OX bOsU STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2008011347 v. Return Receipt Requested: 7002 2410 0001 4236 1711 WHITSYMS LIMITED INC. d/b/a 7002 2410 0001 4236 1728 WHITSYMS NURSING REGISTRY Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (hereinafter “AHCA” or the “Agency”) by and through the undersigned counsel, and files this administrative complaint against Whitsyms Limited Inc. d/b/a Whitsyms Nursing Registry (hereinafter “Whitsyms Nursing Registry”) pursuant to 28-106.111, Florida Administration Code (2007) and Chapter 120, Florida Statutes (2007), and alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine in the amount of $1,000.00 pursuant to Sections 400.484, 400.506, Florida Statutes and Rule 59A-18, Florida Administrative Code. JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57, Florida Statutes and Chapter 28-106, Florida Administrative Code. 3. Venue lies in Palm Beach County pursuant to 120.57, Florida Statutes (2007) and Chapter 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the enforcing authority with regard to nurse vegistries pursuant to Chapter 400, Part III, Florida Statutes (2007) and Rule 59A-18, Florida Administrative Code. 5. Whitsyms Nursing Registry is a nurse registry agency iocated at 2605 W. Atlantic Avenue, Suite 1018-103B, Delray Beach, Florida 33445 and is licensed under number 32010978. Whitsyms Nursing Registry 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. ho COUNT I WHITSYMS NURSING REGISTRY FAILED TO PROVIDE CONTRACTORS CAPABLE OF DELIVERING SERVICES. RULE 59A-18.010(2), FLORIDA ADMINISTRATIVE CODE (ACCEPTANCE OF PATIENTS STANDARD) CLASS IIT 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Whitsyms Nursing Registry was cited with one (1) Class Til ceficiency as a result of complaint investigation surveys conducted on August 26, 2008 and February 27, 2008. 8. A complaint investigation survey was conducted on February 27, 2008. Based on record review and interview, it was determined that the Nurse Registry failed to provide contractors capable of delivering services for i of 5 sampled patients (Patient #1) as requested by the patient and or family representative. The findings include the following. 9. During a review of Patient #1's clinical record, an activity note dated 8/27/07, documented that the patient needs a live-in driver with a car. Continued review revealed that the start of care date was 8/29/07. An activity note dated 8/28/07, documented, "Once Alzheimer's DX (Diagnosis) come into play WNR (Whitsyms Nurse Registry?) cannot let him/her sign anything. Is family member willing to sign documents?" Further review rosy revealed weekly work log/time sheets beginning 8/29/07, at 9:00 AM through 9/12/07 at 6:30 PM documenting the caregiver as a live-in aide. 10. A review of Patient #1's clinical record revealed an e-mail dated 9/25/07, regarding a conversation that occurred between the Nurse Registry's coordinator and Patient #1's, family member on 8/24/07. The family member stated they would need someone to drive the patient around because he/she was legally blind and did not have a car. The coordinator's response "I told...(family member) that our aides are independent contractors and because of that we are not legally able to ask them about their insurance coverage on the vehicles. I told...{family member) that it happens, and our aides do drive patients in the car however we cannot be held accountable for that." E-mail also stated the family member had contacted the agency several times expressing concerns with the wording of the contract and the aide transporting Patient #1. lil. Agency spoke with the family, date unknown, "IT explained to...(family member) that we are able to provide him an aide with a car that drives, but that we could not be held liable if anything happens." 12. A nursing evaluation dated 9/3/07, revealed a diagnosis of Alzheimer's, and Hypertension. An activity note dated 9/6/07, documented the family members refusal to sign any documents making the family member liable for payment, and informed the nurse registry of the physicians notification to the family of mild cognitive impairment. This was to be followed up and confirmed by the nurse registry. 13. Activity note dated 9/10/07, documented the nurse registry's agreement to waive the security deposit and the time and a half rate for holidays. Activity note dated 9/11/07, documented the patients refusal to sign the documents until it was amended. As a result, the nurse registry gave 24 hour notice to the patient/family representative to terminate services. 14. A review of the billing statements from 8/29/07 through 9/12/07 revealed the insurance company and Patient #1, were being charged for the services of a live in aide. The agency was receiving payment from Patient #1, but not their insurance. Further review of the record revealed an activity note dated 9/17/07 documenting that on 9/25/07 the nurse registry had received Patient #1's signed plan of treatment for 8/29/07-10/29/07, a physician's signature is required by the insurance company before payment is made. 15. During an interview on 2/26/08 at 11:15 AM with the Alternate Administrator, it was stated that the nurse registry does not have a contract with Patient #1, because the family member refused to sign it. It was confirmed that the start of care date for Patient #1 was 8/29/07, and the live in aide wag contracted for 15 days. During an interview on 2/26/08, at 12:15 PM, with the Service coordinator, it was stated that the contract agreement made with the family was for a live in aide with a car that can run errands for the patient but is not allowed to transport them in the aide's car due to liability issues. 16. During an interview on 2/26/08 at 12:45 PM with the Service coordinator, it was stated that the family member would not sign the contract because they wanted a caregiver who could transport Patient #1, in their car. The nurse registry agreed to provide contracted services to Patient #1, without a signed contract knowing the patient had a diagnosis to include Alzheimer's, did not have a personal vehicle, and the family wanted an aide with a car to transport Patient #1 on errands and to appointments. 17. The mandated date of correction was designated as March 23, 2008. 18. A follow-up survey was conducted on August 26, 2008. Based on record review and interview, it was determined that the Nurse Registry failed to provide independent contractors capable of delivering services as defined in a specific medical plan of treatment for a patient or services requested by a client, including all visits, for 5 of 7 sampled patients. (Patient #1, #3, #4, #5, and #6).The findings include the following. 19. A review of Patient #1's clinical record revealed the start of care date was 05/20/08. Further review of the record revealed a "Plan of Treatment" dated 05/21/08 signed by the patient's physician with diagnoses to include Spinal Stenosis and Macular Degeneration with the caregiver to assist in Activities of Daily Living (ADL) needs to include, transfer, safety, bathing, toileting, dressing, ambulation and medication assistance. 20. Further review revealed documentation of Registered Nurse visits prn (as needed) and a. HHA (Home Health Aide) /CNA(Certified Nurse Assistant) caregiver to provide personal care 10 hours a day 7 days a week. A review of the care giver's time sheets revealed the HHA/CNA was working from 05/20/08-06/12/08, 10 hours a day, 7 days a week; 06/13/08- 08/09/08, 13 hours a day 7 days a week. Beginning 08/10/08- 08/26/08, documentation revealed that the caregiver was working 13 hours a day, 5 days a week. There is no evidence of documentation in the clinical record of the reasons for the change to the provision of the care initially requested in the Plan of Treatment. 21. A review of Patient #3's clinical record revealed the start of care date was 04/18/08. Further review of the record revealed a "Plan of Treatment" dated 04/18/08 signed by a Registered Nurse, with diagnoses to include Parkinson Disease, Functional Decline, Macular Degeneration and High Fall Risk with the caregiver to assist in ADL needs to include transfer, safety, bathing, toileting, dressing, and ambulation. 22. Further review revealed documentation of Registered Nurse visits prn and a HHA/CNA to provide personal care 10 hours a day 7 days a week. A review of the care giver's time sheets revealed the HHA/CNA was working from 04/19/08-04/27/08, 10 hours a day 7 days a week; 04/28/08-05/30/08, 10 hours a day 5 days a week; 06/01/08-06/25/08, 10 hours a day 7 days a week. There was no evidence of documentation of time sheets documenting a HHA/CNA in the home from 06/26/08-07/27/08. There was no evidence of documentation in the record related to this stoppage of care. Beginning 07/28/08-08/24/08, documentation revealed the HHA/CNA was working 5 hour days, 5 days a week. There was no evidence of documentation, in the clinical record, of the reasons for the change to the provision of the care initially requested in the Plan of Treatment. 23. A review of Patient #4's clinical record revealed the start of care date was 04/18/08. Further review of the record revealed a "Plan of Treatment" dated 04/28/08 signed by the patient’s physician with diagnoses to include Spinal Stenosis, Rotator Cuff Injury, and Macular Degeneration with the caregiver to assist in ADL needs to include transfer, safety, bathing, toileting, dressing, and ambulation. FPurther review revealed documentation of Registered Nurse visits prn and a HHA/CNA to provide personal care & hours a day 7 days a week. A review of the caregiver's time sheets revealed the HHA/CNA was working from 04/28/08-08/16/08, 8 hours a day 6 days a week. There was no evidence of documentation in the clinical record of the reasons for the change to the provision of the care initially requested in the Plan of Treatment. 24. A review of patient #5's clinical record revealed the start of care date was 6/13/08. Further review of the record revealed a "Plan of Treatment" dated 06/16/08 signed by the patient's physician with diagnoses to include C-Difft (Clostridium difficile Bacteria), MRSA (Methicillin-resistant Staphylococcus aureus Bacteria), UTI (Urinary Tract Infection) and Tremors with the caregiver to assist in ADL needs to include transfer, safety, bathing, toileting, dressing, and ambulation and medication management. Further review revealed documentation of Registered Nurse visits prn and a HHA /CNA to provide personal care 10 hours a day 7 days a week. A review of the caregiver's time sheets revealed the HHA/CNA was working 12 hours a day 6 days a week. There was no evidence of documentation in the clinical record of the reasons for the change in the provision of the care initially requested in the Plan of Treatment. 25. A review of Patient #6's clinical record revealed the patient received servi from 09/27/07-05/02/08. A review of the record revealed a "Plan of Treatment" dated 07/03/07, signed by the patients physician, with a diagnosis to include Melanoma, COPD (Chronic Obstructive Pulmonary Disease and HTN (Hypertension) with the caregiver to assist in ADL needs to include transfer, safety, bathing, toileting, dressing, and ambulation. Further review revealed documentation of Registered Nurse visits prn and a HHA /CNA to provide personal care 6.5 hours a day 7 days a week. A review of the caregiver's time sheets from 04/07/08 through 04/28/08 revealed the HHA/CNA was working 7 hours a day 5 days a week. There was no evidence of documentation, in the clinical record of the reasons for the change related in the provision of the care initially requested in the Plan of Treatment. 26. During an interview on 08/26/08 at 1:10 PM with the Alternate Administrator to review the patient's clinical records, it was acknowledged that the records did not contain any notes from the caregiver related to the change in hours and days. It was unable to be determined if the caregiver did not show up to the patient's home on those days or the agreement was changed. The Alternate Administrator stated during the interview, "I do not know if the caregiver and patients change the time and day. The contract is between them. If they do not 10 communicate back to me, the registry (Nurse Registry) does not know. We are not responsible." This is an uncorrected deficiency from the survey of February 27, 2008. 27. Based on the foregoing, Whitsyms Nursing Registry violated Rule 59A-18.005, Florida Administrative Code, herein classified as an uncorrected Class III deficiency, which warrants an assessed fine of $1,000.00. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. Enter a recommended order in favor of the Agency for Health Care Administration against Whitsyms Nursing Registry on Count I. 2. Assess an administrative fine of $1,000.00 against Whitsyms Nursing Registry on Count I for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. 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 (2007). 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 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER Qbbas : a jf ple Fades gett 7 Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration : 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 Home Care Unit 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 Donovan Anderson, Administrator, Whitsyms Nursing Registry, 2605 W. Atlantic Avenue, Suite 101B-103B, Delray Beach, Florida 33445; Donovan Anderson, Registered Agent, 11890 Windmill Lake Drive, Boynton Beach, Florida 33473 on this 7°" day of November, 2008. fit M. bas 1. Boca, ‘WS: Postal Services CERTIFIED MAIL. RE SENDER: compere THis SECTION COMPLETE THIS SECTION ON DELIVERY (CLITA SHI aieUlcic-a lm Complete items 1, 2, and 3. Also complete ay For delivery information. visit our website item 4 if Restricted Delivery is desired. “\ im] ‘cressoe @ 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. B. Reseited by (Printed Name) C. Date of Delivery PROSE TIO U-1LO-O8 D. Is delivery address different from item 1? C1 Yes If YES, enter delivery address below: CNo OFFICIAL : 1. Article Addressed to: Dower Pindaaaow - Uahaigr aang Maan Ales (o- Glam, Cuenas Quite IAD 103-0 Cl insured Mail 0 C.0.D. Data) Dracr, Fimise 23444 4 Becticted Delivery? (Extra Fee) 0 Yes Eimer 7002 2410 OOOL 423b 1?i1 Tob OU Sevens (Transfer from service label) 5 . . 10259! -1540 PS Form 3811, February 2004 Domestic Return Receipt (EL nen Con py Certified Fee Return Reciept Fee (Endorsement Required) Restricted Delivery Fee {Endorsement Required) 3. Service Type (Cl Certified Mail 1 Express Mail DD Registered ( Return Receipt for Merchandise Total Postage & Fees 7002 2410 OOO) 4¥23b L711

Docket for Case No: 08-006054