EXHIBIT A STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS Fr WITH DISABILITIES, MAY 28 2019 Petitioner, APD v. Agency Clerk's Office License Number: 15-IV-160 BARBARA TERRACE HOUSE, OWNED AND OPERATED BY ADAMS ACRES, INC., Respondent. ADMINISTRATIVE COMPLAINT The AGENCY FOR PERSONS WITH DISABILITIES, (“Agency”), issues this Administrative Complaint against Barbara Terrace House, owned and operated by Adams Acres, 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, residential habilitation centers, and comprehensive transitional education programs 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 the following address: 3921 Barbara Terrace, St. Augustine, Florida 32086. 3. Pursuant to the Florida Division of Corporations, Adams Acres, Inc., is a registered and active Florida Corporation. 4. Section 393.0673, Florida Statutes, sets forth the Agency’s authority for denial, suspension, or revocation of license; moratorium on admissions; and administrative fines. (1) The agency may revoke or suspend a license or ail an administrative fine, not to exceed $1,000 per violation per day, if: (a) The licensee has: 1] 1. Falsely represented or omitted a material fact in its license application submitted under s. 393.067; 2. Had prior action taken against it under the Medicaid or Medicare program; or 3. Failed to comply with the applicable requirements of this chapter or rules applicable to the licensee; or (b) 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. COUNT I The Agency re-alleges and incorporates paragraphs one through four as if fully set forth herein. On or about April 19, 2018, J.W., a vulnerable adult resident of Respondent’s group home, eloped from the group home. J.W. was located over an hour later at a nearby hospital. On or about April 19, 2018, the Department of Children and Families (“DCF”) commenced an investigation involving allegations of abuse, neglect or exploitation of a vulnerable adult. On or about July 2, 2018, DCF closed the investigation with verified findings of abuse, neglect or exploitation of a vulnerable adult against the Respondent. Pursuant to Section 393.13(3)(a), Florida Statutes, persons with developmental disabilities shall have a right to dignity, privacy, and humane care, including the right to be free from abuse, including sexual abuse, neglect, and exploitation. Pursuant to Rule 65G-2.009(1)(d), Florida Administrative Code, the facility shall adhere to and protect resident rights and freedoms in accordance with the Bill of Rights of Persons with Developmental Disabilities, as provided in section 393.13, F.S., Violations of section 393.13(3)(a), F.S., relating to humane care, abuse, sexual abuse, neglect, or exploitation and all violations of section 393.13(3)(g), F.S., shall constitute a Class I violation. Pursuant to Rule 65G-2.0041(2)(a), Florida Administrative Code, the Agency shall consider the following factors when determining the sanctions for a 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. 12. 13. 14, 15. COUNT II The Agency re-alleges and incorporates paragraphs one through four as if fully set forth herein. On or about April 19, 2018, J.W., a vulnerable adult resident of Respondent’s group home, became verbally aggressive with another resident of the home. J.W. then went outside onto the porch while Respondent’s staff remained inside. Shortly after, J.W. eloped from the group home. His absence was noted by another resident, who alerted staff. J.W. was located over an hour later at a nearby hospital. J.W.’s behavior plan states that arguments with another person are precursors to elopement. The elopement risk protocol requires that staff maintain line of sight supervision at all times for at least the next four hours. Respondent’s staff failed to maintain continuous visual supervision of J.W. after his verbal aggression, despite protocol requiring such. Residential facility services shall ensure the health and safety of the residents and shall also address the provision of appropriate physical care and supervision. Fla. Admin Code R. Rule 65G-2.009(1). | Each facility shall facilitate the implementation of client support plans, behavior plans, and any other directions from medical or health care professionals as applicable. Fla. Admin Code R. 65G- 2.009(1)(a)1 Each 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. Fla. Admin. Code R. Rule 65G-2.009(6). Direct service providers must be given specific information and strategies to provide such an environment for all of residents of the facility. Jd. A violation of this subsection shall constitute a Class I violation. Fla. Admin. Code R. Rule 65G-2.009(6)(c). COUNT III The Agency re-alleges and incorporates paragraphs one through four as if fully set forth herein. On or about November 3, 2018, S.B., a vulnerable adult resident of the Barbara Terrace House Group Home, owned and operated by the Respondent, aggressed Marquez King, Respondent’s staff. S.B. was placed in physical restraint by Marquez King and another of the Respondent’s staff. While restraining S.B., Marquez struck S.B. repeatedly on the head and injured S.B. 19. | On or about November 3, 2018, the Department of Children and Families (“DCF”) commenced an investigation involving allegations of abuse, neglect or exploitation of a vulnerable adult. 20. On or about December 21, 2018, DCF closed the investigation with verified findings of abuse, neglect or exploitation of a vulnerable adult against the Respondent. va] Physical or corporal punishment that includes but is not limited to hitting, slapping, smacking, pinching, paddling, pulling hair, pushing or shoving residents is strictly forbidden. Fla. Admin Code R. 65G-2.009(8)(d)1. A violation of this section constitutes a Class | violation. Fla. Admin Code R. 65G-2.009(8)(d). Based on the foregoing and pursuant to 393.0673, Florida Statutes, the Agency requests that a Final Order be entered that revokes the license of the Respondent or imposes a fine in the amount of $1,000 for each Class I violation or places any other penalty against Respondent’s license as proscribed by law. / / ) Dated May 24, 2019 % ‘44 Trevor S tet, Esg—— . _ Senipr Attorney ~~_Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Attachments: Notice of Adminisirative Hearing Rights Copies furnished to: Wendy Moran Leslie Richards Executive Director, Adams Acres, Inc. APD Regional Operations Manager 1735-1 SR 16 Northeast Region St. Augustine, Florida 32084 ogo agency for persons with disabilities State of Florida Notice of Administrative Hearing Rights For Administrative Complaint You have the right to request a hearing to be conducted in accordance with sections 120.569 and 120.57, Florida Statutes (F.S.), and to be represented by counsel or qualified representative to challenge the administrative complaint. To obtain an administrative hearing, you must file a written request for hearing with the Agency Clerk by 5:00 PM Eastern Time within 21 days of the day that you receive the administrative complaint. Filed with the Agency Clerk means received by the Agency Clerk’s Office. If you fail to file the request for hearing within the 21 days, you waive the right to have a hearing. The request for hearing shall include: 1. Your name, address, e-mail address, telephone number, and facsimile number, if any, if you are not represented by an attorney or a qualified representative; 2. The name, address, e-mail address, telephone number, and facsimile number of your attorney or qualified representative, if any, upon whom service of pleadings and other papers shall be made; 3. A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. (Pursuant to sections 120.569 and 120.57, F.S., a disputed issue of material fact entitles you to a formal hearing; if there are no disputed issues of material fact then you are entitled to an informal hearing); 4. A statement of when you received notice of the administrative complaint; and 5. A statement including the file number on the administrative complaint. You must file your request for hearing with the Agency Clerk by hand delivery, express delivery service, U.S. mail, facsimile transmission, or by email at the following address: Agency for Persons with Disabilities Attention: Agency Clerk Filed with the Agency Clerk means received in 4030 Esplanade Way, Suite 335 the Office of Agency Clerk by 5:00 pm on the Tallahassee, FL 32399 due date. APD. AvencyClerkic apdcares.orz (850) 922-4556 (phone) Mediation under s.120.573, Florida Statutes, is (850) 410-0665 (fax) not available for this proceeding. Rev. OGC May 19, 2017 http:/lapdcares.org CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy of this Administrative Complaint was sent to the above-named individuals by U.S. Mail, facsimile, or electronic mail, this ag day of May 2019. | VEE “hems cu ielle Thompson, Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950

Docket for Case No: 19-003656FL