STATE OF FLORIDA AGENCY FOR PERSONS WITH DISABILITIES AGENCY FOR PERSONS WITH DISABILITIES, Petitioner, v. I License No. 13442280A CARLTON PALMS EDUCATIONAL CENTER, lnc.,? d.b.a. Orange Villas Educational Center, Respondent. The AGENCY FOR PERSONS WITH ("Petiticner" or "Agency"), issues this Administrative Complaint against Carlton Palms Education Center, Inc., d.b.a Orange Villas Education Center, 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 comprehensive transitional education program facility license issued by the Agency for the following address: 28308 Churchill Smith Lane, Mt. Dora, Florida, 32757. The Respondent also has contracted with APO to provide the residents with Medicaid Waiver developmental disability services. COUNT resident, became agitated and began charging towards several of the staff members present at the education center. The staff memb rs present implemented reactive strategies, which included placing in Velcro iestraints on the hands, leather restraints on his ankles, and then placing 4. During this restraining process. ?a - Comm ented Identi?er NAME removed pursuant to of arm pain immediately after being released from the restraint at approximately 2:30 pm. At approximately 3:00 Diana Ries, RN, was Commented Identi?er identi?es ADMISSION DATE removed pursuant to 45 CFR [64.5 I Commented Identi?er NAME removed pursuant to 1 45 CFR Hg" Commented Identi?er NAME removed pursuant to I 45 CFR Commented Identi?er NAME removed pursuant to 45 CFR 45 CFR Commented Identi?er NAME removed pursuant to 45 CFR notified of the incident. At 5:00 pm, Ms. Rice met with ?jgr eggs],an Iden??erNAMEremoved pursuant 101 assessment. At 7:47 at the emergeney room to; _h 4SCFR164514cbx2xi) examination and treatment. - - Commented Identi?er-NAME removed pursuantto 45 can At mergency room. x-rays were taken at 8:44 pm. It was determined that merge; Commented Idrmti?er NAME removed pursuant to 45 CFR The following day. on on his "ff-{Commented which included the lacement of pins in his upper arm. returned removed 1 to his residence on h2g4. Upgg discharge, the hospital provided removed pursuant instructions regarding daily cleaning of the pin site, covering of the upper 1045 CFR arm with sterile 4x4 gauze, and wrapping the upper arm with an ace Commented removed pursuant 1 bandage_ ?x to 45 CFR {Commented Identi?er DISCHARGE DATE 1 A review of the Advoserve nursing notes from_, 2014 through removed pursuant to 45 cm Au ust 11, 2014 reveal only one note, entered by Bonnie Clugston on Commented [01141: DATE heme. regarding essential with emovedpueuameecm menswear the dressing reinforced over the pins. There is no documentation Commented [01151: Identi?er DISCHARGEDATE indicatin that any additional follow-up care to the pin site occurred from removed pursuant to 45 ingot 4- Commented [one]: Identi?er DISCHARGE DATE removed pursuant to 45 CFR Accordingly, Respondent failed to provide for the essential care of ._fg_r Commented Identi?erNAME-removed pursuant follow-up measures directed by a health care practitioner following his to 45 CFR surgery, for a period of six days. Respondent failed to provide appropriate training of staff on essential care measures that were medically necessary and directed by a treating physician or health care practitioner for the purpose of continuing an ongoing course of treatment. 0" -_2914_._I__r_etv_r_ned_te the Commented Identi?er ADMISSION DATE fever. At that time cultures indicated ?hatingstaangreusinfectjon: q? removed Pursuant?) 45 4 0n er arm .erereosxedpxer. -t DiaZ- discharged. Co mmented 19]: Identi?er NAME removed pursuant to 45 CFR 164.5 Commented [0120}: Identi?er NAME removed pursuant _1 to 45 CFR Commented Identi?er ADMISSION DATE removed pursuant to 45 CFR 164.5 ?n I ll ?12. 13. Progress notes at the hospital dated August 25, 2014, by Sherryl Gordon, M.D., noted that daily wound dressings were not performed at the facility as recommended as part of his out-patient management. The aforementioned incident constitutes violations of section F.S section F.S., Rule and rule 65G- 2.009(f) 1., Florida Administrative Code, which is a Class Ivioiationcan Commented [012 Identi?er NAME removed pursuant 1 to 45 CFR I Commented [0124]: Identi?er DISCHARGE DATE removed pursuant to 45 CFR . Commented Identi?er NAME removed pursuant 1 14. 15. 16. 17. 18. 19. Section 393.0673, Florida Statutes, sets forth the Agency's authority for denial, su3pension, or revocation of license; moratorium on admissions; and administrative fines. Section Florida Statutes, provides that the Agency may revoke a license, or impose an administrative fine if the licensee has failed to comply with the applicable recluirements of Chapter 393, Florida Statutes, or the rules applicable to the licensee. Section Florida Statutes, states that "{p]ersons 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. Section Florida Statutes, states "[p]ersons 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." Rule 4(13)(a) of the Florida Administrative Code (F.A.C.), provides, in relevant part, that Comprehensive Transitional Education Programs must "comply with all aspects of the Bill of Rights of Persons with Developmental Disabilities, Section 393.13, Rule (SS-82.00.41 F.A.C., provides that Class lviolations may be penalized by a moratorium on admissions, by the suspension, denial or revocation of a license, by the nonrenewal of licensure, or by a fine of up to $1,000 dollars per day per violation. Rule 1., Florida Administrative Code, provides as follows: 1. Within the scope of the licensee's responsibility for care and supervision of residents, the licensee shall ensure that there is appropriate action taken for a resident's essential care following a resident?s medical, dental, therapy or other health care-related appointments to include scheduling additional appointments for residents, or assisting residents in scheduling their own appointments, as well as appropriate training of staff on changes in medication or dietary regimens, positioning of residents, utilization of specialized equipment, or any other area which has changed subsequent to any such appointments that would be withinthe purview and authority of the licensee to accomplish. As used in this paragraph "essential care" refers to care and follow-up measures that are medically necessary or directed by a treating physician or health care practitioner for the purpose of continuing an ongoing course of treatment of, or therapy for, a resident's illness, injury, medical condition or diagnosis until such time as such care and follow-up measures are no longer directed or recommended by the physician or health care practitioner. A violation of this paragraph shall constitute a Class lviolation. 20. 21. 22. 23. 24. 25. 26. 27. Count II Petitioner re-alleges and incorporates the allegations set forth above. A review of the Advoserv nursing notes from? 291 ithrgugh Au ust 11, 2014 reveal only one note, entere onnie Clugston on follow-up care .91? the surgiqataitsauttbuu ressing reinforced over the pins. There is no documentation indicatini that any additional follow?up care to the pin site occurred from ReSpondent failed to provide appropriate training of staff on routine or preventive care measures following medical care for the purpose of continuing an ongoing course of treatment. action taken for the resident's routine or preventive care of Accordingly, Respondent failed to ensure that there was ap ropriate following his medical treatment for a period of six days after [5 surgery. Rule 2., Florida Administrative Code, provides as follows: 2. Within the scope of the licensee's responsibility for care and supervision of residents, the licensee shall ensure that there is appropriate action taken for a resident's routine or preventive care following a resident's medical, dental, therapy or other health care-related appointments to include scheduling additional appointments for residents, or assisting residents in scheduling their own appointments. As used in this paragraph "routine or preventive" means care other than essential care such as routine examinations, annual check-ups, or preventive screenings and dental care and cleanings. A violation of this paragraph shall constitute a Class llviolation. The aforementioned incident constitutes violations of section F.S., section F.S., Rule and rule 656- 2.009(f) 2., Florida Administrative Code, which is a Class II violation. COUNT Petitioner re-alleges and incorporates the allegations set forth above. Commented Identi?er DISCHARGE DATE removed pursuant to 45 CFR Commented Identi?er DISCHARGE DATE I removed pursuant to 45 CFR Commented Identi?er DISCHARGE DATE removed pursuant to 45 CFR [0128]: Identi?er NAME removed pursuant to 45 CFR . A review of the Advoserv nursing notes from? 2014_t_hrough Au ust 11, 2014 reveal only one note, entere onnie Clugston on essential follow?up care of the surgjgalsjte, the dressing reinforced over the pins. There is no documentation indicatin that any additional follow-up care to the pin site occurred from ?gilliihteystt?uvgust 11.29.14- - Co enter! Identi?er DISCHARGE DATE removed pursuant mmen?ted Identi?er DISCHARGE DATE removed pursuant to 45 cm 164.5 "Flo mm emed [ms Identi?er DISCHARGE DATE removed pursuant to 45 CFR 164.5 28. 29. 30. 31. 32. 33. 34. 35. 36. Respondent is required to establish and maintain an individual record for each client on the premises. Reapondent failed to roperly enter, document, or otherwise maintain documents on resident?s medical history and special instructions pertaining to aspects of his medical care. Respondent failed to provide appropriate training of staff on the establishment and maintenance of individual client records documenting continuing medical care required by a health care provider, or preventive care measures following medical care. for the purpose of continuing an ongoing course of treatment The aforementioned failure to document constitutes violations of section rule Florida Administrative Code. which is a Class violation. COUNT iv Petitioner re-alleges and incorporates the allegations set forth above. During this restraining of arm pain immediately after being released from the restraint at approximately 2:30 pm. At approximately 3:00 Dia Ries, RN. was noti?ed of the incident At 5:00 Ms. Ries met with assessment Although . apparent lack of ability on the part of personnel did not take immediate steps to evaluate the injury following the restraining procedure. Further. there was a tong delay between the time whenreceivedua physical assessment of his injury at 5:00 and the time he arrived at the emergency room to receive medical attention. Section Florida Statutes, pertaining to client rights states: Each client shall receive prompt and appropriate medical treatment and care for physical and mental ailments and for the prevention of any illness or disability. Medical treatment shall be consistent with the accepted standards of medical practice in the community Rule 656-20090 F.AC.. provides in pertinent part, as follows: . Comm ented Identi?er NAME removed pursuant to 45 CFR 164.5 14(1)) - Commented Identi?er NAME removed pursuant to 45 CFR Co In merited 34}: Identi?er NAME removed pursuant to 45 CFR Commented 35]: Identi?er NAME removed pursuant to 45 CFR . Co mmented 3 Identi?er NAME removed pursuant to 45 CFR Hg" Commented Identi?er NAME removed pursuant to 45 cm Identi?er NAME removed pursuant to 45 CFR 37. 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 F.S. relating to humane care. abuse, sexual abuse, neglect, or exploitation and all violations of Section F.S shall constitute a Class Iviolation. All other violations of Section F.S., shall constitute Class violations. All violations of Sections 2., and (9), PS, shall constitute Class lvioiations. All violations of Section F.S. shall constitute Class II violations. All other violations of Section F.S., shall constitute Class Ill violations: The aforementioned constitutes a violations of section F.S., and Rule 65G-2.009, F.A.C., and is a Class WHEREFORE, Petitioner seeks a moratorium on new admissions, and a fine in the amount of $1,000 dollars per day for each count of a Class Iviolation, $500 per day for each count of Class llviolation. and $100 dollars per day for each count of Class for a total fine of $10,000.00. Kurt E. Ahrendt Senior Attorney, Office of General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 Copies furnished to: Thomas P. Shea, Manager Harlow Middleton, Esq. Carlton Palms Educational Center harlowmiddletonlaw@gmail.com 28308 Churchill Smith Lane Mount Dora, Fl 32757 CERTIFICATE OF SERVICE HEREBY CERTIFY that'a copy of this Final Order was provided to the above-named individuals at the listed addresses, by US. Mail or electronic mail, this {021%day of f}er 1x24 2014. David De La Paz, . Agency Clerk Agency for Persons with Disabilities - STATE OF FLORIDA AGENCY FOR PERSONS WITH 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 pr0posed 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 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 ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT RESPONDENT: CARLTON PALMS EDUCATIONAL CENTER, d.b.a. Orange Villas Educational Center, I have read the accompanying Administrative Complaint and Explanation of Rights in this matter. lwould like to request a hearing, and lelect for the following heanng op?on: Idispute the material {3915 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 120.570), Florida Statutes. Specifically. IdiSpute the following material facts (attach additional sheets if necessary): not disggje the facts alleged in the Administrative Complaint and wish to be heard on the issue of penalty or conclusions of law. i request an informal hearing pursuant to Section 120.5712), Florida Statutes. I understand that at that hearing iwill 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. 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 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. Failure to sign and return the glgg?gn 91 Lights form heard in this matter and the Agency may commence without your participation, which may result in genalties against yogr ligense. As provided in 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 Zip MAIL 0R FAX THE COMPLETED FORM TO: David De La Paz, Esq., 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 recor