A EC a = STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION a o3 coy 2. . < STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA No: 2003005097 Return Receipt Requested CATALANO’ S NURSES REGISTRY, 7002 2410 0001 4236 8758 INC., d/b/a CATALANO’S NURSES 7002 2410 0001 4236 8765 REGISTRY, INC., 7002 2410 000104236 8772 Respondent a ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or the “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against Catalano’s Nurses Registry, Inc., d/b/a Catalano’s Nurses Registry, Inc. (hereinafter “Catalano’s Nurses Registry” or the “registry”) pursuant to 28-106.111, Florida Administration Code (2002) (hereinafter “FLA.C.”), and Chapter 120, Florida Statutes (2002) (hereinafter “Fla. Stat.”), and alleges: NATURE OF ACTION 1. This is an action to impose and maintain the Agency’s administrative fine in the amount of $1,000.00, pursuant to Sections 400.484, 400.506, Fla. Stat., and Rule 59A-18.016, Florida Administrative Code (“F.A.C.”). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 3. venue lies in Lee County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4, AHCA is the enforcing authority with regard to home health agencies licensure law, pursuant to Chapter 400, Part Iv, Fla. Stat., and Rules 59A-18, F.A.C. 5. Catalano’s Nurses Registry is a nurses registry agency located at 5240 Bank Street, Fort Myers, Florida 33907, and is licensed under Chapter 400, Part IV, Fla. Stat., and Chapter 59A-18, F.A.C.; license number 30210968. COUNT I CATALANO’S NURSES REGISTRY FAILED TO ENSURE THAT THE RESIDENTS’ PLAN OF TREATMENT INCLUDED WRITTEN PHYSICIANS’ ORDERS, CONTAINING THE METHOD/MODE OF ADMINISTRATION AND THE SITE OF INJECTION. 59A-18.013, and 59A-18.011, F.A.C. (ADMINISTRATION OF DRUGS AND BIOLOGICALS) UNCORRECTED VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the licensure survey conducted by AHCA on 12/17/02 and based on a review of 8 clinical records, and interview with administrative staff, the Agency found that Catalano’s Nurses Registry failed to ensure that the residents’ plan of treatment included written physicians’ orders, containing the method/mode of administration and the site of injection. The Agency found that the registry nurses did not ensure verbal physician's orders for medications were reduced to writing and signed by the physician in 1 of the records reviewed (for patient #4, as identified in the survey). The findings include the following, to wit: (a) Patient #4's clinical record revealed that on 4/8/2002, the nurse received an order from the physician to reduce the patient’s insulin dosage to 25 units in both morning and night. The nurse did not reduce this order to writing at the time of taking the verbal order. Administrative staff agreed there was no order for this insulin change in the record. On 11/14/2002, the nurse obtained a verbal order from the physician to change the patient's Coumadin dosage to 1 tablet every Tuesday, Thursday, Saturday and Sunday. On the remaining days, the patient was to take 1 and 1/2 tablets until the next Protime was drawn. There were no physician's orders written by the nurse for this change in medication. On 11/27/02, the nurse noted the iv) patient was recovering from a bout of pneumonia and was on antibiotics. However, there was no documentation in the record indicating what antibiotic the patient was taking. On 12/5/02, the nurse noted the physician gave a verbal order for the nurse to home the Coumadin as of 12/2/2002 until another Protime could be drawn. Administrative staff agreed there were no physician's orders in the record for these changes. Mandated Correction Date: 01/17/03. 8. During the follow-up survey completed by the Agency on 5/19/03 and based on a review of 2 skilled cases that include the giving or the setting up of medications, the Agency again found that Catalano’s Nurses Registry failed to ensure that the residents’ plan of treatment included written physicians’ orders, containing the method/mode of administration and the site of injection. The Agency found that a Plan of Treatment did not include the method of administration or the site, if the medication is by injection (for Patients #2 and #5, as identified in the follow-up survey). The findings include the following, to wit: (a) Patient #2 was to have the nurse visit twice a day to have his/her blood sugar checked and insulin to be administered 30 minutes prior to breakfast and dinner. The physician's orders state to give the insulin by injection but does not include that it be subcutaneous or mention the site of the injection or if the site was to be rotated, as is the usual practice with insulin administration. The orders also state that the nurse is to assist with medications daily. The only 2 medications listed on this Plan of Treatment are for the insulin and Nizoral cream and it was unclear if there are any other medications for the nurse to assist with or if this is the total. The Plan of Treatment was reduced to writing and sent to the physician for signature by a licensed practical nurse rather than a registered nurse. (o) Per the Plan of Treatment of Patient #5, the nurse is to fill the medication box on a weekly basis. The Plan of Treatment includes a list of the medications but does not include the method (mode) of their administration. 9. Based on the foregoing, Catalano’s Nurses Registry violated 59A-18.013 and 59A-18.011, F.A.C., herein classified as an uncorrected violation, pursuant to Rule 59a-18.016, F.A.C., which carries a $500.00 fine. COUNT ITI CATALANO’S NURSES REGISTRY FAILED TO ENSURE THAT ITS EMERGENCY MANAGEMENT PLAN AND POLICY MET ALL STATUTORY REQUIREMENTS: THE REGISTRY FAILED TO ASSIST PATIENTS WHO WOULD NEED ASSISTANCE IN REGISTERING WITH A LOCAL EMEREGENCY MANAGEMENT AGENCY, AND/OR THE REGISTRY FAILED TO DISTRIBUTE THE EMERGENCY MANAGEMENT INFORMATION TO ALL OF THE INDEPENDENT CONTRACTORS FOR READING; THE FORMS WERE NOT COMPLETED AND RETURNED TO THE REGISTRY; AND THERE WERE NO LISTS OF MEDICATIONS AND EQUIPMENT, OR A PRIORITIZED LIST DEVELOPED OR MAINTAINED. SECTIONS 400.506(15),(16), and 252.355(4), Fla. Stat. (EMERGENCY MANAGEMENT PLAN) UNCORRECTED VIOLATION 10. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 11. Based on a licensure survey conducted by the Agency on 12/17/02 and upon a review of the emergency management plan and interview with administrative staff, the Agency found that Catalano’s Nurses Registry failed to ensure that its emergency management plan and policy met all statutory requirements: the registry failed to assist patients who would need assistance in registering with a local emergency management agency, and/or the registry failed to distribute the emergency management information to all of the independent contractors for reading; the forms were not completed and returned to the registry; and there were no lists of medications and equipment, or a prioritized list developed or maintained. The findings include the following, to wit: (a) The registry’s emergency management plan indicates, "General instructions for registering pursuant to Florida Statutes 252.355, consistent with the local emergency management agencies, will be disseminated to all patient/clients that are being services in the home. CNRI (Catalano's Nurse Registry Inc) will have staff available who are knowledgeable with the process to assist those patient/clients who may need assistance in registering pursuant to 252.355". Interview with administrative staff on 12/17/02 at approximately 2 P.M. revealed this information is provided to patients by letter after admission to the registry for care. The letter states the following: "In order to be accepted at one of these shelters during an emergency situation, you must register in advance. If you choose to be the registration process, you simply call your county's special needs registration phone number provided on page 2. If, following a County special needs review, medical sheltering if deemed appropriate and you are accepted, please inform Catalano's of your completed registration and the location of your shelter..." The telephone number is provided on page 2 of the letter. However, there is no provision of the form needed to register and no assistance in filling out the form is provided by the registry contract employees. Interview with administrative staff revealed there are no patients who are serviced by the nurse registry who have been registered with the Special Needs registry. The registry contractors do not provide assistance with special needs registration for patients. A form letter does not provide assistance in registering with an emergency management agency or educate special needs patients about procedures that may be necessary for their safety during disasters, as not all special needs patients have good eyesight and mental faculties to be able to read the form and call for assistance. Registries are required to collect information on special needs patients as part of a program intake process. Mandated Correction Date: 4/13/2003. 12. During the follow-up visit conducted by the Agency on 5/19/03 and based on a review of the corrections that were included in the Directed Plan of Correction for this citation and administrative interview, the registry has not distributed the emergency management information to all of the independent contractors for reading, forms have not been completed and brought back to the registry, lists of medications and equipment, and no prioritized list has been developed or maintained. The findings include: (a) Based on an interview with administrative staff, the registry has not distributed the forms from the county to all independent contractors for reading and discussion. During the survey, one of the independent contractors entered the registry. The surveyor inquired as to this person's knowledge of Emergency Management System as related to the patients and to the registry. The independent contractor was unable to provide any answers and would be equally unable to assist the client and answer any questions presented by the client prior to returning any completed information forms to the registry. Had this independent contractor received training in emergency preparedness, the contractor would have been able to respond to the surveyor. 252.355(15) (16) (bo) It was also shared during interview with administrative staff, that the independent contractors are not bringing the completed forms back to the registry for forwarding to the County Emergency Management offices. The office nurse has been attempting to contact the patients to gather this information. Not all patients had been contacted at the time of the survey. 252.355(15) (16) (c) (c) The nurse registry has obtained approximately 4 completed forms returned. These forms had not been organized or processed at the time of the survey. A prioritized list has not yet been completed by the registry as required by s. 252.355(b) (15). {d) Patient #2 has mental disabilities and requires the administration of insulin twice a day. It had not been determined how this patient would get this care during an emergency. The patient record did not include a description of how this care would be continued during a disaster or emergency that interrupts the provision of care in the patient's home as required in s. 252.355(a). s. 252.355(4) states: "All appropriate agencies & community- based service providers, including home health care providers, shall assist emergency managements agencies by collecting information for persons with special needs as part of program intake processes, establishing programs to increase the awareness of the registration process, and educating clients about the procedures that may be necessary for their safety during disasters. Clients of state or federally funded service programs with physical, mental, or sensory disabilities who need assistance in evacuating, or when in shelters, must register as persons with special needs.” (e) Of the 22 patients the surveyor inquired about to the administrative staff person present on 5/19/03, Patient B was on oxygen and refused any emergency planning assistance but did not share what action would be taken, 1 required the administration of insulin (Patient #2), 1 was bed bound and it was stated that this patient would be admitted to the hospital, and 2 patients were out of town at the time of the survey but the registry had not made a determination as to the needs of these patients (Patients C and T) in the event of a disaster. Patient S$ was stated to be interested in registering, but had not turned in any paperwork yet. Patient H was planning on having any decisions be handled by the live- in caregiver. Patient M has had a CVA and has the spouse for 10 a caregiver. No emergency action had been determined for this client. When the surveyor inquired about Patient I, the response was that he lived with his spouse. Of these 22 patients, emergency care needs determinations had not been made on 6 of the 22 patients. (252.355 (15) (16) 13. Based on the foregoing, Catalano’s Nurses Registry violated Sections 400.506(15), (16), 252.355(4), Fla. Stat., herein classified as an uncorrected violation, pursuant to Rule 59A-18.016, F.A.C., which carries a $500.00 fine. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Counts I and Il. B. Assess and maintain the Agency’s administrative fine totaling $1,000.00 against Catalano’s Nurses Registry, in accordance with $§400.506, Fla. Stat. and Rule 59A-18.016, F.A.C. C. Award the Agency for Health Care Administration reasonable attorney’s fees, expenses, and costs, if the Court finds that costs are applicable, and D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Agency Clerk, 2727 Mahan Drive, Building 3, Mail Stop #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, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Kathryn F. Fenske, Esq. Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 NW 53°¢ Street, 1°° Floor Miami, Florida 33166 (305) 499-2165 Copies to: Kathryn F. Fenske, Assistant General Counsel Agency for Health Care Administration Manchester Building 8355 NW 53™ Street Miami, Florida 33166 Elizabeth Dudek, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, MS#9 Tallahassee, Florida Harold Williams, Field Office Manger Agency for Health Care Administration 2295 Victoria Avenue, Room 340 Ft. Myers, Florida 33901 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 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 Barbara Zacka, Administrator, Catalano’s Nurses Registry, Inc., 5240 Bank Street, Fort Myers, Florida 33907; Catalano’s Nurses Registry, Inc., 9703 South Dixie Highway, Miami, Florida 33156, and to Arlene Catalano, Registered Agent, 630 W. 50°" Place, Hialeah, Florida 33012- 3615 on sy. xn , 2003. Kathryn F. Fenske, Esq.

Docket for Case No: 03-003846