APR-LS-ZUUS (HON) = L2SU8 UNSTED HUME CAKE Pb (FAR) 9b1 1427994 PUUL/ ULE STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2005001580 Return Receipt Requested: ve 7002 2410 0001 4234 0068 7002 2410 0001 4234 0075 UNITED HOME CARE SERVICES, INC. d/b/a UNITED HOME CARE SERVICES OF PALM BEACH, a 5) j 0) Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against United Home Care Services, Inc, d/b/a United Home Care Services of Palm Beach (hereinafter “United Home Care Services of Palm Beach”), pureuant to Chapter 400, Part IV, and Section 120.60, Florida Statutes. NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,500.00 pursuant to Section 400.464, Florida Statutes for the protection of public health, safety and welfare. EXHIBIT "B" APK-JB-ZUUS(HON) = L2:U8 UNITED HUME CAKE PB TEAK) 9b1 421994 P.UUS/ULE JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part IV, Florida Statutes. 3. Venue lies in Palm Beach County pursuant to Rule 28.106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority xesponsible fer licensure and enforcement of all applicable statutes and rules governing home health agencies, pursuant to Chapter 400, Part Iv, Florida Statutes and Chapter 59A-8 Florida Administrative Code. 5. United Home Care Services of Palm Beach operates a home health agency located at 2400 High Ridge Road, Boynton Beach, Florida 33426. United Home Care Services of Palm Beach is licensed as a home health agency under license number 299991563. United Home Care Services of Palm Beach was at all times Material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. APRLB-ZUUS (HON) = V2-UY UNITED HOME CARE Pb (EAR) D1 142994 P.UU4/ ULE COUNT I UNITED HOME CARE SERVICES OF PALM BEACH FAILED TO PROPERLY ESTABLISH AND FOLLOW PHYSICIAN TREATMENT ORDERS. SECTION 400.487 (2), FLORIDA STATUTES 59A-8.0215 (2), FLORIDA ADMINISTRATIVE CODE (PHYSICIAN ORDERS) CLASS IIrt 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. United Home Care Services of Palm Beach was cited with two (2) Class III deficiencies due to a recertification and licensure survey conducted from March 22, 2004 through March 26, 2004, 8. A recertification and licensure survey was conducted from March 22, 2004 through March 26, 2004. Based on record review, it was determined that physician treatment orders were not established, nor followed, nor put into writing, nor signed and dated with the date of receipt, in 2 out of 15 sampled patients. (#4 and #7). The findings include the following: 9. A xrecord review of the Plan of Care (POC) dated 2/2/04-4/1/04 for Patient #4 xrevealed orders for physical therapy (PT) to be held two times in one week and three times during four weeks, However, a review of PT notes revealed that the therapist documented only one visit the first week and two visits during the third week. There was no explanation for the APR B-2UUS(HON) = LZ SU9 UNITED HOME CARE Pb (FAK) VDL /421994 PUUS/ULS two missed visits, nor any evidence that the physician was aware of the missed visits, 10. A record review of the Poc dated 3/8/04-5/6/04 for Patient #7 revealed a diagnosis of decubitus ulcer but no wound care orders from the physician. A review of subsequent physician orders did not reveal any orders to provide care to the decubitus. Skilled nursing documentation on more than one visit revealed that the skilled nurse was cleansing with saline, uBing mepilex, tegaderm and/or mefix to a stage II pressure ulcer near the patient’s thoracic spine. 11. The mandated date of correction was Gesignated as April 25, 2004. 12. A re-licensure survey was conducted from January 24, 2005 through January 27, 2005. Based on, record review and interview, it was determined that the home health agency did not follow the physician's treatment orders contained in the plan of care and did not notify the physician if changes were needed in the plan of care in 1 out of 15 sampled patiente. (#6)... The findings include the following: 13. Patient #6 was admitted to the agency on 10/2/04 with Qiagnoses including an open wound on the trunk and diabetes mellitus. As of 10/28/04, there were wound care orders to the bilateral lower extremities in addition to daily wound care to the right trunk area. A review of the POC dated 10/2/04-11/30/04 4 APR-L8-2005(HON) = 12:09 UNITED HOWE CARE PB (FAX) 5b1 7427554 PUUO/ULE and 12/1/04-1/29/05 revealed orders for daily skilled nursing (SN) visits to provide wound care. However, record review revealed that most of the daily sn visits were conducted by a licensed practical nurse (LPN). 14. Clinical recorg review also revealed Physician orders dated 10/21/04 to change wound care to the right trunk. a review ef clinical decumentation of LPN visits did not refleet compliance with the change in orders during four visits. Again on 10/28/04, there was a physician order for skilled nursing to provide daily wound care to bilateral lower legs, compression wraps, unna boots and Aquacel gauze to the leg in order to decrease volume in legs and allow for ulcers to heal. However, a review of SN documentation revealed no evidence that wound care was provided to lower extremities until 11/1/04. 15. A review of daily SN . documentation from 12/1/04- 1/22/04 revealed More than twenty intermittent visits, Yet, there was no documentation regarding the use of Aquacel dressings and or wound care to the lower extremities. There was also no evidence of physician follow-up for change in orders or LPN/RN communication, 16. During a home visit conducted on 1/25/05 with the rn case manager, it wag observed that there were no Aquacel @ressings to be applied to the bilateral lower extremities of Patient #6. The RN Opened a plastic bag in the patient's supply 5 APR-18-2005(HON} = 12:10 UNITED HOME CARE Pb (FAX) 5017427954 PUT / ULB box of dressings, observed what appeared to be "soiled Aquacel", and discarded the bag. While observing the RN removing dressings from the patient's bilateral lower extremities, it was noted that there were no Aquacel dressings on the right lower extremity. Instead, there were Aquacel dressings on the lower left calf area only. The RN was also unable to reapply Aquacel dressings since there was none available in the home. 17. A review of the physician orders revealed that the Aquacel was to be applied to bilateral lower extremities. This is a repeat deficiency from the survey of March 26, 2004. 18. Based on the foregoing facts, United Home Care Services of Palm Beach violated Section 400.487 (2), Florida Statutes, and/or 59A-8.0215(2) Florida Administrative Code, herein classified as a repeat Class III deficiency, which carries, in this case, an assessed fine of $500.00 [one (1) patient x $500.00 per patient]. counT If UNITED HOME CARE SERVICES OF PALM BEACH FAILED TO DEVELOP AN INDIVIDUALIZED PLAN OF CARE THAT INCLUDED ALL PERTINENT TREATMENT ORDERS AND GOALS FOR SAMPLED PATIENTS. RULE 59A-8.0215 (1), FLORIDA ADMINISTRATIVE CODE. (PLAN OF CARE) CLASS III APR-{8-2005(MON) = 12:10 UNITED HOME CARE PB (FAX) 5617427534 PUUG/UES 19. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 20. A recertification and licensure survey was conducted from March 22, 2004 through March 26, 2004. Based on record review and interview, it was determined that the agency failed to develop an individualized plan of care that included all Pertinent treatment orders and goals for 3 out of 15 sampled patients (#4, #9, #10). The findings include the following: 21. A review of the PoC dated 2/2/04-4/1/04 for Patient #4 revealed two diagnoses: gait abnormality and pr, Further pPoc review revealed that the patient was new to Isosorbide and Lasix medication, but there was no corresponding diagnoses on the Poc, A review of a comprehensive assessment revealed that the patient had been discharged from the hospital prior to admission to home care status. The patient had post hysterectomy, cardio respiratory and gastrointestinal postoperative complications requiring the use of oxygen continuously at night. However, the Poc did not have an order for oxygen. 22. A review of the Poc dated 1/22/04-3/21/04 for Patient #9 revealed skilled nursing frequency every 3 weeks but without Mention of its duration. A review of specific goals for Patient #9 revealed that pain would be controlled with decreased Tylenol, and that the Patient would be knowledgeable of comfort measures to decrease pain, However, a review of the medications APR-{8-2005(MON) = 12:10 UNITED HOME CARE Pb (FAX) 5617427594 PUYY/ UE revealed that the patient was not taking Tylenol. Also, a review of assessment and subsequent nursing notes revealed that the patient had no pain. In addition, the medication section did not include a dosage of Haldol Decanoate to be administered intramuscularly by the sN. 23. A review of the POC dated 1/31/04-3/30/04 for Patient #10 revealed an incomplete description of medication being administered via a Medtronic pump. According to locator 10 as it relates to medication, the medication was Baclofen 2000.0 UG 1M~L simple continuous 27.9 with route being documented as "thecal." However, a review of SN documentation revealed that the patient was receiving a continuous infusion of 35,4 ug /per hour of Baclofen as directed by the physician via intrathecal route. 24. The mandated date of correction was designated as April 25, 2004. 25. A follow-up survey was conducted on January 17, 2005. Based on record review and interview, it was determined that the agency failed to develop an individualized Plan of care that included all pertinent diagnoses and functional limitations in the plan of care for 2 out of is Sampled patients (#4, #8). The findings include the following: 26. Patient #4 was admitted to the agency on 12/24/04 with Giagnoses including gastrointestinal hemorrhage and diabetes mellitus. A review of a comprehensive start of care OASIS APR-{8-2005(HON) 12:41 UNITED HOWE CARE PB (PAK) 5617427594 PULU/DLS assessment completed by a xegistered nurse (who was also reported to be the patient's daughter) revealed that the patient had left eye cataract surgery on 12/20/04. This surgery waa unsuccessful and the patient was blind in the left eye. Further review of the comprehensive assessment (MO 390) as related to vision revealed that the patient's vision was severely impaired. In fact, the patient could not locate objects without hearing or touching them. A review of the Plan of care (POC) dated 12/24/04-2/21/05 revealed no diagnoses velated to recent unsuccessful cataract surgery and no evidence of any functional limitation related to vision, During an interview with the Director of Profession Services (DPS) on 1/26/05 at approximately 3:00 PM, it was agreed that pertinent diagnoses and functional limitations were omitted from this Poc for unknown reasona,. 27. A review of the Poc dated 1/6/05-3/6/05 for Patient #6 revealed diagnoses of gait abnormality, bronchopneumonia and herpes zoster. A review of the medication list revealed that as of 1/6/05 there were new cardiac medications listed to include Norvasc 5 mg daily and Atenolol 25 mg twice daily. A review of the start of care comprehensive assessment dated 1/6/05 revealed that the patient was treated for hypertension in hospitalization prior to start of home health care. During record review with the DPS, it wae reported that the diagnoses of hypertension 9 APR-(8-2005 (HON) 12:11 UNITED HOWE CARE PB (FAN}5 617427554 PULL/ULS should have been included on the POC as a pertinent diagnoses for home health services and that it was omitted for unknown reasons. 28. Based on the foregoing facts, United Home Care Services of Palm Beach violated Rule 59A-8.0215 (1), Florida Administrative Code, herein classified as a repeat Clase III deficiency, which carries, in this case, an assessed fine of $1,000.00 [two (2) patients x $500.00]. CLAIM FOR RELIEF WHEREFORE, the Agency requesta the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against United Home Care Services of Palm Beach on Counts I and II. 2, Assess against United Home Care Services of Palm Beach an administrative fine of $1,500.00 on Counts I and II for the violations cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. Grant such other relief as the court deems is just and proper on Counts I and II. 10 APR-{8-2005(WON) 2:11 UNITED HOME CARE PB (FAX) 5617427554 PULZ/ UL 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 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 Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #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 WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Agency for Health Care Administration 8355 N.W. 52 Terrace - #103 Miami, Florida 33166 305-470-6800 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive West Palm Beach, Florida 33407 (U.S. Mail) 11 APR-18-2005(WON) 12:12 UNITED HOWE CARE Pb (FAK)561 742754 PULS/08 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Home Health Agency Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Intexroffice 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 Tina Kae Peery, Administrator, United Home Care Services of Palm Beach, 2400 High Ridge Road, Boynton Beach, Florida 33426; Jose R. Fox, Registered Agent, 5255 N. W. 87 Avenue - Suite 400, Miami, Florida 33178 on this th day of , 2005.

Docket for Case No: 05-002101