STATE OF FLORIDA 6 AGENCY FOR HEALTH CARE ADMINISTRATION 40k Misip el} o > STATE OF FLORIDA, AGENCY FOR HEALTH Hed Tigh CARE ADMINISTRATION, Wag Ve Petitioner, AHCA No.: 2006010930 Return Receipt Requested: v. 7002 2410 0001 4232 0183 7002 2410 0001 4232 0190 SUNSHINE CAREGIVERS, INC. d/b/a 7002 2410 0001 4232 0206 SUNSHINE CAREGIVERS, Respondent. ) 0 a . Od5S” ( 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 Sunshine Caregivers, Inc. d/b/a Sunshine Caregivers (hereinafter “Sunshine Caregivers”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $16,000.00 pursuant to Section 400.484, Florida Statutes for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part IIt, 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 Til, Florida Statutes (2006), and Chapter 59A-8, Florida Administrative Code. 5. Sunshine Caregivers operates a home health agency located at 11921 8. Dixie Highway, Pinecrest, Florida 33158. Sunshine Caregivers is licensed as a home health agency under license number 299991631. Sunshine Caregivers 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 SUNSHINE CAREGIVERS FAILED TO PROVIDE A COMPREHENSIVE COMPETENCY EVALUATION PROGRAM TO ENSURE THAT TRAINED QUALIFIED PERSONNEL (HOME HEALTH AIDES) WERE BEING SENT INTO THE PATIENTS HOMES TO PROVIDE PERSONAL CARE AND SERVICES SECTION 400.497 (1), FLORIDA STATUTES RULE 59A-8.0095(5), FLORIDA ADMINISTRATIVE CODE. HOME HEALTH AIDE COMPETENCY TEST CLASS I 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Sunshine Caregivers was cited with three (3) Class I deficiencies and one (1) Class II deficiency due to a complaint investigation survey that was conducted from October 31, 2006 through November 3, 2006. 8. A complaint investigation survey was conducted from October 31, 2006 through November 3, 2006. Based on record review and interview, it was determined that the agency failed to provide a comprehensive competency evaluation program to ensure that trained, qualified personnel (Home Health Aides) were being sent into the patients homes to provide personal care and services for 10 of 13 (#1,# 2,# 4,# 5,# 9, #10, #11, #14, #15, #16) home health aide employee files reviewed. The findings include the following. 9. Review of the personnel records of the home health aides of the agency revealed that the competency tests were not. graded for sample home health aide #2 (date of hire 2-2-06), #4 (date of hire 8-1-06), #5 (date of hire 2-4-03), #9 (date of hire 3-1-06), #11 (date of hire 5-25-03), #14 (date of hire 8- 10-05), #15 (date of hire 11-17-05). Review of the current payroll list confirmed that the above employees were currently providing care to patients in their homes. 10. Review of the employee file of sample home health aide #1 (date of hire 1-18-02) revealed that there was no evidence that the aide had taken the competency test. There was no test in the file for that employee. Review of the current payroll list confirmed that the above employee was currently providing care to patients in their homes. “4a. Review of the competency test of home health aide #10 (date of hire 7-15-05) revealed a score of 88 out of 104 and #16 (date of hire 9-7-05) revealed a score of 81 out of 104 on the Home Health Aide Competency Test, AHCA form number 3110-1007, February 2001. Neither score was considered passing by AHCA as the passing grade was to be 90 or above. Review of the current payroll list confirmed that the above employee was currently providing care to patients in their homes. 12. Review of the Skills Checklist for sample home health aide #10 (date of hire 7-15-05) completed by the nurse on 7-15- 05 revealed that the aide needed instruction on Foley catheter care, intake and = output, oxygen therapy and medication assistance reminder. The nurse documented that the aide was given review and education for the topics. Additionally, the aide needed review on reinforcing dressings, bowel’ program, documentation of care, diabetic symptoms, procedure for death in the home, sitz bath, specimen collections, care of traction, but there was no evidence of follow up with any education. Review of the on-site Competency Evaluation for sample home health aide #10 completed by the nurse on 5-15-06 revealed that the aide was not competent to perform bathing, hair care, skin care, nail care, transfers/ ambulation, transfer belt, Hoyer lift, transfer from bed to chair, toileting and elimination, positioning and range of motion. There was no evidence in the record that the home health aide had received further training for these skills. Review of the evidence confirmed that the home health aide had been providing care to patients of the agency from 7-15-05 until 5-15-06 (sample patients #3 and #5) before the evaluation had been conducted. 13. Review of the clinical record of sample patient #3 revealed that home health aide #10, who had no passing grade on the competency test and an incomplete skills checklist, had been providing care in the home of the patient when the patient choked and went into respiratory arrest and eventually died. Review of the record revealed that in the team communication form written by the support coordinator it was documented that 5 on 12-13-05 the patient choked on a piece of tangerine prepared for the patient by the parent. The home heath aide (sample employee #10) tried to clear the airway, but the patient bit his/her. hand. The aide went behind the patient to do CPR and sent the housekeeper to find the parent. When the parent arrived, he/she took over performing CPR on the child and told the home health aide to call 911. The’ 911 operator requested to speak with the parent of the child. When rescue arrived the patient was unresponsive. The child died that. day. 14. Interview with the Administrator on 11-2-06 at 11:00 am confirmed that all of the home health aides were providing personal care to Medicaid waiver patients. 15. Review of the current job description for home health aides revealed that the aides were to accept only those assignments for which he/she was qualified. The qualifications for the job include evidence’ of formal training, evidence of competency training and evaluation as well as quarterly in- service education programs. 16. Interview with the Human Resource Coordinator on 11-2- 06 at 11:00 am revealed that the tests were given and graded by him/her before the home health aides were allowed to go into the patient's homes to provide care. A competency checklist and evaluation by the nurse was to be conducted before the employees were sent into a patient’s home to provide care. The agency used a passing score of 80 on the competency tests. The agency did not offer any education or training. The agency expected the home health aides to provide all of the education and updates from outside sources. 17. Based on the foregoing facts, Sunshine Caregivers violated section 400.497(1), Florida Statutes (2006), and Rule 59A-8.0095(5), Florida Administrative Code, herein classified as a Class I deficiency, which warrants an assessed fine of $5,000.00. COUNT IT SUNSHINE CAREGIVERS FAILED TO ENSURE THAT HOME HEALTH AIDES HAD A CURRENT CPR CARD IN THE FILES. RULE 59A-8.0095(5) (1), FLORIDA ADMINISTRATIVE CODE. HH AIDE CNA CPR CERTIFICATION CLASS I 18. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 19. A complaint investigation survey was conducted from October 31, 2006 through November 3, 2006. Based on record review and interview, it was determined that the agency failed to ensure that all home health aides sent into the patient's home to provide care and services were qualified to provide those services in that they did not have a current CPR card in the files for 8 of 13 (#3, #5, #7, #9, #10, #11, #12, #13) personnel files reviewed. The findings include the following. 20. The Administrator stated on 11-2-06 at 11:00 am that none of the employees would be in the homes of patients without a current CPR certification. It was expected that the employees would obtain the certification every 2 years and provide the document to the agency. It was a requirement of the agency. 21. Review of the personnel files of sampled employee #3 (date of hire 12-19-02) confirmed that the CPR certification had expired on 10-10-05. 22. Review of the personnel Files of sampled employee #5 (date of hire 2-4-03) confirmed that the CPR certification had expired in 5-2006. 23. Review of the personnel files of sampled employee #7 (date of hire 12-4-05) had no evidence of a current CPR card in their employee file. 24. Review of the personnel files of sampled employee #9 (date of hire 3-1-06) had no evidence of a current CPR card in their employee file. 25. Review of the personnel files of sampled employee #11 (date of hire 5-23-03) confirmed that the CPR certification had expired in 3-2006. 26. Review of the personnel files of sampled employee #12 (date of hire 11-29-00) confirmed that the CPR certification had expired in 3-2006. 27. Review of the personnel files of sampled employee and #13 (date of hire 1-31-03) revealed that the CPR certification had expired in 7-2006. 28. Review of the employee file of sample employee 10 revealed that the employee CPR certification had expired in 9- 2005 and did not have current CPR certification from this date until August 2006. The aide was employed by the agency, providing patient care services to sample patient #3 (December 2005) and sample patient #5 (documented notes from December 2005, September 2006, and October 2006). 29, Interview with the Human Resource Coordinator on 10- 31-06 at 3 pm confirmed that the cards were not in the files and that the home health aides were currently providing care to patients. A list of patients to whom the sampled employees provided care was requested by the surveyor. The list was not provided by agency. staff by the time of the exit survey. Current CPR cards were also requested at this time, but no CPR cards were provided to the survey team by the time of exit on 11/3/06. 30. Review of the clinical record of sample patient #3 (start of care 11-10-05) revealed that the patient was a child with autism, mental retardation and attention deficit disorder and receiving personal care services from the agency by a home health aide (sample employee #10). Review of the clinical record revealed that in the team communication form written by the support coordinator it was documented that on 12-13-05 the patient choked on a piece of tangerine prepared for the patient by the parent. The home heath aide (sample employee #10) tried to clear the airway, but the patient bit his/her hand. The aide went behind the patient to do CPR and sent the housekeeper to find the parent. When the parent arrived, he/she took over performing CPR on the child and told the home health aide to call 911. The 911 operator requested to speak with the parent of the child. When rescue arrived the patient was unresponsive. The child died that day. Interview with the Administrator on 11-1-06 at 3:00 pm confirmed the findings. 31. Review of the clinical record of sample patient #5 (start of care 7-8-05) revealed that the patient was disabled and receiving personal care services from the agency by a home health aide. The patient had neuropathy and gait instability. The patient was confused and needs complete care. The patient was at risk for falls, risk for not being able to make needs known due to difficulty with confusion, risk for resuscitative efforts related to aspiration. The aide providing care to this patient was sample home health aide #10, who had no current CPR certification. The card had expired and the employee had not provided the agency a current one. 32.. Review of the job description for Home Health Aides revealed that the responsibilities and duties include to recognize emergencies. and have knowledge of emergency procedures and performs tasks/duties that are specifically assigned by the supervisor, and for which aide has been specifically trained. Documentation of specific training must be included in employee's personnel file. 33. Review of the agency's “current cardiopulmonary resuscitation (CPR) policy revealed that CPR is provided only by - specially trained staff when the patient ceases breathing and/or cardiac functioning. : . 34. Based on the foregoing facts, Sunshine Caregivers violated Rule 59A-8.0095(5)(1), Florida Administrative Code, herein classified as a Class I deficiency, which warrants an assessed fine of $5,000.00. 11 COUNT III SUNSHINE CAREGIVERS EMPLOYED EMPLOYEES THAT HAD A DOCUMENTED HISTORY OF DISQUALIFYING CRIMINAL OFFENSES. SECTION 435.06, FLORIDA STATUTES RULE 59A~8.0086(1) (b), FLORIDA ADMINISTRATIVE CODE. BACKGROUND SCREENING REQUIREMENTS CLASS I 35. AHCA ve-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 36. A complaint investigation survey was conducted from October 31, 2006 through November 3, 2006. Based on record review and interview, it was determined that the agency employed 1 of 7 (#8) employees that had a documented history of disqualifying criminal offenses without providing an exemption from disqualification letter. The findings include the following. 37. Review of the background screen of employee #8 (RN) revealed that the ‘employee had been working for the agency since 1-20-06. The background screen was requested on 2-23-06. 38. The employee had documented two felony convictions at Florida Statute A903 (drug trafficking and possession), two felony convictions at Florida Statute 812 (robbery/theft), one felony conviction at Florida Statute 784.03, one misdemeanor conviction at FPlorida Statute 784.03 (battery), and one misdemeanor conviction at Florida Statute 893. All of these 12 convictions were disqualifying offenses according to Florida Statute 435.03. Interview with the Administrator on 11-2-06 at 2 pm confirmed the felony convictions. The exemption from disqualification letter for this employee was requested of the Administrator on 11-1-06, but was never provided by the date of the exit survey (11-3-06). The Administrator stated that the convictions did not prevent the nurse from working in the agency. 39. Based on the foregoing facts, Sunshine Caregivers violated Section 435.06, Florida Statutes (2006), and Rule 59A- 8.0086(1) (b), Florida Administrative Code, herein classified as a Class I deficiency, which warrants an assessed fine of 85,000.00. COUNT IV SUNSHINE CAREGIVERS FAILED TO ENSURE THAT HOME HEALTH AIDES WERE : SUPERVISED BY AN RN. SECTION 400.487(3), FLORIDA STATUTES RULE 59A-8.0095(5) (a) & (b), FLORIDA ADMINISTRATIVE CODE. HHAIDE CNA SUPERVISION CLASS IIT 40. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 41. A complaint investigation survey was conducted from October 31, 2006 through November 3, 2006. Based on record review and interview, it was determined that the agency failed 13 to ensure that the home health aides providing patient care in the home of unskilled patients receiving personal care services were supervised by the RN, as required for 5 of 5 sampled -Clinical records reviewed. The findings include the following. 42. Review of the clinical record of sample patient #1 (start of care 4-8-05) revealed that the patient was disabled and receiving personal care services from the agency by a home health aide. The patient was an adult with a degenerative bone disorder, severe weakness and unable to transfer or pick him/herself up. The patient needed complete assistance with activities of daily living (ADLs). The patient was provided a home health aide 12 hours a day, 7 days a week. The RN had not provided any supervision as is required from the start of care to (4-8-05) to date of the survey (11-3-06). 43. Review of the clinical record of sampled patient #2 (start of care 4-20-05) with mental retardation receiving personal care from the home health aides of the agency revealed that the RN had not provided any supervision as required from the start of care to the discharge date of 12-14-05. The patient was a mentally retarded adult. The patient was provided a home health aide for 12 hours a week. The RN had not provided any supervision as is required from the start of care (4-20-05) to the discharge date of 12-14-05. 14 44. Review of the clinical record of sample patient #3 (start of care 12-4-05) revealed that the patient was a child with autism, mental retardation and attention deficit disorder and receiving personal care services from the agency by a home health aide (sample employee. #10). Review of the record revealed that in the team communication form written by the support coordinator it was documented that on 12-13-05 the patient choked on a piece of tangerine prepared for the patient by the parent. The home heath aide (sample employee #10) tried to clear the airway, but the patient bit his/her hand. The aide went behind the patient to do CPR and sent the housekeeper to find the parent. When the parent arrived, he/she told the home health aide to call 911. The 911 operator requested to speak with the parent of the child. When rescue arrived the patient was unresponsive. The child died that day. 45. Review of the employee file of sample employee #10 revealed that the employee CPR certification had expired in 9- 2005 and did not have current CPR certification from this date until August 2006. 46. Review of the clinical record of sample patient #4 (start of care 1-1-05) revealed that the patient was disabled and receiving personal care services from the agency by a home health aide. The patient was a child with cerebral palsy and profound mental retardation. The patient needs complete 15 assistance with ADLs and constant supervision. The patient does not sit in a upright position. The patient can only eat blended foods. The patient was provided a home health aide 6 hours a day, 7 days a week. The RN had not provided any supervision as is required from the start of care (1-1-05) to the discharge date of 2-7-06. 47. Review of the clinical record of sample patient #5 (start of care 7-8-05) revealed that the patient was disabled and receiving personal care services from the agency by a home health aide. The patient had neuropathy and gait instability. The patient was confused and needed complete care with ADLs. The patient was provided a home health aide 2 hours a day, 3 days a week. The RN had not provided any supervision as is required from the start of care (7-8-05) to the date of the survey (11-3- 06). 48. Interview with the Administrator on 11-1-06 at 3 pm confirmed that none of the agency's 180 unskilled Medicaid waiver patients receiving personal care services had been provided with supervision by the RN. The Administrator stated that all of the unskilled patients were disabled and most were children under the age of 18. The home health agency had been providing care to the patients for more than 2 years. The Administrator was under the impression that no supervision was ‘required. The agency had no evidence of a policy for supervision of unskilled patients from the Medicaid waiver program. 49. Based on the foregoing facts, Sunshine Caregivers violated Section 400.487(3), Florida Statutes (2006), Rule 59a~A- 8.0095(5) (a)&(b), Florida Administrative Code, herein classified as a Class II deficiency, which warrants an assessed fine of $1,000.00, 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 Sunshine Caregivers on Counts I through IV. 2. Assess against Sunshine Caregivers an administrative fine of $16,000.00 on Counts I through IV for violations cited above. This complaint investigation survey also resulted in an imposition of an Immediate Order of Moratorium on Elective Admissions. 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 IV. 17 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. rdes A. Naranjo, Esq. a. Bar No.: 997315 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. 537? Street Miami, Florida 33166 (U.S. Mail) 18 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 copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Ana Malberti, Administrator, Sunshine Caregivers, Inc., 11921 8. Dixie Highway, Pinecrest, Florida 33156; Sunshine Caregivers, Inc. 12651 S. Dixie Highway - Suite 406, Miami, Florida 33156; Paul tb. Orshan, Esq., Registered Agent, 200 S. Biscayne Blvd., Suite 3400, Miami, Florida 33131, on this (2 day of DLeCy ber 2006. Wer he, Clean urdes A. Naranjo, Esq. 19 Mm U.S. Postal Services: —— . emcee a _ a PS CERTIFIED MAIL. REC! : . | (Domestic Mail Only; No Insurance Co, SENDER: COMPLETE THIS SECTION oa Complete items 1, 2, and 3. Also complete peaks yeh ru item 4 if Restricted Delivery Is desired. : Gy Agent m a Print yn name and aldose the reverse | q Rt OO Addressee { __ so that we caf-retum.the card to you. fan r Wi Attach this card.to the back of the mailplece, my Recs ed by {Binted Name) i or on the front if space permits. imo or (Do TOF , = o ‘ ; , CE) eum peclopt Fee 4) Article Addressed to: He ee a Or aasrene he ays of CI (Endorsement Requirad) . ' , enter delivery eye = fe! bo one { 1 _ Restricted Delivery Fas CGmo. Hadhente =| (Endorsement Raquired) , l = . é ‘s UL TU Total Postage & Fees - 7 aie WA S Baa He a Gant To, a . 4 73. Senice Type : o - feat yey 5 seenathe Hadden / ave Pimosnoor. Foonidas 33S Ccertifed Mat 1] ExpregeMal { ~ Bireet Ant , i { O Registered CO ReturiyFecelpt fhrtderchandise rece Clinsured Mail. _ £1.C.0,D. | <0 . . ~= 5 ; BBD rs rere sm. sune 2 Jona 2440 OOOL, 4232, er GATS r= U.S. Postal Senin a : CE al Service, (Transfer from service label) Med. im TIFIED MA lL RECehi Form 3811, August 2001 Domestic Retum Receipt. fe eC e CPRI-09-Z-0885 COMPLETE THIS SECTION ON DELIVERY mu mpo& : : ru (@) F F I C ‘| A. L = Complete items 1, 2, and.3. Also complete . Sign: 7 Posts item 4 If Restricted Delivery Is desired. WO 2 Cr'Agent 4 ge m Print your name and address on the reverse XS aF7) ce Et nttiressee =] -- Gertited Fee so that we can.return-the card'to you. Recelved ’Pritted 7 =] "tum Fok @ Attach this card to the back of the mailpiace, ‘Reecelved by ( Name) G. Dato of Dalvery (Endorsamant equine, or on the front if space permits. . {2-2 6 =} Rastricted Deilva 1, Article Addressed to: is delivery address different from Item 1? CI Yes 3 (Endorsament Require) | ibe ot IFYES, enter delivery address below: C1. No 4 : Gumodunen. (2651 9. Qasse Hoy Suds Loe . [Sheer aor Fa Q 1] esac hE PA Des . a Or PO Bax deme . . ‘ 3. Service Type . : : so - [ iP toh . Mic, FO Aas FAS loe O.Certified Mail [1 Express Mall ay “A j . | Ci Registered’ © C) Return Receipt for Merchandise insurer Mall __F.2.0.5.—.. 4, 2, and 3, Also complete (1 Agent e— CERTIFIED MAIL. wm Complete items oO TH, R a ru MCLE ae . item 4 if Restricted Dalivary Is desired. =) : aE RLEe es wi Print your name and address on the reverse (1 Addressee RT so that we can retum the card to you. 4 lm Attach this card to the back of the mallplece, ru or on the front If space permits. -- + Pe $ 7 ~ D. Is delivery address different eth 5 q Postage _ 1. Article’Addressed to: IFYES, enter delivery addres below: 5 | Cortited Fee \ eC, q G hon - =} : - 204 i =I (gndoredment Hecuree) : fag 6. Prd - Restricted Delivery Fas ! . x (Endorsement Required) K SLAD 1 ~ 3. Service Type U Total Postage & Face Mean. FDercdos AAI Ci certified Mail” 4 : O Registered . 5 1 Insured Mail .Q.D. . - —— _ 2 Beahjated Delivery? (Extra Fg) ET Vos f 7002 2410 ooo1 423¢ oeob | OAT PS Form 3000, , dune 2002 2ACPALIO-ZON8S | ix PS Form 3811, August 2001 Domestic Retum Receipt GA

Docket for Case No: 07-000251