STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

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i STATE OF FLORJDA, AGENCY FOR

:

·! HEALTH CARE ADMINISTRATION,

Petitioner,

vs. Case No. 2011010730

RECOVER.YHOME CARE SERVICES, INC.,

Respondent.

ADMINISTRATIVE COMPLAINT

COMESNOW the Petitioner, State of Florida, Agency For Health. Care Administration (hereimifter ''the A e;ncy"), by and through its undersigned counsel, and files this Administrative

ComplaintagainWJhe Respondent, RECOVERY HOME CARE SER.VICJ;S; INC. (hereinafter "the Respondent );.pmsuantto Seqtions 120.569 and 120.57, Florida Statutes (2011), and alleges

1 · as follows:

NATURE OF THE ACTION

This i8: afiaction to impose an administrative fine against a home_ he lth agency in the

. amount of ONJITHOUSAND DOLLARS .($ 1,000.00} pursuant .to Sections·. 400.474 and

400.484(2)(c), FloridaStatutes (2011), based upon one (1) uncorrected Class Ill deficiency.

JURISDICTION AND VENUE

1. This Court has jurisdiction over the subject matter pursuant to Sections 120.5(>9 and 120.57, Florida Statutes (2011).

1. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, Florida Statutes (2011); Chapters 408, Part II, and 400, Part III, Florida Statutes (2011), and Chapter59A-8, Florida Administrative Code.

   
   

   Filed May 18, 2012 11:08 AM Division of Administrative Hearings

   
   

2. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code.

   
   

   PARTIES

3. The Agency is the licensing and regulatory authority that oversees home health agencies in Florida and is responsible for the enforcement of the applicable state regulations,

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   I statutes and rules governing home health agencies pursuant to Chapter 408, Part II, and Chapter

   I 400, Part III, Florida Statutes (2011), 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 (2011), and Rules 59A-8.003 and 59A-8.0086, Florida Administrative Code.

4. The Respondent was issued a license by the Agency to operate a home health agency in Florida (License Number 299991723) located at 5585 Marquesas Circle, Sarasota, Florida 34233, and was at all material times required to comply with the applicable state regulations, statutes and rules governing home health agencies.

   COUNTI

   The Respondent Failed To Ensure That The Skilled Nurse Provided Adequate Medication Safety In Violation Of Rule 59A-8.0095(3)(a), Florida Administrative Code

   
   

5. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5).

6. Pursuant to Florida law, a registered nurse shall be currently licensed in the state, pursuant to Chapter 464, Florida Statutes (2011), and be the case manager in all cases involving nursing or both nursing and therapy care. Be responsible for the clinical record for each patient receiving nursing care; and assure that progress reports are made to the physician for patients receiving nursing services when the patient's condition changes or there are deviations from the plan of care. Rule 59A-8.0095(3)(a), Florida Administrative Code.

7. On or about July 25, 2011 through July 28, 2011, the Agency conducted a

   
   

   Relicensure Survey of the Respondent's Facility.

   
   

8. Based on clinical record review, observation during home visit and staff

   i interview, the home health agency failed to ensure each Registered Nurse coordinated the care of·

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   ' two (2) of twelve (12) sampled patients, specifically Patient number eight (8) and Patient numb.er

   eleven (11), to ensure care and services were provided in accordance with the Plan of Care.

   
   

9. Patient number eight (8) was recertified for care on June 1, 2011 and received the services of a Psychiatric Nurse for depressive disorders. A review of the Home Health Certification and Plan of Care dated June 1, 2011 through July 30, 2011 documented specific orders for the skilled nurse to evaluate and to establish a plan addressing depression. The Registered Nurse was to assess effectiveness of medication regimen and medication compliance.

IL A review of the Behavioral Health clinical visit notes, from June I, 2011 through July 13, 2011 revealed Patient number eight (8) remained depressed. The notes for June 8,2011, June18,201I; June 22,201I; July 6, 2011 and July 13,2011 did not contain documentation of the effectiveness of the medications. A review of the Home Health Certification and Plan of Care, for June 1, 2011 through July 13, 2011 revealed the medication regimen for Patient number eight (8) included the use ofWellbutrin SR 100 milligrams (mg) in the morning. Wellbutrin is an antidepressant.

1. On July 27, 2011 at 11:00 a.m., a visit was made to Patient number eight's (8) home. Areview of Patient number eight's (8) medications revealed on June 9, 2011, Patient number eight (8) started taking Buspar SR 100 mg daily (antidepressant). Patient number eight

   (8) reported he/she was taking each medication as per the physician's order and the label on the bottle. The medications at the patient's home did not include Wellbutrin SR.

2. An interview on July 28, 2011 during the home visit with the Licensed Nurse revealed she was not aware of this change in the antidepressant medications. The psychiatric

   
   

   nurse revealed Patient number eight (8) had a private nurse who managed her medications and

   
   

   fills his/ her weekly pill box. The Licensed nurse stated she would have to call the physician and

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   i verify the medications. The clinical record did not contain documentation at the time of the

   survey the home health agency coordinated the care of Patient number eight (8) with the private nurse to ensure all medication changes were immediately reported to assess for effectiveness, possible side effects and drug interactions.

3. Patient number eleven (11) was admitted to the home health agency on May 14, 2011 and recertified for care on July 8, ZOil. Areview of the clinical record on July 27, 2011 documented the skilled nurse made a visit to Patient number eleven's (11) home on July 18, 2011. The skilled nurse documented Patient number eleven (11) had numerous skin tears to the right and left arm, right lower leg and left ankle. The nurse indicated in her note she treated all wounds with viscopaste and kling. Under the section communicated with physician she checked "Yes" and wrote: "New orders for Coumadin, MD to patient." The clinical record did not contain documentation the skilled nurse informed the physician of the multiple skin tears. The clinical record did not contain documentation the physician ordered the treatment to the skin tears applied by the skilled nurse,

4. An interview on July 28, 2011, at 10:20 a.m. with the Director of Nursing

   
   

   confirmed the findings.

   
   

5. 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 (2011),

6. The Agency cited the Respondent for a Class III violation in accordance with Section 400.184(2)(c), Florida Statutes (2011).

7. The Agency provided the Respondent with a mandatory correction date of August

   
   

   28, 2011.

   
   

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   I 19. On or about September 7, 2011 through September 8, 2011, the Agency

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   conducted a Follow-Up Survey of the Relicensure Survey of July 25, 2011 through July 28, 2011

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   of the Respondent's facility.

   
   

   1. Based on observation, clinical record review, and patient and staff interview, the skilled nurse responsible for the clinical record of the patient failed to promote adequate medication safety for one (1) of two (2) sampled patients for home visit, specifically Patient

      .· number one(!).

      
      

   2. A review of the clinical record for Patient number one (!) revealed a sixty (60)

. day summary dated September 4, 2011. The summary indicated Patient number one (I) was a pleas!1!1tly confused female. The diagnoses included Diabetes Mellitus type 2, hypertension,

• atrial fibrillation and macular degeneration. The summary indicat!ld Patient number one (1) was instructed and encouraged to use medication boxes and continued with this practice. Patient

• number one (I) was recertified for continued management of diabetes, atrial fibrillation as well

· •·. asmedication management.

· 22. A review of the Recertification assessment dated September 5, 2011 revealed Patient number one (1) was alert and oriented to person, place and time. The skilled nurse documented Patient number one (1) reported he/she took his/her entire weeks' worth of C:oumadin and had no idea why he/she did this. The Licensed Nurse documented she immediately contacted the physician. The physician issued an order to hold the Coumadin, 11dminister 5 milligrams of Vitamin K and perform daily PT and INR (Prothrombin time and International Normalized Ratio). On September 5, 2011, the INR was 5.0.

1. On September 8, 2011 at 9:30 a.m., a home visit was made to Patient number one's (1) home with the Licensed Nurse. The International Normalized Ratio was 2.8. During the

   
   

   
   

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   home visit, Patient number one (I) was interviewed and stated he/she did take more Coumadin than what he/she normally takes but was not sure how much of the Coumadin he/she had taken. Patient number one (I) stated he/she reported it to the Licensed Nurse due to the potential for bleeding.

2. An observation of the dining room table revealed Patient number one's (I) medications were kept on the table, including a bottle of Coumadin which contained two (2) pills and was placed upside down on the table. Patient number one (I) stated the bottle was turned upside down to remind him/her not to take anymore Coumadin and Patient number one's (!) grandson was helping with Patient number one's(!) medications and a pill box. At the time of the survey, the grandson was not present and the medications were left unsupervised.

2.5. On September 7, 2011 at 12:50 p.m., an interview was held with the skilled nurse.

The skilled nurse stated Patient number one (I) is very forgetful and was not able to explain why he/she took mor!l Coumadin than usual. The.skilled nurse added although she spoke to Patient number one's (I) grandson about managing the medications, she did not follow up to ensure steps were taken at Patient number one's(!) home to prevent further dosage error.

1. 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 (2011).

2. The Respondent's deficient act, omission or practice constitutes an uncorrected Class III deficiency. Section 400.484(2)(c), Florida Statutes (2011).

3. Upon finding an uncorrected or repeated Class III deficiency, the agency shall impose an administrative fine not to exceed $1,000 for each occurrence and each day that the uncorrected or repeated deficiency exists pursuant to Section 400.484(2)(c), Florida Statutes (2011).

   
   

4. The Agency provided the Respondent with a mandatory correction date of

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I October 8, 2011.

WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE

THOUSAND DOLLARS ($1,000.00) based upon one (I) occurrence ofan uncorrected Class III deficiency pursuant to Sections 400.474 and 400.484(2)(c), Florida Statutes (2011).

CLAIM FOR RELIEF

WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief against the Respondent:

I. Make firidings offact and conclusions of law in favor of the Agency.

1. Impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00),

2. Enter any other relief that this court deems just and appropriate.

   
   

   Respectfully submitted this ()._ ay        of    ,rA'-'-1\'f-'C,_,   ...,\' '2012.

   
   

   Andrea M. Lang, Assistant General Coun 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) 335-1253

   
   

   NOTICE

   
   

   THE RESPONDENT IS NOTIFIED THAT IT HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, OF THE FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT 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 FORM.

   
   

   THE RESPONDENT IS FURTHER NOTIFIED IF THE ELECTION OF RIGHTS FORM IS NOT RECEIVED BY TJIE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINALORDERWILL BE ENTERED.

   
   

   THE ELECTION OF RIGHTS FORM SHALL BE MADE TO THE AGENCY FOR HEALTH CARE ADl\llINISTRATION AND DELIVERED TO: AGENCY CLERK, AGENCY FOR HEALTH.CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG 3, MAIL STOP 3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 412-3630.

   
   

   CERTIFICATE OF SERVICE

   
   

   I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights fonn has been served to: Pamela Sue OConnor, Administrator, Recovery Home Car Services, Inc., 5585 Marquesas Circle, Sarasota, Florida 34233, by U.S. Certified Mail, Return Receipt No. 7011 :2000 0001 4884 4343, and Mark T. Conklin, Registered Agent

   for Recovery Home Care Services, Inc., 727 Claremore Road, West Palm Beach, Florida 33409, by U.S. Certified Mail, Return Receipt No. 7011 2000 0001 4884 4350, this 2I£':':::': day of

   
   

   Andrea M. Lang, Assistant General Cnsel 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) 335-1253

   
   

   Pamela Sue OConnor, Administrator Recovery Home Care Services, Inc. 5585 Marquesas Circle Sarasota, Florida 34233 (U.S. Certified Mail) ·	Andrea M. Lang, Assistant General Counsel Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901
   Mark T. Conklin, Registered Agent for Recovery Home Care Services, Inc. 727 Claremore Road West Palm Beach, Florida 33401 (U.S. Certified Mail)	Harold Williams Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) .

   Copies furnished to:

   
   

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Docket for Case No: 12-001838