14-001025 Agency For Health Care Administration vs. Summerville At Lakeland, Llc, D/B/A Emeritus At Lakeland Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Monday, April 21, 2014.

F- FIL. FIL. s L .D . D

STATE STATE STATE OF OF OF FLORIDA, FLORIDA FLORIDA k

AGENCY AGENCY AGENCY FOR FOR FOR HEALTH HEALTH HEALTH CARE CARE CARE ADMINISTRATION ADMINISTRATION ADMINISTRATION

STATE STATE STATE OF OF OF FLORIDA, FLORIDA, FLORIDA, AGENCY AGENCY AGENCY FOR FOR FOR 2014 2014 2014 MAY MAY! MAY! 15 5 5 A A A q: q: 5 53 53 3

HEALTH HEALTH HEALTH CARE CARE CARE ADMINISTRATION, ADMINISTRATION, ADMINISTRATION,

Petitioner, Petitioner, Petitioner,

V. v. v. AHCA AHCA AHCA Case Case Case No. No. No. 2013010761 2013010761 2013010761

DOAH DOAH DOAH Case Case Case No. No. No. 14- 14-1025 14-1025 1025

SUMMERVILLE SUMMERVILLE SUMMERVILLE AT AT AT LAKELAND, LAKELAND, LAKELAND, LLC LLC LLC RENDITION RENDITION RENDITION NO.: NO.: NO.: AHCA- AHCA- AHCA- I I - - M53 - 3 3 S- oS-OLe oS-OLe OLC

d/b/ a d/b/a d/b/a EMERITUS EMERITUS EMERITUS AT AT AT LAKELAND, LAKELAND, LAKELAND,

Respondent. Respondent. Respondent.

---------------_----.:/ ---------------_----.:/

FINAL FINAL FINAL ORDER ORDER ORDER

Having Having Having reviewed reviewed reviewed the the the Administrative Administrative Administrative Complaint, Complaint, Complaint, I I I and and and all all all other other other matters matters matters of of of record, record, record, the the the Agency Agency Agency for for for

Health Health Health Care Care Care Administration Administration Administration finds finds finds and and and concludes concludes concludes as as as follows: follows: follows:

1. 1. 1. The The The Agency Agency Agency has has has jurisdiction jurisdiction jurisdiction over over over the the the above- above-named above-named named Respondent Respondent Respondent pursuant pursuant pursuant to to to Chapter Chapter Chapter 408, 408, 408,

Part Part Part 11, II, II, Florida Florida Florida Statutes, Statutes, Statutes, and and and the the the applicable applicable applicable authorizing authorizing authorizing statutes statutes statutes and and and administrative administrative administrative code code code provisions. provisions. provisions.

2. 2. 2. The The The Agency Agency Agency issued issued issued the the the attached attached attached Administrative Administrative Administrative Complaint Complaint Complaint and and and Election Election Election of of of Rights Rights Rights form form form to to to

the the the Respondent ( Respondent Respondent Ex. (Ex. (Ex. 1). 1). 1). The The The Election Election Election of of of Rights Rights Rights form form form advised advised advised of of of the the the right right right to to to an an an administrative administrative administrative hearing. hearing. hearing.

3. 3. 3. The The The parties parties parties have have havesince since since entered entered entered into into into the the the attached attached attached Settlement Settlement Settlement Agreement Agreement Agreement ( (Ex. (Ex. Ex. 2). 2). 2).

Based Based Based upon upon upon the the the foregoing, foregoing, foregoing, it it it is is is ORDERED: ORDERED: ORDERED:

1. 1. 1. The The The Settlement Settlement Settlement Agreement Agreement Agreement is is is adopted adopted adopted and and and incorporated incorporated incorporated by by by reference reference reference into into into this this this Final Final Final Order. Order. Order.

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

2. 2. 2. The The The Respondent Respondent Respondent shall shall shall pay pay pay the the the Agency Agency Agency $ $6,000.00. $6,000.00. 00. 6, 000. If If If full full full payment payment payment has has has been been been made, made, made, the the the

cancelled cancelled cancelled check check check acts acts acts as as as receipt receipt receipt of of of payment payment payment and and and no no no further further further payment payment payment is is is required. required. required. If If If full full full payment payment payment has has has not not not

been been been made, made, made, payment payment payment is is is due due due within within within 30 30 30 days days days of of of the the the Final Final Final Order. Order. Order. No No No interest interest interest shall shall shall be be be assessed assessed assessed if if if paid paid paid within within within

this this this period period period of of of time. time. time. Overdue Overdue Overdue amounts amounts amounts are are are subject subject subject to to to statutory statutory statutory interest interest interest and and and may may may be be be referred referred referred to to to collections. collections. collections.

A A A check check check made made made payable payable payable to to to the the the " "Agency "Agency Agency for for for Health Health Health Care Care Care Administration" Administration" Administration" and and and containing containing containing the the the AHCA AHCA AHCA ten­ ten­ ten-

digit digit digit case case case number number number should should should be be be sent sent sent to: to: to:

Office Office Office of of of Finance Finance Finance and and and Accounting Accounting Accounting

Revenue Revenue Revenue Management Management Management Unit Unit Unit

Agency Agency Agency for for for Health Health Health Care Care Care Administration Administration Administration

2727 2727 2727 Mahan Mahan Mahan Drive,Mail Drive,Mail Drive, Mail Stop Stop Stop 14 14 14

Tallahassee, Tallahassee, Tallahassee, Florida Florida Florida 32308 32308 32308

1 1 1 The The The Nature Nature Nature of of of the the the Action Action Action allegation allegation allegation within within within the the the Administrative Administrative Administrative Complaint Complaint Complaint contains contains contains a a a scrivener's scrivener's scrivener' s error error error in in in that that that the the the total total total fine fine fine

sought sought sought was was was $ $8,000.00. $8,000.00. 8, 00. 000.

ORDERED at Tallahassee, Florida, on this d day Of __ ----=,------"----f ' 2014.

NOTICE OF RIGHT TO J

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 of this Final Orde ws served on the below-named

persons by the method designated on this oT ,2014.

Richard , gency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308-5403

Telephone: [phone]

JanMills Finance & Accounting

Facilities Intake Unit Revenue Management Unit

(Electronic Mail) (Electronic Mail)

Suzanne Suarez Hurley Thomas Caufman, Esq.

Office of the General Counsel Quintairos, Prieto, Wood & Boyer, P.A.

Agency for Health Care Administration 4905 West Laurel Street, Suite 200

(Electronic Mail) Tampa, FL 33607

(U.S. Mail)

D. R. Alexander Tony Sanford, VP Quality Services

Administrative Law Judge Emeritus at Lakeland

Division of Administrative Hearings 2111 Lakeland Hills Blvd.

(Electronic Mail) Lakeland, FL 33805

(U.S. Mail)