SETTLEMENT AGREEMENT

The Agency for Persons with Disabilities ("Agency" or "APO") provides. through
its licensing authority and its license application procedures: provider qualifications.
facility and client care standards, requirements for client records. requirements for staff
qualifications and training, and requirements for monitoring comprehensive transitional
educational programs.
Carlton Palms Educational Center, dlb/a Orange Villas Educational Center. Inc.
("Carlton Palms"}, serves children, adolescents and adults with autism, developmental
disabilities, severe behavioral or emotional disturbances, dual diagnoses, medical
concerns and related diagnoses. Individuals referred to Carlton Palms Educational
Center require highly specialized treatment for significant behavioral problems, such as
aggression, property destruction, and self-injurious behavior. and intensive teaching in
life skills.
Carlton Palms currently holds two comprehensive transitional education program
("CTEP") facility licenses issued by the Agency, License Numbers 13002082A and
13002280A, for the following addresses:

(each "CTEP License" and collectively, the "CTEP Licensees·).
The CTEP Licensees atso hold a Medicaid Waiver Services Agreement under Carlton
Palms Educational Program, Inc.

1

Client
addresses
redacted in
compliance
with federal
HIPAA
regulations

 Moreover, the parties recognize the impending changes to the Center for
Medicare & Medicaid (CMS) regulations effective March 17, 2014, which are set forth in
Vol. 79, No. 11 of the Federal Register, dated January 16, 2014, as amended from time
to time, (the "Federal HCBS Waiver Rule""), providing for a five year duration for certain
demonstration projects and waivers at the discretion of the Secretary of Health and
Human Services. The effect of the new regulations would no longer permit Medicaid
funding for the current CTEP program at Carlton Palms and for other CTEP programs
subsequent to March 17, 2019. Therefore. the Agency and Carlton Palms desire to
formulate a transition plan for development of residential facilities under the Home and
Community Based Services Medicaid Waiver. 1
Following prior incidents of verified abuse and neglect over the last several
years. the Agency directed that Carlton Palms develop additional specific terms and
conditions, beyond those established and required by law and administrative rules,
which would serve to protect the residents. and further enhance the Agency's ability to
provide oversight, monitoring and transition of residents.
WHEREFORE, in consideration of the mutual obligations and covenants set forth
herein, and other good and valuable consideration , the parties agree to following terms
and conditions:

I.

AGREED UPON TERMS AND CONDITIONS:

A.

APO Actions/Expectations:

' Department of Health and Human Services, Centers for Medicare and Medicaid Services
42 CFR Part 430, 431 et al. Medicaid Program; State Plan Home and Community-Based Services,
5-Year Period for Waivers, Provider Payment Reassignment, and Home
and Community-Based Setting Requirements for Community First Choice
and Home and Community-Based Services (HCBS) Waivers.
2

 Carlton Palms will agree to allow:
1. The Department of Children and Families (DCF) to outpost an Adult or Child
Protective Services Investigator on the facility grounds to provide additional
support to decrease the likelihood of abuse, neglect and exploitation.
Investigations will begin immediately and the investigator(s) will have access to
all areas of the facility to include the ability to view video tape recordings. The
investigator(s) will monitor facility actions in order to determine if recommended
follow-up actions are in place and effective.
2. An APO Monitoring Team will initiate an increased monitoring plan of the facility
beginning on May 25, 2016. This team is referred to as a "Bridge Teamn as it will
conduct monitoring for the APO Central Region until a contract is secured with a
3rd party entity for monitoring. Key components of the monitoring plan will
include, but not be limited to:
a. Monitoring schedule that covers all days and shifts and areas of the
facility,
b. Monitoring checks will incorporate assessment of the following:
i. Behavioral programming,
ii.Implementation of restrictive behavioral procedures,
iii.
Medical care and follow-up,
iv.
Residential settings,
v.
Recreational, training and therapeutic areas,
vi.
Educational and work programs,
vii.
Staff interactions, and
viii.
Staffing and supervision ratios.
c. The team will be required to document findings of all checks.
d. Taped/live video/audio recordings will be used by the team to conduct
the monitoring to determine individual and systemic issues.
e. The team will investigate all critical incidents and any reports of abuse,
neglect and exploitation.
f. A defined reporting and escalation process will be used by the team in
order to quickly report and resolve issues that impact resident health .
safety and progress.
g. The team leader will interact directly with the Carlton Palms CTEP
Program Director and communicate all issues of concern that cannot be
readily resolved directly to the Deputy Director of Operations.
3. APO will contract with a 3'" Party vendor (within approximately 30-60 days), as
referenced in Paragraph 1.8.3 of this Settlement for the oversight, monitoring
and transition of the CTEP Program residents (the CTEP Residents) which will:

3

 a. Relieve and continue the "Bridge Team" monitoring activities to ensure
health and safety.
b. Coordinate a resident transition process, using a person-centered
approach, to transition all CTEP Residents currently served under each
CTEP license to alternative settings.
All deliverables in the 3,a Party vendor contract must be reviewed and approved
by the Agency prior to payment by Carlton Palms.
The 3m Party vendor contract shall include 2(a) through (g). The vendor shall
also assist Carlton Palms to assess, determine, monitor, and ensure that
adequate staffing levels are maintained for resident health and safety based on
each individual's level of need, and to ensure all Agency licensing and waiver
requirements are met.
4. APO will not approve any new admissions of APO clients to any Carlton Palms
CTEP licensees and Carlton Palms expressly agrees not to accept any new
CTEP Residents of any type into their CTEP facilities. However, if the Agency
determines that emergency admissions are necessary, prior written authorization
is required from the Agency for any new admissions.
5. Contingent upon and subject to Carlton Palms' compliance with this Settlement
Agreement, Carlton Palms will maintain their existing Medicaid Waiver Services
agreement in order to continue the provision of services to meet clients' levels of
needs and to transition out their remaining CTEP Residents . APO clients
leaving the CTEP will be offered a choice of alternative residential settings which
are available and willing/able to meet their needs consistent with individualized
transition plans developed by the 3,a Party vendor, in collaboration with the
individual/legal guardian and Carlton Palms, and approved by the Agency.
6. Any subsequent application for licensure with APO is contingent upon and
subject to Carlton Palms' full compliance with this agreement, and subject to all
applicable state and federal requirements.

B.

Carlton Palms Actions/Expectations:

1. Carlton Palms will provide office space for an out-posted DCF Adult or Child
Protective Services Investigator who will investigate allegations of abuse, neglect
and exploitation , have access to facility grounds and video tapes and conduct
monitoring to ensure recommended follow-up actions are in place and effective.

4

 2. Carlton Palms will work cooperatively with and provide office space for
monitoring teams (APD Bridge Team and 3rd party contracted
oversight/monitoring/transition vendor) to ensure health and safety of the
residents and to help transition the CTEP Residents safely to new residential
provider locations. Carlton Palms agrees to enter into a three-party contract with
APD and the 3'd party vendor described within this paragraph in which Carlton
Palms will pay the vendor for all services rendered in accordance with the terms
of said contract.
3. Carlton Palms will not admit any new individuals to their CTEP facilities including
clients who are private pay, funded through other agencies, or from other
states/countries. However, if the Agency determines that emergency admissions
are necessary, prior written authorization is required from the Agency for any
new admissions.
5. Carlton Palms will work with families, guardians, other states or countries to
transition CTEP Residents safely back to their places of origin or other agreed
upon locations for further services. If Carlton Palms chooses to serve out-ofstate residents within APO-licensed group homes which they subsequently
develop for CTEP Residents, then at least 50 percent of the census of each of
those group homes must be comprised of APD clients.
6. Carlton Palms will comply with all requirements set forth in the Settlement
Agreement dated March 16, 2015, as well as this Settlement Agreement. Within
twenty (20) days of signing this Settlement Agreement Carlton Palms will
implement a systemic policy and procedure to review all recorded video on a
daily basis (and document the findings) in the following situations:
a. All physical/mechanical restraints.
b. Incidents where client injuries are sustained.
c. Any incidents reported to Florida Abuse hotline as potential
Abuse, neglect, or exploitation.
d. Ongoing random sampling of recorded video to detect abuse and/or
neglect committed by staff members.
Additionally, Carlton Palms will use the daily recorded video monitoring to
provide oversight of staff behavior to ensure resident training and supervision is
occurring as needed and to aid in the prevention of abuse and neglect. If the
video reviews indicate any concerns related to inappropriate staff interactions
with CTEP Residents or program deficiencies, Carlton Palms staff will
immediately report such observations directly to the Chief Operating Officer and
the Bridge Team lead or 3'0 Party vendor. Carlton Palms will implement
immediate corrective action as necessary to protect the health and safety of

5

 CTEP Residents. All video reviews shall be documented and reported to the
Bridge T earn or 3rd Party vendor on a weekly basis.
7. Within thirty (30) days of executing this Settlement Agreement, Carlton Palms
will implement daily activity schedules which are person centered and ensure
that CTEP Residents will be engaged in recreational, therapeutic, and training
activities in their residences as well as during outside activities and community
outings in order to provide for a nurturing and therapeutic environment. The
Bridge Team or the 3,d Party vendor shall review the changes to the activity
schedules for each CTEP Resident referenced in this Paragraph and will notify
Carlton Palms of the changes that are needed to ensure compliance with the
terms of this Settlement Agreement. Upon notification, Carlton Palms shall have
ten (10) business days within which to submit additional changes to the Agency
to remedy the deficiencies. Upon Agency approval of the changes to the activity
schedules, Carlton Palms shall implement the activity schedules.
8. Carlton Palms will develop and immediately implement a staff dress code which
requires appropriate and professional workplace attire. The adoption of a dress
code will be implemented within thirty (30) days after the date this Settlement
Agreement is fully executed.
9. Carlton Palms will train all staff on the rights and humane treatment of individuals
with developmental disabilities. Such training may be developed and provided by
Carlton Palms or obtained from an outside entity.
10. Carlton Palms will conduct training of all supervisory staff to ensure the
appropriate oversight of staff-resident interactions as well as behavioral
interventions.

WI-I EREAS, Petitioner, the Agency for Persons with Disabilities, and
Respondent, Carlton Palms Educational Center, Inc., d/b/a Orange Villas Educational
Center, License numbers 13002082A and 13002280A, desire to amicably settle and
resolve all potential claims arising out of this action.

II.

GENERAL ACKNOWLEDGEMENTS:
A. Respondent acknowledges that this proposed Settlement Agreement is subject

to approval of the Director of the Agency for Persons with Disabilities. and that this
6

 Settlement Agreement will have no force and effect until signed by the Director's
designee, the Agency's Deputy Director of Operations.
B. This Settlement Agreement is binding on all the parties herein and shall become

effective on the date upon which it is fully executed by all the parties.
C. If any verified breach of this Settlement Agreement is identified by the Agency,
then the Agency shall provide Respondent with written notice of the breached items.
Upon receipt of such notice, Respondent shall have thirty (30) business days by which
to remedy the identified violations before any action to interpret, challenge or enforce
the terms of this Settlement Agreement may be brought. If the breach is not remedied
to the Agency's satisfaction, the Agency shall exercise its right to file an Administrative
Complaint with the Division of Administrative Hearings seeking revocation of the subject
licenses.
D. Venue for any action brought to interpret, challenge, or enforce the terms of this
Settlement Agreement shall lie solely in the circuit court of the Second Judicial District in
and for Leon County, Florida. In the event legal action is required to enforce the terms
of this Settlement Agreement, the prevailing party will be entitled to recover from the
non-prevailing party reasonable attorneys' fees and costs incurred in the enforcement
action.
E. This Settlement Agreement may not be amended without the express approval of
the parties in writing.
F. The undersigned have read and understand this Settlement Agreement and have
the authority to bind their respective principals to it. All parties agree that a facsimile
signature suffices for an original signature.

7

 G. Carlton Palms, for itself and its successors or transferees, attorneys, heirs, and
executors or administrators, does hereby discharge the State of Florida, Agency for
Persons with Disabilities, and its agents, representatives, and attorneys of and from all
claims, demands, actions, causes of action, suits, damages, losses, and expenses, of
any and every nature whatsoever, arising out of or in any way related to this matter,
including, but not limited to, any claims that were or may be asserted in any federal or
state court or administrative forum, by or on behalf of Respondent, against the Agency ,
excepting any claims arising out of this Settlement Agreement.
H. All parties enter into this Settlement Agreement freely and voluntarily and intend
to be bound by the terms herein, and have sought or had the opportunity to seek legal
counsel as evidenced by their signatures, effective as dated below.
I.

Carlton Palms agrees that breach of this Agreement by Carlton Palms shall

constitute grounds for discipline pursuant to Chapter 393, Florida Statutes, and Rule
65G-2, Florida Administrative Code.

Further, Carlton Palms waives any objections

that it may have to the introduction of this Agreement or a facsimile of this Agreement in
any proceedings that result from the breach of this settlement agreement.

J. To the extent that any provision of this Settlement Agreement is prohibited by
law for any reason, such provision shall be effective to the extent not so prohibited, and
such prohibition shall not affect any other provision of this Settlement Agreement.
K. All parties agree that a facsimile signature suffices for an original signature.
L. The Agency shall distribute an executed copy of the Settlement Agreement to

Respondent once all signatures are made.

8

 M. The following representatives hereby acknowledge that they are duly authorized
to enter into this Settlement Agreement.

Date:

Date:
Tom Rankin, Deputy Director of Operations
Agency for Persons with Disabilities

9

ot,,/r7 /~14,
j