JUN-@4-2889 Jun 4 2009 11:21 12:33 AGENCY HEALTH CARE ADMIN STATE OF FLORIDA AGENCY POR HEALTH CARR ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitloner, Case No.; 2009002309 Vi. ACE HOMECARE LLC, d/b/a ACE HOMECARE, Respondent, ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against, Ace Homecare LLC d/t/a Ace Homecare, (hereinafter "Respondent") and alleges: NA’ THE This is an action to impose a fine in the amount of five thousand dollats ($5,000.00) Purguani to Sections 400.474 Florida Statutes (2008) Florida Administrative Code for one patterned deficiency. ICTIO Vv 1. The Agency has jurisdiction over the Respondent pursuant to Chapters 400, Part I, and 408, Part IL, Florida Statutes, (2008). 2. Venue lies pursuant to 120.57, Florida Statutes (2008), and Chapter 28, Florida Adminisirative Cade (2008). EXHIBIT 856 921 4158 Jun 4 2009 11:21 JUN-@4-2889 12:34 AGENCY HEALTH CARE ADMIN 856 921 4158 P.14 ARTIES 3. The Agency is the licensing and enforcing authority with regard to Home Health Agencies pursuant to Chapters 400, Part III, and 408, Part II, Florida Statutes (2008) and Chapter 594-8, Florida Administrative Code. 4, Respondent is a Home Health Agency located at 10707 66" Street North, Pinellas Park, Florida, 33782, having been issued license number 299992351. 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I 6. The Agency re-alleges and incorporates (1) through (5) as if fully set forth herein. 7. That pursuant to Florida law, when nursing services are ordered, the home health agency to which a patient has been admitted for care must provide the initial admission visit, all service evaluation visits, and the discharge visit by a direct employee. Services provided by others under contractual arrangements to a home health agency must be monitored and managed by the admitting home health agency. The admitting home health agency is fully responsible for ensuring that all care provided through its employees or contract staff is delivered in accordance with this part and applicable rules... 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 care, Section 400.487(5) and (6), Florida Statutes (2008). 8. That pursuant to 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 interpreter that speaks the same language, or through technology that translates so that the 00 2 Jun 4 2009 11:21 JUN-@4-2889 12:34 AGENCY HEALTH CARE ADMIN 856 921 4158 P.is 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. Rule 59A-8.020(1), Florida Administrative Code, 9. That pursuant to Florida law, the agency shall impose a fine of $5,000 against a home health agency that demonstrates a pattern of failing to provide a service specified in the home health agency's written agreement with a patient or the patient's legal representative, or the plan of care for that patient, unless a reduction in service is mandated by Medicare, Medicaid, or a state program or as provided in s, 400,492(3). A pattern may be demonstrated by a showing of at least three incidences, regardless of the patient or service, where the home health agency did not provide a service specified in a written agreement or plan of cave during a 3-month period. The agency shall impose the fine for each occurrence. The agency may also impose additional administrative fines under s. 400.484 for the direct or indirect harm to a patient, or deny, revoke, _ or suspend the license of the home health agency for a pattern of failing to provide a service specified in the home health agency's written agreement with a patient or the plan of care for that patient. Section 400.474(5), Florida Statutes (2008). 10, That the Petitioner completed a Recertification and Licensure Survey of the Respondent on January 29, 2009. 11, That based upon the review of records and interview, Respondent failed to ensure that seven (7) physician ordered physical therapy visits were conducted over a period of Jess than two (2) calendar months and failed to notify the patient’s physician of the same, such omissions oan Jun 4 2009 11:22 JUN-@4-2889 12:34 AGENCY HEALTH CARE ADMIN 856 921 @158 P.i6 constituting a pattern of deficient practice and contrary to the requirements of law. 12. That Petitioner’s representative reviewed Respondent’s records regarding patient number fourteen (14) during the survey and noted as follows: a. The patient was admitted to services with a start of care date of December 2, 2008; b. Services included: i. Skilled nursing two (2) times a week for two (2) weeks, then one (1) time a week for one (1) week; ii, Physical therapy to evaluate and treat with orders to follow; iii. Occupational therapy to evaluate and treat with orders to follow; c. After the initial ordered physical therapy evaluation, the patient was ordered to receive physical therapy three (3) times per week; d. Physical therapy notes reflect that seven (7) scheduled physical therapy visits were missed: December 3, 12, 24, 26 2008 and January 2, 7,and 14, 2009; e. These visits, some of which were annotated for the stated reason the visit was missed, were not rescheduled to meet the ordered frequency of visits; f. Absent from the records was any indication that the patient’s physician had been notified that ordered physical therapy was missed; g. Absent from the records was any indication that the ordered occupational therapy evaluation had been conducted. 13. That Petitioner’s representative interviewed Respondent’s Director of Nursing during the survey who indicated as follows: a. There was no documentation in the records of patient number fourteen (14) which would indicate that the patient’s physician had been notified of the missed 0 4 Jun 4 2009 11:22 JUN-@4-2089 12:35 AGENCY HEALTH CARE ADMIN 856 921 4158 P.1? physical therapy visits; b. There was no documentation to indicate that the ordered occupational therapy had been conducted; 14. That the physical therapist who was responsible for coordinating services was contacted on January 28, 2008 by Respondent’s Director of Nursing who indicated that patient number fourteen (14) had, on December 5, 2008, requested that occupational therapy not be provided, and that the physical therapist had called the information to the physician and Respondent’s offices. , 15. That a late entry Care Note of January 28, 2008 documented that the physical therapist who was responsible for coordinating services indicated that patient number fourteen (14) had, on December 5, 2008, requested that occupational therapy not be provided, and that the physical therapist had called the information to the physician and Respondent's offices. 16. That the above reflects Respondent’s failure to provide ordered services to patient number fourteen (14), the same being contrary to law. 17. That 2 pattern of non-compliance occurs when there exist at least three incidences, regardless of the patient or service, where the home health agency did not provide a service specified in a written agreement or plan of care during a 3-month period. See, Section 400.474(5), Florida Statutes (2008). 18. ‘That the failure to provide seven (7) ordered physical therapy visits for patient number fourteen constitutes seven (7) incidences where a service ordered for the patient was not provided within a period of less than two (2) calendar months, 19. That the Agency shall impose a fine of five thousand dollars ($5,000.00) for such a violation. Section 400.474(5), Florida Statutes (2008). Jun 4 2009 11:22 JUN-@4-2889 12:35 AGENCY HEALTH CARE ADMIN 856 921 @158 P.i8 WHEREFORE, the Agency intends to impose a fine in the amount of five thousand dollars ($5,000) for the above recited deficient practice as authorized under Section 400.474, Florida Statutes (2008). Respectfully submitted this Z 4 day of April, 2009. . Walsh, II, Esq. Fla. Bar, No. 566365 Counsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 (office) 727.552.1440 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent 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 to the Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 5489 on April 2, 2009 to Constance A. Miller, Administrator, ACE Homecare, 10707 66" Street North, Pinellas Park, Florida, 33782 and by Regular U.S. Mail to Arthur Barlaan, Registered Agent, 3506 Country Creek Lane, Valrico, FL 33596. Ish IE, Esquire JUN-@4-2089 12:35 Copies furnished to: Constance A, Miller, Administrator ACE Homecare 10707 66” Street North Pinellas Park, Florida, 33782 (U.S. Certified Mail) Patricia R. Caufiman Field Office Manager 525 Mirror Lake Drive, 4" Floor St. Petersburg, Florida 3370] (Interoffice) AGENCY HEALTH CARE ADMIN Jun 4 2009 11:23 Arthur Barlaan, Registered Agent For ACE Homecare LLC 3506 Country Creek Lane Valrico, FL 33596 (U.S. Mail) Thomas J. Walsh I, Esquire Agency for Health Care Admin. $25 Mirror Lake Drive, #330G St. Petersburg, FL 33701 (Interoffice Mail) 856 921 4158 P.1i9 Jun 4 2009 11:23 JUN-@4-2089 12°36 AGENCY HEALTH CARE ADMIN 856 921 4158 P.28 SENDER: CompbLey " fom 4 RoeblowApewvey a desea livery Ia desired, @ Print your name and eddreee on the reverse 80 thatyve can return the card to you. © Atta card to the back of the mailplece, oren nt if space permits. 1. Arttele fildrmased to: HIS SECTION D. la dolivery addrmxa different from item 172 Yea It'YES, enter delivery address balow: ai Constigice A. Milles, Admin. ACE Hgmecare 10707 66” Street North . P, ida, 33782 4. Service Type Pinellas ark, Florids, AdConifed Mal C1 Expose Mall OC) Registered «= 22K Getum Reosipt for Merchandise Clinued Mai O1G.0.0. “2004 2840 Dono s5au 54yaq 7H/ROOSCOZFOF PS Form 3811, February 2004 Domeatic etum Recelpt 102855-02-4-1540 Jun 4 2009 11:23 JUN-@4-2889 12:36 AGENCY HEALTH CARE ADMIN 856 921 @158 P.2i RARE WE PRU AGENCY FOR HEALTH CARE ADMINISTRATION RE: ACE HOMECARE, LLC CASE NO: 2009002309 Pi eo d/b/a ACE HOMECARE ANCA AGENCY CLERK ELECTION OF RIGHTS - 01 MAY 21 A Ll 25 This Election of Righty (orm is attached to a proposed action by the Agency for Health Care Administration (AHCA), The title may be an Administrative Complaint, Notice of Intent to Impose a Late Kee, or Notice of Intent to Impose 2 Late Finn. Hyour Election of Rights with your elected Option is not received by AHCA within twemy-one (21) days from the date you recived this notice of proposed action by AHCA, you will have given up your right tp contest the Agency's proposed action ard a Foual Order will be issuced. Ploase age this form unless you, your storey or your representizive prefer to reply in accordance with Chapter! 20, Florida Statutes (2008) and Rule 28, Florida Administrative Code. PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Deive, Mail Stop #3 Tallahassee, Florida 32308 Phone: 850-922-5873 Fax: 950-921-0158 PLEASE SELECT ONLY | OF THESE 3 OPTIONS OPTION ONE (1) audit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. | understind that by giving up my right to a hearing, a Final Order ‘will be issued that adopts the proposed agency action and fpases the penalty, finc or action. OPTION TWO (2) _____L_ admit the allegations of fact and luw contained in the Notice of Totent to impose a Late Fine or Fee, or Adwiaistrative Complaint, bot I wish to be heard at an informal proceeding (putruant to Section 120.57(2), Florida Stautes) where [ may submit testimony aod written evidence to the Agency to show that the proposed administrative action ia tno severe or that the fine should be reduced. OPTION THREE (3) x4 __ [ dispnte the allegations of fact and law contained in the Notice of Intent to Cerpose a Late Fee, the Notice of Iotent to Impose a Late Fine, or Administrative Complaint, and I requcst 9 formal bearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. Jun 4 2009 11:24 JUN-@4-2089 12:46 AGENCY HEALTH CARE ADMIN 856 921 @158 P22 BLEASE NOTE: Choosing OFTION THREE (3) by itself is NOT sufficient to obtain 2 formal bearing. You also must file a written petition in order to ebtain a formal bearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes, Jt must be received by the Agency Clerk at the address above within 21. days of your receipt of this proposed administrative action, The request for foonal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it comtair: 1. ‘Your anme, address, telephone number, and the name, address, and telephonic mumber of YoU tepresentative or lawyer, if any. 2. The file number of the proposed action, 3. A statement of when you received notice of the Agency’s proposed action. 4. A Staiament of all disputed issues of material fact. [f there are none, you rust state that there are none. Mediation under Section 120.573, Florida Statutes may be available in this mailer if the Agency AgTCES, License Type: Home Health (Assisted Living Facility, Nursing Home, Medical Equipment, Onher) Licensee Name: Ace Homecare ___,_License Number: 299992361 Contact Person: Cynthia Mikos Attomey Name Title Address; Allen Dell PA 202 &. Rome Ave Suite 100 Tampa FL 33606 Street and Number City State Zip Code Telephone No, (B13) 223-5351 Fax No. (613) 229-6682 E-Mail (optional) Thereby certify Ghat | am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the above licensee. sete SRP EA Date: sleol6 4 Print Name:__Jocelyn Barlaan Tite: CEO TOTAL FP. 22

Docket for Case No: 09-003025