STATE OF FLORIDA EEF pm AGENCY FOR HEALTH CARE ADMINISTRATION Gy “6 STATE OF FLORIDA Dvr FH y, AGENCY FOR HEALTH Oi ISOM oye CARE ADMINISTRATION, iedaTearh Hog VE Petitioner, Case No.: 2006001432 vs. SENIOR HOME CARE, INC., a) (e- Od Y& Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against, Senior Home Care, Inc. (hereinafter “Respondent”), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of three thousand dollars ($3,000.00) pursuant to §§ 400.474(2)(a) and 400.484 (2)(b), Fla. Stat. (2005), for three cited State Class II deficiencies. JURISDICTION AND VENUE 1. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part IV, Florida Statutes, (2005). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the enforcing authority with regard to Home Health Agencies pursuant to Chapter 400, Part IV, Florida Statutes (2005) and Rules 59A-8, Florida Administrative Code. 4. Respondent is a Home Health Agency (hereinafter HHA) located at 6748 Gall Boulevard, Suite 110, Zephyrhills, Florida 33542, having been issued license number 299992124. 5. Respondent was at all times material hereto, licensed under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. 6. Pursuant to Section 400.462(2), Fla. Stat. (2005), “Admission” means a decision by the home health agency, during or after an evaluation visit to the patient’s home, that there is reasonable expectation that the patient’s medical, nursing, and social needs for skilled care can be adequately met by the agency in the patient’s place of residence. Admission includes completion of an agreement with the patient or the patient’s legal representative to provide home health services as required in Section 400.487(1), Fla. Stat. COUNT I 7. The Agency re-alleges and incorporates paragraph (1) through (6) as if fully set forth herein. 8. Pursuant to Fla. Admin. Code R. 59A-8.0095(3)(a), (2005), a registered nurse shall be the case manager in all cases involving nursing or both nursing and therapy care, be responsible for the clinical record for each patient receiving nursing care and assure that progress reports are made to the physician for patients receiving nursing services when the patient’s condition changes or there are deviations from the plan of care. 9. On or about 01/03/06, the Agency conducted a complaint investigation (CCR #2005009557) at Respondent’s facility. 10. Based on clinical record review and interview, for one of three patients reviewed, Respondent's nurses failed to assure case management oversight by not conducting ongoing pain assessments for a patient with deteriorating decubitus ulcers; failed to communicate clinical findings to the physician and Respondent's administration regarding the inability to carry out physician's orders for wound care, and; failed to communicate with the Respondent's administration when it became clear that a patient's nursing care needs could not be met at the place of residence, an assisted living facility (Patient # 1). 11. Closed record review revealed that Patient # 1 was admitted by the Respondent for physical therapy per the plan of treatment, dated 07/13/05. 12. A Physician’s Modification Order Confirmation (PMOC), dated 07/20/05 (relative to wound care), indicated: “Effective 07/21/05, skilled nurse (SN) to visit to assess Decubitus ulcers R buttock and perform wound care as follows: cleanse wounds on buttocks with normal saline, pat dry, apply Duoderm once a week for one week, and three times per week for three weeks.” 13. A Skilled Nursing Clinical Note (SNCN), dated 07/21/05, for the initial nursing evaluation contained the following documentation pertaining to wound care: “SN assessed vital signs and integumentary status. Cleansed b/I (? bilateral) buttock wounds with normal saline, applied Duoderm and secured with Mefix. Lg, st. 3 with necrosis to ri ght, smaller st. 2's to right and left buttocks.” 14, The assessment did not include temperature measurement as part of vital signs, pain assessment, or wound care assessment in the form of appearance, color, drainage, and size. No wound measurements were documented. 15. The section devoted to wound/pressure sores location on the SNCN was not completed. 16. _ In the section of the SNCN denoting communication, nothing was documented that the nurse communicated the findings of the assessment to a supervisor, in light of the presence of a stage IIT Decubitus ulcer with necrosis. 17. ASNCN, dated 07/23/05, indicated under "comments:" “Pt. with multiple open wounds, #1 is 5.5 em x 3 cm x 3 cm with necrotic center.” 18. The wound identification graph was completed, identifying five wounds, four on the buttocks and one of the right lower extremity posterior calf area. 19. Four of the wounds were identified as follows: Wound # 1 is measured at 5.5 centimeters (cm) long, 3 cm wide and unknown depth due to necrosis, with a large amount of foul smelling drainage and indicated that the dressing was urine saturated; Wound # 2, Wound # 3, and Wound # 4 were measured ranging from 2 to 3.5 cm long, 2 to 3 cm wide, depth of 0.2 cm; all described the wound bed as red, surrounding tissue as red, all with a moderate amount of red drainage. 20. Under the section, “Progress toward goals/plan,” it was documented that all wounds open and draining and to continue wound care as indicated. 21. Under the section denoting, “Communications,” nothing was documented that indicated that the nurse who performed this assessment notified the supervising nurse or physician. 22, ‘There was no evidence that the nurse performed a pain assessment. 23. Review of the patient's medication of 07/13/05, revealed that the patient was taking only one medication, Depakote. There was no evidence of a medication requirement being performed. 24, ASNCN, dated 07/25/05, revealed that Wound # 1, "had extended significantly to 9 cm x 4.5 cm necrotic area, 2.5 cm x 2.5 cm open area on top of necrotic area and 2 cm x 2 cm open area at bottom of necrotic area. Red area to right of necrotic area 2 x 2.cm. Duoderm to left buttock, back of right leg and under right buttock changed. Pt. was incontinent of urine and small amount of stool. Changed (adult brief) and ICG (instructed caregiver) to avoid keeping pt. in any one position longer than one hour." 25. The nursing assessment did not include a temperature measurement or a pain assessment. 26. ‘The patient was designated as confused, forgetful, and incontinent. 27. Under “Communications,” it was noted that a supervisor had been notified. 28. Review of the patient's clinical record did not contain any further indication of care coordination among the Respondent's staff had been performed to discuss the deterioration in the patient's wounds. 29. A “Missed Treatment/Visit” document, dated 07/27/05, and completed by a licensed practical nurse (LPN), indicated that a missed scheduled appointment was due to, “ARNP in attendance, debriding wounds and doing txs (treatments). Office notified." This procedure was performed in the ALF and should have been referred for hi gher level care. 30. On the same date, a PMOC specified "effective 07/28/05 SN to visit four times per week for the current week, and seven times per week for four weeks to perform wound care. Cleanse wounds on coccyx and right ischium with normal saline or wound cleanser, apply Accuzyme when available to wounds on right coccyx and right ischium. Cleanse wounds left side of coccyx with normal saline, pat dry, apply Duoderm, change q 3 days. Goals: wound beds will be clean and granulation tissue will be evident within 4 weeks without signs/symptoms of infection." 31. There was no documentation that indicated the patient was seen on 07/28/05. 32. ASNCN, dated 07/29/05, detailed the following, “SN used aseptic technique to perform wound care to pts. coccyx. Large amt. of foul odor noted, pt. was lying in urine and stool soaked diaper.” This procedure was performed in the ALF and should have been referred for higher level care. 33. The “Progress toward goals/plan," indicated that "Wound coccyx necrotic, SN to continue wound care." This visit note failed to indicate if the wounds were measured following a debridement on 07/27/05. There was no pain evaluation, and no communication was made with the supervising physician or nurse. The leg wound was not addressed. 34. ASNCN, dated 07/30/05, indicated under "Comments," “On arrival to pts. home pt. lying in urine and stool soaked diaper-foul odor from pt. SN removed old Duoderm, large amt. of foul odor noted. Duoderm applied, Accuzyme not in home. Caregiver stated, “I don’t know when it will be here.” 35. | Under "Progress Toward Goals/plan," “No change in wound status. SN continue wound care Accuzyme not in home yet.” 36. The “Communications” section was slashed through, indicating that the supervising physician or nurse was not contacted regarding the unavailability of Accuzyme, and a pain assessment was not performed. 37. ASNCN, dated 07/31/05 at 11:30 a.m., revealed that the coccyx wound was measured at 13.5 cm by 7.5 cm. This was the first measurement since the debridement took place on 07/27/05. The note indicated there was a large necrotic area, but was not specified. There was an old dressing saturated with foul odor drainage. Family has not provided Accuzyme per staff. 38. The “Communications” section was completed stating: "7 p.m. to [doctor], return call by [doctor], pt. to be sent to hospital." 39. Under “Progress toward goals/plan, “Spoke with [doctor], pt. to be transferred to hospital today, [ALF employee] at facility notified that pt. must go today per MD orders.” This was the first documented communication that could be found in the clinical record. 40. The Agency determined that the Respondent had by act, omission, or practice directly and adversely affected the health, safety, or security of a patient and cited this deficient practice as a State Class II deficiency. 41. Respondent was provided a mandated correction date of 02/03/06. WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand dollars ($1,000.00) for the State Class II deficiency as authorized under §§ 400.484(2)(b) and 400.474(2)(a), Fla. Stat. (2005). COUNT II 42. The Agency re-alleges and incorporates paragraph (1) through (6) as if fully set forth herein. 43. Pursuant to Fla. Admin. Code R. 59A-8.0095(6)(b), (2005), in relevant part, the responsibilities of the physical therapist are: a. To observe and record activities and findings in the clinical record and report to the physician the patient’s reaction to treatment and any changes in patient’s condition, or when there are deviations from the plan of care; b. To instruct the patient and caregiver in care and use of physical therapy devices; and c. To instruct the caregiver on the patient’s total physical therapy program. 44, On or about 01/03/06, the Agency conducted a complaint investigation (CCR #2005009557) at Respondent’s facility. 45. Based on clinical record review and interview, the Respondent failed to assure that physical therapy clinical notes accurately reflected the patient's health status; failed to assess the appropriateness of ongoing physical therapy (PT) services, and failed to assure that physical therapy visit notes contained relevant patient interventions and patient responses to therapy for two of three patients reviewed (Patient # 1 and Patient # 2). 46. The Respondent received a referral from an employee of the assisted living facility (ALF) where Patient # 1 resided, dated 07/07/05, for a PT Evaluation and treat for abnormality of gait, if necessary. 47, The patient was admitted and evaluated by the Respondent on 07/13/05, six days after receiving the referral from the ALF, with a principle diagnosis of Physical Therapy NEC (Not elsewhere classified). 48. On the plan of treatment, Patient #.1, 85 years old, had other pertinent diagnoses listed of Abnormality of Gait, and Fall NOS (not otherwise specified). 49. Review of the Outcome Assessment and Information Set (OASIS) completed by the physical therapist revealed the following assessment of the patient’s function by “MO locator”: a. MO370: Receives assistance from the primary caregiver several times during day and night. b. MO380: The type of primary caregiver assistance includes: ADL assistance (bathing, dressing, toileting, bowel/bladder, eating/feeding); IADL assistance (meds, meals, housekeeping, laundry, etc.); environmental support, psychosocial support; advocates or facilitates patient’s participation in appropriate medical care; financial agent; health care agent. c. MO410: Minimal difficulty in expressing ideas and needs. d. M0440: Pt has no skin lesion or open wound. e. MO520: No urinary incontinence or urinary catheter f. MO530: (When does urinary incontinence occur?) Timed-voiding defers incontinence. g. MOS40: Very rarely or never has bowel incontinence. h. MO560: Requires assistance and some direction in specific situations. i. MO610: (Behaviors Demonstrated at least once a week?) Is marked “2” indicating impaired decision making; failure to perform usual ADL’s or IADLS, inability to appropriately stop activities, jeopardizes safety through action. Then, “7” is also marked, indicating that none of the above behaviors demonstrated, contradicting the above response. 50. Review of the PT Evaluation, dated 07/13/05, revealed under comments: “Patient informed of start of care/duration/frequency, goals and discharge plans. Pt. fell last night. Tripped over (? illegible) with laceration to right buttocks.” 51. This contradicts the OASIS assessment finding under MO440, indicating no skin lesion or open wound. 52. As aresult of the PT assessment, the following orders for PT were obtained: "PT to visit three times per week for four weeks, as reflected on the POT to perform therapeutic exercises, instruct in transfer training, gait training with assistive device, establish and instruct in home exercise program, perform pulmonary physical therapy." 53. Further review of the subsequent clinical visit notes revealed that the PT visits on July 15, 16, 18, 19, 23, 29 and 30, were conducted by a physical therapy assistant (PTA), who made no further mention of the buttocks laceration, or any reference to the worsening wounds and positioning needs of the patient as a response to the decubitus ulcers, or coordination of care with skilled nursing. 54. This documentation was all but illegible on many of the notes, especially under “Patient/Caregiver Instruction” and “Patient/Caregiver Response to Instruction” sections of the notes. 55. The PT saw the patient on 07/27/05. Review of these notes, compared with the skilled nursing notes revealed incongruence in patient assessment, and failed to acknowledge the patient’s functional and cognitive decline as the certification period progressed. 56. Interview with the Administrator on 01/03/06 confirmed the observations. 57. Clinical record review of three successive admissions of Patient # 2. revealed that the patient, an 87 year old resident of an assisted living facility, received physical therapy on three admissions for certification episodes 08/20/2005 through 09/22/2005 (nursing care for a skin tear and physical therapy), 10/04/2005 through 11/30/2005 (physical therapy and urinary tract infection), and 12/13/2005 to present, per the OASIS assessments of the above dates. 58. The comprehensive adult nursing assessment with OASIS elements, dated 10/04/05 and 12/13/05, for the second and third admissions revealed the following observations: a. M0220: Conditions prior to medical or treatment regimen change: Urinary incontinence, impaired decision making and memory loss to the extent that supervision is required. b. M0290: High Risk Factors: Obesity c. MO410: Speech/Oral Expression: Expresses simple ideas or needs with moderate difficulty. d. M0520, 530, and 540: Genitourinary: the patient is incontinent of urine during the day and night, and is incontinent of bowel daily. e. MO560: Neuro/Emotional/Behavior Status: Requires considerable assistance in routine situations. Is not alert and oriented or is unable to shift attention and recall directions more than half the time. f. Locator # 19 indicates the patient is disoriented. g. MOS570 Patient is constantly confused. h. MO580 Patient is anxious daily but not constantly. i, MO610 indicates that 1) Memory deficit: failure to recognize familiar persons/places, inability to recall events of past 24 hours, significant memory loss so that supervision is required; and 2) impaired decision- making: failure to perform usual ADL 's or Idles, inability to appropriately stop activities, jeopardizes safety through action. j. Locator # 188 indicated that "activities permitted: wheelchair, up with caution." k. Additional notes on skilled care provided this visit: "SN assessed pt. Instructed patient on safety-poor attention span-pt. confused..." 59. Review of the two discharge OASIS assessments conducted by the physical therapist, dated 09/22/05 and 12/02/05, revealed the following contradictions with the initial comprehensive nursing assessment: a. M0220: Conditions prior to medical or treatment regimen change: None of the above, (The nurse assessed pt. with urinary incontinence, impaired decision making and memory loss to the extent that supervision is required.) b. M0290: High Risk Factors: None of the above. (Nurse marked Obesity) c. MO410: Speech/Oral Expression: “0”-Expresses complex ideas, feelings, and needs clearly, completely, and easily in all situations with no observable impairment (Nurse marked #2, Expresses simple ideas or needs with moderate difficulty.) d. MO520, 530, and 540: Genitourinary: The physical therapist identified the patient as having no urinary incontinence; timed voiding defers incontinence, and very rarely or never has bowel incontinence. (Nursing identified that the patient is incontinent of urine during the day and night, and is incontinent of bowel daily.) e. MO560: Neuro/Emotional/Behavior Status: The physical therapist indicated “O”-alert and oriented, able to focus and shift attention, comprehends and recalls task directions independently. (The nurse: Requires considerable assistance in routine situations. Is not alert and oriented or is unable to shift attention and recall directions more than half the time. f. MO570 “0”-The patient is never confused. (Nurse: Patient is constantly confused) g. MO580 “0”-The patient is anxious none of the time. (Nurse: Patient is anxious daily but not constantly.) h. MO610 “0”-No behaviors are demonstrated at least once a week, reported or observed. (Nurse: indicates that 1) Memory deficit: failure to recognize familiar persons/places, inability to recall events of past 24 hours, significant memory loss so that supervision is required; and 2) impaired decision-making: failure to perform usual ADL 's or Idles, inability to appropriately stop activities, jeopardizes safety through action. 60. The discharge OASIS completed by the physical therapist made the same contradictory assessments of the patient as above on both discharges on 10/04/05 and 12/13/05. 61. Further review of the physical therapy evaluations and treatment episodes revealed that each re-admission took place less than two weeks after the patient was discharged from the home health agency after receiving physical therapy. 62. Review of the discharge summaries, dated 09/22/05 and 11/30/05, documented that patient-centered goals were achieved. 63. A third referral from the ALF, dated 12/12/05, revealed that the patient fell, and was requesting another round of physical therapy. 64. | The comprehensive adult nursing assessment with OASIS elements, dated 10/04/05 and 12/13/05, for the second and third admissions revealed the following observations: a. Risk Factors: Obesity b. MO520, 530, and 540: Genitourinary: the patient is incontinent of urine during the day and night, and is incontinent of bowel daily. c. M0560: Neuro/Emotional/Behavior Status: Requires considerable assistance in routine situations. Is not alert and oriented or is unable to shift attention and recall directions more than half the time. d. Locator # 19 indicates the patient is disoriented, e. MO570 Patient is constantly confused f M0610 indicates that 1) Memory deficit: failure to recognize familiar persons/places, inability to recall events of past 24 hours, significant memory loss so that supervision is required; and 2) impaired decision- making: failure to perform usual ADL 's or IADL's, inability to appropriately stop activities, jeopardizes safety through action. g. Locator # 188 indicated that "activities permitted: wheelchair, up with caution." 65. ‘In view of the above level of cognitive and physical functioning, upon the third referral from an employee of the ALF, the Respondent failed to determine if the patient's fall was due to lack of supervision/confusion, rather than weakness, a chronic condition of the wheelchair bound patient. 66. ‘In the two prior admissions, physical therapy notes consistently documented that the caregiver (ALF staff) was educated on the home exercise program. 67. Review of the PT evaluation, dated 12/13/05, failed to discover an evaluation of the implementation of the home exercise program by ALF staff. 68. An interview with the Director of Nursing (DON), revealed that if an assisted living facility requests a PT evaluation, PT should be done in accordance with that evaluation. 69. The Agency determined that the Respondent had by act, omission, or practice directly and/or adversely affected the health, safety, or security of a patient and cited this deficient practice as a State Class II deficiency. 70. Respondent was provided a mandated correction date of 02/03/06. WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand dollars ($1,000.00) for the State Class II deficiency as authorized under §§ 400.484(2)(b) and 400.474(2)(a), Fla. Stat. (2005). COUNT III 71. The Agency re-alleges and incorporates paragraph (1) through (6) as if fully set forth herein. 72. Pursuant to Fla. Admin. Code R. 59A-8.020(1), when a home health agency accepts a patient or client for service, there shall be a reasonable expectation that the services can be provided safely to the patient or client in the client's place of residence. This includes being able to communicate with the patient, or with another person designated by the patient, either through a staff person or interpreter that speaks the same language, or through teclmology that translates so that the services can be provided. The responsibility of the agency is also to assure that the patient or client receives services as defined in a specific plan of care, for those patients receiving care under a physician’s treatment orders, or in a written agreement, for clients receiving care without a physician’s orders. This responsibility includes assuring the patient receives all assigned visits. 73. On or about 01/03/06, the Agency conducted a complaint investigation (CCR #2005009557) at Respondent’s facility. 74. Based on clinical record review and interview, the Respondent failed to inform the physician that home care intervention could not meet the patient's nursing and medical needs relative to decubitus ulcer care needs in the patient's current place of residence, an ALF, for one of three patient records reviewed (Patient # 1); and repeatedly admitted a resident of an ALF for successive physical therapy episodes when the efficacy of further therapy was not evident (Patient # 2). 75. Clinical record review of Patient # 1 revealed that the Respondent received a referral, dated 07/07/05, from an employee of the assisted living facility where the patient resided for PT evaluation, and treat for abnormality of gait. 76. The patient was admitted and evaluated by the Respondent on 07/13/05, six days after receiving the referral from the ALF, per the Home Health Certification and Plan of Treatment (POT) dated 07/13/05, with a principle diagnosis of Physical Therapy NEC (Not elsewhere classified). 77. Other pertinent diagnoses were listed as Abnormality of Gait, and Fall NOS (not otherwise specified). 7B. The Physical Therapy Initial Evaluation included documentation that the “....Pt. fell last night. Tripped over (? illegible) with laceration to right buttocks.” 79. There was no information in the clinical record that the physical therapist informed the Respondent's care supervisors that the patient had a buttocks laceration for coordination of care purposes, and to determine if a nurse should evaluate the patient for wound care. 80. The agency received another referral from a nurse practitioner, on 07/20/05, for Patient # 1, for “wound care, stage III right buttock, stage I right buttock.” 81. Review of a SNCN, dated 07/21/05, for the initial nursing evaluation contained the following documentation pertaining to wound care: “SN assessed vital signs and integumentary status. Cleansed b/l (? bilateral) buttock wounds with normal saline, applied Duoderm and secured with Mefix. Lg. st.'3 with necrosis to right, smaller st. 2’s to right and left buttocks.” 82. In the space devoted to wound/pressure sores on the Skilled Nurse Clinical Note, where the nurse is instructed to, “Denote location of wound/pressure sores”, the section was not completed in any way. 83. Further, in the section denoting communication, nothing was documented that the nurse communicated the findings of the assessment to a supervisor, in light of the presence of a stage IL decubitus ulcer with necrosis in a patient who resides in an ALF. 84. On the next SNCN, dated 07/23/05, the following was documented: “Pt. with multiple open wounds, #1 is 5.5 cm x 3 cm x 3 cm with necrotic center. All wounds cleansed with normal saline, pat dry, Duoderm applied, secured with Mefix. Instructed caregivers on repositioning and keeping dressing clean, dry and intact. Caregivers receptive to care. Wound #1 waiting a response from (ARNP) for debridement.” 85. | The wound identification graph was completed, which identified five wounds, four on the butiocks and one of the right lower extremity posterior calf area. 86. Four of the wounds were identified as follows: Wound # 1 is measured at 5.5 centimeters (cm) long, 3 cm wide, and unknown depth due to necrosis, with a large amount of foul smelling drainage and indicated that the dressing was urine saturated; Wound # 2, Wound # 3, and Wound # 4 were measured ranging from 2 to 3.5 cm long, 2 to 3 cm wide, depth of 0.2 cm. All wounds were described as the wound bed being red with the surrounding tissue as red and all had a moderate amt. of red drainage. 87. Under the section “Progress toward goals/plan” the nurse documented that all wounds open and draining, continue wound care as indicated. 88. Under the section denoting “Communications” nothing was documented that indicated that the nurse who performed this assessment notified the supervising nurse or physician. 89. There was no evidence that the nurse performed a pain assessment, and review of the medication regimen review (07/13/05) revealed that the patient was taking only one medication; Depakote. 90. A SNCN, dated 07/25/05, revealed that the right buttock wound extended to “9 cm x 4.5 cm necrotic area. 2.5 cm x 2.5 cm open area on top of necrotic area and 2 cm x 2 cm open area at bottom of necrotic area. Red area to right of necrotic area 2 x 2 cm....Pt. was incontinent of urine and small amount of stool. Changed Depends. Instructed caregiver to avoid keeping pt. in any one position longer than one hour. Verbalizes understanding.” Appearance of the other four wounds was not mentioned. The nurse had marked that the supervisor was notified, but there was no pain assessment and temperature had not been taken. 91. | There was no other documentation in the record regarding the outcome of the communication with the supervisor. 92. . SS CJ Addresses | if YES, enter delivery address below: No bh 1 » Senica Type \G3u5 LLS 19 Nu Tul Ay Re eee ji Cl Registered C7 Retum Receipt for Merchandise i O insured Mai Th cop: t : a so th t We can return the card to ou. Fo aes W Attach this conte the back of the, matiplece, Ries cen Ef eRefo of Dein oClean, © e, KD. WES. e “G t . C| Corwveden f{. ; 337, 2} 4. Restricted Delivery? Extra Foe) O Yes } OF on the front if space permits, . url} way (| ; i c ob AQent- | Reo Oster atk 2. Article Numba: ? ; é Tai OO5 4ieo 0002 a254 7873 p LOC Wg | PS Form 3811, Fp 102596-02.M1540

Docket for Case No: 06-002386

Issue Date	Proceedings
Dec. 04, 2006	Final Order filed.
Sep. 21, 2006	Order Closing File. CASE CLOSED.
Sep. 20, 2006	Notice of Appearance (filed by T. Walsh II).
Sep. 20, 2006	Motion to Relinquish Jurisdiction filed.
Jul. 21, 2006	Order of Pre-hearing Instructions.
Jul. 21, 2006	Notice of Hearing (hearing set for October 5, 2006; 9:00 a.m.; Venice, FL).
Jul. 13, 2006	Joint Response to Initial Order filed.
Jul. 07, 2006	Initial Order.
Jul. 06, 2006	Administrative Complaint filed.
Jul. 06, 2006	Request for Formal Administrative Hearing filed.
Jul. 06, 2006	Notice (of Agency referral) filed.