fd STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No: 2003004480 vs. Return Receipt Requested 7002 2410 0001 4236 8628 NURSING UNLIMITED 2000, INC., d/b/a NURSING UNLIMITED 2000, INC., Respondent / ge OUE OSU mea ADMINISTRATIVE COMPLAINT COMZS NOW the Agency for Health Care Administration (hereinafter “AHCA”’ or the ‘“Agency”), by and vhrougn undersigned counsel, and files this Administrative Complaint egainst Nursing Unlimited 2000, Inc., d/b/a Nursing Unlimited 2000, Inc. (hereinafter “Nursing Unlimited 2000” o: the “nome health agency”), pursuant <2 28-106.111, Florida Daministration Code (2000) (hereinafter SPLALC.7) 4 and Chapter 120, Florida Statutes (2002) (hereinafter “Fle. Stat.”), anc alleges: NATURE OF ACTION 1. This is an action ‘to impose an administrative fine in the amount of $500.00, pursuant to Secricns 400.474, and 400.484(7) cl, Fla. Stat. WdTT:S@ 20BZ ro ETH Lecregsoee : “ON ys THI @@BE-TW + }Cds Pd JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat., and Chapter 26-106, F.A.C. 3. venue lies in Dade County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207. F.A.C. PARTIES 4. BUCA is the enforcing authority with regard to home health agencies licensure law, pursuant to Chapter 400, Part IV, Fla. Stat., and Rules S9A-8, F.A.C. 5. Nursing Unlimited 2000 is a home health agency located at 4953 S.W. 74% Court, Miami, Florida 331535, and is licensed under Chapter 400, Part IV, Fla. Stat., and Chapter 59A-8, F.A.C.; license number 299991242. COUNT I NURSING UNLIMITED 2000 FAILED TO MAINTAIN A PATIENI’S CLINICAL RECORD AND/OR INFORM A PHYSICIAN OF CHANGES IN A PATIENT’ S CONDITION AND NEEDS. 59A-8,0095(3), F.A.C.» and/or 42 C.F.R. 484.30. (DUTIES OF THE REGISTERED NURSE) UNCORRECTED CLASS III DEFICIENCY 6. AHCA xre-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the unannounced visit conducted by the Agency on March 13, 2903 and based on clinical record review and interview with the registered murse, the Agency found that the home health agency’ Ss reqisterced nurse failed re LidTT:SO £0@¢ PQ “Sry LeLP e932 : “ON Med ont Geee-nn > Wad Sd to maintain a patient’s clinical record and/or inform a physician of changes in a patient’s condition and needs, in accordance with a registered nurse’s duties. The registered nurse did not inform the physician of the changes in 4 patient’s condition and needs in 1 of 5 records reviewed. The findings include the following, to wit: (a) Review of sampled patient #5 revealed that physician orders directed the skilled nurse to assess vital signs and signs and symptoms of complications of the cardiopulmonary systems; Instruct and evaluate understanding of disease process, medication regimen (actions/side/effects) ¢ detecting complications. The patient's initial nursing assessment indicates that the patient's blood pressure was 176/140; but there 15 no evidence that the nurse contacted the physician to alert him to the elevated blood pressure and cbtain orders. 8. During interview with the Administrator and Acting Director of Nursing at 3:30PM on 3/13/03, they acknowledged the deficient practice of the skilled nurse in not contacting the physician in response to the patient's abnormal blood pressure. Correction Date assigned: April 13, 2003. 9. When a follow-up survey was conducted on June 5, 2003 ard based on review of records, interview and 3 Wd@T:S@ E@B¢ rQ “Er > cat + frm ve — - é jz FO =) CGEPLISSOE © ON Xe oh Bea2-0N > WOed Se observation, the Agency again found that the home sealth agency’s registered nurse failed to maintain a patient’s clinical record and/or inform a physician of changes in a Patient’s condition and needs, in accordance with a registered nurse’s duties. Tne skilled nurse did not assure that one clinical record {sampled record #10) of twenty (20) sampled patients’ records included a complete history. Findings include the following, to wit: (a) Record review and interview revealed that sampled patient #10 was admitted to home health services for Diabetes Mellitus, schizophrenia, congestive heart failure, arteriosclerosis, and cardiac dysrthymias. Start of care date (SoC) was 11/21/0, with re-certification on 5/20/03 to 7/18/03. The patient was to receive skilled nursing services for monitoring of blood sugars twice daily, with insulin coverage as ordered. (b) The patient was chosen for a home wae. \ Upon arriving at the address documented on the Plan of Care (POC), the surveyor determined that the eddress was incorrect. In actuality, present was a gas station; not a residence. Upon verifying with the home health agency, the correct address was obtained. A visit to the correct address did not produce the required home visit, as the client was not in the home. WdeT:SB £BBE Pa “Eny 26EPL99SRE 2 “ON xed ONT @8Ge-"N NL > WOas 10. Interview with the administrator and further investigation revealed that the home health agency did not know the whereabouts of the patient, and could not locate the family to determine the location of the patient. The oe ~- following day, the patient was found at the boyfriend's —_—oooee residence. They admitted that the patient had a history of eloping and non-compliance with therapy. There was no evidence of communication, ex conferences with an interdisciplinary team or the primary physician to update the POC to reflect the patient's history of noncompliance prior to 6/05/2003. The clinical record was not maintained. ll. Based on the foregoing, Nursing Unlimited 2000 violated 59A-8.0095(3), F.A.C., and/or 42 CFR 484.30, herein classified as a repeatec/uncorrected Class III deficiency, pursuant to Section 400.484(2) ic), 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 faver of the Agency on Count I. B. Assess and maintain the Agency's administrative fine totaling $500.00 against Nursing Ww ed Wd@T:S8 EBBZ pa “Eny dEEPLg9SBE 2 ON “HA INI BEEE-TN + Woes Unlimited 2000, in accordance with §400.484(2)(c), Fla. Stat. Cc. Award che Agency for Health Care Administration reasonable attorney’s fees, expenses, and costs, if the Court finds costs are applicable. D. Grant such further relief as the 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 Heaith 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 (20) 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. Sd WdET:S@ £AQe P| “Erig AEEPLSIS2E 2 OW XbA ONT B@BE-NIN > WOAS Respectfully submitted, ——_, Kathryn F. Fenske, Esq. ° Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 NW 53*4 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 Diane Lopez Castillo, Field Office Manger Agency for Health Care Administration 8355 NW 53° Street Miami, Florida 33166 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 Gd WdiT:SB £@@2 Pa “Eng 26EP299S0L : ON xe3s ONT B@BE-NN 2 Woes 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 Aida Salazar Rebull, Administrator, Nursing Unlimited 2000, Inc., 4953 S.W. 74** Avenue, Miami, Florida 33155, on 16% 2003. ryn F. Fenske, Esq. QTd WdtT:S8 S882 PB “Erg A6EPL99S8E 2 “ON Xb ENT G8@2-FN > HCAs

Docket for Case No: 03-003324