JUN-19-2881 11:04 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, VS, ABCA No: 09-01-0034 HHA TEAMWORKS NURSING SERVICES, INC., d/b/a TEAMWORKS NURSING SERVICES. Respondent. J ey ADMINISTRATIVE COMPLAINT P.@3/15 DIVISION © - ADMINISTRATIVE HEARINGS Ol- 23a YOU ARE HEREBY NOTIFIED that after twenty one (21) days from the receipt of this Complaint the Agency for He ib Care Administration (hereinafter referred to as “Petitioner") intends to impose an administrative fine in the amount of Seven Thousand ($7,000) upon Teamworks Nursing Services, Inc., d/b/a Teamworks Nursing Services, d/o/a (hereinafter referred to as "Respondent”), As grounds for this administrative fine the Petitioner alleges as follows: 1. Petitioner has jurisdiction over Respondent by virtue of the provisions of Chapter 400, Part IV, @S.). 2. Respondent is licensed to operate at 7300 West Camino Real, Suite 230, Boca Raton, Florida 33433, as a Home Health Agency in compliance with Chapter 400, Part TV, (F.S.), and Rule 59A-8, Florida Administrative Coae (F.A.C, ). 3. On or about July 19, 2000, an annual Hcensure survey conducted by persomael ; ... ffom the Agency for Health. Care Adtninisiraon reveal “Stich -aled th Respondent was operating ~ S . JUN-19-2881 14:95 (@) . Tag HI. ‘Hours of Operation. Based on interview and observation, the agency was not available to the public for the required number of hours. Findings include: a) The surveyor arrived for an unannounced survey on 7/19/00 at 8:30 am. The agency door was locked. The surveyor waited until 10:00 am when the D.ON. designee arrived to open the office. She stated that “they” like her to stay about 5 hours and then do supervisory visits in the aftemoon. At approximately 2:00 pm the D.O.N. designee began calling patients to inform them that she would be late for the afternoon visit, but hoped to be there by 4:00 pm. The D.ON. designee left the office on an errand from 2:15 pm until 3:00 pm. During this time, there were 5 unanswered telephone calls. ‘The administrator called from the Miami office several times during the survey, but was not on the premises duding the day of the survey. (2) Review of the-agency policy and procedure manual revealed that the agency office hours are from 9:00 am until 4:00 pm. (7 hours) Monday through Friday. (2a) This tag remained out of compliance when a visit was conducted on ‘11/27/00. Findings include: {1) During the follow up visit of 1/27/00 an occupant of a near-by office stopped by to greet the D.O.N. (Director of Nursing) and welcome her back from 2 week’s vacation (taken 11/20-24/))). The visitor also stated that it was nice to have the D.O.N. back because “it was so lonely up here...the lady who was here in your place came in about 8:00 am to 8:30 am and left by 1:00 pm... she didn’t even leave a note on the door like the other one who was here when you went to that class.” The other time referred to 11/08/00. when the D.O.N, attended a one-day set iami-agency came-to fill P.84715 “JUN-19-2001 41:05 and the week of 11/20/00 the phone was answered by a recording when the office was not open during business hours. (3a) During the follow-up visit of O/O8/0L it was determined that this tag remained out of compliance. Findings include: (1) Based on interview with the Director of Nursing (D.O.N.) on 01/08/01, and record review, documentation of the agency office hours revision was not present in the agency office and the director of nursing had not been informed by the administrator what action plan was in place to assure that the office would be open during the normal scheduled business hours when they were both out of the agency’s office, (2) During a telephone interview with the administrator on OL/08/01 at approximately 3:00 pm, he stated to the surveyor that the plan of correction was in the Miami office, but no one there know how to access the plan of correction and fax it to the Boca Raton Office. The administrator also stated that the plan of correction for’ ‘the 11/27/00 2" revisit had not yet been submitted to the area office. This is in violation of rule 59A-8.003(9), F.A.C., uncorrected Class Uff deficiency, carrying in this instance a $1,000 fine. (b) Tag H220. Personnel ~ Director of Nursing. The Administrator has an office space in the Boca Raton office, but routinely works from Miami and did not keep regular office hours in Boca. The Administrator also plans to be the Administrator in Miami. The findings include: (Ll) On 7/19/00 and based on record review, the Director of Nursing (PON) is also listed as the DON of ano9ther HEIA that is not a related business entity. (2) Record review of the personnel file for the DON revealed that the date of employment i is given as 3/20/98. There , Was NO documentation of a termination re.” Review, com ‘files. inthe area ‘office. revealed that the ‘DON: “was Ya thi administrator/DON on a 3/11/99 non-certified home health agency imitial survey of an unrelated 1 business entity located in Boca Raton... P.@5/15, JUN-19-2801 14:05 (2b) This tag remained out of compliance n the follow-up visit of 11/27/00, based on the folowing observations: (1) The 11/22/00 Plan of correction addresses a verbal agreement between the administrator and the Director of } Nursing (DON) and stated that it was inadvertently omitted from her personnel file. Review of the DON’s personnel file on the 11/27/00 second follow-up visit revealed that this documentation was still not in place. » (2) — The plan of correction stated that the DON serves as the nursing consultant for the agency. There was no documentation in the Don’s job description or personnet file to indicate these duties Gb) This tag remained out of compliance during the follow-up visit of 01/08/01. Findings include: (1) Based on interview with the Director of Nursing during the revisit on 01/08/01, and record review off her: “personel file, the director of nursing’s personnel file had not been updated to show actual dates of employment with this agency. The personne} file indicated date of hire as 3/20/98. It was also noted during a period of time in 3/99 that the DON was identified as being an Administrator/DON at an unrelated ‘business entity, (2) Interview revealed that she was not sure of the exact date she began employment. She. stated that she was employed by another agency for approximately 3 months during this time that the agency lists continuous employment. (3) The personnel file did not contain any updated documentation by the administrator and DON to reflect when the DON was working at this agency up to the present date. This is in violation of section 400, 46207), FS., Class’ OF uncorrected, 1 defi scienty at carrying i in this: astance a $1 000. fini ine. tw) Tag H242_ Personne! — Home Health Aid. The personnel files did not contain documentation of required training from approved providers, Findings ineInde:.-° -- P.@6/15 ~ JUN-19-2881 11:85 (1) During the survey of 10/04/00 and based on record review, the home health agency did not have on file successful completion of approved training for every home health aide (HHA). Q) Review of the 21 current personnel files revealed that the home health aide certificates for 3 employees were not issued from a certified school for home health aides. (2c) This tag remained out of compliance during the follow-up conducted on 1/27/00 and based on the following observations: (1) The administrator of the agency did not have a plan of correction prepared or in place for this deficiency. (3c) This tag remained out of compliance on the follow-up visit of 01/08/01 based on the following: (1) Based on review of the agency policy and procedures,’ the administrator did not have a policy in place to assure that home health aides and certified nursing assistants working for the agency as independent contractors had attended approved schools. Interview with the director of nursing revealed that there had been no discussion with the administrator as to how the agency planned to verify education. (2) On the 1* revisit to the annual survey, 4 home health aides who were currently assigned to care for patients were identified as having attended unapproved schools, Record review during this revisit revealed that these home health aides were still assigned to cases. This is in violation of mle S9A-8.0095(5), F.A.C., uncorrected Class I deficiency, carrying in this instance a $1,000 fine. @: ~ contain’ documentation of regiutied training. Findings include the following: Tag HR47. Personnel — ; - ABA and CNA “The personel files did. TOE, an P.@?715 JUN-19-2801 14:06 (1) During the annual survey conducted on 7/19/00 and based on review of HHA and CNA personnel files, not all had the required training. Findings include: (2) The personnel file for HHA #3 did not contain a CPR card. (3) The personnel file for HHA #4 contained a CPR card, which expired on 4/00, (4) The personnel file for HHA #2 contained a HIV/AIDS certificate dated 6/20/96. (24) On the follow-up conducted on 10/04 it was determined that this tag remained out of compliance based on the following observations, () Review of the 27 current active patient census revealed that a total of 2a home health aides (HH A/certified nursing assistants (CNA) were assigned to the cases. Review of the personnel filés Yevealed that 12 of the 21 employees currently assigned to cases did not have a personne] file in the office. Additional veview revealed that an additional 9 employees who had recently been assigned to cases did not have personnel files in the office, Gd) During the follow-up visit conducted on 11/27/00 it was determined that this tag remained out of compliance based on the following observations: (1) Review of the current active patient files as well as the current census revealed that 17 of the 40 HHA/CNA’s (home health aides and certified nursing assistants) currently assigned to cases in the Boca Raton office did not have personnel files in the Boca Raton office. (4d) This tag remained out of _ sompliance when a follow-up visit was conducted on, 01/08/91 based on the following observations: wo Q). Review. of. the..agency policy and procedures: revealed” that ao procedure’ to assure required training for the independent contractor staff was not in place. P.28715 " JUN-19-2001 14:06 The director of nursing was not aware of a plan being developed or put in place for training the Boca Raton office staff. (2) Review of the 3) active Patient files as well as the current census revealed that 35 of the 54 HHA/CNa’ S currently assigned to cases in the Boca Raton office did not have personnel files in the Boca Raton offi ice to verify the required traming. The administrator was out sick and per telephone interview with the administrator on 01/08/01, he indicated that he was not able to bring any files until the afternoon of the next day. This is in violation of mle 59A- -8-0095(5), F.A.C., uncomected Class a deficiency, carrying in this i instance a $1 000 fine. (e) Tag HL Responsibility over ‘Contractors, The agency did not provide nursing visits by qualified personnel on payroll and did not monitor the services Provided by others under contractual agreement.”Findings include: (t) During the follow-up visit of 10/04/00 it was determined that RN who conducts the initial patient assessments and the Supervisory visits was a contractual employee who works on a per diem bases. The Director of Nursing 2 (DOAN) was the only employee in the office, and is therefore unable to conduct assessments and Supervisory visits to manage and monitor the care provided through the contract employees, (2) Review of all HHA/CNA personnel files in the office revealed that all were contract employees. (Ze) This tag remained out of compliance on the follow-up visit of 11/27/00 based on the following observations: () The w-4 Form (Employee’s $ Withholding Allowance Certificate) : / bears.a date and. signature: that-did not appear'to béj © this employees 5 handwriting. ‘The W-4 Form was compared with a Supervisory Visit form that the employee completed and ; ‘Signed on LY 2 7100. P.@9715 i ' : JUN-19-2001 11:06 ; f P.1@/15 He (2) Interview with the employee révealed that although the administrator had discussed changing pay status with this employee, the employee never completed and signed a W-4 Form of 11/06/00. Ge) This lag remained ont of compliance during the follow-up of 01/08/01 based on the following: (1) Based on review of the Personnel filed for the only per-diem Registered Nurse making initial assessments and Supervisory visits, who had been - working for the agency as per-diem for approxirnately a year, had no signed W-2 form in his/her own handwriting in the personne! file. The only employee with W_2 forms in their files are the administrator and the director of nursing. This is in violation of section 400.487, FS., an uncorrected Class aif deficiency, carrying in this instance a $1,000 fine. (f) Tag 4310. Contracted Services, The agency did not provide at least one Service directly by its? employees based on record review during 10/04/00, Findings include: the follow-up of @) Review of the personnel files of the 1 RN and the 21 HHA/CNA’s ‘who provide patient care revealed that all are contracted employees. No patient care js provided by direct employees of the agency. (2f) This tag remained uncorrected when a follow-up visit was conducted on 11/27/00 based on the following: Patient care js being provided by one or more employees of the agency, ~~ Gf) During the follow-up conducted on 01/08/01 it was found that this tag Temained uncorrected based on the following observations: . a JUN-19~-2861 11:86 P.idvis (1) A review of the per-diem Registered Nurse’s personnel file revealed that it did not contain a W-2 form and did not contain a signed W-4 form in the employee’s own handwriting. Review of all Home Health Aids and Certified Nursing Assistant personnel files revealed that they were all contract personnel. This is in violation of rule 59A-5.008, F._AC., uncomected Class H deficiency, carrying in this instance a $1,000 fine. (sg) Tag H356. Clinical Records Contents, The agency patients” files did not contain current clinica! notes. During the annual survey conducted on 7/19/00 it was determined based on record review, patient records did not contain all required information. Findings include: (1) Patients #3 and 44 did not have signed physician orders, @) Patient #1 started care on 01/17/00. The physician’s orders were signed on 5/04/00. 7 (3) Patient #3 stared 24 hours home health live in care on 11/27/99. Home health aide did not ‘Start until 12/13/99. (4) Patient #4 received the last visit on 6/10/00. There was no fermination summary in the chart. the following observations: me ) __ Review of the clinical records for the 27 current open patient cases revealed that the clinical notes for 26 of the 21 were incomplete. Patients #1, 2 2, 3,5, 6, 8, 20,12, 12, 13, 14, 6.171 18, 19,22, 24 and 26 contained notes through July 2000 only. (2) Patients at and #9 had only partial notes from September 2000. (3) Patients #4, 15, 20, 21, 23, and 25 had no clinical notes in the file. (4) Patient #27 just started care on! 0/02/00, Gg) _ This tag remained out of compliance on the follow- ~P visit 0127/00 based on the following: observations: semmeyreee er me ree JUN-19-2001 11:07 (1) The plan of correction submitted by the agency administrator stated that clinical notes would be filed in the patient charts within a maximum of 2 weeks. The follow-up survey conducted on 11/27/00, making the maximum time for notes to be 11/13/00, Review of the clinical records for the 29 open cases revealed that the clinical ; notes for 26 of the 29 cases were incomplete. Patient $3 had notes up to 7/15/00. (2) Patient #24 had notes up to 10/14/00. (3) Patient #2 had notes up to 10/17/00. (4) Patients #1, 6 and 18 had notes up to 10/21/00, 5) Patient #5 had notes up io 10/26/00. (6) Patients #9 and 22 had notes up to 10/28/00. (7) Patient #19 had notes up to 10/28/00. (8) Patient # 20 had notes up to 11/02/00. (9) Patient #8 had notes up to 11/03/00. (10) Patients #4, 10, 12, 23, and 27 had notes up to 11/04/00. (11) Patient 25 had notes up to 11/05/00. (12) Patient #14 had notes up to 11/06/00, (13) Patient #26 had notes up to 11/07/00/ (14) Patient #28 had notes up to 11/09/00. (15) Patients #1} and 17 had notes up to LI/10/00. (16) Patients #15 and 16 had notes up to 11/11/00. (17) Patient 221 had notes up to 11/12/00. (18) Patient 7 had notes from 11/14/00, (19) Patient #13 started care on 11/13/00. (20) Patient #29 started care on 11/14/00. (4g) This tag remained out of compliance when the follow-up of 01/08/01, based on interview with the director of nursing as well as review of the 31 open patient records revealed that the records were incomplete. Examples include: (e0) . A previous plan of correction for this citation stated that the clinical notes would be filed in the Patient charts within a maximum of 2 weeks, The original notes from the staff working out of the Boca Raton office were stil] being sent directly to the Miami office and then forwarded to thé'Boca Raton office. P.12715 JUN-19-2801 11:87 (2) The third revisit to the annual survey was conducted on 01/08/01, making the maximum time for notes to be filed in the patient charts 12/26/00, allowing an extra day for 12/25/00, a legal holiday. (3) During the 01/08/01 revisit, a review of the 31 active clinical records revealed that 22 of 31 did not have current HHA/CNA clinical notes, as they had not yet been received from the Miami office. Examples include: (4) Patient #28, who receives 4-hour live in care, had clinical notes im his/her file up to 11/30/00 at the time of the revisit. Further documentation of clinical notes provided by the agency on 2/15/Olwere clinical notes for the time period of 12/01/00 through 01/04/01. (5) Patient #14, who receives 24-hour live in care, had clinical notes in his/her file up to 12/02/00 at the time of the revisit. Further documentation of clinical notes provided by the agency on 0213/01 was clinical notes for the time period of 12/03/00 through 01/06/01. (6) Patient #20, who received 24-hour live in care, had clinical notes in his/her file up to 12/09/00 at the time of the revisit. Further ‘documentation of clinical notes provided by the agency on 02/15/01 was clinical notes for the Hme period of 12/10/00 through 12/ 13/00, 12/25/00 through OL/OL/OL. (7) — _ Patient #21, who documentation Stated needed only minimal assistance throughout the day but received care for 9 hours a day/5 days a week, had notes up to 1212/00 at the time of the revisit. Further documentation provided by the agency on 02/45/01 Was clinical notes for the period 12 1201 5R80, 127 18/00 through 12/22/00, and 12/25/00 through 12/29/00. P.13715 * tk oo Pag aRRE s Re t ” “ - HEARING WITHIN JUN-19-2801 11:07 (8) Patient #17, who received care 7 days per week, but did not have the number of hours per day that care was provided on any of the clinical notes, had clinical notes up to 12 14/00 at the time of the revisit. Further documentation of clinical notes provided by the agency on 2/15/00 was clinical notes for the time period 12/29/00 through 01/04/01. (9) At the time of the revisit, the following patient notes were also not current: Patients #5 and 23 had notes up to ” 12/15/00; Patients #15, (18, 22 and 32 had ““ROtES up to 12 2/16/00; Patient #9 had notes up to 12/17/00; Patient #16 had notes up to Ly 1510; Patients #2 #2, 3, 29 and 30 had notes up to 12/23/00: and Patients #4, 7,10 and 26 had notes ~ to 12/23/00. This i is in violation of mle ASB. 022, F.A.C., uncorrected Class OY defi iciency, ~tarrying in this instance a $1,000 Fine. 4. The above referenced violation constitutes grounds to levy this administrative fine pursuant to Section 400.474, (F.S.), in that the Respondent has violated the minimum standards, rules and regulations promulgated by the Agency under Chapter 400, Part IV, €S) ELECTION AND EXPLANATION OF RIGHTS FORMS ATTACHED 5. . RESPONDENT IS FURTHER NOTED: THAT FAILURE TO REQUEST A ¥ 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 tme and correct ¢ fumished by US. _ Certifi ‘opy of the foregoing has been ed Mail, Return Receipy. Requested to Carl A. Fawcett, Administrator, Yeamworks Nursing Services, 7300 W. Camino Real, 1, Boca Raton, Florida P.14/15 - re ree or 7 Copy to: JUN-19-2991 14: 8° eg 33433, Teamworks Nursing Services, Inc., 1021 Ives Dairy Road, Bldg. Miami, Florida 33179 and to B & © Corporate Services, Inc., 201 South Biscayne Boulevard, Suite 3000, Miami, Florida 33131 on | oe 200£. #3, Suite F216, Patricia Feeney, Field Office Manager Area Office Supervisor Agency for Health Care Administration 1710 East Tiffany Drive, Suire 10g West Palm Beach, FL. 33407 Alba M. Rodriguez, Assistant General Counsel Agency for Health Care Administration fanchester Building, Ist oor 8355 N.W. 53rd Street Miami, Florida 33166 1 Home Health Agencies Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 TOTAL P.15

Docket for Case No: 01-002786