Dec 2 2009 16:55 Dec O02 2009 4:32PM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS WITH DISABILITIES, : License No. 7050 Petitioner, v. CARC — Advocates for Persons with Disabilities, Respondent. ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner” or “Agency’), issues this Administrative Complaint against CARC — Advocates for Persons with Disabilities (or “Respondent”’), and says: 1. Petitioner is the state agency charged with regulating the licensing and operation of foster care facilities, group home facilities, and residential habilitation centers, pursuant to Section 20.197 and Chapter 393, Florida Statutes. ’ 2. At all times material to this complaint, Respondent has held one group home facility license issued by the Agency for a residence at the following address: 286 Lochlyn Terrace, Lake City, Florida, 32025. 3. Section 393.0673(1)(a)(3), Florida Statutes, provides that the Agency may revoke or suspend a license, or impose an administrative fine if the licensee has failed to comply with the applicable requirements of Chapter 393, Florida Statutes, or the rules applicable to the licensee. P- Dec O02 2009 4:32PM APD Dec 2 2009 16:36 8504100665 FACTUAL ALLEGATIONS 4. Rule 65G-2.012(19)(a}(3), F.A.C. requires, in pertinent part, that: The group home shall have prior approval of area office staff of its intent to accept other than Agency clients. | 5. Rule 65G-2.012(19)(a)(4), F.A.C. requires that: Area office staff shali give prior approval for any admissions which vary from criteria included in the application for licensure as a residential facility. 6. On January 8, 2009, it was discovered by APD residential monitoring staff that the Respondent had permitted A.H., who was not a client of the Agency, to move into the group home without obtaining prior approval from the Agency. | 7, The Respondent stated in its initial application for licensure that the group home would only serve adults. No change of admission criteria had ever been’ requested by the Respondent. At the time of her admission to the group home, A.H. was seventeen years old. 8. On March 4, 2009, an incident report was sent by the Respondent to the Agency alleging that two other residents of the group home had sexually assaulted A.H. COUNT |. 9, Based on the foregoing, the Respondent viclated Rule 65G- 2.012(19)(a)(3), F-A.C. by failing to obtain prior approval from the Agency of its intent to accept other than Agency clients. P- Dec 2 2009 16:36 Dec O02 2009 4:33PM APD 8504100665 COUNT Il 10. Based on the foregoing, the Respondent violated rule 65G- 2,012(19)(a)(4), F.A.C. by failing to obtain prior approval of an admission which varied from the criteria included in its application for licensure as a residential facility. WHEREFORE, Petitioner respectfully requests entry of an order imposing the following penalties: administrative fine not to exceed $1,000 per offense and/or any other relief authorized by Chapter 393, Florida Statutes, or the rules promulgated thereto, this honorable tribunal deems fair and equitable. Assistant General Counsel, Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Dated: October 19, 2009 Cc/ Jim Smith, APD Area 3 Administrator Attachments: Explanation of Rights Election of Rights Form P- Dec 2 2009 16:36 Dec O02 2009 4:33PM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS RESPONDENT: _CARC — Advocates for Persons with Disabilities, Lake City, Florida. I have read the accompanying Administrative Complaint and Explanation of Rights in this matter, and Elect the following hearing option: 01 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 litigation of the charges or explain why the facts alleged do not constitute a violation of law. 0 dispute the material facts alleged in the Administrative Complaint and request an evidentiary hearing pursuant to Section 120.57(1), Florida Statutes. Please be advised this is a legally binding document and contains important information regarding your rights. Should you desire advice regarding your response, you may wish to seek legal counsel before proceeding. By signing this document, you represent you are authorized to act on behalf of the establishment named herein and accept responsibility for compliance with any final order resulting from this action. Failure to complete, sign and return the election of rights form to the agency within 30 days of receipt may constitute a waiver of your right to be heard in this matter and the Agency may commence proceedings without your participation, which may result in penalties against your license. As provided in §393.063(1), Florida Statutes, penalties may include suspension, revocation or denial of licensure, and fines up to $1000 per day for each violation. Telephone number for contact: Fax Signature: Date: Print Name: Title: ee Business Location Address: City State Zip a Mailing Address City State Zip P- Dec 2 2009 16:36 Dec O02 2009 4:33PM APD 8504100665 MAIL OR FAX THE COMPLETED FORM TO: Pete Mallison, Agency Clerk Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 You are advised, per Section 120.573, Florida Statutes, that mediation is not available for this action. Please keep a copy of this document for your records. P- Dec 2 2009 16:37 Dec O02 2009 4:34PM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES EXPLANATION OF RIGHTS The enclosed Administrative Complaint charges you with violating one or more provisions of Chapter 393, Florida Statutes, or the rules supplementing that Chapter. If you have questions regarding your response or best course of action, you may wish to seek the advice of competent legal counsel. Your receipt of this Administrative Complaint packet constitutes service upon you. Your rights under Florida law (Chapter 120, Florida Statutes) are as follows: You may elect to nat dispute the violations alleged in the Complaint and request that a hearing be held to present testimony or documents you wish the Agency to consider in mitigation of the alleged violations prior to disposition of this case. Any penalty levied will be included in a Fina! Order. If a dispute of material fact arises, the hearing will be terminated and the case referred to the Division of Administrative Hearings. You may elect to dispute the violations alleged in the Complaint and request a hearing before an Administrative Law Judge, which is an administrative “trial”. You and the Agency may present evidence and witnesses to prove or disprove the facts alleged and submit a written proposed recommended order after the hearing for the Judge’s consideration. Based on the evidence and any proposed recommended orders submitted, the Judge will issue a Recommended Order containing Findings of Fact, Conclusions of Law, and Recommended Penalty, if any. Following review of the Recommended Order, the Agency will issue a Final Order. An Election of Rights form is included with the Administrative Complaint. The Agency must receive it within 30 days of your receipt of this Administrative Complaint packet. After the Agency determines whether a dispute of material fact exists, it will make arrangements on your behalf for the appropriate hearing. You will receive notice of the date, time, and place of hearing at the address designated by you on your Election of Rights. IMPORTANT: Ifthe Agency does not receive a completed copy of the Election of Rights form, or any other written response from you, within the 30 days of your receipt of this Administrative Complaint, you may have waived your right to a hearing in this matter and the Agency may proceed against you in this matter without your participation. Please note, per Chapter 120.573, Florida Statutes, mediation is not available in this action. P-

Docket for Case No: 09-006603