13-003523 Psl Operating Florida, Llc, A/K/A Psl Operating Florida Limited Liability Company, D/B/A Summit At Venice vs. Agency For Health Care Administration Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, November 12, 2013.

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STATE STATE OF OF FLORIDA FLORIDA 1G„

AGENCY AGENCY FOR FOR HEALTH HEALTH CARE CARE ADMINISTRATION ADMINISTRATION

PSL PSL OPERATING OPERATING FLORIDA, FLORIDA, LLC, LLC, 2014 2014 SEI' SEP 22 22 A A III II: 40 40

d/b/ a dlbla SUMMIT SUMMIT AT AT VENICE, VENICE,

Petitioner, Petitioner,

V. v. AHCA AHCA Nos. Nos. 2013008639 2013008639

2013011466 2013011466

STATE STATE OF OF FLORIDA, FLORIDA, AGENCY AGENCY FOR FOR RENDITION RENDITION NO.: NO.: AHCA- AHCA· /4 - d 07 l 90 - cr 0 S- -S-OlC OLC

HEALTH HEALTH CARE CARE ADMINISTRATION, ADMINISTRATION,

Respondent. Respondent.

_________________ 1

FINAL FINAL ORDER ORDER

THISCAUSE THIS CAUSE came came on on for for consideration consideration before before the the Agency Agency for for Health Health Care Care Administration Administration

the ("the Agency"), Agency"), whichfinds which finds and and concludes concludes as as follows: follows:

1. 1. The The Agency Agency issued issued the the Petitioner (" Petitioner the ("the Applicant") Applicant") the the attached attached Second Second Amended Amended Notice Notice

of of Intent Intent to to Deny ( Deny Ex. (Ex. 1). 1). Case Case No. No. 2013008639. 2013008639. In In addition, addition, the the Agency Agency has has an an open open case case number number

2013011466 2013011466 for for an an administrativefine administrative fine in in the the sum sum of $ of 500. $500.00. 00. The The parties parties entered entered into into the the attached attached

Settlement Settlement Agreement ( Agreement Ex. (Ex. 2), 2), which which is is adopted adopted and and incorporated incorporated by by reference. reference.

2. 2. The The parties parties shall shall comply comply with with the the terms terms of of the the Settlement Settlement Agreement. Agreement.

3. 3. The The Second Second Amended Amended Notice Notice of of Intent Intent to to Deny Deny is is withdrawn. withdrawn.

4. 4. The The Applicant Applicant shall shall pay pay the the Agency Agency ten tenthousand thousand dollars ($ dollars 10, 00) ($10,000.00) 000. by by March March 2, 2, 2015, 2015,

with with the the license license being being surrendered surrendered if if the the payment payment is is late late or or missed. missed. Payment Payment made made on on March March 3, 3,2015 2015 or or

thereafter, thereafter, shall shall be be deemedlate deemed late or or missed. missed. A A check check made made payable payable to to the " the Agency "Agency for for Health Health Care Care

Administration" Administration" containing containing the the AHCA AHCA number( number(s) s) should should be be sent sent to: to:

Agency Agency for for Health Health Care Care Administration Administration

Office Office of of Finance Finance and and Accounting Accounting

Revenue Revenue Management Management Unit Unit

2727 2727 Mahan Mahan Drive, Drive, MS# MS# 14 14

Tallahassee, Tallahassee, Florida Florida 32308 32308

5. 5. The The Agency Agency will will issue issue a a standard standard license license for for the the facility facility effective effective upon upon the the completed completed

execution execution of of this this Settlement Settlement Agreement. Agreement. Unless Unless surrendered, surrendered, the the license license will will be be valid valid until untilthe the survey survey

cycle cycle of of May, May, 2015. 2015. The The Agency Agency will will conduct conduct the the facility' facility's s biennial biennial survey survey before before the the expiration expiration of of the the

May May 2015 2015 license license and and within within the the Agency' Agency's s timeframes timeframes as as defined defined by by protocol. protocol. The The Agency Agency will will then then

complete complete annual annual surveys surveys of of the the facility facility from from that that date date through through the the next next survey survey cycle cycle expiration expiration in in May, May,

1 1

2017. If there are any Class 1, Class 2 or uncorrected 3 or 4 deficiencies during any survey cycle, or

before May, 2017, the facility agrees to relinquish its license. Ifthere are any complaints which result in

a Class 1, Class 2 or uncorrected 3 or 4 deficiencies during this time frame, the facility agrees to

relinquish its license.

6. Any requests for an administrative hearing are withdrawn. The parties shall bear their

own costs and attorney's fees. This matter is closed.

ORDERED in Tallahassee, Florida, on this '22- day ' 2014.

cretary

are Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party that is adversely affected by this Final Order is entitled to seek 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 HEREBY CERTIFY that a true and correct copy Order was served 0 e below-

named persons/entities by the method designated on this .. of ,2014.

Richard Shoop, Agency Cler

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone [phone]

Jan Mills Catherine Anne Avery, Unit Manager

Facilities Intake Unit Licensure Unit

Agency for Health Care Administration Agency for Health Care Administration

(Electronic Mail) (Electronic Mail)

Finance and Accounting Harold Williams, Field Office Manager

Revenue Management Unit Local Field Office

Agency for Health Care Administration Agency for Health Care Administration

(ElectronicMail) (Electronic Mail)

Deborah E. Leoci, Senior Attorney Jay Adams, Attorney for Petitioner

Office of the General Counsel Broad and Cassel

Agency for Health Care Administration 215 South Monroe Street, Suite 400

(Electronic Mail) Tallahassee, Florida 32302

(U. S. Mail)