16-001448 Dunedin Assisted Living Facility vs. Agency For Health Care Administration Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Thursday, July 7, 2016.

1

STATE OF FLORIDA E

AGENCY FOR HEALTH CARE ADMINISTRATION

2016 J1. 1L 21

ASSISTED LIVING FACILITY OF

DUNEDIN, LLC d/ b / a DUNEDIN

ASSISTED LIVING FACILITY,

Petitioner,

v AHCA No. 2016001105

License No. 7292

STATE OF FLORIDA, AGENCY FOR File No. 11910826

HEALTH CARE ADMINISTRATION, Provider Type: Assisted Living Facility

RENDITION NO.: AHCA -'\\, - Oswa - S- OLC

Respondent.

FINAL ORDER

Having reviewed the Notice of Intent to Deny Change of Ownership Application and all other

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

1. The Agency issued the Petitioner, a change of ownership applicant for licensure, the

attached Notice of Intent and Election of Rights form. ( Ex. 1) The Election of Rights form advised of

the right to an administrative hearing pursuant to Sections 120. 57( 1) and 120. 57( 2), Florida Statutes.

The Petitioner received the Notice of Intent and Election of Rights form and later voluntarily withdrew

the application for licensure pursuant to the terms of the attached settlement agreement. ( Ex. 2)

Based upon the foregoing, it is ORDERED:

2. The Petitioner' s change of ownership application for licensure is withdrawn and the

provisional license issued to the Petitioner shall be cancelled 45 days from the date of the date of this

Final Order without any further action by the Agency. The Petitioner shall proceed to discharge the

residents in a safe and orderly manner. At the conclusion of 45 days or upon the discontinuance of

operations, whichever is first in time, the Petitioner shall immediately return the license certificate for

the license which is the subject of this action to the appropriate licensure unit in Tallahassee, Florida.

3. The Notice of Intent is withdrawn.

4. The Petitioner is responsible for any refunds that may be due to any clients.

5. The Petitioner shall remain responsible for retaining and appropriately distributing client

records as prescribed by Florida law. The Petitioner is advised of Section 408. 810, Florida Statutes.

The Petitioner should also consult the applicable authorizing statutes and administrative code provisions

as well as any other statute that may apply to health care practitioners regarding client records.

6. The Petitioner is given notice of Florida law regarding unlicensed activity. The Petitioner

is advised of Section 408. 804 and Section 408. 812, Florida Statutes. The Petitioner should also consult

the applicable authorizing statutes and administrative code provisions. The Petitioner is notified that the

cancellation of an Agency license may have ramifications potentially affecting accrediting, third party

billing including but not limited to the Florida Medicaid program, and private contracts.

ORDERED at Tallahassee, Florida, on this ,(: day of , 2016.

Elizabeth Dudbk, Secretary

Agency for Heal 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 co l f this Final Order was served on the below - named

persons by the method designated on thisi y of Z 2016.

Richard J. Shoop, Agenc Jerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

Telephone: ( 850) 412 - 3630

Facilities Intake Unit Catherine Avery, Unit Manager

Agency for Health Care Administration Licensure Unit

Electronic Mail) Agency for Health Care Administration

Electronic Mail)

Katrina Derico - Harris Pat Caufman, Field Office Manager

Medicaid Accounts Receivable Local Field Office

Agency for Health Care Administration Agency for Health Care Administration

Electronic Mail) Electronic Mail)

Shawn McCauley John E. Bradley, Senior Attorney

Medicaid Contract Management Office of the General Counsel

Agency for Health Care Administration Agency for Health Care Administration

Electronic Mail) Electronic Mail)

Thomas M. Hoeler, Chief Facilities Counsel Thomas W. Caufman, Esq.

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

Agency for Health Care Administration Counsel for Respondent

Electronic Mail) 1410 N. Westshore Blvd. Suite 200, Tampa,

Florida 33607

U. S. Mail)

NOTICE OF FLORIDA LAW

408. 804 License required; display. --

1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers

or provides services that require licensure, without first obtaining from the agency a license authorizing

the provision of such services or the operation or maintenance of such provider.

2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address

that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not

be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the

licensee, provider, and location for which the license is issued.

408. 812 Unlicensed activity. --

1) A person or entity may not offer or advertise services that require licensure as defined by this part,

authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency.

A licenseholder may not advertise or hold out to the public that he or she holds a license for other than

that for which he or she actually holds the license.

2) The operation or maintenance of an unlicensed provider or the performance of any services that

require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed

activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or

any state attorney may, in addition to other remedies provided in this part, bring an action for an

injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed

provider or the performance of any services in violation of this part and authorizing statutes, until

compliance with this part, authorizing statutes, and agency rules has been demonstrated to the

satisfaction of the agency.

3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after

receiving notification from the agency, such person or entity fails to cease operation and apply for a

license under this part and authorizing statutes, the person or entity shall be subject to penalties as

prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate

offense.

4) Any person or entity that fails to cease operation after agency notification may be fined $ 1, 000 for

each day of noncompliance.

5) When a controlling interest or licensee has an interest in more than one provider and fails to license

a provider rendering services that require licensure, the agency may revoke all licenses and impose

actions under s. 408. 814 and a fine of $ 1, 000 per day, unless otherwise specified by authorizing statutes,

against each licensee until such time as the appropriate license is obtained for the unlicensed operation.

6) In addition to granting injunctive relief pursuant to subsection ( 2), if the agency determines that a

person or entity is operating or maintaining a provider without obtaining a license and determines that a

condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person

or entity is subject to the same actions and fines imposed against a licensee as specified in this part,

authorizing statutes, and agency rules.

7) Any person aware of the operation of an unlicensed provider must report that provider to the

agency.

9414 7266 1104 2057 261? So RICK GOVERNOR SCOTT

ELIZABETH DUDEK

SECRETARY

February 4, 2016 CERTIFIED

Maryla B I lawekotte, Administrator and Owner File Number: H 910826

Dunedin Assisted Living Facility License Number: 7292

14605 Coffey Lane Provider Type: dSSiSted living I' WAIIL)

Hudson, FL 34667 RECEAVEM

I"' STAKE UNIT

RE: Complaint Number 2016001105 534 Howell Street, Dunedin

F F 1- 3 0 4 Ji

J

Notice of Intent to Deny for Chan geof Owne m4li, ifi laim)

Dear Ms, Hewekotte,

It is the decision of this Agency that Dunedin Assisted Living Facility Change of Ownership application

for ( an/ the) assisted living facility license be DENIED,

The Specific Basis for this determination is The applicant failed to meet minimum licensure requirements

pursuant to Section 408, Part 11, Florida Statutes ( F. S.) and Section 429, Part 1, FS.

On December 2, 2015 a change of ownership survey was conducted in conjunction with a complaint

investigation and two class III deficiencies were cited. The deficiencies were in the areas of Staffing

Standards and Training,.

Two complaint investigations were completed on January 8. 2016 and eight deficiencies were cited. The

deficiencies included, one class two in the area of Resident CaW, one Unclassifik: d dcN: icm:) in tha a; va

of Background Screening, and six class III deficiencies in the areas of: Medication, Staffing Standards,

Food service, Fiscal, and Resident Contracts,

Therefore, pursuant to Sections 408. 810 FS., 408, 809 F&, and 429, 14( 1) ( f) VS., your Change of

Ownership Application has been denied,

EXPLANATION QF 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 Adininistnative, Hearings under Section 120. 57( 1), F. S.,

your request for an administrative hearing most conform to the requirements in Section 28- 106. 201,

Florida Administrative I I Code ( F. A. C), and must state the material facts you dispute.

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS,

If you have any questions or need further assistance, please call K" ima Green at ( 850) 412- 4419 or e-

mail at Kcanna. Greon0ahca. mytlotida. c- otii.

ShdeShare. net/ AHGAFiprida

Dunedin Assisted Living Facility

February 4, 2016

Page # 2

C( Ti- eZr, ne . Avery, MJar

Assisted Living Unit

Agency for Health Care Administration

cc: Legal Intake Unit, MS# 3

STATZ OF FLORIDA

DIVXSXON OF . A. UXWISTRATM IMARINGS

ASSISTED LIVINCY FACILn - Y

OF DUNDEIN, LLC

d/ b/ a DUNEDIN ASSISTED

LIVING 1~ ACILTTY

Petitioner,

CASE No. 16 - 1448

AHCA No.: 2016001105

YS,

STATE OF FLOMA

AGENCY FOX MEALTII CARE

ADMINISTRATION.,

Respondent,

U1 TTLP, MMNT AGREE1k M

Respondent, State of Florida, Agency for Health Gam Administmion ( hcreinaNr the

d4Agancy1°), through its undersigned representatives, and Petitioner, A® eistad Living Facility of

Dunedin., LLC d/ b / a Durxedin Assisted Living Facility ( kereinaftor " Providcx' ) pursuant to

Sect on 120. 57( 4), Florida Statutes, each individually, a " party," collectively as " parties," hereby

eater into this Settlement Agreem4r4 ( " A, greementl and agree as follows:

WHtREAS, PetitiOner, at all tines relevant, were assisted living facilities licensed

Pursuant to Chapters 408, }? art Il and 429, Part L Florid4 Statutes, and Chapter 58A - 5, Florida

Adrniaist 4ve Code; and

WREl.. AS, the Agency hu jurisdiction by virtue of being the regulatory and licensing

authority over Respondents, pursuant to Chapters 408, Part 11 and 429, Fart I, Florida Statutes;

and

EXHIBIT 2

WlFl 1 EAS, the Agency iasuod a Notice of Intent to Deny the Prgvider' s cllango of

ownership application on Febn ; ary 4, 2016, lltense number 7292; and

WEOUMAS, Petitioner roqueeted a formal proceeding by selecting Option " 1" on the

Election of Frights form and by the filing of a Petition; and

WHEREAS, the pasties have negotiated and &. greed that the bast intmtit of all the parties

w411 be served by a settlement of this pmeeoding; and

NOW THEREFORE, itt consideration of the mutual promises and recitals herein, t c

parties intending to be legally bound, agree aS follows:

1, All recitals h,= lrx are true and correct and art exprosaly inoorporatod herein.

2. Both parties agree that the " whereas" clauses incorporated herein = binding

findings of the parties.

3. Upon Pull execution of this Agreement, Respaztdetlt agrees to waive any and all

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

proceeding under Subsection 12057( 2), Florida Statutes, a formal pmcecding uacler Subsection

120. 57( 1), Florida Statutes, appeals under $ ection 120. 68, Florida Statutes; and deolaratory and

all writs of relief ki any court or quasi - court of competent jurisdiadon; and agrees to waive

r, Qmpliawe with the ibrm of the Final Order ( Findings of fact and conclusions of law) to which it

may be entitled, provided., however, that no agreement herein shall be deemed a waiver by either

party of its right to judaolal enforcement ofthis , Agreement.

4. Up= full e, Xectuion of this Aarreemvnt, the parties agree as follows:

a. Motive immediately t1le Provider agrees not to admit any further

residents to the; facility.

b. Contingent upon the Provider' s voluntary withdrawal of its change of

ownership application for Iieensure with the Agency, the Agency agrees to rescind the

NOI identified as AHCA Case No. 2016001105.

b. The panics agree that this Agecemmt shall supersede the NQI,

G. All residents residing in the facility shall be discharged pur mrit to Florida

law, within ( 45) days of issuance of the Final Order in this cars.

d.. Effective 5M pra on the ( 45) day from the date a Final Order is issued

incorporating the terms of this agzeernant license no. 97292 shall be deemed

relinquished, cancelled, and legally nonexistent.

e. The provider shall not attempt to transfer ownership of the facility in any

way prior to tho eff ctivB date of cancellation of license no, # 7292. The ( 45) days

granted am expressly and solely for the purpose of faoili% ting the orderly transfer or

d1scharge of residents,

f, Execution of this agmmeant by Marla Hawekotte, as owner and

administrator of the Provider, liccma no, # 7292, will act as affix Ulve

withdrawal of the change of ownership application tur license no. 07292

submitted to the Agency. No further act will be required for withdrawal of the

application.

5. Venue for arty action brought: to challenge, interpret or enforot the tenw of this

Agreement or its Final Order shall lie solely in the Circuit Court of Lcon County, Florida.

The petitioner' s execution of this Agra rent is not an admission of any a11e. tibtz

or wrongdoing against the provider. However, this Agrecarttettt shall not preclude the Agency

frorn imposing a penalty against any other facility licensed by the provider for any dericiency or

violaxion of any Mute or rule identified iit a future survey of licensed facility of the Ptovider.

Upon full execution of this Ageement, the Agency shall enter a Final Order

adoptIU and incorporating the ttTms of this Agreement and closing the above- etyltd case.

10. Each party sbalI bear its own costs and attorney' s fens.

11. This A veement shall became effective on the date upon which it is fully executed

by all the parties,

I2. The Provider, and Marla Hawekotte, individually, for thernselvos and fer their

related or resulting organizatioas. SUCcessots or transferees, attornays, heirs, wd exeetx m or

adminiArators, do hereby discharge the State of Florida, Agency for Health Can: Administration,

and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of

action, suits, damages, lossrss, and expenses, of any and every nature whatsoever, arising out of

or in anyway 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 adrmiriistrative forum,

Including any claims arising out of this agreement, by or on behalf of Respondent or related

facilltles.

13, This Agreement is binding upon all parties herein and those identified in

paragraph twelve ( 12) of this AgremonL

14. In the event that Petitioner was a Medicaid provider at the subject time of the

oCCUrrrmmg Waged, in the complaint heroin, this setdoment does not prevent the Agency from

soelog Medieald overpayments related to the subject issues or from lmposiaa any sanctions

pursuAut to gule 59G9. 470, Florida Administrative Code.

15. Petitioner agrees that if any fan4 to be paid under this agreement to the Apcney

are not paid within thirty - one ( 3l) 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 prosent or futura funds owed to Respon4ent by the

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

Respondent by the Agtney for said amouitts until paid,

16. The undersigned have read and understand this Agreement and have the authority

to bind their rosp& tiva principals to it. Mark Hawakotte, individually, has the capacity to

execute this Agreement,

17. This Agreetnont contains and incorporates the entire undarstandings and

agreements of the patties.

18. Thia AV- owaent SuMsedes any prior oral or written agreements between the

parties,

19. This Agreement may not be amanded except in writing_ Any attempted

assignment oftbIs Agmement shall be void,

20. All parties agree that a facsimile. signaturo suffices for an original signature.

The fallowing representatives hereby nbowledge that they are duly authorized to enter

into this Agreement.

Mo y M s aria Hawe CO , lndi Id ly, and as

D u Se Owner ofAssisttd Living of Dunediu, LLC

Y for eaI are Administration 534 Howell Strut

2727 Mahan D e Dunedin, Florida 34696

aliahassee, F ri 3230$

DATM- 7 / DA` 1" El}: 07

aStt arr F_ s, flencral Counsel Thomas Caufman, Eaq '._: j Id

0frice of the 0eneral Co= wl Counsel for Pctitioner

Amoy for Health Care Administration QuImIros, l? neto, ' Wood & Bayer, FA.

2727 Mahan Drive, MS # 3 4905 West taurel Street, Suite 200

Tailssee, Florida 32308 Tampa, Florida 33607

DATE t6 DATED:

4

An $ radlq, SWOrAUQ

Agency for Heab Cara A ministration

2 Mirror Lake Drive, Suite 3300

St. Petersburg, Iorlda 33701

DATF- D: — 716a/