VY ; . YY STATE OF FLORIDA PE Pp AGENCY FOR HEALTH CARE ADMINISTRATION | "= 155 | | L 29 STATE OF FLORIDA, AGENCY FOR ny AM 10: 43 HEALTH CARE ADMINISTRATION, 4 Danilo OF . Henn bale Petitioner, Was AHCA NO.: 04-00-019-HHA vs. FLETCHER’S MEDICAL SUPPLIES, INC., d/b/a O0-a 7 7O FLECTCHER’S HOME CARE, INC. Respondent. / ADMINISTRATIVE COMPLAINT YOU ARE HEREBY notified that after twenty-one (21) days from receipt of this Complaint, the Agency for Health Care Administration (hereinafter referred to as the “Agency”) intends to impose a civil penalty in the amount of $6,000.00 upon FLETCHER’S MEDICAL SUPPLIES INC., d/b/a FLETCHER’S HOME CARE INC. (hereinafter referred to as “Respondent”). As grounds for the imposition of this civil penalty, the Agency alleges as follows: (1) The Agency has jurisdiction over the Respondent pursuant to Chapter 400 Part IV, Florida Statutes. . (2) Respondent is licensed to operate as a Home Health Agency at 1615 University Boulevard West, Jacksonville, Florida 32217, in compliance with Chapter 400 Part- IV, Florida Statutes (1999) and Rule 59A-8, Florida Administrative Code. (3) The Respondent has violated the provisions of Chapter 400 Part IV, Florida Statutes (1999) and provision of Rule 59A-8, Florida Administrative Code, in that it was cited for one (1) class II deficiencies during the complaint investigation of June 7, 2000: (H-0320) Based on record review and staff interview, and interviews with the administrator and director of nursing on 6/7/00 the home care agency did not provide the . care for patient # 1 as ordered by the physician in the plan of care. The physician ordered 24 hour nursing service for this patient. On May 14, 27, 28, 2000, and on June 1, 5, and 6, 2000, 12 hours of the 24 hours day were not covered by nursing care. This is a violation of Section 400.487(5), 400.484(2)(b), Florida Statutes and Rule SB9A- 8.0215, Florida Administrative Code. Class II deficiency. Fine: $6,000.00. @) Notice was provided in writing to the Respondent of the above violations and _ the time frame for correction. (5) Respondent is notified that they have a right to request an administrative hearing pursuant to 120.57, Florida Statutes, to be represented by counsel (at its expense), to take testimony, to call or cross examine witnesses, to have subpoenas and/or subpoenas duces tecum issued, and to present written evidence or argument if they requests a hearing. Chapter 59-1, Part 2, Florida Administrative Code, constitutes the Agency’s procedural rule for administrative proceedings resulting from this complaint. In order to obtain a formal proceeding under Section 120.57(1), Florida Statutes, your request for an administrative hearing must conform to the requirements in Rule 28-5.201, Florida Administrative Code, and must state which issues of material fact you dispute. Failure to dispute material issues of the fact in your request for a hearing may be treated by the Agency as election by you of an informal proceeding under Section 120.57 (2), Florida Statutes. All requests for hearing shall be made to the Agency for Health Care Ce UY Administration, and delivered to Agency for Health Care Administration, Building 3, Suite 3431, 2727 Mahan Drive, Tallahassee, Florida 32308; Attention: Michael O. Mathis, Senior Attorney. Payment of fines shall be sent to the Agency for Health Care Administration, P.O. Box 13749, Tallahassee, Florida 32317-3749, (Please reference the case number and facility name on the front of your check). (6) Respondent is Further Notified that failure to request 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. I HEREBY CERTIFY that a true copy hereby was sent by Certified Mail, Return Receipt Requested, to Jane Park, R. N. Administrator, Fletcher’s Home Care, Inc., 1615 : University Boulevard West, Jacksonville, Florida 32217, this ne [6 day of , 2000. Y ——— Karen K. Swann Area Office #4 Supervisor Division of Health Quality Assurance Agency for Health Care Administration 921 N. Davis Street, Bldg. A, Suite 115 Jacksonville, FL 32209 Copies furnished to: Jane Park, RN, Administrator Michael O. Mathis, Esquire Fletcher’s Home Care, Inc. Senior Attorney 1615 University Boulevard West Agency for Health Care Administration Jacksonville, Florida 32217 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308-5408 ( LY Agency for Health Care Administration Finance & Accounting Department P.O. Box 13749 Tallahassee, Florida 32317-3749 U . Karen Swann Area Office #4 Supervisor Agency for Health Care Administration 921 North Davis Street. Suite 115 Jacksonville, Florida 32209

Docket for Case No: 00-002970