L7- $304 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No.: 2007005293 Petitioner, Return Receipt Requested: v. 7002 2410 0001 4232 2118 7002 2410 0001 4232 2125; A FAMILY MEMBER HOME CARE CORP d/b/a Sota A FAMILY MEMBER HOME CARE CORP., “2 co Respondent. — / u ia Oo ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against A Family Member Home Care Corp. d/b/a A Family Member Home Care Corp. (hereinafter “A Family Member Home Care Corp.”), pursuant to Florida Statutes Chapter 400, Part III, and Section 120.60, (2006), and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,000.00 pursuant to Section 400.484, Florida Statutes (2006), for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes (2006). 3. Venue lies in Broward County pursuant to Rule 28.106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licersure and enforcement of all applicable statutes and rules governing home health agencies, pursuant to Chapter 400, Part III, Florida Statutes (2006), and Chapter 59A-8 Florida Administrative Code. 5. A Family Member Home Care Corp. operates a home health agency located at 2525 N. State Road 7 - Suite 215, Hollywood, Florida 33021. A Family Member Home Care Corp. is licensed as a home health agency under license number 299991692. A Family Member Home Care Corp. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I A FAMILY MEMBER HOME CARE CORP. FAILED TO ENSURE THAT THE PERSONAL CARE SERVICES WERE ASSIGNED BY AND UNDER THE SUPERVISION OF A REGISTERED NURSE AND FAILED TO ENSURE THAT THE CLIENTS WERE ADEQUATELY SUPERVISED AND HAD THEIR NEEDS MET. RULE 59A-8.0095(5) (a) FLORIDA ADMINISTRATIVE CODE. HOME HEALTH AIDE CNA SUPERVISION CLASS II 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. A Family Member Home Care Corp. was cited with one (1) Class II deficiency due to a complaint investigation survey conducted on March 27, 2007. 8. A complaint investigation survey was conducted on March 27, 2007. Based on record reviews and interviews, it was determined that the home health agency failed to ensure that the personal care services were assigned by and under’ the supervision of a Registered Nurse, and so failed to ensure that the clients were adequately supervised and had their needs met for 1 out of 4 sampled client records reviewed (Client #4). This was evidenced by the Aide providing live-in supervision to Client #4 and failing to contact emergency services (911) in a timely manner. The findings include the following. 9. During a review of the record of Client #4 and the personnel records of the Home Health Aides that provided the personal care services to the client, it was determined that the Registered Nurse did not do Aide assignments or supervise the Aides. 10. During a record review of the clinical record of Client #4 it was determined the client was being provided with a live-in aide since 03/19/06. The initial intake was done by the agency on 03/20/06. The most recent plan of care in the record was signed by the physician on 09/06/06 and reflected orders for SN (Skilled Nurse) for evaluation, and HHA ( Home Health Aide) for assistance with ADL's ( Activities of Daily Living). No frequency was listed on the plan of treatment. The client was diagnosed with OBS (Organic Brain Syndrome), Senility and Hypertension. 11. The comprehensive nursing assessment dated 08/04/06 documented the client had a history of falls (as recent as 07/06) however, there was no documentation in the record of the fall. 12. Review of the documentation in the employee file for Employee #1 revealed Employee #1 was the relief Aide for Client #4. Another employee was Client #4's primary Aide. Further review revealed documentation that on 01/29/07 at approximately 6:00 AM Employee #1 heard a noise and checked on the client. He/She stated that the client was "in the tub" and "did not look like he/she was in pain, no groaning or anything. There wasn't any water running, the tap was off. I asked him/her what are you doing there.” He/she said "looking for a ...ring and fell into 4 the tub." Employee #1 "pulled the client out of the tub and sat the client on the toilet. The client was shivering and talking". Employee #1 then "called...(another employee) to tell him/her that he/she was calling 911 but the other employee told Employee #1 to push the lifeline first, but if he/she could not find it then go to the neighbor. 13. Employee #1 returned to the apartment with the neighbor who located the lifeline button and pushed it. Employee #1 then stated upon their return to the client, the client was still sitting on the toilet. The paramedics came and took the client to the hospital. 14. The....(municipality) police report was obtained and documented that the incident occurred on 01/28/07, not 01/29/07. -... (Residential Community Nurse) responded to the medical alarm at the client's residence and found the client sitting on the toilet. The shower curtain had fallen and the water in the tub was red from blood. The client was observed to have a "serious" burn on the back and a laceration on the back of the head. There was no evidence of this documentation in the agency's records. 15. Further review of the documentation revealed the client was transported to the hospital on 01/28/07 and ultimately transferred to a Burn Unit at another hospital with second degree burns of the back and upper extremities. 16. During an interview with the owner at 3:00 PM on 03/27/07, it was determined that the client expired in the 5 hospital. The owner further stated that another employee was the only one the client would allow to bathe him/her, and not Employee #1. 17. However, further review of the agency's record of Client #4 revealed that there was no documentation of the client's preference and no documentation of how the agency would ensure that the client received the physician ordered assistance with bathing. There was no documentation of care coordination, case management, or supervision of the aides. There was no documentation that the client was willing or not willing to allow supervision of the aides as required. There was no documentation of an aide assignment. There was no evidence of documentation that the agency coordinated the assignment of care of Client #4 between both Employee #1 and another employee to assure that Employee #1 would be aware of the availability and location of emergency assistance in order to contact emergency services in a timely manner. In addition, there were documented deficiencies in the agency's personnel records (Refer to H202, H204, H211, H245 and H250) and no evidence of documentation of a Quality Assurance program in place to ensure that Aides were properly assigned, oriented, trained and supervised in order to meet the client's needs. 18. Based on the foregoing facts, A Family Member Home Care Corp. violated Rule 59A-5.0095(5) (a), Florida Administrative Code, herein classified as a Class II deficiency, which warrants an assessed fine of $1,000.00. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against A Family Member Home Care Corp. on Count I. 2. Assess against A Family Member Home Care Corp. an administrative fine of $1,000.00 on Count I for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. Grant such other relief as the court deems is just and proper on Count I. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #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 WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER odriguez, E Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Karen Davis Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Home Health Agency Unit Program Agency for Health Care Administration 2727 Mahan Drive - Tallahassee, Florida 32308 (Interoffice Mail) 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 Nebert Whyte, Administrator, A Family Member Home Care Corp., 2525 N. State Road 7 - Suite 215, Hollywood, Florida 33021; Brian Gauthier, Registered Agent, 2525 N. State Road 7, Suite 215, Hollywood, Florida 33021 on this pote day of (4, yeole , 2007. eo. fa f Lik bow wa ‘ Rade LED. Alba M. Rodriguez, ‘Esq. ( 7002 2410 on01 4232 2118 U.S. Postal Service... CERTIFIED MAIL... RECEIPT (Do! 1estic Mail Only; No Insurance Coverage Provided) For Jelivery information visit our website at ww PS Form 3800, June 2002 7002 2410 O001 4e32 2125 U.S. Postal Service-» Serle CERTIFIED MAIL f — MPLETE T! PS Form 3800, June 2002 °° USPS - Track & Confirm Page 1 of 1 Ba psa. Home | Help | Signin Track & Confirm Search Results Label/Receipt Number: 7002 2410 0001 4232 2118 Status: Detivered Track & Confirm Enter Label/Receipt Number. Your item was delivered at 11:26 AM on August 13, 2007 in Co HOLLYWOOD, FL 33021. — — _ Notification Options _ Track & Confirm by email . Get current event information or updates for your item sent to you or others by email. ( Go>) F A POSTALINSPECTORS sitemap contactus government services jobs National & Premier Accounts . Preserving the Trust Copyright © 1999-2004 USPS. All Rights Reserved. Terms of Use Privacy Policy http://trkcnfrm 1 .smi.usps.com/PTSInternetWeb/InterLabellnquiry.do 08/16/2007 ws . USPS - Track & Confirm Page 1 of 1 Bad rosat save. Mom | Hl | Son Track & Confirm Search Results Labei/Receipt Number: 7002 2410 0001 4232 2125 Status: Delivered Track & Confirm “Se Enter Label/Receipt Number. Your item was delivered at 11:26 AM on August 13, 2007 in HOLLYWOOD, FL 33021. Track & Confirm by email Get current event information or updates for your item sent to you or others by email. POSTALINSPECTORS sitemap contactus government services jobs National & Premier Accounts Preserving the Trust Copyright © 1999-2004 USPS. Ail Rights Reserved. Terms of Use Privacy Policy http://trkenfrm1.smi.usps.com/PTSIntemetWeb/InterLabelInquiry.do 08/16/2007

Docket for Case No: 07-004504