& = 06 Le D STATE OF FLORIDA OC 8 é AGENCY FOR HEALTH CARE ADMINISTRATION 1 PH Appa Sh STATE OF FLORIDA, ae OMINISEN Of HE Ap RAT, AGENCY FOR HEALTH CARE ARINGS VE ADMINISTRATION, a Petitioner, : 0 ( A { 4 | vs. ACHA No. 2006008270 INNOVATIVE NURSING, INC., Respondent. , / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Agency”) by and through its undersigned counsel, and files this “Administrative Complaint against the Respondent, INNOVATIVE NURSING, INC., (hereinafter “Respondent”), pursuant to sections 120.569 and 120.57, Florida Statutes (2006), and alleges as follows: Oo NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of ONE THOUSAND DOLLARS ($1,000.00) against a home health agency pursuant to Section 400.474(1), Florida Statutes (2006), based upon one uncorrected class II violation cited at a Licensure survey conducted on or about August 1, 2006, that was a uncorrected deficiency from a previous survey performed on or about June 5 through June 7, 2006. JURISDICTION AND VENUE LL This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2006). 2. The Agency has jurisdiction over: the Respondent pursuant to Chapter 400, Part IV, Florida Statutes (2006), and Chapter 59A-8, Florida Administrative Code (2006). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2006). PARTIES 4. Pursuant to Chapter 400, Part I, Florida Statutes (2006)', and Chapter 59A-8, Florida Administrative Code (2006), the Agency is the regulatory authority responsible for the licensure of home health agencies and the enforcement of all applicable federal and state statutes and rules governing home health agencies. 5. At all times material, the Respondent was a home health agency located at 499 E. Central Parkway, Suite 100, Altamonte Springs, FL 32701. At all times material, the Respondent was licensed by the Agency to operate a home health agency in Seminole County having been issued license number 213030961 by the Agency. 6. At all times material, the Respondent is and was a licensed home health agency required to comply with Chapter 400, Part II, Florida Statutes (2006), and Chapter 59A-8, Florida Administrative Code (2006). COUNT I THE RESPONDENT FAILED TO ACCURATELY ASSESS AND PLAN THE NEEDS FOR 2 OUT OF 8 SAMPLED PATIENTS. . RULE 594A-8.0095(3)(a), Florida Administrative Code (2006) UNCORRECTED CLASS Tif DEFICENCY 7. The Agency re-alleges paragraphs 1 through 7. ' Prior to July 1, 2006, Chapter 400, Part TI, Florida Statutes, had been numbered Chapter 400, Part IV, Florida Statutes. _8 ‘The regulatory provision of the Florida Administrative Code. that is specifically pertinent here includes the following: Rule 58A-8.0095, Florida Administrative Code 59A-8.0095 Personnel (3) Registered Nurse. (a) A registered nurse shall be currently licensed in the state, pursuant to Chapter 464, F.S., 1. Be the case manager in all cases involving nursing or both nursing and therapy care. 2. Be responsible for the clinical record for each patient receiving nursing care; and 3. Assure that progress reports aré made to the physician for patients receiving nursing services when the patient’s condition changes or there are deviations from the plan of care.’ 9. On or about June 7, 2006, AH'CA. surveyors conducted a Licensure survey of the Respondent’s facility that resulted in a Class III deficiency. The standard that the Respondent shall accurately assess and plan the needs for residents-is not met based on record review and interview, the home health agency failed to accurately assess and plan for the needs for 2 of 10 sampled patients (#7 & #9). The findings include: Review of the clinical record for patient #7 revealed a plan of care dated 5/31/03 and updated 5/13/06. This plan of care indicated that s/ne was wheelchair-bound with significant neurological deficits. The most recent on site nursing assessment, dated 4/4/06, revealed a checked box that indicated that there were “no problems” regarding the patient’s “functional deficits.” Review of the clinical record for patient #9 revealed a plan of care dated 5/22/06. This plan of care included a checked box that indicated the patient's “activities permitted” included “up as tolerated.” The box under this category that included — “wheelchair” was not checked. The nursing assessment dated 5/22/06 Indicated _ that the patient was wheelchair-bound with no weight-bearing activities permitted. In an interview with the administrator on 6/7/06 at 1 p.m., these fi findings were confirmed. 10. The Respondent was provided a mandated correction date of June 27, 2006, for this Class I violation. 11.’ AHCA surveyors conducted, another survey of the Respondent’s facility on or about August 1, 2006. The standard that the Respondent shall accurately assess and plan the needs for the residents were again not met based on record review and interview, the home health agency failed to accurately assess and plan for the needs for 2 of 8 sampled patients (#4 & #5) Findings include: . Review of the clinical record for Patient #4 revealed a plan of care dated 6/19/06. The only diagnoses’ noted on the plan of treatment or nursing assessment were Bacteremia and Diabetes Mellitus without complications. This plan of care indicated that. wound care-would be provided in the following manner: wet-to-dry daily dressing change (wound location not specified) and IV (intravenous) infusion of Ancef 2 grams (antibiotic) every -8 hours ‘with a plan to instruct a caregiver regarding antibiotic infusions. There was no evidence found in the clinical record of a change in the plan of care from 6/19/06-7/10/06. Review of the skilled nursing visit notes revealed the following: On 6/29/06, two skilled nurse visit notes by two different nurses were revealed that indicated a wet-to-dry dressing. change for an abdominal wound. A notation was made on both notes that indicated that family stated the IV antibiotic infusion was “going well.” On 7/10/06,. a skilled nurse visit noted that there was.no skin impairment. The nurse also noted that Rocephin 1 gram daily/every 8 hours was given. On 7/15/06, a visit note indicated that the nurse administered “medication with SASH.” The nurse also noted that the patient “went to Shands to see about liver transplant....right now on hold.” There was no prior nursing assessment that revealed significant liver impairment. . Review of the clinical record for patient #5, with a diagnosis of an exacerbation of multiple sclerosis, revealed a comprehensive adult nursing assessment dated 7/21/06. This nursing assessment revealed checked boxes that indicated that the patient had’ “No Problem” with pain, “No Problem” with the neuron/emotional/behavior status, and “No Problem” with the musculoskeletal! system, including “able to independently walk on even and uneven surfaces and climb stairs with or without, raflings(no human assistance or assistive devices). However, the Activities Permitted: section indicated the use of a cane. The physician ordering the. IV Solumedrol treatment noted that the patient had ataxic gait, head pain, increased sensory symptoms and bilateral extremity pain. The medication list included Gabapentin, a medication used to control abnormal neurological activity. In an interview with the administrator on 8/1/06 at 3:00 p.m., these findings were confirmed. 12. The Respondent was provided a mandated correction: date. of August 23, 2006 for this Class II violation. 13. The foregoing violation is cited as a Class II deficiency pursuant to Rule 59A- 8.0095(3)(a), Florida Administrative Code, which requires the. Respondent shall accurately assess and plan the needs for residents. 14. Such violations constitute the grounds for the imposed Class III deficiency in that it has an indirect adverse effect on the health, safety or security of the facility’s residents, other than Class I or Class II violations. 15. Pursuant to Section 400.484(c), Florida Statutes, Class I violations are subject to an administrative fine of not to. exceed $500.00 for each occurrence and each day that the ‘uncorrected or repeat deficiency exists, Therefore, the Agency is authorized to impose a fine in the amount of ONE THOUSAND DOLLARS ($1,000.00) for Count I. CLAIM FOR RELIEF WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of Count I; . 2. Impose a fine in the amount of $1,000.00 for the referenced violations: 3. Enter other legal or equitable relief as this Court may find appropriate. _ Respectfully submitted on this oh 1 day of 0 ct 2006. Eric R. Bredemeyer, exidr ‘Attormey Florida Bar No. 318442 Agency for Health Care Administration Office of the General Counsel Fort Myers Office 2295 Victoria Avenue, #346C . Fort Myers, Florida 33901-3884 Telephone: (239) 338-3203 Facsimile: (239) 338-2699 NOTICE THE RESPONDENT IS NOTIFIED THAT IT HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING. PURSUANT TO SECTION 120.569 AND 120.57, FLORIDA STATUTES. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS FORM. THE RESPONDENT IS FURTHER NOTIFIED If THE ELECTION OF RIGHTS FORM IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. THE ELECTION OF RIGHTS FORM SHALL BE MADE TO THE AGENCY FOR HEALTH CARE ADMINISTRATION AND DELIVERED TO: AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG 3, MAIL STOP 3, TALLAHASSEE, FL 32308; TELEPHONE (850) 922-5873. CERTIFICATE OF SERVICE. I HEREBY CERTIFY that the original Administrative Complaint and Election of Rights form has been served to: Administrator, Innovative Nursing, Inc; 499 East Central Parkway #100, Altamonte Springs, FL 32701, by U.S. Certified Mail, Retum Receipt Requested (No. 7006 0810 0005 8953 0242), and that a true and correct copy has been served to: Ivan M. Lefkowitz ; Registered Agent, 430 N. Mills Avenue, Orlando, FL 32803, by U.S. Certified Mail, Retum Receipt Requested (No. 7006 0810 0005 8953 0259), on this S247 day of O ebro, 2006. Florida Bar No. 31844 Agency for Health Care Administration Office of the General Counsel, Fort Myers Office 2295 Victoria Avenue, #346C Fort Myers, FL 33901-3884 Telephone: (239) 338-3203 Facsimile: (239) 338-2699 Copies furnished to: Administrator Innovative Nursing, Inc 499 East Central Parkway #100 Altamonte Springs, Florida 32701 (U.S. Certified Mail) . Eric R. Bredemeyer, Senior Attorney Agency for Health Care Administration Office of the General Counsel, Fort Myers Office 2295 Victoria Avenue, #346C — Fort Myers, FL 33901-3884 : Ciateroffice) Ivan M. Lefkowitz : Registered Agent 430 N. Mills Avenue Orlando, FL 32803 ~ (U.S. Certified Mail) Joel Libby _ | Field Office Manager, Orlando Office Agency for Health Care Administration 400 W. Robinson, Suite $390 Orlando, Fi 32801 ‘acsimile COMPLETE THIS SECTION ON DELIVERY NDER: COMPLETE THIS SECTION Complete items 1; 2;and 3: ‘Also’ ‘complete 22." item 4 if. Restricted’ Delivary is: desired. Print your:nameé and: address on'the reverse so that wa: can ‘return ‘the: card to you, Attach ‘this card to the back of the mallpiece, or on the front if ‘space: permits. Article Addressed to:" ANMASISCA OE Mola oe WOSSING, Inc! 49 East Cen\tol Ras Luana! bo ernonte Sar nas, Florida : D. Js delivery addiess different from item 171 Yes °.. IEYES, enter delivery address below: Tino’ 9. Service Type | : O Certified Mal = Express Mall 3a To) O Reg!sterad G3 Return Recelpt for Merchandise CO Insured Mall Ocop — ; 4, Restricted Delivery? (Extra Fee) O ves Article Number : . (Transtér from service labia) 7008 0410 ogas 8453 Dee 3 Form 3811, February 2004 Domestic Return Recelpt 102595-02-M-1540 : : CERTIFIED MAIL oon (pomestic Mail. Only; No Insurance Coverage Provicted) Postaga Cartifisd Fee Postmart jatum Flecalpt Fe (enderoomant Hequired} Here 0 ws {Endorsement Required) ‘Tatal Postage & Feas | | Restricted Delivery Fag } J J | | SantTa — BAK Shwe hor Tnneive (lS. ’ | Siraai, Apt Na; ceeonr ABest Condoos Rackwsysh 100. ( Bras} EL 3070 DIVISION of ADNINISTR AY HSA ve

Docket for Case No: 06-005151