STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR PERSONS WITH DISABILITIES, Petitioner, Vv. License Number: 5444-6-GC V-Agape, LLC., Tracy Court Group Home, Respondent. / ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner,” “Agency”, or “APD”), issues this Administrative Complaint against Tracy Court Group Home, owned and operated by V-Agape, LLC, (“Respondent”), and states the following as the basis for this complaint: 1. Petitioner is the state agency charged with regulating the licensing and operation of foster care facilities, group home facilities, and residential habilitation centers, pursuant to Section 20.197 and Chapter 393, Florida Statutes. 2; At all times material to this complaint, Respondent has held foster or group home facility licenses issued by the Agency. The current group home license was issued for the following address: 19103 Tracy Court, Lutz, Florida 33548. V-Agape, LLC, is owned by Tonya Nelson, who is the sole managing member. The Respondent also has contracted with APD to provide the residents with Medicaid Waiver developmental disability services. 3. Section 393.0673(2)(b), Florida Statutes, states that the Agency may deny an application for licensure if “[t]he Department of Children and Family Services has verified that the applicant is responsible for the abuse, neglect, or abandonment of a child or the abuse, neglect, or exploitation of a vulnerable adult.” 4. Section 393.0673(2)(a)3, Florida Statutes, states that the Agency may deny an application for licensure if the applicant has “[flailed to comply with the applicable requirements of this chapter or rules applicable to the applicant.” 5) Section 393.13(3)(a), Florida Statutes, states “[pJersons with developmental disabilities shall have a right to dignity, privacy, and humane care, including the right to be free from abuse, including sexual abuse, neglect, and exploitation.” 6. Section 393.13(3)(g), Florida Statutes, states “[p]ersons 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.” re Rule 65G-2.012(5)(c), F.A.C., requires that “[s]taff 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 the supervisory staff.” 8. Page A-8 of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook, incorporated into rule through Rule 59G- 13.083(2), Florida Administrative Code, requires that each provider of waiver services must agree "to safeguard the health, safety, and well- being of all recipients receiving services from the provider." 9. Rule 65G-2.012(4), F.A.C. requires the following: Group home facility services shall include, but not be limited to, provision of adequate living accommodations, proper and adequate dietary supervision, appropriate physical care, support, guidance, supervision and assistance with training required to assure each individual the opportunity for personal growth and development. Specific services to be provided shall be defined by the needs of the clients to be served. Consideration shall be given to age, sex, developmental level and specific needs. 10. Rule 65G-7.005(2), F.A.C., requires the following: “A validated medication assistance provider must comply with the following requirements: (e) Limit administration, or assistance with self-administration, to medications prescribed in writing by the client’s health care practitioner and properly labeled and dispensed in accordance with Chapters 465 and 499, F.S.; (f) Immediately report torn, damaged, illegible, or mislabeled prescription labels to the dispensing pharmacist; (h) Verify that the correct medication is administered to the correct client, at the correct time, with the correct 12. 13. 15. 16. dosage, by the correct route, and for the correct reason, as prescribed by the health care practitioner; (i) Observe complete ingestion of oral medication before leaving the client and before recording or documenting the administration of the medication on the MAR; (j) Record the date, time, dosage, and name of each medication in the MAR immediately following administration and sign the entries health care practitioner and, if a client is residing in a residential facility, notify the facility supervisor.” Rule 65G-7.009(1), F.A.C., requires the following: “If a client will be away from a licensed residential facility or supported living home and requires during that time administration of medication by persons other than the medication assistance provider, the medication assistance provider must comply with the following requirements to assure that the client has appropriate medications during his or her absence: Perform a count of the medication amounts provided to the client for administration during the absence and a second count of the medication amounts received upon the client's return; Record both medication counts in an “Off- site Medication Form,” APD Form 65G7-08.” Rule 65G-7.002(3), F.A.C., requires that “[t]he medication assistance provider must maintain a current Authorization form, reviewed by the client’s physician, physician assistant, or ARNP at least annually and upon any change to the client's medical condition or self-sufficiency which would affect the client's ability to self-administer medication or to tolerate particular administration routes.” Rule 65G-7.002(5), F.A.C., requires that “[i]n addition to an executed Authorization for Medication Administration and before providing a client with medication assistance, a provider must also obtain from the client or the client's authorized representative an “Informed Consent for Medication Administration” APD Form 65G7-02.” Rule 65G-2.011(3), F.A.C., requires that “[t]he facility shall establish and maintain on the premises an individual record for each client. The record shall be kept in a lockable container and include at least: An accounting of the client’s funds received and/or distributed by the vendor.” Rule 65G-2.011(8), F.A.C., requires the following: “[vJolatile materials shall be isolated from the client’s living area. Such items shall be stored in approved metal containers. All doors with locks must be readily opened from the inside.” Rule 65G-2.011(9), F.A.C., requires that “[tlemperature and humidity shall be maintained within a normal comfort range for the climate.” 17. Rule 65G-2.012(8), F.A.C., requires that “[t]he facility shall maintain the interior and exterior of the building in a clean, safe, presentable and repaired condition.” 18. Rule 65G-2.006(4), F.A.C., requires that “[i]f an operator wishes to increase the capacity of his/her facility, he/she shall notify the Area Administrator or his/her designee in writing 30 days prior to the proposed change. The facility shall be resurveyed and a new license may be issued setting forth the new maximum capacity.” 19. Rule 65G-2.012(19), F.A.C., requires the following: “A group home facility serving clients shall not provide residential services to any private client whose physical or mental condition might adversely affect the welfare and development of Agency clients accepted by the facility. The group home shall have prior approval of area office staff of its intent to accept other than Agency clients. Area office staff shall give prior approval for any admissions which vary from criteria included in the application for licensure as a residential facility.” 20. Rule 65G-2.012(5), F.A.C., requires the following: “Staff identified in the application for licensure and providing direct care services must be at least eighteen years of age. Written evidence of the qualifications of the direct care staff shall be maintained. Minimum criteria shall be demonstrated ability to meet the written established job description, appropriate life experience, and eighth grade education. 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 the supervisory staff. At least three written character references (excluding relatives) and an employment work history shall be required for direct care staff.” 21. Rule 65G-2.009(3), F.A.C., requires the following: “The licensee shall ensure that the placement of new residents within the facility does not adversely affect the health, safety, or welfare of existing facility residents. The licensee must obtain the Agency's approval prior to any proposed placement that would deviate from the criteria specified on the facility's application for licensure. The licensee shall notify the Agency and provide descriptive information 22. 23. 24. 25. 26. 27. 28. on the prospective resident if the proposed placement involves an individual who is not a client of the Agency.” Count | On or about December 28, 2012, Myra Leitold, APD residential licensing supervisor, conducted a visit to the foster home. The following violations were observed: a door lock to the office and bedroom was keyed so that it could not be readily opened from the inside; the accounting of Resident 1.’s finances was not current; there was no prescription found for one of Resident 1’s medications; one of Resident 1’s medication labels had incorrect instructions on it; the heat was not on and the temperature of the home was below 65 degrees. The aforementioned incident constitutes violations of Rule 65G-2.011(3), F.A.C., Rule 65G-2.011(8), F.A.C., Rule 65G-2.011(9), F.A.C., and Rule 65G-7.005(2), F.A.C. Count II On or about January 11, 2013, Ms. Nelson exceeded the maximum licensed capacity of three in her foster home when she accepted a fourth resident in the home. She did not have approval from APD to exceed her licensed capacity by accepting another placement. The aforementioned incident constitutes violations of Rule 65G-2.006(4), F.A.C. Count III On or about January 17, 2013, a visit to the foster home was conducted by Myra Leitold, APD residential licensing supervisor. The following violations were observed: volatile materials were not stored in approved metal containers; three prescriptions for Resident 2’s medications were not present. The aforementioned incident constitutes violations of Rule 65G-2.011(8), F.A.C., and Rule 65G-7.005(2), F.A.C. Count IV On or about May 30, 2013, APD representative Mitchell Turner conducted a visit to the group home and observed that the instructions on the medication administration record for Resident 1 did not match the prescribed doses and frequency on the written physician’s orders for the medications. 29. 30. 31. 32. 33. 34. 35. 36. The aforementioned incident constitutes a violation of Rule 65g-7.005(2), F.A.C. Count V On or about June 18, 2013, APD representative Mitchell Turner conducted a visit to the group home and observed the following violations: water stains on the ceiling and wall; stains on the baseboard and wall that appeared to be mold; the medication dose documented as administered to Resident 3 did not match the dose on the written physician’s order. The aforementioned incident constitutes violations of Rule 65G-7.005(2), F.A.C., and Rule 65G-2.012(8), F.A.C. Count VI On or about September 25, 2013, APD representative Mitchell Turner conducted a visit to the group home and observed that Ms. Nelson had accepted another resident for placement in the group home without notifying APD or obtaining approval from APD prior to acceptance. The aforementioned incident constitutes a violation of Rule 65G- 2.012(19), F.A.C. Count VII On or about January 24, 2014, it was alleged that Resident 2, a minor female resident of the Respondent's Tracy Court Group Home, sustained bruising and a red mark on the back of her hand from being struck on her hands by Tonya Nelson. Resident 2 is non-verbal and intellectually disabled. The subsequent investigation by Department of Children and Families was ultimately closed with verified indicators for physical injury upon Resident 2 but did not identify the caregiver responsible. The Respondent's failure to provide appropriate supervision, safeguard the health, safety, and well-being of the residents, and provide an environment free from abuse and neglect constitutes a violation of Section 393.13(3)(a), F.S., 393.13(3)(g), F.S., Rule 65G-2.012(5)(c), F.A.C., Rule 65G-2.012(4), F.A.C., and Page A-8 of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook, incorporated into rule through Rule 59G-13.083(2), F.A.C. 37. 38. 39. 40. 41. 42. Count Vill On or about April 9, 2014, APD representative Mitchell Turner conducted a visit to the group home and observed the following violations: the authorization for medication administration from Resident 1’s physician had 2xpired; Resident 1’s informed consent for medication administration was incomplete; the medication administration record did not indicate the strength of medication that was being administered to Resident 1. The aforementioned incident constitutes violations of Rule 65G-7.002(3) and (5), F.A.C., and Rule 65G-7.005(2), F.A.C., Count IX On or about May 20, 2014, the Department of Children and Families commenced an investigation into unexplained bruises observed on Resident 2, a vulnerable minor female and resident of the Respondent’s Tracy Court Group Home. Resident 2 had a large bruise on her left thigh and a bruise on her left arm. Ms. Nelson was not able to explain how Resident 2 sustained the bruises on her thigh and arm. The Department of Children and Families ultimately closed the investigation with verified findings of threatened harm against Tonya Nelson. Resident 2 was moved from the Respondent's group home after this incident. The Respondent's failure to provide appropriate supervision, safeguard the health, safety, and well-being of the residents, and provide an environment free from abuse and neglect constitutes a violation of Section 393.13(3)(a), F.S., 393.13(3)(g), F.S., Rule 65G-2.012(5)(c), F.A.C., Rule 65G-2.012(4), F.A.C., and Page A-8 of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook, incorporated into rule through Rule 59G-13.083(2), F.A.C. Count X On or about June 26, 2014, APD representative Mitchell Turner conducted a visit to the group home and observed the following violations: the personnel file for direct care staff Genora Walker did not contain a job description or three character references. The personnel file for direct care staff Shawn Davis was missing three character references, employment history, or evidence of experience related to his qualifications for the job. 43. 44. 45. 46. 47. 48. 49. The aforementioned incident constitutes violations of Rule 65G-2.012(5), F.A.C. Count XI On or about August 14, 2014, APD representative Mitchell Turner conducted a visit to the group home and observed the following violation: Resident 1 was being administered her medications at lower doses than what was prescribed by her physician. The aforementioned incident constitutes a violation of Rule 65G-7.005(2), F.A.C. Count XII On or about November 4, 2014, Ms. Tonya Nelson sent an email to APD employee Meisha Stewart, the residential planning coordinator for the Suncoast Region, to advise that she intended to accept a non-APD client for placement in the Tracy Court Group Home. Ms. Stewart responded to Ms. Nelson on November 4, 2014, that pursuant to Rule 65G-2.009(3), F.A.C., descriptive information about the prospective resident must be submitted to APD for review and approval prior to accepting an individual who is not a client of the Agency. Ms. Nelson did not submit the requested documentation to Ms. Stewart. On November 11, 2014, Ms. Nelson sent an email to Meisha Stewart to advise that she had allowed Resident 4, a minor child under the supervision of Camelot Community Care who is not a client of the Agency, to move into the Tracy Court Group Home on November 10, 2014. On November 13, 2014, Ms. Nelson forwarded a copy of the court order placing Resident 4 in her custody on November 10, 2014, to Meisha Stewart. The aforementioned incident constitutes a violation of Rule 65G-2.009(3), F.A.C. WHEREFORE, based on the aforementioned violations of rules and laws applicable to the licensee as described above, and pursuant to s. 393.0673(2)(a)3, Florida Statutes, the application for licensure renewal sought for the group home facility license held by Tracy Court Group Home, owned and operated by V-Agape, LLC, is denied. Dated: December 4, 2014 MU cael urt Ahrendt Senior Attorney, Office of General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Attachments: Explanation of Rights Election of Rights Form Tonya Nelson, Owner Lindsey West, Esq. V-Agape, LLC The Plante Law Group, PLC 15822 Spring Crest Cir. 806 North Armenia Ave. Tampa, Fl 33624 Tampa, Fl 33609 Jeffrey Smith, APD Suncoast Region Manager CERTIFICATE OF SERVICE | HEREBY CERTIFY that a copy of the above named individuals by U.S. Mail, facsimile, or electronic mail, this 4th day of December, 2014. David De La Paz, ney Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS RESPONDENT: _V-Agape, LLC.,Tracy Court Group Home, | have read the accompanying Notice of License Denial and Explanation of Rights in this matter, and | elect the following hearing option: CL dispute the material facts alleged in the Notice of License Denial and request that a formal evidentiary hearing be held before an Administrative Law Judge at the Division of Administrative Hearings, pursuant to Section 120.57(1), Florida Statutes. Specifically, | dispute the following material facts (attach additional sheets if necessary): | do not dispute the facts alleged in the Notice of License Denial but wish to be heard in an informal hearing, held pursuant to Section 120.57(2), Florida Statutes. | understand that at that hearing | will be permitted to submit written or oral evidence to explain why the facts do not warrant denial of licensure. 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. Failure to complete, sign and return the election of rights form to the agency within 21 days of receipt will constitute a waiver of your right to be heard in this matter. Election of Rights page 1 10 Please fill out completely: Telephone number for contact: Signature: Print Name: Business Location Address: City Mailing Address City Electronic Mail for contact Fax Date: Title: State Zip State Zip MAIL OR FAX BOTH PAGES OF THE COMPLETED FORM TO: David De La Paz, Esq., Agency Clerk Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Fax: (850) 414-5759 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. 11 Election of Rights page 2 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES EXPLANATION OF RIGHTS The enclosed Administrative Complaint charges you with violating one or more provisions of Chapter 393, Florida Statutes, or the rules supplementing that Chapter. If you have questions regarding your response or best course of action, you may wish to seek the advice of competent legal counsel. Your receipt of this Administrative Complaint packet constitutes service upon you. Your rights under Florida law (Chapter 120, Florida Statutes) are as follows: You may elect to not dispute the violations alleged in the Complaint and request that a hearing be held to present testimony or documents you wish the Agency to consider in mitigation of the alleged violations prior to disposition of this case. Any penalty levied will be included in a Final Order. If a dispute of material fact arises, the hearing will be terminated and the case referred to the Division of Administrative Hearings. You may elect to dispute the violations alleged in the Complaint and request a hearing before an Administrative Law Judge, which is an administrative “trial”. You and the Agency may present evidence and witnesses to prove or disprove the facts alleged and submit a written proposed recommended order after the hearing for the Judge’s consideration. Based on the evidence and any proposed recommended orders submitted, the Judge will issue a Recommended Order containing Findings of Fact, Conclusions of Law, and Recommended Penalty, if any. Following review of the Recommended Order, the Agency will issue a Final Order. An Election of Rights form is included with the Administrative Complaint. The Agency must receive it within 21 days of your receipt of this Administrative Complaint packet. After the Agency determines whether a dispute of material fact exists, it will make arrangements on your behalf for the appropriate hearing. You will receive notice of the date, time, and place of hearing at the address designated by you on your Election of Rights. IMPORTANT: If the Agency does not receive a completed copy of the Election of Rights form, or any other written response from you, within the 21 days of your receipt of this Administrative Complaint, you may have waived your right to a hearing in this matter and the Agency may proceed against you in this matter without your participation. Please note, per Chapter 120.573, Florida Statutes, mediation is not available in this action. 12

Docket for Case No: 15-000034FL

Orders for Case No: 15-000034FL