _

DATED: 03/02/21

James D. Varnado ·.el

General Counsel

Agency for Health Care Administration

2727 Mahan Drive, MS #3

Tallahassee, Florida 32308

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Tallahassee, Florida 32308

Florida Bar No. 586617

DATED: _____ _ DATED: ____ _

a tl, Seni r Attomey

alth Care Administration

525 Mirror ake Drive North, Suite 330

St. Petersburg, Florida 33 701

Florida Bar No. 69097

DA 2_\\_

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