STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, CY 20 [ AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2008004022 © ACCESS HOME HEALTH OF FLORIDA, INC. d/b/a GENTIVA HEALTH SERVICES, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency For Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, ACCESS HOME HEALTH OF FLORIDA, INC. d/b/a GENTIVA HEALTH SERVICES (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges as follows: NATURE OF THE ACTION This is an action to impose an administrative fine against a home health agency in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to Sections 400.474 and 400.484(2)(c), Florida Statutes (2007), based upon one repeat Class III deficiency. JURISDICTION AND VENUE lL. This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2007). . 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, Florida Statutes (2007); Chapters 408, Part II, and 400, Part IH, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code. 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversees home health agencies i in | Florida and i is is responsible for the enforcement of the applicable federal and state regulations, statutes and rules governing home health agencies pursuant to Chapter 408, Part II, and Chapter 400, Part III, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code. The Agency may deny, revoke, or suspend a license, or impose an administrative fine, for violations as provided for by Sections 400.474 and 400.484, Florida Statutes (2007), and Rules 59A-8.003 and 59A-8.0086, Florida Administrative Code. 5. The Respondent was issued a license by the Agency to operate a home health agency in Florida (License Number 299991086) located at 1832 SE Port St. Lucie Boulevard, Port Saint Lucie, Florida 34952, and was at all material times required to comply with the applicable federal and state regulations, statutes and rules governing home health agencies. COUNT I The Respondent Failed To Ensure That It Shall Maintain A File For All Employees Which Shall Include Name And Address Of Employee, Name And Address Of Next Of Kin Or Guardian, Evidence Of Qualifications, Licensure Or Registration If Applicable, A Signed and Notarized Affidavit Of Good Moral Character, Results Of Background Screening, And Dates Of Employment And Separation From The Agency In Violation Of Rule 59A-8.0185(3), Florida Administrative Code 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, the Agency shall maintain a file for all employees which shall include name and address of employee, name and address of next of kin or guardian, evidence of qualifications, licensure or registration if applicable, a signed and notarized Affidavit of Good Moral Character, results of background screening, and dates of employment and separation from the agency. Evidence of continuing education and in-service training for home health aides shall be on file and this information shall be kept in the personnel files or in a separate filing system maintained for this purpose and shall be available for inspection within three G) hours of request. Rule 594-8. 0185(3), Florida Administrative Code (2007). 8. On or about April 25, 2005 through April 28, 2005 the Agency conducted ¢ an 7 Annual Licensure Survey of the Respondent and its facility. 9. Based on review of personnel records and interviews with agency staff conducted during the April 25, 2005 survey, it was determined the facility failed to maintain personnel records as in accordance with Chapter 59A-8.0185. Twelve (12) of twelve (12) records reviewed lacked evidence of continuing education or qualifications (home health aide) or results of background screening, and/or appropriate health screening. The documentation was unavailable for inspection within three (3) hours of the request. 10. | A review of personnel records on April 25, 2005 between 12:00 p.m. - 3: 30 p.m. revealed twelve (12) of twelve (12) personnel records lacked one or more of the required items. The findings were reviewed with the administrator at 3:30 p.m. on April 25, 2005. On April 26, 2005 at 11:00 a.m. the administrator stated, "We are trying to get the personnel records in order. Maybe we can go over them later.” 11. On April 27, 2005 at 8:00 a.m. the person in charge of the personnel records stated, “We found the things that were missing from the personnel records." The documentation was unavailable for inspection within three (3) hours of the request. 12. The Respondent’s act, omission or practice had an indirect, adverse effect on the health, safety, or security of a patient constituting a Class III deficiency. Section 400.484(2)(c), Florida Statutes (2007). 13. | The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 14. The Agency provided the Respondent with a mandatory correction date of May the Respondent had corrected the deficiency. 16. Onor about February 25, 2008 through February 28, 2008 the Agency conducted a Relicensure Survey of the Respondent and its facility. 17. Based on record review and interview, the agency failed to maintain a file for each employee that included a copy of their current license, for one (1) of two (2) sampled Registered Nurses, Employee number seven (7). 18. A review of the employee file for employee number seven (7), a Registered Nurse, revealed that the file contained no evidence of current licensure in Florida. The license on file had expired in 2007. An interview with the Human Resource personnel on February 25, 2008 at 1:30 p.m. confirmed that the file did not contain a copy of the current licensure for the employee or the online verification. 19. A review of the current agency policy for licensure verification (#7-10) revealed that license expiration dates must be tracked to ensure renewals are received and filed appropriately. A review of the current agency policy for personnel record content (#8-2) confirmed that each personnel record should contain license verification. 20. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents, and indirectly or potentially threatened the physical or emotional health, safety, or security of Facility residents. 21. The Agency cited the Respondent for a repeat Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2007). 22. The Agency provided the Respondent with a mandatory correction date of March 29, 2008. Ce oo vaya yn gence . WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the total amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to Section 400.484(2)(c), Florida Statutes (2007). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to enter a final order granting the following relief against the Respondent. 1. Make findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of FIVE HUNDRED DOLLARS ($500.00). 3. Enter any other relief that this court deems just and appropriate. Respectfully submitted this_“T+*~_of Mon , 2008. Quinte ons - Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 NOTICE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO RETAIN AND BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS. ~ALL REQUESTS FOR HEARING SHALL BE MADE AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 922-5873. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING 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 BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and the Election of Rights form has been served to: Karen Duke, Administrator, Access Home Health of Florida, Inc. d/b/a/ Gentiva Health Services, 1832 SE Port St. Lucie Boulevard, Port Saint Lucie, Florida 34952, by U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1537 2948, and Blumberg Excelsior Corporate Services, Inc., Registered Agent for Access Home Health of Florida, Inc. d/b/a Gentiva Health Services, 4435 Old Winter Garden Road, Orlando, Florida 32811, by U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1537 2931, this V4 Fay of Manny , 2008. Qo Ae in ¥, > Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 Copies furnished to: Karen Duke, Administrator Access Home Health of Florida, Inc. d/b/a Gentiva Health Services 1832 SE Port St. Lucie Boulevard Port Saint Lucie, Florida 34952 (U.S. Certified Mail) -| Blumberg Excelsior Corporate Services, Registered Agent for Access Home Health of Florida, Inc. d/b/a Gentiva Health Services 4435 Old Winter Garden Road Orlando, Florida 32811 (US. Certified Mail) Andrea M. Lang, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Interoffice Mail ‘| Arlene Mayo-Davis =" Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (U.S. Mail) COMPLETE THIS SECTION ON DELIVERY SENDER: COMPLETE THIS SECTION ™ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ™ Print your name and address on the reverse so that we can return the card to you. ™@ Attach this card to the back of the mailpiece, or on the front if space permits: 1. Article Addressed to: 20° ged Yo? Blum bors Excelsior Corporate Seruces Resistered Agent fe Gentiva Healt Sernces “yss Old hinter Garden oad Ts. Servo po ese Or laude Florida 329// CI Registered DB Return Receipt for Merchandise ? OC Agent C1 Addressee Cl insured Mail 1.6.0.0. 4. Restricted Delivery’? (Extra Fee) 2. Article Number . (Transfer from service label) 7006 27b0 0003 1537 2931 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ™ Complete items 1, 2, and 3. Aiso complete item 4 if Restricted Delivery Is desired. ®@ Print your name and address.on the reverse so that we can'return the card to you. _ @ Attach this card to the back of the mailplece, _-or on the front If space permits. 1. Article Addressed to: - 20OB0OYo22 Karen Duke, Ad minis trator Gentive Hes lin Gernees 1832 SE Port St Luce Blvd. Port Saint Luce, Florida 39952. | yeas Vu cases D. 1s delivery address different from item 1? 0 Yes If YES, enter delivery address.below:. [1 No 3. Service Type ( Certified Mall [1 Express Mall Ci insured Mall 16.0.0, 4. Restricted Delivery? (Extra Fee) Cl Yes + enerfonvencoesep «700 27b0 OD03 1537 2548 C] Registered (© Return Receipt for Merchandise PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

Docket for Case No: 08-003307