|O-U920 STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES IN THE MATTER OF: - License Revocation Against Docket # 10-1 Consuming Fire Deliverance Ministries, Inc., ~ d/b/a Joseph Storehouse of Florida Restoration Center License Number 12-41-AD-4883-01 1027 9" Street West, Bradenton, Florida 34205 ADMINISTRATIVE COMPLAINT NOTICE OF LICENSE REVOCATION NATURE OF THE CASE 1. This case arises from the Respondent’s failure to comply with Chapter 397, Florida Statutes, and Rule 65D-30 Florida Administrative Code (F.A.C.) with respect to substance abuse requirements. 2. This is an administrative action for the revocation of the license to provide residential substance abuse services per known incidents of occurrence as authorized in Section 397.415, Florida Statutes, and Rule 65D-30 Florida Administrative Code. 3. Petitioner, State of Florida, Department of Children and Families, is the Administrative agency of the State of Florida, charged with the duty to enforce and administer the provisions of Chapter 397, Florida Statutes, and Rule 65D-30 Florida Administrative Code. 4. Based on its application for a license to operate a residential level Il substance abuse treatment, the Department issued to Joseph Storehouse Restoration Center ("JSFR Center") a probationary treatment license to operate a residential level Il substance abuse treatment center, effective from May 7, 2010 through August 6, 2010. 5. On June 11, 2010, the Department received a letter stating that the Medical Director, Dr. James Hanusa, resigned effective June 11, 2010. Therefgre, the Department sent JSFR Center a letter dated June 11, 2010, advising them that no new admissions are permitted until a new Medical! Director has been named and an agreement detailing the medical director's responsibilities submitted to the Department. The JSFR Center has provided the Department with the name of the new Medical Director, Dr. Robert W. Brochu, but has not provided a copy of a signed agreement detailing the medical director's responsibilities as required. The acts and practices described in paragraph 5 above are violations of Rule 65D-30.004(6), Florida Administrative Code, Medical Director, which states in part: This requirement applies to addictions receiving facilities, detoxification, intensive inpatient treatment, residential treatment, day or night treatment with host homes, and medication and methadone maintenance _ treatment. Providers shall designate a medical director who shall oversee all medical services. The medical director's responsibilities shall be clearly described. The provider shall notify the district office in writing when there is a change in the medical director and provide proof that the new medical director holds a current license in the state of Florida. In those cases where a provider operates treatment components that are not identified in this subsection, the provider shall have access to a physician through a written agreement who will be available to consult on any medical services required by clients involved in those components. The chief executive officer, chief financial officer and the chief executive Officer liaison have not fully complied with the fingerprinting/background screening requirements. Since the submission of the application, there have been assignments of five (5) chief executive officers and not one has fully completed the background screening requirements. Alphonso Davis is either the owner (based on corporate information), an employee or volunteer. Mr. Davis is physically present at the JSFR Center, is making administrative decisions and has direct contact with clients. Dorothy Davis has admitted she is the chief financial officer. Neither Alphonso Davis nor Dorothy Davis have complied with the fingerprinting/background screening requirements. The acts and practices described in paragraph 7 above are violations of Section 397.451(1)(a)1, F.S., Background Checks of Service Provider Personnel, which states in part: All owners, directors, and chief financial officers of service providers are subject to level 2 background screening as provided under chapter 435. Inmate substance abuse programs operated directly or under contract with the Department of Corrections are exempt from _ this requirement. 10. 11. 12. 13. in addition, those acts and practices are violations of Rule 65D- 30.004(4)(b), Florida Administrative Code, Screening of Staff, which states in part: Owners, chief financial officers, and directors, and staff, volunteers, and host families who have direct contact with clients as provided for under Section 397.451, F.S., shall be fingerprinted and have a background check completed. In addition, individuals shall be re-screened within 5 years from the date of employment. Re-screening shall include a level I! screening in accordance with Chapter 435, F.S. The Department conducted a site visit on June 17, 2010, and requested to see the schedules or rosters for the staff working the weekend of June 12- 13, 2010. There were seven (7) residential clients at the JSFR Center that weekend. The JSFR Center did not have schedules and the roster provided stated "vacant". The Chief Execute Officer at that time, Ms. Styles, could not identify who were the staff members on duty the weekend of June 12-13, 2010. Ms. Styles could not provide documentation to identify who worked that weekend. Ms. Styles resigned subsequent to the site visit. Therefore, the JSFR Center could not provide verification of paid awake staff coverage 24 hours a day, seven (7) days a week as required by Rule 65D-30.007(6), Florida Administrative Code. The acts and practices described in paragraph 9 above are violations of Rule 65D-30.007(6), Florida Administrative Code, Staff Coverage, which States in part that, "Providers shall maintain awake, paid staff coverage 24 hours-per-day, 7 days per week." The JSFR Center failed to comply with Rule 65D-30.004(11), Florida Administrative Code, in that it failed to demonstrate that its nutrition and diet plans have been reviewed and approved by a Florida registered dietitian. The acts and practices described in paragraph 11 above are violations of Rule 65D-30.004(11), Florida Administrative Code, Meals, which states in pertinent part, "the provider shall document and ensure that nutrition and dietary plans are reviewed and approved by a Florida registered dietitian at least annually.” The regulations require that a signed and dated psychosocial assessment be completed on each client by clinical staff. If the psychosocial assessment was not completed initially by a qualified professional, the psychosocial assessment shall be reviewed, countersigned, and dated by a qualified professional within ten (10) calendar days of completion. The 14. 15. 16. 17. 18. 19. 20. Department found that this was not done when it conducted an unannounced site visit on June 17, 2010. The acts and practices described in paragraph 13 above are violations of Rule 65D-30.004(14)(b)3., Florida Administrative Code, Psychosocial Assessment Sign-off Requirements, which states in part: The psychosocial assessment shall be completed by clinical staff and signed and dated. If the psychosocial assessment was not completed initially by a qualified professional, the psychosocial assessment shall be reviewed, countersigned, and dated by a qualified professional within 10 calendar days of completion. Inmate Substance Abuse Programs Operated by or under contract with the Department of Corrections, shall conduct the review and sign-off within 30 calendar days. On June 17, 2010, during its site inspection, the Department reviewed the bank statements of the JSFR Center and found that it had a balance of $340.00. As of June 14", 2010, the rent for the facility was at least 3 months in arrears. According to Mr. Keith Lasson, the landlord of the property at 1027 9" Street West, Bradenton, Florida 34205, the rent on the property has not been paid in a significant amount of time. The JSFR Center could not prove its financial ability and organizational capability to continue to operate in accordance with these rules. The acts and practices described in paragraph 15 above are violations of Rule 65D-30.003(6)h., Florida’ Administrative Code, which require documentation of the JSFR Center's “financial ability and organizational capability to operate in accordance with these rules." The Department found that a primary counselor was not assigned to each client placed in a component and no primary counselor could be identified on staff as is required. The acts and practices described in paragraph 17 above are violations of Rule 65D-30.004(16)(a), Florida Administrative Code, Primary Counselor, which states in part that, "A primary counselor shall be assigned to each client placed in a component. This standard does not apply to detoxification and additions receiving facilities." The Department could find no evidence of any documented counseling. Level 2 residential treatment centers are required to provide certain service to each client including at least 10 hours of counseling each week. The acts and practices described in paragraph 19 above are violations of 21. 22. 23. 23. Rule 65D-30.007(4)(b), Florida Administrative Code, Required Hours of Services, which states in part that, "For level 2, each client shall receive services each week in accordance with subsection 65D-30.007(3), F.A.C., including at least 10 hours of counseling.” On June 11, 2010, the Department received a letter stating that the Clinical Director/Qualified Professional, David Hervig, resigned effective June 11, 2010. The JSFR Center has not provided the Department with the name of the successor "qualified professional" responsible for the supervision of clinical services. Further, the JSFR Center has not provided a copy of an agreement detailing the qualified professional's duties. Therefore, the JSFR Center does not have a "qualified professional" on staff to supervise clinical services as is required. The acts and practices described in paragraph 21 above are violations of Rule 65D-30.004(32), Florida Administrative Code, Clinical Supervision, which states in part that, "A qualified professional shall supervise clinical services, as permitted within the scope of their qualifications. In the case of medical services, medical staff may provide supervision within the scope of their license. Supervisors shall conduct regular reviews of work performed by subordinate employees." On June 17, 2010, the Department conducted an unannounced monitoring visit. The Department reviewed the records of two (2) of the seven (7) clients for compliance. After completion of the substance abuse monitoring assessment it was found that the compliance for the records reviewed validated at 41.99% for meeting the licensure standards. The tequirement for a passing score for licensure is 80%. The acts and practices described in paragraph 21 above are violations of Rule 65D-30.003(9){a)3, Florida Administrative Code, Licensing Determination, which states in part: A performance-based rating system shall be used to evaluate a provider's compliance with licensing standards. Providers shall attain at least 80 percent compliance overall on each component reviewed. This means that each component within a facility operated by a provider is subject to the 80 percent compliance requirement. If any component within a facility falls below 80 percent compliance, an interim license would be issued for that component. In addition, there may be instances where a component is rated at an 80 percent level of compliance overall but is in substantial noncompliance with standards related to health, safety, and welfare of clients and staff. This would include significant or chronic violations regarding standards that do not involve 24. 25. direct services to clients. In such cases, the district office shall issue an interim license to the provider or take other regulatory action permitted in Section 397.415, F.S. The probationary license for JSFR Center has been effective since May 7, 2010. On May 12, 2010, the first moratorium was imposed by the Department for admissions as a result of the resignation of the Chief Executive Officer. On June 11, 2010, the second moratorium was imposed by the Department for admissions as a result the resignation of the Medical Director and the Clinical Director. For more than half of the time the probationary license has been in effect, it has been in a moratorium status. The Department has met with the JSFR Center on several different occasions, most recently June 17", 2010, in an effort to assist them in becoming compliant with ss.65D-30 F.A.C. and ss. 397 F.S. However, the JSRC Center continues to fail to meet the regulatory requirements to maintain its substance abuse license. These chronic and substantial violations listed above impact the quality of care received by the clients of the JSFR Center. Based on the above listed violations of both Florida Statutes and Florida Administrative Code, the Substance Abuse License No. 12-41-AD-4883-01 is hereby revoked. NOTIFCATION OF RIGHTS UNDER CHAPTER 120, FLORIDA STATUTES IF YOU BELIEVE THE DEPARTMENT'S DECISION IS IN ERROR, YOU MAY REQUEST AN ADMINISTRATIVE HEARING TO CONTEST THE DECISION. YOUR REQUEST FOR AN ADMINISTRATIVE HEARING MUST BE RECEIVED BY THE DEPARTMENT WITHIN 21 DAYS OF YOUR RECEIPT OF THIS NOTICE. FAILURE TO REQUEST AN ADMINISTRATIVE HEARING WITHIN THE 21 DAYS PROVIDED SHALL CONSTITUTE A WAIVER OF THE RIGHT TO A HEARING. You may submit your request for an administrative hearing to the Department at the following addresses: Department of Children and Families Legal Counsel, (Attention: Jennifer Lima-Smith) 9393 North Florida Avenue, Room 902 Tampa, Florida 33612 Telephone (813) 558-5510 Department of Children and Families Agency Clerk (Attention: Greg Venz) Office of General Counsel 1317 Winewood Blvd Building 2, Room 204 Tallahassee, FL 32399 Please note that a request for an administrative haring must comply with Section 120.569(2)(c), Florida Statutes, and Rules 28-106.201(2), Florida Administrative Code. Those provisions, when read together, require a petition for administrative hearing to include: (a) The name and address of each agency affected and each agency’s file or identification number, if known; (b) The name, address, and telephone number of the petitioner; the name, address and telephone number of the petitioner's representative, if any, which shall be the address for service purposes during the course of the proceeding; (c) An explanation of how the petitioner’s substantial interests will be affected by the agency determination; (d) A statement of when and how the petitioner received notice of the agency decision; (e) A statement of all disputed issues of material facts. If there are none, the petition must so indicate; : (f) A concise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency’s proposed action; (g) A statement of the specific rules or statutes the petitioner contends require reversal or modification of the agency’s proposed action, including an explanation of how the alleged facts relate to the specific rules or statutes; and (h) A statement of the relief sought by the petitioner, stating precisely the action petitioner wishes the agency to take with respect to the agency's proposed action. Section 120.569, Florida Statutes, and Rule 28-106.201(4), Florida Administrative Code, require that a petition to be dismissed if it is not in substantial compliance with the requirements above. Mediation as described in Section 120.573, Florida Statutes, may be available if agreed to by all parties, and on such terms as agreed to by ail parties. The right to an administrative proceeding is not affected when mediation does not result in a settlement. Certificate of Service | hereby certify that a true copy hereof was hand delivered on this 29 day of June, 2010 to Alphonso Davis, as Director of Consuming Fire Deliverance Ministries, Inc., the Owner of Joseph Storehouse of Florida Restoration Center, 1027 9" Street West, Bradenton, Florida 34205. STATE OF FLORIDA, DEPARTMENT OF CHILDREN AND FAMILIES Debbie Spellman Regional Administrator Substance Abuse and Mental Health Program State of Florida County of Hillsborough ‘ The foregoing instrument was acknowledged before me this 4 day of Tune , 2010 by Sel ee Soe Umnax who is personally known to me. Signature ¢ Notary Public Received by: Date: | Witness; Date: CC: Jennifer Lima-Smith, DCF Region Legal Counsel Bob Holm, Regional Director

Docket for Case No: 10-006920