Mar 1 2010 9:50 Mar O1 2010 9:47AM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS WITH DISABILITIES, License No. 3886-6-GA Petitioner, v. Meadow Oak Place Group Home, Responcent. ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner” or “Agency’), issués this Administrative Complaint against Meadow Oak Place Group Home, (or “Respondent’), and says: ' 1, Petitioner is the state agency charged with regulating the licensing and operation of foster care facilities, group home facilities, and residential habilitation centers, pursuant to Section 20.197 and Chapter 393, Florida Statutes. 2. At all times material to this complaint, Respondent has held one group home facility license issued by the Agency for a residence at the following address: 2960 Meadow Oak Drive, Clearwater, Florida, 33761. 3. Section 393.0673(1)(a)(3), Florida Statutes, provides that the Agency may revoke or suspend a license, or impose an administrative fine if the licensee has failed to comply with the applicable requirements of Chapter 393, Florida Statutes, or the rules applicable to the licensee. P- Mar 1 2010 9:51 Mar O1 2010 9:47AM APD 8504100665 FACTUAL ALLEGATIONS 4. Rule 65G-7.005(6), F.A.C. states, in pertinent part, that: The provider must attach to the client's MAR a copy of the prescription or order legibly displaying the following information: (a) The name of the medication; (b) The prescription number, if applicable; (c) The prescribed dosage; and (d) Specific directions for use, including the medical basis for the medication, the time intervals for administration, the maximum number of doses, the maximum number of days that the medication should be administered, and conditions under which the health care practitioner should be notified. 5. On April 17, 2008, June 17, 2008, July 31, 2008, and March 5, 2009, APD staff member Myra Zareva observed that prescription drugs were being administered to group home residents without copies of the written prescriptions for those medications maintained on the premises. COUNT L 6. Based on the foregoing, the Respondent violated Rule 65G-7.005(6), F.A.C. on multiple occasions by not maintaining written prescriptions for the medications administered to group horne residents in accordance with administrative rule. P- Mar 1 2010 9:51 Mar O1 2010 9:47AM APD 8504100665 WHEREFORE, Petitioner respectfully requests entry of an order imposing the following penalties: administrative fine not to exceed $1,000 per offense and/or any other relief authorized by Chapter 393, Florida Statutes, ar the rules promulgated thereto, this honorable tribunal deems fair and equitable. Dated: October 19, 2009 a CW bos uan R. Collins Assistant General Counsel, Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Co/ ‘Carl Littlefield, APD Suncoast Region Administrator Attachments: Explanation of Rights Election of Rights Form P- Mar 1 2010 9:51 Mar O1 2010 9:47AM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS RESPONDENT: Meadow Oak Place Group Home, Clearwater, Florida. | have read the accompanying Administrative Complaint and Explanation of Rights in this matter, and Elect the following hearing option: O11 do not dispute the facts alleged in the Administrative Complaint and wish to be: heard on the issue of penalty or conclusions of law. | request an informal hearing pursuant to Section 120.57(2), Florida Statutes, | understand that at that hearing | willbe permitted to submit only written or oral evidence in litigation of the charges or explain why the facts alleged do not constitute a violation of law. OL dispute the material facts alleged in the Administrative Complaint and request an evidentiary hearing pursuant to Section 120.57(1), Florida Statutes. Please be advised this is a legally binding document and contains important information regarding your rights. Should you desire advice regarding your response, you may wish to seek legal counsel before proceeding. By signing this document, you represent you are authorized to act on behalf of the establishment named herein and accept responsibility for compliance with any final order resulting from this action. Failure to complete, sign and return the election of rights form to the agency within 30 days of receipt may constitute a waiver of your right to be heard in this matter and the Agency may commence proceedings without your participation, which may result in penalties against your license. As provided in §393.063(1), Florida Statutes, penalties may include suspension, revocation or denial of licensure, and fines up to $4000 per day for each violation. Telephone number for contact: Fax Signature: Date: Print: Name: Title: Business Location Address: City State Zip Mailing Address City State Zip P- Mar 1 2010 9:51 Mar O1 2010 9:47AM APD 8504100665 MAIL OR FAX THE COMPLETED FORM TO: Pete Mallison, Agency Clerk Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 You are advised, per Section 120.573, Florida Statutes, that mediation is not available for this action. Please keep a copy of this document for your records. P- Mar 1 2010 9:51 Mar O1 2010 9:47AM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES EXPLANATION OF RIGHTS The enclosed Administrative Complaint charges you with violating one or more provisions of Chapter 393, Florida Statutes, or the rules supplementing that Chapter. If you have questions regarding your response or best course of action, you may wish to seek the advice of competent legal counsel. Your receipt of this Administrative Complaint packet constitutes service upon you. Your rights under Florida law (Chapter 120, Florida Statutes) are as follows: You may elect to not dispute the violations alleged in the Complaint and request that a hearing be held to present testimony or documents you wish the Agency to consider in mitigation of the alleged violations prior to disposition of this case. Any penalty levied will be included in a Final Order. If a dispute of material fact arises, the hearing will be terminated and the case referred to the Division of Administrative Hearings. You may elect to dispute the violations alleged in the Complaint and request a hearing before an Administrative Law Judge, which is an administrative “trial”. You and the Agency may present evidence and witnesses to prove or disprove the facts alleged and submit a written proposed recommended order after the hearing for the Judge’s consideration. Based on the evidence and any proposed recommended orders submitted, the Judge will issue a Recommended Order containing Findings of Fact, Conclusions of Law, and Recommended Penalty, if any. Following review of the Recommended Order, the Agency will issue a Final Order. An Election of Rights form is included with the Administrative Complaint. The Agency must receive it within 30 days of your receipt of this Administrative Complaint packet. After the Agency determines whether a dispute of material fact exists, it will make arrangements on your behalf for the appropriate hearing. You will receive notice of the date, time, and place of hearing at the address designated by you on your Election of Rights. IMPORTANT: If the Agency does not receive a completed copy of the Election of Rights form, or any other written response from you, within the 30 days of your receipt of this Administrative Complaint, you may have waived your right to a hearing in this matter and the Agency may proceed against you in this matter without your participation. Please note, per Chapter 120.573, Florida Statutes, mediation is not available in this action. P-

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Orders for Case No: 10-001000