12-002274 Southern Oaks Alf vs. Agency For Health Care Administration Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Friday, August 17, 2012.

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 shall district be

where the Agency maintains its headquarters or where a party resides. Review of proceedings

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~ y of this Final Order was served on the below- named

persons by the method designated on this day of 2012.

Richard Shoop, - Agency C

Agency for Health Care Administration

2727 Mahan Drive, Bldg. # 3, Mail Stop # 3

Tallahassee, Florida 32308- 5403

Telephone: ( 850) 412- 3630

Jan Mills Shaddrick Haston, Unit Manager

Facilities Intake Unit Assisted Living Unit

Electronic Mail) Agency for Health Care Administration

Electronic Mail)

Suzanne S. Hurley Rafael Gaitan, Esq.

Office of the General Counsel Gus Suarez, Esq.

Agency for Health Care Administration Counsel for Southern Parks, Inc.

Electronic Mail) 1110 Brickell Avenue, Suite 407.

Miami, Florida 33131- 3135

U. S. Mail)

Pat Caufman, Field Office Manager R. Bruce McKibben

Area 5/ 6 Administrative Law Judge

Agency for Health Care Administration Division of Administrative Hearings

Electronic Mail) Electronic Mail)

Paul Brown, Health Facility Evaluator Supervisor

Area 5/ 6

Agency for Health Care Administration

Electronic Mail)

FLORIDA A E. NCY FOR HEATH CARF AFAI N1, 5MTrA - ELIZABETH D

RICK SCOTT Better Health Care for all Floridians SECRETARY

GOVERNOR INTERIM

August 8, 2012

Sanny P. Panningbatan, Administrator

Southern Parks, Inc. d/ a/ b/ Southern Oaks ALF

P. O. Box 789

Wauchula, FL 33873

re: Case No.: 2012005197

AMENDED NOTICE OF INTENT TO DENY

Dear Ms. Panningbatan:

The Agency for Health Care Administration hereby DENIES the application by Southern Parks,

Inc. d/ a b/ Southern Oaks ALF for renewal of its Assisted Living Facility license.

The Specific Basis for this determination is a failure by the facility to pay outstanding fines and

assessed fees from 2008 in the amount of $ 154; a failure by the facility to pay an outstanding

Medicaid fine in the amount of $ 6000 in Case # 121947000; a failure by the facility to obtain a

satisfactory Level 2 background screen for its Chief Financial Officer; and the facility has shown

a pattern of deficient practice as indicated in detail below. The applicant failed to meet minimum

licensure standards pursuant to Sections 408. 809, 408. l)( 815( d), 408. 831, l)( 429. 14( e),

429. 3), 14( and 429. 174, Florida Statutes.'

On June 22, 2010, a complaint investigation was conducted. A widespread Class I deficiency

was cited because the facility was found out of compliance with local authorities that oversee

building construction codes and water and fire safety standards. The county fire jurisdiction had

to issue a cease and desist order to suspend the use of the facility as related to multiple electrical

violations; a " boil water" alert had also been put in place and all of the facility' s 49 residents had

to be relocated on an emergency basis. A widespread Class II deficiency was also cited for the

facility' s failure to maintain a safe and decent living environment and physical plant. The had place

was filthy throughout, including mattresses in the rooms, dirty floors & walls, bathrooms

mold, toilets were filled with feces and cigarette butts, blinds were broken, cockroaches were

everywhere. The facility agreed to an immediate moratorium on admissions until corrections

were made and approved by the Agency.

On May 18, 2011, a complaint investigation was conducted. Four Class III deficiencies were

cited because the facility had failed to assure that its staff had received training in basic CPR and

For each citation subsequently noted, the relevant section( s) of the Florida Statutes or Administrative Rule( s)

violated, as was provided contemporaneously to the facility in writing, is incorporated herein by reference.

2727 Headquarters Mahan Drive 525 Mirror Lake Area Drive, Office N.

Tallahassee, FL 32308 St. Sebring Peter Building, # 330H Iq701

hftp:// myforida. ahca. comQ

EXHIBIT 1

First Aid, failed to assure proper training for its staff who worked with mental health residents,

failed to assure sufficient staff to provide the necessary supervision, safety and care to the

residents, and failed to obtain and keep the required medical examination reports for the

residents. A patterned Class II deficiency was also cited for the facility' s failure to assure the

required criminal background clearance for employees who were providing personal services.

On June 28, 2011, a revisit to the complaint investigation was conducted and the facility had

failed to correct the cited deficiencies. The Agency cited four uncorrected Class III deficiencies

as it still lacked sufficient staff to provide proper care and supervision; it lacked sufficient

qualified staff to care for the mental health residents; it failed to provide minimum staffing hours

and it had still not required proper training in CPR and First Aid for the staff providing services.

On July 22, 2011, a follow up survey was conducted in regard to the above and three Class III

deficiencies were cited. The deficiencies included that the facility was failing to provide care and

services appropriate to the needs of the residents, medications were being mishandled, and the

physical plant was still filthy with evidence of pest and/ or insect droppings.

On September 15, 2011, a second revisit to the June 28 complaint investigation was conducted

and two uncorrected Class III deficiencies were cited. The facility had still not required the

proper training in CPR and First Aid for staff providing personal services and had failed to

assure that one staff member trained in CPR and First Aid were available on all shifts.

Corrections were not completed until October 27, 2010.

On August 4, 2011, a monitoring visit was conducted with " operation spot check." Twelve Class

III deficiencies were cited, including: a) residents' health assessments indicated that they were

inappropriate for assisted living; b) some residents lacked the required health assessments; c)

documentation was lacking to show that the residents were receiving proper activities; d) the

facility had no elopement policy and had failed to conduct elopement drills as required; e) the

facility was assisting a resident with medication when there was no signed physician order for

same; f) the facility had failed to put in place the required Do Not Resuscitate (" DNR") policy;

g) staff members were lacking the required training in abuse, neglect, resident rights, emergency

procedures and reporting adverse incidents; h) the facility administrator lacked the required

nutrition and food service training; i) the facility staff lacked the required training for DNR; j)

the facility had failed to obtain the required surety bond before acting as representative payee for

residents; j) the facility had failed to maintain a safe living environment with regard to sanitation;

and k) the facility had failed to assure that it had contracts with all of its residents.

On November 17, 2011, another complaint survey was conducted along with a revisit. Two Class

III deficiencies were cited. The medication observation record was found not to match the

medication orders for residents on healthcare forms signed by their physicians. The residents had

been receiving medications which were not ordered and had been missing medications that their

physicians had ordered for them. The deficiencies appeared to be corrected on January 31, 2012,

when the Agency conducted three complaint surveys.

On March 5, 2012, a complaint survey was conducted in conjunction with a revisit survey and

two Class III deficiencies were cited. The facility was failing to fill out the medication

observation record appropriately and it was using an outdated form for the healthcare

assessments for the residents. Corrections had been made when the Agency returned on April 26,

2012.

The Class I and Class II deficiencies along with an extraordinarily- large number of Class III

deficiencies supports the Agency' s denial.

EXPLANATION OF RIGHTS

Pursuant to Section 120. 569 Florida Statutes, you have the right to request an administrative

hearing. In order to obtain a formal proceeding before the Division of Administrative must Hearings

under Section 120. 1), 57( Florida Statutes, your request for an administrative hearing

conform to the requirements in Section 28- 201, 106. Florida Administrative Code and must state

the material facts you dispute.

SEE ATTACHED ELECTION OF RIGHTS FORM

Sincerely,

Shaddrick A. Haston, Manager

Assisted Living Unit

Bureau of Long Term Care Services

Copy to: Jan Mills, Office of the General Counsel

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: SOUTHERN PARKS, INC. d/ a b/ CASE NO.: 2012005197

SOUTHERN OAKS ALF

ELECTION OF RIGHTSI

This Election of Rights form is attached to a proposed action by the Agency for Health Care

Administration ( AHCA). The title may be Notice of Intent to Deny, Notice of Intent to Impose

a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.

Your Election of Rights must be returned by mail or by fax within 21 days of the day you

receive the attached Notice of Intent to Deny Notice of Intent to Impose a Late Fee, Notice of

Intent to Impose a Late Fine or Administrative Complaint.

If your Election of Rights with your selected 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 according to

Chapter120, 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: [phone]- Fax: [phone]-

PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS:

OPTION ONE ( 1) I admit to the allegations of facts 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 the to a hearing, fine or a

final order will be issued that adopts the proposed agency action and imposes penalty,

action.

OPTION TWO ( 2) I admit to the allegations of facts contained in the Notice of

Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative

Complaint, but I wish to be heard at an informal proceeding ( pursuant to the to Section to 120. 2), show 57( that

Florida Statutes) where I may submit testimony and written evidence Agency

the proposed administrative action is too severe or that the fine should be reduced.

Here filed in response to the Agency' s Amended Notice of intent to Deny

OPTION THREE ( 3) I dispute the allegations of fact 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 Division 120. 1), of Administrative 57( Florida

Statutes) before an Administrative Law Judge appointed by the

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. 1), 57( 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 which must conform that it contain: to the

requirements of Rule 28- 2015, 106. Florida Administrative Code, requires

1. Your name, address, and 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: ALF? nursing home? medical equipment? Other type?)

Licensee Name: License number:

Contact person:

Name Title

Address:

Street and number city Zip Code

Telephone No. Fax No. Email( 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 licensee referred to above.

Si ned: Date:

Print Name: Title:

Deny/ Late fee/ AC fine/

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

SOUTHERN PARKS, INC. d/ a b/

SOUTHERN OAKS ALF,

Petitioner,

VS. DOAH Case No. 12- 2274

AHCA Case No. 2012005197

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Respondent.

SETTLEMENT AGREEMENT

Respondent, the State of Florida, Agency for Health Care Administration ( the

Agency"), through its undersigned representatives, and Petitioner, Southern Parks, Inc. d/ a b/

Southern Oaks ALF (" Petitioner"), pursuant to Section 120. 4), 57( Florida Statutes, each

individually, a " party," collectively as " parties," hereby enter into this Settlement Agreement

Agreement") and agree as follows:

WHEREAS, Petitioner is an assisted living facility licensed pursuant to Chapters 429,

Part I and 408, Part II, Florida Statutes, and Chapter 58A- 5, Florida Administrative Code; and

WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing

authority over Petitioner, pursuant to Chapters 429, Part I and 408, Part II, Florida Statutes; and

WHEREAS, the Agency served Petitioner with a Notice of Intent to Deny dated May 10,

2012, and an Amended Notice of Intent to Deny dated August 8, 2012, notifying the Petitioner of

the Agency' s intent to deny Petitioner' s renewal application for licensure to operate an assisted

living facility in the State of Florida; and

WHEREAS, Petitioner requested a formal administrative proceeding by selecting Option

Y' on the Election of Rights form or by the filing of a Petition; and

EXHIBIT 2

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, Petitioner agrees to waive any and all

appeals and proceedings to which it may be entitled including, but not limited to, an informal

proceeding under § 120. 2), 57( Florida Statutes, a formal proceeding under § 120. 1), 57( Florida

Statutes, appeals under § 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

that the form of the Final Order remains consistent with the recitals, " whereas" clauses, and

terms of this Settlement Agreement; and, further 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, the parties stipulate and agree as follows:

a. Petitioner shall contract with and maintain as a consultant Ms. Marlene

Hunter, MS CHCRM, commencing September 1, 2012, and extending for two ( 2) years

thereafter. Petitioner shall cause its consultant to review and complete a written quarterly

report on a monthly basis regarding the facility' s operations and regulatory compliance.

Said quarterly report shall include, but not be limited to: assessments of and actions taken

related to medication administration and records, quality of care, risk management

activities, staff training activities, and the adoption or amendment of facility policy and

procedures. The quarterly report shall be maintained by Petitioner and provided to the

Agency upon request.

b. The provisions of subparagraph ( a) above and the affirmative duties

therein, shall continue in full force and effect throughout any renewal of the Petitioner' s

license as necessary during the two ( 2) year period referenced herein.

C. Petitioner places itself under a Voluntary Limitation on Admissions

effective ( retroactive to) August 17, 2012. The Voluntary Limitation on Admissions

prohibits Petitioner from admitting any resident which would result in the Facility' s

census exceeding forty ( 40) residents.

d. A violation of the Voluntary Limitation on Admissions shall result in

administrative sanctions by the Agency just as if for violation of a duly- entered

Emergency Immediate Moratorium on Admissions.

e. On or after February 17, 2013, the Petitioner may request the Agency' s

authorization to discontinue its Voluntary Limitation on Admissions. Any such request

shall be supported by documentation, including but not limited to, reports or records of

Petitioner' s consultant referenced in subparagraph ( a) above, which demonstrate actions

undertaken by Petitioner to assure current and future compliance with the regulatory

mandates. Upon receipt of any such request, the Agency may take such action as is

appropriate and prudent, including but not limited to: a survey of the Facility, a request

for further information or direct communication with Petitioner' s consultant. The Agency

agrees to review any request in good faith, in a timely manner and not to unreasonably

withhold consent. Said review shall be conducted as soon as possible and/ or practical for

the Agency. Should consent be denied, the Agency shall state in writing the reasons for

denial and will provide, if applicable, corrective measures to be taken by Petitioner to

receive consent. Petitioner may seek further consent at any time.

f. Upon adoption of this Agreement as a Final Order of the Agency, the

Agency for Health Care Administration shall issue to Petitioner a renewal license for a

facility capacity of sixty ( 60) residents, valid for a period of two calendar years

commencing on May 5, 2012.

g. On or after September 1, 2013, the Petitioner may apply to increase its

licensed capacity at the Facility as provided by law. Any application to increase the

licensed capacity of the Petitioner' s facility filed prior to September 1, 2013, shall be

summarily denied based upon the terms of this Agreement and that the Petitioner waives

any right to challenge said summarily denied application in any judicial or quasi- judicial

forum. The Agency further agrees to review any application, received on or after

September 1, 2013, to increase Petitioner' s licensed capacity in good faith and not to

unreasonably deny the same other than as provided by law. Should Petitioner' s

application be denied, the reasons for the denial shall be set forth in writing or as

provided by law.

h. Should Petitioner be cited for one Class I, one Class II, or three or more

uncorrected Class III deficient practices at any survey over a two- year period from the

date of the issuance of the renewal license ( i. e., May 5, 2012), Petitioner stipulates that

the deficient practice( s) will, if proven, constitute grounds for revocation of the

Petitioner' s license ( if provided for by law) in addition to additional Agency action

pursuant to applicable provisions of law.

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, Petitioner denies the allegations set forth in the

Notice of Intent to Deny and the Amended Notice of Intent to Deny, and the Agency asserts the

validity of the allegations raised in these Notices of Intent to Deny. No agreement made herein

shall preclude the Agency from imposing a penalty against Petitioner for any deficiency/

violation of statute or rule identified in a future survey of Petitioner, which constitutes a " repeat"

or " uncorrected" deficiency from surveys identified in the administrative complaint.

7. No agreement made herein shall preclude the Agency from using the deficiencies

from the surveys identified in the Notice of Intent to Deny in any decision regarding licensure of

Petitioner, including, but not limited to, licensure for limited mental health, limited nursing

services, extended congregate care, or a demonstrated pattern of deficient performance, as

provided for by then existing law. The Agency is not precluded from using the subject events for

any purpose within the jurisdiction of the Agency as provided for by law. Further, Petitioner

acknowledges 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 Petitioner' 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. Petitioner 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 Petitioner or related facilities; provided and limited, however, that Petitioner' s

rights to any costs, expenses or attorneys fees arising from or relating to enforcement of this

Settlement Agreement shall survive.

12. This Agreement is binding upon all parties herein and those identified in

paragraph eleven ( 11) of this Agreement.

13. In the event that Petitioner 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- 070, 9. Florida Administrative Code.

14. Petitioner 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 Petitioner in the Final Order, or any portion thereof,

owed by Petitioner to the Agency from any present or future funds owed to Petitioner by the

Agency, and that the Agency shall hold a lien against present and future funds owed to Petitioner

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. Petitioner has the capacity to execute this Agreement.

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.

Molly Ki stry Ra ael aitan, Esq.

Depu ecretar3 Florida 13ar No. 17987

Agency for Health Care Administration Gus Suarez, Esq.

2727 Mahan Drive Florida Bar No. 616613

Tallahassee, Florida 32308 Counsel for Southern Parks, Inc.

1110 Brickell Avenue; Suite 407

Miami, Florida 33131- 3135

DATED: DATED:

Stuart F. Williams l

General Counsel Name ( printed); _ S hP ( q

Agency for Health Care Administration Position:

2727 Mahan Drive, Building # 3 j( E(; P- r(

Tallahassee, Florida 32308- 5407 Southern Parks, Inc.

DATED: I DATED: 9- a jCl~~

ley, Sen' ttorney

Floridoa5775

Age ` cy are A istration

525 anngfoeal eve, Suite 330H

St. Petersburg, Florida 33701

DATED: 0 C C~