STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner -G 0% (70 vs. ; AHCA No: 2002048576 Return Receipt Requested MEDICAL STAFFING OF S.W. 7000 1670 0011 4849 2124 FLORIDA, INC., d/b/a A BETTER 7000 1670 0011 4849 2131 HEALTH CARE, 7000 1670 0011 4849 3180 Respondent / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against medical Staffing of §.W. Florida, Inc., d/b/a A Better Health Care (hereinafter “A Better Health Care” or the “agency”) pursuant to 28-106.111, Florida Administration Code (2000) (hereinafter oF.ALC."), and Chapter 120, Florida Statutes (2002) (hereinafter “Fla. Stat.”), and alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine in the amount of $2,500.00, pursuant to Sections 400.474, and 400.484(2) (c), Fla. Stat. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 3. Venue lies in Collier County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4. ‘HCA is the enforcing authority with regard to home health agencies licensure law, pursuant to Chapter 400, Part IV, Fla. Stat., and Rules 59A-8, F.A.C. 5. A Better Health Care is a home health agency located at 501 Goodlette Road, Suite B100, Naples, Florida 34102, and is licensed under Chapter 400, Part IV, Fla. Stat., and Chapter 59A-8, F.A.C.; license number 299991565. COUNT I A BETTER HEALTH CARE FAILED TO IMPLEMENT AN EFFECTIVE QUALITY ASSURANCE PROGRAM TO IMPROVE OR CORRECT DEFICIENCIES. 59A-8.0095(2) F.A.C. (PERSONNEL-DIRECTOR OF NURSING) UNCORRECTED CLASS III DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the annual licensure survey conducted by AHCA on 9/16/02 and based on a review of the agency's QA (quality assurance) program, AHCA found that the agency failed to implement an effective quality assurance (QA) program to improve or correct deficiencies. The agency’s QA program did not show “that any reviews or correlation were done to identify any problems or to determine trends, and the agency did not use any of the findings to improve the services of the agency. The findings include the following, to wit: (a) The agency had a QA program. Documentation showed it’to be summaries of patients. It did not show that any reviews or correlation were done to identify any problems or to determine trends. No findings were used to improve the services provided. Mandated correction by 10-16-02 8. During the follow-up visit conducted by AHCA on 10/23/02 and based on record review and interview with the Administrator, AHCA found that the agency failed to implement an effective quality assurance program to improve or correct deficiencies. The agency failed to implement an effective Quality Assurance Program to improve or correct deficiencies identified during their annual licensure survey of 9/16/02. The findings include the following, to wit: (a) There were no documented Quality Assurance minutes since the Annual Survey of 9/16/02. (b) During an interview ‘with the Administrator on 10/23/02, no further information could be provided. This is an uncorrected deficiency from the survey of 9-16-02. 9. Based on the foregoing, A Better Health Care violated 59A-8.0095(2), F.A.C., herein classified as an uncorrected Class III deficiency, pursuant to Section 400.484(2) (c), Fla. Stat., which carries a $500.00 fine. COUNT II A BETTER HEALTH CARE FAILED TO DOCUMENT/PROVIDE EVIDENCE THAT SUPERVISORY VISITS BY A REGISTERED NURSE WERE BEING CONDUCTED IN THE PATIENTS’ HOME FOR ALL PATIENTS AND/OR FAILED TO PROVIDE SUPERVISORY VISITS BY A REGISTERED NURSE. RULES 59A-8.0095(5) (b), and/or 59A-8.022(1), F.A.C., and/or 400.487(3), Fla. Stat. (PERSONNEL-HHA AND CNA) UNCORRECTED CLASS III DEFICIENCY 10. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 11. During the annual licensure survey conducted on 9/16/02 and based on chart review and agency practice, AHCA found that A Better Health Care failed to document /provide evidence that supervisory visits by a registered nurse were being conducted in the patients’ home for all patients and/or failed to provide supervisory visits by a registered nurse. The agency did not document and/or provide aide supervision timely. The findings include the following, to wit: (a) Patients #1, #4, and #5 had been receiving personal care services from the agency and had been on service since 3-20-02(#1), 6-25-02(#4) and 8-23-02(#5). Each of the ’ aide assignment sheets for these patients stated that the supervisory visits would be done every 2 weeks. (b) The Director of Nurses stated during interview, that this had been the practice of the agency since she has been there. (c) Patient #1 received services from the agency from 3-20-02 to 5-2-02. A supervisory visit was done on 3/25 and 3/27. No-other supervisory visits were noted after that time. (d) The chart of patient #4 was reviewed from 7-31-02 thru 9-12-02. During that time (7 weeks), no aide supervision was documented. (e) The chart of patient #5 was reviewed from the start of care on 8-23-02 thru 9-13-02. During that time, no aide supervisory visits were documented. Mandated correction by 10-16-02. 12. During the follow up conducted on 10/23/02 and Based on record review and interview with the Administrator, AHCA again found that A Better Health Care failed to document/provide evidence that supervisory visits by a registered nurse were being conducted in the patients’ home for all patients and/or failed to provide supervisory visits by a registered nurse. The agency failed to provide evidence in the clinical record that supervisory visits were being conducted in the patients’ home every 30 days, as per their policy, as stated in their plan of wa correction, for 3 of 6 patients reviewed (Patients #2, #5 and #6). The findings include the following, to wit: (a) Record review for Patient #2 revealed that the patient was admitted to the agency's service 5/14/02 requiring the services of a HHA (Home Health Aide). There are no RN (Registered Nurse) supervisory visits documented in the clinical record. ‘) Record review for Patient #5 revealed that the patient was admitted to the agency's service on 3/1/02 requiring the services of a Home Health Aide. There are no RN supervisory visits documented in the clinical record. (c) Record review for Patient #6 revealed that the patient was admitted to the agency's service 2/18/02 requiring the services of a HHA. There are no RN supervisory visits documented in the clinical record. 13. The agency's Administrator was asked where the supervisory visit documentation could be found. She stated that they were kept in the employees’ personnel files. She then brought the surveyor several supervisory visit forms to review from the employee personnel files. The forms have a date and the employees name but there is no visit time documented and they do not specify where the supervisory visit occurred or with what patient. The most recent supervisory visit form documentation given to the surveyor for review was dated July of 2002. 14. Based on the foregoing A Better Health Care violated Rules 59A-8.0095(5) (b), and/or 59A-8.022(1), F.A.C., and/or 400.487(3),, Fla. Stat., herein classified as an uncorrected Class III deficiency, pursuant to Section 400.484(2)(c), Fla. Stat., which carries a $500.00 fine. COUNT III A BETTER HEALTH CARE FAILED TO ENSURE THAT HOME HEALTH AIDES WERE FUNCTIONING WITHIN THE SCOPE OF THEIR RESPONSIBILITIES. 59A-8.0095(5) (m), F.A.C. {PERSONNEL — HHA and CNA) UNCORRECTED CLASS III DEFICIENCY 15. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 16. “During the annual licensure survey conducted on 9/16/02 and based on a review of 5 patient records where personal care services were provided, AHCA found that A Better Health Care failed to ensure that home health aides were functioning within the scope of their responsibilities. AHCA found that 1 aide (#1) did not follow the aide assignment sheet and 2 aides (#4 & #5) did not notify the agency of patient changes. The findings include the following, to wit: (a) The aide assignment sheet of patient #1 indicate that the aide was to take the patient's vital signs including the blood pressure. A review of the aide notes show that the aide only provided this service on 3 occasions between 3-20-02 and 5-2-02. The vital signs were not taken on the visits of 4/3, 4/5, 4/8, 4/10, 4/17, 4/18, 4/22, 4/23, 4/26, 4/27, 4/30, 5/1, and 5/2. (bo) Patient #5 was admitted to the agency on 8-23-02 for personal care services. During the time that the agency provided care, the patient was also receiving physical therapy services from another source. On 9/3 the aide documented the patient having a heavy feeling in the head and that the left shoulder was bothering her more. It could not be seen that the aide notified the agency of this change. (c) Patient #4 was admitted to the agency on 6-25-02 for personal care services. On 8/1, the aide documented that the patient had not taken the previous night’s pills. The agency was not notified of this fact, so that a further assessment could be done. Mandated Date for Correction: 10/16/02. 17. During the follow up conducted on 10/23/02 and Based on record review and interview with the agency's Administrator, AHCA again found that A Better Health Care failed to ensure that home health aides were functioning within the scope of their responsibilities. The agency failed to ensure that the HHA's (Home Health Aides) were functioning within the scope of their responsibilities for 1 of 6 patients reviewed (Patient #6, as evidenced by: the HHA documenting wound description and drainage and performing wound care dressing changes. The findings include the following, to wit: (a) Record review for Patient #6 revealed that the patient was admitted to the agency's service on 2/18/02 requiring the services of a HHA to assist with personal care, mobility, housekeeping, laundry, errand and meal preparation. (b) HHA visit notes dated 9/25, 9/27, 9/30, 10/1, 10/2, 10/7, 10/8, 10/9 and 10/10/02 document a wound to the patient's leg with descriptions of large amounts of drainage, infected, wanting to close and documentation that the HHA changed the dressing. (c) The last nursing assessment in the record is dated 6/28/02, and states that there are no skin problems. There is no indication in the record that nursing is aware of this wound or of the HHA activities in caring for this wound. There is nothing in the record to indicate how the wound occurred or which leg the wound is on. There is no nursing assessment of the wound with a description and measurements. There are no physician's orders for wound care and there is nothing regarding a wound or special skin care on the HHA assignment sheet. The last update of the aide assignment sheet is documented as 2/19/02. (a) During an interview with the Administrator on 10/23/02, she stated that she was not aware that the aide was performing and/or documenting performing dressing changes for this patient; she stated that the Director of Nursing had ‘recently seen this patient but there was no documentation in the clinical record to indicate this visit or the findings from this visit. She stated that she believed that the patient's wound was from a screw coming out from a previous knee surgery and was being addressed by the patient's physician. This is an uncorrectéd deficiency. 18. Based on the foregoing, A Better Health Care violated 59A-8.0095(5) (m), F.A.C., herein classified as an uncorrected Class III deficiency, pursuant to Section 400.484(2)(c), Fla. Stat., which carries a $500.00 fine. COUNT IV A BETTER HEALTH CARE FAILED TO ENSURE THAT ALL PATIENTS THAT REQUIRED SKILLED CARE HAD A PHYSICIAN’S ORDERED PLAN OF CARE ON RECORD, AND/OR FAILED TO ENSURE THAT THE SKILLED CARE SERVICES PROVIDED WERE IN ACCORDANCE WITH A PATIENT’S PLAN OF CARE. 400.487(6), Fla. Stat., and/or Rule 59A-8.0215, F.A.C. (PLAN OF CARE) UNCORRECTED CLASS III DEFICIENCY 19. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 20. During the annual licensure survey conducted on 9/16/02 and Based on a review of 5 patient records and administrative staff interview, AHCA found that A Better Health Care failed to ensure that all patients that required skilled care had a physician’s ordered plan of care on record, and/or failed to ensure that the skilled care services provided were in “accordance with a patient’s plan of care. AHCA found that skilled care was being provided in 3 (#1, #3, & #4) of the cases, even though these records did not contain a plan of care for this skilled care. The findings include the following, to wit: *(a) Patient #4 was admitted to the agency on 6-25- 02. The aide assignment sheet stated that the aide was to monitor the patient for the self-administration of medications. It also stated that the RN would do medication pours every other week. (b) During an interview with the administrative staff on 9/16/02 it was stated that a nurse fills medication boxes. This skilled care was being provided without the benefit of physician's orders. (c) Patient #1 was seen by the agency from 3-20-02 thru 5-2-02 for personal care services. There was no plan of treatment for this patient. On 4/18, the agency received an order for a "straight cath PRN(as needed) /urinary retention-- and send for a urinalysis and culture and sensitivity today. Run STAT." A review of the chart revealed a skin break in 5-6 areas with stage II progression. The nurse then documented the instruction of skin care. On 4/18 the nurse did the straight i catheterization of the patient and obtained the urine specimen. On 4/23 the nurse made another visit and documented a new ‘breakdown on the buttocks. DuoDerm was applied and the patient was catheterized for 600 cc of urine. On 4/30 the nurse made another visit and documented the giving of an injection of Vitamin K, ‘the giving of a Fleets enema, and wound care. On 5/1 the nurse made another visit to the patient for skin care. A plan of treatment for this skilled care was not developed for this patient. (d) Patient #3 was seen by the agency from 7-7-02 thru 7-8-02 (12:45 AM) when the patient expired. This patient was cared for by a nurse. During the time that this patient was seen by the agency, the nurse administered medications and provided skilled assessments, without the benefit of physician's orders or a plan of treatment. Correction by 10-16-02. 21. During the follow-up conducted on 10/23/02 and based on record review and interview with the Administrator, AHCA again found that A Better Health Care failed to ensure that all patients that required skilled care had a physician’s ordered plan of care on record, and/or failed to ensure that the skilled care services provided were in accordance with a patient’s plan of care. The agency failed to ensure that 1 of 1 patient's reviewed requiring skilled care (Patient #3) had a physician ordered plan of care on record. The findings include: 12 (a) Record review for Patient #3 revealed that the patient was admitted to the agency's service on 10/14/02. There ‘is a Home Health/Home Care Aide Assignment Sheet on the record dated 10/16/02, which states, "RN (Registered Nurse) 24 hours a day, 7 days a week." RN services included in this Assignment Sheet include personal care, assist with medications, monitor IV (intravenous) site and monitor infusion pump, dry dressing to a right arm abrasion as needed etc. There are no physician's orders and no physician's plan of care on the record. (b Nurses note dated 10/13/02 states, "12:30 IV site changed with relief; Tylenol tabs ii po (by mouth) good effect." (c Nurses note dated 10/14/02 states, "meds given; bowel prep for IVP; IV infusing left forearm." (d Nurses note dated 10/16/02 states, "Triple antibiotic ointment cream and Tegaderm to 3 inch abrasion right forearm." (e) Nurses note dated 10/17/02 states, "patient fall; antibiotic ointment to back and Tegaderm to right arm.” (f) Nurses note dated 10/20/02 states, "Metrogel to face, hydrocortisone to back and Lotrisone to perineal." (gq) There is no physician's order and no plan of care for any of the above treatments. (h) During an interview with the agency Administrator, she states that the patient was in the hospital 13 during this care and she doesn't believe the agency nurses were providing this care. It is not stated in the nurse's notes that someone else provided the documented care and treatments. 22. Based on the foregoing A Better Health Care violated 400.487 (6), Fla. Stat., and/or Rule 59A-8.0215, F.A.C., herein classified as an uncorrected Class III deficiency, pursuant to Section 400.484(2) (c), Fla. Stat., which carries a $500.00 fine. COUNT V A BETTER HEALTH CARE FAILED TO LIST GOALS FOR THE SKILLED CARE PROVIDED, AND/OR A STATEMENT OF THE LEVEL OF CARE TO BE PROVIDED, AND/OR THE FREQUENCY OF THE HOME VISITS. 59A~-8.0215, F.A.C. (PLAN OF CARE) UNCORRECTED CLASS III DEFICIENCY 23. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 24. During the annual licensure survey conducted on 9/16/02 and based on a review of 3 patients that received skilled care from the agency, AHC found that A Better Health Care failed to list goals for the skilled care provided, and/or a statement of the level of care to be provided, and/or the frequency of the home visits. AHCA found that 3 patients (#1, #3, & #4) did not have a plan of treatment that addressed the goals for the skilled care provided, the level of staff to see the patient or the frequency of visits. The findings include the following, to wit: 4 (a) Patients #s 1, 3, & 4 received skilled care from the agency staff. There was no plan of treatment for this care ‘and as a result there were no goals for the skilled care provided or a statement of the level of care to be provided along with,the frequency of the visits made. (b) No plan of care was available for staff seeing the patients to review. (c) This data was confirmed by the administrative staff of the agency at the time of the survey. Mandated correction by 10-16-02 25. During the follow-up conducted on 10/23/02 and based on record review and interview with the Administrator, AHCA again found that A Better Health Care failed to list goals for . the skilled care provided, and/or a statement of the level of care to be provided, and/or the frequency of the home visits. The agency failed to ensure that 1 of 1 patient's reviewed requiring skilled care (Patient #3) had a physician ordered plan of care with goals and plans for implementation of the plan to reach the goals. The findings include the following, to wit: (a) Record review for Patient #3 revealed that the patient was admitted to the agency's service on 10/14/02. There is a Home Health/Home Care Aide Assignment Sheet on the record dated 10/16/02, which states, "RN (Registered Nurse) 24 hours a day, 7 days a week." RN services included in this Assignment 15 Sheet include personal care, assist with medications, monitor IV (intravenous) site and monitor infusion pump, dry dressing to a : right arm abrasion as needed etc. There are no physician's orders and no physician's plan of care on the record. (b) Nurses note dated 10/13/02 states, "12:30 IV site changed with relief; Tylenol tabs ii po (by mouth) good effect." ‘(c) Nurses note dated 10/14/02 states, “meds given; bowel prep for IVP; IV infusing left forearm." (d) Nurses note dated 10/16/02 states, "Triple antibiotic ointment cream and Tegaderm to 3 inch abrasion right forearm." (e) Nurses note dated 10/17/02 states, "patient fall; antibiotic ointment to back and Tegaderm to right arm." (f) Nurses note dated 10/20/02 states, "Metrogel to face, hydrocortisone to back and Lotrisone to perineal." (g) There is no physician's order and no plan of care for any of the above treatments. (h) During an interview with the agency Administrator, she states that the patient was in the hospital during this care and she doesn't believe the agency’s nurses were providing this care. It is not stated in the nurse's notes that someone else provided the documented care and treatments. 26. Based on the foregoing A Better Health Care violated 59A-8.0215, F.A.C., herein classified as an uncorrected Class 16 IIt deficiency, pursuant to Section 400.484(2) (c), Fla. Stat., which carries a $500.00 fine. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on counts I through V. kg, Assess and maintain the Agency’s administrative fine of $2,500.00 against A Better Health Care, in accordance with §400.484(2)(c), Fla. Stat. C. Award the Agency for Health Care Administration reasonable attorney’s fees, expenses, and costs, if the Court finds that costs are applicable. D. 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 (2002). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care 7 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. Respectfully submitted, ryn F. Fenske, Esq: Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 NW 53°° Street, 1°* Floor Miami, Florida 33166 (305) 499-2165 Copy to: Kathryn F. Fenske, Assistant General Counsel Agency for Health Care Administration Manchester Building 8355 NW 53 Street Miami, Florida 33166 Elizabeth Dudek, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, MS#9 Tallahassee, Florida 18

Docket for Case No: 03-001970