Aug 16 2010 11:45 Aug 16 2010 10:42AM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS WITH DISABILITIES, License No. 7G130A Petitioner, Vv. THE SPRINGS GROUP HOME, owned and operated by LIFE CONCEPTS dib/a QUEST, INC., Respondent. ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner” or “Agency’), issues this Administrative Complaint against THE SPRINGS GROUP HOME, owned and operated by LIFE CONCEPTS d/b/a QUEST, INC., (or “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 a group home facility license issued by the Agency for a residence at the following address: 765 Wekiwa Springs Road, Apopka, Florida, 32742. The P- Aug 16 2010 11:45 Aug 16 2010 10:42AM APD 8504100665 Respondent also has contracted with APD to provide the residents with ‘ Medicaid waiver developmental disability services. 3. Section 393.0673(1)(a)(3), Florida Statutes, provides that the Agency may revoke or suspend a license, or impose an administrative fine if the licensee has failed to comply with the applicable requirements of Chapter 393, Florida Statutes, or the rules applicable to the licenses. 4. Rule 65G-2.012(6)(a), F.A.C. requires, in pertinent part, that: The facility shall be located, equipped, and designed to assure safe care and supervision for all residents. 5. Rule 65G-2.012(4), F.A.C. requires, in pertinent part, that: 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 residents to be served. Consideration shall be given to age, sex, developmental level and specific needs. 6. Rule 65G-2.012(15)(b), F.A.C. requires, in pertinent part, that: The facility shall take all reasonable precautions to assure that no resident is exposed to, or instigates, such behavior as might be physically or emotionally injurious to him/herself or to another person. 7. Section 393.13(3)(g), Florida Statutes, states that: Persons 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. 8. Section 393.13(4), Florida Statutes, states that: Each resident shall receive prompt and appropriate medical treatment and care for physical and mental ailments and for the P- Aug 16 2010 11:45 Aug 16 2010 10:42AM APD 8504100665 10. 11. prevention of any illness or disability. Medical treatment shall be consistent with the accepted standards of medical practice in the community. 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., 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.” Rule 65G-7.005, F.A.C. states: (2) A validated medication assistance provider must comply with the following requirements: (k) Observe the resident directly for a minimum of 20 minutes following the first three doses of a new or PRN medication in order to detect and respond immediately to potential side effects, unless ordered differently by the prescribing health care practitioner, and review the MAR for any special instructions by the prescribing practitioner regarding required observations. (6) The medication assistance provider may not assist with PRN medications, including OTC medications, unless a health care practitioner has provided written directions for the medication. The provider must attach to the resident's MAR a copy of the prescription or order legibly displaying the following information: (a) The name of the medication; (b) The prescription number, if applicable; (c) The prescribed dosage; and (d) Specific directions for use, including the medical basis for the medication, the time intervals for administration, the maximum number of doses, the maximum number of days that the medication should be administered, and conditions under which the health care practitioner should be notified. Rule 65G-4.009(8), F.A.C. states: The provider shall ensure that persons responsible for implementing, monitoring and providing behavior analysis services receive performance-based training that prepares them to properly implement the behavior analysis procedures involved, within the P- Aug 16 2010 11:47 Aug 16 2010 10:42AM APD 8504100665 12, 13. 14. 15. 16. circumstances under which the services will be provided. Rule 65G-8.004, F.A.C. states: (1) Upon an individual's admission to a facility or program and at least annually thereafter, the facility or provider must obtain information and documents relevant to the use of reactive strategies from a variety of sources for the individual's records. (3) In addition to the annual review, the individual's file information must be updated whenever there is a change in the individual's physical or psychological condition that might affect his or her tolerance of one or more reactive strategies, or updated in compliance with any reassessments required by State or Federal law. Rule 65G-8.006(7), F.A.C. states: Reactive strategies must be implemented in a manner that permits the greatest possible amount of comfort and protection from injury to the individual. FACTUAL ALLEGATIONS B.B., a vulnerable adult client of the Agency, was admitted to the Respondent’s group home on March 7, 2005. At that time, the APD Area 7 Behavior Analyst approved a variation of a wrist-triceps restraint for this resident involving forearm-only restraints. On June 9, 2010, at approximately 5:00 PM, B.B. began exhibiting self abusive behaviors which included hitting and biting himself. Two staff ‘ members employed by the Respondent physically restrained B.B. by ’ holding his wrists and shoulders. The reactive procedure involved in restraining resident B.B. on June 9, 2010, was applied incorrectly. The reactive procedure should have been limited to restraint of the forearm. According to interview with staff by APD P- Aug 16 2010 11:47 Aug 16 2010 10:42AM APD 8504100665 17. 18. 19. 20. representatives on June 14, 2010 following the incident, the restraint was : extended to the individual's shoulder area. The misapplication of the restraint procedure placed this individual at risk for further injury. : When the resident calmed, he expressed to staff that he was experiencing pain. Direct care staff contacted the group home manager who authorized the provision of Tylenol to the resident based on a physician's standing PRN order for the resident. There were no specific directions given by the attending physician for the application of the Tylenol given to this resident after he complained of pain. The resident was not personally assessed by a licensed healthcare professional to determine the nature and extent of the injury, the level of pain, and if the administration of Tylenol was the appropriate course of action. The resident subsequently was fed dinner, and removed from his _ wheelchair with a Hoyer lift for a shower. He slept the night and the following morning was observed to have significant bruising around his arm and shoulder. He was then taken to a hospital emergency room. Since B.B. cannot feed himself, toilet without assistance, and cannot - eommunicate with hospital staff, a hospital nurse informed the staff member that B.B. would require a caregiver be present until he was officially admitted to the hospital. The staff member told the hospital nurse that B.B. did not need anyone to stay with him and subsequently left him in the hospital emergency room without a caregiver. P- Aug 16 2010 11:47 Aug 16 2010 10:42AM APD 8504100665 21. 22. 23. 24, 25. B.B. was ultimately admitted to the hospital and was found to have a : shoulder fracture which ultimately required hospitalization and surgery to repair. According to interview with staff by APD representatives on June 14, 2010 following the incident, the resident complained of pain. Despite the intensity of the behavior, which involved self injury (biting which drew blood), and his subsequent compiaints of pain, he was not physically assessed before providing further care, which involved lifting him out of his wheelchair via a Hoyer Lift. There is no indication in the resident's record that he had been evaluated annually after March 7, 2005,to assess the effectiveness of reactive strategies utilized for his behaviors. There is no indication in the personnel records maintained by the Respondent that the two staff members who physically restrained B.B. on June 9. 2010 had received training on the implementation of authorized restraint techniques to be employed with this particular resident. COUNT L : Based on the foregoing, the Respondent violated Rule 65G-2.012(6)(a), F.AC., Rule 65G-2.012(4), F.A.C., Rule 65G-2.012(15)(b), F.A.C., Rule 65G-4.009(8), F.A.C., Rule 65G-8.006(7), 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), FA.C., by employing an unauthorized physical restraint technique with a resident. P- Aug 16 2010 11:48 Aug 16 2010 10:43AM APD 8504100665 26. 27. 28. COUNT II. "Based on the foregoing, the Respondent violated Rule 65G-2.012(6)(a), F.A.C., Rule 65G-2.012(4), FAC. Rule 65G-2.012(15)(b), F.A.C., Section 393.13(3)(g), Florida Statutes, 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., by leaving a resident unattended in the emergency room of a hospital. COUNT Ill ‘ Based on the foregoing, the Respondent violated Rule 65G-2.012(6)(a), F.A.C.. Section 393.13(4), Florida Statutes, 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..,, and Rule 65G-7.005, F.A.C. by administering an over-the-counter pain medication to a resident without first obtaining an examination by a : licensed professional and specific direction to administer that particular : medication. COUNT IV Based on the foregoing, the Respondent violated Rule 65G-2.012(6)(a), F.A.C., page A8 of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook, incorporated into rule through Rule 59G-13.083(2), F.A.C., and Rule 65G-4.009(8), F.A.C. by allowing two staff members to employ a restraint technique with a resident without © those staff members being trained on said technique. -10 Aug 16 2010 11:48 _ Aug 16 2010 10:43AM APD 8504100665 p.11 COUNT V 29. - Based on the foregoing, the Respondent violated Rule 65G-8.004, F.A.C by failing to obtain and annually update information and documents relevant to the use of reactive strategies for a group home resident. WHEREFORE, Petitioner respectfully requests entry of an order imposing the following penalties: administrative fine not to exceed $1,000 per offense, revocation of licensure and/or any other relief authorized by Chapter 393, Florida Statutes, or the rules promuigated thereto, this honorable tribunal deems fair and equitable. Dated: July 19, 2010 Sdhior Attorney, Office of General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Cco/ :Merari Perez, APD Area 7 Administrator Attachments: Explanation of Rights Election of Rights Form Aug 16 2010 11:48 Aug 16 2010 10:43AM APD 8504100665 Copies furnished to: M. Katie Porta, President Merari Perez, Life Concepts/d/b/a Quest, Inc. APD Area 7 Administrator §00 East colonial Drive Orlando, Fl 32803 Tom Rice, Central Office Operations CERTIFICATE OF SERVICE | HEREBY CERTIFY that a copy of the above named individuals by U.S. Mail or electronic mail, this 20th day of July, 2010. Percy W. Mallison, Jr., Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 -1le2 Aug 16 2010 11:48 Aug 16 2010 10:43AM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS. RESPONDENT: THE SPRINGS GROUP HOME, owned and operated by LIFE CONCEPTS d/b/a QUEST, INC., Apopka, Florida. | have read the accompanying Administrative Complaint and Explanation of Rights in this matter, and Elect the following hearing option: 0 | 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. 0 I dispute the material facts alleged in the Administrative Complaint and request an evidentiary hearing pursuant to Section 120.57(1), Florida Statutes. Specifically, | dispute the following materiai facts: 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 lega! 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. Failure to complete, sign and return the election of tights form to the agency within 21 days of receipt may 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. Telephone number for contact: Fax -13 Aug 16 2010 11:49 Aug 16 2010 10:44AM APD 8504100665 Signature: Date: Print Name: Title: a Business Location Address: City State Zip a Mailing Address City State Zip MAIL OR FAX THE COMPLETED FORM TO: Pete Mallison, Agency Clerk Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Fax: (850) 410-0665 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. 10 ~14 Aug 16 2010 11:49 Aug 16 2010 10:44AM APD 8504100665 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES EXPLANATION OF RIGHTS The énclosed 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. 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 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. 1 215

Docket for Case No: 10-007578

Orders for Case No: 10-007578