@e@ @ OF-GN7 . STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE : F oi i ADMINISTRATION, i Petitioner, vs. AHCA CASE NO. 2003004478 FLORIDA FIRST CARE, INC., Respondent. / ' ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Agency for Health Care Administration (hereinafter “Agency”), by and through its undersigned counsel, and files this Administrative Complaint against Respondent, Florida First Care, Inc. (hereinafter “PFC”) pursuant to Sections 120.569 and 120.57, Florida Statutes (2002), and as grounds therefore states the following: NATURE OF THE ACTION 1. This is an action: (a) to impose an administrative fine in the amount of $500.00 against FFC pursuant to Sections 400.474(2)(a) and 400.484(2)(c), Florida Statutes (2002); and (c) to assess costs related to the investigation of this case pursuant to Section 400.484(3), Florida Statutes (2002), based on one uncorrected class III deficiency. : Ex. | JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). 3. The Agency has jurisdiction over FFC pursuant to Chapter 400 Part IV, Florida Statutes (2002). 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2002). PARTIES 5. Pursuant to Chapter 400, Part IV, Florida Statutes, and Chapter 59A-8, Florida Administrative Code, the Agency is the regulatory agency responsible for the licensure of home health agencies and for the enforcement of all applicable laws and rules governing home health agencies. 6. FFC is a Florida for profit corporation with a principal address of 310 South Palm Avenue, Suite 3, Palatka, Florida 32177. 7. FFC is a home health agency located at 310 South Palm Avenue, Suite 3, Palatka, Florida 32177, having been issued licensed license number HHA21496096 by the Agency to operate in Putnam, Alachua, Marion, Bradford and Union Counties. 8. FFC is or was at all times material hereto a licensed home health agency required to comply with Chapter 400, Part IV, Florida Statutes, and Chapter 59A-8, Florida Administrative Code. COUNT I FFC FAILED TO ENSURE THAT THE PHYSICIAN SIGNED TREATMENT ORDERS WITHIN THIRTY (30) DAYS AFTER THE START OF CARE. § 400.487(2), Fla. Stat. (2002) UNCORRECTED CLASS III DEFICIENCY 9. The Agency re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. Survey on or about November 12-13, 2002. 10. On or about November 12-13, 2002, the Agency conducted a state licensure survey at FFC and cited FFC for a class III deficiency based on the findings below involving Patient #12 or Patient #14. Patient #12 11, On or about November 12-13, 2002, an Agency surveyor reviewed Patient #12’s clinical record. The Physical Therapy Care Plan/Goals form dated September 25, 2002, established a physical therapy plan of treatment for Patient #12. The form was signed by an advanced registered nurse practitioner (‘ARNP”), not a physician. 12. Patient #12’s start of care date was on or about July 24, 2002. 13. A physician signed the treatment order on or about September 10, 2002, approximately forty-eight (48) days after the start of care date. 14. FFC failed to ensure that a physician signed the treatment order within thirty (30) days of the start of care. Patient #14 15. On or about November 12-13, 2002, an Agency surveyor reviewed Patient #14’s clinical record. 16. Patient #14’s start of care date was on or about October 10, 2002. 17. As of the date of the survey on or about November 12-13, 2002, a physician had not signed the treatment order. 18. FFC failed to ensure that a physician signed the treatment order within thirty (30) days of the start of care. 19. Based on all of the foregoing, FFC violated Section 400.487(2), Florida Statutes (2002), by failing to ensure that a physician signed treatment orders within thirty (30) days after the start of care. 20. The foregoing violation is a class Ill violation because it had an indirect, adverse effect on the health, safety or security of Patient #12 or Patient #14. § 400.484(2){c), Fla. Stat. (2002). 21. The Agency gave FFC a mandated correction date of December 13, 2002. On or about February 3, 2003, the Agency performed a follow-up survey at FFC. FFC failed to correct the foregoing deficiency by the mandated correction date. Survey on or about February 3, 2003. 92. On or about February 3, 2003, the Agency performed a follow-up survey at FFC and cited FFC for an uncorrected class III deficiency based on the findings below involving Patient #1 or Patient #4. Patient #1 93. On or about February 3, 2003, an Agency surveyor reviewed Patient #1’s clinical record. 24. Patient #1’s start of care date was on or about December 12, 2002. 25. As of the date of the survey on or about February 3, 2003, a physician had not signed the treatment order. 26. FFC failed to ensure that a physician signed the treatment order within thirty (30) days of the start of care. Patient #4 27. On or about February 3, 2003, an Agency surveyor reviewed Patient #4’s clinical record. 28. Patient #4’s start of care date was on or about December 16, 2002. 29. A physician signed the treatment order on or about January 31, 2003, approximately forty-six (46) days after the start of care date. 30. FFC failed to ensure that a physician signed Patient #4’s treatment order within thirty (30) days of the start of care. 31. Based on all of the foregoing, FFC violated Section 400.487(2), Florida Statutes (2002), by failing to ensure that a physician signed treatment orders within thirty (30) days after the start of care. 32. The foregoing violation is a class HI violation because it had an indirect, adverse effect on the health, safety or security of Patient #1 or Patient #4, § 400.484(2)(c), Fla. Stat. (2002). 33. Pursuant to Sections 400.484(2)(c) and 400.474(2)(a), Florida Statutes, the Agency is authorized to impose a fine against FFC in the amount of $500.00 per patient or per occurrence and $500.00 per day for each day the uncorrected deficiency exists. In accordance with the foregoing, the Agency seeks a total fine amount of $500.00 for this uncorrected class III violation. CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1) Make factual and legal findings in favor of the Agency on Count I; 2) Impose a fine on FFC in the amount of $500.00; and 3) Assess costs against FFC related to the investigation of this case pursuant to Section 400.484(3), Florida Statutes (2002). NOTICE FFC hereby 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 form (two pages) and explained in the attached Explanation of Rights form (one page}. All requests for a hearing shall be sent to Lealand McCharen, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308. FFC IS FURTHER NOTIFIED THAT THE REQUEST FOR HEARING MUST BE RECEIVED BY THE AGENCY WITHIN TWENTY-ONE (21) DAYS FROM THE DATE FFC RECEIVES THIS ADMINISTRATIVE COMPLAINT. IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY WITHIN TWENTY-ONE (21) DAYS FROM THE DATE OF FFC’S RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ISSUED BY THE AGENCY FINDING THE DEFICIENCIES AND/OR VIOLATIONS CHARGED AND IMPOSING THE PENALTY SOUGHT IN THE ADMINISTRATIVE COMPLAINT. AL! fS\pp bo} “ Respectfully submitted on this —~ C: day of Ut fe ie 2003. Pri C. Qsorwet Lori C. Desnick Senior Attorney Florida Bar No. 0129542 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32303 (850) 922-8854 (850) 921-0158 (fax) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that one original Administrative Complaint, Election of Rights form and Explanation of Rights form has been served via Certified Mail, Return Receipt Requested (# Viieme VAC 5 3, to Charles Engelbrecht, Administrator, Florida First Care, Inc. that one original Administrative , 203B South Moody Road, Palatka, Florida 32177 and Complaint, Election of Rights form and Explanation of Rights form has been served via Certified Mail, Return Receipt Requested (# F ent, 2656 Country Club Boulevard, 2003. to Charles W. Englebert, RE Ag Orange Park, Florida 32073 on this 2 Yay of me ity bok: ne C. LORI C. DESNICK, ESQUIRE soa SH sa COMPLETE THIS SECTION ON DELIVERY SENDER: COMPLET! THIS SECTION ; “tems'1;2,"and 3: Also. complete’ -A:#f Restricted Delivery is desired. *~ your name and address on the reverse yo that we can return the card to you. ‘Attach this card to the back of the mailpiece; =~ onithe front if space permits. , “Article Number {Transfer from service jabel)

Docket for Case No: 04-000019