STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS WITH DISABILITIES, License No. 7G342A/C Petitioner, v. Threshold, Inc. Respondent. ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner’ or “Agency”), issues this Administrative Complaint against Riverton Group Home operated by Threshold, Inc. (or “Respondent’), and states the following as the basis for this complaint: 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 a group home facility license issued by the Agency for a residence at the following address: 4515 Riverton Drive, Orlando, FL 32817. The Respondent also Filed March 23, 2011 3:49 PM Division of Administrative Hearings has contracted with APD to provide the residents with Medicaid waiver developmental disability services. 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. 4. Section 393.0673(1)(b), Florida Statutes, provides that the Agency may revoke or suspend a license, or impose an administrative fine if the Department of Children and Family Services has verified that the licensee is responsible for the abuse, neglect, or abandonment of a child or the abuse, neglect, or exploitation of a vulnerable adult. 5. Rule 65G-2,012(4), F.A.C. requires, in pertinent part, that: Group home facility services shall include, but not be limited to, provision of adequate living accommodations, proper and adequate dietary supervision, appropriate physical care, support, guidance, supervision and assistance with training required to assure each individual the opportunity for personal growth and development. Specific services to be provided shall be defined by the needs of the clients to be served. Consideration shall be given to age, sex, developmental level and specific needs. 6. Rule 65G-2.012(15)(b), F.A.C. requires, in pertinent part, that: The facility shall take all reasonable precautions to assure that no client is exposed to, or instigates, such behavior as might be physically or emotionally injurious to him/herself or to another person. 7. Section 393.13(3)(g), Florida Statutes, states that: Persons with developmental disabilities shall have a right to be free from harm, including unnecessary physical, chemical, or mechanical restraint, isolation, excessive medication, abuse, or 10. 11. 12. neglect. Page A-8 of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook (2008), incorporated into rule through Rule 59G-13.083(2), F.A.C., requires that each provider of waiver services must agree “to safeguard the health, safety, and well being of all recipients receiving services from the provider.” FACTUAL ALLEGATIONS On May 30, 2010, the group home operated by the Respondent was serving six adult individuals with developmental disabilities. On May 30, 2010, one of the individuals, an incompetent adult, was injured. However, he did not receive medical treatment until Friday, June 4, 2010, at which time he was seen by the EMTs. EMTs reported that he had bump the size of a small orange on the back of the left side of his head and his left eye was dark black and blue. No alleged perpetrator was identified. As of June 22, 2010, Abuse Investigation conducted by the Department of Children and Families is closed with Verified Findings. The final report of the investigation notes that there are low implications for the individual's safety as he has a guardian and a safety plan in place. COUNT I. Based on the foregoing, the Respondent violated Section 393.0673(1)(b), Florida Statutes, because the Department of Children and Family Services has verified that the Respondent is responsible for the neglect of one adult victim. WHEREFORE, Petitioner respectfully requests entry of an order imposing the following penalties: $1000 fine for failure to provide timely medical services. Dated: 28 February 2011 Lt A /h AY z Lal! Jonathan Grabb Senior Attorney, Office of General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Cc/ Merari Perez, Area Administrator Attachments: Explanation of Rights Election of Rights Form Copies furnished to: Kylene Beard APD Area 7 Office 3550 N. Goldenrod Road Winter Park, Fl 32792 CERTIFICATE OF SERVICE | HEREBY CERTIFY that a copy of the above named individuals by U.S. Mail or electronic mail, this 1st day of March, 2011. oe on QQQ2 A _- Percy W. Mallison, Jr., Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS RESPONDENT: Threshold, Inc. | have read the accompanying Administrative Complaint and Explanation of Rights in this matter, and Elect the following hearing option: C1 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 | will be permitted to submit only written or oral evidence in mitigation of the charges or explain why the facts alleged do not constitute a violation of law. O Ldispute the material facts alleged in the Administrative Complaint and request an evidentiary hearing pursuant to Section 120.57(1), Florida Statutes. Specifically, | dispute the following material facts: 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 21 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 $1000 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 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 Fax: (850) 410-0665 Zip 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. 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 21 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 21 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.

Docket for Case No: 11-001542

Orders for Case No: 11-001542