20-003325 Agency For Health Care Administration vs. South Florida Home Services, Inc. Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, September 29, 2020.

(Composite Ex. I). The parties have since entered into the attached Settlement

Agreement (Ex. 2), which is adopted and incorporated by reference into this Final

Order.

2. All right, title and interest in its assisted living facility license (license number

9352) by SFHS is relinquished effective as of October 31, 2020.

3. VN#1 's assisted living facility license (license number 1 0840) shall be deemed

surrendered and canceled effective December 31, 2020 without further action by

any party, unless change of ownership licensure has been granted to a third-party

applicant prior thereto.

4. SFHS shall pay the Agency one hundred ninety-three dollars and eighty-seven cents

($193 .87) by December 31, 2020, or prior to the issuance of a change of ownership

licensure for VN#l, whichever shall first occur. VN#l shall pay the Agency

administrative fines of thirty-eight thousand two hundred fifty dollars eight cents

($38,250.08) plus survey fees of two hundred twenty-six dollars thirty-five cents

($226.35) for a total assessment of thirty-eight thousand four hundred seventy-six

dollars and forty-three cents ($38,476.43) to the Agency by December 31, 2020 or

prior to the issuance of a change of ownership licensure for VN#1, whichever shall

first occur. A check made payable to the "Agency for Health Care Administration"

and containing the AHCA ten-digit case numbers should be sent to:

Central Intake Unit

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 61

Tallahassee, Florida 32308

5. An additional administrative fine of $2,749.92 is imposed upon VN#1 payable

directly to Resident #3 or Resident #3 's estate as a resident refund pursuant to

Section 429.24(3)(a), Florida Statutes.

6. VN#1 shall provide the Agency a written confirmation and documentation of the

resident's refund. The refund due to Resident #3 shall be paid to said resident by

VN#l by December 31, 2020 or prior to the issuance of a change of ownership

licensure for VN#l, whichever shall first occur. The written confirmation and

documentation shall be submitted to the Agency's counsel of record and Assisted

Living Unit verifying the refund for the resident. The Assisted Living Unit contact

information is:

Assisted Living Unit

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 30

Tallahassee, Florida 32308

ORDERED at Tallahassee, Florida, on this _____2_ day of '2020.

reta •S

for Health 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 copy OrdeM, serve_d oyhe below-

named persons by the method designated on this of I , 2020.

op, Agenc

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

Telephone: [phone]

Facilities Intake Unit Central Intake Unit

Agency for Health Care Administration Agency for Health Care Administration

(Electronic Mail) (Electronic Mail)

Nicola L. C. Brown Gisela Iglesias

Assistant General Counsel Assistant General Counsel

Office of the General Counsel Office of the General Counsel

Agency for Health Care Administration Agency for Health Care Administration

(Electronic Mail) (Electronic Mail)

Shaddrick A Haston, Esq. Arlene Mayo-Davis, Field Office Manager

Counsel for South Florida Home Services, Inc.; Local Field Office

Vida Nueva #1 Corp.; and, Agency for Health Care Administration

Ileana Paez, Individually (Electronic Mail)

Ullman Bursa Law

3812 Coconut Palm Drive

Tampa, Florida 33619

(Electronic Mail)