STATE OF FLORIDA . . AGENCY FOR HEALTH CARE ADMINISTRATION C2 DEC -8 py J: 5 3 STATE OF FLORIDA, Cy a AGENCY FOR HEALTH CARE O < OS : ADMINISTRATION, Petitioner, vs. Fraes No: 2008010729 RELIABLE PRIVATE CARE, INC., 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, Reliable Private Care, Inc. (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2008), 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 four thousand five hundred dollars ($4,500.00) based upon nine class III deficiencies. JURISDICTION AND VENUE 1. This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2008). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, Florida Statutes (2008), Chapters 408, Part II, and 400, Part lI], Florida Statutes (2008), 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 and enforces the applicable federal and state statutes, regulations and rules governing home health agencies. Ch. 408, Part II, Ch. 400, Part Ill, Fla. Stat. (2008), Ch. 59A-8, Fla. Admin. Code. The Agency is authorized to deny, revoke, or suspend a license, and impose an administrative fine, for violations as provided for by Sections 400.474 and 400.484, Florida Statutes (2008), and Rules 59A-8.003 and 59A-8.0086, Florida Administrative Code. 5. The Respondent was issued a license by the Agency (License No. 299992506) to operate a home health agency located at 775 South Kirkman Road, Suite 112, Orlando, Florida 32811, and was at all material times required to comply with the applicable federal and state statutes, regulations and rules governing home health agencies. COUNT I (Tag 130 The Respondent Failed To Provide The Agency Documentation Necessary To Ensure Its Financial Stability In Violation Of F.S. 408.810(8) 6. The Agency re-alleges and incorporates by reference paragraphs | through 5. 7. Under Florida law, in addition to the licensure requirements specified in this part, authorizing statutes, and applicable rules, each applicant and licensee must comply with the requirements of this section in order to obtain and maintain a license. § 408.810, Fla. Stat. (2008). Upon application for initial licensure or change of ownership licensure, the applicant shall furnish satisfactory proof of the applicant's financial ability to operate in accordance with the requirements of this part, authorizing statutes, and applicable rules. The Agency shall establish standards for this purpose, including information concerning the applicant's controlling interests. The Agency shall also establish documentation requirements, to be completed by each applicant, that show anticipated provider revenues and expenditures, the basis for financing the anticipated cash-flow requirements of the provider, and an applicant's access to contingency financing. A current certificate of authority, pursuant to chapter 651, may be provided as proof of financial ability to operate. The Agency may require a licensee to provide proof of financial ability to operate at any time if there is evidence of financial instability, including, but not limited to, unpaid expenses necessary for the basic operations of the provider. § 408.810(8), Fla. Stat. (2008). 8. Under Florida law, if a licensee has shown signs of financial instability at any time, pursuant to Section 408.810(8), Florida Statutes, the Agency shall require proof of financial ability to operate, by submitting schedules 2 through 7 of AHCA Form 3110-1013, December 2004, described in subsection (5) above, and documentation of correction of the financial instability, to include evidence of the payment of any bad checks, delinquent bills or liens. If complete payment cannot be made, evidence must be submitted of partial payment along with a plan for payment of any liens or delinquent bills. If the lien is with a government Agency or repayment is ordered by a federal, state, or district court, an accepted plan of repayment must be provided. Fla. Admin. Code R, 59A-8.004(6). 9. Under Florida law, “financial instability” means the home health agency cannot meet its financial obligation. Evidence such as the issuance of bad checks or an accumulation of delinquent bills shall constitute prima facie evidence that the ownership of the home health agency lacks the financial ability to operate. Evidence also includes the Medicare or Medicaid program’s indications or determination of financial instability or fraudulent handling of govern- ment funds by the home health agency. Fla. Admin. Code R. 59A-8.002(15). 10. Under Florida law, a controlling interest may not withhold from the Agency any evidence of financial instability, including, but not limited to, checks returned due to insufficient funds, delinquent accounts, nonpayment of withholding taxes, unpaid utility expenses, non- payment for essential services, or adverse court action concerning the financial viability of the provider or any other provider licensed under this part that is under the control of the controlling interest. Any person who violates this subsection commits a misdemeanor of the second degree, punishable as provided in Section 775.082 or Section 775.083, Florida Statutes. Each day of continuing violation is a separate offense. § 408.810(9), Fla. Stat. (2008). 11. Under Florida law, "controlling interest" means: (a) The applicant or licensee; (b) A person or entity that serves as an officer of, is on the board of directors of, or has a 5- percent or greater ownership interest in the applicant or licensee; or (c) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater ownership interest in the management company or other entity, related or unrelated, with which the applicant or licensee contracts to manage the provider. The term does not include a voluntary board member. § 408.803(7), Fla. Stat. (2008). 12. The Agency re-alleges and incorporates by reference Count I of the administrative complaint dated August 29, 2008, that it served on this Respondent. Exhibit 1. 13. On or about August 13-14, 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). 14. | Based upon interview and record review, the Respondent failed to maintain financial stability. 15. At the time of the revisit, no financial information (schedules 2-7) was available for review. . 16. During an interview with the Director of Nursing (“DON”) on August 14, 2008, at 3:00 p.m., this finding was confirmed. 17. She stated that this information would be provided to the Agency area office by August 15, 2008. 18. The information was not available in the Agency area office at close of business on August 15, 2008. 19. The Respondent’s act, omission or practice constituted an uncorrected class IIT deficiency. 20. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 21. | Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 22. The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT Hl (Tag 223) The Respondent’s Director Of Nursing Failed To Provide Supervision For Staff Members, Failed To Provide Supervision Of Care For Patients And Failed To Ensure That Appropriate Infection Control Practices Were Followed In Violation Of F.A.C. 59A-8.0095(2) 23. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 24. Under Florida law, the director of nursing of the home health agency shall: 1. Meet the criteria as defined in Section 400.462(10), Florida Statutes; 2. Supervise or manage, directly or through qualified subordinates, all personnel who provide direct patient care; 3. Ensure that the professional standards of community nursing practice are maintained by all nurses providing care; and 4. Maintain and adhere to home health agency procedure and patient care policy manuals. Fla. Admin. Code R. 59A-8.0095(2). 25. The Agency re-alleges and incorporates by reference Count I of the administrative complaint dated August 29, 2008, that it served on this Respondent. Exhibit 1. 26. On or about August 14; 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). . 27. Based upon interview and record review, the Respondent’s DON failed to maintain appropriate DON duties for 5 of 5 sampled patients (Patients #1 - #5). 28. The DON failed to maintain home health agency nursing standards as follows: a. A review of the clinical records for Patient #1 revealed that on July 31, 2008, the Patient's blood pressure reading was 210/90 (normal=<130/80). There was no evidence in the record that the physician was notified, that the reading was repeated, or that the frequency of skilled nursing visits was adjusted for repeat assessment. b. A review of the clinical‘records for Patient #2 revealed that skilled nurse visits were made on March 24, 2008, and June 23, 2008, for the purpose of catheter changes. No supplies were available in the home and the nursing staff revisited the patient on March 27, 2008, and June 26, 2008, for the catheter change. No visits were conducted from April 1-30, 2008, due to the unavailability of catheter supplies. c. A review of the clinical records for Patient #3 revealed a physician's order dated July 7, 2008, for 4 additional skilled nurse visits. However, no frequency or duration of the visits was specified. An unsigned verbal physician's order dated July 18, 2008, requested recertification of the patient's care from July 9, 2008, through September 7, 2008. However, no frequency or discipline of care was defined. The records reflected skilled nurse visits on May 10, 2008, July 3 and 16, 2008, with no further visits. d. A review of the home health aide (HHA) care plan for Patient #4 required that the HHA check the Patient's vital signs every visit, report vital signs by guidelines provided, and "take as needed if patient shows changes.” During an interview with the DON on August 14, 2008, at 3:00 p.m., she — stated that she was not sure which the nurse meant to have the HHA : follow. e. A review of the clinical records for Patient #5 revealed that care was initiated on August 24, 2007. The records did not contain evidence that the Patient/Representative was offered the option of nursing supervisory visits for the HHA at any time. 29. During an interview with the DON on August 14, 2008, at 3:30 p.m., these findings were confirmed. . 30. The Respondent’s act, omission or practice constituted an uncorrected class III deficiency. 31. Acclass Ill deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 32. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 33. The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT Hl (Tag 248) The Respondent Failed To Provide Appropriate Supervision Of Home Health Aides In Violation Of F.A.C. 59A-8.0095(5)(m) 34. The Agency re-alleges and incorporates by referenced paragraphs | through 5. 35. Under Florida law, the responsibilities of the home health aide and CNA shall include: 1. The performance of all personal care activities contained in a written assignment by a licensed health professional employee or contractor of the home health agency and which include assisting the patient or client with personal hygiene, ambulation, eating, dressing, shaving, physical transfer, and other duties as assigned; 2. Maintenance of a clean, safe and healthy environment, which may include light cleaning and straightening of the bathroom, straightening the sleeping and living areas, washing the patient’s or client’s dishes or laundry, and such tasks to maintain cleanliness and safety for the patient or client; 3. Other activities as taught by a licensed health professional employee or contractor of the home health agency for a specific patient and are restricted to the following: a. Assisting with the change of a colostomy bag, reinforcement of dressing, b. Assisting with the use of devices for aid to daily living, such as a wheelchair or walker, : c. Assisting with prescribed range of motion exercises, d. Assisting with prescribed ice cap or collar, e. Doing simple urine tests for sugar, acetone or albumin, f. Measuring and preparing special diets, g. Measuring intake and output of fluids, and h. Measuring temperature, pulse, respiration or blood pressure; 4. Keeping records of personal health care activities; 5. Observing appearance and gross behavioral changes in the patient or client and reporting to the registered nurse; and 6. Supervision of self-administered medication in the home is limited to the following: a. Obtaining the medication container from the storage area for the patient, b. Ensuring that the medication is prescribed for the patient, c. Reminding the patient that it is time to take the medication as prescribed, and d. Observing the patient self-administering the medication. Fla. Admin. Code R. 59A-8.0095(5)(m). 36. On or about July 9-10, 2008, the Agency conducted a complaint survey of the Respondent (CCR 2008007671). During the survey, the Agency reviewed the Respondent’s records, observed practices and conditions and conducted interviews. 37. Based upon interview and record review, the Respondent failed to ensure that appropriate tasks were performed by the HHA for 2 of 3 sampled patients (Patients #1 and #2). 38. On July 9, 2008, a review of the clinical records for Patient #1 revealed an admission service agreement for 2 hours of homemaking services and 1 hour of personal care services per week. 39. The HHA care plan dated January 20, 2008, last updated on February 20, 2008, required that the HHA take the Patient's vital signs on every visit. 40. Additionally, the HHA was to notify the care manager if the vital signs were "Temp 97.3 axillary, blood pressure 130/palpable, pulse 64, respirations 20." 41. No further definition of these parameters was available for review. 42. A review of the documentation for care provided by the Respondent Owner/HHA on May 6, 8, 20, 22, 27, 29, 2008, and June 3 and 5, 2008, and by a different HHA on June 24 and 26, 2008, revealed that the vital signs were not documented. 43. | The documentation indicated that the HHA was in the Patient's home for 4 hours each visit and there was no indication of nursing review or report found in the documentation. 44. On July 9, 2008, a review of the clinical records for Patient #2 revealed a HHA care plan dated September 14, 2007, that required the HHA to take the Patient's vital signs on every visit. 45. Additionally, the HHA was to notify the care manager if the Patient’s vital signs were "Temp one 100, Pulse one 100, Respirations over 40, urine less than 60." 46. No further definition of these parameters was available for review. 47, A review of the records for March 21, 26, 28, 31, 2008, and April 2, 4, 7, 9, 11, 14, 16, 18, 21, 2008, and for care provided by the Respondent Owner/HHA on April 23 and 25, 2008, revealed no documentation of the Patient’s vital signs. 48. There was no indication of nursing review or report found in the documentation. 49. The September 14, 2007, HHA care plan included that the Patient would receive a bed bath every visit. 50. | The documentation indicated that the Patient received a chair bath on April 14, 16, and 18, 2008, and a tub/shower on April 21 and 23, 2008. 51. There was no indication was found of an update or change to the HHA care plan. 52. During an interview with the DON on July 10, 2008, at 12:30 p.m., she confirmed these findings. 53. The Respondent’s act, omission, or practice constituted a class III deficiency. 54. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 55. The Respondent was given a mandatory correction date of August 1, 2008. 56. On or about August 14, 2008, the Agency conducted a revisit to the complaint 10 survey of the Respondent (CCR 2008007671). 57. Based upon interview and record review, the Respondent failed to provide appropriate supervision of HHAs for 2 of 5 sampled patients (Patients #4 and #5). 58. The DON failed to maintain home health agency nursing standards for Patients #4 and #5 as set forth: Patient #4 59. A review of the HHA care plan for Patient #4 required that the HHA check the Patient's vital signs every visit, report vital signs by guidelines provided, and "take as needed if patient shows changes." 60. During an interview with the DON on August 14, 2008, at 3:00 p.m., she stated that she was not sure which the nurse meant to have the HHA follow. 61. On August 14, 2008, at 2:35 p.m., the HHA providing care for the Patient on August 8, 11, 12 and 13, 2008, was contacted by telephone. 62. | The HHA stated that she had taken the Patient's vital signs on August 13, 2008, and that they were normal, but had not performed this activity on any of the other recent dates of service. Patient #5 63. Review of the clinical records for Patient #5 revealed that care was initiated on August 24, 2007. 64. The records did not contain evidence that the Patient/Representative was offered the option of nursing supervisory visits for the HHA at any time. 65. A review of the HHA care plan dated August 27, 2007, indicated that the HHA would monitor the Patient's vital signs one time per week and as needed. 11. 66. A review of the HHA visit notes revealed no evidence that the vital signs were ever monitored. 67. During an interview with the DON on August 14, 2008, at 3:30 p.m., these findings were confirmed. 68. | The Respondent’s act, omission or practice constituted an uncorrected class IIT deficiency. 69. Acclass III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 70. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 71. | The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT IV (Tag 304 The Respondent Failed To Obtain Complete Written Agreements With Patients In Violation Of F.S. 400.487(1) 72. The Agency re-alleges and incorporates by referenced paragraphs 1 through 5. 73. Under Florida law, services provided by a home health agency must be covered by an agreement between the home health agency and the patient or the patient's legal representative specifying the home health services to be provided, the rates or charges for services paid with private funds, and the sources of payment, which may include Medicare, Medicaid, private insurance, personal funds, or a combination thereof. A home health agency 12 providing skilled care must make an assessment of the patient's needs within 48 hours after the start of services. § 400.487(1), Fla. Stat. (2008). 74. On or about July 9-10, 2008, the Agency conducted a complaint survey of the Respondent (CCR 2008007671). During the survey, the Agency reviewed the Respondent’s records, observed practices and conditions and conducted interviews. , 75. Based upon interview and record review, the Respondent failed to provide a written agreement for care for 1 of 3 sampled patients (Patient #3). 76. A review of the Respondent’s records for Patient #3 did not reveal any evidence of an agreement signed by the Patient or Representative indicating the care to be provided and the Patient’s financial obligation. 77. During an interview with the DON on July 10, 2008, at 12:00 p.m., these findings were confirmed. . 78. The Respondent’s act, omission or practice constituted a class III deficiency. 79. Aclass III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 80. The Respondent was given a mandatory correction date of August 1, 2008. 81. On or about August 14, 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). 82. Based upon interview and record review, the Respondent failed to provide a completed written agreement for patients for 4 of 5 sampled patients (Patients #1, #2 #3 and #5). 83. A review of the clinical records for Patient #1 revealed an agreement with no listing of services to be provided. 84. A review of the clinical records for Patient #2 revealed an agreement with no 13 listing of services to be provided or the amount to be charged for services. 85. A review of the clinical records for Patient #3 revealed an agreement with no listing of services to be provided. 86. A review of the clinical records for Patient #5 revealed an agreement with no indication of the amount to be charged for services. 87. During an interview with the DON on August 14, 2008, at 3:00 p.m., these findings were confirmed. 88. The Respondent’s act, omission or practice constituted an uncorrected class III ’ deficiency. 89. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 90. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 91. The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT V (Tag 306) The Respondent Failed To Provide And Follow A Plan Of Care For All Patients In Violation Of F.S. 400.487(6) 92. The Agency re-alleges and incorporates by referenced paragraphs 1 through 5. 93. Under Florida law, the skilled care services provided by a home health agency, directly or under contract, must be supervised and coordinated in accordance with the plan of 14 care. § 400.487(6), Fla. Stat. (2008). 94. On or about July 9-10, 2008, the Agency conducted a complaint survey of the Respondent (CCR 2008007671). During the survey, the Agency reviewed the Respondent’s records, observed practices and conditions and conducted interviews. 95. Based upon interview and record review, the Respondent failed to provide a plan of care for skilled care provided for 2 of 3 sampled patients (Patients #2 and #3). 96. A review of the clinical records for Patients #2 and #3 did not reveal a plan of care, including a description of the skilled care that would be provided, or the frequency/interval that the care would be provided. 97. During an interview with the DON on July 10, 2008, at 12:00 p.m., these findings were confirmed. 98. The Respondent’s act, omission, or practice constituted a class III deficiency. 99. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 100. The Respondent was given a mandatory correction date of August 1, 2008. 101. On or about August 14, 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). 102. Based upon interview and record review, the Respondent failed to provide and follow a plan of care for 3 of 5 sampled patients (Patients #1, #2 and #3). 103. On August 14, 2008, a review of the clinical records for Patients #1 and #3 revealed no care plan. 104. On August 14, 2008, a review of the clinical records for Patient #2 revealed a start of care date of January 25, 2008. 15 105. The care plan was initiated at that time and was updated on February 15, 2008. 106. No further updates were found documented. 107. During an interview with the DON on August 14, 2008, at 3:00 p.m., these findings were confirmed. 108. The Respondent’s act, omission or practice constituted an uncorrected class III deficiency. 109. A class Ill deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 110. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 111. The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT VI (Tag 315) The Respondent’s Registered Nurses Failed To Ensure The Acceptance Of Patients For Service For Which Care Could Be Provided In A Safe And Timely Manner In Violation Of F.A.C. 59A-8.020() 112. The Agency re-alleges and.incorporates by referenced paragraphs 1 through 5. 113. Under Florida law, when a home health agency accepts a patient or client for service, there shall be a reasonable expectation that the services can be provided safely to the patient or client in his place of residence. This includes being able to communicate with the patient, or with another person designated by the patient, either through a staff person or 16 interpreter that speaks the same language, or through technology that translates so that the services can be provided. The responsibility of the agency is also to assure that the patient or client receives services as defined in a specific plan of care, for those patients receiving care under a physician, physician assistant, or advanced registered nurse practitioner’s treatment orders, or in a written agreement, as described in subsection (3) below, for clients receiving care without a physician, physician assistant, or advanced registered nurse practitioner’s orders. This responsibility includes assuring the patient receives all assigned visits. Fla, Admin. Code R. 59A-8.020(1). 114. On or about July 9-10, 2008, the Agency conducted a complaint survey of the Respondent (CCR 2008007671). During the survey, the Agency reviewed the Respondent’s records, observed practices and conditions and conducted interviews. 115, Based upon interview and record review, the Respondent failed to accept only patients for service with a reasonable expectation that the care would be provided in a safe and timely manner for 1 of 3 sampled patients (Patient #3). 116. A review of the clinical records for Patient #3 revealed an admission date of June 21, 2008. 117. The Patient stood 4 fect 11 inches tall and weighed 77 pounds. 118. The diagnoses for this Patient included extreme debilitation/malnutrition and uncontrolled atrial fibrillation. 119. The referral included skilled nursing and physical therapy. 120. On June 30, 2008, the physical therapist saw the Patient for the first time. 121. The follow-up request for additional visits, with a recommended frequency of two times per week for five weeks, was not faxed until July 7, 2008. 17 122. As of July 10, 2008, at 12:00 p.m., no approval had been received by the insurer. 123. During an interview with the DON on July 10, 2008, at 12:00 p.m., she stated, "We only have the one PT and he doesn't have time to see people all the time. We haven't had a chance to follow-up with the insurer for visit approval so we couldn't go out again." 124, The Respondent’s act, omission, or practice constituted a class III deficiency. 125. A class II] deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 126. The Respondent was given a mandatory correction date of August 1, 2008. 127. On or about August 14, 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). 128. Based upon interview and record review, the Respondent failed to ensure the acceptance of only patients for service for which care could be provided in a safe and timely manner for 1 of 5 sampled patients (Patient #1). 129. A review of the clinical records for Patient #1 revealed a physician's order dated July 22, 2008, for a start of care on that date, with an evaluation by a skilled nurse and a physical therapist. 130. The documentation revealed an admission date of July 23, 2008, with a visit by a skilled nurse. 131. The documentation indicated that the physical therapist evaluation did not occur until July 25, 2008. 132. The physical therapist’s evaluation recommended that two visits be provided the following week. 133. No further physical therapist visits were provided until August 8, 2008. 134. During an interview with the DON on August 14, 2008, at 1:00 p.m., she stated: "We have 2 new PT contracts. I don't know why no visits were made, but we're trying.” 135. The Respondent’s act, omission or practice constituted an uncorrected class III deficiency. 136. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 137. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 138. The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an ‘administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT VII (Tag 316 The Respondent’s Registered Nurses Failed To Complete Discharge Documentation For All Patients In Violation Of F.A.C. 59A-8.020(4) - 139. The Agency re-alleges and incorporates by referenced paragraphs 1 through 5. 140. Under Florida law, when the home health agency terminates services for a patient or client needing continuing home health care, as determined by the patient’s physician, physician assistant, or advanced registered nurse practitioner, for patients receiving care under a physician, physician assistant, or advanced registered nurse practitioner’s treatment order, or as determined by the client or caregiver, for clients receiving care without a physician, physician assistant, or advanced registered nurse practitioner’s treatment order, a plan must be developed and a referral made by home health agency staff to another home health agency or service 19 provider prior to termination. The patient or client must be notified in writing of the date of termination, the reason for termination, pursuant to Section 400.491, Florida Statutes, and the plan for continued services by the agency or service provider to which the patient or client has been referred, pursuant to Section 400.497(6), Florida Statutes. This requirement does not apply to patients paying through personal funds or private insurance who default on their contract through non-payment. The home health agency should provide social work assistance to patients to help them determine their eligibility for assistance from government funded programs if their private funds have been depleted or will be depleted. Fla. Admin. Code R. 59A-8.020(4). 141. On or about July 9-10, 2008, the Agency conducted a complaint survey of the Respondent (CCR 2008007671). During the survey, the Agency reviewed the Respondent’s records, observed practices and conditions and conducted interviews. 142. Based upon interview and record review, the Respondent failed to ensure that a patient needing continued home care was appropriately referred for further care after discharge for 1 of 3 sampled patients (Patient #2). 143. A review of the clinical records for Patient #2 revealed a start of care date of September 14, 2007. 144. The Patient’s care included assistance with activities of daily living to be provided by a HHA. 145. The last date of service documented was April 25, 2008. 146. During an interview with the DON, she stated: "That was the last date that the patient received care. I think [the Patient] went to another agency, but I don't have any kind of documentation regarding what happened.” 147, The Respondent’s act, omission, or practice constituted a class II deficiency. 20 148. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). . 149. The Respondent was given a mandatory correction date of August 1, 2008. 150. On or about August 14, 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). 151. Based upon interview and record review, the Respondent failed to complete discharge documentation for 1 of 5 sampled patients (Patient #3). 152. On August 13, 2008, at 1:45pm, the DON provided a list of active patients currently receiving care from the Respondent. 153. This list included Patient #3. 154. On August 14, 2008, review of the medical records for Patient #3 revealed that the last skilled nursing visit was provided on July 16, 2008. 155. On August 14, 2008, at 3:00 p.m., the DON stated: "I'm not sure if (Patient #3) is an active patient or not. [He or she] doesn't know how to conduct blood glucose testing, so [he or she] needs more visits.” 156. The Respondent’s act, omission or practice constituted an uncorrected class III deficiency. , 157. A class III deficiency is any, omission or practice had an indirect adverse effect ‘on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 158. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 159, The Respondent was given a mandatory correction date of September 5, 2008. 21 WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). COUNT VIM (Tag 375) The Respondent’s Registered Nurses Failed To Maintain An Accurate List Of It’s Patients For An Emergency Or Disaster Evacuation In Violation Of F.S. 400.492(2) 160. The Agency re-alleges and incorporates by referenced paragraphs 1 through 5. 161. Under Florida law, each home health agency shall maintain a current prioritized list of patients who need continued services during an emergency. The list shall indicate how services shall be continued in the event of an emergency or disaster for each patient and if the patient is to be transported to a special needs shelter, and shail indicate if the patient is receiving skilled nursing services and the patient's medication and equipment needs. The list shall be furnished to county health departments and to local emergency management agencies, upon request. § 400.492(2), Fla. Stat. (2008). 162. On or about July 9-10, 2008, the Agency conducted a complaint survey of the Respondent (CCR 2008007671). Duting the survey, the Agency reviewed the Respondent’s records, observed practices and conditions and conducted interviews. 163. Based upon interview and record review, the Respondent failed to prepare and maintain a comprehensive emergency management plan with a prioritized list of patients. 164, On July 10, 2008, at 11:00 a.m., a review of the Respondent’s records did not reveal a prioritized list of patient's emergency status category. 165. During an interview with the DON on July 10, 2008, at 12:30 p.m., she stated: "We do not have a record of an updated Comprehensive Emergency Management Plan. There 22 has been no one available to consistently update the patients.” 166. The Respondent’s act, omission, or practice constituted a class III deficiency. 167. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 168. The Respondent was given a mandatory correction date of August 1, 2008. 169. On or about August 14, 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). 170. Based upon interview and record review, the Respondent failed to maintain an accurate list of its patients for an emergency or disaster evacuation. 171. A list of active patients was requested on August 13, 2008, at 10:00. 172. A list was provided by the DON on August 13, 2008, at 1:45 p.m. This list included 20 patients. 173, Subsequent documentation revealed that the Respondent has 35 active patients. 174. An accurate/updated list was requested on August 13, 2008, at 2:40 p.m. 175. The DON provided a second version of the list on August 13, 2008, at 3:20 p.m. This list included 24 active patients. 176. An accurate list was again requested, along with a separate list of patients discharged within the last 30 days. 177. On August 14, 2008, at 9:30 a.m., these lists were not available. 178. On August 14, 2008, at 9:45 a.m., the DON provided a third version of the active patient, which failed to include sampled Patient #3. 179. On August 14, 2008, at 10:15 am., the DON provided a list of discharged patients. 23 180. The Respondent’s act, omission or practice constituted an uncorrected class III deficiency. 181. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 182. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). 183. The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). ’ COUNT IX (Tag 380) The Respondent’s Registered Nurses Failed To Maintain An Accurate List Of Medications For All Patients For Emergency Evacuation Purposes In Violation Of F.A.C. 59A-8.027(17) 184. The Agency re-alleges and incorporates by referenced paragraphs 1 through 5. 185. Under Florida law, the home health agency is required to maintain in the home of the special needs patient a list of patient-specific medications, supplies and equipment required for continuing care and service should the patient be evacuated. The list must include the names of all medications, their dose, frequency, route, time of day and any special considerations for administration. The list must also include any allergies; the name of the patient’s physician and the physician’s phone number(s); the name, phone number and address of the patient’s pharmacy. If the patient permits, the list can also include the patient’s diagnosis. Fla. Admin. Code R. 59A-8.027(17). 24 186. On or about July 9-10, 2008, the Agency conducted a complaint survey of the Respondent (CCR 2008007671). During the survey, the Agency reviewed the Respondent’s records, observed practices and conditions and conducted interviews. 187. Based upon interview and record review, the Respondent failed to maintain an accurate list of patient medications for emergency evacuation purposes for 3 of 3 sampled patients (Patients #1 - #3). 188. A review of the clinical records for Patients #1, #2 and #3 did not reveal an updated, accurate list of medications. 189. During an interview with the DON on July 1, 2008, at 12:30 p.m., these findings were confirmed. 190. The Respondent’s act, omission, or practice constituted a class III deficiency. 191. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008). 192. The Respondent was given a mandatory correction date of August 1, 2008. 193. On or about August 14, 2008, the Agency conducted a revisit to the complaint survey of the Respondent (CCR 2008007671). 194. Based upon interview and record review, the Respondent failed to maintain an accurate list of patient medications for emergency evacuation purposes for 2 of 5 sampled patients (Patients #3 and #5). 195. A review of the clinical records for Patients #3 and #5 did not reveal an updated, accurate list of medications, including the name, address and telephone number of the pharmacy. 196. During an interview with the DON on August 14, 2008, at 12:30 p.m., these findings were confirmed. 25 197, The Respondent’s act, omission or practice constituted an uncorrected class III deficiency. 198. A class III deficiency is any, omission or practice had an indirect adverse effect on the health, safety, or security of a patient. § 400.484(2)(c), Fla. Stat. (2008).. 199. Upon finding an uncorrected class III deficiency, the Agency may impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected deficiency exists. § 400.484(2)(c), Fla. Stat. (2008). . 200. The Respondent was given a mandatory correction date of September 5, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an administrative fine against the Respondent in the amount of five hundred dollars ($500.00). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully seeks an order that: 1. Makes findings of fact and conclusions of law in favor f gency. 2. Imposes an administrative fine against the Respénfeny/An/jhe amount of four thousand five hundred dollars ($4,500.00). Respectfully submitted on this 12th day of Nove Thomas M. Hoeler, Sentor Attorney Florida Bar No. 709311 Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 26 NOTICE The Respondent has the right to request a hearing to be conducted in accordance with Sections 120.569 and 120.57, Florida Statutes, and to be represented by counsel or other qualified representative. Specific options for the administrative action are set out within 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, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 922-5873. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights Form have been served to: Shelia Ramdhane, Administrator, Reliable Private Care, Inc., 775 South Kirkman Road, Suite 112, Orlando, Florida 32811, by U.S. Mail, and Norma Y. Hanson, Registered Agent, Reliable Private Care, Inc., 2089 Cabbage Palm Drive, Thomas M. Hoeler, Senier“Attorney Florida Bar No. 709311 Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 27 Copies furnished to: Thomas M. Hoeler, Senior Attorney Office of the General Counsel Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330 St. Petersburg, Florida 33701 Interoffice Mail) Joel Libby, Field Office Manager Agency for Health Care Administration Hurston South Tower - 400 West Robinson Street, Suite $309 Orlando, Florida 32801 -S. Mail Shelia Ramdhane, Administrator Reliable Private Care, Inc. 775 South Kirkman Road, Suite 112 Orlando, Florida 32811 (U.S. Mail) Norma Y. Hanson, Registered Agent Reliable Private Care, Inc. 2089 Cabbage Palm Drive Ocoee, Florida 34761 (U.S. Certified Mail) Thomas E. Pryor, Jr., Esquire Thomas E. Pryor, Jr., P.A. Post Office Box 2888 Orlando, Florida 32802 (U.S. Mail - Courtesy Copy) 28 U.S. Postal Service. TIFIED MAIL... RECEIPT rove if festic Mai! Only; No Insurance Covi For delivery info visit our at w OFFICIAL USE Norma Y. Hanson, Registered Tl Agent ‘semt% Reliable Private Care, Inc. wisat 2089 Cabbage Palm Drive Fir sa COLE, Florida 34761 7006 8500 O001 O4281 4574 2, e....4'3. Also complete. . if Restricted Delivery is desired. . @ Print your name and address on thé reverse : .. So that we can retum the card to you. - Attach this card to the back of the mailpiece, or on the front if space permits, "1, Atlole Addressed to: ‘1 Complete items 1, iter 4 If Norma Y. Hanso i Agent nt, Registered Reliable Private Care, Inc. 2089 Cabbage Palm Drive Ocoee, Florida 34761 3. Service Type : kContified Mail 1) Express Mall O Registered —_S8Retumn Receipt for Merchandise Oinsured Matt O01 6.00, am 7008 OSO0 COD) O42% 4576 TH 200PE1D 729 Eira PS Form 3811, February 2004 Domestic Return Receipt 102505-02M-1500 }

Docket for Case No: 08-006050