STATE OF FLORIDA 07 . AGENCY FOR HEALTH CARE ADMINISTRATION OCT 19 PH 4; 06 STATE OF FLORIDA AGENCY FOR AD Mee OF HEALTH CARE ADMINISTRATION, ‘ EA RALIVE OTTO NS Case No. 2007008581 Petitioner, vs. DEVEREUX FOUNDATION, INC., d/b/a DEVEREUX FLORIDA/DEVEREUX ORLANDO SIPP, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“Agency”), by and through the undersigned counsel, and files this Administrative Complaint against DEVEREUX FOUNDATION, INC., d/b/a DEVEREUX FLORIDA/DEVEREUX ORLANDO SIPP (“Respondent” or “Respondent Facility”), pursuant to Section 120.569, and 120.57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine of two thousand dollars ($1,500.00) based upon three (3) deficiencies. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60, 394.875, 394.879, and 408.802(7), Florida Statutes (2006). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. ATTACHMENT "A" PARTIES 3. The Agency is the regulatory authority responsible for licensure of residential treatment centers and enforcement of all applicable federal regulations, state statutes and rules governing residential treatment centers pursuant to Chapter 394, Part IV, and Chapter 408, Part II, Florida Statutes (2006) and Chapter 65E-9, Florida Administrative Code. 4, Respondent operates a 24-bed residential treatment center for children and adolescents located at 6147 Christian Way, Orlando, Florida 32808, and is licensed as a residential treatment center, license number 29. 5. Respondent was at all times material to the allegations of this complaint a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth in this count. 7. Rule 65E-9.011, Florida Administrative Code, requires that Respondent Facility have and use a comprehensive discharge plan: 65E~-9.011 Discharge and Discharge Planning. (1) The provider shall have and use on an ongoing basis a written procedure on discharge planning and aftercare services that specifies the availability of services and the persons responsible for implementation of the aftercare plan. (2) Discharge planning shall begin at the time of admission. A discharge plan shall be developed, written and interpreted in collaboration with the child, parent or guardian, department, foster parents and guardian ad litem, if applicable, within ten days of admission, and a projected date for discharge shall be included in the child's treatment plan. A copy of the discharge plan shall be given to the parent or guardian, the guardian ad litem, and the department. (3) Discharge planning shall include input from the child, the child's parent or guardian, foster parents, department, and guardian ad ‘litem. (4) Discharge planning may include a period of " transition into the community, such as home visits and ! meetings with community mental health service providers, (5) Discharges shall be approved and signed by the treating psychiatrist. (6) A child may be discharged only to the parent, guardian or placing organization, unless the provider is otherwise ordered by the court. (7) The provider shall finalize the discharge plan and have it approved and signed by the treatment team. A copy of this discharge plan shall be provided to the parent or legal guardian, guardian ad litem and department at least 30 days before the proposed discharge date, which, at a minimum, shall include: (a) The initial formulation and diagnosis; (b) A summary of treatment and services which have been provided, the outcomes of treatment in relation to the child's presenting problem on admission, and identification of needs for continuing treatment and is services in the community following discharge; . (c) Recommendations for the child and parent or guardian following release from care, including referrals for community-based mental health services; (d) The projected date of discharge and the name, address, telephone number and relationship of the person or organization to whom the child will be discharged; and (e) A copy of the child's medical, dental, educational, medication and other records for the use of the person or organization who will assume care of the child following discharge. (8) Aftercare plans shall be developed by the provider staff under the guidance of the clinical director and shall encourage the active participation of the child and parent or guardian and guardian ad litem. (9) The provider shall have and utilize written procedures for follow-up care, including a written plan for follow-up services and at least one contact with the discharged child and his parent or guardian and guardian ad litem within the first 30 days following discharge. (10) For children age 17, the provider shall assess ‘their needs for continuing services in the adult mental health service system and assist them in planning for and accessing those services. (11) Within 10 business days of the physical departure of a child placed from out-of-state, the provider shall complete, date, and sign an ICPC 100B Interstate Compact Report on Child's Placement Status, Form CF 795, Oct 96, which is hereby incorporated by reference, place a copy of the form in the child's record, and mail the original and two copies of the form to: Office of the Interstate Compact on the Placement of Children, Child Welfare Program Office, Florida Department of Children and Family Services, 1317 Winewood Boulevard, Tallahassee, FL 32399-0700. (12) Notwithstanding paragraphs 1-11 of Rule 65E-9~ 001, F.A.C., Providers who serve children committed under. Section 985.223, F.S., shall abide by the following standards with regard to discharge planning: (a) The provider shall finalize the discharge summary and have it approved and signed by the treatment team. At least 30 days before the proposed discharge, a copy of the discharge summary shall be sent to the child's home district. The provider and district shall coordinate with each other to assist the district in the development of the discharge plan based on the provider's recommendations for services after discharge. (b) Once noticed by the court of a pending hearing related to child's competency to proceed, the discharge summary shall be copied to the parties identified in Section 985.223, F.S. (c) A copy of this discharge summary shall be provided to the parent or legal guardian, guardian ad litem and department at least 30 days before the proposed discharge date, which, at a minimum, shall include: 1. The initial formulation and diagnosis; 2. A summary of treatment and services which have been provided, the outcomes of treatment in relation to the child's presenting problem on admission, and identification of needs for continuing treatment and services in the community following discharge; 3. Recommendations for the child and parent or guardian following release from care, 4, The name, address, telephone number and relationship of the person or organization to whom the child will be discharged; and 5. A copy of the child's medical, dental, educational, medication and other records for the use of the person or organization who will assume care of the child following discharge. (13) Discharge summaries shall be developed by the provider staff under the guidance of the clinical director and shall encourage the active participation of the child and parent or guardian and guardian ad litem. g. On June 29, 2007, the Agency conducted an Initial Licensure Survey of the Respondent facility: 8.1. Based on a review of resident records, policy and procedure and interview, the Respondent Facility failed to implement and follow written procedures for discharge for 1 of 4 residents, resident #4. 8.2. Review of resident #4's clinical record revealed that the record did not contain documentation reflecting that any discharge procedures were implemented, or that the Respondent Facility had prepared a discharge pian for resident #4. The record contained an e-mail, dated June 26, 2007, from the Utilization Review Coordinator to the placement agency that stated the resident had been officially discharged on June 17, 2007 8.3. Interview with the clinical director, clinical manager, acting program manager, nurse manager and program coordinator on June 28, 2007, at 1:30 p.m. confirmed that the Respondent Facility did not follow the Respondent Facility’s procedures for discharge. The clinical team stated that they were not aware the resident had been discharged until June 24, 2007, when the hospital contacted the clinical manager to arrange transportation to return to the Respondent Facility. They stated that the Respondent Facility’s executive director issued a letter on June 19, 2007, to the Agency for Health Care Administration and to the funding source stating that resident #4 would not be accepted back by the Respondent Facility. 9. The Agency cited Respondent Facility for a violation of applicable law pursuant to Rule 65E-9.011, Florida Administrative Code, subject to fine as set forth in § 394.879, Florida Statutes (2006). WHEREFORE, the Agency intends to impose an administrative fine in the amount of $500.00 against Respondent, a residential treatment center in the State of Florida, pursuant to § 394.879, Florida Statutes (2006). COUNT IT 10. The Agency re~alleges and incorporates paragraphs one (1) through five (5), paragraph seven (7), and paragraph 8.2, as iff fully set forth in this count. 11. Pursuant to Florida law, discharges shall be approved and signed by the treating psychiatrist. Rule 65E-9.011(5), Florida Administrative Code. 12. On June 29, 2007, the Agency conducted an Initial Licensure Survey of the Respondent Facility: 12.1. Based on record review and interview, the Respondent Facility failed to ensure that the treating psychiatrist approved and signed off on the discharge for 1 of 4 residents, resident #4. 12.2. Review of resident #4’'s clinical record revealed that resident #4 was discharged while in the hospital, and that the treating psychiatrist had not approved the discharge or signed off on it. 12.3. Interview with the clinical director, clinical manager, acting program manager, nurse manager and program coordinator on June 28, 2007, at 1:30 p-m. confirmed that the discharge was not approved or signed off on by the treating psychiatrist. 13. The Agency cited Respondent Facility for a violation of applicable law pursuant to Rule 65E-9.011, Florida Administrative Code, subjecting the Respondent Facility to fine pursuant to § 394.879, Florida Statutes (2006). WHEREFORE, the Agency intends to impose an administrative fine in the amount of $500.00 against Respondent, a residential treatment center in the State of Florida, pursuant to § 394.879, Florida Statutes (2006). ‘ COUNT IIIT 14. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and paragraph seven (7), as if fully set forth in this count. 15. Pursuant to Florida law, a child may be discharged only to the parent, guardian or placing organization, unless the Florida Administrative Code. 16. On dune 29, 2007, the Agency conducted an Initial Licensure Survey of the Respondent Facility 16.1. Based on record review and interview the Respondent Facility failed to discharge 1 of 4 residents sampled, resident #4, to resident #4’s parents, guardian or placing organization. 16.2. Review of the clinical record for resident #4 revealed that resident #4 was taken to the emergency room on June 17, 2007, because resident #4 deliberately swallowed a battery taken from a radio. The resident was left at the hospital because the hospital determined the _ resident should be Baker Acted. The staff at the Respondent Facility continued working resident #4's file, © planning for the resident's return to the Respondent Facility. On June 25, 2007, the clinical staff members were notified by the Respondent Facility’s administrative office that resident #4 would not be accepted back to the Respondent Facility. The resident was discharged to the custody of the hospital. 16.3. Interview with the clinical director, acting program manager, clinical manager, nurse manager and program coordinator on June 28, 2007, at 1:30 p.m. revealed that the clinical staff onsite at the Respondent Facility were unaware that the administrative staff offsite had decided to discharge the resident. The clinical personnel confirmed that the resident was not discharged to resident i #4's parents, guardian or placing organization. 17. The Agency cited Respondent Facility for a violation of applicable law pursuant to Rule 65E-9.011, Florida Administrative Code, subjecting the Respondent Facility to a fine pursuant to § 394.879, Florida Statutes (2006). WHEREFORE, the Agency intends to impose an administrative fine in the amount of $500.00 against Respondent, a residential treatment center in the State of Florida, pursuant to § 394.879, Florida Statutes (2006). ste Respectfully submitted this ZS day of September, 2007. es H. Harris, Esq. FN. Bar. No. 817775 Assistant General Counsel Agency for Health Care Administration : 525 Mirror Lake Drive, 330H ‘ St. Petersburg, FL 33701 727-552-1435 Facsimile 727-552-1440 Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for -administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922~5873. : 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 ALLEGRD IN THE COMPLAINT AND THE ENTRY OF A PINAL ORDER BY THE AGENCY. 10 ‘CERTIFICATE OF SERVICE T HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7007 0710 0004 0429 1914 on September 2S , 2007 to Michael C. Becker, Administrator/Reg. Agent, Devereux Florida/Devereux Orlando Sipp, 6147 Christian Way, Orlando, Florida 32808. — es H. Harris As¥istant General Counsel Copies furnished to: Michael C. Becker Joel Libby Administrator and Reg. Agent "| Field Office Manager Devereux Florida/Devereux Orlando Sipp Hurston South Tower 400 W. Robinson, #5309 Orlando, FL 32801 (U.S, Mail) -6147 Christian Way Orlando, Florida 32808 (U.S, Certified Mail) James H. Harris, Esq. Agency for Health Care Admin. §25 Mirror Lake Drive, 330H St. Petersburg, Florida 33701 (nteroffice) ii

Docket for Case No: 07-004790