FLORIDA’S ONLY

1 FLORIDA S ONLY COMPREHENSIVE TRANSITIONAL EDUCATION PROGRAM: carlton PALMS Executive Summary As Florida s Protection and Advocacy System for individuals with disabilities, and in a specific effort to protect and advocate for the rights of individuals with intellectual and developmental disabilities, Disability Rights Florida (Disability Rights) maintains the authority to pursue remedies or approaches to ensure the protection of, and advocacy for, the rights of those within the State who are eligible for treatment, services or This authorization vests Disability Rights with an ability to investigate incidents of abuse and neglect of individuals with developmental For the past several years Disability Rights monitored carlton Palms corrective efforts after the death of a young resident in restraints in the summer of 2013.

2 Ultimately, multiple allegations of abuse and neglect resulted in several licensure complaints and Settlement Agreements with the Agency for Persons with Disabilities (APD). Our monitoring included review of APD s election to impose a moratorium on admissions to carlton Palms, as well as carlton Palm s agreement to certain changes in the provision of medical care of residents, oversight of staff, nursing best practices, and surveillance measures intended to ensure compliance with licensing and other measures. We also attended carlton Palms quarterly-scheduled monitoring meetings in conjunction with other interested stakeholders and entities. As part of its monitoring of use of restraint, Disability Rights documented and advised the Agency for Persons with Disabilities that carlton Palms had been utilizing approximately thirty-four low-back chairs with restraints that appeared to be constructed in-house with bolts in the legs and eyelets in the arms used for restraint.

3 Lacking proper head and neck support, arm padding, and sound engineering, Disability Rights suggested to APD that the chairs did not comply with 1 42 15043(a)(2)(A)(i) 2 42 15043(a)(2)(B) 1 Florida Statutes3, Administrative Rules4, carlton Palms own corporate policies to use only commercially produced restraints, as well as paragraph eight of the 2014 Settlement Agreement between APD and carlton Palms5. Rather than discontinue use of the chairs, carlton Palms obtained commercially-produced restraint chairs and Disability Rights requested the development of a training curriculum and re-training for all staff. In November, 2016, Disability Rights determined that there was probable cause to believe that incidents of abuse or neglect continued at carlton Palms.

4 Despite increased oversight from APD and monitoring efforts from Disability Rights, the Department of Children and Families (the Department) had conducted no fewer than 28 adult- and child-protective investigations regarding allegations of abuse or neglect lodged by, or on behalf of, at least 21 individual carlton Palms residents. Notably, that partial-year total of investigations was already twice the total of all adult and child protective investigations (14) related to allegations of abuse and neglect of residents at carlton Palms in Of the cases where Disability Rights identified probable cause for abuse and neglect, twenty-one individuals files were reviewed for Disability rights identified the following eight findings: 1.

5 Incomplete and Misleading Reporting of Abuse and Neglect 2. Failures to comply with abuse and neglect reporting requirements 3. Inadequate staffing and resident supervision 4. Inadequate staff oversight and compliance with behavior programming 5. Non-compliance with behavior services laws and regulations 6. Lack of Individualization in Behavior Plan 7. Failure to Comply with Resident s Behavior Plans 8. Failure to comply with restraint documentation requirements 3 Fla. Stat. (4)(c)(8)(h)(2) prohibits inherently dangerous restraint or seclusion procedures. 4 Fla. Admin. Code, Rule (2) prohibits untested or experimental procedures.

6 5 Paragraph 8 required revised policies on the utilization of mechanical and physical restraints 6 This does not include reports that were lodged with the Department of Children and Families under a different name than carlton Palms. Other reports are lodged against the parent company, Advoserv or Bellwether Behavioral Health, or a variation of carlton Palms Educational Program. 7 Disability Rights may access the records of any individual with a developmental disability if such individual, or the legal guardian, conservator, or other legal representative of such individual, has authorized [Disability Rights] to have such access. 42 15043(a)(2)(I)(i); see also 45 (a)(1).

7 While Disability Rights makes a good faith effort to contact the individual s legal guardian, conservator, or other legal representative upon the prompt receipt of necessary contact information, see 45 (a)(3); see also 42 15043(a)(2)(I)(iii), if Disability Rights determines that the health or safety of an individual is in serious and immediate jeopardy, no consent from another party is needed. 45 (a)(4) 2 A Separate, Single, Statutory License for A Single Provider In 2006, the Florida Legislature statutorily created the Comprehensive Transitional Education Program (CTEP) to serve individuals primarily, though not limited to those with developmental disabilities, who have severe or moderate maladaptive behaviors.

8 The services provided by the CTEP were proscribed as temporary in nature and delivered in a structured residential setting, having the primary goal of incorporating the principle of self-determination in establishing permanent residence for persons with maladaptive behaviors in facilities that are not associated with the comprehensive transitional education program. 8 Though the CTEP license capacity has grown to 230 individuals, it has taken statutory action in order to do so and further the licensure s goal of transition. In 2010, the statute was changed to add other components and require the CTEP to provide those services in a sequential order in order to result in a setting that is largely unrestricted with less monitoring and supportive of the development of independent living Originally limited to 120 residents, the capacity limit was changed in 2014, when the statute was amended to reflect a restriction of any residential unit to only 15 There is only one entity that holds CTEP licenses known as carlton Palms which is owned and operated by Bellwether Behavioral Health (Bellwether), formerly AdvoServ.

9 Florida s Agency for Persons with Disabilities11 (APD) has licensed a maximum capacity of 230 individuals for carlton Palms The CTEP continued its growth and by February 2016, the CTEP housed nearly thirty percent (30%) of all state residents who are in group homes diagnosed with developmental and intellectual disabilities and having challenging Its census as of September 2017 was 166 8 Fla. Stat. (effective July 1, 2006 to June 30, 2010) 9 Fla. Sat6. (1)(e) (effective July 1, 2010 to June 30, 2014) 10 Fla. Stat. (4) (effective July 1, 2014-June 30, 2016), with the exception of grandfathering in residential units that were previously permitted to operate with more than 15 residents.

10 11 Florida s Agency for Persons with Disabilities reviews and grants the licenses for residential settings that provide services through the Individual Budgeting Medicaid Waiver for Floridians with intellectual and developmental disabilities. 12 Provided by Agency for Persons with Disabilities pursuant to a public records request. 13 Vogell, Heather, Monopoly Status of For-Profit Group Home Reconsidered, ProPublica Feb. 23, 2016. 14 Monthly Status Report for September 2017, provided by Tom Rankin, Deputy Director of Operations, Agency for Persons with Disabilities, dated October 16, 2017. 3 The State s Oversight of Abuse and Neglect Complaints at carlton Palms Previous complaints and Settlement Agreements have been entered into between APD and carlton A licensure complaint from APD against carlton Palms in 2011 charged physical abuse of three residents and requested a fine of $3, Another case was filed in 2012 alleging abuse to another resident and sought an additional $1, APD settled both cases in February 2012 and waived the fines in return for carlton Palms retraining its staff and maintaining supervisory personnel on premises for all hours of the day and However.