OT dILY STATE OF FLORIDA ; AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS WITH DISABILITIES, Os es License Cert. Nos. 11-640, 11-40, @ eo and 11-804 © a“, et & et Petitioner, & a v. po SS RAINBOW RANCH GROUP HOME No. 1, INC.; RAINBOW RANCH GROUP HOME No. 2, INC.; RAINBOW RANCH GROUP HOME No. 3, INC., Respondents. ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner’), files this Administrative Complaint against the above-named RAINBOW RANCH GROUP HOMES, (“Respondents”), and states: 1. Petitioner is the state agency charged with regulating the licensing and operation of foster care facilities, group home facilities, and residential habilitation centers, pursuant to Section 20.197 and Chapter 393, Florida Statutes. 2. Respondents are: Rainbow Ranch Group Home #1, Inc., Rainbow Ranch Group Home #2, Inc., and Rainbow Ranch Group Home #3, Inc. (hereinafter collectively referenced as “Rainbow Ranch” or individually as “Group Home #1”, Group Home #2, or Group Home #3, as appropriate). The homes are under common management and ownership. 3. At all times material to this Complaint, Respondents have held licenses _..ssued_by.the Agency for.Persons with Disabilities for.group.home facilities at the following addresses: Group Home #1 at 310 Northwest Drive, Miami, Florida; Group Home #2 at 1890 NE 37 Avenue, Homestead, Florida; Group Home #3 at 17335 Southwest 248 Street, Homestead, Florida. 4. In addition to operating group homes, Rainbow Ranch has contracted with the Agency to provide the residents in those homes with Medicaid Waiver developmental disability services, including in-home support services, residential habilitation services, respite care, behavioral assistant, and non-residential support services. 5. On June 1, 2007, the Agency filed an emergency suspension order pursuant to sections 120.60(6) and 393.0673(4), Florida Statutes, suspending the licenses of the three Rainbow Ranch group homes based on a threat of imminent and irreparable harm to the residents of those facilities. 6. Before the Agency issued the emergency order, Rainbow Ranch housed eight residents with developmental disabilities, including mental retardation, Prader-Willi syndrome, and autism. 7. Seven of the eight former residents are children, and four of those children are in the custody of the Department of Children and Families. 8. On Wednesday, May 23, 2007, a twelve-year-old autistic resident of one of the Rainbow Ranch homes (“D.M.”) died unexpectedly during a trip to the flea market with seven other residents, while in the care of Rainbow Ranch employees. The cause of death has not been determined. ‘D.M. was in good -health-before his.death. 9. Mr. Sanchez, the driver, dropped two staff persons and three children off in front of the market, parked the van, and went inside the flea market, leaving Ms. Gross, the sole staff member in the van with the remaining four children. This was inadequate supervision for the children in light of their known disabilities and medical conditions. 10. When Mr. Sanchez returned, D.M. was screaming and kicking. Ms. Gross laid D.M. prone on the seat and restrained his legs. Soon, they noticed that D.M. was silent and non-responsive. Ms. Gross turned D.M. over on his back and discovered that he was not breathing. 11. Mr. Sanchez and Ms. Gross attempted to revive him, and called 911. D.M. was transported by paramedics to a hospital where he was pronounced dead. 12. The Department of Children and Families investigated the death and issued a report that included a history of abuse investigations involving D.M. at Rainbow Ranch. The Department of Children and Families also reported previously conducting abuse investigations involving other children residing at Rainbow Ranch, including the following: (A). Report No. 2007-335885: The Department of Children and Families investigated a February 28, 2007 report the G.R. had spots of blood in his diaper. DCF received reports that the child had a bite mark, scratches, and decreased tone in his rectum. Jackson Rape Center diagnosed him as having been anally penetrated. The Department.closed the case. with some indicators of lack.of supervision. (B)._ Report No, 2007-323182: The Department investigated a February 7, 2007 report that a small child hit another child who weighs 200 Ibs. The larger child retaliated by hitting the smaller child On the arm. Rainbow Ranch staff noticed the bruise the next morning and took the child to the hospital, where X-rays revealed his arm was broken. The report concluded with some indicators of inadequate supervision and neglect. (C). Report No. 2007-303829: The Department received an abuse report alleging abrasions, sores, and bruises in the shape of fingers on D.M. A second report alleged that Rainbow Ranch neglected him, overmedicated him, and he had to be hospitalized because he was overmedicated. The investigator stated that he would monitor the facility, contact David Glatt as to the complainant's concerns, and concluded the report with a finding of some indicators of inadequate supervision and neglect. (D). Report No.2006-477762: A complainant alleged that a child’s caregiver dispensed medications to the child at non-prescribed times and non-prescribed doses, causing side effects sleepiness, excessive drooling, and tremors. The report concluded with some indicators of medical neglect, based on a teacher’ report that the child was sleeping in class, shaking, and trembling, and that a _psychiatrist visiting the school.immediately stated that the child was...............0. over-medicated. {E), Report No. 2006-400376: A complainant reported that an autistic and mentally retarded child was “acting out” and the facilities owner tied his feet and hands together and put him in a closet. The child, who is non-verbal, demonstrated to the investigator how he was tied up by crossing his legs. His mother removed him from Rainbow Ranch with the assistance of Miami- Dade Police. The report concluded that the risk level associated with the case was high because the child does not speak clearly, but added that he is safe as he is no longer residing at Rainbow Ranch. 13. In an April 2, 2007 memorandum to the Agency’s Central Office, Agency employee Hilary Jackson reported that she had received complaints about Rainbow Ranch Homes #1 and #2 from three waiver support coordinators. One coordinator, Ms. Gloria Sue Diaz, formally advised Ms. Jackson of a number of concerns with Rainbow Ranch, including the following: (A). A lack of a direct care worker for her client despite repeated statements that the client needs one-to-one supervision and a high number of direct care hours; (B). Certified behavioral assistant services not in place, despite approval of.the.services,.a-behavior assistant plan, and-documented.billing.for.the services; (C). Requests by Rainbow Ranch personnel that she change her client's | doctor to the doctor Rainbow Ranch uses and Rainbow Ranch’s failure to adhere to medication dosages and schedules. 14. Ms. Jackson also received a complaint from an Agency client’s mother regarding her son “G.C.,” a Rainbow Ranch resident. The mother reported that G.C. appeared to be overmedicated when she took him home; that there was an unexplained bite mark on his face; and when she attempted to visit G.C., no one would open the door to the group home. She added that Rainbow Ranch employer/director, David Glatt, would not return her telephone calls. 15. Ms. Jackson and another Agency employee, Kirk Ryon, also spoke with Marc Kepner, a Clinical Psychologist Intern, who expressed concerns about two young clients residing at Rainbow Ranch that attend school where he works. Mr. Kepner reported that one of them appeared lethargic but seemed to be improving; he also expressed concern about sexually inappropriate behaviors the two children displayed towards each other and towards staff. 16. Ms. Jackson and Mr. Ryon also spoke with Ms. Anne Siede, a former Rainbow Ranch manager, who reported the following: (A). Rainbow Ranch failed to report incidents in the log book to the Agency as required. (B). The homes were inadequately staffed, with Rainbow Ranch providing only two.staff.persons.for four.clients, and.on the.evening. shift,.providing-only one staff person. (C). Rainbow Ranch did not provide adequate medical attention, such that she refused to work with one client who was always asleep and barely walking; she insisted that he be taken to the hospital, where he was diagnosed with meningitis and admitted for treatment. On another occasion, Ms. Seide’s brother, who worked at Rainbow Ranch on the night shift, found a child crying in pain with a swollen arm. He called Ms. Seide at another Rainbow Ranch home for assistance, but she was alone and could not leave. She could not reach any of the Rainbow Ranch administrators. When the child was taken to the hospital the next day, he was diagnosed with a broken arm. (D). The group home provided inadequate food, relying on restaurant- delivered meals during the week but providing very little food on weekends, with the residents eating whatever the staff could gather. Ms. Seide also related that a Rainbow Ranch staff worker called her for assistance when there was no food to give the residents. The staff worker had managed to find some hot dogs, which she gave to the clients without bread. One of the residents wanted more because he was still hungry; however, there were no more hot dogs and the client punched the staff person in the eye. , (E). Rainbow Ranch provided inadequate training to staff. Ms. Seide witnessed staff stress and Agency clients always agitated and out of control on the day shift. She stated that David Glatt assigned her management responsibilities, although she had little experience in management and little help from Mr. Glatt. | (F). Rainbow Ranch was receiving compensation for more staff than it was supplying. 17. After meeting with Ms. Seide, Ms. Jackson began requesting the case notes from other waiver support coordinators. She observed that many of the support coordinators and parents or guardians shared concerns regarding children being overmedicated at Rainbow Ranch, and Mr. Glatt's unavailability. 18. Ms. Jackson also obtained prescription records for the eight clients residing at Rainbow Ranch and found that a physician not listed in the clients’ support plans as a provider was prescribing psychotropic medications for four residents. 19. Rainbow Ranch does not have consents from the appropriate parties for the physician to prescribe psychotropic medications for the patients involved. 20. Rainbow Ranch permitted prescriptions for psychotropic drugs to run out without being timely refilled by the prescribing physician. An agent or employee of Rainbow Ranch, Dr. Robert Auston, prescribed replacement drugs without consulting with the established physician for the children or conducting the examination required by the applicable standard of practice. 21. The Agency issued a Corrective Action Plan dated January 27, 2007 requiring that Rainbow Ranch correct the following violations: obtain background screening, provide appropriate staff training, submit an Emergency Plan, report staff vacancies, post information regarding the Florida Advocacy Council, and provide proof of Worker's Compensation insurance. Rainbow Ranch corrected _-the violations. 22. But shortly afterwards, on February 28, 2007, Agency inspection of Group Home #1 and Group Home #2 revealed more deficiencies, in violation of the statutes or rules regulating licensed group homes: (A). | Overall lack of appropriate documentation of Medicaid services, including Behavior Focus services and Residential Habilitation services; (B). Lack of documentation of medication administration, medications missed without explanation, medications charted but not initialed; (C). Inadequate staffing and supervision of the residents; (D). Prescription of medication and restraint devices by an unauthorized physician; (E). Prescription and use of unauthorized restrictive devices (i.e., posey mitts); (F). Medical neglect through delay in seeking timely medical attention and treatment; (G). Doctors’ orders missing; (H). ~ No health and safety notes in client’s files; (I). Diagnoses and allergies missing on a medication administration record; (J). | Physician’s statements of client ability either missing or not signed; (K). | Client behavior data not recorded, with gaps of months between recordings. 23. David Glatt served the Rainbow Ranch homes as a supervisor, . manager, and service. provider..Rainbow-Ranch_never declared_his involvement or responsibilities in its licensing submissions. Nor did it provide information about Mr. Glatt’s experience, training or background screening. VIOLATIONS ALLEGED. 24. Section 393.067(13), Florida Statutes, provides that facilities and programs licensed pursuant to this section shall adhere to all rights specified in section 393.13, including those enumerated in s. 393.13(4), Florida Statutes. Section 393.13(4), Florida Statutes, provides that the term “client,” as defined in s. 393.063, shall also include any person served in a facility licensed under section 393.067, Florida Statutes. Section 65G-2.005, Florida Statutes, provides that a license shall be revoked at any time, pursuant to Chapter 28-107, Florida Administrative Code, if the applicant fails to maintain applicable standards or to observe any limitations specified in the license. COUNT I. 25. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 26. Based on the foregoing, Respondents violated section 393.13(3)(a), Florida Statutes, which states that persons with developmental disabilities shall have a right to dignity, privacy, and humane care, including the right to be free from sexual abuse in residential facilities. 10 COUNT Il. 27.. Petitioner realleges-and-incorporates.the allegations.set forth.in paragraphs 1 through 23. 28. Based on the foregoing, Respondents violated section 393.13(3)(g), Florida Statutes, which states that persons with developmental disabilities shall have a right to be free from harm, including unnecessary physical, chemical, or mechanical restraint, isolation, excessive medication, abuse, or neglect. COUNT III. 29. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 30. Based on the foregoing, Respondents violated section 393.13(4)(c), Florida Statutes, which provides that each client shall receive prompt and appropriate medical treatment and care for physical and mental ailments and for the prevention of any illness or disability. COUNT IV. 31. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 32. Based on the foregoing, Respondents violated section 393.13(4)(c) 1., Florida Statutes, which states that medication shall be administered only at the written order of a physician and shall not be used as punishment, for the convenience of staff, as a substitute for implementation of an individual or family support plan or behavior- analysis services, or in unnecessary or excessive quantities. COUNT V. 33. . Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 34. Based on the foregoing, Respondents violated section 393.13(4)(c) 2., Florida Statutes, which requires that daily notation of medication received by each client in a residential facility be kept in the client’s record. COUNT VI. 35. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 36. Based on the foregoing, Respondents violated section 393.13(4)(h), which states that clients shall have the right to be free from the unnecessary use of restraint or seclusion and that restraints shall be employed only in emergencies or to protect the client or others from imminent injury; restraints may not be employed as punishment, for the convenience of staff, or as a substitute for a support plan; restraints shall impose the least possible restrictions consistent with their purpose and shall be removed when the emergency ends. COUNT VII 37. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 38. Based on the foregoing, Respondents violated section 393.13(4)(h)1., Florida Statutes, which requires that daily reports on the employment of restraint seclusion be made to the administrator of the facility or program licensed under this chapter, and a monthly compilation of such reports shall be relayed to the 12 agency’s local office. The monthly reports shall summarize all such cases of _~festraints, the type used, the duration of usage, and.the.reasons therefor... - - COUNT VIII 39. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 40. Based on the foregoing, Respondents violated Rule 65 G-2.012 (4), Florida Administrative Code, which states that group home facility services shall include but not be limited to provision of adequate living accommodations, proper and adequate dietary supervision, appropriate physical care, support, guidance, supervision, and assistance with training required to assure each individual the opportunity for personal growth and development. COUNT IX 41. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 42. Based on the foregoing, Respondents violated of Rule 65G- 2.012(10)(b), Florida Administrative Code, which states that each client shall receive adequate and appropriate attention each day from the staff, regardless of the client’s chronological age, degree of retardation or accompanying handicaps. | COUNT X 43. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 44. Based on the foregoing, Respondents violated Florida Administrative Code Rule 65G-2.012(5)(a), which provides in pertinent part that sufficient staff shall be provided to ensure that facility operation is not dependent upon the use ~-of clients or volunteers;-Rule-65G-2.012(5)(c), which provides in-part-that staff shall be of suitable physical and mental ability to care for the clients they propose to serve; have knowledge of the needs of-the clients; be capable of handling an emergency situation promptly and intelligently; and be willing to cooperate with supervisory staff. COUNT XI 45. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 46. Based on the foregoing, Respondents violated Rule 65G-2.012(9)(a), Florida Administrative Code, which requires that food and beverages shall be of adequate quantity and variety, served at appropriate temperatures, prepared by methods which conserve nutritional value, and served in a form easy for the clients to manage. Respondents also violated Rule 65G-2.012(9)(c)3. which states that fresh foods sufficient for two days and staple food supplies sufficient for at least five days shall be available in the facility at all times. Respondents also violated Rule 65G-2.012(9)(d)1. which states that dining and serving arrangements shall provide for a variety of eating experiences and the opportunity for clients to make food selections with guidance. COUNT XIil 47. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 14 48. Based on the foregoing, Respondents violated Rule 65G- 2.012(23)(c), Florida-Administrative Code,-which-states.that serious illness, accident, injury, death, assault, and missing clients should be handled as an emergency; staff should meet the immediate needs of the client and then report to incident by telephone to the area office as instructed by the social worker serving the facility; in suspected cases of abuse, the incident should be reported to the Central Abuse Hotline. COUNT Xill 49. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 50. Based on the foregoing, Respondents violated Rule 65G- 2.012(14)(a), Florida Administrative Code, which states that no client shall be given prescriptive medication or treatment except upon the written order of the physician of the individual. Respondents also violated Rule 65G-2.012(14)(d), which requires that a daily record must be kept of prescription and/or nonprescription medication administered, except which self-medication is approved as part of the habilitation plan. The record must specify the client’s name, date, time, dosage, name of medication, and signature of person administering. COUNT XIV 51. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 52. Based on the foregoing, Respondents violated Rule 65G- 2.012(15)(b),.Florida Administrative Code,.which.states that the facility shall take all reasonable precautions to assure that no client is exposed to, or instigates, such behavior as might be physically or emotionally injurious to him/herself or to another person. COUNT XV 53. Petitioner realleges and incorporates the allegations set forth in paragraphs 1 through 23. 54. Based on the foregoing, Respondents violated section 393.067, Florida Statutes by not disclosing managers and supervisors or providing information about their training and experience. WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following penalties: administrative fine not to exceed $1,000 per offense; suspension, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other relief authorized by Chapter 393, Florida Statutes, or the rules promulgated thereto. Rebecca M. Maguire, Chief, Bureau of R ential and Clinical Supports. Agency for Persons with Disabilities By delegation of the Director, Jane E. Johnson June 22, 2007 STATE-OF.FLORIDA.... AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS Respondent: | have read the accompanying Administrative Complaint and Explanation of Rights in this matter, and elect as follows (MARK ONE BOX ONLY): HEARING OPTIONS do not dispute the facts alleged in the Administrative Complaint and wish to be heard on the issue of penalty or conclusions of law. | request an informal hearing pursuant to Section 120.57(2), Florida Statutes. | understand that at that hearing | will be permitted to submit only written or oral evidence in mitigation of the charges or explain why the facts alleged do not constitute a violation of law. | dispute the material facts alleged in the Administrative Complaint and request an evidentiary hearing pursuant to Section 120.57(1), Florida Statutes. Please be advised this is a legally binding document, and contains important information regarding your rights. Should you desire advice regarding your response, you may wish to seek legal counsel before proceeding. By signing this document, you represent you are authorized to act on behalf of the establishment named herein and accept responsibility for compliance with any final order resulting from this action. Failure to complete, sign and return the election of rights form within 30 days of receipt may constitute a waiver of your right to be heard in this matter and the Agency may commence proceedings without your participation which may result in possible penalties against your license. As provided in §393.063(1), Florida Statutes, penalties may include suspension, revocation or denial of licensure, and fines up to $1000 per day for each violation. 17 Representative: Telephone No.: Fax: Signature: Date: Print Name: Title: Business Location Address: City State Zip Mailing Address City State Zip MAIL OR FAX THIS COMPLETED FORM TO: Michael MCGuckin, Esq., Agency Clerk, Agency for Persons with Disabilities 4030 Espianade Way, Suite 380, Tallahassee, Florida 32399-0950 You are advised, per Section 120.573, Florida Statutes, that mediation is not available for this action. STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES EXPLANATION OF RIGHTS The enclosed Administrative Complaint: charges you with violating one or more provisions of Chapter 393, Florida Statutes, or the rules promulgated thereto. If you have questions regarding your response or best course of action, you may wish to seek competent legal counsel. Failure to make an election, as described below, within the 30 days of your receipt of this Administrative Complaint may waive your right to a hearing in this matter, and the Agency may proceed against you without your participation. Your receipt of this Administrative Complaint packet constitutes service upon you. Your rights under Florida law (Chapter 120, Florida Statutes) are as follows: You may elect to not dispute the violations alleged in the Complaint and request that a hearing be held pursuant to section 120.57(2), Florida Statutes, in order to present testimony or documents you wish the Agency to consider in mitigation of the alleged violations prior to disposition of this case. Any penalty levied will be included in a Final Order. If a dispute of material fact arises, the hearing will be terminated and the case referred to the Division of Administrative Hearings. You may elect to dispute the violations alleged in the Complaint and request a hearing on the disputed facts before an Administrative Law Judge, which is an administrative “trial”. You and the Agency will be given an opportunity to present evidence and witnesses to prove or disprove the facts alleged and, after the hearing, submit a written proposed recommended order for the Judge’s consideration. Based on the evidence and testimony presented and any proposed recommended orders submitted by the parties, the Judge will issue a Recommended Order to the Agency containing Findings of Fact, Conclusions of Law, and Recommended Penalty, if any. The parties may submit exceptions to the Recommended Order. Following review of the Recommended Order and exceptions, if any, the Agency may issue a Final Order. You also may elect to waive hearing in this matter, and the Agency will continue proceedings and possible penalty without your participation. An Election of Rights form is included with the Administrative Complaint. You must respond to the Administrative Complaint by electing one of the options on the Election of Rights form and the Agency must receive it within 30 days of your receipt of this Administrative Complaint packet. Failure to make an election within 30 days, as described in paragraphs 1 and 2 above, will waive your right to a hearing. After the Agency determines whether a dispute of material fact exists, it will make arrangements on your behalf for the appropriate hearing. You will receive notice of the date, time, and place of hearing at the address designated by you on your Election of Rights. Please note, per Chapter 120.573, Florida Statutes, mediation is not available in this action. . 20

Docket for Case No: 07-003168