STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR PERSONS WITH DISABILITIES, Petitioner, Vv. License Number: 5144-8-GA Serenity Village Inc., 7002 2410 O00b 4982 O50b Freedom Court Group Home Respondent. / ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Petitioner,” “Agency”, Or “APD”), issues this Administrative Complaint Serenity Village Inc., owner and operator of Freedom Court Group Home (“Respondent’), and states the following as the basis for this complaint: ie 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 § 20.197 and § 393, Fla. Stat. (2016). 2. At all times material to this complaint, Respondent has held a group home facility license issued by the Agency for the following address: 11277 Freedom Court, Seminole, Florida 33772. The Respondent also has contracted with APD to provide the residents with Medicaid Waiver developmental disability services. 3: Fla. Stat. § 393.0673 (2016), sets forth the Agency's authority for denial, suspension, or revocation of license; moratorium on admissions; and administrative fines. Fla. Stat. § 393.0673(1) (2016), provides that the Agency may revoke a license if the licensee has failed to comply with the applicable requirements of this chapter or rules applicable to the licensee. 4. Fla. Stat. § 393.0673(1)(b) (2016), provides that the Agency may revoke a license if the Department of Children and Families 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. 5. Fla. Admin. Code R 65G-2.0041(4)(a)2. (2014), provides that Class | violations may be penalized by a moratorium on admissions, by the 12. 13. 14. 15. 16. 17. violation: The gravity of the violation, including whether the incident involved the abuse, neglect, exploitation, abandonment, death, or serious physical or mental injury of a resident, whether death or serious physical or mental injury could have resulted from the violation, and whether the violation has resulted in permanent or irrevocable injuries, damage to property, or loss of property or client funds; The actions already taken or being taken by the licensee to correct the violations, or the lack of remedial action; The types, dates, and frequency of previous violations and whether the violation is a repeat violation.” Pursuant to Fla. Admin. Code R 65G-2.008(1) (2014), “[t]he licensee shall employ adequate staff to maintain the facility in a manner that promotes and ensures the health, safety, and welfare of residents, and protects those who are not residents of the facility from any known dangerous behaviors that the residents exhibit. A violation of this subsection shall constitute a Class | violation.” Pursuant to Fla. Admin. Code R 65G-2.009(1) (2014), “[rjesidential facility services shall ensure the health and safety of the residents and shall also address the provision of appropriate physical care and supervision.” Pursuant to Fla. Admin. Code R 65G-2.009(1)(a)1 (2014), “[e]ach facility shall facilitate the implementation of client support plans, behavior plans, and any other directions from medical or health care professionals as applicable.” Pursuant to Fla. Admin. Code R 65G-2.009(6)(a) and (c) (2014), “[eJach facility must provide the level of supervision necessary to ensure that residents are protected from harm and that a safe and healthy living environment is created and maintained. . . A violation of this subsection shall constitute a Class | violation.” Pursuant to Fla. Admin. Code R 65G-2.009(3)(b) (2014), “[t]he facility shall not serve residents unless it can meet their specific programmatic and physical accessibility needs. The facility must be capable of effectively and safely meeting the needs of all facility residents accepted for placement.” Pursuant to Fla. Admin. Code R 65G-2.007(20)(a) (2014), “[a] licensee or applicant shall not make willful or intentional misstatements, orally or in writing, to intentionally mislead Agency staff, the Department of Children and Families, or law enforcement in the performance of their duties. Willful or intentional misstatements regarding the health, safety, welfare, abuse, neglect, exploitation, abandonment or location of a resident shall be considered a Class | violation.” 24. 25, 26. 27. 28. 29. investigative summary that staff Anthony Batten was reportedly given a written reprimand. The aforementioned incident constitutes a violation of Fla. Admin. Code R 65G-2.009(1) (2014), Fla. Admin. Code R 65G-2.009(1)(d) (2014), Fla. Admin. Code R 65G-2.008(1) (2014), Fla. Admin. Code R 65G- 2.009(1)(a)1 (2014), Fla. Admin. Code R 65G-2.009(6)(a) and (c) (2014), Fla. Admin. Code R 65G-2.009(3)(b) (2014), Fla. Stat. § 393.13(3)(a) and (g) (2016), and is a Class | violation. Count Il On or about June 12, 2016, at approximately 12:29 am, a 911 call was placed by Kevin Jones, direct care staff at Freedom Court Group Home, to report Resident 1 as missing. The police report from Pinellas County Sheriff's Office states that Officer Maldonado spoke with Kevin Jones, who reported that he had arrived to work on June 11, 2016, at approximately 11:00 pm. He checked on Resident 1 at 11:15 pm and observed that he was in his room. He did not check again until midnight, when he noticed that Resident 1 was gone and that his bedroom window was open. In Officer Maldonado’s report, he stated that since Resident 1 had left the facility more than three times within the last 6 months, he called DCF to report that Resident 1 may need to be placed in a more secure facility based on the previous incidents. The Department of Children and Families subsequently initiated an investigation into this incident. In the incident report submitted by Serenity Village Inc. to APD, it states that Kevin Jones failed to set the alarm system and that he would be suspended from his duties for one week. According to Kevin's statement to police, no one at Freedom Court Group Home checked on Resident 1 every 10 minutes as required in his behavior plan, from approximately 11:15 pm to 12:00 am. DCF Adult Protective Investigator Lisa Newmark-Miller noted in the course of her investigation that three different timelines of events were provided — one to the police, one to DCF, and another on the incident report submitted to APD. All three versions of events, however, indicate that Resident 1 was not checked on every 10 minutes as required and the alarm system was not activated at the time of Resident 1’s elopement. Resident 1 was later found at Morton Plant Hospital, where he had been taken at approximately 2:30 am on June 12, 2016. He was picked up near Freedom Court Group Home, after he knocked on a stranger's front door WHEREFORE, based on the aforementioned violations of rules and laws applicable to the licensee as described above, Petitioner respectfully requests revocation of the group home license held by Serenity Village, Inc., owner and operator of Freedom Court Group Home, in accordance with Fla. Stat. § 393.0673(1) (2016). Dated: September 9, 2016 esl Jeannette Estes, Esq. Senior Attorney Office of the General Counsel Agency for Persons with Disabilities 200 N. Kentucky Ave., Suite 422 Lakeland, FL 33801 Attachments: Explanation of Rights Election of Rights Form Copies furnished to: Gary Hartfield Jeff Smith Serenity Village Inc. Regional Operations Manager 15301 Roosevelt Blvd. Ste. 304 APD Suncoast Region Clearwater, FL 33760 STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES EXPLANATION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT 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 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 dispute the violations and alleged material facts in the Complaint and request a formal hearing with the Division of Administrative Hearings 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. In the alternative, you may elect to not dispute the material facts alleged in the Complaint and request that an informal 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. If a dispute of material fact is raised during the informal hearing, the hearing will be terminated and the case referred to the Division of Administrative Hearings for a formal hearing before an Administrative Law Judge. 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 Failure to complete, sign and return the election of rights form to the agency within 21 days of receipt will 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. Election of Rights page 1 Please fill out completely: Telephone number for contact: Fax Signature: Date: Print Name: Title: Business Location Address: City State Zip Mailing Address City State Zip Electronic mail for contact MAIL OR FAX BOTH PAGES OF THE COMPLETED FORM TO: Lori Oakley, Acting Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Fax: (850) 414-5759 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. 11 21 days of your receipt of this Administrative Complaint, you will be . considered to have waived your right to a hearing in this matter and the | () Agency may proceed against you in this matter without your participation. STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT RESPONDENT: Serenity Village Inc. | have read the accompanying Administrative Complaint and Explanation of Rights in this matter. | would like to request a hearing, and | elect for the following hegring option: | dispute the material facts alleged in the Administrative Complaint and request that a formal evidentiary hearing be held before an Administrative Law Judge at the Division of Administrative Hearings, pursuant to Section 120.57(1), Florida Statutes. Specifically, | dispute the following material facts (attach additional sheets if necessary): / = O | 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 written or oral evidence in mitigation of the charges or explain why the facts alleged do not constitute a violation of law. fo Please be advised this is a legally binding document and contains important information regarding your rights. Should you desire advice tegarding your response, you may wish to seek legal counsel before proceeding. By signing this document, you represent that 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. 10 articipation, which may result in e Provided in §393.063(1), Florida Statutes. penaltles May include suspension, ency may conjmence revocation or denial of licensure, and fines up to {$1000 per Gay for each violation Please fill out completely Election of Rights page 1 Telephone number for contact ACA ASC BaKY Fax ATL. BUZZ. Date Alzg ky Le ® | Signature JA.) Ww PrintName: (- XV Mstxme ih _ Title Preseecd \SS0\ Roaosevelt Qiud Surte Bd =. C \ecewse ker FL Zip ‘SVE Business Location Address City State Dhan e = : : : a Mailing Address City State ora wor EE e\h@sv-Cas, ore) Electronic mail for contact MAIL OR FAX BOTH PAGES OF THE COMPLETED FORM TO: Lori Oakley, Acting Agenty Clerk Agency for Persons with isabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 323 9-0950 Fax: (850) 414-57 You are advised, per Section 120 573, Florida ra available for this action Please keep a copy of thi utes. that mediation is not document for your records 062S0005085330 ih OCT -4U PFI Wwco, sdureys 9102 62 das Lusee NOUS SSVTO-1SUl4 a9vLsOd SN oL7°0$ HM QLOL-66ETE 14 SOSSEYEIEL oge als ‘Ae epeuejdsy O€0r KajyeO 07 SaIIGeSIG UM SUOSIS, 40} Aoueby Xbb 92S Of, das & Gee fF LLGEe Tq ‘Uopuetg peoy uspsiuny ‘MM SE9 Wid Youle “g Atou

Docket for Case No: 16-006001FL