STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION , Petitioner, AHCA No.: 2011005801 v. Return Receipt Requested: 7009 0080 0000 0586 2722 CITY OF ANGELS HOME HEALTH CARE LLC d/b/a CITY OF ANGELS HOME HEALTH CARE LLC, Respondent... ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against City of Angels Home Health Care LLC d/b/a City of Angels Home Health Care LLC (hereinafter “City of Angels Home Health Care LLC”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes (2010), and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,000.00 pursuant to Section 400.484, Florida Statutes (2010), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes (2010). Filed March 21, 2012 4:35 PM Division of Administrative Hearings 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing home health agencies, pursuant to Chapter 400, Part III, Florida Statutes, and Chapter 59A-8 Florida Administrative Code. 5. City of Angels Home Health Care LLC operates a home health agency located at 13170 S.W. 128% Street, Suite 200, Miami, Florida 33186. City of Angels Home Health Care LLC is licensed as a home health agency under license number 299992682 with an expiration date of March 7, 2013. City of Angels Home Health Care LLC was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I CITY OF ANGELS HOME HEALTH CARE LLC FAILED TO PROVIDE AT LEAST ONE SERVICE DIRECTLY TO PATIENTS FOR A PERIOD OF 60 DAYS Sections 400.474, and 400.462(9), Florida Statutes, and/or Rules 59A-8.008(4), and 58A-8.002 (31), Florida Administrative Code, (DIRECT SERVICES) UNCLASSIFIED DEFICIENCY 6. AHCA re-alleges and -incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the Follow-up Survey conducted on 4/18/2011 toa State Licensure survey conducted: on 02/15/2010, and based on record review and interview, it was determined that the home health agency failed to provide at least one service directly to a patient for a period of 60 days. 8. During the entrance conference conducted on 4/19/2011 at 9:30 am with the Administrator, he stated that the home health agency currently has only one patient. The Administrator advised that the director of nursing is the only discipline providing services to that one patient. The Administrator stated that the director of nursing has the key to the file cabinet. He advised that she is the only one with the key. The Administrator stated that he will provide payroll documentation for the director of nursing, but he doesn't have the key for the file cabinet where the patient record is kept. 9. The Administrator provided payroll documentation for the director of nursing, but stated on 4/19/2011 at 9:48 am, that he was unable to open the file cabinet without the key. The Administrator stated that the director of nursing was in a class, and would not be leaving class until 3:00 pm. The Administrator failed to provide at least one clinical record for a patient at the time of the survey, demonstrating at least one service directly provided to a patient for a period of 60 days. 10. Based on the foregoing facts, City of Angels Home Health Care LLC violated Sections 400.474, and 400.462(31), Florida Statutes, and/or Rules 59A-8.008(4), and 59A- 8.002(31), Florida Administrative Code, an unclassified deficiency and carries in this case a $1,000.00 Fine. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against City of Angels Home Health Care LLC on Count I. 2. Assess against City of Angels Home Health Care LLC an administrative fine of $1,000.00 on Count I for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4; Grant such other relief as the court deems.is just and proper on Count I. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER Nelson E. Rodney, Es Assistant General Cotinsel Agency for Health Care Administration 8333 NW 53° Street, #300 Miami, Florida 33166 Copies furnished to: Field Office Manager Agency for Health Care Administration 8333 N.W. 534 Street, Suite 100 Miami, Florida 33166 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Michael C. Trutt, Administrator, City of Angels Home Health Care, 13170 S.W. 128%" Street, Suite 200, aA Miami, Florida 33186, on thisA3 day of Sener are , 2012, elson E. Rodney \ 5 THIS SECTION } COMPLETE THIS SECTION ON DELIVERY apres Mall urh Recelpt for Merchandise * ves 102695-02-M-1540

Docket for Case No: 12-001068

Orders for Case No: 12-001068