STATE OF FLORIDA a I. Ee D AGENCY FOR HEALTH CARE ADMINISTRATION 06 Ny ~ . OV 29 PH 3; \ STATE OF FLORIDA, Olvis & AGENCY FOR HEALTH ADMIN) REN OF CARE ADMINISTRATION, HEA RAT VE Petitioner, Case No.: 2006006150 vs. FIRST HEALTH RESOURCES CORPORATION, O lo : Uf | 7 () d/b/a FAMILY HOME CARE, 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, First Health Resources Corporation, d/b/a Family Home Care (hereinafter “Respondent”), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of five thousand dollars ($5,000.00) for one cited repeat State Class III deficiency pursuant to Sections 400.484(2)(c) and 400.487(2), Florida Statutes (2005), and Rule 59A-8.0215(2) Florida Administrative Code. JURISDICTION AND VENUE 1. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part IV, Florida Statutes, (2005). 2. Venue lies in Hendry County pursuant to 120.57 Florida Statutes (2005), and Chapter 28, Florida Administrative Code (2005). 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 (2005). 4. Respondent is a Home Health Agency located at 820 W. Sugarland Highway, Suite E8, Clewiston, Florida 33440, having been issued license number 299991018. . COUNT I 5. The Agency re-alleges and incorporates paragraphs one (1) through four (4) as if fully set forth herein. 6. That pursuant to Florida law, the attending physician for a patient who is to receive skilled care must establish treatment orders which must be signed by the physician within thirty days of the start of care and must be reviewed as frequently as the patient’s illness requires. § 400.487(2), Fla. Stat. (2004). In addition, law requires that 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 contacted and 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. Fla. Admin. Code R. 59A-8.0215(2). 7. That the Agency conducted an annual licensure survey of the Respondent on or about December 15, 2004. 8. That based on a review of fifteen (15) clinical records, the Respondent did not follow the plan of treatment and frequency of service for nine (9) of said patients and did not ensure that physician's orders were signed within thirty (30) days of the date of order as required for six (6) of said patients, both practices being in violation of law. 9. That the Petitioner’s representative reviewed the Respondent’s patient-records for fifteen (15) patients on December 15, 2004 in consultation with Respondent’s staff and noted the following: a. Patient number two (2): i. That the patient was admitted to the Respondent on November 18, 2004; ii. That diagnoses included malaise, fatigue and renal failure; iti. That the patient’s plan of treatment required that physical therapy was to see the patient three times a week for four weeks; iv. That the patient’s plan of treatment required that a home health aide see the patient two times a week for nine weeks; v. That during the first week of service, the home health aide only saw the patient once; vi. That during the second week of service, the patient was only seen twice by physical therapy and once by the home health aide; vii. That there are no indicia that the ordered and missed physical therapy and. . home health aide visits were attempted by Respondent. b. Patient number five (5): i. That the patient was admitted to the Respondent on December 1, 2004; ii. That the patient’s diagnoses include open wound to left knee and paraplegia; iti, That the patient’s plan of treatment orders that nursing see the patient seven times a week for four weeks and instruct the patient in signs and symptoms of infection control; iv. That there were no indicia in the record that the ordered instruction on | signs and symptoms of infection control was provided. c. Patient number seven (7): i. That the patient was admitted to the Respondent on November 12, 2004; ii. iv. That the patient’s diagnoses include myalgia and myosis; That the patient’s physician orders as annotated in the plan of treatment required a home health aide to see the patient two times a week for three weeks; That the patient’s clinical record revealed documentation of only one home health aide visit on November 16, 2004; That there was no indicia that other ordered home health aide visits were conducted or attempted; That Respondent’s nursing staff confirmed that other ordered visits had not been conducted; That the patient’s plan of treatment, dated in excess of thirty days from the physician’s order, had not been signed by the physician as required by law. d. Patient number fourteen (14): i. That the patient was admitted to the Respondent on October 17, 2004; That the patient’s diagnoses included dermatitis; . That the patient’s physician’s orders as annotated in the plan of treatment required nursing services to provide wound care and orders for the patient to wear thigh high TED hose, on in the morning, off at bedtime; That the patient’s chart lacked any documentation or indicia that the nurse instructed on or observed the patient's use of the TED hose; That physician orders specifically required nursing to provide wound care as follows: right anterior leg and left cheek: ifred and inflamed, stop using Aldara cream; if not red and inflamed, use Aldara cream 3 times per week ...left lower leg: clean with 1/4 peroxide and 3/4 water gently, pat dry and apply Bactroban ointment 2 x daily for 2 weeks; That the initial nursing assessment contained the following annotation: "Bactroban placed on left cheek area which looked red and inflamed." i. That the nurse’s entry and service provided was contrary to and did not follow the physician orders for the care of the patient's left cheek; i. That the physician signed the plan of treatment on December 13, 2004, in excess of 30 days from date of order as is required by law. e, Patient number one (1): i. ii. iii. iv. That the Respondent provided nursing visits to the patient's home to perform nursing care October 28, 2004, November 4, 2004 and December 2, 2004; That there were no physician orders in the patient’s records or other indicia of a physician's direction for these nursing visits; That the record did contain physician orders for one nursing visit and two aide visits to be performed the week of November 19, 2004; That the record contains no indicia that the ordered nursing visit during the week of November 19, 2004 and only one of the two ordered aide visits was documented for that week; That the physician's Plan of Treatment dated October 15 through December 13, 2004 was not signed by the physician until November 22, 2004, greater than the allowed 30 days from date of order as required by law. f. Patient number three (3): iv. . That Respondent has a physician's order dated November 12, 2004 for the Respondent to resume care of the patient status post hospitalization; That the physician's order includes nursing to visit the patient three times the week of November 12, 2004; That records reflect that only two nursing visits were performed the week of November 12, 2004; That there is no indication in the records as to why the third visit was not done as ordered. g. Patient number ten (10): i. iv. vii. That a physician's order dated October 12, 2004 required that the patient receive daily wound care until October 27, 2004; That the patient record does not reflect that wound care was performed on October 19, 2004 or why the same was not performed; That a second physician's order dated November 9, 2004 stated to hold nursing Visits until November 13, 2004, and then to resume wound care/dressing changes every two days; That the record reflects that nursing performed the wound care on November 13, 2004; That the record reflects that the patient saw the physician on November 15, 2004; That the patient record does not reflect that a nursing visit was performed on November 17, 2004 nor does it reflect why prescribed care was not provided; That the Respondent’s nurse confirmed the visit of November 1, 2004 was not completed; That physician's order dated October 12, 2004 was for nursing to perform wound care to the patient's left foot using Normal Saline Wet to Dry dressings daily until October 27, 2004; That nursing visit notes document that on October 18, 2004 and October 20 through October 24, 2004, the nurse was cleaning the wound with Normal Saline then applying an Aquacel dressing; That this was confirmed with respondent’s Case Manager on December 15, 2004 between 2 and 3:00 p.m.; h. Patient number twelve (12): i. iii. iv. That the patient’s rrecord contained a physician's order dated October 25, 2004 requiring daily wound care for ten days then decrease to every two days; That a second physician's order dated November 29, 2004 required daily wound care for five days then decrease to every two days; That the documented nursing visits during these periods were only one time per week rather than the daily and every two days as ordered by the physician; That the Respondent’s nurse on December 15, 2004 stated that the patient has a family member who was performing the wound care, that nursing was seeing the patient weekly to monitor, and that this was not reflected in the physician's orders dated October 25, 2004 or November 29, 2004. i. Patient number fifteen (15): i. That the patient was admitted to Respondent on August 3, 2004 with physician orders for nursing to perform wound care twice a week for the first week then three times a week for four weeks; ii. That the physician's plan of treatment remained unsigned longer than 30 days from date of order in violation of law; iii. That the patient’s nursing documentation reflected only two visits performed the week of August 17, 2004 rather than the ordered three; iv. That there was no indication as to why the third visit was not performed as ordered; v. That Respondent’s nurse stated that the patient often could not be found; vi. That the patient was discharged from the Respondent's service September 10, 2004. j. Patient number eleven (11): i. That the patient #11 was admitted to the Respondent on August 25, 2004 and discharged October 20, 2004; ~ ii. That the physician's plan of treatment remained unsigned, greater than 30 days from date of order, in violation of law. k. Patient number thirteen (13): i. That the patient was admitted to the Respondent on November 9, 2004; ii. That the physician's plan of treatment remained unsigned, greater than 30 days from date of order, in violation of law. 10. That the above reflects multiple incidents where physician’s orders were not followed by the Respondent in violation of law and that pyhysician’s plans of treatment were not executed by the physician within thirty days, the same also being violative of law. 11. That the Agency determined that these deficient practices related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited the Respondent for a State Class III deficiency. 12.‘ That the Respondent was provided a mandated correction date of January 15, 2005. 13. . That during a follow-up survey conducted on January 18, 2005 the Agency determined that the Respondent had corrected the deficiency. 14. That on or about June 8, 2006, the Agency conducted a recertification survey of Respondent. 15. That pursuant to Florida law when required by the provisions of Chapter 464; Part I, Part IH, or Part V of Chapter 468; or Chapter 486, the attending physician, physician assistant, or advanced registered nurse practitioner, acting within his or her respective scope of practice, shall establish treatment orders for a patient who is to receive skilled care. The treatment orders must be signed by the physician, physician assistant, or advanced registered nurse practitioner before a claim for payment for the skilled services is submitted by the home health agency. If the claim is submitted to a managed care organization, the treatment orders must be signed within the time allowed under the provider agreement. The treatment orders shall be reviewed, as frequently as the patient's illness requires, by the physician, physician assistant, or advanced registered nurse practitioner in consultation with the home health agency. Section 400.487(2) Florida Statutes (2005) 16. That pursuant to Florida law home health agency staff must follow the physician, physician assistant, or advanced registered nurse practitioner’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, physician assistant, or advanced registered nurse practitioner 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, physician assistant, or advanced registered nurse practitioner’s office. Florida Administrative Code R. 59A-8.0215(2) 17. That Based on observations during patient home care visits, clinical record review, interview with agency staff and review of nursing guidelines, the Respondent failed to ensure care was afforded to patients as per the written plan of care established by the physician for ten (10) of fifteen (15) sampled patients, the same being in violation of law. 18. That the Petitioner’s representative reviewed the Respondent’s patient records for fifteen (15) patients on June 5-8, 2006 in consultation with Respondent’s staff and on patient home care visits and noted the following: a. Patient number three (3): i. iv. That patient was admitted to the Respondent with a start of care date of May 11, 2006; That a physician's verbal order dated May 15, 2006 noted that physical therapy requested a medical social worker evaluation; That the patient’s record review on June 5, 2006 lacked documentation of any medical social worker (MSW) visits; That after surveyor intervention, the home health agency provided a medical social services visit note on June 5, 2006 for a visit completed on June 2, 2006; That the home health agency provided/faxed to the office after survey completion additional documentation of a MSW evaluation completed and dated May 30, 2006; That there was no indication in the record of the why the physician's orders had not been followed for fifteen days from May 15 to May 30 or 10 how the patient's needs had been met during that period. b. Patient number six (6): i. iii. That the patient was admitted to the Respondent on May 24, 2006; That the patient’s physician's verbal order dated by the home health agency nurse May 28, 2006 or May 29, 2006, (unable to accurately read date) and signed by the physician on May 31, 2006 required that a home health aide was to provide care three times per week for four weeks; That the patient’s clinical record revealed the home health aide completed two visits from May 24, 2006 through May 28, 2006 without benefit of a . physician's order; c. Patient number seven (7): i. iv. That the patient was admitted to the Respondent on May 13, 2006; That the patient’s clinical record noted on May 19, 2006 that a skilled nurse documented a “RBS” 146; That no physician’s order in the record required glucose testing; That Respondent’s skilled nurse, on June 5, 2006, confirmed that the blood sugar testing on May 19, 2006 was completed without benefit of a physician's order; That after surveyor intervention, a physician's verbal order for blood sugar testing was obtained and provided on June 5, 2006. d. Patient number eight (8): i. ii. That the patient was admitted to the Respondent with a referral date of May 16, 2006 and an expected start of care of May 18, 2006; That the patient’s record revealed that the patient had services provided by 11 physical therapy for osteopenia, left arm fracture acute, bilateral weal legs, and COPD; iii. That the Patient’s record revealed a physician's prescription dated May 18, 2006 for: "physical therapy dx-deconditioning;" iv. That the patient’s record revealed the physical therapist completed an evaluation on May 22, 2006 with recommended frequency of physical therapy visits; two times per week for four weeks; . v. That there is no evidence physical therapy completed any additional visits, completed a comprehensive assessment (OASIS), and/or assessed the patient's current medications; vi. That there was no missed visit modification order present in the record and this lack of care was, therefore, inconsistent with current physician's orders; vii. That there was no indication in the record of how the patient's needs would be met in the absence of providing ordered services and care. e, Patient number nine (9): i. That the patient has been receiving skilled nursing services from the home health agency since February 3, 2006; ii. That a physician's verbal order dated May 2, 2006, required that the patient was to receive Ceftriaxone 2Gm via IV over 30 minutes every 24 hours x 14 days; iti, That the clinical record revealed the skilled nurse failed to teach, instruct and assess the patient or caregiver in medication actions, use, or side effects. 12 f. Patient number ten (10): i. iv. That the patient was admitted to the Respondent on April 21, 2006 with services provided by skilled nursing and physical therapy; That a May 8, 2006 a physician's verbal order was recorded for a home health aide to provide home visits two times per week for four weeks; That the clinical record reflected that the home health aide completed the first visit on May 24, 2006; That there was no documentation in the record of how the patient's needs had been met during the sixteen days delay in care from when services were first ordered on May 8, 2006; That the Respondent also provided a home health aide visit on June 6, * 2006 without benefit of a physician's orders. g. Patient number twelve (12): i. iti. iv. That the patient was admitted to the Respondent on May 31, 2006; That per the Home Health Certification and Plan of Care, services were to be provided by skilled nursing and physical therapy; That the clinical record revealed the skilled nurse completed a home health aide care plan on May 31, 2006; That the record reflects that a home health aide provided a home visit on June 5, 2006 without benefit of a physician's order. h. Patient number thirteen (13): i. That the patient was admitted to the Respondent on April 23, 2006; That the record revealed physical therapy was to provide services three times per week for four weeks; iti. XL That the clinical record revealed the physical therapist completed only two visits during the week of May 15, 2006 through May 21, 2006; That the clinical record contained no physician's modification order for the missed visit; That on May 7, 2006 a post hospital/facility order was received for a home health aide to provide services three times per week for two weeks (M-W- F @ 9AM) and two times per week for one week; That documentation in the record reflected that the home health aide provided the first visit on May 25, 2006 and another visit on May 26, 2006; That further review of the record revealed a post hospital/aclity order dated May 8, 2006 that did not prescribe any services by a home health ~ aide; That therefore the home health aide visits of May 25, and 26 were completed without benefit of a physician's order; That there was no physician's modification order documented in the record for the home health aide visits; That on April 23, 2006 the skilled nurse documented the patient/caregiver was instructed to "put ice to hand for 20 minutes;" That there was located no physician's order for any ice application to either hand. i, Patient number fourteen (14): i. That the patient was admitted to the home health agency on May 26, 2006; That per the Home Health Certification and Plan of Care, services were to 14 iii. iv. be provided by skilled nursing and physical therapy; That physician's orders for skilled nursing included, “the patient/caregiver may perform wound care when able to demonstrate ability to perform care;” That Wound Care orders included, “Change dressing to left shoulder wash with half strength peroxide and half water for five days, and then apply DSD. Then leave wound uncovered and apply polysporin twice a day until wound healed;” That documentation on May 26, 2006 reflected that the skilled nurse instructed the patient’s spouse in dressing changes and caregiver verbalized understanding of incision; That the record failed to reflect that the skilled nurse assessed the competency of the caregiver in wound care dressing changes as ordered. j. Patient number fifteen (15): i. iti. iv. That the patient was admitted to the home health agency on March 27, 2006; That on May 22, 2006, a physician's verbal order was received for skilled nursing to complete a PRN (as needed) visit to obtain urine for U/A and C&S; That review of the record revealed the following skilled nursing documentation: “SN straight cathed pt using #14 F. catheter & obtained cloudy yellow urine;” That the skilled nurse, on June 6, 2006 at approximately 3:30 p.m., confirmed this procedure was completed without the benefit of a 15 physician's order. 19. That a copy of the home health agency's Policy and Procedure for Physician Participation in Plan of Care was requested. 20. That the following documentation was provided: Policy No. 2-019.1 states, “A physician will direct the care of every home health patient admitted for service... The attending physician...will participate in the care planning process by reviewing and revising therapeutic and diagnostic orders. The care will be provided in compliance with his/her therapeutic and diagnostic orders and accepted standards and practice.” 21. That the above reflects at least ten (10) patients suffered incidents where physician’s orders were not followed by the Respondent in violation of law. 22. That the Agency determined that these deficient practices related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited the Respondent for a repeated State Class II deficiency. 23. Respondent was provided a mandated correction date of July 8, 2006. 24, That the same constitutes a repeated State Class III deficiency pursuant to § 400.484(2)(c), Fla. Stat. (2005). 25. That pursuant to § 400.484(2)(c), Fla. Stat. (2005), the Agency may impose an administrative fine not to exceed five hundred dollars ($500.00) for each occurrence and each day of a repeated State Class II deficiency. WHEREFORE, the Agency intends to impose an administrative fine in the amount of five thousand dollars ($5,000.00) for the repeated State Class I deficiency as authorized under Sections 400.484(2)(c), Fla. Stat. (2005). 16 Respectfully submitted this Che day of October, 2006. Thor ‘eT. Walsh, Il, Esq. Bla. Bar. No, 566365 /Agency for Health Care Administration 525 Mirror Lake Drive, N. 330G St. Petersburg, Florida 33701 727.552.1525 (office) 727.552.1440 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, 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: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida 32308. Telephone (850) 922-5873 RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7005 1160 0002 2254 8351 on October ZO ; 2006 to: Grace M. Penano, Registered Agent/Administrator, Family Home Care, 820 W. Sugarland Highway, Suite E8, Clewiston, Florida 33440. vA ‘Walsh II, Esquire Copies furnished to: Grace M. Penano Thomas J. Walsh, I, Esquire Registered Agent/Administrator Agency for Health Care Administration Family Home Care §25 Mirror Lake Drive N., 330G 820 W. Sugarland Hwy, Suite E8 St. Petersburg, Florida 33701 Clewiston, Florida 33440 (nteroffice) (U.S. Certified Mail) 17 ™ Complete items 1'..; and 3. Also complate item 4 if Restricted Delivery Is desired. @ Print your name and address on the raverse so that we can return the card to you, ® Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: B CB cunts aD CO certified Mail? Mal fall = Registered Oo Retum Recelpt for Merchandise _ | C1 Insured Mail . 4. Restricted Delivery? tte Foe) zi _ ee very? ( : 2, Articla Number “7005 1bO OO02 2254 8351 ecLaI BD { (iansfer from Ser vncer rece $$ nn ' PS Form 3811, February 2004 Domestic Return Receipt ' 102595-02-M-1540 r won an er wets

Docket for Case No: 06-004770