STATE OF FLORIDA CS y AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCANO. 2005003361 SENIOR HOME CARE, INC. OS 2) { ~) 4 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, SENIOR HOME CARE, INC. (hereinafter “Respondent”) pursuant to Sections 120.569 and 120.57, Florida Statutes (2004), and as grounds therefore, alleges the following: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of one thousand dollars ($1000.00) against SENIOR HOME CARE, INC. pursuant to Sections 400.474(2)(a) and 400.484(2)(b), Florida Statutes (2004) based on one (1) uncorrected class III deficiency cited at a survey on or about March 7, 2005. 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 Respondent pursuant to Chapter 400, Part !V, 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, SENIOR HOME CARE, INC. was a home health agency located at 405 Commercial Court, Bidg. 3A, Suite C, Venice, FL 34292. 7. At all times material hereto, Respondent was licensed by the Agency to operate a home health agency in Sarasota County having been issued license number 299991620 by the Agency. 8. At all times relevant hereto, SENIOR HOME CARE, INC. 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. COUNT 1! THE AGENCY FAILED TO ENSURE THAT PATIENT CARE FOLLOWED THE PHYSICIANS’ PLAN OF TREATMENT, in violation of Rule 59A-8.0215(2), Florida Administrative Code (2004) and Section 400.487(2), Florida Statutes (2004) CLASS Ili DEFICIENCY 9. The Agency re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 40. Section 400.487(2), Florida Statutes (2004) states: When required by the provisions of chapter 464; part |, part Ill, or part V of chapter 468; or chapter 486, the attending physician for a patient who is to receive skilled care must establish treatment orders. The treatment orders must be signed by the physician within 30 days after the start of care and must be reviewed, as frequently as the patient's illness requires, by the physician in consultation with home health agency personnel that provide services to the patient. 41. Rule 59A-8.0215(2), Florida Administrative Code (2004) reads: Home health agency staff must follow the physician’s treatment orders that are contained in the plan of care. If the orders cannot be followed and must be altered in some way, the patient's physician must be notified and must approve of the change. Any verbal changes are put in writing and signed and dated with the date of receipt by the nurse or therapist who talked with the physician’s office. 42. Ina survey conducted on or about March 7, 2005, the following deficiency in violation of the preceding two provisions was found by agency surveyors: 302 Based on review for 5 clinical patient records, the agency failed to follow the plan of treatment and ensure 2 (#26 and #27) sampled patients received services as ordered by the attending physician. The findings include: 4. Patient #26 was admitted to the agency on 2/14/05. Per the plan of treatment (POT), skilled nursing was to "instruct the patient to use an incentive spirometer 4x day for 10 reps." The only documentation in the clinical record is dated 2/17/05 with no evaluation of patient's competency recorded. There is no documentation of teaching having been completed at start of care or after 2/17/05. Physician's telephone order dated 2/21/05 stated "at each visit the Home Health Aide (HHA) to assist with bathing, oral hygiene, dressing and activities of daily living." The HHA care plan prepared by the registered nurse provided this care on an "as needed" basis rather than at each visit per physician's order. 2. Patient #27 was admitted to the agency with 2/24/05 as a start of care date. Per the POT, skilled nursing was to provide wound/incision care and perform wound care as follows, "Patient to wash incision daily with antibiotic soap and water and apply dry sterile dressing and tape as needed for drainage only." There is no documentation in the clinical record of the patient having been taught wound care or any evaluation of the patient's competency in performing this procedure. 13. | This was an uncorrected deficiency as, on or about January 10-13, 2005, Agency surveyors conducted a review of patient records which also revealed the following: Based on a review of 13 clinical records, the agency failed to notify the physician in 2 cases of changes in the status of the patient (#4 & 6). Care did not follow the plan of treatment in 4 instances (#3, 7, 8, & 14). The findings include: 4. Patient #4 was admitted to the agency on 11/13/04 following a Cardiovascular Accident. Due to the severity of the CVA, the patient required the services of nursing, physical therapy, occupational therapy, speech therapy and a home health aide for personal care services. On 11/17/04, the nurse documented that the patient had fallen the prior day and that the spouse had to call 911 to help get him up. No apparent injuries were noted and the patient was not taken to the hospital for further evaluation. The physician was not notified of the fall. On 12/23/04, the physical therapist saw the patient and noted that the patient had been taken to the emergency room 2 nights prior for vertigo and constipation. The patient reported having vertigo during the therapist's visit and seemed "slightly depressed.” The clinical record lacked evidence that the physician was notified. 2. Patient #6 was admitted to the agency on 12/3/04 with the primary diagnosis of Drug Abuse. The history given in the clinical record showed that the spouse had been the primary caregiver, however, due to a recent stroke, was in a rehabilitation center. Various family members who did not live locally continued care. It was also documented that the patient's blood sugars had been running in the 140's. On 12/4/04, the nurse documented 2 blood sugars, 543 and 477. The nurse continued to see he patient in the home and recorded the following blood sugars, 12/7104-264, 12/10/04-77, 42/13/04-426, and 12/15/04-351. It could not be seen that the nurse ever notified the physician of any of these elevated blood sugars. 3. Patient #3 was admitted to the agency on 10/6/04, for diagnoses that included decubitus ulcer buttocks, paraplegia, and protein-calorie malnutrition. Per the POT (Plan of Treatment) dated 12/5/04, nursing was to see this patient 3 times per week for 2 weeks. The POT had orders for skilled nursing to cleanse buttock wound with normal saline, pat dry, pack with foam, use skin prep around wound, and apply wound vac. Documentation in the nursing clinical note for 12/6/04 and 12/8/04 revealed the nurse used adaptic dressing to edge of wound. There was no physician's order in the POT for skilled nursing to apply this wound dressing. 4. Patient #7 was admitted to the agency on 11/13/04 with physician orders for Skilled nursing, Physical Therapy, Occupational Therapy, Speech Therapy, a Home Health Aide, and a Medical Social Service Worker. Per the POT (Plan of Treatment), the physical therapist was to see the patient 3 times a week for 4 weeks, effective 11/16. The physical therapist saw the patient on 11/15/04 for an evaluation. There was no order for that visit. Between 11/16/04 and 12/5/04, the therapist only saw the patient twice a week. During the 4th week of service, the physical therapist saw the patient 3 times. On 12/9/04, a new order was received from the physician that instructed the therapist to continue to treat the patient 3 times a week for another 4 weeks effective 42/13/04. During the weeks of 12/13/04 and 12/20/04, the physical therapist only saw the patient twice a week. The Occupational therapist was to see the patient for an evaluation. The OT did not see this patient until 11/22/04 (9 days after the start of care). The OT then proceeded to see the patient 3 times a week for the next 4 weeks without the benefit of physician's orders. On 12/13/04, the OT received orders to continue services 3 times a week for 3 weeks and 1 time a week for 1 week (from 12/20/04 thru 1/11/05). 5. Patient #8 most recent recertification date is 12/19/04. The patient was being seen for an open wound to the right leg. Physician orders included applying antibiotic cream to the wound. Observation during a home visit on 1/11/05 revealed the nurse applied antibiotic ointment instead of the cream. 6. Patient #14 was admitted to the agency on 12/19/04 for nursing and personal care services. The patient was noted to be Oxygen dependent and the orders on the POT included orders for the nurse to do a daily pulse ox (the patient was to be seen daily by the nurse for 11 days) on the patient and titrate the Oxygen liters according to the pulse ox results when it was tested. On the day of admission the pulse ox reading was 88%. The clinical record contained no visit not for 12/26/04 or any reason for the missed visit. The patient was seen the next day but no Pulse ox reading was documented for that date. 14. The original mandated correction date for this deficiency was February 6, 2005. This date of correction was not met as indicated by paragraph 12 above. 45. This is characterized as an uncorrected class III deficiency for which an administrative fine in the amount of five hundred dollars ($500.00) for each patient impacted is appropriate pursuant to Section 400.484(2)(c), Florida Statutes (2004). As two patients were impacted, the total fine comes to one thousand dollars ($1000.00). 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 of one thousand dollars ($1000.00) for Count | against Respondent, 3) Enter whatever other relief as this court deems just and appropriate. 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 (2004). 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. RESPONDENT 1S 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 RESPONDENT, 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 Oo day of April, 2005 Respondent’s Counsel Assistant General Counsel Agency For Health Care Administration 2295 Victoria Avenue, Room 346C Fort Myers, FL 33901-3884 (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 # 7004 1160 0002 9084 \1099) to Julie Odenweller, Administrator, SENIOR HOME CARE, INC., 405 Commercial Court, Bldg. 3A, Suite C, Venice, FL 34292 on this day of April, 2005. oe tow ba JOAN FOWLER STATE OF FLORIDA /, fA AGENCY FOR HEALTH CARE ADMINISTRATION 4 aon 4 “4 g EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES (To be used with Election of Rights for Administrative Complaint) In response to the allegations set forth in the Administrative Complaint issued by the Agency for Health Care Administration (“AHCA” or “Agency’), Respondent must make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint and your Election of Rights in this matter must be received by AHCA within twenty- one (21) days from the date you receive the Administrative Complaint. Please make your election of the attached Election of Rights form and return it fully executed to the address listed on the form. OPTION 1. _ If Respondent does not dispute the allegations in the Administrative Complaint and Respondent elects to waive the right to be heard, Respondent should select OPTION 1 on the election of rights form. A final order will be entered setting forth the allegations as being deemed admitted and imposing the penalty sought in the Administrative Complaint. You will be provided a copy of the final order. OPTION 2. If Respondent does not dispute any material fact alleged in the Administrative Complaint (Respondent admits all the material facts alleged in the Administrative Complaint.), Respondent may request an informal hearing pursuant to Section 120.57(2), Florida Statutes before the Agency. At the informal hearing, Respondent will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, Respondent should select OPTION 2 on the Election of Rights form. OPTION 3. __If the Respondent disputes the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal hearing, Respondent should select OPTION 3 on the Election of Rights form. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., 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 disputed. If you select Option 3, mediation may be available in this case pursuant to Section 120.573, Florida Statutes, if all parties agree to it. PLEASE CAREFULLY READ THE FOLLOWING PARAGRAPH: In order to preserve the 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. 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Docket for Case No: 05-002158