13-001617 Agency For Health Care Administration vs. 4602 Northgate Court, Llc, D/B/A, Springwood Care And Rehabilitation Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Thursday, September 19, 2013.

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR 714 ~' r r A y

HEALTH CARE 3

ADMINISTRATION,

Petitioner,

V. AHCA NO.: 2012009469

DOAH NO.: 13- 1617

NO.: AHCA- S- OLC

4602 NORTHGATE COURT, LLC d/ a b/ SPRINGWOOD RENDITION Q( 20 - 4

CARE AND REHABILITATION CENTER,

Respondent.

FINAL ORDER

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 11, 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

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.

s

ORDERED at Tallahassee, Florida, on this L day of 2014.

t

y~ GL ,

Eli th D e Secretary

Ag y for eal h Care Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this Final Order is entitled to judicial review, which shall be

instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy,

along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district

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

conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30

days of rendition of the order to be reviewed.

CERTIFICATE OF SERVICE

I CERTIFY that a true and correct py of this Final Order was served on the below- named

persons by the method designated on this, > 6a y of 32014.

Richar hoop, Agency Clerk

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, 2nd 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/ a b/ 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/ a b/ 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, 00) 000. pursuant to Section 400. 8)( 23( a), Florida Statutes ( 2012),

based upon one ( 1) Class I deficiency; to assess a survey fee in the amount of SIX THOUSAND

DOLLARS ($ 6, 00) 000. based upon Respondent being cited for one ( 1) Class I deficiency pursuant

to Section 400. 3), 19( Florida Statutes ( 2012), and to assign conditional licensure status beginning

on August 30, 2012, pursuant to Section 400. 7)( 23( 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 11, Florida Statutes ( 2012).

3. Venue lies pursuant to Rule 28- 207, 106. 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. 7), 23( 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. 1)( 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. 1)( 022( 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/ 25 0. 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 eyes 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; I 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 I and F.

15. In an 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 m., 2: 25p. 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. 8)( 23( a), Florida Statutes ( 2012).

WHEREFORE, the Agency intends to impose an administrative fine in the amount of TEN

THOUSAND DOLLARS ($ 10, 00) 000. against Respondent, a nursing home in the State of Florida,

pursuant to Sections 400. 8)( 23( a), Florida Statutes ( 2012).

COUNT II

Assignment Of Conditional Licensure Status Pursuant To Section 400. 7)( 23( 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. 7), 23( 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 7)( 400. b), 23( Florida

Statutes ( 2012).

COUNT III

Assessment Of Fine Pursuant To Section 400. 3), 19( 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, 00) 000. pursuant to Section 400. 3), 19( 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 ($ 00) 6, 000. against

Respondent, a nursing home in the State of Florida, pursuant to Section 3), 400. 19( 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, 00) 000. pursuant to Section 400. 8)( 23( a), Florida Statutes ( 2012),

and assess a survey fee in the amount of SIX THOUSAND DOLLARS ($ 6, 00), 000. pursuant to

Section 400. 3), 19( Florida Statutes ( 2012), for a total of SIXTEEN THOUSAND DOLLARS

16, 00). 000.

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 day of 2012.

PC\\

Andrea M. Lang, Assistant General Co el

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/ SHE HE/ HAS A RIGHT TO REQUEST AN

ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120. 569 AND 120. 579

FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/ SHE HE/

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, 2727MAIJANDRIVE, 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/ a b/ 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/ a b/ 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 thisday of

S 2012.

Andrea M. Lang, Assistant General Co sel

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 Andrea M. Lang, Assistant General Counsel

4602 Northgate Court, LLC Agency for Health Care Administration

d/ a b/ Springwood Care and Office of the General Counsel

Rehabilitation Center 2295 Victoria Avenue, Room 346C

4602 Northgate Court Fort Myers, Florida 33901

Sarasota, Florida 34234 Electronic Mail)

U. S. Certified Mail)

Corporation Service Company Bernard Hudson, Health Services and

Registered Agent for Facilities Consultant Supervisor

4602 Northgate Court, LLC Bureau of Long Term Care Services

d/ a b/ Springwood Care and Long Term Care Unit

Rehabilitation Center Agency for Health Care Administration

1201 Hays Street 2727 Mahan Drive, Building # 3, Room 1213B

Tallahassee, Florida 32301 Tallahassee, Florida 32308

U. S. Certified Mail) 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/ a b/ 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: [phone]- Fax: [phone]-

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. 2), 57( 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. 1), 57( 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. 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 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:

Print Name: Title:

4AHCA

RICK SCOTT FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

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,

9 C

Agency for Health Care Administration

Division of Health Quality Assurance

Enclosure

cc: Medicaid Contract Management

2727 Mahan Drive, MS# 33 F P Visit AHCA online at

Tallahassee, Florida 32308 ahca. com myflorida.

Exhibit A

Original Certificate of Conditional License

4602 Northgate Court, LLC

d/ a b/ Springwood Care and Rehabilitation Center

Certificate No. 17737

License No. SNF15130962

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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/ a b/

SPRINGWOOD CARE AND REHABILITATION CENTER,

Respondent.

SETTLEMENT AGREEMENT

Petitioner, State of Florida, Agency for Health Care Administration ( hereinafter the

Agency"), through its undersigned representatives, and Respondent, 4602 Northgate Court,

LLC d/ a b/ Springwood Care and Rehabilitation Center ( hereinafter " Respondent"), 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, 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

an informal

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

under Subsection

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

and

120. 1), 57( Florida Statutes, appeals under Section 120. 68, Florida Statutes; and declaratory

all writs of relief in any court or quasi- court of competent jurisdiction; and agrees to waive

to which it

compliance with the form of the Final Order ( findings of fact and conclusions of law)

a waiver either

may be entitled, provided, however, that no agreement herein shall be deemed by

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

2012 and

accepts the assignment of conditional licensure status commencing August 30, 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- 070, 9. 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.

Mo McKi y Susan Ritchie, Administrator

D ty Seer ry 4602 Northgate Court, LLC

Agency for Health Care Administration d/ a b/ Springwood Care and

2727 Mahan Drive, Bldg # 1 Rehabilitation Center

Tallahassee, Florida 32308 4602 Northgate Court

Sarasota, Florida 34234

DATED: DATED:

s

rr 11

Stu F, neral Counsel Thomas W. Caufman, Esq.

Agency for Health Care Administration Quitairos, Prieto, Wood & Boyer, P. A.

2727 Mahan Drive, Mail Stop # 3 4905 West Laurel Street, 2nd floor

Tallahassee, Florida 32308 Tampa, Florida 33607

Attorney for Respondent

DATED: DATED: I2- 13

Andrea M. Lang, Senior Attorney

Agency for Health Care Administration

2295 Victoria Avenue

Fort Myers, Florida 33901

DATED: L