L (2 YS Us . STATE OF FLORIDA. AGENCY FOR HEALTH CARE ADMINISTRATION Pa M, AGENCY FOR HEALTH CARE- ‘ADMINISTRATION, Petitioner, " -RHCA No.: 2003005724 , Return Receipt ‘Requested: xr. 7002 2410 0001 4237 3097 . 7002 2410 0001 .4237 3103 A.S. A. HOME CARE, INC. a//a ASA 7002 2410 0001 4237. 3110 HOME CARE, -INC., . Respondent. “i if ai 1 ee e ADMINISTRATIVE. COMPLAINT ‘COMES NOW the “Agency | for Health care Administration _(“AHCA”), by and through the undersigned counsel, and files: this ‘adnintatretive complaint against A.S.A. Home Care, Inc. d/b/a : ASA Home Care, Inc. “(hereinafter “ASA Home - Care, Inc.”), pursuant to. Chapter 400, Part. IV.and Section 120.60, “Florida Statutes,.and herein alleges; © : NATURE OF THE ACTION. 1. This is. an. action_to..impose an. administrative fine of io $2,000:00 ‘pursuant to Section 400.484, Florida Statutes for the protection of the public health, safety and welfare. - JURISDICTION AND VENUE 2. ABCA has jurisdictiof: pursuant to Chapter 400, Part IV, Florida Statutes. 3. Venue lies in Dade County pursuant to Rule 28.106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory. authority responsible for licensure. and enforcement of all applicable statutes and rules. governing home health agencies, pursuant to Chapter 400, Part IV, Florida Statutes.and Chapter 592-4, “Florida Administrative . Code. located at 8700 West Flagler Street, Miami, Florida 33174. ASA Home Care, Inc. is licensed as a home health agency under license number 21477096. ASA Home Care, Inc. was at ail ‘times material hereto a licensed facility under the licensing : authority of AHCA and was. required to comply with all. applicable - rules and statutes. — COUNT I ASA HOME CARE, INC., FAILED TO MEET THE NEEDS OF RESIDENTS RULE 59A-8. 020 (1) , FLORIDA ADMINISTRATIVE CODE CLASS II 6. . AHCA re-alleges. and incorporates ' paragraphs — (1) 5. ASA Home Care, Inc.” operates~-a-home: health agency through (5) as if fully set forth herein. 7. ASR Home Care, Inc. was cited with two (2).Class II el, deficiencies. 8. During an unannéunced visit from June 12, 2003 through June 13, 2003 and ‘based on observation, interview and. record review, the agency ‘failed to. adequately meet the needs of patients, who were accepted for treatment in 6 of 19 sampled ‘patients. (#1, # 3, #4, #6, #8, #20) The findings include the following. ‘ ° 9. Observation of sample patient #1 during a home visit on 6/13/03 at 9 am revealed an elderly patient admitted to the : agency on 4/27/03 with a primary diagnosis of obstructive hydrocephalus, status post ventricular peritoneal stunt who was receiving physical therapy for decline in function. The patient . could ambulate with a walker, was incontinent, confused and needed assistance with activities of daily living. The patient! is primary caregiver was an elderly frail sibling. 10. Interview with sampled patient #1!'s primary caregiver on "6/13/03 at 9. dm revealed ‘that | a nurse had obtained the patient’ ‘s signature on’ admission papers. “but ‘had not offered the services of a home health aide to. assist the patient. . | le Interview with - the agency nurse on 6/13/03 at 11 am revealed that she had ‘given a report. to the. case manager “and had “recommended a home héalth aide but either the case manager did not contact the physician for orders or the HMO may have denied the authorization. 12. Review of the record ‘Of ‘sampled patient #1. on 6/13/03 at 3 pm revealed no evidence of attempts to obtain orders for a home health aide to assist the patient. 13. Review of sampled patient #4..0on 6/13/03 revealed a patient who. was admitted’ to - home care on 5/20/03 with. a diagnosis of CVA and gait disturbance. The patient had a history of hypertension and was on two medications for lowering the blood pressure: A physical therapist performed the comprehensive assessment. The physical therapist documented a blood pressure ~ ofS 190/100 suring the admission assessment. There was no evidence _in the record of the ‘therapist | calling the physician’ or: notifying the agency supervisor of the patient's elevated blood pressure. There are no further therapy visits in the record» after the start of care. 14. Interview with the Director of Nursing on 6/13/03 at 2. pm revealed that when’ she contacted the. ‘therapy company they told her that ‘the ‘therapist was unable ‘to complete any ‘further visits due to caregiver/therapist conflicts ins scheduling. 15. Record review of sampled "patient #3 “on 6/13/03. revealed the patient was admitted to. home care ‘for, skilled nursing injections and physical and occupational therapy.. There was no evidence of any physical therapy visits after the therapy evaluation nor was there an occupational therapy evaluation in the record. 16. Record review of ‘gampled patient #6 on 6/13/03 revealed - the patient was ordered to: receive’ a medical social worker evaluation for long term planning and decision-making. There is no evidence in the record of the visit being made. 17. Record review of _ Sampled patient #8. on 6/13/03 revealed the patient was’ ajmitted to home care on 10/23/02 with a diagnosis of cerebral palsy and to receive physical therapy 2 times a week for 9 weeks. There was no evidence in the record of “any therapy being provided.’ ae. Record review of. sampled patient #10 revealed a patient who was admitted to home health on 5/10/03~ with a diagnosis of gait disturbance. There was a physician order for the patient to receive physical therepy, occupational therapy and speech therapy for one week. The. plan of care orders reflects an order for physical therapy | 3 times a week for 4 weeks. There was no evidence in the record of any therapy visits having -been made. . | . . 19. Interview with the .: “Director... of. Nursing (DON) ° on 6/13/03 at 3 pm’ “regarding the missing visits of sampled patients _ #3, #8 and #10 revealed that the agency contracts out. the "therapy provided to "patients | and the notes were not being provided in a timely manner. The DON told the surveyor she. had contacted the therapy company to have the therapy notes faxed. No further notes were provided - to the surveyor during the ely survey. . 20. ‘Based on record review and interview the agency failed to initiate plan of care orders which set forth a specific frequency and duration of visits-—for each service (i.e., 93 visits per week for 4 weeks) to-ensure that the most appropriate level of service is provided to the patient in 7 of 19 sampled patients. (#1, #2, #3, #6, #7, #16, #17) . The findings include: 21. Review of the records of sampled patient #1, #2, #3, #6, #7 #16 and #17 on 6/13/03 revealed that the plan of care frequency reflected what visits were authorized by the HMO insurarice ‘case managers and : did not set forth’ a range of " grequency and duration of visits which are based on patient need and physician orders. . a 22. Interview | with the Director of Nursing (DON) on 6/13/03 at 11 am revealed that. the number of visits the patient receives _ is based on the. authorization given by the HMO insurance case managers: whe DON further revealed ‘that ‘she has instructed the agency case managers to contact the physician for frequency and Seare orders and then contact the HMO for’ the . , supporting authorizations . . 23. The mandated correction date was designated ‘as July 13, 2003. 24. Based on an unannounced complaint investigation survey conducted on duly 31, 2003 and “based on record ee and interview the agency did not. “meet the patient" s medical and nursing needs: in the patient's place of residence for 1 of 5 (#3) patient records sampled. The findings include the following. 25. Review of the record from sampled patient #3, revealed a Plan of Care (PoC) fot the certification period from May 28, 2003 through July 26, °2003.: There is evidence of three "prescriptions by © two physicians for “patient .needs Foley catheter changed every month." The prescriptions are dated June 20. and 26 by one physician. and June 30 bY another physician. Examination ‘of the “Pac _failed to indicate a modification to include. the new order for the "changing of the patient's Foley . monthly." the nursing documentation reveals only one indication: of a Foley change on June 6, 2003. It was recorded in the nurse’s progress notes, that the actual” date of change was June 2, 2003. There was no mention of any Foley changes in ’-the nurse’ s progress notes vafter June 6 2003. Additionally, there “was a memo dated ‘Joly 4, 2003 faxed by : a. family member found in. the patient’s record. The memo reflects that the patient: had to be taken to the personal physician for ‘the Foley change. This was due to the home health agency not sending skilled nursing to the patient. Interview with the QI coordinator confirmed the validity of the prescriptions with no rationale for the omitted documentation and missed visit for the Foley change. ‘27. Based on the foregofng’ facts, ASA Home Care, Inc. ‘violated Rule 59A-8.020, Florida Administrative: Code, herein classified as a Class II deficiency pursuant to section 400.484, Florida Statutes, which warrants an assessed fine of $1000.00. { courr Il ASA HOME CARE, INC. MODIFIED “THE PHYSICIAN ORDER-ON THE POT. SECTION 400.487 FLORIDA STATUTES (PLAN OF CARE) CLASS II. 28. AHCA re-alleges and ; incorporates-~ paragraphs (1) through (5) as if fully set forth herein. . 29. During an unannounced visit from June:12, 2003 through June 13, 2003 and based on record review and interview the agency did not develop a plan of care to include a modification to the initial orders of the physician in’ 8 of 19 records reviewed. (#3, #6, 47, #11; #12, #13, #16 and #17) . The findings include. the following. . ee nn , 30. Review of the record of sampled patients #3, #6, “27, #11, ‘412, #813, #16 and- #17 revealed the physician was ‘not contacted for modification | orders | for additional visits authorized by the insurance company and made by the agency's staff. 31. Interview with the “Director of Nursing (DON) on- 6/13/03 at 11 am revealed that the ‘frequency of visits- the patient receives is based on the authorization given by the HMO insurance case managers. The DON. further revealed that she has instructed the agency case’ “managers to contact | the physician if. additional visits are needa and then contacting the HMO for the supporting authorizations.:: 32. The mandated correction date was designated as July 13, 2003. 33. Based on an unannounced complaint investigation Survey conducted © on ‘July “31, 2003 “and based - on record review and — interview the agency did not develop a plan of care to include a modification to new orders by two physicians in 1 of 5 (#3) records reviewed. The findings include the following. 34, Review of the record from sampled patient 43, revealed a Plan of Care (PoC) for the certification period from May 28, 2003 thought duly 26,. 2003. ‘There is evidence of. three prescriptions by two _ physicians for patient. needs Foley catheter changed every month." The prescriptions are dated June 20. and 26. by one physician and June 30 PY another physician. Examination of the Poc fails to indicate a modification to include the new order for the "changing of the patient! Ss Foley monthiy." The nursing documentation reveals only one indication of a Foley change on June 6, 2003. The nurse’s progress notes reflect that the actual date 6f the change was June 2, 2003. “Further review of nurse's progress notes fail to document any ‘more Foley changes. Additionally,. the record contains a memo faxed to the agency by a family member, which reflects that the patient was seen by the personal physician for the Foley change. This was due to the homg health agency not sending skilled nursing to the patient. 35. Based on the foregoing facts, ASA Home Care, Inc. violated Section 484.18(a), Florida Statutes, herein classified as a Class Ir deficiency pursuant to Section 400.484 (2) (b), which warrants an assessed fine of $1000.00. following relief: * CLAIM FOR RELIEF WHEREFORE ,_ the Agency requests the Court to order the 1. Enter a judgment in favor of the Agency for Health Care Administration: against ASA Horie Care, Inc. on Counts I: and Ii. 2. Assess against ASA Home Care, Inc. an administrative fine of $2,000.00 on Counts I and II for the violations cited above. 10 ' 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. Grant such other reli®f”as the court deems is just and proper on Counts I and II. Respondent is notified that it has a right to “request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. Specific options for administrative action are set out in the attached Eiéction 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 Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3,. Tallahassee, Florida . "32208. . St Bee seis RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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. Alba ¥. oarigue!, Esa Assistant General Counsél Agency for Health Care_ Administration ; 8355 N. W. 53 Street Miami, Florida 33166 - Copies furnished to: ii Diane Castillo Field Office Manager Agency for Health Care Administration 8355 N. W. 53 Street = Miami, Florida 33166 - (U.S. Mail) : Jean Lombardi . Finance and Accounting Agency for Health Care Administration 2727. Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) : L Home Health Agency Unit Program - 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 Diego A. Jimenez, Administrator, ASA Home Care, Inc., 8700 W. Flagler Street, Miami, Florida 33174; A.S.A. Home care, Inc.,. 8700 West Flagler Street - Suite 110, Miami, : Florida 33174; J. Everett Wilson, 2151 Le Jeune Road, Mezzanine, loth . Coral Gables, Florida 33172.o0n this >eth day. of-September, 2003, Riba M. Rodriguez, Esq. 12 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION A.S.A. Home Care, Inc. d/b/a AHCA No.: 2003005724 ASA Home Care, Inc. ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. ; on OPTION ONE (1) ___Respondent does not dispute the allegations of fact contained in the Administrative Complaint and waives Respondent’s right to object or to be heard. Respondent understands that by waiving Responclent’s rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) ___ Respondent does not dispute and Respondent admits the allegations of Jact in the Administrative Complaint, but Respondent does wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time Respondent will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) 4 Respondent does. dispute the allegations of fact contained in the Administrative Complaint and Respondent requests a formal hearing, pursuant to Section 120.5 7(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hi earings. Respondent’s request for an administrative hearing must conform to the requirements in Section 28- 106.201, Florida Administrative Code (F.A.C.), and must state the material facts you dispute. In order to preserve Respondent’s right to a hearing, Respondent’s original Election of Rights in this matter must be received. by AHCA within twenty-one (21) days from the date Respondent receives the Administrative Complaint. If the election of rights form with Respondent’s selected option is not received by AHCA within twenty-one (21) days from the date of the Respondent’s receipt of the Administrative Complaint, a final order’will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. If Respondent is interpsted in discussing a settlement of this matter with the Agency, please also mark and check this block. ( ). SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL RESPONDENT RECEIVES A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON. PAYMENT OF ANY FINES. (Please sign and fill in your current address.) Respondent (Licensee) A SA ese (<2. Ture : Address; 700 | Flac - meas FO Ss License. No. and Facility Type 2A MAG ; Phone No, <(2 Wich