Findings Of Fact At all times material to the allegations of this matter, Respondent was licensed to operate an assisted living facility at 817 Eleventh Street, West Palm Beach, Florida. The Department is the state agency charged with the responsibility of regulating, and assuring compliance with state laws governing, assisted living facilities. Joseph Narkier, a human services surveyor employed by AHCA, was assigned to perform an appraisal of the Respondent's facility in September, 1995. He visited the facility on September 27, 1995, along with Polly Weaver, chief of field operations. In accordance with his instructions, Mr. Narkier did not perform a full survey but only looked at certain items, "tags," which had historically been out of compliance at the facility. Based upon his review, Mr. Narkier found the following deficiencies at the Aries Retirement Living facility: Respondent failed to display its current license inside the facility as required by state standard A 003. This deficiency had been cited on an earlier survey, March 14, 1995. Fiscal records were not on the premises, thus Respondent could not identify income and expenses as required by state standard A 100. This deficiency had also been cited on March 14, 1995. Since fiscal records were not on the premises, it could not be determined that the facility was administered on a sound financial basis as required by state standard A 101. This deficiency had also been cited on March 14, 1995. The Respondent did not produce an accurate written admission and discharge record as required by state standard A 201. This deficiency had also been cited on March 14, 1995. The Respondent did not produce an executed contract for each resident dated at the time of admission as required by state standard A 300. There were three residents for whom no evidence of a contract, executed at admission, could be produced. This deficiency had also been cited on March 14, 1995. State standard A 301, which relates to the content of the resident contract, was also deficient. Since there were no contracts for three residents, the contract content did not exist. This deficiency had also been cited on March 14, 1995. The Respondent did not have medical records or other support documentation to show that one resident had had a medical examination either within sixty days prior to admission or within thirty days after admission to the facility. Such exams are required to verify the residents are free of signs and symptoms of any communicable disease which is likely to be transmitted to other residents and is required by state standard A 406. The Respondent also could not produce documentation regarding admissions criteria as required by state standard A 408. According to records for one resident, medications were to be administered by a licensed professional. Since records did not verify the medications were administered according to the physician's orders, state standard A 601 was not met. Electrical outlets in the kitchen were not maintained in a safe condition in violation of state standard A 901. Hot and cold water faucets were not identified by use of the "H" and "C" initials as required by state standard A 1023. The records needed to verify the facility was in compliance with the state standards were not made available to the surveyors prior to their departure from the facility. Moreover, fiscal records were not made available to Mr. Narkier at the follow-up review on November 21, 1995. The fiscal records were not available until a third survey date, February 13, 1996, the second follow-up date. Based upon the foregoing, at the time of the survey Respondent had at least six class III deficiencies. None of the excuses suggested by Respondent to explain the survey findings has been deemed credible. This Respondent has a history of deficient performance. Two prior contested administrative complaints resulted in findings of numerous violations. Those violations were fully addressed in DOAH Case Nos. 94-5078 and 94-6908. On April 5, 1995, a recommended order was entered in DOAH Case Nos. 94-5078 and 94-6908. That order was adopted and incorporated by reference in the final order entered by AHCA on May 15, 1995. The final order entered in DOAH Case Nos. 94-5078 and 94-6908 imposed an administrative fine in the amount of $8,000.00 which Respondent has not paid. In addition to this outstanding administrative fine, Respondent has a history of two other administrative actions which also resulted in administrative fines. In DOAH Case No. 92-2415, the parties entered into a stipulation wherein Respondent agreed to pay a fine in the amount of $1,125.00. The Respondent did not timely remit that administrative fine. The second administrative action also resulted in an administrative fine. That case was not referred to the Division of Administrative Hearings. The final order (AHCA Exhibit 4), entered on August 8, 1991, imposed an administrative fine in the amount of $750.00. Respondent eventually paid this fine on April 22, 1992. Respondent has consistently failed to honor the state standards set for this type facility.
Recommendation Based on the foregoing, it is, hereby, RECOMMENDED: That the Agency for Health Care Administration enter a final order dismissing Case No. 95-0128 since the applicant has withdrawn the request to increase capacity of the ALF; denying the renewal of licensure sought in Case No. 95-0129; and imposing an administrative fine in the amount of $1,200.00 in Case No. 95-5678. DONE AND ENTERED this 30th day of September, 1996, in Tallahassee, Leon County, Florida. JOYOUS D. PARRISH, Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 30th day of September, 1996. APPENDIX TO RECOMMENDED ORDER Rulings on the proposed findings of fact submitted by the Petitioner: Paragraphs 1, 3, 11, 12, 13, and 14 are accepted. With regard to paragraphs 2, and 4 through 10, such paragraphs reiterate findings of fact made in DOAH Case Nos. 94-5078 and 94-6908 which have been adopted by final order and are not at issue in this proceeding. As a matter of law, unless set aside such findings remain in effect. Paragraph 15 is rejected as hearsay. Notwithstanding that Respondent's proposed findings of fact failed to comply with Rule 60Q-2.031(3), Florida Administrative Code, and contained multiple facts per paragraph (some of which could not be accepted while others could), to the extent possible, the following rulings on the proposed findings of fact submitted by the Respondent are made: The first sentence of paragraph 1 is accepted; the remainder is rejected as irrelevant or inaccurate. An administrative proceeding related to two complaints against this Respondent which found numerous violations resulted in a final order being entered by the Department. With regard to paragraph 2, the last sentence is accepted; the remainder of the paragraph is rejected as irrelevant or inaccurate or procedural issues unrelated to this matter. Further, as to the unannounced survey conducted by Mr. Narkier, notice of an intended survey is not required as a matter of law. With regard to paragraph 3, it is accepted a current license was not displayed. Otherwise rejected as contrary to the weight of the credible evidence. Paragraph 4 is rejected as irrelevant or contrary to the weight of the credible evidence. The violation stems from the failure to display the current license. Paragraph 5 is rejected as mischaracterization of the testimony or contrary to the weight of the credible evidence. Paragraphs 6 through 8 are rejected as no record cited supported the findings or irrelevant or contrary to the weight of the evidence in its entirety. COPIES FURNISHED: Sam Power, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3 Tallahassee, Florida 32308-5403 Douglas M. Cook, Director Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3 Tallahassee, Florida 32308-5403 Jerome W. Hoffman, General Counsel Agency for Health Care Administration 2727 Mahan Drive, Suite 3431 Fort Knox Building 3 Tallahassee, Florida 32308-5403 Linda L. Parkinson, Esquire Agency for Health Care Administration Division of Health Quality Assurance 400 West Robinson Street, Suite S-309 Orlando, Florida 32801 Esther A. Zaretsky, Esquire 1655 Palm Beach Lakes Boulevard Forum III, Suite 900 West Palm Beach, Florida 33401
Conclusions Having reviewed the Notice of Intent to Deny (hereinafter “NOID”), and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency has jurisdiction over the above-named Petitioner pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing status and administrative code provisions. 2. The Agency issued the attached NOID and Elections of Rights form to the Petitioner with respect to its license renewal application. (Ex. A) The Election of Rights form advised of the right to an administrative hearing. The Petitioner received the NOID and timely filed the Election of Rights form with the Agency Clerk. (Ex. B) 3. On September 30, 2011, the Agency filed a motion to dismiss with the Agency Clerk, citing the mootness of the NOID due to the revocation of the underlying assisted living facility license. (Ex. C) The Agency Clerk granted the motion and directed the entry of a final order. (Ex. D) Based upon the foregoing, it is ORDERED: 1. The Agency’s NOID is withdrawn as moot due to the revocation of the underlying license to operate the assisted living facility in question. ORDERED in Tallahassee, Florida, on this /7_ day of Algae} , 2012. Secretary Care Administration Elizabeth Dude Agency for He 1 Filed February 21, 2012 1:58 PM Division of Administrative Hearings
Other Judicial Opinions A party that is adversely affected by this Final Order is entitled to seek judicial review which shall be instituted by filing one copy of a notice of appeal with the agency clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The notice of appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy eas Final Order was served on the below- named persons/entities by the method designated on this 2/*~day of feller , 2012. Richard Shoop, Agency Clérk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone (850) 412-3630 Jan Mills Shaddrick Haston, Unit Manager Facilities Intake Unit Assisted Living Facility Unit Agency for Health Care Administration Agency for Health Care Administration Unteroffice Mail) Cnteroffice Mail) Tria Lawton-Russell John D.C. Newton, II Office of the General Counsel Administrative Law Judge Agency for Health Care Administration (Interoffice Mail) Division of Administrative Hearings (Electronic Mail) Lawrence Bessser, Esquire Samek and Besser 1200 Brickell Avenue, No. 1950 Miami, Florida 33131 (U.S. Mail)
The Issue The issues to be determined are whether Respondent, Miracles House, Inc. (Respondent or Miracles), as licensee of Miracles House, Inc., a group home facility, violated provisions of section 393.0673, Florida Statutes (2017), and administrative rules,1/ as alleged in the Administrative Complaint; and, if so, what is the appropriate sanction.
Findings Of Fact APD is responsible for regulating the licensing and operation of group home facilities in the state of Florida. APD's clients include vulnerable individuals with developmental disabilities attributed to autism, cerebral palsy, intellectual disabilities, Phelan-McDermid syndrome, Prader-Willi syndrome, or spina bifida. APD's clients can choose to live in an institutional setting, group home, or independently. A client is assisted in this choice by a residential placement coordinator. A group home is a licensed facility providing a living arrangement similar to a family setting. It is the provider's responsibility to provide not only room and board but also safety, transportation, assistance with the activities of daily living, and to attempt to provide all residential habilitation services at the level needed by the client, as established by the client with a waiver support coordinator. A waiver support coordinator is an independent contractor for APD who acts as a case manager and is responsible for coordinating the services provided to a client. Support plans are prepared and submitted to APD by a client's waiver support coordinator. A support plan is a "snapshot" of a client's life. It includes a summary of events and activities that have occurred throughout the year, including hospitalizations, medications, and the client's goals. The resources and capabilities available to a client and his support givers are not always sufficient to meet all of the client's needs. The support plan is implemented to maximize the attainment of habilitative goals. The support plan is periodically reviewed to assess progress toward habilitative and medical objectives and revised annually after consultation with the client. Each client is assigned a level of care code that relates to payment made to the group home on the client's behalf. As its name suggests, there is some correlation between the level of care code that is assigned and the level of care to be given by the provider, but because additional services may be provided by other individuals and resources, the assigned level of care does not necessarily reflect all needs and services necessary for, or being provided to, the client. If a group home believes that it cannot provide the required residential habilitation services or meet its responsibilities with respect to a particular client, it can make this known to the waiver support coordinator. Adjustments are periodically made to the support plan, including the level of care code. If adjustments sufficient to address the provider's concerns are not made, a group home may request that a client be placed in another facility. APD issued license number 11-1088-GH to Miracles for the purpose of operating a group home located at 113211 Northwest 26th Court, Miami, Florida. Ms. Whipple is a corporate officer of Miracles and the on-site manager of its group home. There was no evidence introduced indicating that Miracles had previously received discipline based upon its group home license. Client R.H. At all times material to this case, Client R.H. was a resident of Miracles' group home, where he has lived for several years. Client R.H. has an intellectual disability. Mr. Lumumba was a contracted waiver support coordinator working with APD. He began work in this capacity in July of 2016 and was assigned to Client R.H. at that time. Mr. Lumumba prepared support plans and many incident reports for Client R.H. after that date. Incident reports prior to Mr. Lumumba's service were also admitted into evidence. Successive support plans repeat much of the narrative from prior plans, and because only selected plans were introduced into evidence, it is difficult to determine exactly when many of the additions or entries were made. Client R.H. is reported as having suicidal thoughts, and it is noted that when he is under the influence of drugs, he requires support and direction to be safe. He is described as needing reminders, instruction, redirection, and support to avoid danger and to remain healthy and safe. Notations in the support plans and numerous incident reports document a distinct pattern of behaviors by Client R.H. In an incident report dated January 26, 2015, it was reported that Client R.H. became agitated, left the group home alone, and walked to the Mental Health Center located at Northwest 27th Avenue and 151st Street. He was later transported by the Mental Health Center staff to Jackson Memorial Behavioral Health Unit and admitted. In an incident report dated February 11, 2015, it was reported that Client R.H. became agitated and left the group home to go to the store, refusing to be accompanied by staff. He later presented himself at North Shore Medical Center where he was admitted to the Crisis Stabilization Unit. In an incident report dated February 17, 2015, it was reported that Client R.H. visited his mother, got into an argument with her, left her home, and went to Memorial Regional Hollywood Emergency Room (ER). He was later discharged in the care of Miracles' group home staff. In an incident report dated March 30, 2015, it was reported that Client R.H. became argumentative and left the group home unaccompanied under the pretext of going to the nearby corner store. He traveled to the North Shore Medical Center ER and was admitted to the Behavioral Health Unit. He was discharged on March 25, 2015, and returned to Miracles by hospital staff. A July 19, 2015, update to the Client R.H.'s support plan indicates that Client R.H. reported that he was not abused at the Miracles' group home, and that he felt safe and wanted to stay there. In an incident report dated August 14, 2015, it was reported that Client R.H. left the group home and went to the North Shore Medical Center ER, where he was admitted as a psychiatric patient. The group home was informed he would be kept for 72 hours and then discharged. In an incident report dated August 18, 2015, it was reported that Client R.H. "eloped" from the group home. He later made contact with his mother, began acting in bizarre ways, and said he needed drugs. He ran into the street shouting, began to undress, and lay down in front of cars. He was taken to Aventura Hospital and admitted as a psychiatric patient. A September 21, 2015, update to the support plan reflects that Client R.H. had moved out of the Miracles group home to stay with his sister. In September of 2015, Client R.H. was removed from Miracles at Dr. Whipple's request, made 30 days earlier, according to Mr. Lumumba. A December 14, 2015, entry in the support plan indicates that Client R.H. went to jail in October 2015 for trespassing and petty theft. When he was released on December 6, 2015, he asked to return to Miracles' group home. The support coordinator was unable to place Client R.H. in another group home, and Miracles' group home was requested to take him back, which it did. In an incident report dated February 12, 2016, it was reported that Client R.H. became agitated, argumentative, and uncontrollable. He walked to the street, pulled down his pants, screamed, and began to roll around in the street. Police were called, and he was arrested and transported to the North Shore Medical Center. In an incident report dated March 9, 2016, it was reported that Client R.H. was verbally and physically out of control. He went to the street in front of the house, fell to the ground, and began rolling around. He could not be physically restrained or verbally redirected. The police were called, and he was restrained and taken to North Shore Medical Center where he was admitted for psychiatric treatment. In an incident report dated March 17, 2016, it was reported that police arrived at the facility and arrested Client R.H. for a 2014 charge of stealing church equipment. During the annual support plan meeting on June 1, 2016, Client R.H. indicated that he still felt comfortable at the group home and said that "Ms. Felicia" (Whipple) was like a mother to him. Client R.H. indicated he had been going to church with her every Sunday since he returned to the group home in December. The July 1, 2016, support plan prepared by Mr. Lumumba suggested that the rate for client R.H. be changed from minimal to moderate and stated: [Client R.H.] requires 24 hours' supervision to ensure health and safety as he suffers from insomnia, seizures, psychosis and mood disorder, Bipolar, depression, and drug addictions. The approval of this services request will ensure that [Client R.H.] receives the support that he needs to achieve his goal and maintain a healthy life style. The July 1, 2016, support plan also noted: Consumer has had history of abuse in the past when he was living with his mother. He was abused by mother's boyfriend. However since he has been at Miracle House, there was an abuse allegation made by [Client R.H.'s] mother, however it was investigated and they have find that the mother was the one who initiated the allegation. There was no foundation on those allegations. No history of abuse or neglect that has been documented in his records. Mr. Lumumba testified that the notations in the support plans that Client R.H. required 24-hour supervision were "recommendations" as opposed to "requirements." In an incident report dated July 13, 2016, it was reported that Client R.H. went to his mother's housing complex unannounced, where security was unable to reach his mother, and he was denied access. He became agitated, verbally aggressive, and out of control. The police were called, and he was taken to Hialeah Hospital. In an incident report dated July 23, 2016, it was reported that Client R.H. left the group home without stating where he was going. He failed to return to the group home overnight. His mother called the group home to inform staff that he had been arrested after police approached him and found crack cocaine in his possession. A support plan update dated December 1, 2016, indicates that Miracles requested a change from "minimal" to "moderate" behavioral focus to provide additional services to Client R.H. In an incident report dated December 5, 2016, it was reported that Client R.H. was verbally abusive, out of control and agitated, screaming and cursing staff, and running in the street. The report states that police were called, and he was transported to North Shore Medical Center's crisis unit. He was discharged from North Shore Medical Center and returned to the group home on December 7, 2016. In an incident report dated December 28, 2016, it was reported that Client R.H. went to his mother's housing complex unannounced, where security was unable to reach his mother, and he was denied access. He became agitated, verbally aggressive, and out of control. The police were called, and he was taken to Hialeah Hospital. In an incident report dated February 25, 2017, it was reported that Client R.H. informed staff at about 10:00 p.m. that he was going to buy cigarettes from the corner store. He did not return and called the group home from the jail to report that he had been stopped by police, searched, and arrested for possession of crack cocaine. In an incident report dated March 27, 2017, it was reported that Client R.H. told staff he was going to a store to buy cigarettes. He did not return and was assumed to be at his mother's house. His mother called late in the afternoon to report that he had gone to the North Shore Medical Center ER and been admitted to the crisis unit. Ms. Whipple testified that in March of 2017, Client R.H.'s level of care code was changed to Extensive 1. In an incident report dated April 6, 2017, it was reported that Client R.H. became agitated, combative, and threatening. Staff was unable to de-escalate his behaviors. Police were called, and he was taken to North Shore Medical Center. In an incident report dated April 17, 2017, it was reported that Client R.H. went to visit his mother on Easter morning. His mother called in late afternoon to report that he had gone to North Shore Medical Center ER and been admitted to the crisis unit. In an incident report dated April 26, 2017, it was reported that Client R.H. left the group home in the afternoon for cigarettes. He did not return. His mother called at 10:30 p.m. to report that he had called her from Palmetto General Hospital where the police had taken him. In an incident report dated May 7, 2017, it was reported that Client R.H. left the group home for cigarettes but walked to the Jackson Memorial Hospital mental health unit instead, where he was admitted. In an incident report dated May 17, 2017, it was reported that Client R.H. left the group home saying he needed cigarettes from the store. He later called his mother to report that he had been picked up by the police for burglary. In an "annual summary" entry in the support plan, it was noted, in relevant part: [Client R.H.] has not make much progress this year. He has been in and out of Crisis and has been Backer Acted too many times and at the time that I'm writing this Support plan, [Client R.H.] is an crisis since May 17-2017. [Client R.H.] needs another supportive alternative program to rehabilitate him for his constant going to crisis. He need to be a program where he can be monitored and with a restricted rules and regulation and Medical intervention or his constant substance issues. In an incident report dated May 28, 2017, it was reported that Client R.H. left the group home to go to his mother's home on May 27, 2017, and did not return as expected. He called the group home on May 28, 2017, and said he was at Jackson Memorial Hospital in the crisis unit. He was released on May 29, 2017. In an incident report dated June 5, 2017, it was reported that Client R.H. left the group home to go to the store the previous day and failed to return. His mother called to report that he had been arrested for breaking and entering and stealing merchandise from someone's home. Following the 2017 support plan meeting, in which the number of incident reports and alternatives to address Client R.H.'s drug issues were discussed, the July 1, 2017, support plan stated that "[Client R.H.] has been unpredictable and it require a lot of man power to really keep [Client R.H.] living at Miracles House, the group home is asking the Behavior analyst to have [Client R.H.] level of care has been approved to change from Moderate to Extensive Behavior focus [] 1." Mr. Lumumba noted that no abuse or neglect had been reported since he began working with Client R.H. in 2015. In an incident report dated August 5, 2017, it was reported that Client R.H. became verbally agitated and physically aggressive with medical staff while at an appointment at a mental health provider. The report states that police were called, and Client R.H. was "taken under Baker Act." In an incident report dated August 14, 2017, it was reported that Client R.H. left the group home for cigarettes. He called later to say that he had checked himself in at Jackson Memorial Hospital ER. In an incident report dated November 29, 2017, it was reported that Client R.H. left the group home to purchase cigarettes and did not return. His mother called to report that he had been arrested for property theft. In an incident report dated January 27, 2018, it was reported that Client R.H. became agitated and said he wanted to go to the crisis unit. He called the police, and when they arrived, he was outside running up and down in front of the home and saying he wanted to go to the hospital. He was taken to North Shore Medical Center Crisis Unit. In an incident report dated February 12, 2018, it was reported that Client R.H. began screaming uncontrollably. He became verbally aggressive, ran outside the facility, said he wanted to kill himself, and asked for the police to be called. After unsuccessful attempts to de-escalate the situation, police were called, and he was taken to North Shore Medical Center's crisis unit. In an incident report dated March 26, 2018, it was reported that Client R.H. left to get items from the corner store and did not return. North Shore Medical Center called to say he had arrived there. He was admitted. In an incident report dated May 30, 2018, it was reported that Client R.H. left the group home to get items from the store. He called in the afternoon saying he had gone to Jackson Memorial Hospital ER and been admitted into the crisis unit. In an incident report dated June 2, 2018, it was reported that Client R.H. went to his mother's home for a visit, where he initiated an altercation with his mother. He was taken to the North Shore Medical Center Crisis Unit. In an incident report dated June 12, 2018, it was reported that Client R.H. left the group home. His mother later advised that he had walked to Jackson North and checked himself into the Crisis Unit. In an incident report dated June 26, 2018, it was reported that Client R.H. left the group home to go to the store. He wandered in to North Shore Medical Center and stated he was not feeling well. He was admitted as a medical patient. Ms. Whipple testified that Client R.H. was a competent adult and that she was legally unable to restrain him. She testified that he always asked for permission to leave. But when they told him he could not go, she testified, he would get mad and storm out the door anyway. Ms. Whipple recognized that Client R.H. required a great deal of supervision, and she requested that his level of care code be increased, so that she would be compensated in part for her increased responsibilities, but she testified that she was never focused that much on the amount of money she was receiving. Ms. Whipple testified that she trained her staff to redirect Client R.H.'s behaviors to ensure that he would not run off. She stated that an Extensive 1 level meant that he should be closely watched, and that is what the staff at Miracles' group home was trained to do. Mr. Lumumba testified that he had tried to place Client R.H. in other group homes, but that Miracles' group home was the only place that he knew Client R.H. would survive. The notations in these incident reports and support plans strongly support Mr. Lumumba's sentiment that Client R.H. "needs another supportive alternative program to rehabilitate him for his constant going to crisis." APD did not clearly show that the support plan's statement that Client R.H. "requires 24 hours' supervision" created a legal obligation for Miracles to literally provide constant supervision. APD did clearly and convincingly show that Miracles failed to facilitate the implementation of Client R.H.'s support plan, because, taken as a whole, it obviously required a very high level of supervision that Miracles could not, or did not, provide. APD does not argue, and there was no evidence to show, that Client R.H.'s dignity was infringed, that his right to privacy was violated, or that he was subjected to inhumane care, harm, unnecessary physical, chemical or mechanical restraint, isolation, or excessive medication. There was no evidence that the Department of Children and Families (DCF) verified that Miracles was responsible for any abuse, neglect, or exploitation of Client R.H. The record contains evidence of a single DCF investigation into allegations of maltreatment and inadequate supervision, opened on November 30, 2017, and closed on January 22, 2018. That investigation concluded that the allegations were not substantiated, that no intervention services or placement outside the home was needed, and that Client R.H.'s needs were being met. There was no compelling evidence to show that Client R.H. was subjected to abuse or exploitation by Miracles while at the group home. Client J.B. Client J.B. has an intellectual disability and lived at Miracles' group home from May until December of 2017. In an incident report filed by Ms. Loriston dated December 14, 2017, it was reported, in relevant part, that: On 12/14/17 at 6:15 pm wsc received a phone call from Ms. Felicia Whipple stating that she threw the consumer's belonging in the front yard as she is no longer welcome to her group home. Ms. Whipple also stated that [Client J.B.] is on the way home from her part-time job, she contacted [Client J.B.] to let her know of her belongings bein in the front yard. [Client J.B.] contacted law enforcement because she feared for her safety, WSC immediately was able to find an emergency accommodation at Paradise Gaine Group Home. While she testified that her report was accurate, Ms. Loriston described the events a bit differently at hearing. She testified that Ms. Whipple called her to say that Client J.B. could no longer come back to the group home and that her belongings would be waiting for her in front of the door. She specifically testified that Ms. Whipple did not tell her that she threw Client J.B.'s belongings in the front yard, but rather told her that they were at the front door. Ms. Loriston testified that when she arrived at Miracles' group home, she did not see the belongings, that the incident was over, and the police were gone. In an incident report filed by Ms. Whipple, dated December 16, 2017, it was reported that: Consumer receives her Social Security Disability Check and she is currently employed at MACY's. From these funds she refused to pay Room and Board and refused to move from the facility. Following a confrontation requesting payment, she left the facility and returned later with 2 cars loaded with family and associates to the facility to threaten the owner and the facility. Police were called and APD, Residential Services Coordinator, Carey Dashif. He along with the WSC coordinated the transition of consumer to another group home in the interest of safety for Miracles House residents and staff. Ms. Loriston's account of events was less than clear and convincing due to the discrepancies between her statement in the incident report and her testimony at hearing. She did not actually see any of the events of that evening and did not remember distinctly the exact admissions of Ms. Whipple, the critical competent evidence in the case. She was consistent in her testimony that Ms. Whipple admitted she had moved Client J.B.'s belongings. Her remaining testimony was largely hearsay. While Ms. Whipple's account of events was less than credible, it was not her burden to prove what happened. Ms. Llaguno testified that the proper procedure to terminate services to Client J.B. would have been for Miracles to send a 30-day notice terminating the placement. Ms. Loriston similarly testified that this was also her understanding. Remarkably, no APD rule establishing this policy was recognized or identified at hearing, however. Neither were Miracles' written criteria or procedures for termination of residential services introduced. Though Ms. Loriston's testimony that she had to immediately find other housing for Client J.B. is credited, violation of APD rules was not clearly shown. APD did not show that Miracles failed to have written criteria and procedures for termination in place or that they were not consistent with Florida Administrative Code Chapter 65G-3. Medicaid Action As stipulated by the parties, in July of 2017, the Agency for Health Care Administration took action against Miracles by terminating its Medicaid provider number. As stipulated by the parties, Miracles lost its Medicaid provider authorization, and has lost the right to furnish Medicaid services and receive payment from Medicaid in Florida. No evidence as to the basis for, or purposes of, the Medicaid termination was introduced. There was no evidence that Miracles previously had its license to operate a residential facility revoked by APD, DCF, or the Agency for Health Care Administration.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Persons with Disabilities enter a final order finding Miracles House, Inc., as licensee of Miracles House, Inc., Group Home, in violation of Florida Administrative Code Rule 65G-2.009(1)(a)1. and section 393.0673(1)(a)2., Florida Statutes; suspending its license to operate a group home until its right to furnish Medicaid services and receive payment from Medicaid in Florida is restored; and imposing a fine in the amount of $100. DONE AND ENTERED this 17th day of September, 2018, in Tallahassee, Leon County, Florida. S F. SCOTT BOYD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 17th day of September, 2018.
The Issue Whether Respondent committed the offenses described in the Administrative Complaint issued by Petitioner? If so, what penalty should be imposed?
Findings Of Fact Elenor's Retirement Home (Home) is a licensed adult congregate living facility located in Miami, Florida. Eric Peavy is the owner of the Home. His wife is the Home's administrator. In November, 1989, OLC personnel visited the Home to conduct a survey to determine compliance with licensure requirements. Resident contracts on file were reviewed. Three of the contracts reviewed contained neither a refund policy of the type specified in Chapter 10A- 5, Florida Administrative Code, a bed hold policy, nor a statement as to whether the Home is affiliated with any religious organization. A previous survey conducted by OLC personnel had revealed that resident contracts on file at the Home lacked these provisions. The Peavys were so notified and directed to take corrective action. They failed to do so within the mandated time frame. This deficiency still existed as of the November, 1989, survey. During the November, 1989, survey, an examination was also conducted of the medication records maintained at the facility. The records were incomplete. They did not contain daily, up-to-date information regarding the administration of medication to three of the Home's residents. A previous survey conducted by OLC personnel had revealed that the Home did not have complete, up-to-date records concerning the daily administration of medication to all of its residents. The Peavys were so notified and directed to take corrective action. They failed to do so within the mandated time frame. This deficiency still existed as of the November, 1989, survey. During the November, 1989, survey, OLC personnel observed a resident who required greater care than the Home was able to provide. The resident was incapable of doing virtually anything for herself. Among other things, she needed to be administered medication. The Home, however, did not have the licensed staff to provide this service. The resident was totally incontinent. Because of her physical condition, the resident was unable to participate in any of the social activities at the Home. The same resident had been observed at the facility during an earlier survey conducted in June of that year. Although the matter of the inappropriateness of the resident's continued placement at the Home had been raised during the survey, the resident was still at the facility when OLC personnel returned to the Home in November. During the November, 1989, survey, the Home's fire drill records were inspected. There was no record of any fire drills being conducted at the facility in September or October of that year. This was not the first time that OLC personnel had found a lack of documentation concerning the conducting of monthly fire drills at the Home. Such a deficiency had been uncovered during an October, 1988, survey of the Home. The Peavys were made aware of this deficiency at that time. The Peavys were given written notice of the deficiencies found during the November, 1989, survey. OLC personnel revisited the Home in February, 1990, and discovered that all of the deficiencies found during the November, 1989, survey had been corrected.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby recommended that Petitioner enter a final order finding Respondent guilty of the violations alleged in the Administrative Complaint, imposing a civil penalty in the amount of $1,000 for these violations and giving the Home a reasonable amount of time within which to pay this penalty. RECOMMENDED in Tallahassee, Leon County, Florida, this 6th day of May, 1991. STUART M. LERNER Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 6th day of May, 1991.
