2° STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE . ADMINISTRATION, Petitioner, AHCA No.: 2006001802 v. Return Receipt Requested: 7002 2410 0001 4234 8477 CARIDAD NURSE CARE, INC., d/b/a 7002 2410 0001 4234 8484 CARIDAD NURSE CARE, INC., Respondent. Ole - | | yx / ADMINISTRATIVE COMPLAINT NE COMES NOW the Agency for Health Care Administration (“AHCA"), by and through the undersigned counsel, and files this administrative complaint against Caridad Nurse Care, Inc., d/b/a Caridad Nurse Care, Ine (hereinafter “Caridad Nurse Care”), pursuant to Chapter 400, Part IV and Section 120.60, Florida Statutes, (2005), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the license of Caridad Nurse Care pursuant to Section 400.474, Florida Statutes, and 59A-8.0036(1) (c), Florida Administrative Code (2005). SURISDICTION AND VENUE 2. This Court has jurisdiction Pursuant to Sections 120.569 and 120.57 Florida Statutes, Chapter 28-106, Florida Administrative Code. Evil "AY dazs'eo 90 OT 4eH e° 3. Venue lies in Miami-Dade County pursuant to Section 120.57 Florida Statutes, 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 (2005) and Chapter 59~-a, Plorida Administrative Code. 5. Caridad Nurse Care operates a home health agency located at 175 Fontainebleau Boulevard, Suite 2G 11, Miami, Plorida 33172. Caridad Nurse Care is licensed as a home health agency unde: license number 21800096. Caridad Nurse Care was al: all 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 CARIDAD NURSE CARE FAILED TO PROVIDE HOME HEALTH SERVICES DIRECTLY TO AN INDIVIDUAL IN THE INDIVIDUAL‘S HOME OR PLACE OF RESIDENCE 400.462(8), Florida Statutes (HHA OPERATIONAL) 6. AHCA re-alleges and incorporates Paragraphs (1) through (5) as if fully set forth herein. 7. Based on record review and interview, it was determined that the facility failed to provide home health d4S'6O0 90 OT 42H gerd services to an individual in the individual's home or place of residence. . 8. An interview with the Director of Nurses (DON) on January 24, 2006 at 2:00 pm revealed that the HHA had one patient. Sample 1 of 1 patient medical record revealed that the start of care date was December 8, 2004, Per the visit sheet signed by the patient, the last date seen prior to the Survey was January 18, 2006. The medical record contained plan of care (poc) forms with the following certification periods: 12-8-04 thru 2-8-05, 2-9-05 thru 4-9-05, 4-10-05 thru 6-10-05, 6-11-05 thru 8-11-05, 8-12-05 thru 10-12-05, 10-13-05 thu 12-13-05, 12-14-05 thru 2-14-05, with orders for the discipline of skilled nursing. The medical record contained nursing supervisory evaluation of services for the following dates: 1-7-05, 1-21-05, 2-4-05, 2-18-05, 3-4-05, 4-11-05, 4-15-05, 4-15-05, 4-29-05, 5-13-05, 5-27-05, 6-10- 05, 6-24-05, 7-B8-Of, 7-14-05, 7-22-05, 6-5-05, 8-19-05, 9- 16-05, 9-30-05, 10-14-05, 10-18-05, 11-11-05, 12-9-05, 12- 24-05. Clinical record review for sample 1 of 1 patient lists the following dates: 2-7-05, 4-7-05, 6-6-05, §8-6-05, 10-7-05, and 12-02-05. 9. On January 25, 2006 at 3:36 pm the surveyor contacted the 1 sampled patient for an interview. The patient stated she does not speak English. On the same date and time, the patient was contacted by a second surveyor who das:e€0 90 OT 4FW spoke to che patient in Spanish. The surveyor asked the patient kim/her name, and the patient provided the information. When asked if he/she receives services from the HHA, the patient stated no, he/she does not know who they are. When asked if a nurse comes to his/her house, the patient stated no. When asked if he/she had ever received services fiom any HHA, or if anyone had ever been to his/her house, the patient stated no. When asked if he/she knew the DON, the patient stated no. When asked if his/her doctor had advised he/she would be receiving HHA services, the patient stated no. The surveyor asked the patient his/her name again, and had him/her to spell it. ‘The name is the Same as the patient's name on the poc, visit sheets, nursing Supervisory evaluation of services forms, and other documentaticn contained in the medical record. 10. Based on the foregoing Caridad Nurse Care violated S9A-8.0086(1)(c), Florida Administrative Code, and gives ground to the revocation of its license. CLAIM FOR RELIEF —— OEE WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in Favor of the Agency for Health Care Administration against Caridad Nurse Care on Count I. 2. Revoke the license of Caridad Nurse Care for the violation cited above. daSiteo 90 OT 4EW 3. Assess costs related to the investigation and prosecution of this matter, if the court finds costs applicable. . 4, Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2005). Specific options for administrative action are set out in the attached Blection 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. Nelson E. Rodney, Eqq. Assistant General Cbunsel Agency for Health Care Administration 8350 N. W. 52" Terrace Miami, Florida 33166 d4GteO 90 Of +e Copies furnished to: Harold Williams Field Office Manager Agency for Health Care Administration 8355 NW 53° Street Miami, Florida 33166 (Interoffice mail) Home Care Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE Sat SE Ce I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to: Miguel Jorge, Administrator, Caridad Nurse Care, Inc., 175 Fontainebleau Boulevard, Suite 2 G il, Miami, Florida 33172, and to Irma c. Garcia, Registered Agent, 3160 N.W. 3° -street, Miami, Florida 33125 on this g& day of Marck , 2006. Neison E. Rodney des'eo s0 OT 4e\q

Docket for Case No: 06-001132