STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Tp Ce, WE S STATE OF FLORIDA, “Aiolhas AGENCY FOR HEALTH CARE AHCA NO: 2007002481/% ADMINISTRATION, ve. Petitioner, | : 07 ; (qUy TWIN OAKS JUVENILE DEVELOPMENT, INC., ; D/B/A APALACHICOLA FOREST YOUTH CAMP, Respondent. / ADMINI STRATIVE COMPLAINT (COMES NOW the Agency for Health Care Administration (hereinafter *“AHCA"), by and through undersigned counsel, and files this Administrative Complaimt against TWIN OAKS JUVENILE DEVELOPMENT, INC., D/B/A APALACHICOLA FOREST YOUTH cAMP, (hereinafter “Respondent” ) and alleges: NATURE OF THE ACTION 1. This ig an action to impose an. administrative fine in the amount of seven thousand dollars ($7,000), based upon the $500/day fine allowed by §394.879(4), Fla. Stat. (2006) for a period of non-compliance starting February 28, 2007, until significant facility improvements were noted during the March 14, 2007 monitoring visit. Respondent is being cited for violations in contravention of § 394, Fla. Stat. (2006) and Fla. Admin. Code R. 65E-9. JURISDICTION AND VENUE 2. The Agency has jurisdiction pursuant to §§120.569 and 120.57, Fla. Stat. (2006), § 394, Parts III and Iv, Fla. Stat. (2006). 3. Venue lies in Liberty County, Division of Administrative Hearings, pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 4. The State of Florida, Agency for Health Care “administration ("“AHCA”) is the enforcing authority with regard to residential treatment center for children and. adolescents pursuant to § 394, Parts IITf and IV, Fla. Stat. (2006). 5. Respondent is a residential treatment center for , children and adolescents located at Highway 65 South, Sumatra, Florida 32335. Respondent was, at all time material hereto, a licensed residential treatment center for children and adolescents, with provisional License number 9, under § 394, Parts III and Iv, Fla. Stat. (2006). COUNT _I RESPONDENT IS IN VIOLATION OF PROGRAM STANDARDS CONCERNING TREATMENT AND SERVICES, IN CONTRAVENTION OF FLA. ADMIN. CODE R. 65E-9.005(5) (a) (6). RESPONDENT IS IN VIOLATION OF THE RIGHTS OF CHILDREN AS STATED IN FLA. ADMIN. CODE R. 65E-9.012(1). RESPONDENT IS IN VIOLATION OF THE RIGHTS OF CHILDREN CONCERNING CHILD ABUSE AND NEGLECT, IN CONTRAVENTION OF FLA. ADMIN. CODE R.. 65E-9.012 (3) (c). . RESPONDENT IS IN VIOLATION OF THE PROPER USE OF RESTRAINT OR SECLUSION, IN CONTRAVENTION OF 65E-9.13(1) (b), (c) and (e) PURSUANT TO §394.879(4), Fla. Stat. (2006), AN ADMINISTRATIVE FINE OF $500/DAY FOR A PERIOD OF NON- _ COMPLIANCE STARTING FEBRUARY 28, 2007 UNTIL SIGNIFICANT FACILITY IMPROVEMENTS WERE. NOTED DURING THE MARCH 14, 20076 MONITORING VISIT, IS WARRANTED. 6. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 7. On or about March 8, 2007, a complaint investigation was conducted. Based on interviews, observation, and record review the Agency’s surveyor’s findings were as follows: INCIDENT. I: Record review révealed sampled resident. #1 was «+. admitted on 02/12/07 with a diagnosis of Major - Pepression, Post Traumatic Stress Disorder, Antisocial Pattern of Behavior, and Seizure Disorder. Record review of sampled resident #1 revealed that on 02/28/07 the resident was taken to time out in a hold that was not deemed professionally appropriate/one that-would be utilized. according to the facility's. ~~ policy and a Nationally Recognized training of utilizing TACT-2 Crisis Prevention Training (Paresei, Steve, 2003). On 3/7/07 at 1:19 PM, the video (without audio) of the 2/28/07 incident with resident #1 was viewed by the surveyor, along with the facility Assistant Administrator, who narrated the events. The chronology of this event occurs as the resident is first seen in the common area appearing to be talking with other residents. The assistant administrator voiced that the resident asked for “token points” from the sampled personnel “A” as the other residents around him/her were teasing him/her and he/she did not respond. The staff responded with a “no” and the resident apparently asks why. The staff member then sends the resident to time out. The resident refuses to go to time out and the staff.member closes up his glasses, puts down his paperwork, and comes over to the resident who has now lain down over the bench, hugging it. The staff member takes the resident. by the feet, lifts him/her upside down, and begins to drag him by his/her feet with the resident still hugging onto the bench towards the time out room. As the staff member struggles to round a corner that is too small to get both the child (who is on his/her back dragging the picnic bench), a second staff member (sampled personnel “E”) who has been watching the. entire event, intervenes and frees the resident’s hands for a moment. He then steps back and facility personnel “A” continues to drag the resident as the resident reached back to grab back hold of the’ picnic table. The facility personnel “A” then steps. over the resident and takes him/her by the arm and leg and. drags him/her on his/her back to the time out room. Once there, the resident bolts out the door and down the residential hallway. The same staff member then heads down the hall after him/her .cornering him/her and turns him/her around using his/her arm, wrapping it around his/her back and then jerking it up his back. The resident is seen walking ina stance that is bent over forward. As seen on the video and explained by the assistant administrator on 03/07/07 at 1:19 p.m., additional human services worker (‘“E”) could have aided. and chose not to in the event. This was further collaborated by the Night Shift Supervisor on 03/07/07 at 5:05 p.m. The assistant administrator also stated in his interview that a third staff member, who was a registered nurse (“B”), was present towards the end of the incident, but did not intervene on the resident's behalf. Further review of the facility’s personnel records, revealed that the staff ( three members - sampled personnel “A”, “B”, and ‘E”) were each trained in this modality of TACT-2 Crisis Prevention Training. This training instructs the staff to verbally de- escalate residents and work as a team with other staff members during behavioral situations. Review of the current behavior management plan used at this facility (revised January 2007), the resident had a right to request tokens for demonstrated socially appropriate behaviors. This was confirmed in an interview with the facility behavior specialist on 3/7/07 at 12:15 PM. Facility personnel record review revealed that sampled personnel “A” had a prior suspension of duty for 3 days in July, 2006 for Use of Unnecessary Physical Force/Cruel/Inhumane Treatment of a Juvenile. Also, it was found that this same staff member had received another suspension for 3 days for the event occurring on 02/28/07 for the same Use of Unnecessary Physical Force/Cruel/Inhumane Treatment of a Juvenile. An interview with the resident on 03/8/07 at 8:05 p.m. revealed that the resident described being lifted backwards by his/her feet and dragged on his/her back. This tactic was not described in the facility’s manual on TACT-2 training. Furthermore, interviews with six other residents, who were eyewitnesses to the event, were conducted on 03/08/07 at 7:35 p.m. These interviews yielded confirmation that the staff “A” dragged resident #1 through the common area on his/her back towards the time out area, with no intervention from other facility personnel in the area. Interview . with the Night Shift Supervisor on 03/07/07 at 5:05 p.m. via telephone with the administrator and assistant administrator present revealed that he had viewed it on camera as it was happening, and then on video afterwards and verbalized, “I didn’t agree how it started and the whole event - Not one bit!” He further stated, “if he had time to fold up his glasses and put down his papers, then he had time to call for back-up." The Night Shift Supervisor further. stated he did not see a level of aggression that warranted the time out. ; An interview with the facility’s trainer of TACT-2 Behavior Management Control Techniques was conducted on 03/07/07 at 11:27 a.m. where he pointed out’ pages in the manual that detailed instructions for staff to follow. He stated that staff should have dealt with the situation with verbal warnings and reminders, and a team-centered approach. On page 27 of Twin Oaks Juvenile Development, Inc., Personnel Resources Manual, (Revised edition May 11, 2006) it states that under Use of Unnecessary Physical Force or Cruel or Inhumane Treatment of a Juvenile - the ist discipline for employees step is Suspension, and 2nd is Reassignment/Termination. Personnel record review does not reveal for sampled staff member "A" a reassignment/termination notice by the administrator. An interview with the administrator on 03/07/07 at 5:48 p.m. confirms this. She stated, "we were waiting to find out if there were any indicators and I can only keep him out (on suspension) so long." Further review of the facility's personnel records, revealed the staff present (sampled personnel "A", "B", and "E") were each trained in the modality of TACT-2 Crisis Prevention Training. This training. instructs the staff to verbally de-escalate residents and work as a team with other staff members during. behavioral situations. A review of the current behavior management plan used at this facility (revised January 2007) revealed that the resident had a right to request tokens for demonstrated socially appropriate behaviors. This was confirmed in an interview with the facility behavior specialist on. 3/7/07 at 12:15 PM. ; . A review of the resident's treatment plan lists Problem #3 as anger management problems with a goal of learning skills necessary to help communicate feelings and deal with conflict in an appropriate manner, and Problem #4 as poor social skills with a goal of learning socially acceptable ways in which to express him/herself. Per this treatment plan, interventions ‘are to provide a behavior management system whereby: points.are given for positive behaviors. A record review of the facility's resident handbook reveals a description of this behavior management system that . awards points for positive behaviors and behaviors that are working towards the treatment goals. In the facility's Restraint Policy and Procedure signed by the facility administrator on 12/29/06 it states that the program's strategies are to reduce and strive to eliminate the need for use of restraints. An interview with the facility behavior management program specialist on 03/07/07 at 11:33 a.m. confirmed that each employee receives training on the facility's behavior management program. Resident #1 stated that “a boy started laughing at me and I asked if I could get extra points because I did not respond. So, I had asked facility personnel "A" for the extra points and he said ‘no’ and that I’ would have to go the time out room. I said, ‘No, I ain't, I'm bein' good.‘ The facility personnel "A" picked me up to drag me and then slammed me to the ground." The facility administrator and assistant administrator stated in an interview on 3/7/07 at 1:52 PM that on 2/28/07 staff “A” received a written reprimand from the Night Shift Supervisor. Further actions taken by the facility were that staff “A” was placed on a three day suspension (without pay) with plans for him to return to work on 3/9/07. The administrator stated that there were no further corrective actions planned for staff “A”, and that the. staff member’s actions were “just stupid.” These facility management staff . verified during this interview that no personnel action was planned for staff *“B” and “E” who witnessed the incident but failed. to. intervene. INCIDENT II: Record review revealed saitpled resident. #4 was’ ‘admitted with. diagnosis. Conduct disorder and Mental Retardation. Record review of sampled resident #4 revealed that on 03/06/07 the resident was taken to time out in a hold that was not deemed professionally appropriate and that would.not be utilized according to the facility’s policy and a Nationally Recognized - “otyaining of utilizing .TACT-2..Crisis..Prevention........ Training (Paresei, Steve, 2003). An interview with the resident on 03/08/07 at 9:02 p.m. revealed the resident stated that on 3/6/07 s/he was grabbed by the neck and dragged up against a fence “then put to the ground with arms behind his/her back in a raised position. S/he stated this occurred after breakfast when s/he had asked if s/he could’ make an abuse call as his/her boxers and pants did not fit (“they were too tight”). S/he further reported the staff member said, “No, and turn the hell around and ‘shut up!” S/he stated it was at this point that staff “G" grabbed the resident, pulling his/her arm behind his/her back, “rushing” the resident to the fence. The resident reported then falling to the ground, and staff “G” and “H” then placed the resident's arm. behind his/her back again, pushing the arm up. The resident reported that as s/he was lying on the ground s/he was yelling that his/her arm was hurt. Staff “H”. then walked the resident to time out. The resident then stated while in time out s/he told a registered nurse (staff “I”) that his/her arm hurt, but the nurse “refused to care”, insisting the resident needed to remain in time out. Review of the incident report revealed that resident #4 was in time out for five minutes (7:53 AM until 7:58 AM). Facility nursing notes dated 3/6/07 (timed 1400) revealed the resident was sent to the hospital later that morning at 8:10 AM where s/he was diagnosed with a fractured humerus. Review of the 3/6/07 hospital discharge diagnosis for. resident #4 revealed the resident sustained a spiral fracture of the right humerus. During the interview resident #4 was observed to have a semi flex cast to the right lower and upper arm and was supported by a sling to support the extremity to be non-weight bearing on the extremity. Interviews with six other residents, who were eyewitnesses to the event, were conducted on 03/08/07 at 7:35 p.m. All tell a similar story. All reveal a point where the resident was, “rushed to the fence and slammed down from the fence with his/her face in the mud and arms behind the back. The staff kept pushing up [his/her] arms and a crack was heard: - like a root coming out of the ground.” The facility administrator stated in an interview on 3/8/07 at 3:40 PM that staff “G” and “H” were placed on administrative leave that day (two days post- incident) pending results of an investigation. INCIDENT III: An observation by the Agency surveyor occurred with supplemental sample resident # 5 happened on 03/08/07 at 8:45 p.m. Facility personnel “F” was heard to say directly to a resident in a loud tone of voice, “shut- up and sit back down in that chair unless you want a time out.” This was after the surveyor had requested that the resident be interviewed by the surveyor. Facility personnel “F” then came over to the surveyor and asked directly, “How. could I have handled that. differently?” a A personnel record review reveals that the facility personnel “F” had on October 28, 2006 a written: reprimand for “initiating a use of force ona...» resident.” Interview with the facility administrator on 03/08/07 at 11:00 p.m. confirmed these findings. 8. On or about March 8, 2007, a complaint investigation was conducted. The findings of the Agency's surveyors are contained in Paragraph 7 of this wa Administrative Complaint. 9. Based on observation, interview and record: ” review, the facility failed to provide treatment that— included behavior management that is neither harm£ul-nor: aversive for 3 of the 5 sampled residents (#1, 4, and supplemental sample #5) . The findings constitute a. violation of Fla. Admin. Code R. 65E-9.005(5) (a) (6). 10. Based on observation, interview and record review, the facility failed to protect children’s rights as evidenced by subjecting them to cruel, severe, and unnecessary punishment for 2 of the 5 sampled residents (#1 & 4), subjecting one resident (#5) to verbal abuse and denying: prompt medical care to one of five sampled - residents (#4). The findings constitute a violation of. Fla. Admin. Code R. 65A-9.012(1). 11. Based on record review and interview, the facility failed to implement a written procedure for immediate protection of residents in cases of suspected abuse for two of five sampled residents (#1 and 4). A failure to immediately implement corrective actions in cases of resident abuse/ neglect result in the potential for harm to all facility residents. The findings constitute a violation of Fla. Admin. Code R. 65A-9.012(3)c). 12. Based on observation and record review the facility failed to ensure restraint. did not result in harm or injury for 1 of 5 (#4) sampled residents. The findings constitute a violation of Fla. Admin. Code R. 65A- 9.013 (1) (b). ; 13. Based on observation, interview and record review, the facility failed to provide restraints/time - out /seclusion that was not used for the purposes of punishment, coercion, discipline, convenience, or retaliation for 2 of the 5 sampled residents (#1 and #4). The findings constitute a violation of Fla. Admin. Code R. 5A -9.013(1)¢). Based on observation, record review and interview ‘the facility failed to use a restraint in a manner that is safe and proportionate to the severity of the behavior for 3 of 5° sampled residents (#1 and #4). The findings constitute a violation of Fla. Admin. Code R. 65A- 9.013 (1)¢). CLAIM FOR’ RELIEF ~~ WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that the Court order the following relief against Respondent: (A)* Make factual and legal findings in favor of the Agency on Count I; (B) Recommend an administrative fine amount of $500/day for a period of non-compliance starting February 28, 2007 until significant facility improvements were noted during the March 14, 2007 monitoring visit, against 10 Respondent totaling seven thousand dollars ($7,000) -£ . Count I, pursuant to § 394.879(4) Fla. Stat. (2006) 7... (C) Assess attorney’s fees and costs; and (D) Grant all other general and equitable relief. allowed by law. _ Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120. 569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Plorida 32308. . If you want to hire an attorney, you have the right. to be represented by an attorney in this matter. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE ‘FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, orkaine M. Novak, Esq. Florida Bar # 0023851 Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy hereof has been sent by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 8255, Facility Administrator Karen Freidman, Highway 65 South, Sumatra; Florida 32335, by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 8231, to Owner Twin Oaks Juvenile Development , Inc., PO Box 68, Bristol, Florida 32321 and by U.S. Certified Mail, Return Receipt’ No. 7004 1160 0003 3739 8248, to Registered Agent Donnie wb Read, 11939 NW SR 20, Bristol, Florida 32321, on this day of April, 2007. orraine M. Novak, Esquire Copy furnished to: Barbara Alford, FOM 4 “3735 8248 rent Postmark \ Here | Rustricted Delh fEndorsement A 7004 LLbo 0003 COMPLETE THIS SECTION ON DELIVERY A. Received by (Plea: int Cl /) * oe of Deli Davi d RR an 5 Cc. Sig . aS Cl Agent x O Addressee SENDER: COMPLETE THIS SECTION ® Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. @ Print your name and address on the reverse so that we can return the card to you. ™ Attach this card to the back of the mailpiece, or on the front if space permits. } | D. Is delivery address different from item 1? C1 Yes 1. Article Addressed to: It'YES, enter delivery address below: [1 No Registered Auger Dounrie Rack Wasa WU 3K Zo Brisvol WO 32324 3. Sefice Type Certified Mail 1 Express Mail C1 Registered D Return Receipt for Merchandise Ol Insured Mail 1 C.0.D. 4. Restricted Delivery? (Extra Fee) 0 Yes ‘ 7004 L1bO 0003 3739 6248 ee cee een | PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952 ES (Endorse Restricied Oe! fEncorsement i i | ‘Total Postage & Fees | $ | 7004 1Lib0 0003 3739 8234 COMPLETE THIS SECTION ON DELIVERY SENDER. COMPLETE THIS SECTION Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ® Print your name and address on the reverse so that we can return the card to you. § Attach this card to the back of the mailpiece, or on the front if space permits. . Article Addressed to: C] Addressee D. Is delivery address different from item 1? [1 Yes If YES, enter delivery address below: [1 No “TT . kt a Tusa Gavia Vuyente Day Ty > s, yO Cs oe &% G too Sere 3. jee Type Gertified Mail 1 Express Mail D Registered C2 Return Receipt for Merchandise 0 Insured Mail = C.0.D. 4, Restricted Delivery? (Extra Fee) O Yes 7004 1160 0003 3734 6231 PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952

Docket for Case No: 07-001946