STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR PERSONS WITH DISABILITIES, Petitioner, Vv. License Number: 7G394A Rose of Tara Group Home, Owned and ?O02 2410 OOOb 4982 0353 Operated by Florida Mentor, Respondent. / ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (‘“Petitioner,” “Agency”, Or “APD’), issues this Administrative Complaint against Rose of Tara Group Home, owned and operated by Florida Mentor, (“Respondent”), and states the following as the basis for this complaint: As 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 § 20.197 and § 393, Fla. Stat. (2015). 2. At all times material to this complaint, Respondent has held a group home facility license issued by the Agency for the following address: 4639 Rose of Tara Way, Orlando, Florida 32808. The Respondent also has contracted with APD to provide the residents with Medicaid Waiver developmental disability services. 3. Fla. Stat. § 393.0673 (2015), sets forth the Agency’s authority for denial, suspension, or revocation of license; moratorium on admissions; and administrative fines. Fla. Stat. § 393.0673(1) (2015), provides that the Agency may revoke a license if the licensee has failed to comply with the applicable requirements of this chapter or rules applicable to the licensee. 4. Fla. Admin. Code R. 65G-2.0041(4)(a)2 (2014) provides that Class | violations may be penalized by a moratorium on admissions, by the suspension, denial or revocation of a license, by the nonrenewal of licensure, or by a fine of up to $1,000 dollars per day per violation. 5. Pursuant to Fla. Admin. Code R. 65G-2.0041(4)(a), [c]lass | statutory or rule violations are violations that cause or pose an immediate threat of death or 10. serious harm to the health, safety or welfare of a resident and which require immediate correction.” Fla. Admin. Code R. 65G-2.009(1)(d), provides in pertinent part, as follows: (d) The facility shall adhere to and protect resident rights and freedoms in accordance with the Bill of Rights of Persons with Developmental Disabilities, as provided in § 393.13, Fla. Stat. (2015). Violations of § 393.13(3)(a), Fla. Stat. (2015) relating to humane care, abuse, sexual abuse, neglect, or exploitation and all violations of § 393.13(3)(g), Fla. Stat. (2015), shall constitute a Class | violation. All other violations of Section 393.13(3), Fla. Stat. (2015), shall constitute Class III violations. All violations of §§ 393.13(4)(c)1.- 2., (f)-(g), Fla. Stat. (2015), shall constitute Class | violations. All violations of § 393.13(4)(h), Fla. Stat. (2015) shall constitute Class II violations. All other violations of § 393.13(4), Fla. Stat. (2015), shall constitute Class III violations. Fla. Stat. § 393.13(3)(a) (2015), states that “[p]ersons 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. Fla. Stat. § 393.13(3)(g) (2015), 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.” Pursuant to Fla. Admin. Code R. 65G-2.0041(1)(d)-(e), “[iJn determining whether to pursue disciplinary action in response to verified findings by the Department of Children and families of abuse, neglect, or exploitation involving the licensee or direct service providers rendering services on behalf of the licensee, the Agency will consider the licensee’s corrective action plan and other actions taken to safeguard the health, safety, and welfare of residents upon discovery of the violation. Considerations shall include the following: Whether the licensee took immediate and appropriate actions necessary to safeguard the health, safety, and welfare of residents during and after any investigations. Whether the occurrence is a repeat violation and the nature of such violation.” Pursuant to Fla. Admin. Code R. 65G-2.0041(2)(a)-(c) (2014), “[t]he Agency shall consider the following factors when determining the sanctions for a violation: The gravity of the violation, including whether the incident involved the abuse, neglect, exploitation, abandonment, death, or serious physical or mental injury of a resident, whether death or serious physical or mental injury could have resulted from the violation, and whether the violation has resulted in permanent or irrevocable injuries, damage to property, or loss of WHEREFORE, based on the aforementioned violations of rules and laws applicable to the licensee as described above, Petitioner respectfully requests revocation of the group home license held by Rose of Tara Group Home, owned and operated by Florida Mentor, in accordance with § 393.0673 (1), Fla. Stat. (2015). Dated: March 24, 2016 Attachments: Explanation of Rights Election of Rights Form Copies furnished to: Sonia Bermudez Florida Mentor 5035 Edgewater Drive Orlando, FL 32801 ead ell A Senior Attorney Office of the General Counsel Agency for Persons with Disabilities 200 N. Kentucky Ave., Ste. 422 Lakeland, FL 33801 Clarence Lewis Regional Operations Manager APD Central Region CERTIFICATE OF SERVICE | HEREBY CERTIFY that a copy of this Administrative Complaint was sent to the above named individuals by U.S. Mail, facsimile, or electronic mail, this OAD day of wrath 20l0. Jeannette Estes Senior Attorney Office of the General Counsel 200 N. Kentucky Ave., Ste. 422 Lakeland, FL 33801 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES EXPLANATION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT 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 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 dispute the violations and alleged material facts in the Complaint and request a formal hearing with the Division of Administrative Hearings 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. In the alternative, you may elect to not dispute the material facts alleged in the Complaint and request that an informal 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 is raised during the informal hearing, the hearing will be terminated and the case referred to the Division of Administrative Hearings for a formal hearing before an Administrative Law Judge. 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 will be considered to have waived your right to a hearing in this matter and the Agency may proceed against you in this matter without your participation. STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT RESPONDENT: Florida Mentor | have read the accompanying Administrative Complaint and Explanation of Rights in this matter. | would like to request a hearing, and | elect for the following hearing option: Ol dispute the material facts alleged in the Administrative Complaint 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 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 written or oral evidence in mitigation of the charges or explain why the facts alleged do not constitute a violation of law. 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 that 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 21 days of receipt will 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. Election of Rights page 1 Please fill out completely: Telephone number for contact: Fax Signature: Date: Print Name: Title: Business Location Address: City State Zip Mailing Address City State Zip Electronic mail for contact 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. Election of Rights page 2 10

Docket for Case No: 16-002315FL