STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

! " ""'" t""'\

: • . . i l

2014 JUN ! 6 A C;: 52

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Case Nos. 11-5126PH.l 1-5127PH · 11-5128PH, 12-118PH

FINAL ORDER

RENDITION NO.: AHCA- Jll - <JS J () -S-OLC

Having reviewed the Administrative Complaints, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows:

1. The Agency issued the attached Administrative Complaints and Election of Rights forms to the Respondent. (Composite Ex. 1) The Respondent waived receipt of the additional Administrative Complaints. The parties have since entered into the attached Settlement Agreement, which is adopted and incorporated by reference into this Final Order. (Ex. 2)

   
   

2. The Respondent shall pay the Agency $23,000.00. 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 ARCA ten-digit case number should be sent to:

Office of Finance and Accounting Revenue Management Unit

Agency for Health Care Administration 2727 Mahan Drive, MS 14

Tallahassee, Florida 32308

ORDERED at Tallahassee, Florida, on this /.,3 day of      

---"""'---------' 2014.

k, Secretary

Agency for He th Care Administration

Filed June 23, 2014 3:20 PM Division of Administr1ative Hearings

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 correft copy of this F"

persons by the method designated on thisl.b..±:_ day of

...

1 Order was served on the below-named

;'\...,- , 2014.

R fr'd Shoop, Agency Q{rlZ

Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone: (850) 412-3630

2

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADl\.fINISTRATION

STATE OF FLORIDA, AGENCY FOR

i HEALTH CARE ADMINISTRATION,

J

Petitioner,

vs. Case Nos.: 2011006766

2011006764

PREMIER BEHAVIORAL SOLUTIONS OF FLORIDA, INC. d/b/a MANATEE PALMS GROUP HOMES

Respondent.

,/

ADMINISTRATIVE COMPLAINT

COMES NOW the State of Florida, Agency for Health Care Administration (hereinafter "Petitioner" or "Agency"), by and through the undersigned counsel, and files this Administrative Complaint against Premier Behavioral Solutions of Florida, Inc. d/b/a Manatee Palms Group Homes (hereinafter "Respondent"), pursuant to Section§ 120.569 and Section§ 120.57, Fla.

Stat. (2011), and alleges:

NATURE OF THE ACTION

This is an action to impose an administrative fine in the amount often thousand dollars ($10,000.00) based upon four (4) uncorrected Class III deficient practices pursuant to Sections

§408.813 (2)(c) and §394.879(4) Fla. Stat. (2011).

JURISDICTION AND VENUE

1. The Agency has jurisdiction pursuant to Sections 120.60 and Chapters 395, Part I and 408, Part II, Florida Statutes (2010).

2. Venue lies pursuant to Florida Administrative Code R. 28-106.207.

   
   

   
   

   
   

   PARTIES

   
   

3. The Agency is the regulatory authority responsible for licensure of residential treatment programs for children and adolescents and enforcement of all applicable regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part II, and 395, Part I, Florida Statutes, and Chapter 65E-9, Florida Administrative Code.

4. Respondent operates a twelve (12) bed residential treatment center located at 1324 37th Avenue East, Bradenton, FL 34208, and is licensed as a residential treatment center, license# 53.

5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

   LAW APPLICABLE TO ALL COUNTS

   
   

6. '·' Residential treatment centers s,uch as Manatee Palms Group Homes are intensive residential treatment programs for children and adolescents, specialty hospitals which provide 24-hour care and have the primary function of diagnosis and treatment of patients under the age of 18 having psychiatric disorders in order to restore such patients to an optimal level of functioning. See Section 395.002(15), Fla. Stat. (2011).

7. A "residential treatment center for children and adolescents" means a 24-hour residential program, including a therapeutic group home, which provides mental health services. to emotionally disturbed children or adolescents. Section 394.67(21), Fla. Stat. (2011).

8. The purpose of a residential treatment center for children and adolescents is to provide mental health assessment and treatment services pursuant to 394.491, 384.495 and [part of]

   394.496. See Section 394.875(1)(c), Fla. Stat. (2011). The requirements of Part II of chapter 408 apply to the provision of services that require licensure under 394.455 and Part II of chapter 408. A license issued by the Agency is required in order to operate a residential treatment center for

   
   

   children and adolescents in this state. See Section 394.875(2), Fla. Stat. (2011).

   
   

9. The provisions of Chapter 408, Part II (ss. 408.801-408.832) apply to residential treatment centers for children and adolescents. See Section 408.802(7), Fla. Stat. (2011).

   In-accordance with part II of chapter 408, the agency may impose an administrative penalty of no more than $500 per day against any licensee that violates any rule adopted pursuant to this section.

   
   

   Section 394.879, Fla. Stat. (2011)

   
   

   ***

   The agency may impose an administrative fine, not to exceed $1,000 per violation, per day, for the violation of any provision of this part, part II of chapter 408, or applicable rules. Each day of violation constitutes a separate violation and is subject to a separate fine.

   
   

   Section 395.1065(2)(a), Fla. Stat. (2011)

   ***

   Class "III" violations are those conditions or occurrences related to the operation .i - and maintenance of a provider or to the care of patients which the agency ,: · determines indirectly or potentially threatens the physical or emotional health,

   . safety, or security of patients, other than class I or class II violations. The agency shall impose an administrative fine as provided in this section for a cited class III violation. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, a fine may not be imposed.

   
   

   Section 408.813(2)(c), Fla. Stat. (2011)

   
   

   COUNT I - Tag C0ll

   
   

10. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set

    
    

    forth herein.

    
    

11. The residential treatment center is required to abide by its own internal policies and procedures regarding clients who required close observation as follows:

    
    

    Operating Standards - Written procedures.

    The provider shall establish and implement written procedures that ensure compliance with all provisions of this rule.

    Fla. Admin. R. 65E-9.005(2)

12. On April 27,2011, the Agency conducted an unannounced complaint investigation,

CCR# 2011004340, and found the facility out of compliance with the above rule. The investigation was conducted in conjunction with a revisit to complaint investigation CCR

I

I

i

#2011002722 (N71Gl2).

i 13. Based on staff interviews and a review of facility policies and procedures and other records, it was determined that the facility had failed to implement its policy and procedure for special precautions related to attending school while on close observation. Findings included: ·- .

The facili'ty s policy "Special Precautions Procedures," last revised 2/17/11:

Purpose: To provide specific direction to assure that safe, therapeutic care is provided to any resident who requires additional structures, support, or high intensity monitoring based on specific behaviors and clinical assessment. Two levels of precautions may be implemented. These include One to One and Close Observation.

.' ,':-:

Close Observation: The resident will remain within direct line of supervision at all · !· .. times. When residents shower, change clothes or use the bathroom, the staff will remain outside the bedroom or bathroom door with the door slightly opened and visually check the resident at least every 30 seconds. Staff will attempt to

maintain the resident's privacy as much as possible; however the safety of the resident must be the main consideration. Staff will be able to view the resident at all times. Observations may be completed standing in the doorway, or at a short distance (6 feet), particularly for residents who are sleeping; however, checks must be made every ten minutes. It is expected that staff conducting checks will enter the room, approach the resident and check their identity, respirations, and ensure that they are not in any distress. The designated staff shall document in the progress note every shift, along with conducting 15 minute checks on the Constant Visual Observation Sheet. Staff must sign off responsibility for maintaining observation of the assigned resident(s) for any break, etc. The resident must have a face to face observation every 24 hours to determine continued need for the status. In order for a resident to be removed from Close Observation, an assessment must be completed by a qualified clinician.

Close observation status is generally utilized when a resident requires Special Precautions status but does not require One to One supervision. Residents requiring chronic Close Observation will be reevaluated for a higher level of care.

Policy Statement for Special Precautions Procedures

Resident on a One to One or Close Observation status will not be permitted to attend off campus activities or school in the community due to safety concerns.

Patient #2

Patient #2 was placed on Close Observation on March 31, 2011, for safety after a return from the Crisi_s Center where the patient had been placed pursuant to the Baker Act. The original March 31, 2011 (2:30 PM), Order stated: "Patient is to be on close observation." The Order for Close Observation was renewed on April 1, 201lat 7:00 AM.

A''Nursing-MHT Flowsheet/Progress record" dated April 1, 2011 and found in Patient.#2's record stated," Arrived at school at 9:15 a.m." The progress record documented a physical altercation where physical restraints were required at school. Patient #2 sustained injuries and left school at 11:45 a.m. to return to the group home.

The facility's "Close Observation Location Sheet" revealed that the Close Observation Protocol was not followed while Patient #2 was at school or upon return to the group home. On the section for time, behavior, and location, the time

. from 9:00 am. to 9:30 a.m. was noted as "schooL" There was no documentation of Close Visual Observation as required from 9:00 a.m. to 3:45 p.m.

Patient #4

On April 3, 2011, Patient #4 was placed on Close Observation following two elopeme;nt attempts. The Close observation Order was renewed on April 4, 5, & 6 at 7:00 AM and discontinued at 11:00 AM on April 6, 2011.

The "Nursing-MHT Flowsheet Progress record for April 5 & 6 revealed that the patient attended school both days, including leaving for school prior to the order being discontinued on April 6 at 11: 00 AM.

Patient #1

An April 14, 2011, Progress Note in Patient #1's clinical file, written at 1:00 p.m. documented: "Patient on close observation, checks done by MHTs (Mental Healtli Technicians) every 10 minutes. Observed Client wake up, take medications, eat breakfast and leave for school with no complications. Continue on close observation."

Patient #3

Patient #3's clinical file revealed Nursing-MHT Flow sheet/Progress Records that documented:

'

04/15/11 Precautions: "Close Observation1 School: "Attended"

04/21/11 Precautions: "Close Observation" School: 11Attendend

Record review of Client #3's Physician order sheets for the latter dates confirmed that an order for the close observation was in effect for the dates listed.

Interview ll_'ith the Group Homes Director

The Group Home Director stated that she was not aware that the Special Precautions Procedure policy required that patients on Close Observation were not to attend school in the community.

1. The facility's failure to abide by its own Close Obse-rvation policy for the safety of the patients is unacceptable.

2. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class II violations.

3. The Agency cited the Respondent for a Class III violation in accordance with Section 408.813(2)(c), Fla. Stat. (2011). It also provided a mandatory correction date of May 27, 2011.

1. On June 6 through 8, 2011, the Agency returned to the facility for a revisit to complaint investigation CCR# 2011004340. Based on a review of facility reports, patient records and an interview of the staff, the facility failed to follow its policy and procedure for supervision of patients and elopement procedures. Findings included:

   
   

   Missing patients

   
   

   Facility reports, dated May 30, 2011, revealed that patient# 1 and patient# 3 eloped from the facility through an unsecured gate at 4: 00 PM that day. As of June 8, 2001, these patients had not been found.

   
   

   Patients #1 and #3, both under Close Observation, were outside in the back courtyard of the unit called Aquarius (group home #1), as soon as staff turned their back, they eloped through locked gate. When staff went outside to see how they escaped, the lock was unlocked.

   
   

   Policy Statement for General Supervision

   
   

   The Group Home Program Manager was asked to provide a policy and procedure for the general supervision of patients (clients).She provided a policy entitled, Guidelines for Supervision of Residents on constant visual observation, revised 5/3/11, and said this policy included guidelines for general supervision of clients. The policy stated:

   
   

   • This is a 24 hour facility. During these hours, all staff must remain alert, awake and knowledgeable of resident interactions and whereabouts at all times. ·

     
     

   • During waking hours, observations should also include 'checking in' with the patient verbally to ensure their safety and well being, and identify needs for further assessment and/or intervention.

     
     

   • Residents are to be accounted for at all times.

     
     

   • While supervising activities on/off campus, staff must have residents in line of sight at all times.

     
     

     Interview with the Program Director

     
     

     On June 6, 2011, during an interview, the Program Director, said that, actually, four patients eloped at the same time on May 30, 2011. The other two eloped from Hercules Group Home (Group Home # 2). She said that direct care staff were found not supervising the patients in accord with policy; the gate was unlocked, and no one saw the patients leave. It was possible, she stated, that one of the clients from group home # 2 had a key to the gate or the gate may have been left open after an activity. There has been no fmal determination as to why the gate was unlocked. After the elopement, a key count was conducted, locks were changed on the gates, and staff conducted head counts of the patients.

     
     

     The Director said that corrective action was planned against the staff member responsible for lack of supervision. Facility documentation revealed:

     
     

     On 5/30/11, you contacted the supervisor and reported that two of the residents you were assigned to watch eloped through the back gate of Aquarius. Staff is supposed to have awareness of a resident's location at all times, including when the resident is in the backyard. You failed to comply with this expectation.

     
     

     The corrective action had not been applied to the employee as of 6/6/11 and was still going through the human resource department process. Six days after the elopement, no corrective action had been taken.

     
     

     Facility Record for Patient #3

     
     

     Petient # 3's record revealed a May 30, 2011, progress note written by a nurse, which stated: ''This writer received a phone call from the resident's mom who said the resident told her biological father that she and her roommate were planning to run this night. This info was reported to unit staff."

     
     

     Policy Statement for Elopement Procedures and Response Guidelines

     
     

     The facility's policy and procedure for Elopement Procedures and Response Guidelines, last revised 2/21/11, revealed:

     
     

     It is the policy of Manatee Palms Group Home to implement appropriate precautions for any resident who presents as or becomes at risk for elopement (leaving the program without authorization).

     
     

     Purpose: To minimize the potential for resident elopement from the program through prompt identification and assessment of

     · residents at risk and to minimize risk in the event of an elopement.

     
     

     Assessment and Prevention: Identify residents who may be at risk for possible elopement.

     
     

     Nurse will notify the physician of a resident suspected of being an elopement risk.

     
     

     Interview with the Program Director

     
     

     During an interview on June 7, 2011, the Group Home Program Director said she was not aware of this Progress Note and was never made aware that a phone call had been received regarding patient # 3•s plan to elope with another patient. She

     
     

     
     

     said that the information should have been passed on to the supervisors so that all of the staff members were aware and so that precautions could be put in place.

     
     

2. The facility's continued failure to follow its own policies for the safety of the patients is a violation of Florida law.

3. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

4. The Agency cited the Respondent for an uncorrected Class III violation in accordance with Section 408.813(2)(c), Florida Statutes (2011).

   WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes

   (2011).

   
   

   COUNT II - Tag C031

   
   

5. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set forth herein.

6. The residential treatment center is required to abide by its own internal policies and

   
   

   procedures regarding safety for the patients as follows:

   
   

   Facility standards - Buildings, grounds and equipment

   The interior and exterior of buildings and the furniture and furnishings shall be safe, comfortable, and reasonably attractive, in good repair and shall function for the purpose for which such building and furniture has been designed.

   Fla. Admin. R. 65E-9.005(5)(a)(6)

7. On April 27, 2011, the Agency conducted an unannounced complaint investigation,

   
   

   CCR# 2011004340, and found the facility out of compliance with the above rule. The investigation was conducted in conjunction with a revisit to complaint investigation CCR #2011002722 (N71Gl2).

8. Based on policy review and observation, the facility failed to maintain the interior and exterior of the building in a manner that promoted a safe and sanitary environment. Findings included:

   A broken piece of hard clear plastic approximately 12" in length by 4" was found on the ground in the enclosed yard of the Group Home.

   
   

   Room 101: a"used" plastic push up piece, possibly from a deodorant hygiene product was in the shower stall. A bottle of body wash was in the shower stall. No toilet paper was in the toilet paper dispenser. A plastic shoe box containing hygiene products was on the desk. A resident was observed in the bedroom.

   
   

   Room 102: A broken plastic pen was located on a desk; the innards of the pen were lying next to the encasement.

   
   

   Room 103: The bathroom toilet paper dispenser was broken, the innards were crooked and the roll of toilet paper was on top of the dispenser.

   
   

   Room 105: A bottle of lotion was found. The bathroom toilet paper dispenser was empty and the roll of toilet paper was sitting on top of the dispenser. The bathroom floor for this room was stained with dark marks and in need of cleaning.

   
   

   Room 106: A hygiene box with products was sitting on a desk.

   
   

   Room 107: The toilet paper dispenser was empty and the toilet paper was sitting on top of the dispenser.

   
   

   The facility's Contraband Search Guidelines, issue dated 03/10, stated that the policy of the Group Home was to strive to maintain a safe and therapeutic environment for residents. In the contents section of the Guidelines was a list of items considered to be "contraband." The list included hygiene products and stated: "No hygiene products of any kind are allowed to be kept in the resident rooms."

   
   

   Outside the building, approximately 25 feet from the facility dumpster (trash bin) was a picnic table an<la pile of miscellaneous debris consisting of 5 pieces of hard roofing plastic 1-1.5 feet in length; 20 pieces of various lengths of2x6 boards; and metal board-like pieces along the curb. In front of the dumpster were two

   
   

   
   

   ----i'

   
   

   
   

   
   

   
   

   upside down trash containers; two hoses; broken drawers; a broken kitchen cabinet and a pile of approximately 25 2x4 boards of various lengths.

   
   

9. The facility's failure to maintain the interior and exterior of the building in a safe and sanitary manner is unacceptable.

10. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class II violations.

1. The Agency cited the Respondent for a Class III violation in accordance with Section

   
   

   408.813(2)(c), Fla. Stat. (2011). It also provided a mandatory correction date of May 27, 2011.

   
   

2. On June 6 through 8, 2011, the Agency returned to the facility for a revisit to complaint investigation CCR# 2011004340. Based on record review, interviews and observation, the facility failed to maintain the interior of the building in a manner that promoted a safe and sanitary environment and failed to see that staff members were adequately trained to recognize contraband. Findings included:

   Room 101: A small plastic medicine cup was observed on the floor next to the commode; the toilet paper holder was open and possibly non-functioning as the toilet paper roll was on top of the holder.

   
   

   Room 107: Toilet paper holder was not functioning and toilet roll was located on the floor next to the commode. In the shower stall were two personal hygiene products and bottles on the floor of the stall. Two underwire bras were located on the personal clothing shelves.of the client.

   
   

   Room 106: One underwire bra was observed in the soiled laundry; a set of ear phones with a cord approximately 3 feet long was present on the desk.

   
   

   Room 105: A belt was located on the clothing shelf; two under wire bras were also present.

   
   

   In the residential common hallway that runs between the bedrooms, two ceiling

   
   

   l l

   
   

   
   

   tiles had noticeable water stains. One was approximately 8" by 4" and the second was4" by3".

   
   

   The facility's Contraband Search Guidelines, issue dated 03/10, stated that the policy of the Group Home was to strive to maintain a safe and therapeutic environment for residents. In the contents section of the Guidelines was a list of items considered to be "contraband." The list included hygiene products, bras with under wires and any item that could be used as possible ligature.

   
   

   The Plan of Correction submitted by the facility for the survey conducted on 04/27/11, documented that the facility management staff would conduct "Rounds on the Road," i.e., leadership would monitor to ensure bedrooms and bathrooms were clean and free of contraband items including broken toilet paper holders and hygiene products.

   
   

   During interviews, staff members #1 and 2, admitted that they did not know that underwire bras were on the contraband list.

   
   

3. The facility's continued failure to follow its own policies for the safety of the patients is a violation of Florida law.

4. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

5. The Agency cited the Respondent for an uncorrected Class III violation in accordance with Section 408.813(2)(c), Florida Statutes (2011).

   WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2011).

   COUNT III - Tag Cl21

   
   

6. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set

   
   

   
   

   forth herein.

   
   

7. The residential treatment center is required to assure that minimum staffing is accomplished for the safety for the patients as follows:

   Staffing - Staff composition.

   
   

   The provider shall have the following staffing, any of which may be part-time, if the required equivalent full-time coverage is provided, except for those positions with a required specified staffing ratio:

   
   

   Direct care staff. At a minimum, two (2) direct care staff shall be awake and on duty at all times. In addition, the following direct care staff-to-child ratios shall be provided and maintained:

   
   

   1. During hours when children are present in the facility and normally awake, the direct care staff to child ratio shall be no less than 1:4; and

   2. During hours when the children are normally asleep, the direct care staff to child ratio shall be no less than 1:6; and

   3. While residents are away from the facility, the staffing ratio for those residents shall be no less than 1:4. The need for more intensive staffing will be determined by the child's physician; and

   4. Direct care staff shall not divide time on their shift between programs located in other areas of the facility or other buildings; and

   5. While transporting residents of residential treatment centers other than group homes, the driver shall not be counted as the direct care staff providing care, assistance or supervision of the child. For therapeutic group home residents, prior to a single staff person transporting one or more children in a motor vehicle, children must be assessed to ensure the safety of the children and staff.

      
      

      Fla. Admin. R. 65E-9.007(3)(e)

8. On April 27, 2011, the Agency conducted an unannounced complaint investigation, CCR# 2011004340, and found the facility out of compliance with the above rule. The investigation was conducted in conjunction with a revisit to complaint investigation CCR #2011002722 (N71Gl2).

9. Based on client record review, staff interviews and a review of facility policy and procedures, it was determined that the facility failed to ensure minimum staffing for the facility.

   
   

   Findings included:

   
   

   During an interview, the Director and Chief Operating Officer revealed that mental health technicians at the group home leave the group home during school hours and move to the Youth Academy (a public school located on the grounds of the Manatee Palms Youth Services Hospital). The staff members are then considered day school staff and answer to and work for the principal of the school.

   
   

   The staff members return to the group home after school and resume their duties as mental health te hnicians for the group home. The staff members are paid by the group home during their entire shift, including the hours spent at the school as day school staff. They clock in by hand scan at the group home at the beginning of their shift and clock out at the group home at the end of their shift. They do not clock in or out at the school.

   
   

   The Program Director and Chief Operating Officer said that five to seven mental health technicians from this group home go to the school each day. "They have a different job function, a different position that they are filling over there." Direct care staff members were dividing their time between programs located in other

   areas of the facility or other buildings, failing to ensure proper staffing for patients #1, #2, #3 and #4.

   
   

   Staff interviews and a review of the facility policy, "Special Precautions Procedures (last revised 2/17111)," see #13 above - incorporated here by reference, revealed the need for more intensive staffing. The minimum staffing ordered by the physician was not being followed.

   
   

10. The facility's failure to assure that staff did not divide time on their shift between programs located in other areas of the facility or other buildings and to assure that the staff composition was correct in accord with the number of patients as well as with the physicians' orders was unacceptable.

11. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, oth r than class I or class II violations.

12. The Agency cited the Respondent for a Class III violation in accordance with Section

    
    

    408.813(2)(c), Fla. Stat. (2011). It also provided a mandatory correction date of May 27, 2011.

    
    

13. On June 6 through 8, 2011, the Agency returned to the facility for a revisit to complaint investigation CCR# 2011004340. Based on record review, interviews and observation, the facility was still understaffed. Findings included:

    At the Aquarius Group Home during the 1st shift, Staff member #1 was assigned two patients on "close observation." However, Aquarius,staff member #1 was observed during her shift at Aquarius at a second group home unit with one patient. Yet the requirement at the Aquarius group home was two staff members at all times. Staff members had been scheduled at the Aquarius unit, ai the school and at more than one group home simultaneously. The required minimum staffing of 1:4 during the patients.' awake time was not met.

    
    

    During an interview, the Group Home Manager confirmed that Staff member #1 had originally been assigned to Aquarius but when her Aquarius patients went to school, she was sent to the other Group Home, Lynx. Staff member #1 con.firmed that the June 6, 2011, staffing schedule for the 1st shift inaccurately docU111ented her assignment and the assignment for the Aquarius patients.

    
    

    Staff member #1 at the Lynx Group Home was observed sitting in the dining area with a client who was on "close observations." Staff member #1 was alone on the unit with the client. During an interview, Staff member #1 confirmed that she had been the sole staff member on the Lynx unit since 9:00 a.m. and expected another staff member at 4:00 p.m. when the other patients returned from school.

    
    

    The staff assignment sheets for Aquarius, revealed the following:

    
    

    06/05/11

    
    

    06/05/11

    
    

    06/04/11

    
    

    06/04/11

    
    

    06/03/11:

    
    

    06/02/11

    1st shift: 2 staff - one assigned 6 patients & one assigned 5

    
    

    2nd shift: 3 staff - two assigned 5 patients each & one assigned 5

    
    

    1st shift: 2 staff - one assigned 5 patients and one assigned 6

    
    

    2nd shift: 2 staff - one assigned 5 patients and one assigned 6

    
    

    1st shift: 2 staff - both assigned 5 patients each (one client with no staff member assigned)

    
    

    1st shift: 2 staff - both assigned 5 patients each (one client with no staff member assigned)

    
    

    No additional documentation was made available to confirm that staff were not responsible for more than 4 residents at one time.

    
    

14. The facility's continued failure to ensure the minimum of two staff members on the unit and the minimum of a 1:4 {l staff member: 4 clients) ratio; to ensure that direct care staff did not divide their time during one shift between two or more areas of the facility, to ensure that Staff Assignment sheets were accurate and that minimum staffing requirements were maintained. is a

    violation of Florida law.

    
    

15. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

16. The Agency cited the Respondent for an uncorrected Class III violation in accordance

    
    

    with Section 408.813(2)(c), Florida Statutes (2011).

    
    

    WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2011).

    COUNT IV - Tag ClO0

    
    

17. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set forth herein.

18. The residential treatment center is required to develop a quality assurance program and follow a written procedure for a systematic approach to assessing, monitoring and evaluating its quality of care and treatment, improving its performance, ensuring compliance with standards, and disseminating results as follows:

    
    

    
    

    Program Standards · Quality assurance program. The quality assurance program shall address and include:

    1. Appropriateness of service assignment, intensity and duration, appropriateness of resources utilized, and adequacy and clinicai soundness of care and treatment given;

    2. Utilization review;

    3. Identification of current and potential problems in service delivery and strategies for addressing the problems;

    4. A written system for quality improvement, approved by the provider's governing board that includes:

       1. A written delineation of responsibilities for key staff;

       2. A policy for peer reviews;

       3. A confidentiality policy complying with all statutory confidentiality requirements, state and federal; and

       4. Written, measurable criteria and norms assessing, evaluating, and monitoring quality of care and treatment.

    5. A description of the methods used for identifying and analyzing problems, determining priorities for investigation, resolving problems, and monitoring to assure desired results are achieved and sustained;

    6. A systematic process to collect and analyze data from reports, including, but not limited to, incident reports, grievance reports, department and agency monitoring or inspection reports and self-inspection reports;

    . (g) A systematic process to collect and analyze data on process.outcomes, client outcomes, priority issues chosen for improvement, and satisfaction of clients;

    1. A process to establish the level of performance, priorities for improvement, and actions to improve performance;

    2. A process to incorporate quality assurance activities in existing programs, processes and procedures;

    3. A process for collecting and analyzing data on the use of restraint and seclusion to monitor and improve performance in preventing situations that involve risks to children and staff The provider shall:

       1. Collect and regularly analyze, at least quarterly, restraint and seclusion data to ascertain that restraint and seclusion are used only as emergency interventions, to identify opportunities for reducing the rate and improving the safety of restraint and seclusion use, and to identify any need to redesign procedures;

       2. Aggregate quarterly restraint and seclusion data by all settings, units or locations, including:

          1. Shift;

          2. Staff who initiated the procedure;

          3. Details of the interactions prior to the event;

          4. Details of the interactions during the event;

          5. The duration of each episode;

          6. Details of the interactions immediately following the event;

          7. Date and time each episode was initiated and concluded;

          8. Day of the week each episode was initiated;

          9. The type of restraint used;

          10. Whether injuries were sustained by the child or staff; and

              
              

              
              

          11. Age and gender of each child for which emergency safety interventions had been found necessary.

       3. Prepare and submit a report quarterly to the district/region mental health program office, including the aggregate data and:

          1. Number and duration of each instance of restraint or seclusion experienced by a child within a 12-hour timeframe;

          2. The number of instances of restraint or seclusion experienced by each child; and

          3. Use of psychoactive medications as an alternative for or to enable discontinuation of restraint or seclusion.

    4. Analysis of the use of time-out shall be conducted quarterly by the treatment team and

       shall include:

       1. Patterns and trends, for example, by shift, staff present, or day of the week;

       2. Multiple instances of time-out within a 12-hour time:frame;

       3. Number of episodes per child; and

       4. Instances of extending time-out beyond 30 minutes.

    
    

    Fla. Admin. R. 65E-9.006 (13)

19. On March 15, 2011 and April 27, 2011, the Agency conducted an ongoing complaint investigation, CCR# 2011002722, and found the facility out of compliance with the above rule. Written records that assess, monitor and evaluate its quality of care and treatment in an effort to improve its performance and ensure compliance with legal standards were missing or insufficient.

20. In an Administrative Complaint served on June 16, 2011, the Agency assessed a $500.00 fine against Respondent for an uncorrected Class III deficiency. A Final Order was issued on

July 13, requiring the fine to be paid within thirty days. See Final Order, attached as Exhibit A.

'

i

I 43. On June 8, 2011, the agency conducted a second revisit to complaint investigation CCR# 2011002722. Based on policy review and observations, the facility was still not properly docwnenting its monitoring of patients and utilizing a thorough and systematic process to analyze data from reports involving patients involved in untoward events. Findings included:

Facility reports dated May 30, 2011, revealed that patients# 1 & # 3 eloped from

the facility through an unsecured gate at 4: 00 p.m. that date. As of June 8, 2011, these patients had not been found.

rI

A facility report entitled, "To be completed by Risk Management- Findings of

· Investigation, recommendations and outcome" was reviewed. It had been completed by the Risk Manager Designee on June 3, 2011. The narrative stated: 11Risk Management, HR, and facility manager interviewing staff for procedure. Investigation is ongoing. Residents are not back yet. Risk Manager and facility manager will perform corrective action in regards to keys, hand offs, using pagers. Maintenance has replaced all locks on exterior gates with only management having keys."

During an interview, the Program Director discussed the four clients who had eloped at the same time on 5/30/11. Two had eloped from the Respondent group home and two others from Hercules Group Home (Group Home# 2). She admitted that there was a supervision issue and that direct care staff were not supervising the patients pursuant to policy. The gate was unlocked and no one saw the clients. leave. There was a possibility that one of the clients from group home # 2 had a key to the gate or that the gates were left open after an activity. However, there has been no final determination as to why the gate was unlocked. She stated that after the incident a key count was conducted, locks were changed and staff now conduct head counts.

The Program Director said she intended to impose corrective action for lack of supervision on the involved staff member. Her documentation was reviewed and appeared as follows: "On 5/30/11, you contacted the supervisor and reported that two of the residents that you were watching and· were assigned to, had eloped through the back gate of Aquarius. Staff is supposed to have awareness of the resident's location at all times, including when the resident is in the back yard.

You failed to comply with this expectation." As of June 6, 2011, six days later, no "corrective action" had been imposed on the involved employee and the issue "was going through the human resource department process."

Patient# 31s record contained a progress note written by a nurse, dated 5/30/11 at 1:40 a.m., which stated, "This writer received a phone call from resident's mom stating that resident said her biological father knew she and her roommate were planning to run this night. This info was reported to unit staff."

The risk manager's investigation did not address the lack of supervision, numbers of staff present in accord with the schedule or the fact that staff had knowledge of the potential elopement. There was no mention in the investigation documentation that a staff member had received or was receiving discipline of any kind.

A May 28, 2011, facility report for patient# 1, noted: "I was cleaning up the laundry room. I then seen a razor piece in her makeup bag." This was signed by a mental health technician. Razors are considered contraband according to a facility policy (Mar. 2010) entitled, "Contraband Search Guidelines."

The May 11, 2011 facility policy entitled "Patient's Personal Hygiene II required: "All razors, mirrors, mail clippers and/or files will be kept in the nurse's station and will need to be signed out for use by staff. After use, patient will need to return the razor to staff to be given back to the nurse. This process is monitored and supervised by staff."

The facility report at "to be completed by Risk Manager" was written: "findings of investigation, recommendations and outcome: incident appears to have occurred as reported: Staff removed razor from resident's makeup bag. Resident was cautioned about not having a razor in her bag due to facility rules for protection of all residents. Resident had a room search performed for additional contraband. None found 6/2/11. Every week on morning rounds rooms searched for potential contraband. No further recommendations at this time."

On June 7, 2011, during an interview, the Risk Manager confirmed that there was no investigation conducted to determine where the razor came from or how it was obtained. From the date of the event and for five days afterward, nothing had been documented about how the patient obtained the razor, whether an investigation

had been conducted or whether the facility subsequently searched for contraband. :'

1. The facility's continued failure to keep careful written records showing that it assesses, monitors and evaluates its own quality of care to improve its performance in accord with the : mandates of the above Rule is unacceptable as a matter oflaw.

2. The Respondent's continued failure to comply with Florida Administrative Rule

   
   

   65E-9.006 from March 15, 2011, the date of the initial complaint investigation, through June 8, 2011, the date of the second revisit, invokes grounds for a penalty in accord with Section 394.879, Fla. Stat. (2011), see #9 above.

   WHEREFORE, the Agency intends to impose an administrative fine in the amount of

   
   

   eight thousand five hundred dollars ($8,500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 394.879, Florida Statutes (2011).

   NOTICE OF RIGHTS

   
   

   Respondent is notified of its right to request an administrative hearing pursuant to §120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this

   
   

   matter. Specific options for administrative action are set out in the attached Election of Rights.

   
   

   All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, FL 32308; Telephone (850) 412-3689.

   RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUESTA HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.

   
   

   CERTIFICATE OF SERVICE

   
   

   I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been served by U.S. Certified Mail, Return Receipt No. 7010 0780 0001 9836 0189 to CT Corporation System, Registered Agent for Premier Behavioral Solutions of Florida, 1200 Pine Island Road, Plantation, FL 33324 and by U.S. Mail to JeffTuriczek, Administrator, Manatee Palms Group Home, 1324 37th Ave.,.Bradenton, FL 34208, thisq ay of August, 2011.

   STATE OF FLORIDA, AGENCY FOR

   RATION

   
   

   The Se nng Building

   525 Mirror Lake Dr. N., Suite 330H St. Petersburg, Florida 33701 Phone: (727) 552-1945

   Fax: (727) 552-1440

   
   

   Copy furnished to:

   Pat Caufman, FOM

   
   

   F\LED

   STATE OF FLORIDA AHCA

   AGENCY FOR HEALTH CARE ADMINISTRATION AGEXCY CLERK

   2011 JUL 13 A II: l43

   STATE OF FLORIDA, AGENCY FOR HEALTII CARE AD:MINISTRATION,

   
   

   Petitioner,

   
   

   v. AHCA NO. 2011005809

   PREMIER BEHAVIORAL SOLUTIONS OF FLORIDA INC. d/b/a MANATEE PALMS GROUP HOMES,

   
   

   ;/

   Respondent.

   
   

   
   

   FINAL ORDER

   
   

   Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration fmds and concludes as follows:

   
   

   1. The Agency has jurisdiction over the above named Respondent pursuant to Chapter 408, Part IT, Florida Statutes, and the applicable authorizing statutes and administrative code provisions.

      
      

   2. The Agency issued the attached Administrative Complaint and Election of Rights fonn to the Respondent (Ex. 1). The Election of Rights form advised of the right to an administrative hearing. The Respondent returned the Election of Rights form selecting "Option l" (Ex. 2). The Respondent thus waived the right to a hearing to contest the allegations and sanction sought in the Administrative Complaint.

Based upon the foregoing, it is ORDERED:

1. The findings of fact and conclusions of law set forth in the Administrative Complaint are adopted and incorporated by reference into this Final Order.

   
   

   equrre .

   payment

   eek i&JlltUHl\: e

   . Overdue amounts are

2. . The Respondent shall pay the Agency $500.00. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is

has not been made, payment is due within 30 days of the Final Ord subject to statutory interest and may be referred to collections. Ac

"Agency for Health Care Administration" and containing the AHCA ten-digit case number should be sent to:

Office of Finance and Accounting Revenue Management Unit

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 14

_Jv_i-----------

Tallahassee, Florida 32308

cretary

are Administration

ORDERED at Tallahassee, Florida, on this \ day of 2011.

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

Richard Shoop, Agency

I

I CERTIFY that a true and correct copy of this Final Order was served on the below­ named persons by the method designated on this t3i!=fa.y of_: --_:--=-=.., ---' 2011.

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308-5403

Telephone: (850) 412-3630

------ ·------------- 1--- ----··

Copies to:

I ..

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner,

vs. Case Nos.: 2011005809

PREMIER BEBAVIORAL SOLUTIONS OF FLORIDA, INC. d/b/a MANATEE PALMS GROUP HOMES

Respondent.

------------------'

ADMINISTRATIVE COMPLAINT

COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE

ADMINISTRATION (hereinafter "Petitioner" or "Agency''), by and through the undersigned counsel and files this Administrative Complaint against Premier Behavioral Solutions of Florida, Inc. d/b/a Manatee Palms Group Homes (hereinafter "Respondent"), pursuant to Section

§ 120.569 and Section§ 120.57, Fla. Stat. (2010), and alleges:

NATURE OF THE ACTION

This is an action to impose an administrative fine in the amount of five hundred dollars ($500.00) based upon one (1) Class III deficiency pursuant to Sections§§ 408.813 (2)(c) and 394.879(4) Fla. Stat. (2010).

JURISDICTION AND VENUE

1. 1. The Agency has jurisdiction pursuant to Sections 120.60 and Chapters 395, Part I

   
   

   
   

   EXHIBIT 1

   and 408, Part II, Florida Statutes (2010).

   
   

2. Venue lies pursuant to Florida Administrative Code R. 28-106.207

PARTIES

3• The Agency is the regulatory authority responsible for licensure of residential treatment programs for children and adolescents and enforcement of all applicable regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part II, and 395, Part I, Florida Statutes, and Chapter 65E-9, Florida Administrative Code.

1. Respondent operates a twelve (12) bed residential treatment center located at 1324 37th

   
   

   ·Avenue,, Bradenton, FL 34208, and is licensed as a residential treatment center, license # 53.

   
   

2. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

   COUNT I -Tag ACl00

   
   

3. The Age cy re-alleges and incorporates paragraphs one (1) through five (5) as if fully set

   
   

   forth herein.

   
   

4. Residential treatment centers such as Manatee Palms Group Homes are intensive residential treatment programs for children and adolescents, specialty hospitals which provide 24-hour care and have the primary function of diagnosis and treatment of patients under the age of 18 having psychiatric disorders in order to restore such patients to an optimal level of functioning. See Section 395.002(15), Fla. Stat. (2010).

5. A "residential treatment center for children and adolescents" means a 24-hour residential

   
   

   program, including a therapeutic group home, which provides mental health services to emotionally disturbed children or adolescents. Section 394.67(21)t Fla. Stat. (2010).

6. The purpose of a residential treatment center for children and adolescents is to provide mental health assessment and treatment services pursuant to 394.491, 384.495 and [part of]

394.496. See Section 394.87S(l)(c), Fla. Stat. (2010). The requirements of Part II of chapter 408

apply to the provision of services that require licensure under 394.455 and Part II of chapter 408. A license issued by the Agency is required in order to operate a residential treatment center for children and adolescents in this state. See Section 394.875(2), Fla. Stat. (2010).

IO. The provisions of Chapter 408, Part II (ss. 40&.801-408.&32) apply to residential treatment centers for children and adolescents. See Section 408.802(7), Fla. Stat. (2010).

In accordance with part II of chapter 408, the agency may impose an administrative penalty of no more than $500 per day against any licensee that violates any rule adopted pursuant to this section.

Section 394.879, Fla. Stat. (2010)

The agency may impose an administrative fine, not to exceed $1,000 per violation, per day, for the violation of any provision ofthis part, part II of chapter 408, or applicable rules. Each day of violation constitutes a separate violation and is subject to a separate fine.

Section 395.1065(2)(a), Fla. Stat. (2010)

***

Class "III" violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or·class IT violations. The agency shall impose an administrative fine as provided in this section for a cited class III violation. A citation for a class Ill violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, a fine may not be imposed.

Section 408.813(2)(c), Fla. Stat. (2010)

1. When incidents occur between staff members and patients or between patients (peers), extensive and complete documentation of the incident is required by law as follows:

   Quality assurance program. The provider shall develop and follow a written procedure for a systematic approach to assessing, monitoring and evaluating its quality of care and treatment, improving its petfonnance, ensuring compliance with standards, and disseminating results. The quality assurance program shall

   
   

   
   

   address and include:

   1. Appropriateness of service assignment, intensity and duration, appropriateness of resources utilized, and adequacy and clinical soundness of care and treatment given;

   2. Utilization review;

   3. Identification of current and potential problems in service delivery and

      strategies for addressing the problems;

   4. A written system for quality improvement, approved by the provider's governing board that includes:

      1. A written delineation of responsibilities for key staff;

      2. A policy for peer reviews;

      3. A confidentiality policy complying with all statutory confidentiality requirements, state and federal; and

      4. Written, measurable criteria and norms assessing, evaluating, and monitoring quality of care and treatment.

         
         

   5. A description of the methods used for identifying and analyzing problems, detennining priorities for investigation, resolving problems, and monitoring to assure desired results are achieved and sustained;

   6. A systematic process to collect and analyze data from reports, including, but not limited to, incident reports, grievance reports, department and agency monitoring or inspection reports and self-inspection reports;

   7. A systematic process to collect and analyze data on process outcomes, patient outcomes, priority issues chosen for improvement, and satisfaction of patients;

   8. A process to establish the level of performance, priorities for improvement, and actions to improve perfonnance;

   9. A process to incorporate quality assurance activities in existing programs, processes and procedures;

   10. A process for collecting and analyzing data on the use of restraint and seclusion to monitor and improve performance in preventing situations that involve risks to children and staff. The provider shall:

       1. Collect and regularly analyze, at least quarterly, restraint and seclusion data to ascertain that restraint and seclusion are used only as emergency interventions; to identify opportunities for reducing the rate and improving the safety of restraint and seclusion use, and to identify any need to redesign procedures;

          
          

          
          

       2. Aggregate quarterly restraint and seclusion data by all settings, units or locations, including;

          1. Shift

          2. Staff who initiated the procedure;

          3. Details of the interactions prior to the event;

          4. Details of the interactions during the event;

          5. The duration of each episode;

          6. Details of the interactions immediately following the event;

          7. Date and time each episode was initiated and concluded;

          8. Day of the week each episode was initiated;

          9. The type of restraint used;

             J. Whether injuries were sustained by the child or staff; and

             1. Age and gender of each child for which emergency safety interventions had been found necessary.

                
                

       3. Prepare and submit a report quarterly to the district/region mental health program office, including the aggregate data and:

          1. Number and duration of each instance of restraint or

             seclusion experienced by a child within a 12-hour tirneframe;

          2. The number of instances of restraint or seclusion experienced by each child; and

          3. Use of psychoactive medications as an alternative for or to enable discontinuation of restraint or seclusion.

   11. Analysis of the use of time-out shall be conducted quarterly by the treatment team and shall include:

1. Patterns and trends, for example, by shift, staff present, or day of the week;

   
   

2. Multiple instances of time-out within a 12-hour tirneframe;

   
   

3. Number of episodes per child; and

   
   

4. Instances of extending time-out beyond 30 minutes.

Fla. Admin. R. 65E-9.006(13)

1. On March 15, 2011, the Agency conducted an unannounced complaint investigation, CCR# 2011002722, and found the facility out of compliance with the above statute and rules.

   
   

   
   

   
   

2. Based on facility record and staff interviews, it was determined that.the facility failed to ensure consistent documentation of monitoring for compliance with standards for a thorough investigation related to an event involving 1 (#1) of 2 patients reviewed; and implementmg proactive measures to prevent the occurrence of patient physical harm in regards to possible fingernail scratching. Findings included:

   Record review of a March 1, 2011, facility report documented an event where direct care staff members placing Patient #1 in a restraint at approximately 8:18 PM. A staff nurse had written: "Patient has a 7 to 8 inch superficial red scratch on left upper under arm." The facility report also contained a witness fonn, signed by the fifteen year-old patient (Patient #1), detailing her recollection of the event, and stating that a technician ("Mental Health Technician #2") who had participated in physically restrruning her, scratched her with long fingernails, leaving a six to eight inch scratch on her arm. There was no documentation in the facility report regarding how the teenager received the scratch marks.

   
   

   During a 1:00 PM interview, Mental Health Technician #2 confirmed that she was involved in the altercation where the patient got scratched. During the interview, Mental Health Technician #2 was observed to have fingernails that extended one­ quarter of an inch beyond the tip of her fingers.

   
   

   The facilityts Dress Code Policy, effective November 6, 2000 and revised June 30, 2007 stated:

   
   

   General Appearance Guidelines Applicable to all Staff: Fingernails are to be clean, trimmed and, for the purposes of staff and youth safety, shall not extend beyond the tips of the fingers.

   
   

   During a 1:30 PM interview, the management staff at the facility confirmed that, as of the date of interview, they were unaware whether anyone was monitoring or enforcing this policy.

   
   

   The incident had not been carefully documented; there was no documentation indicating that a full investigation of the cause of the scratches had been accomplished. There was no documentation indicating that measures had been taken or put into place to protect the patients from another similar occurrence.

   
   

3. The facility's failure to keep careful written records that assess, monitor and evaluate its

   quality of care and treatment to improve its performance and ensure compliance with standards required as a matter of law is unacceptable.

   
   

   
   

4. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class TI violations.

5. The Agency cited the Respondent for a Class III violation in accordance with Section 408.813(2)(c), Fla. Stat. (2010). It also provided amandatory correction date of April 15, 2011.

6. On April 27, 2011, the Agency returned to the facility for a revisit to Complaint investigation CCR# 2011002722. Based on facility record and staff interviews, it was determined that the facility was still not thoroughly and correctly documenting incidents involving staff and patients or between patients. In regard to events involving two (#1 and #3) patients, there was insufficient documentation a) of an investigation for an allegation of verbal abuse; b) of an

   accusation that staff antagonized a patient; and c) regarding an incident where a patient unlocked

   
   

   a yard gate "while under close observation of staff." Findings included:

   
   

   Patient #1-First Event

   
   

   A event report dated March 20, 2011, 10:15 AM noted: "Verbal Abuse­ Staff/Patient" where Staff member #1 said that Patient #1 had called her a       The report noted 11Hann to Staff" and described the event as follows: 110n Sunday morning at approximately 10:55 a.m.• Patient #1 was very upset because she felt that she was being antagonized by staff." But she was "being re directed verbally." She went to the laundry room and began destroying hygiene products belonging to other patients. Patient #1 was placed in a capture hold until she was able to calm down. While in the capture hold, the patient decided to lay down on her side. Patient #1 reported that the staff member called her a derogatory name. On being interviewed, the staff denied this. HR (Human Resources) had investigated and did not find the staff member at fault. A second event report documented that the event occurred as reported. It noted that Patient #1 was aggressive toward the staff and was placed in a restraint. After the "capture hold," the patient calmed down. A therapist ·was to de-brief. There were no further recommendations.

   
   

   
   

   During an interview, the Risk Manager Designee produced a witness form, dated March 20, 2011, where Patient #1 accused Staff member #1 of saying: "This

   thinks she can do whatever the she wants to do." Staff member #2 was also present; all other staff were down the hall. "I just looked at her and then walked off the unit because I was mad; I couldn't believe she said it."

   
   

   The Risk Manager Designee also produced a second witness fonn filled out the same day where Staff member #2 noted that she did not recall Staff member #1

   calling Patient #1 a . What she heard Staff member #1 say was: ''I'm tired

   of these kids running the unit and not having any consequences!" There was no documentation indicating that StaffMember#l had been removed from the unit after Patient #1's allegation was received.

   
   

   During an interview, the Director of the Group Home confirmed that the abuse hotline was not called and no further documentation regarding this event was available. She said that HR usually assists with such investigations but had no documentation in regards to this one.

   
   

   Patient #I -Second Event

   
   

   A second facility event report, dated March 21, 2011, 5:15 PM, noted that Patient #1 was sitting at the dinner table and started verbally assaulting her peer, another patient. When staff attempted to remove patient #1, she squirted hot sauce in her peer's eye. The peer was immediately removed and Patient #2 taken off the unit.

   
   

   A Progress Note (second event report) added more detail: Patient #1 was eating dinner, got inad for an unknown reason, picked up the hot sauce and squirted it in a peers eye. After that Patient#1 tried to start a fight with other peers on the unit. Police were called. Patient #1 was not taken into custody ostensibly because the police only reviewed the first event report and did not know about the fight.

   
   

   Patient #3:

   
   

   An event report dated April 9, 2011, 7:35 PM, described an attempted elopement. Patient #3 and 2 other patients went out the backyard gate. Patient #3 opened the lock to the gate and ran through the apartments on the west side of the building. Her therapist was advised and a Baker act applied. Patient #3 returned on April 11, 2011 and was placed on close observation. Her therapist debriefed. The patient's guardian was contacted. No further recommendations were provided.

   
   

   During an interview, the Risk Manager Designee confirmed that there was no documentation of any investigation regarding how Patient #3 opened the backyard gate lock. The Director of the Group Home, when interviewed, said that all

   · backyard gates are to be kept locked. Staff members keep and secure the keys to the locks.

   --:---------------

   
   

   There was no documentation available regarding any investigation as to whether

   the gate was actually locked or how Patient #3 had escaped through the gate. Physician orders dated April 8 and 9, 2011, were found in Patient #3's clinical file and required: "Renew close observation for safety."

   
   

   During an interview, the Director of the Group Home said "close observation" means the patient should be kept in the line of sight of the staff member.

   
   

7. The facility's continued failure to keep careful written records that assess, monitor and evaluate its quality of care and treatment, improve its performance and ensure compliance with legal standards is a violation of Florida law.

8. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health. safety, or security of patients, other than class I or class II violations.

9. The Agency cited the Respondent for an uncorrected Class III violation in accordance

with Section 408.813(2)(c), Florida Statutes (2010).

WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2010).

NOTICE OF RIGHTS

Respondent is notified of its right to request an administrative hearing pursuant to §120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights.

All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS#3, Tallahassee, FL 32308; Telephone (850) 412-3689.

RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARJNG

WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN

,·

ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.

CERTIFICATE OF SERVICE

,,,

I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been served by U.S. Certified Mail, Return Receipt No. 7003 1010 0001 3600 3364 to CT Corporation System, Registered Agent for Premier Behavioral Solutions of Florida,

1200 Pine Island Road, Plantation, FL 33324 and by U.S. Mail to JeffTuriczek, Administrator,

Manatee Palms Group Home, 1324 37th

Copy furnished to:

Pat Cauftnan, FOM

.

Ave., Bradenton, FL 34208, this -1.::t: aay of June, 2011.

STATE OF FLORIDA, AGENCY FOR

H TION

s

.The Se""'-UJ...-- uilding

525 Mirror Lake Dr. N., Sui St. Petersburg, Florida 33701

Phone: (727) 552-1945; Fax: (727) 552-1440

. STATE OF FLORIDA

AGENCY FOR BEALfl CARE ADMlNISTRATION

RE: Premier Behavioral Solutions of Floridat

Inc., d/b/a Manatee Palms Group Homes

ELECTION OF RIGHTS

CASE NO.: 2.011005809

This ElectiQn of Rights form is attached to a proPQsed action by the Agency for Health Care Administration (AIICA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.

Your Election or Rights must be returped by mail or by fu witbin 21 days of the day you receive the attached Notice of Intent to TmpQMi 1t Late Fee, Notice of Intent to Impose a Late Fine or AdministrativeComplaj.nt.

If your Election or Rights with your selected option is not received by AHCA within twenty­ one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your·right to contest the Agency's proposed action and a rmal order will be issued.

(Please use thisform unless you, your attorney or your representative prefer to reply according to

Chapterl20, Florida Statutes (2006) and Ru1e 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO TillS ADDRESS:

Agency for Health Care Administration

Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308.

Phone: 850-412-3630 Fax: 850-921-0158.

PLEASE SELECT ONLY 1 OF THE$ 3 OPTIONS

OPTION ONE (1)     I admit to the aJlegadons of facts and law contained in the Notice

of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action.

OPTION TWO (2) I admit to the allegations orfacts contained in the Notice of Intent

to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be beard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that

the proposed administrative action is too severe or that the fine should be reduced.

OPTION THREE (3) I dispute the allegations of f'act contained in the Notice of Intent

to Impose . a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative

Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes)

before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE rfQTE: Choosing OPTION THREE (3), by itself, is :w;!I sufficient to obtain a formal bearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be

received by the Agency Clerk at the address above within 11 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it contain:

1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any.

1. The file number of the proposed action.

2. A statement of when you received notice of the Agency's proposed action.

3. A statement of all disputed issues of material fact. ff there are none, you must state that there

   are none.

   Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency

   agrees.

   
   

   License type:                 (ALF? nursing home? medical equipment? Other type?)

   Licensee Name:                                       ..,cLicense number:           _ Contact person:                                                                                                         

   Address:

   Name

   Title

   _

   Street and number City Zip Code

   Telephone No.              Fax No 'Email(optional),                            _

   on

   Ihereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency·

   for Health Care Administration behalf of the licensee referred to above.

   
   

   .!,!S ign ed :'-                                                           Date:                         

   
   

   Print Name:                                            Title:               _

   
   

   
   

   
   

   Late fee/findAC

   
   

   
   

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMJNISTRATION

   
   

   RE: Premier Behavioral Solutions of Florida, Inc., d/b/a Manatee Palms Group Homes

   ELECTION OF RIGHTS

   CASE NO.: 2011005809

   
   

   This Election of R.iiht§ form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.

   · Your Electifp of .Ricbts must be returned by man or by fax within 21 dan of the day you reeeite the attached Notice of Intent to Impose a Late Fee, Notice of Intent to!mpo aLate Fine or Administrative Complaint,

   
   

   If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency's proposed action and a final order will be issued.

   
   

   (Please use this form unless you. your attorney or your representative prefer to reply according to

   Chapter120, Florida Statutes (2006) and R.Qle 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO nns ADDRESS:

   Agency for Health Care Administration Attention: Agency Clerk

   2727 Mahan Drive, Mail Stop #3

   Tallahassee, Florida 32308.

   Phone: 850-412-3630 Fax: 850-921•0158. w

   0:,

   PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS

   
   

   OPTION ONE (1) .../ . I admit to the allegations of facts and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action.

   
   

   OPTION TWO (2) I admit to the allegations of facts contained in the Notice of Intent

   to Impose a Late Fee, the Notice of Intent to Im.pose a Late Fine, or Adminittrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced.

   
   

   OPTION THREE (3) I dispute the allegations of fact contained in the Notice of Intent

   to Impose a Late Fee. the Notiee of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1); Florida Statutes) before an Administrative Law Judge appointed by the Division of Admini'!Itm 'ffimtnmr ,

   PLEASE NOTE: Choosing OPTION THREE (3), by itself, is lillI suffi..,HJB z

   formal hearing. You also must file a written petition in order to obtain form"'arlieanng oe'tore

   the Division of Administrative Hearings under Section 120.57(1), Flori Statutes. It must be

   
   

   " 'J n:28-2011 01:30 PM M.10.:atee P.:alm ;th Service 94'17611632

   
   

   received by the Apncy Clerk at the addreas above wtlhla 21 dayt of your receipt of dlls proposed adminisa-aliw aedon. The request fbr fbrmal bouiag muai ;onft,nn to tho S"Cq\lircdtOnta of Rule 28-106.2015, Florida Adminbtrative Cade, wbioh DIIPDI that it contain:

   1, Your nam,, addr1aa, and telephone numb er1 and th, name, address. and telephone number of YOW' representativeor lawyer, lfany.

   1. The file number of the proposed action.

   2. A atatement of when·you received nodce of'the A&eney•s proposed action.

   3. A acuemem of all disputed Issues of material 1\c:t. If thme are none, you must Rate that thare

.....

ARnono.

Mediation under Section 120.573, Florida Statutea, may be available in this matt.er if the Asency

,-+t IC:.

Llctnee t)'Po: f&o->P H:£W· (AU? nureioa home? medlcal equipment? Other iype?)

Liaensoe Name: D') JM.'F'.Oi:f! &w,,.,wA 58,og.JP LiGMU Lioenae number: S  

Contact person: G:EcaQ,,c;;lit ,. Isae( M\Q F Cfh  

Name Title

Addrca1:_tiffl:2 Qor 6tu,er: '4, ,&&4:cer4,n ! EL:

Street and number City

3+ o

Zip Code

I hereby cent that I am duly authorized to submit this Notice of Election of'Riahts to the Aaency for Hoalth Care Admini1trati.0n on behalf of the li0anne refi:md u, above.

.s.i.anfd    ...,:_._.4..{.._·...r..< ,4..                 oat.:_, u:Ho

Print Name:_--JG...sea...,.1> .11.:1..c.«.....:f:Hn--=11;4P;.,;I.A1r-..2.0...,._                      Tit1e: Crf:A

Late flle/flne/ AC

\

. ' j

7 STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION·

STATE OF FLORIDA, AGENCY FOR HEALTHCARE ADMINISTRATION,

Petitioner,

vs. Case No.: 2011006769

PREMIER BEHAVIORAL SOLUTIONS OF FLORIDA, INC. d/b/a MANATEE PALMS GROUP HOMES #2

Respondent.

-----------------·'

ADMINISTRATIVE COMPLAINT

COMES NOW the State ofFlorida,-'.Agency for Health Care Administration (hereinaft r

•'Petitioner" or "Agency'), by and through the undersigned counsel, and files this Administrative Complaint against Premier Behavioral Solutions of Florida, Inc. d/b/a Manatee Palms Group Homes #2 (hereinafter "'Respondent"), pursuant to Section§ 120.569 and Section§ 120.57, Fla. Stat. (20I1), and alleges:

NATURE OF THE ACTION

This is an action to impose an administrative fine in the amount of five hundred dollars ($500.00) based upon one (1) Class III deficiency pursuant to Sections§§ 408.813 (2)(c) and 394.879(4) Fla. Stat. (2010).

JURISDICTION AND VENUE

1. The Agency has jurisdiction pursuant to Sections 120.60 and Chapters 395, Part I and 408, Part II, Florida Statutes (2010).

2. Venue lies pursuant to Florida Administrative Code R. 28-106.207.

   \

   j

   
   

   PARTIES

   
   

3. The Agency is the regulatory authority responsible for licensure of residential treatment programs for children and adolescents and enforcement of all applicable regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part II, and 395, Part I, Florida Statutes, and Chapter 65E-9, Florida Administrative Code.

4. Respondent operates a twelve (12) bed residential treatment center located at 1324 37th Avenue, Bradenton, FL 34208, and is licensed as a residential treatment center, license# 54.

5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

   COUNT I - tag ClOO

   
   

6. The Agency re-alleges and incorporates p agraphs one (1) through five (5) as if fully set

   
   

   forth herein.

   
   

7. Residential treatment centers such as Manatee Palms Group Homes are intensive residential treatment programs for children and adolescents, specialty hospitals which provide 24-hour care and have the primary function of diagnosis and treatment of patients under the age of 18 having psychiatric disorders in order to restore such patients to an optimal level of functioning. See Section 395.002(15), Fla. Stat. (2010).

8. A "residential treatment center for children and adolescents" means a 24-hour residential

   
   

   program, including a therapeutic group home, which provides mental health services to emotionally disturbed children or adolescents. Section 394.67(21), Fla. Stat. (2010).

9. The purpose of a residential treatment center for children and adolescents is to provide mental health assessment and treatment services pursuant to 394.491, 384.495 and [part of]

   394.496. See Section 394.875(l)(c), Fla. Stat. (2010). The requirements of Part II of chapter 408

   ')

   
   

   apply to the provision of services that require licensure under 394.455 and Part II of chapter 408. A license issued by the Agency is required in order to operate a residential treatment center for children and adolescents in this state. See Section 394.875(2), Fla. Stat. (2010).

10. The provisions of Chapter 408, Part II (ss. 408.801-408.832) apply to residential treatment centers for children and adolescents. See Section 408.802(7), Fla. Stat. (2010).

    In accordance with part II of chapter 408, the agency may impose an administrative penalty of no more than $500 per day against any licensee that violates any rule adopted pursuant to this section.

    
    

    Section 394.879, Fla. Stat. (2010)

    
    

    ***

    The agency may impose an administrative fine, not to exceed $1,000 per violation, per day, for the violation of any provision of this part, part II of chapter 408, or applicable rules. Each day of violation constitutes a separate violation and is subject to a separate fine. '

    
    

    Section 395.1065(2)(a), Fla. Stat. (2010)

    
    

    ***

    Class "III" violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations. The agency shall impose an administrative fine as provided in this section for a cited class III violation. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, a fine may not be imposed.

    
    

    Section 408.813(2)(c), Fla. Stat. (2010)

    
    

11. When incidents occur between staff members and patients or between patients (peers), extensive and complete documentation of the incident is required by law as follows:

    Quality assurance program. The provider shall develop and follow a written procedure for a systematic approach to assessing, monitoring and evaluating its quality of care and treatment, improving its performance, ensuring compliance with standards, and disseminating results. The quality assurance program shall

    
    

    address and include:

    1. Appropriateness of service assignment, intensity and duration, appropriateness of resources utilized, and adequacy and clinical soundness of care and treatment given;

    2. Utilization review;

    3. Identification of current and potential problems in service delivery and strategies for addressing the problems;

    4. A written system for quality improvement, approved by the provider's governing board that includes:

       1. A written delineation of responsibilities for key staff;

       2. A policy for peer reviews;

          and

       3. A confidentiality policy complying with all statutory confidentiality requirements, state federal; and

       4. Written, measurable criteria and norms assessing, evaluating, and monitoring quality of care and treatment.

          
          

    5. A description of the methods used for identifying and analyzing problems, determining priorities for investigation, resolving problems, and monitoring to assure desired results are achieved and sustained;

    6. A systematic process to collect and analyze data from reports, including, but not limited to, incident reports, grievance reports, department and agency monitoring or inspection reports and self-inspection reports;

    7. A systematic process to collect and analyze data on process outcomes, patient outcomes, priority issues chosen for improvement, and satisfaction of patients;

    8. A process to establish the level of performance, priorities for improvement, and actions to improve performance;

    9. A process to incorporate quality assurance activities in existing programs, processes and procedures;

1. A process for collecting and analyzing data on the use of restraint and seclusion to monitor and improve performance in preventing situations that involve risks to children and staff. The provider shall:

   1. Collect and regularly analyze, at least quarterly, restraint and seclusion data to ascertain that restraint and seclusion are used only as emergency interventions, to identify opportunities for reducing the rate and improving the safety of restraint and seclusion use, and to identify any need to redesign procedures;

      )

      
      

   2. Aggregate quarterly restraint and seclusion data by all settings, units or locations, including:

      1. Shift

      2. Staff who initiated the procedure;

      3. Details of the interactions prior to the event;

      4. Details of the interactions during the event;

      5. The duration of each episode;

      6. Details of the interactions immediately following the event;

      7. Date and time each episode was initiated and concluded;

      8. Day of the week each episode was initiated;

         1. The type of restraint used;

            J. Whether injuries were sustained by the child or staff; and

            k. Age and gender of each child for which emergency safety interventions had been found necessary.

            
            

   3. Prepare and submit a report quarterly to the district/region mental health program office, including the aggregate data and:

      1. Number and duration of each instance of restraint or seclusion experienced by a child within a 12-hour timeframe;

      2. The number of instances of restraint or ieclusion experienced by each child; and

      3. Use of psychoactive medications as an alternative for or to enable discontinuation of restraint or seclusion.

1. Analysis of the use of time-out shall be conducted quarterly by the treatment team and shall include:

   1. Patterns and trends, for example, by shift, staff present, or day of the week;

      
      

   2. Multiple instances of time-out within a 12-hour timeframe;

      
      

   3. Number of episodes per child; and

      
      

   4. Instances of extending time-out beyond 30 minutes.

Fla. Admin. R. 6SE-9.006(13)

1. On February 14, 2011, the Agency conducted an unannounced complaint investigation, CCR# 2011001230, and found the facility out of compliance with the above statute and rules.

2. Based on facility record review and staff interview, it was determined that the facility

   )

   
   

   failed to thoroughly and consistently document as required its investigation related to a event involving Patient #1. Findings included:

   A facility report, dated January 5, 2011, indicated that, while running away from staff, Patient #1 attempted to throw a brick at them and hit and punch them. The patient was subsequently restrained. There was no documentation in the facility report of an investigation as to how the client obtained a brick or whether the facility and surrounding grounds were searched for any additional bricks or unsafe objects that remained accessible to patients. In addition, though multiple staff were involved, it appeared that only one staff member had documented the incident.

   
   

   During an interview, the Assistant Program Director said that other statements from staff members had been obtained but the originals were provided to another agency without the facility securing copies. The facility Risk Manager said she investigated how the patient obtained a brick and she searched for other unsafe objects but did not document her search.

   
   

3. The facility's failure to keep careful written records that assess, monitor and evaluate its quality of care and treatment to improve its performance and ensure compliance with the required standards was unacceptable.

4. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class II violations.

5. The Agency cited the Respondent for a Class III violation in accordance with Section 408.813(2)(c), Fla. Stat. (2010). It also provided a mandatory correction date of March 16, 2011.

6. On June 7 through 9, 2011, the Agency returned to the facility for a revisit. Based on facility record and staff interviews, it was determined that the facility was still not thoroughly and correctly documenting incidents involving staff and patients or between patients.

7. Based on record review, review of facility reports, and staff interviews, it was determined

that the facility failed to document its investigation of elopement by two patients.

)

Findings included:

Patient #1

A facility report for patient #1, dated 5/30/11, noted that, "During a head count on the unit for the residents, it was noticed by staff that [Patient # 1] was missing.

Staff searched the room, the unit and the perimeter of the facility. When time elapsed of 30 minutes, the sheriffs department was called as well as the AOC (Administrator on call)."

Under 11findingsof investigation, recommendations and outcome11 the facility reported that these were being investigated. Patient #1 eloped from the facility with three other residents. The Risk Manager spoke with the patient's therapist when she returned to the facility to debrief. The Manager was noted as "reviewing staffing with Risk Management; Investigation open." The report also noted that "Risk Manager and Facility Manager will perform a corrective action with regard to hand offs, supervision, proper use of codes, (unknown word) 6/3/11."

The Risk Management investigation included no documentation of any investigation regarding how the patient eloped from the facility or how the facility was staffed at the time. There was no documentation of corrective actions taken.

Patient #2

A facility report for patient #2, dated 5/30/11, noted: "During a head count on the unit for the residents it was noticed by staff that [patient#1] was missing. Staff searched the room, the unit and the perimeter of the facility. When time elapsed of 30 minutes, the sheriff was called as well as the AOC (Administrator on call).11

Under "Findings oflnvestigation, Recommendations and Outcome," the facility report for patient # 2 noted that the patient walked away from the unit, that the staff searched the unit and the surrounding area then called the police who found Llie patient the following day, on 5/31/11. It also noted that the patient tested positive for drugs and that the therapist debriefed the resident regarding elopement from the facility and from drug rehabilitation. It said that the Staff would receive training on elopement procedures, that the patient was placed on close observation for safety and that there were "no further recommendations at this time."

In regard to the above documentation by the risk manager designee, there was no documentation that any investigation followed regarding how the resident eloped, the factility staffing at the time of the incident, the supervision being provided.

Nor was there any mention of the three other patients who eloped at the same time. No documentation indicated that the staff had received elopement procedures training after this incident.

)

1. The facility's continued failure to keep careful written records that assess, monitor and evaluate its quality of care and treatment, improve its performance and ensure compliance with legal standards is a violation of Florida law.

2. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

3. The Agency cited the Respondent for an uncorrected Class III violation in accordance with Section 408.813(2)(c), Florida Statutes (2010).

l WHEREFORE, the Agency intends to impose an administrative fine in the amount of

five hundred dollars ($500.00), against Respondent, a residential treatment programs for children

and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2010).

NOTICE OF RIGHTS

Respondent is notified of its right to request an administrative hearing pursuant to§ 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights.

AH requests for hearing shall be made10 the Agency for Health Care Administration, and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, FL 32308; Telephone (850) 412-3689.

RESPONDENT IS FURTHER NOTIFIED THAT T.HE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been served by U.S. Certified Mail, Return Receipt No. 7010 0780 0001 9836

0202 to CT Corporation System, Registered Agent for Premier Behavioral Solutions of Florida, Inc., 1200 South Pine Island Road, Plantation, FL 33324 and by U.S. Mail to JeffTuriczek,

n.d. . Se >I\w

Administrator, Manatee Palms Group Homes.#2, 1324 37'h Avenue East, Bradenton, FL 34208, this Z day of §t, 2011.

STATE OF FLORIDA, AGENCY FOR

TION

T ts lding

525 Mirror Lake Dr. N., Suite 330K St. Petersburg, Florida 33701

Phone: (727) 552-1945 /Fax: (727) 552-1440

Copy furnished to: Pat Caufman, FOM

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: Premier Behavioral Solutions of Florida, Inc. d/b/a Manatee Palms Group Homes #2

CASE NO. 2011006769

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed· action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.

Your Election orBilbf§ must be returned by mail or by fax within 21 dan or the day you receive the attached Notice ofintent to ImPose a Late Fee. Notice of Intent to Im,poae a Late Fine or Administrative Complaint.

If your Election of Rights with your selected option is not received by AHCA within twenty­ one (21) days from the date you received this ,notice of proposed action by AHCA, you will have given up your right to contest the Agency's proposed action arid a final order will be issued.

(Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

PLEASE RETURN YOUR ELECTION OF RIGHTS TO nns ADDRESS:

Agency for Health Care Administration Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308.

Phone: 850-412"3630 Fax: 850-921-0158.

PLEASE SELECT ONLY I OF THESE 3 OPTIONS

OPTION ONE (1)   I admit to the alleptions of facts and law contained in the Notice

of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to ·· object and to have a hearing. I understand that by giving up my right to a hearing, a ftnal order will be issued that adopts the proposed agency action and imposes the penalty, fine or action.

OPTION TWO (2) I admit to the allegations of facts contained in the Notice of Intent

to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be heard at an informal proceedina (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the tine should be reduced.

OPTION THREE (3) I dispute the allegations of fact eontaiaed in the Notice of Intent

to Impose a Late Fee, tlle Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before

) )

.,,)._ I

the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action The request for formal hearing must confonn to the requirements of Rule 28·106.2015, Florida Administrative Code, which requirt,J that it contain:

1. Your name, address, and telephone number, and the name, address, and telephone number of

   your representative or lawyer, if any.

2. The file number of the proposed action.

3. A statement of when you received notice of the Agency's proposed action.

4. A statement of all disputed issues of material fact. If there are none you must state that there are none.

   
   

   Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.

   License type:                 (ALF? nursing home? medical equipment? Other type?)

   
   

   Licensee Name:                                          License number:                        

   
   

   Contact person:                                                         _

   Address:

   Name Title _

   Street and number · City Zip Code

   
   

   Telephone No.              Fax No.             Email(optional)                   _

   
   

   Ihereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.

   
   

   Signed:                                                Date:                        

   
   

   Print Name:                                        Title:                                 

   
   

   Late fee/fine/AC

   )

   1

   i

   -1 STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATION

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   
   

   vs. Case No.:

   
   

   2011006774

   
   

   PREMIER BEHAVIORAL SOLUTIONS OF FLORIDA, INC. d/b/a MANATEE PALMS GROUP HOMES #3

   
   

   Respondent.

   
   

   _....;/

   
   

   
   

   ADMINISTRATIVE COMPLAINT

   
   

   COMES NOW the State of Florida, Agency for Health Care Administration (hereinafter "Petitioner" or "Agency"), by and through the undersigned counsel, and files this Administrative Complaint against Premier Behavioral Solutions of Florida, Inc. d/b/a Manatee Palms Group Homes #2 (hereinafter "Respondent"), pursuant to Section§ 120.569 and Section § 120.57, Fla. Stat. (2011), and alleges:

   NATURE OF THE ACTION

   
   

   This is an action to impose an administrative fine in the amount of one thousand dollars ($1,000.00) based upon one (2) Class III deficiencies pursuant to Sections§§ 408.813 (2)(c) and

   394.879(4) Fla. Stat. (2010).

   
   

   JURISDICTION AND VENUE

   
   

   1. The Agency has jurisdiction pursuant to Sections 120.60 and Chapters 394, Parts III & IV, 395, Part I and 408, Part II, Florida Statutes (2010).

   2. Venue lies pursuant to Florida Administrative Code R. 28-106.207.

      )

      
      

      PARTIES

      
      

   3. The Agency is the regulatory authority responsible for licensure of residential treatment programs for children and adolescents and enforcement of all applicable regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part II, and 395, Part I, Florida Statutes, and Chapter 65E-9, Florida Administrative Code.

   4. Respondent operates a twelve (12) bed residential treatment center located at 1324 3ih Avenue, Bradenton, FL 34208, and is licensed as a residential treatment center, license# 57.

   5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

      LAW APPLICABLE TO ALL COUNTS

      
      

   6. Residential treatm t centers such as Manatee Palms Group Homes are intensive residential treatment programs for children and adolescents, specialty hospitals which provide 24-hour care and have the primary function of diagnosis and treatment of patients under the age of 18 having psychiatric disorders in order to restore such patients to an optimal level of functioning. See Section 395.002(15), Fla. Stat. (2010),

   7. A "residential treatment center for children and adolescents" means a 24-hour residential program, including a therapeutic group home, which provides mental health services to emotionally disturbed children or adolescents. Section 394.67(21), Fla. Stat. (2010).

   8. The purpose of a residential treatment center for children and adolescents is to provide mental health assessment and treatment services pursuant to 394.491, 384.495 and [part ofJ

      394.496. See Section 394.875(1)(c), Fla. Stat. (2010). The requirements of Part II of chapter 408 apply to the provision of services that require licensure under 394.455 and Part II of chapter 408. A license issued by the Agency is required in order to operate a residential treatment center for

      
      

      ) )

      
      

      children and adolescents in this state. See Section 394.875(2), Fla. Stat. (2010).

      
      

   9. The provisions of Chapter 408, Part II (ss. 408.801-408.832) apply to residential treatment centers for children and adolescents. See Section 408.802(7), Fla. Stat. (2010).

      In accordance with part II of chapter 408, the agency may impose an administrative penalty of no more than $500 per day against any licensee that violates any rule adopted pursuant to this section.

      
      

      Section 394.879, Fla. Stat. (2010)

      
      

      ***

      
      

      The agency may impose an administrative fine, not to exceed $1,000 per violation, per day, for the violation of any provision of this part, part II of chapter 408, or applicable rules. Each day of violation constitutes a separate violation and is subject to a separate fine.

      
      

      Section 395.1065(2)(a), Fla. Stat. (2010)

      
      

      ***

      
      

      Class "III" violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.-The agency shall impose an administrative fine as provided in this section for a cited class III violation. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, a fine may not be imposed.

      
      

      Section 408.813(2)(c), Fla. Stat. (2010)

      
      

      COUNT I - tag C027

      
      

   10. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set forth herein.

   11. A residential treatment center is required to keep its grounds safe and reasonably attractive, free from trash and hazardous conditions as follows:

       
       

       Facility standards - Buildings, grounds and equipment.

       Grounds shall have space for children's activities, which shall be designed based on the type of activities offered and age appropriateness. The grounds shall be maintained in a safe and reasonably attractive manner and kept free of standing water, debris, garbage, trash and other hazardous conditions.

       Fla. Admin. R. 65E-9.00S(a)2

   12. On October 13, 2010, the Agency conducted a survey of the Respondent facility and found the facility out of compliance with the above Rule.

   13. Based on observation, the facility failed to ensure that the grounds accessed by patients were maintained in a safe manner and free from debris and hazardous conditions. Findings included:

       Outside of a hallway connected to Group Home #3A is a yard that surrounded by a fence. A door in the hallway opens into the yard. Inside the fenced yard a double wide mobile home is positioned approximately 3 feet off the ground and surrounded by plastic cross fencing to prevent clients from climbing underneath. During an interview, the Director of Group Homes #3 said that the mobile home was being used for storage.

       
       

       Two sets of stairs provide access up and into the mobile home and wires were visible underneath through the stairs. This is an access point where patients can easily climb underneath. The window frames of the mobile home were in disrepair and broken off. Beneath the rear door a plastic guard was observed 6 inches short of covering worn and splintered wood. Above this was a broken piece of wood with nails protruding.

       
       

   14. The facility's failure to maintain the grounds, including the mobile home on the grounds, in a safe and reasonably attractive manner, free from hazardous conditions was unacceptable.

   15. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class II violations.

       
       

   16. The Agency cited the Respondent for a Class III violation in accordance with Section 408.813(2)(c), Fla. Stat. (2010). It also provided a mandatory correction date ofNovember 13, 2010.

   17. On June 6 through 9, 2011, the Agency returned to the facility for a revisit and Complaint investigation, CCR# 2011005476. Based on facility record and staff interviews, it was determined that the facility was still not maintaining its grounds in a safe manner.

   18. Based on observation and staff interviews, it was determined that the grounds of the facility were not free of hazardous conditions. Findings included:

       On June 6, 2011, a second outside area on the southeast comer of the building included a fenced gated area between Group Homes# 3 (Orion) and Group Homes# 5 (Lynx). A large hole in the ground was observed under the fence, 5 by 4 feet wide and 1.5 feet deep. During an interview, the Group Home manager confirmed that patients of the facility had dug the hole.

       
       

       A fenced area, approximately 20 ' x 20 ' on the grounds of the facility housed the pool pump apparatus. The door access was fenced, locked with a pad lock and chain at approximately 4 feet from the ground. The lower portion of the fence door was visibly bent inward, leaving a gap of 12'' - 14", enough for a small person to fit through. Inside the fenced area, strewn on the ground, were multiple hazards: 3 canisters of pool chemicals, a broken plastic 5-gallon bucket, a garden hose, a 5-foot rope, a pool hose and other miscellaneous items.

       
       

       The fence surrounding the grounds of the facility had been rewired in four distinct areas and had sharp edges protruding.

       
       

       The wood door to a storage area attached to an outbuilding had a gap of 8-10 inches at the bottom. Inside on the ground of the storage area was a hammer.

       
       

       Four sections of the fence surrounding the outdoor pool were broken and accessible and a four foot section of the fence was missing entirely. The pool and grounds is accessible to both Group Homes# 2 and Group Homes# 3.

       
       

   19. The facility's continued failure to maintain the grounds in a safe and reasonably attractive manner, free from hazardous conditions, is a violation of Florida law.

       I

       1

       
       

       1

       i'I

       j

       
       

       
       

       )

       
       

   20. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

   21. The Agency cited the Respondent for an uncorrected Class Ill violation in accordance with Section 408.813(2)(c), Florida Statutes (2010).

       WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2010).

       COUNT II - tag C031

       :('i

       
       

   22. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set

       
       

       · forth herein.

       
       

   23. A residential treatment center is required to keep both interior and exterior of its buildings safe and in good repair as follows:

       Facility standards - Buildings, grounds and equipment.

       The interior and exterior of buildings and the furniture and furnishings shall be safe, comfortable, reasonably attractive, in good repair and shall function for the purpose for which such building and furniture has been designed.

       
       

       Fla. Admin. R. 65E-9.00S(a)6

   24. On October 13, 2010, the Agency conducted a survey of the Respondent facility and found the facility out of compliance with the above Rule.

   25. Based on observations and staff interview, the facility failed to ensure that the interior building was equipped in a safe manner. Findings included:

       j

       j

       l

   26. 
       

       
       

       In the Group Homes #3 patient bathrooms 301,303 & 305, the ceiling vents were very large - approximately 12 11 by 12 "with vent holes one inch in diameter.

       During the tour, the Chief Operating Officer agreed that the large vent holes were a safety hazard.

       The facility's failure to maintain the interior building in a safe manner for the patients

       
       

       was unacceptable.

       
       

   27. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the ageney determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class II violations.

   28. The Agency cited the Respondent for a Class III violation in accordance with Section 408.813(2)(c), Fla. Stat. (2010}. It also provided a mandatory correction date of November 13, 2010.

   29. On June 6 through 9, 2011, the Agency returned to the facility for a revisit and Complaint investigation, CCR# 2011005476. Based on facility record and staff interviews, it was determined that the facility was still not maintaining its interior building in a safe manner.

   30. Based on record review, observation and interviews, the facility had continued its failure to maintain the interior of the building in a safe and secure manner. Findings included:

       The facility's Contraband Search Guidelines (Issued: 03/10) stated: "Contraband is anything that may be considered dangerous to residents or others." The list of contraband that the following not be allowed kept in the residents' rooms: a) hygiene products of any kind; and b) any item that could possibly be used as ligature.

       
       

       Yet, observations on June 6, 2011, revealed that:

       
       

       • The common hallway area for the unit bedrooms had a ceiling tile with an 8 x 8" dark, moldy black spot with growth present;

         
         

       • In Room 301, a personal hygiene product bottle was on the desk as was an ear phone listening device with a cord.

         
         

         \

         J

         
         

       • In Room 303 there was a broken toilet paper holder with no toilet paper present in the bathroom and a sprinkler head in the ceiling above the sink had a 1 x 1.5 inch gap between the sprinkler and the ceiling tile.

         
         

       • The door in the common hallway between the client bedrooms that lead to the outside area was broken, the push handle was not present, the door was not flush with the molding and a noticeable gap was present to the outside air.

         
         

   31. The facility's continued failure to maintain the interior building in a safe manner and in good repair is a violation of Florida law.

   32. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

   33. The Agency cited the Respondent for an uncorrected Class III violation in accordance

with Section 408.813(2)(c), Florida Statutes (2010).

WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2010).

NOTICE OF RIGHTS

Respondent is notified of its right to request an administrative hearing pursuant to §120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights.

All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS#3, Tallahassee, FL 32308; Telephone (850) 412-3689.

RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF IBIS COMPLAINT WILL RESULT IN AN

ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been served by U.S. Certified Mail, Return Receipt No. 7010 0780 0001 9836 0219 to CT Corporation System, Registered Agent for Premier Behavioral Solutions of Florida, Inc., 1200 South Pine Island Road, Plantation, FL 33324 and by U.S. Mail to Jeff Turiczek,

vd

Administrator, Manatee Palms Group Homes #3, 1324 3ih Avenue East, Bradenton, FL 34208,

this a.:_ day of September, 2011.

STATE OF FLORIDA AGENCY FOR

RATION

Ffa.

The'SeJQDIILl(Building

525 Mirror Lake Dr. N., Suite 330K St. Petersburg, Florida 33701

Phone: (727) 552-1945 / Fax: (727) 552-1440

Copy furnished to: Pat Caufman, FOM

) )

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: Premier Behavioral Solutions of Floridat Inc. d/b/a Manatee Palms Group Homes #3

CASE NO. 2011006774

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.

Your llection of Rights mpst be returned by mail or by fax within 21 days of the dav you receive the attached Notice of Intent to Impose a Late Fee. Notice of Intent to Impose a Late Fine or AdministrativeComplaint.

If your Election of Rights with your selected option is not received by AHCA within·twenty­ one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency's proposed action and a (mal order will be issued.

(.Please use this form unless you, your attorney or your representative prefer to reply according to Chapterl20, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

PLEASE RETURN YOUR ELECTION OF RIGHTS TO nns ADDRESS:

Agency for Health Care Administration Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308.

Phone: 850-412-3630 Fax: 850-921-0158.

PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS

OPTION ONE (1)   I admit to the allegations of facts and law contained in the Notice

of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a bearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action.

OPTION TWO (2)   I admit to the allegations of facts contained in the Notice of Intent

to Impose a Late Fee.. the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced.

OPTION THREE (3) _ I dispute the alleptions of fact contained in tlle Notice of Intent to Impose a Late Fee, the Notice or Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE NOTE: Choosing OPTION THREE (3), by itself, is lmI sufficient to obtain a formal hearing. You also must rde a writte• petition in order to obtain a formal hearing before

.. ) )

the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28 106.2015, Florida Administrative Code, which reqµires that it contain:

1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any.

2. The file number of the proposed action.

3. A statement of when you received notice of the Agency's proposed action.

4. A statement of all disputed issues of material fa.ct. If there are none you must state that there

   are none.

   
   

   Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.

   License type:                 (ALF? nursing home? medical equipment? Other type?)

   Licensee Name:                                        License number:             Contact person:-"----------------------

   Name Title

   Address:                                                                            Street and number City Zip Code

   Telephone No.              Fax No.             Email(optional)                   _

   
   

   Ihereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency

   for Health Care Administration on behalf of the licensee referred to above.

   
   

   Signed:                                                Date:             _

   
   

   Print Name:                                       Title:                                 

   
   

   
   

   
   

   Late fee/fine/AC

   
   

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTRATION

   
   

   STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

   
   

   Petitioner,

   
   

   vs. Case No.:

   
   

   2011006776

   
   

   PREMIER BEHAVIORAL SOLUTIONS OF FLORIDA, INC. d/b/a MANATEE PALMS GROUP HOMES #5

   
   

   Respondent.

   
   

   _..:/

   
   

   
   

   ADMINISTRATIVE COMPLAINT

   
   

   COMES NOW the State of Florida, Agency for Health Care Administration (hereinafter '" "Petitioner" or "Agency"), by and through the undersigned counsel, and files this Administrative Complaint against Premier Behavioral Solutions of Florida, Inc. d/b/a Manatee Palms Group.

   Homes #2 (hereinafter "Respondent"), pursuant to Section§ 120.569 and Section§ 120.57, Fla. Stat. (2011), and alleges:

   NATURE OF THE ACTION

   
   

   This is an action to impose an administrative fine in the amount of one thousand dollars ($1,000.00) based upon one (2) Class III deficiencies pursuant to Sections§§ 408.813 (2)(c) and 394.879(4) Fla. Stat. (2010).

   JURISDICTION AND VENUE

   
   

   1. The Agency has jurisdiction pursuant to Sections 120.60 and Chapters 394, Parts III &

      
      

      IV, 395, Part I and 408, Part II, Florida Statutes (2010).

      
      

   2. Venue lies pursuant to Florida Administrative Code R. 28-106.207.

      
      

      PARTIES

      
      

   3. The Agency is the regulatory authority responsible for licensure of residential treatment programs for children and adolescents and enforcement of all applicable regulations, state statutes and rules governing assisted living facilities pursuant to the Chapters 408, Part II, and 395, Part I, Florida Statutes, and Chapter 65E-9, Florida Administrative Code.

   4. Respondent operates a twelve (12) bed residential treatment center located at 1324 3ih

      
      

      Avenue, Bradenton, FL 34208, and is licensed as a residential treatment center, license# 57.

      
      

   5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.

      LAW APPLICABLE TO ALL COUNTS

      
      

   6. Residential trea ent centers such as Manatee Palms Group Homes are intensive residential treatment programs for children and adolescents, specialty hospitals which provide 24-hour care and have the primary function of diagnosis and treatment of patients under the age of 18 having psychiatric disorders in order to restore such patients to an optimal level of functioning. See Section 395.002(15), Fla. Stat. (2010).

   7. A "residential treatment center for children and adolescents" means a 24-hour residential

      
      

      program, including a therapeutic group home, which provides mental health services to emotionally disturbed children or adolescents. Section 394.67(21), Fla. Stat. (2010).

   8. The purpose of a residential treatment center for children and adolescents is to provide mental health assessment and treatment services pursuant to 394.491, 384.495 and [part ot]

      394.496. See Section 394.875{1)(c), Fla. Stat. (2010). The requirements of Part II of chapter 408 apply to the provision of services that require licensure under 394.455 and Part II of chapter 408. A license issued by the Agency is required in order to operate a residential treatment center for

      \

      J

      
      

      children and adolescents in this state. See Section 394.875(2), Fla. Stat. (2010).

      
      

   9. The provisions of Chapter 408, Part II (ss. 408.801-408.832) apply to residential treatment centers for children and adolescents. See Section 408.802(7), Fla. Stat. (2010).

      In accordance with part II of chapter 408, the agency may impose an administrative penalty of no more than $500 per day against any licensee that violates any rule adopted pursuant to this section.

      
      

      Section 394.879, Fla. Stat. (2010)

      
      

      ***

      The agency may impose an administrative fine, not to exceed $1,000 per violation, per day, for the violation of any provision of this part, part II of chapter 408, or applicable rules. Each day of violation constitutes a separate violation and is subject to a separate fine.

      
      

      Section 395.1065(2)(a), Fla. Stat. (2010)

      
      

      ***

      Class "'Ill" violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations. The agency shall impose an administrative fine as provided in this section for a cited class III violation. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within . the time specified, a fine may not be imposed.

      
      

      Section 408.813(2)(c), Fla. Stat. (2010)

      
      

      COUNT I - tag C027

      
      

   10. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set forth herein.

   11. A residential treatment center is required to keep its grounds safe and reasonably attractive, free from trash and hazardous conditions as follows:

       
       

       Facility standards - Buildings, grounds and equipment.

       Grounds shall have space for children's activities, which shall be designed based on the type of activities offered and age appropriateness. The grounds shall be maintained in a safe and reasonably attractive manner and kept free of standing water, debris, garbage, trash and other hazardous conditions.

       Fla. Admin. R. 65E-9.005(a)2

   12. On October 13, 2010, the Agency conducted a survey of the Respondent facility and found the facility out of compliance with the above Rule.

   13. Based on observation and interview, the facility failed to ensure that the grounds accessed by patients were maintained in a safe manner, free from debris and hazardous conditions. Findings included:

       Outside of a hallway connected to Group Home #5 is a yard surrounded by a fence. The yard is accessed through a door in the hallway. During an interview, the Chief Operating Officer confirmed that patients have access to the yard.

       
       

       The ground had several depressions in the grass and was not level, creating a potential trip hazard. The yard also contained rocks of various sizes and cement pieces of various sizes, one approximately 2 x 1.5 feet wide.

       
       

       There were two 6 x 6 foot posts cut off at 8 inches above the ground, broken pipe pieces, an uncapped pipe, 3 x 3 inches and a metal rod one-half inch in diameter and 3 inches above the ground sticking up from the ground.

       
       

       During an interview, the Chief Operating Officer confinned that the mobile home, kept in the yard previously, had been removed. He agreed that the hazardous items, above noted, needed to be removed.

       
       

   14. The facility's failure to maintain the grounds in a safe and reasonably attractive manner, free from hazardous conditions, was unacceptable.

   15. The Agency detemiined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class II violations.

       
       

   16. The Agency cited the Respondent for a Class III violation in accordance with Section 408.813(2)(c), Fla. Stat. (2010). It also provided a mandatory correction date of November 13, 2010.

   17. On June 6 through 9, 2011, the Agency returned to the facility for a revisit and Complaint investigation, CCR# 2011005878. Based on facility record and staff interviews, it was determined that the facility was still not maintaining its grounds in a safe manner.

   18. Based on observation and staff interviews, it was dete ined that the facility failed to maintain ou side grounds in a safe manner. Findings included:

       On June 6, 2011, outside common area for Group Homes #5, a hole was observed in the ground, approximately 2 feet by 1 foot and 9 inches deep in front of a door to another Group Home (Pegasus).

       
       

       A fenced gated yard on the south east comer of the building and located between Group Homes #5 (Lynx) and, another group home (Orion), was also accessed by Group Homes #5 patients. A large hole was observed in the ground under the fence, approximately 5 feet by 4 feet wide and 1.5 feet deep. During an interview, the Group Home Manager confirmed that patients had dug the hole.

       The hole extended into the fenced outside area of Group Homes# 5.

       
       

   19. The facility's continued failure to maintain the grounds in a safe and reasonably attractive manner, free from hazardous conditions, is a violation of Florida law.

   20. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

   21. The Agency cited the Respondent for an uncorrected Class III violation in accordance

       
       

       with Section 408.813(2)(c), Florida Statutes (2010).

       
       

       WHEREFORE, the Agency intends to impose an administrative fine in the amount of

       five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2010).

       COUNT II - tag C031

       
       

   22. The Agency re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set forth herein.

   23. A residential treatment center is required to keep both interior and exterior of its buildings safe and in good repair as follows:

       Facility standards - Buildings, grounds and equipment.

       The interior and exterior of buildings and the furniture and furnishings shall be safe, comfortable, reasonably attractive, in good repair and shall function for the purpose for which such building and furniture has been designed.

       
       

       Fla. Admin. R. 65E-9.00S(a)6

   24. On October 13, 2010, the Agency conducted a survey of the Respondent facility and foW1d the facility out of compliance with the above Rule.

   25. Based on observations and staff interview, the facility failed to ensure that the interior building was equipped in a safe manner with regards to Wl-caulked handrails that had sharp edges where the metal met along the base of the rail. Findings included:

       The bathrooms ofrooms 501, 502 and 503 had hand rails along the wall next to the commodes. The hand rails had been filled with metal to disallow anyone from grasping the entire surface. During the inspection, a very sharp edge was found along all three. The Chief Operating Officer agreed during an interview that the edges were too sharp and needed to be caulked to protect the patients.

   26. The facility's failure to maintain the interior building bathrooms in a safe manner for the patients was unacceptable.

   27. The Agency determined that this deficient practice was related to the operation

       
       

       )

       \

       )

       
       

       and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threatens the physical or emotional health, safety, or security of patients, other than class I or class II violations.

   28. The Agency cited the Respondent for a Class III violation in accordance with Section

       
       

       408.813(2)(c), Fla. Stat. (2010). It also provided a mandatory correction date ofNovember 13,

       
       

       2010.

       
       

   29. On June 6 through 9, 2011, the Agency returned to the facility for a revisit and Complaint investigation, CCR# 2011005878. Based on facility record and staff interviews, it was determined that the facility was still not maintaining its interior building in a safe manner.

   30. Based on observation and interview, the facility failed to ensure that it maintained the interior of the building in a manner that promoted a safe and sanitary environment in regards to a missing shower curtain and a broken laundry basket. Findings included:

       On June 6; 2011, there was no shower curtain in the Room 501 patient's bathroom. During an interview, The Group Home Manager said that the shower curtain had been missing since Friday, June 3, 2011, and this had been reported to maintenance. However, during a second observation on June 8, 2011, the shower curtain was still missing.

       
       

       IIi Room 502, on observation, the handles of a laundry basket were broken and missing and the body of the basket was also broken.

       
       

   31. The facility's continued failure to maintain the interior building in good repair is a violation of Florida law.

   32. The Agency determined that this deficient practice was related to the operation and maintenance of a provider or to the care of patients which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of patients, other than class I or class II violations.

   33. The Agency cited the Respondent for an uncorrected Class III violation in accordance

with Section 408.813(2)(c), Florida Statutes (2010).

WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Respondent, a residential treatment programs for children and adolescents in the State of Florida, pursuant to Section 408.813(2)(c), Florida Statutes (2010).

NOTICE OF RIGHTS

Respondent is notified of its right to request an administrative hearing pursuant to§ 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights.

All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, FL 32308; Telephone (850) 412-3689.

RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN

ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been served by U.S. Certified Mail, Return Receipt No. 7010 0780 0001 9836

0226 to CT Corporation System, Registered Agent for Premier Behavioral Solutions of Florida, \ Inc., 1200 South Pine Is and Road, Plantation, FL 33324 and by U.S. Mail to JeffTuriczek, Administrjttor, Manat Palms Group Homes #5, 1324 37th Avenue East, Bradenton, FL 34208,

cr-

this 2_ of A ust, 2011.

STATE OF FLORIDA, AGENCY FOR HE HCARE A MINISTRATION

S e

Fla. B No.

The Sebnng Building

525 Mirror Lake Dr. N., Suite 330K· St. Petersburg, Florida 33701

Phone: (727) 552-1945 / Fax: (727) 552-1440

Copy furnished to: Pat Caufman, FOM

8

/

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: Premier Behavioral Solutions of Florida, Inc. d/b/a Manatee Palms Group Homes #5

CASE NO, 2011006776

ELE<;TJQN OF RIGHTS

This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fe Notice of Intent to Impose a Late Fine or Administrative Complaint.

four Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Notice oflJJtent to Impose a Late Fee. Notice oflntent tQ Impose a Late Fine or Admini,trative Complaint.

If your Election of Rights with your selected option is not received by AHCA within twenty­ one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency's proposed action and a fmal order will be issued.

(Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)

PLEASE RETURN YOURELECTION OF RIGHTS TO THIS ADDRESS:

Agency for Health Care Administration Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308.

Phone: 850-412-3630 Fax: sso.921..01ss.

PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS

OPTION ONE (1)   I admit to the allegations of facts and law contained in the Notice

of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a bearing. I understand that by giving up my right to a hearing, a final order will be i_ssued that adopts the proposed agency action and imposes the penalty, fine or action.

OPTION TWO (2) I admit to the aDegations of facts contained in the Notice of Intent

to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced.

OPTION THREE (3) _ I dispute the aDegations of fact contained in t)le Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE NQTI: Choosing OmON THREE (3), by itself, is mil suff'teient to obtain a formal hearing. You also must tile a written petition in order to obtain a formal hearing before

b ) \

the Division of Administrative Hearings under Section 120.57(1), Flonda Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which regyires that it contain:

1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any.

2. The file number of the proposed action.

3. A statement of when you received notice of the Agency's proposed action.

4. A statement of all disputed issues of material fact If there are noner you must state that there

   are none.

   Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency

   agrees.

   
   

   License type:                 (ALF? nursing home? medical equipment? Other type?)

   Licensee Name:                                       License number:            Contact person:                                                                                                  

   Name

   Address:

   Street and number City

   Title

   
   

   Zip Code

   
   

   Telephone No.              Fax No.              Email(optional).                    _

   
   

   Ihereby certify that I amduly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.

   
   

   Signed:                                               Date:                        

   
   

   Print Name:                                       Title:                                 

   
   

   Late fee/fme/AC

   
   

   
   

   STATE OF FLORIDA

   AGENCY FOR HEALTH CARE ADMINISTR,\ TION

   
   

   STATE OF FLORIDA, AGENCY FOR

   HEALTH CARE ADMINISTRATION, Case No. 12-l l 8PH

   
   

   Petitioner,	AHCA Nos. 2011006764
   	2011006766
   vs.	2011006769
   	2011006774
   PREMIER BEHAVIORAL SOLUTIONS	2011006776
   OF FLORIDA, INC., d/b/a	2012002157
   MANATEE PALMS GROUP HO 1ES,	2012002160
   	2012002200
   Respondent.	2012002203

   
   

   SETTLEMENT AGREEMENT

   
   

   The Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), by and through its undersigned representatives, and the Respondent, Premier Behavioral Solutions of Florida, Inc. dlb/a Manatee Palms Group Homes (..the Respondent"}, pursuant to Section 120.57(4), Florida Statutes, enter into this Settlement Agreement ("Agreement") and agree as follows:

   WHEREAS, the Respondent ·was licensed as a residential treatment center pursuant to

   
   

   Chapter 408, Part IT, and Chapter 394, Florida Statutes; and

   
   

   WHEREAS, the Agency has jurisdiction by virtue of being the licensing and regulatory authority over the Respondent pursuant to the above-referenced provisions; and

   WHEREAS, the Agency served the Respondent with Administrative Complaints and was prepared to serve additional Administrative Complaints notifying the Respondent of the Agency's intent to impose administrative fines; and

   WHEREAS, the parties have negotiated and agreed that the best interest of all the parties

   
   

   will be served by a settlement of this proceeding;

   
   

   Pagel of5

   
   

   NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows:

   1. All recitals herein are tme and correct and are expressly incorporated herein.

1. All parties agree that the above "whereas" clauses incorporated herein are binding findings of the parties.

2. Upon full execution of this Agreement the Respondent agrees to waive any and all appeals and proceedings to which it may be entitled including, but not limited to. an infonnal proceeding under Subsection 120.57(2), Florida Statutes, a formal proceeding under Subsection 120.57(1), Florida Stahltes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court of competent jurisdiction; and agrees to waive compliance with the form of the Final Order ( findings of fact and conclusions of law) to which it may be entitled, provided, however, that this agreement shall not be deemed a waiver by either party of its right to judicial enforcement of this Agreement.

3. Upon full execution of this Agreement, the Respondent agrees to pay the Agency

   
   

   $23,000.00 within 30 days of the entry of the Final Order.

   
   

4. Venue for any action brought to interpret, enforce or challenge the terms of this Agreement and its corresponding Final Order shall lie solely in the Circuit Court of FJorida, in and for Leon County, Florida.

5. By executing this Agreement, the Respondent neither admits nor denies the allegations set forth in the Administrative Complaints or Statements of Deficiencies. Should the Agency attempt to use any of these alleged violations against the Respondent in any manner, the Respondent retains all rights wider Florida law to contest the allegations of fact and conclusions of Jaw and any sanction that the Agency may seek to impose.

6. Upon full execution of this Agreement, the Agency shall enter a Final Order

   
   

   adopting and incorporating the tenns of this Agreement and closing the above-styled case.

   
   

7. Each party shall bear its own costs and attorney's fees.

   
   

8. This Agreement shall become effective on the date upon which it is fully executed by all parties.

l 0. The Respondent, for itself and its related or resulting organizations, successors. transferees, attorneys, heirs. and executors or administrators, discharges the State of Flolida, Agency for Health Care Administration, and its agents, representatives, and attomeys, of and from all claims. demands. actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever. arising out of or in any way 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 administrative fomm, including any claims arising out of this agreement, by or on behalf of the Respondent or its related or resulting organizations.

1. This Agreement is binding upon all parties and those persons and entities that are identified in the above paragrnph.

2. In the event that the Respondent was a Medicaid provider at the time of the occurrences alleged in the Administrative Complaints, this Agreement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any further sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not settle any pending or potential federal issues against the Respondent. This Agreement does not prohibit the Agency from taking any action regarding the Respondent's Medicaid provider status, conditions, requirements or contract, if applicable.

3. The Respondent agrees that if any funds to be paid under this Agreement to the Agency arc not timely paid as set forth in this Agreement, the Agency may deduct the amounts assessed against the Respondent in the Final Order, or any portion thereof, owed by the

   
   

   Respondent to the Agency from any present or future fw1ds owed to the Respondent by the Agency, and that the Agency shall hold a lien against present and future funds owed to the Respondent by the Agency for said amounts until paid.

4. The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. The Respondent has the legal capacity to execute this Agreement. The Respondent understands that it has the right to consult \\7ith its own independent counsel and has knowingly and freely entered into this Agreement. The Respondent understands that Agency counsel represents only the Agency and that Agency counsel has not provided any legal advice to, or influenced, the Respondent in its decision to enter into this Agreement

5. This Agreement contains and incorporates the entire understandings and agreements of the parties. This Agreement supersedes any prior oral or written agreements between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void.

6. All parties agree that a facsimile signature suffices for an 01iginal signature and that this Agreement may be executed in counterparts.

The following representatives acknowledge that they are duly authorized to enter into this Agreement.

Molly Mc · stry, Deputy Secretary Agency for ealth Care Administration 2727 M Drive, Bldg. #3

Tallahasse,e, Florida 32308

K        

..,.

... --,

: :J)tr:")fl:i£>·e

Premier Behavioral Solutions of Florida, Inc.,

d/b/a Manatee Palms Group Homes

DATED: DATED: -------

s, General Counsel Office of the General Counsel

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32 8

Thomas M. Hoeler, Chief Facilities Counsel Office of the General Counsel

dzbi

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308

DATED:                                

Esquire Smith & Associates

2834 Remington Green Circle Tallahassee, Florida 32308 Counsel for Respondent

Docket for Case No: 11-005126

Orders for Case No: 11-005126