16-002869 Agency For Health Care Administration vs. Coolidge Palms Assisted Living Resort, Inc. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Friday, August 5, 2016.

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STATE OF FLORIDA AGENCY AHCA CLERK

AGENCY FOR HEALTH CARE ADMINISTRATION

2016 SEP - b A 11: 2U

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION, DOAH No. 16 - 2869

Petitioner, AHCA Nos. 2016001704

2016001809

VS. File No. 11968059

License No. 12022

COOLIDGE PALMS ASSISTED LIVING Provider Type: Assisted Living Facility

RESORT, INC., RENDITION NO.: AHCA - 11p - O4 (. t5 - S- OLC

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 issued the attached Administrative Complaint and Election of Rights forms

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

hearing.

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

Based upon the foregoing, it is ORDERED:

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

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

4. The Respondent shall pay the Agency $ 10, 000. 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:

Central Intake Unit

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 61

Tallahassee, Florida 32308

5. Except for his current providers, Mr. Herskovitz, individually, agrees, that pursuant to §

429. 14( 3), Fla. Stat., for a period of no less than five years from the date of the Final Order in this case,

he will not apply for or hold, directly or indirectly, any type of license issued by the Agency, or exercise

any type of control, directly or indirectly, over any Agency licensee.

ORDERED at Tallahassee, Florida, on this & day of - R" X.— , 2016.

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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 coy of this Final Order was served on the below - named

persons by the method designated on this ay of . f , 2016.

Richard J. Shoop, Agency erk

Agency for Health Care Administration

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

Tallahassee, Florida 32308 - 5403

Telephone: ( 850) 412 - 3630

Jan Mills, Anne Avery, Unit Manager

Facilities Intake Unit Assisted Living Unit

Agency for Health Care Administration Agency for Health Care Administration

Electronic Mail) Electronic Mail)

Central Intake Unit Arlene Mayo- Davis, Field Office Manager

Agency for Health Care Administration Local Field Office- Region 10

Electronic Mail) Agency for Health Care Administration

Electronic Mail)

Andrew B. Thornquest, Senior Attorney Roni Herskovitz, Owner

Office of the General Counsel Coolidge Palms Assisted Living Resort, Inc.

Agency for Health Care Administration 2057 Coolidge Street

Electronic Mail) Holywood, Florida 33020

U. S. Mail)

Mary Li Creasy Christopher Parrella, JD, CHC, CPC, CPCO

Administrative Law Judge Health Law Offices of Anthony C. Vitale

Division of Administrative Hearings 2333 Brickell Avenue, Suite A - 1

Electronic Mail) Miami, Florida 33129

U. S. Mail)