OA - V4.2 CERTIFIED ARTICLE NUMBER 7108 4575 1294 posgay ra i STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION — ft 17 1? STATE OF FLORIDA, AGENCY FOR ae HEALTH CARE ADMINISTRATION, uo Petitioner, vs. 21°" NURSE, INC. d/b/a, 215" NURSE, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint, against 21" Nurse, Inc., d/b/a 21% Nurse, Inc. (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of one thousand dollars ($1000) pursuant to Sections 400.474(2)(a), and 400.484(2)(b), Florida Statutes, and Rule 59A-8.0086(1)(d), Florida Administrative Code. 2. The Respondent was cited for the deficiencies set for the below asa result of complaint investigation survey conducted on or about F ebruary 15, 2002. CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4734 Jurisdiction 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400 Part IV, Florida Statutes.. 4. Venue lies in Leon County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28-106.207 F.A.C. Parties 5. AHCA is the enforcing authority with regard to home health agency law pursuant to Chapter 400, Part IV, Florida Statutes and Rules 59A-8, Florida Administrative Code. 6. Respondent is a home health agency located at 223 John Knox Road, Tallahassee, 32030. The facility is licensed under Chapter 400, Part IV, Florida Statutes and Chapter 59A-8, Florida Administrative Code. COUNT I RESPONDENT FAILED TO PROVIDE DAILY ORDERED VISITS VIOLATING RULE 59A-8020(1), F.A.C. CLASS II 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. Based on interviews, record review and observation, Respondent to provide Patient #1 with ordered home visits. 9. Based on interviews and record reviews conducted with the subject of the complaint and the home health agency's assistant administrator, it was determined that patient #1 was not receiving his ordered daily visits. An interview with the assistant administrator revealed that Patient #1 had not been seen by the Respondent since CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4734 1/15/2002. Case notes revealed: last visit was made on 01/15/02, documentation of a conversation with the patient explaining the unavailability of an aide to continue his visits and that the Respondent was seeking a replacement; and a note dated 02/04/02 that stated Respondent had failed to staff the home health visits for patient #1 and that the Respondent is still trying to find someone to staff the visits that are ordered and needed by the patient (visits twice a day-every AM and PM). When interviewed, patient #1 stated he had to pay for a private aid to provide his/her necessary services and ordered AM & PM daily visits, which was creating a financial strain. 10. This is a violation of Rule 59A-8.020(1), which requires the Respondent to assure that the patient or client receives services as defined in a specific plan of care, for those patients receiving care under physician’s treatment orders, or in a written agreement. 11. The above referenced violation constitutes the grounds for the imposed Class II deficiency and for which a fine of one thousand dollars ($1000) is authorized under Sections 400.474(2)(a), and 400.484(2)(b), Florida Statutes. WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count J; B. Impose a fine of one thousand dollars ($1,000) for the violation cited in Count I, against the respondent under Sections 400.474(2)(a) and 400.484(2)(b), Florida Statutes, and 59A-8.0086(1)(d), Florida Administrative Code; C. Allother general and equitable relief allowed by law. CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4734 NOTICE Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the attention of Attention: Ursula Eikman, 2727 Mahan Drive, Mail Stop #3,.Tallahassee, Florida 32308-5403. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. Respectfully Submitted, LOL Ursula Eikman, Esquire San Assistant General Counsel Florida Bar I.D. 0500941 Agency for Health Care Administration 2727 Mahan Drive, MS#3 Tallahassee, FL 32308 (850) 922-5873 (office) CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4734 CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original complaint was sent by U.S. Mail, Return Receipt Requested, to: David Perkins, Administrator, 21 Nurse, Inc., 223 John Knox Road, Tallahassee, 32303 on this tu day of July, 2002. ; f Nn Ursula Eikman, Esquire . UE/sr

Docket for Case No: 02-004142