Gor ON Veg o wv aN Pv a 4 STATE OF FLORIDA __—idi. AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. . AHCANO. 2004010165 FAMILY HOME HEALTH SERVICES, O “. 0 SUL Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through its undersigned counsel, and files this Administrative Complaint against Respondent, Family Home Health Services (hereinafter “Family Home Health”) pursuant to Sections 120.569 and 120.57, Florida Statutes (2004), and as grounds therefore, alleges the following: NATURE OF THE ACTION 41. This is an action: (a) to impose an administrative fine in the amount of $3500.00 against FAMILY HOME HEALTH pursuant to Sections 400.474(2)(a) and 400.484(2)(b), Florida Statutes (2004); and (b) to assess costs related to the investigation of this case pursuant to Section 400.484(3), Florida Statutes (2004), based on SEVEN (7) class III deficiencies cited at a survey on or about October 11, 2004. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2004). 3. The Agency has jurisdiction over Family Home Health pursuant to Chapter 400, Part IV, Florida Statutes (2004). 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2004). “ 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 state laws and rules governing home health agencies. 6. At all times material hereto, FAMILY HOME HEALTH was a home health agency located at 2200 King’s Highway, Suite 3J, Punta Gorda, Florida 33982. 7. At all times material hereto, FAMILY HOME HEALTH was licensed by the Agency to operate a home health agency in Charlotte County having been issued license number 299991814 by the Agency. 8. At all times relevant hereto, FAMILY HOME HEALTH is and was a licensed home health agency required to comply with Chapter 400, Part IV, Florida Statutes, and Chapter 59A-8, Florida Administrative Code. COUNTI THE CARE OF TWO OF TWO PATIENTS SAMPLED DID NOT FOLLOW THE AIDE CARE PLAN AND ONE PATIENT CARE PLAN DID NOT GIVE CLEAR INSTRUCTION TO THE AIDE FOR CARE Rule 59A-8.0095(5), Florida Administrative Code (2004) Section 400.487(2) and (6), Florida Statutes (2004) 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. 40. On or about October 11, 2004, a survey team from the Agency's Area 8 Office conducted a survey at FAMILY HOME HEALTH that resulted in two class Ill deficiencies cited against FAMILY HOME HEALTH based on the following: 11. On or about October 11, 2004, Agency surveyors reviewed two residents’ clinical records. FAMILY HOME HEALTH failed to ensure adequate nursing case management as evidenced by the following: 1. Patient #2 was admitted to the agency on 7-24-04. It was determined that the patient would benefit by having home health aide assistance. The aide was instructed to take the temperature, pulse, respirations, and blood pressure of the patient along with the personal care. The patient was to be seen by the aide twice a week. During the week of 8-1-04, the patient was seen on 8-4-04 and 8-6-04. The vital signs were only taken once that week with the date not being identified. During the second week, the aide was seen on 8-10-04 and 8-12-04 but only one set of vital signs appeared on the note. 2. Patient #5 was admitted to the agency on 9-29-04 with a diagnosis of Cerebral Vascular Accident with right hemiparesis. This patient was to receive nursing, physical therapy, occupational therapy and a home health aide. The aide assignment sheet was made on 9-29-04. The aide assignment has all the care items listed as PRN or per patient's request, including tub or shower bathing. The therapist (PT) did not see the patient until 10-3-04 to determine if the patient was safe to chose a shower or tub bath. The occupational therapist saw the patient on 9-29-04 for the first time but the note failed to declare the patient safe for a shower. The aide was not given proper guidance | as to the care the patient was safe to be assisted with. 12. This is an uncorrected deficiency, as a survey conducted July 27, 2004 found: Based on record review the Agency failed to insure the home health aide followed the care plan for 2 (#6 and #7) of 8 active sampled patients. Findings include: 1. Review of the record for Patient #6 reveals he/she was admitted to the agency and care started on 7/7/04. The home health aide care plan, dated 7/7/04, assigns the aide to take the patient's temperature, pulse, respirations, and pain rating on every visit. The weekly visit record shows that on 7/8/04 this was not done. 2. Review of the record for Patient #7 reveals he/she was admitted to the agency and care started on 6/19/04. There are no indications on the home health aide care plan, dated 6/19/04, for the home health aide to provide any assistance with activity/mobility. The weekly visit record shows that on 6/23/04 and 6/25/04 patient #7 was assisted with activity/mobility. The supervisory visit note, dated 7/9/04 indicates (in item 8) the home health aide is following the care plan when the aide is not. 13. This is characterized as a class III deficiency, and as it impacts two patients, administrative fines of five hundred dollars ($500.00) each are appropriate for a total fine of one thousand dollars ($1000.00) pursuant to Section 400.419(1)(c), Florida Statutes (2004). COUNT TWO FAMILY HOME HEALTH FAILED TO INCLUDE ALL THE DATA NEEDED ON THE MEDICATION SHEET TO MEET THE NEEDS OF THE EMERGENCY MANAGEMENT PROGRAM IN FIVE OF THE RECORDS REVIEWED Rule 59A-8.027(16), Florida Administrative Code (2004) CLASS III DEFICIENCY 14. The Agency re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 15. On or about October 11, 2004, a survey review established that the agency failed to maintain medication records in accordance with Rule 8.027(16), Florida Administrative Code (2004). Based on a review of 5 clinical records and staff interview, the agency failed to include all the data needed on the medication sheet to meet the needs of the emergency management program in 5 of the records reviewed. The findings include: 1. The agency has made it a practice to maintain a copy of the medication sheet both in the home and in the patient file. A review of the med sheet of patient #2 failed to include the address of the pharmacy the patient uses. This form does not include any of the special equipment that is provided for the continued care of the patient. No other form was identified as going with the patient. It was noted that this patient uses a wheel chair, a walker, has a hospital bed with side rails, and has a PEG tube for feedings. The med sheet also contains the diagnosis of the patient. There was no evidence that the patient gave permission for this information to be released. 2. Patient #5 has Oxytrol 3.9 mg/24 hour topical twice a week- to decrease urine. This medication was to daily be administered via a patch. This route was omitted from the med sheet. This patient also had the diagnosis listed on the med sheet without the permission of the patient. 3. Patient #4 has the diagnosis of the patient listed although the patient did not grant permission for this. 4. The med sheet of patient #3 has 7 medications listed as being taken. Per the Plan of Treatment (POT), the patient is taking Toprol XL (long acting) tab. 50 mg., one tablet a day by mouth. On the med sheet, the medication is listed as Toprol (not long acting) 50 mg. daily orally. The POT lists Hydrochlorot Cap 2.5 mg. 1/2 tablet daily. On the med sheet, the dose is listed as 25 mg. 1/2 tablet. These two medications are not as they are ordered on the POT. Under Allergies, the nurse filling out the form wrote "Antibiotic" without identifying which antibiotic. This med sheet also listed the patient's diagnosis with out the permission of the patient. 5. The med sheet of patient #1 does not include the full address of the pharmacy nor the phone number of the physician. Per the POT, the patient is to take Depakote 500 mg tablet EC once a day. On the med sheet, the instruction is for twice a day. The Atenolol is listed as a 25mg. tablet daily. On the med sheet, this medication is listed a 10 mg once a day. The POT lists the Potassium to be 1 tablet daily. The med sheet lacks a dose either in meg or in the number of tablets. The POT has the patient taking Lortab 75 mg every 6 hours by mouth. This medication is completely missing from the med sheet. This medication sheet also lists the diagnosis of the patient without the permission of the patient. . 46. This is an uncorrected deficiency, as a survey conducted July 27, found: Based on record review the agency failed to have the required information in the medication list for emergency management use for 4 (#s 2, 4, 7, and 8) of 8 records reviewed. Findings include: 4. Review of the medication list for Patient #2 reveals allergies and address of the pharmacy are not listed as required. 2. Review of the medication list for Patient #4 reveals the address of the pharmacy, the pharmacy phone number and the physician's phone number are not listed as required. 3. Review of the medication list for Patient #7 reveals the address of the pharmacy is not listed as required. 4. Review of the medication list for Patient #8 reveals the address of the pharmacy is not listed as required. 17. This is characterized as a class Ill deficiency, and as it impacts five patients, administrative fines of five hundred dollars ($500.00) each are appropriate for a total fine of two thousand dollars five hundred ($2500.00) pursuant to Section 400.419(1)(c), Florida Statutes (2004). CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1) Make factual and legal findings in favor of the Agency on Count | and Count I; 2) Impose a fine of ONE THOUSAND DOLLARS ($1000.00) for Count | and TWO THOUSAND FIVE HUNDRED DOLLARS ($2500) for Count !I against FAMILY HOME HEALTH for a total amount of THREE THOUSAND FIVE HUNDRED DOLLARS ($3500.000); and 3) Assess costs related to the investigation of this case pursuant to Section 400.484(3), Florida Statutes (2004). NOTICE Respondent 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 and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. FAMILY HOME HEALTH IS FURTHER NOTIFIED THAT IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT BY FAMILY HOME HEALTH, A FINAL ORDER WILL BE RENDERED BY THE AGENCY FINDING THE DEFICIENCY AND/OR VIOLATION CHARGED AND IMPOSING THE PENALTY SOUGHT IN THE ADMINISTRATIVE COMPLAINT. Respectfully submitted on this V/: (7 day of December 2004. wlL~ qeeo “he (sf n Fowler Bar No.: 3339067 Respondent’s Counsel Assistant General Counsel BS Agency For Health Care Administration 2295 Victoria Avenue, Room 346C Fort Myers, FL 33901 (239) 338-3203 (239) 332372 fax CERTIFICATE OF SERVICE | HEREBY CERTIFY that one original Administrative Complaint has been sent via certified mail return receipt requested (return receipt # 7003 1010 0000 9716 0489) to Irene Tuttle-Wait, Administrator, or her designee, Family Home Health Services, 2200 King’s Highway, Punta Gorda, FL 33982, on this Lé day of December 2004. wn JOAN FOWLER

Docket for Case No: 05-000546