Jul 1 2008 15:23 Jul 01 2008 3:21PM APD 9504100665 p-6 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES APD-09-C010 AGENCY FOR PERSONS WITH DISABILITIES, . License No(s).: 07-12-043 Petitioner, License Type: Standard y . FAD 3 4 oan (PD uD mi 3. 7008 F { aPRIT anon nite as EAGLE’S NEST OF DELAND, INC., Parsons with Clcabittieg Respondent ADMINISTRATIVE COMPLAINT _The AGENCY FOR PERSONS WITH DISABILTIES (‘Petitioner’), files this Administrative Complaint — against Eagie’s Nest of Deland, Inc. (‘Respondent’) and states: ‘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, Fiorida Statutes. 2. Respondent Eagle’s Nest Of Deland, Inc., owned and operated by Delores Kramer, has at all times material to this Complaint held a residential facility license issued by the Agency for Persons With Disabilities for a group home residence at the following address: 1525 Carr Street, Deland, Florida 32720. 3. Respondent's business address of record is the same as the address listed above. ‘4, On Thursday March 13, 2008, at 3:15 p.m., APD inspectors visited Eagle’s Nest. The owner, Ms. Kramer, was not at the facility. Ronald Kramer, a direct service provider, was at the | residence with APD clients. No other direct service providers were present. 5. At the Agency's request, Respondent could not produce documentation of a Level 2 Background Screening for Ronald Kramer, as required by section 393.0655, Fiorida Statutes. When the APD inspectors contacted Ms. Kramer by telephone, she admitted that she had not obtained a Level 2 Background Screening for Mr. Kramer. 6. Additionally, Respondent was unable to produce documentation indicating that Mr. Kramer had completed training in Cardio Pulmonary Resuscitation, First Aid, or Medication Administration. 7. Inspection also revealed that the medication Zocor, prescribed for APD client ‘T.T.”, had been removed from its original container and taped to a note from Ms. Kramer, instructing Mr. Kramer to “give one pill to [T.T.] on Thursday moming, and Saturday morning.” The medication and administration directions were not being maintained in a locked cabinet, as required. Jul 1 2008 15:24 Jul 01 2008 3:21PM APD 8504100665 &. 10. 10. COUNT ! Petitioner realleges and incorporates paragraphs (1) through (7). Section 435.04(1), Florida Statutes, provides in pertinent part, “all employees in positions designated by law as positions of trust or responsibility shall be required to undergo security background investigations as a condition of employment and continued employment. For the purposes of this subsection, security background investigations shall include, but not be limited to, fingerprinting for alt purposes and checks in this subsection, statewide criminal and juvenile records checks through the Florida Department of Law Enforcement, and federal criminal records checks through the Federal Bureau of Investigation, and may include local criminal records checks through local law enforcement agencies.” Based on the foregoing, Respondent violated section 435.04(1), Florida Statutes, by failing to obtain a security background investigation on Mr. Kramer. _ COUNT II Petitioner realleges and incorporates paragraphs (1) through (7). Section 393.0655, Florida Statutes, provides in pertinent part, “the agency shall require level 2. employment screening pursuant to chapter 435 for direct service providers who are unrelated to their clients, including support coordinators, and managers and supervisors of residential facilities or comprehensive transitional education programs licensed under this chapter and any other person, including volunteers, who provide care or services, who have access to a client's living areas, or who have access to a client's funds or personal property. Background screening shall include employment history checks as provided in s. 435.03(1) and local criminal records checks through local law enforcement agencies.” . Based on the foregoing, Respondent violated section 393.0655, Florida Statutes, by failing to complete a Level Two screening for Mr. Kramer. COUNT III Petitioner realieges and incorporates paragraphs (1) through (7). Rule 65G-2.012(12), Florida Adminsitrative Code, provides in pertinent part, “staff shall complete a basic first aid course, including instruction in the Heimlich maneuver and cardio-pulmonary resuscitation, as arranged for by the area office.” Jul 1 2008 15:24 Jul 01 2008 3:22PM APD 8504100665 11. Based on the foregoing, Respondent violated rule 65G-2.012(12), Florida Administrative Code, by failing to provide required training to Mr. Kramer. COUNT IV 12. Petitioner realleges and incorporates paragraphs (1) through (7). Section 393.506(b)(3), Florida Statutes, provides in pertinent part, “a direct service provider may supervise the self- administration of medication by a client or may administer medication to a client only if the client, or the client's guardian or legal representative, has given his or her informed consent to self- administering medication under the supervision of an unlicensed direct service provider or to receiving medication administered by an unlicensed direct service provider. Such informed consent must be based on a description of the medication routes and procedures that the direct service provider is authorized to supervise or administer. Only a provider who has received appropriate training and has been validated as competent may supervise the self-administration of medication by a client or may administer medication to a client.” . 13. Based on the foregoing, Respondent violated section 393.506, Florida Statutes, by directing Mr. Kramer to administer medication without authorization and training. COUNT Ill 14. Petitioner realleges and incorporates paragraphs (1) through (7). Rule 65G-2.012 (15)(c)(d), Florida Administrative Code, provides in pertinent part, “facility staff shall be instructed by Agency staff in Developmental Disabilities Act abuse reporting procedures and shall report suspicion or evidence of abuse in accordance with Section 39.201 or 415.1034, F.S. Facllity Staff shall be knowledgeable of provisions of the Bill of Rights of Persons with Developmental ~ Disabilities, Section 393.13, F.S.” 15. Based on the foregoing, Respondent violated Rule 65G-2.012(15) of the Florida Administrative Code by failing to ensure that Ronald Kramer received training in Developmental Disabilities Act abuse reporting and the Bill of Rights of Persons with Developmental Disabilities. COUNT IV 16. Petitioner realleges and incorporates paragraphs (1) through (7). Rule 65G-2.012(14)(d), Florida p-8 Jul 1 2008 15:25 Jul Q1 2008 3:22PM APD 8504100665 Adminsitrative Code, provides in pertinent part, “a daily record must be kept of prescription and/or nonprescription medication administered, except when self-medication is approved as part of the habilitation plan. The record must specify the client's name, date, time, dosage, name of medicine and signature of person administering.” 17. In addition, Rule 65G-2.012(14)(b), Florida Administrative Code, provides in pertinent part, “all prescription medication shail be kept in its original container with dated label with legible information stating the prescription number, direction for use, client's name, physician’s name, and address of the issuing pharmacy’ and Rule 65G-2.012(14)(e), Florida Administrative Code, provides in pertinent part, “medications shall be stored in a locked enclosure.” 18. Based on the foregoing, Respondent violated Rule 65G-2.012(14) of the Florida Administrative Code by failing to ensure that medications were stored in a locked enclosure, maintained in their original labeled container, or that the daily record for the administration of the medication was maintained. : WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following penalties: administrative fine nat to exceed $1, 000 per offense; suspension or revocation of its license, and / or any other relief authorized by Chapter 393, Florida Statutes, or the rules promulgated thereto. Edwin B. DeBardeleben, Area Administrator COUNSEL FOR THE AGENCY: Gail Scott Hill, Senior Attorney; Florida Bar No. 909289 4030 Esplanade Way, Suite 380, Tallahassee, Florida 32399-0950 March 27, 2008 Attachments: Explanation of Rights Election of Rights Form Pp. Jul 01 2008 3:23PM APD CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: (or) BY HAND-DELIVERY: served me on this Jul 1 2008 15:25 8504100665 Nooy ASIO C0OS HAA UH IU pate: 4-\\- 08 A copy of the foregoing ADMINISTRATIVE COMPLAINT has been day of , 2008. Operator's Signature Title -10 Jul 1 2008 15:25 Jul 01 2008 3:23PM APD 8504100665 STATE OF FLORIDA ; AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS Respondent: Eagle’s Nest of Deland, Inc. | have read the accompanying Administrative Complaint and Explanation of Rights in this matter, and elect as follows (MARK ONE BOX ONLY): HEARING OPTIONS O 1 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 only written or oral evidence in mitigation of the charges or explain why the facts alleged do not constitute a violation of law. Ol di the material facts alleged in the Administrative Complaint and request an evidentiary hearing pursuant to Section 120.57(1), Florida Statutes. Mail this form to the address listed below. 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 and accept responsibility for compliance with any final order resulting from this action. 211 Jul 1 2008 15:25 Jul O1 2008 3:23PM APD 8504100665 Failure to complete, sign and return the election of rights form to the agency within 30 days of receipt may constitute a waiver of your right to be heard in this m 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. Telephone number for contact: Fax: Signature: Date: Print Name: eee Business Location Address: City State Zip Mailing Address City State Zip MAIL OR FAX THIS COMPLETED FORM TO: Debra Scott, Acting Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Sulte 380 Tallahassee, Florida 32399-0950 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. -12 Jul 1 2008 15:26 Jul O1 2008 3:23PM APD 8504100665 Pp. 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 thata ° 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. Ifa 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 recaive it within 30 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 13 Jul 1 2008 15:26 Jul O1 2008 3:24PM APD 8504100665 p- 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 30 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. 14

Docket for Case No: 08-003176APD