STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS WITH DISABILITIES, License No. 7G401A/C Petitioner, v. Threshold, Inc. Respondent. ADMINISTRATIVE COMPLAINT. The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner’ or “Agency’), issues this Administrative Complaint against Tucker House Group Home operated by Threshold, 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: 3550 Goldenrod Rd, Winter Park, FL 32792. The Respondent also has contracted with APD to provide the residents with Medicaid waiver developmental disability services. Filed March 23, 2011 3:51 PM Division of Administrative Hearings 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 licensee. Section 393.0673(1)(b), Florida Statutes, provides that the Agency may revoke or suspend a license, or impose an administrative fine if the Department of Children and Family Services has verified that the licensee is responsible for the abuse, neglect, or abandonment of a child or the abuse, neglect, or exploitation of a vulnerable adult. 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 clients to be served. Consideration shall be given to age, sex, developmental level and specific needs. 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 client is exposed to, or instigates, such behavior as might be physically or emotionally injurious to him/herself or to another person. 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. Page A-8 of the Developmental Disabilities Waiver Services Coverage and_ Limitations Handbook (2008), incorporated into rule through Rule 10. 11. 12. 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.” FACTUAL ALLEGATIONS On March 22, 2010, the group home operated by the Respondent was serving five individuals with developmental disabilities. Four of the individuals were minor children and one individual is an adult. On March 21, 2010, one of the minor children residents (the victim) was observed to have four bite marks, one on her right calf, and three on various places on her arms. The victim is 16 years-old. In the past the victim has been involved in other altercations with the adult resident of the home. It is alleged that between March 20, 2010 8 PM and March 21, 2010 8 AM, while the victim was in her bedroom, the adult resident entered her room and bit her, leaving her with a large bite mark on her right calf, two bites on her right thigh, one bite on her left forearm, and scratches on her nose. At the time the allegation was made, the Mr. Clerveaux, the direct service provider of the group home was working on the overnight shift alone. Reportedly, there were to be alarms on the victim’s door, and Mr. Clerveaux was supposed to be monitoring the halls during the night. It is unknown where Mr. Clerveaux was located during the incident. 13. On March 23, 2010, the Department of Children and Families commenced an investigation regarding the alleged inadequate supervision and physical injury of the victim. The victin was examined by the Child Protection Team in March 25, 2010, and the results were positive for neglect and physical abuse. 14. As of May 09, 2010, Abuse Investigation conducted by the Department of Children and Families is closed with Verified Findings. The final report of the investigation notes that there are low implications for the individual’s safety as her room has been moved to the other side of the house, and overnight supervision has been increased to two staff. Mr. Clerveaux, the direct service provider on duty the night victim sustained her injuries was terminated by the respondent following their own internal investigation. COUNT L 13. Based on the foregoing, the Respondent violated Section 393.0673(1)(b), Florida Statutes, because the Department of Children and Family Services has verified that the Respondent is responsible for the neglect of one child victim. WHEREFORE, Petitioner respectfully requests entry of an order imposing the following penalties: $1000 fine for failure to adequately supervise client in group home which lead to injuries to a client. Dated: 28 February 2011 es af Grabb Senior Attorney, Office of General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Cc/ Merari Perez, Area Administrator Attachments: Explanation of Rights Election of Rights Form Copies furnished to: Kylene Beard APD Area 7 Office 3550 N. Goldenrod Road Winter Park, Fl 32792 CERTIFICATE OF SERVICE | HEREBY CERTIFY that a copy of the above named individuals by U.S. Mail or electronic mail, this 1st day of March, 2011. Percy W. Mallison, Jr., Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS RESPONDENT: __ Threshold, inc. | have read the accompanying Administrative Complaint and Explanation of Rights in this matter, and Elect the following hearing option: O ldo 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. O | 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 material 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 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. Failure to complete, sign and return the election of rights 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 Signature: Date: Print Name: Title: Business Location Address: City State Zip Mailing Address City State 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 Zip 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. 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 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 penaity levied will be included in a Final Order. If a 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.

Docket for Case No: 11-001543