STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, Mii isp HOF AGENCY FOR HEALTH CARE HEAP OLIVE ADMINISTRATION, wae Petitioner, , vs. . AHCANO. 2006004324 D & N HOME HEALTH SERVICES, INC. d/b/a D & N HOME HEALTH SERVICES, INC., a G . 20 26) Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (‘AHCA"), by and through its undersigned counsel, and files this Administrative Complaint against D & N HOME HEALTH SERVICES, INC. d/b/a D & N HOME HEALTH SERVICES, INC. (“Respondent”) pursuant to Sections 120.569 and 120.57, Florida Statutes (2005), and as grounds therefore, alleges the following: ( NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the total amount of sixty-one thousand dollars ($61,000.00) against D & N HOME HEALTH SERVICES, INC. pursuant to Sections 400.474(2)(a) and 400.484(2)(a) and (b), Florida Statutes (2005) based on one (1) class | deficiency and two (2) class || deficiencies cited at a complaint survey conducted on or about March 30, 2006. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2005). 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400, Part IV, Florida Statutes (2005), and Chapter 59A-8, Florida Administrative Code (2005). 4, Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2005). PARTIES 5. Pursuant to Chapter 400, Part IV, Florida Statutes, and Chapter 59A-8, Florida Administrative Code, AHCA is the regulatory agency responsible for the licensure of 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, D & N HOME HEALTH SERVICES, INC. was a home health agency located at 3750 West 16" Ave., Suite 132U, Hialeah, FL 33012. At all times material hereto, Respondent was licensed by AHCA to operate a home health agency in Dade County having been issued license number 299992019 by the Agency. 7. At all times material hereto, D & N HOME HEALTH SERVICES, INC. is and was a licensed home health agency required to comply with Chapter 400, Part IV, Florida Statutes (2005), and Chapter 59A-8, Florida Administrative Code (2005). COUNT | THE AGENCY FAILED TO SUPERVISE ITS PERSONNEL AND ALLOWED UNQUALIFIED PERSONNEL TO PERFORM MEDICAL SERVICES, in violation of Rule 59A-8,0095(3), Florida Administrative Code (2005) CLASS | DEFICIENCY ‘8. The Agency re-alleges and incorporates by reference paragraphs one (1) through seven (7) above as if fully set forth herein. 9. Rule 59A-8.0095(3), Florida Administrative Code (2005) provides: 59A-8,0095 Personnel. (3) Registered Nurse. (a) A registered nurse shall be currently licensed in the state, pursuant to Chapter 464, F.S., and: 1. Be the case manager in all cases involving nursing or both nursing and therapy care. 2. Be responsible for the clinical record for each patient receiving nursing care; and 3. 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. (b) A registered nurse may assign selected portions of patient care to licensed practical nurses and home health aides but always retains the full responsibility for the care given and for making supervisory visits to the patient's home. 10. This rule was not followed as evidenced by the survey conducted on or about March 30, 2006. . Based on record review and interview the Director of Nurses failed to provide appropriate supervision of home care services by an agency RN for 10 of 10 sampled patients; the Director of Nurses failed to assign patient care to qualified personnel. The findings include: , Clinical record review of sampled patient #1, #7, #8, #9 and #10 revealed that supervisory visits were done; however they were conducted by employee #1 who is an office clerk and not a Registered Nurse (RN) or a Licensed Healthcare Professional from the State of Florida. The name of the employees being supervised was not identified in the reports; therefore it was unclear if the supervision actually took place. Review of the facility policy and procedure for supervisory visits revealed that alt supervisory visits would be documented on-site by the agency RN to ensure that services were provided in accordance with physician 's plan of treatment. Clinical record review of all 10 sampled patients revealed that nursing services including OASIS assessment, home visits with insulin injections were being provided by the agency office clerk and not a Registered Nurse (RN) or a Licensed Healthcare ; Professional from the State of Florida. Review of the agency policy and procedure for client assessment revealed that "the client assessment and reassessment would be performed by a professional. A qualified professional is one who has education, experience, registration/licensure, and authority based on agency policy. " Interview with the facility alternate administrator on 3-30-06 at 12 pm revealed that it was the alternate administrator's idea to allow a clerk to go into the patients ' homes and provide both medical services and conduct supervisory visits and to provide: medical services to the patients. 11. | This was appropriately cited as a class | deficiency, and as it impacted ten (10) patients, a total fine of fifty thousand dollars ($50,000) was properly imposed. 12. Section 400.484(2)(a), Florida Statutes (2005) provides: 400.484 Right of inspection; deficiencies: fines.— (2) The agency shall impose fines for various classes of deficiencies in accordance with the following schedule: (a) A class | deficiency is any act, omission, or practice that results in a patient's death, disablement, or permanent injury, or places a patient at imminent risk of death, disablement, or permanent injury. Upon finding a class | deficiency, the agency may impose an administrative fine in the amount of $5,000 for each occurrence and each day that the deficiency exists. In addition, the agency may immediately revoke the license, or impose a moratorium on the admission of new patients, until the factors causing the deficiency have been corrected. COUNT II THE AGENCY FAILED TO CONDUCT BACKGROUND SCREENING, in violation of Section 400.491(1), Florida Statutes (2005) CLASS II DEFICIENCY 13. | The Agency re-alleges and incorporates by reference paragraphs one (1) through seven (7) above as if fully set forth herein. 14. Section 400.491(1), Florida Statutes (2005) reads: 400.491 Clinical records.-- (1) The home health agency must maintain for each patient who receives skilled care a clinical record that includes pertinent past and current medical, nursing, social and other therapeutic information, the treatment orders, and other such information as is necessary for the safe and adequate care of the patient. When home health services are terminated, the record must show the date and reason for termination. Such records are considered patient records under s. 400.494, and must be maintained by the home health agency for 6 years following termination of services. If a patient transfers to another home health agency, a copy of his or her record must be provided to the other home health agency upon request. 15, This rule was not followed for ten of ten sampled patients as shown by the survey conducted on about March 30, 2006:. . Based on record review and interview the home health agency failed to maintain a complete clinical record for each patient who receives skilled care for 10 of 10 sampled patients receiving home care services by the agency. The findings include: Review of 10 sampled patients’ clinical records revealed that the records were missing any home visit notes for the past 2 months. All of the clinical records contained calendars of billed visits for each patient from the start of care, including the past 2 months. Review of the current policy for documentation in the clinical records revealed that all information gathered regarding the patients care would be documented into the patients’ record on a weekly basis. Interview with the facility alternate administrator on 3-30-06 at 12 pm revealed that it was the alternate administrator's idea to allow a clerk to go into the patients' homes and do the documentation on the patients’ files because the alternate administrator said that the clerk was very good in record completion. 16. This was appropriately cited as a class ll deficiency, and as it impacted ten (10) patients, a fine of ten thousand dollars ($10,000.00) was properly assessed. 17. Section 400.484(2)(b), Florida Statutes (2005) provides: 400.484 Right of inspection; deficiencies; fines. — (2) The agency shall impose fines for various classes of deficiencies in accordance with the following schedule: : : (b) A class II deficiency is any act, omission, or practice that has a direct adverse effect on the heaith, safety, or security of a patient. Upon finding a class II deficiency, the agency may impose an administrative fine in the amount of $1,000 for each occurrence and each day that the deficiency exists. In addition, the agency may suspend the license, or impose a moratorium on the admission of new patients, until the deficiency has been corrected. * COUNT Ill THE AGENCY FAILED TO CONDUCT BACKGROUND SCREENING, in violation of , Section 400.512(4), Florida Statutes (2005) and Rule 59A-8.004(10), Florida Administrative Code (2005) CLASS II DEFICIENCY 18. The Agency re-alleges and incorporates by reference paragraphs one (1) through seven (7) above as if fully set forth herein, 19. Section 400.512(4), Florida Statutes (2005) provides: 400.512 Screening of home health agency personnel; nurse registry personnel; . and companions and homemakers.--The agency shall require employment or contractor screening as provided in chapter 435, using the level 1 standards for screening set forth in that chapter, for home health agency personnel; persons referred for employment by nurse registries; and persons employed by companion or homemaker services registered under s. 400.509. : (4) Proof of compliance with the screening requirements of chapter 435 shall be accepted in lieu of the requirements of this section if the person has been continuously employed or registered without a breach in service that exceeds 1 80 days, the proof of compliance is not more than 2 years old, and the person has been screened by the Department of Law Enforcement. A home health agency, nurse registry, or companion or homemaker service registered under s. 400.509 shall directly provide proof of compliance to another home health agency, nurse registry, or companion or homemaker service registered under s. 400.509, The recipient home health agency, nurse registry, or companion or homemaker service registered under s. 400.509 may- not accept any proof of compliance directly from the person who requires screening. Proof of compliance with the screening requirements of this section shall be provided upon request to the person screened by the home health agencies; nurse registries; or companion or homemaker services registered under s. 400.509. : 20. Rule 59A-8.004(10), Florida Administrative Code (2005) provides: 59A-8.004 Licensure Procedure. (10) Level 1 Screening for good moral character for all personnel, including contractors, who enter the home shall consist of: Submission of the Request for Level 1 Criminal History Check, AHCA form 3110-0002, June 1998, incorporated by reference. The FDLE form can be submitted either through AHCA's Background Screening Unit, directly to FDLE, or through a third party vendor. The address for submission to AHCA’s Background Screening Unit is AHCA Background Screening Unit, Mail Stop 40, 2727 Mahan Drive, Tallahassee, FL 32308. The address for submission through FDLE is FDLE, Crime Information Bureau, Post Office Box 1489, Tallahassee, Florida 32302. _ The form may be obtained at the Agency for Health Care Administration web site, http:/Awww.fdhe.state.fl.us, at the Background Screening page. The cost of processing the screening request must be paid by the home health agency or the employee being “screened, The check must accompany the screening request and be made payable to the FDLE or to the home health agency's agent, if one is used for FDLE screening. 21. The agency was in violation of these provisions as evidenced by the survey conducted on or about March 30, 2006 which found: Based on record review and interview the agency failed to conduct background screening on all employees providing care to patients in the homes. The findings include: ‘ : Review of sampled employee #1, a clerk with the agency, revealed that there was no evidence that a background check had been conducted. Further record review revealed that employee #1 was providing care and services to patients in their homes. Interview with the alternate administrator on 3-30-06 at 12:30 pm revealed that it was the alternate administrator's idea to assign patient care to this employee. 22. ‘This was cited as a class II deficiency for which a fine of one thousand dollars ($1000.00) is appropriate. 23. Section 400.484(2)(b), Florida Statutes (2005) provides: 400.484 Right of inspection; deficiencies; fines.— (2) The agency shall impose fines for various classes of deficiencies in accordance with the following schedule: . (b) A class II deficiency is any act, omission, or practice that has a direct adverse effect on the heaith, safety, or security of a patient. Upon finding a class II deficiency, the ‘agency may impose an administrative fine in the amount of $1,000 for each occurrence and each day that the deficiency exists. In addition, the agency may suspend the license, or impose a moratorium on the admission of new patients, until the deficiency has been corrected. , : CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: 1) Make factual and legal findings in favor of the Agency on Count | through III; 2) Impose a fine of fifty thousand dollars ($50,000.00) for Count I, ten thousand dollars ($10,000) for Count II, and one thousand dollars ($1000..00) for Count III against Respondent, for a total fine of sixty-one thousand dollars ($61,000.00); 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 (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, 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 __ | Aa day of June, 2006. [JOAN Aout | bA M. Rodriguez, Esquire a. Bar No. 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52d Terrace, Suite 103 Miami, FL 33166 (305) 470-6804 (phone) (305) 470-6809 (fax) CERTIFICATE OF SERVICE | HEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights, and Election of Rights form have been sent via certified mail return receipt requested (return receipt # 7004 2510 0007 6070 9954) to Mirina M. Resirepo, Administrator, D & N HOME HEALTH SERVICES, INC., 3750 West 16" Ave., Suite 132U, Hialeah, FL 33012, and a copy has been sent via certified mail return receipt requested (return receipt # 7004 2510 0007 6070 9947) to Norma Reyes, Registered Agent, 4167 West 9 Lane, Hialeah, FL 33012 on this 12 day of June, 2006. STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION! JUL iT Alb GO STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2006004324 Return Receipt Requést di: v. 7002 2410 0001 4235 092 , 7002 2410 0001 4235 Op44, D & N HOME HEALTH SERVICES, INC. d/b/a D & N HOME HEALTH SERVICES, INC., Respondent. AMENDED ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (“AHCA”"), by and through the undersigned counsel, and files this administrative complaint against. D & N Home Health Services, Inc. d/b/a D & N Home Health Services, Inc. (hereinafter “D & N Home Health Services, Inc."), pursuant to Chapter 400, Part IV, and Section 120.60, Florida Statutes, and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $36,000.00 pursuant to Section 400.484, Plorida Statutes for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part Iv, Florida Statutes. 3. Venue lies in Miami-Dade County pursuant to 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 and Chapter 59A-8 Florida Administrative | Code. 5. D & N Home Health Services, Inc. operates a home health agency located at 3750 West ‘16t Avenue - Suite 132U, Hialeah, Florida 33012. D & N Home Health Services, Inc. is licensed as a home health agency under license number 299992019. D & N Home Health Services, Inc. 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. COUNT I D & N HOME HEALTH SERVICES, INC. FAILED TO CONDUCT BACKGROUND SCREENING ON ALL EMPLOYEES PROVIDING CARE TO PATIENTS IN THE HOME. SECTION 400.512(4), FLORIDA STATUTES RULE 59A-8.004 (10) FLORIDA ADMINISTRATIVE CODE. CLASS IL 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. D & N Home Health Services, Inc. was cited with two (2) Class II deficiencies and one (1) Class I deficiency due to a complaint investigation conducted on March 30, 2006. 8. A complaint investigation survey was conducted on March 30, 2006. Based on record review and interview, it was determined that the agency failed to .conduct background screening on all employees providing care to patients in the homes. The findings include the following. 9. Review of sampled employee #1, a clerk with the agency, revealed that there was no evidence that a background check had been conducted. Further record review revealed that employee #1 was providing care and services to patients in their homes. Interview with the alternate administrator on 3-30-06 at 12:30 pm revealed that it was the alternate administrator's idea to assign patient care to this employee. 10. Based on the foregoing facts, D & N Home Health Services, Inc. violated Section 400.512{4), Florida Statutes and Rule 59A-8.004(10), Florida Administrative Code, herein classified as Class II deficiency, which carries an assessed fine of $1,000.00. COUNT IT D & N HOME HEALTH SERVICES, INC. FAILED TO PROVIDE APPROPRIATE. SUPERVISION OF HOME CARE SERVICES WITH QUALIFIED PERSONNEL. RULE 59A-8.0095(3), FLORIDA ADMINISTRATIVE CODE CLASS I 11. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 12. A complaint investigation survey was conducted on March 30, 2006. Based on record review and interview, it was determined that the Director of Nurses failed to provide appropriate supervision of home care services by an agency RN for 10 of 10 sampled patients. The Director of Nurses failed to assign patient care to qualified personnel. The findings include the following. 13. Clinical record review of sampled patient #1, #7, #8, #9 and #10 revealed that supervisory visits were done. However, they were conducted by employee #1 who is an office clerk and not a Registered Nurse (RN) or a Licensed Healthcare Professional from the State of Florida. Review of the facility policy and procedure for supervisory visits revealed that all supervisory. visits would be documented on-site by the agency RN to ensure that services were provided in accordance with physician's plan of treatment. 14, Clinical, record review of all 10 sampled patients revealed that’ nursing services “includitig OASIS assessment, home visits with insulin injections were being provided by the agency office clerk and not a Registered Nurse (RN) or a Licensed Healthcare Professional from the State of Florida. Review of the agency policy and procedure for client assessment revealed that "the client assessment and reassessment would be performed by a professional. A qualified professional is one who has education, experience, registration/licensure, and authority based on agency policy". 15. Interview with the facility alternate administrator on 3-30-06 at 12 pm revealed that it was the alternate administrator's idea to allow a clerk to go into the patients! homes and provide both medical services and conduct supervisory visits and to provide medical services to the patients. 16. Based on the foregoing facts, D & N Home Health Services, Inc. violated Rule 59A-8.0095(3), Florida Administrative Code, herein classified as Class I deficiency, which carries an assessed fine of $25,000.00. COUNT IIT D & N HOME HEALTH SERVICES, INC. FAILED TO MAINTAIN A COMPLETE CLINICAL RECORD FOR EACH PATIENT WHO RECEIVES SKILLED CARE. SECTION 400.487 (2), FLORIDA STATUTES CLASS II 17. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 18. A complaint investigation survey was conducted on March 30, 2006. Based on record review and interview, it was determined that the home health agency failed to maintain a complete clinical record for each patient who receives skilled care for 10 of 10 sampled patients receiving home care services by the agency. The findings include the following. 19. Review of 10 sampled patient's clinical records revealed that the records were missing any home visit notes for the past 2 months. All of the clinical records contained calendars of billed visits for each patient from the start of care, including the past 2 months. 20. Review of the current policy for documentation in the clinical records revealed that all information gathered regarding the patients care would be documented into the patients’ record on a weekly basis. 21. Interview with the facility alternate administrator on 3-30-06. at 12 pm revealed that it was the alternate administrator's idea to allow a clerk to go into the patients’ homes and do the documentation on the patients' files because the alternate administrator said that the clerk was very good in record completion. 22. Based on the foregoing facts, D & N Home Health Services, Inc.. violated Section 400.491(1), Florida Statutes herein classified as Class II deficiency, which carries an assessed fine of $10,000.00. CLAIM FOR RELIEF 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 D & N Home Health Services, Inc. on Counts I through IIT. 2. Assess against D & N Home Health .Services, Inc. an administrative fine of $36,000.00 on Counts I through III for violations cited above. This complaint investigation survey also resulted in an imposition of an Immediate Order of Moratorium. 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 through III. 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. 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. 1 Bare, M. “Rode aed Esq Legs Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Harold Williams Field Office Manager Agency for Health Care Administration 8355 N. W. 5374 Street Miami, Florida 33166 (Interoffice Mail) 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 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct foregoing has been furnished by U.S. Certified copy of the Mail, Return Receipt Requested to Mirina Restrepo, Administrator, D & N Home Health Services, Inc., 3750 West 16% Avenue, Suite 132U, Hialeah, Florida 33012; Norma Reyes, 4167 West gth Lane, Hialeah, Florida 33012 on this 14™ day of July, 2006. bb) TP): Alba M. Rodriguez, (Esq.

Docket for Case No: 06-003020