14-000521 Agency For Health Care Administration vs. Senior Care Group, Inc., D/B/A Lakeshore Villas Health Care Center Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Friday, February 21, 2014.

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STATE STATE OF OF FLORIDA FLORIDA AGENCY AGENCY CLERK CLERK

AGENCY AGENCY FOR FOR HEALTH HEALTH CARE CARE ADMINISTRATION ADMINISTRATION

2014 2014 HAR HAR 3\\ 3\\ P-, P-, II: II: 22 22

SENIOR SENIOR CARE CARE GROUP, GROUP, INC, INC, d/b/a d/b/a

LAKESHORE LAKESHORE VILLAS VILLAS HEALTH HEALTH

CARE CARE CENTER, CENTER,

Petitioner, Petitioner,

vs. vs. Case Case No. No. 13-395PH 13-395PH

AHCA AHCA No. No. 2013005471 2013005471

STATE STATE OF OF FLORIDA FLORIDA AGENCY AGENCY FOR FOR RENDITION RENDITION NO.: NO.: AHCA- AHCA- /4 /4 - - Dl15 Dl15 -S-OLC -S-OLC

HEALTH HEALTH CARE CARE ADMINISTRATION, ADMINISTRATION,

Respondent. Respondent.

--------------_..-!/ --------------_..-!/

STATE STATE OF OF FLORIDA, FLORIDA, AGENCY AGENCY FOR FOR

HEALTH HEALTH CARE CARE ADMINISTRATION, ADMINISTRATION,

Petitioner, Petitioner,

vs. vs. ACHA ACHA No. No. 2013006461 2013006461

SENIOR SENIOR CARE CARE GROUP, GROUP, INC. INC. d/b/a d/b/a

LAKESHORE LAKESHORE VILLAS VILLAS HEALTH HEALTH

CARE CARE CENTER, CENTER,

Respondent. Respondent.

______________ ______________ -e/ -e/

STATE STATE OF OF FLORIDA, FLORIDA, AGENCY AGENCY FOR FOR

HEALTH HEALTH CARE CARE ADMINISTRATION, ADMINISTRATION,

Petitioner, Petitioner,

vs. vs. ACHA ACHA No. No. 2013006462 2013006462

SENIOR SENIOR CARE CARE GROUP, GROUP, INC. INC. d/b/a d/b/a

LAKESHORE LAKESHORE VILLAS VILLAS HEALTH HEALTH

CARE CARE CENTER, CENTER,

Respondent. Respondent.

--------------_/ --------------_/

1 1

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner, DOAH No. 14-248

vs. ACHA No. 2013006534

SENIOR CARE GROUP, INC. d/b/a

LAKESHORE VILLAS HEALTH

CARE CENTER,

Respondent.

----------------,/

STATE OF FLORIDA, AGENCY FOR

HEAL TH CARE ADMINISTRATION,

Petitioner, DOAH No. 14-528

vs. ACHA No. 2013007612

SENIOR CARE GROUP, INC. d/b/a

LAKESHORE VILLAS HEALTH

CARE CENTER,

Respondent.

---------------_/

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner, DOAH No. 14-521

vs. ACHA No. 2013010196

SENIOR CARE GROUP, INC. d/b/a

LAKESHORE VILLAS HEALTH

CARE CENTER,

Respondent.

---------------_/

FINAL ORDER

Having reviewed the Administrative Complaints and Notices of Intent to Deny, and all other

matters of record, the Agency for Health Care Administration finds and concludes as follows:

1. The Agency has jurisdiction over Senior Care Group, Inc. d/b/a Lakeshore Villas Health

Care Center pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes

and administrative code provisions.

2. The Agency issued the attached Administrative Complaints and Notices of Intent to Deny

and Election of Rights forms to Senior Care Group, Inc. d/b/a Lakeshore Villas Health Care Center.

(Ex. 1) The Election of Rights forms 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 Notice of Intent to Deny is superseded by this Agreement.

3. Senior Care Group, Inc. d/b/a Lakeshore Villas Health Care Center shall pay the Agency

$25,500.00. 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

4. Conditional licensure status is imposed on Senior Care Group, Inc. d/b/a Lakeshore

Villas Health Care Center beginning on April 12, 2013.

ORDERED at Tallahassee, Florida, on this 2.J day of 1'1 01 ('4... ,2014.

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 true and co.rrect.£912Y of this Final served on the below-named

persons by the method designated on this of 4: . ,2014.

Richard Shoop, Agency Clerk

Agency for Health Care Administration

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

Tallahassee, Florida 32308-5403

Telephone: [phone]

Jan Mills Finance & Accounting

Facilities Intake Unit Revenue Management Unit

(Electronic Mail) (Electronic Mail)

Thomas J. Walsh II Anna G. Small, Esq.

Office of the General Counsel Allen Dell, P.A.

Agency for Health Care Administration 202 South Rome Avenue

(Electronic Mail) Tampa, Florida 33606

(U.S. Mail)

Linzie F. Bogan Lynne A. Quimby-Pennock

Administrative Law Judge Administrative Law Judge

Division of Administrative Hearings Division of Administrative Hearings

(Electronic Mail) (Electronic Mail)

Certified Article Number

719b 9008 9111 6922 9925

SENDERS RECORD

Fl.ORIDA AGENCY FOR HEAlTH CARE ADMiNiSTRATION

RICK SCOTT Better Health Care for all Floridians ELIZABETH DUDEK

GOVERNOR SECRETARY

May 22, 2013

HEALTH CARE UNiTLICENSE NUMBER: 1282096

16002 LAKESHORE VILLA DR FILE NUMBER: 62921

TAMPA, FL 33613 MAY 2: 3 2013 CASE #: 2013005471

Dear Ms. Johnson:

It is the decision of this Agency that Lakeshore Villas Health Care Center's license renewal application

for a nursing home be DENIED.

Thespecific basis for the Agency's decision is based on the following grounds:

• Pursuant to section 400.121(3)(d), F.S., the Agency shall revoke or deny a nursing home license for two

class I deficiencies arising from separate surveys within a 30 month period. Lakeshore Villas Health Care

Center was cited for Class I deficiencies on October 13,2011 and November 14,2012.

• Section 408.815(1), F.S., states that in addition to the grounds provided in authorizing statutes, grounds that

may be used by the agency for denying and revoking a license or change of ownership application include

any of the following actions by a controlling interest: (a) a violation of this part, authorizing statutes, or

applicable rules; and (d) a demonstrated pattern of deficient performance.

EXPLANATION OF RIGHTS

Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to obtain a formal

proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an

administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code

(F.A.C), and must state the material facts you dispute.

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS.

cc: Agency Clerk, Mail Stop 3

EXHIBIT 1

2727 Mahan Drive,MS#33 Visit AHCA online at

Tallahassee, Florida 32308 ahca. myflori da. com

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: LAKESHORE VILLAS HEALTH CARE CENTER

CASE NUMBER: 2013005471

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed Notice of Intent to Deny of the Agency for

Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Fine,

Administrative Complaint, or some other notice of intended action by AHCA.

An Election of Rights must be returned by mail or by fax within twenty-one (21) days of

the day you receive the attached Notice of Intent to Impose a Fine, Administrative

Complaint or any other proposed action by AHCA.

If an Election of Rights with your selected option is not received by AHCA withintwenty­

one (21) days from the date you received this notice of proposed action, you will have given up

your right to contest the Agency's proposed action and a final order will be issued.

(Please reply using this Election of Rights form unless you, your attorney or your representative

prefer to reply according to Chapter 120, Florida Statutes (2006) and Rule 28, Florida

Administrative Code.)

Please return your ELECTION OF RIGHTS to:

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 Fine, Administrative Complaint, or other notice of intended

action by AHCA and I waive my right to object and 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 proposed penalty, fine or action.

OPTION TWO (2) __ I admit to the allegations of facts and law contained in the

Notice of Intent to Impose a Fine, Administrative Complaint, or other proposed action by

AHCA, 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 facts and law contained in the

Notice of Intent to Impose a Fine, Administrative Complaint, or other proposed action by

AHCA, and I request a formal hearing (pursuant to Section 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 twenty-one (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, 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: Nursing Home License number: 1282096

Applicant Name: SENIOR CARE GROUP INC. d/b/a LAKESHORE VILLAS HEALTH

CARE CENTER

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.

Signed: Date:

Print Name: Title: _

RICK SCOTT flORIDA AGENCY FOR HEALTH CARE AD,'v1INISTRATION

ELIZABETH DUDEK

GOVERNOR SECRETARY

July 8, 2013 RECEIVED

GENERAL COUNSEL

LAKESHORE VilLAS HEALTH CARE CENTER JUl 12 2013

16002 LAKESHORE VILLA DR

TAMPA, FL 33613 Care Agency Administration for Health

Dear Administrator:

The attached license with Certificate #18248 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 status change to Conditional.

Sincerely,

g 'taCetf ftvt

Kathy Munn

Agency for Health Care Administration

Division of Health Qu.ality Assurance

Enclosure

cc: Medicaid Contract Management

2727 Mahan Drive, MS#33 Visit AHCA online at

Tallahassee, Florida 32308 ahca. myflorida.com