APR-26-2007 THU 01:32 PH Shutts and Bowen FAX NO. 3053819982 -EPR-04-2007 VED 07:48 Plt FAK tlO. une 03/28/2007 21:18 = -388a636' _ PAGE 22/13 STRTN OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARH ADMINISTRATION, Petitioner, . AHCA No.: 2007000776 Retura Receipt Requested: v. 7002 2410 9002 4235 2023 , 7002 2410 0001 4232 2030 NANY HOME HEALTH CART, mac. d/b/a WANY HOME HRALTR CARE INC... om . q D4 Respondant. / rn 1 ADEN OTRATIVE COMPLAINT cComEg NOW the srate of Florida, Agency for Health Care ndminiatration (*AHCA”"}), by and through the undersigned counsel, and files thia administrative complaint againat Nany Home Health Cara, Inc. d/b/a Nany Home Health Cara Inc.- (hereinafeer any Home Health Care Ine.”"), pursuant to Chapter 400, Paxt IIT, and Bection 120.60, Floride Statutes (2006), and herein alleges: NATURE OF THE ACTION 1. Thin is an action te impose an administrative fine of $500.00 purguant to Section 400.484, Florida statutee (2006), for the protection of public health, eafery and welfare. PAGE 21" RCVD AT 22/2007 10:20:31 AA YEaslenn Dayfight Time] SUR:FAXGERVERIS DN'S;7856 ‘ CBID.A059835407 DURATION (mmsss},02-52 APR-26-2007 THU 01:33 PH Shutts and B Biba 2UU WED U/i4y Pi wT ie i oie S a 2 “tt =) 7 az/2a/2087 2:19 _ saseeas | 4 ' PAGE 93/12 : i TORLEDTCTION AND VENUB 1 3, ACR has jurisdiction pursuant to Chapter 400, Part III, Florida statutes (2006). 3. Venue tes in Miami-Dade County purauant to Rule ii 26.106.207, Florida Administzative code. PARTIES 4. BHCA jie tha wregulatory authority reaponsible for licensure and anfercement of all applicable statutes and xules governing home health agencies, pursuant to Chapter 4oc, Part IIL, Florida sAtatutea (2006), end Chapter SSA-B Plorida Administrative Code. 5. Hany Home Health Care Inc. operates 4 home health i agency located at 9010 gS. W. 137 avenue ~ Suite i111, Miami, Florida 33186. Nany Home Health, Care Inc. ia licensed as a home health agency under licanse number 2hecgo96. Nany Home Health Care Inc. was at all timas material nerete pn licensed facility under the licanaing authority 9f AHCA ‘and wae required to comply | with all applicable rules and atatutas. 2 PAGE 0 RCVDAT 3/20/2007 19:20:34 AM {Eastern Daylight Time]? SVRCFAXSERVER/S ONS7056 * (S40 9054838497 * DURATION (nm ss}:0342 I P, 08 3853835. ' ' PAGE 44/13 ApR-26-2007 THU 01:33 PH Shutts and Bowen FAX NO, 3053819982 82/20/2007 21:19 ‘count _I NANY HOME HEALTH CARE Inc. PAILED TO DOCUMENT PATIENT CARE OBEBRVATIONS AND RHPORT CHANGES In THH PATIZNT'S CONDITION. RULE 59A-8.0095 (4) (b), FLORIDA ROMINISTRATIVE CODE. (PERSONNEL - LICENSED PRAQTICAL NURSE) cuass III 6. AuCA yre-alleges and incorporates paragrapha = (1} through (5) as if fully set forth harein. 7. Nany Home Health Care Inc. was cited with one (12) Class III deficiency due to licensure surveys that were conducted on June 16, 2005 and December 21, 2006. 8. R licensure survey was conducted on dune 16, 2005. Based on observation, elinical record review and interview, it wap determined that the ageray LPN failed to document patient care obeervations, and report changes in the patient's condition to the registered nurse with the reports documented in the clinical record, and perform care a3 apecified in ths plan of care for 2 of 19 clinical recorda reviewed (Patienta 2, #9, #15). 3. Closed clinical record review of the Homa Wealth Certification and Plan of Care (POC) datad 7/1/04 revealed that Patient #2 was admitted to tha HHA on 7/1/04 with a principal diagnosis of Diabetes Mellitus, uncomplicated, Type It, uneentrolied, and with other pertinent daiagnosea including DAGE 4/40" RCVD AT 4/24/2007 {0:20:24 AM [Eastern Daylight Time] SVR:FAXGERVERIS * ONIS:7B8G ¢ C1D:J05J035497 DURATION (mms): 0052 APR-< 26-2007 THU 01: 33 F Shutts and Bowen FAX NO, 3053819962 P, 09 Proud ed ii ACU Ut ian pan WM te 3/23/2087 21:19 3053035 : PAGE @5/13 schizophrenia end chronic airway obstruction. orders for Discipline and Treatments called for akilled nurae (SN) visita twice per day for 60 days to: assess and perform ‘blood eugar level via glucometer before adminietering insulin subcutaneously (SQ) twice per day. SN to report abnormal findinga to physician every visit. Medication ordara included the twice daily insulin dosages as well as paramsatera for a sliding stale dose of regular insulin based on blood sugar levels, with the parameter "5401 mg/dl, = 140 8Q and call M.D." SW "Goals" atated: Patiant will maintain BSL within normal limite. The blood sugar levels were taken twice per day and insulin was administered by a Liceneed Practical Nuraz (LPN). lo. Review of the SN visit notes, performed by 4 Licensed Practical Marea, of eight weeka of cara revealed that for the firat four and one half weeka,. between 7/10/04 and 9/12/o4, the LEN documented that the blood augar level was over 400 on eight different days. 11. the LPN'g notes decumented on ons occasion on 7/22/04 when the blood sugar level was 405 that "SN administer on ahd. erea Novolin 70/30 30 unita and: call M.0." Further record review failed to reveal documantatien of the outcome of the communication with che phyaicien, when tha physician wae contacted, whether tha patient ox caregiver waa given education regarding diet, or communication with the Clinical supervisors. 4 . PAGE SI" RCVD AT 5121/2007 10:20:34 AM ‘Eastern Daylight Time)® SVR:FAXSERVERUS * ONIG:78S6 CBID: 2052835497 * DURATION {mm-s.02-52 APR-26-2007 THU 01:33 GRRE CULT WED Uli4y rt Shults and Boven FRR Ho. 3063619982 @2/20/2807 21:1¢ 3gSaba5e Page 12. This form of documentation waa present on all vigits when blood glucose level was over 400. Interview with the Director of Nureea on 6/16/05 at approx. 41:00 a.m. xevealed that Patient #2 was a challenging case due to the mantal illness and waa difficult fo manage. and that the LPN did call the phyaician and was in close contact with the physician, The DON confirmed that therr was no documented avidence of the LPN's communication with the physician or agency etaft. 13. QGlinical record review of the POC dated 4/10/08 revealed that Patient #9 was admitted to the HHA on 12/10/04 and hag been recertified every 60 daya through the current cextification pariad of 6/5/05. 4. The current 7OC specifies the principal diagnosis of "Uleer, Geacubitus NOS, sacral area. NOrders for Diecipline and Treatments are aa follows: "SN ta visit every day for 60 daya, Vac to sacral wound as pear agency protacol 125. SN to nosify “DB of 6/8 infection." 45. Record review of LEN visit notes for the months of May and June 2005 revealed that the LPN failed to document wound sbaervations, deseriptiona of wound care, writing on each vigit “note: 'Yac to sacral wound as per agency protocel @ 125." Interview with the DON on 6/16/05 at approx. 11:30 a.m. confirmed that there was no additional documentation in the Clinical record regarding tha wound care. s° PAGE S12‘ ACVD AT 3/24/2007 10:20;c4 AM [Eastern Daylight Time}* URFAXSERVERIS* DN: 78 *C610:2060825407 * DURATION m-s.0342 . APR-26- 01: Eosiean THU 01:33 PH Shutts and Boven Fak No, 3063819982 “p3/20/28G7 21:19 30898354 | ‘ PAGE 46. Clinical record review of the POC dated 5/3/05 revealed thet Patient #15 wus admitted to the HHA on 7/7/04 and nas been recertified every 60 daya for continued gervicea for a principal diagnesia of HIV disease, and anemia NoB. Orders for diacipline and treatments specify: “aleilled nurse visits avery two weeks; weight (sic) patient avery vieit, gkill so prepare/adminiater eyanocobalanin and depo-teatcaterone intramuscularly every two weeks.” SN goale ineluded: UNutritional needs maintained & addressed...optimal nutrition and hydration "Clinical record review of three certification periods of 11/11/04, 1/6/05, and 5/3/05 revealed no documentation -hat Patient #15 was ever weighed by the LFW during chase three certification periods, or that the nutritional atatus wae assessed aa per the orders in the Poc. 17. The mandatory date of correction was designated as July 17, 2005. 18. A licensure survey was conducted on December 21, 2006. Baged on. clinieal record review and interview the agency's jieensed practical nurse feiled to prepare clinioal notes which accurately reflected asgepnment of the patient in 1 of 16, sampled patient #13. The findings iduclude the following. 19. Review of the clinical xecerd of gampled patient #13, diagnoses of decubitua ulcer to the lower back, the patient was admitted to receive wound care by the skilled nurae 44 fallowa 6 PAGE 7/13*ROVD AT S/24/2007 10:20:31 Atl Eastern Daylight Time)! SVR:FAXGERVERIS* DNS:7856* CBID; 4099005407 ? DURATION {mm-ss):09-92 “APR-26-2007 THU 01: APRrUd-2UU ye WED Dae Hl Shatts and Boven re No, 3089619982 fle vie sie G3/28/2847 21,12 2Q53625¢ i ‘ PAGE 88/13 ‘cleanse with normal saline, pat dry, apply ducdeaxm paten to gacral area and change every other day. Apply silvadine cream Co bilateral buttocks, cover with dressing and seoure with nypofix rape daily." Plan of Care certification pariod dated 10/12/06 to 12/10/06 documente that the nursc ja to agsesa vital signs, effectiveness of medication regimen and evidence of adverse reactiona and to report abnormal clinically significant data to physician. Skilled nursing to observe and record swelling, redness, pain, and elevations in temperature. The goals listed on the Plan of Care indicate that pain will be absent/dacreased and teaching will be given by the skilled nuree. Skilled nurse's notes from 11/11/06 to 11/18/06 revealed no documentation of pain ageeapment while the patient was receiving wound care. There was no documentation of patient teaching in the above akilled nurse's notes. 20. Interview with the Director o£ Wuraing and Administrator on 12/19/06 at 3:00 p.m. confirmed the above findings. This ta a repeat deficiency from the survey of June 16, 2008S. 21. Based on the foregoing facts, Nany Home Health Cara Inc. violated Section Rule S9A-8.0095(4) (b), Florida admindatrative Code, herein classified ae a repeat Claaa Itt deficiency, which warrants an assessed fine of $500.09. DAGE SI13°RCVD AT 42172007 (0:20:04 AM [Eastern Oayllght Time}* BVR-FAKSERVERIS* DNJS:7RS6" CSID:3043825497 * DURATION [nimess}: 03-51 “APR-26-2007 THU 01:33 PM Shutts and APR-O¢-2007 WED O749 PH tits and Boven vere see G2/22/2087 21:13 3953835, PAGE CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to oxder the following relief: L. Enter a judgment in favor of the Agency for Health Care Administration against Nany Homa Health Care Inc. on Count I. 2. the inveatigation and proseaution of this macter, if applicable. 4. Grant euch other relief as the court Geema is just and propar on Count I, » Respondent 1s notified that it haa a right to request an administrative hearing pursuant to Sactiona 120.569 and 120.57, Florida Statutes. Specific options for administrative action are get out in the attached Blection of Righta. All xequests for hearing shall be mada to the Agency far Health Care Administration and delivered to the. Agenoy Clerk, Agency for Health Care Adiiniattatton, 2727 Mahan rive, Ms #3, Tallahaasee, Florida 32308. & PAGE 49° RCVD AT 32{/2007 10:20:24 AM (Eastern Daylight The)! SVR:FAKEERVERS * DM|S:7856 CBI0:2050895407 * DURATION (mm-ss} Usi2 APR-26-2007 THU 01:33 PM Shutts and Bowen FAX NO, 3053819982 RPM am eu We i a PU i TAA * @3/28/2067 21:13 30698954 ; : PAGE ' i RESPONDENT I¢ FURTHER NOTIFIRO THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE | (21! DAYS OF RECEIPT OF if THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THR COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGHNCY. IF you WANT TO HIRE AN ATTORNEY, you HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER t | 0, blewen ourdes A. Naranjo, Esq. Fla. Bax |No.: 997315 AReasistant General Counsel Agency for Health Care Administration a350 N.W! 52 Terrace - #203 Miami, Florida 33166 Copiea furnished to: Harold Williams Field Office Manager Agency for Health Care Administxaction @355 N. W. 537° Street Miami, Florida 33166 (u,6. Mail) Jaan Lombardi Finance and Accounting Agency for Health Care Adminiatration 2727 Mahan Drive Tallahaasee, Florida 32308 (Inkeroffice Mail) | Mone Health Agency Unit Program Agency for Health Care Administration 2727 Mahan Drive ‘ Tallahassee, Florida 32308 (Interoffice Mail) i i I 1 | | PAGE 10/13 ‘ ACVD AY 4/24/2007 40:20:31 AM [Eastern Daylight Time}? SVR;FAXGERVERIS* DN. 7889¢ CSID:2059895497 * DURATION (tnmss):0992 ~APR-26-2007 THU 01:33 PH Shutts and Bowen FAX NO. 3053819982 P, 15 CRYRoUG=2UUF WED UNO Fi PHA NU, rou 2/20/2487 21:19 2G528954 | PAGE 11/13 CERTIFICATE OF SERVICE I’ WEREBY CHRTIPY that a trua and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested ta Roherto Gonzalez, Administrator, Nany Home Health Cara Inc., 9010 S. W. 137 Avenue - Budte 111, Miami, Florida 33186; Roberto Gonzalez, Registered Agent, > ia 5. W. Florida 33176 on thie 7 day of 94 Court, Miami, DIybrAb— 009. rdea A. Naranjo, Esq- 10 PAGE 1143 *ROVO AT 3/24/2007 10:20:31 AM. [Eastern Dayllght Time]? SVR:FAYSERVERIS * DNIS:7858! CSID:I050095497* DURATION (mm-se}:00-82

Docket for Case No: 07-001929

Issue Date	Proceedings
Jul. 03, 2007	Final Order filed.
May 30, 2007	Order Closing File. CASE CLOSED.
May 29, 2007	Motion to Relinquish Jurisdiction filed.
May 11, 2007	Order of Pre-hearing Instructions.
May 11, 2007	Notice of Hearing (hearing set for July 6, 2007; 9:00 a.m.; Miami, FL).
May 09, 2007	Joint Response to Initial Order filed.
May 03, 2007	Initial Order.
May 02, 2007	Petition for Formal Administrative Hearing filed.
May 02, 2007	Order of Dismissal without Prejudice Pursuant to Section 120.569(2)(c), Florida Statutes, to Allow for Amendment and Resubmission of Petition filed.
May 02, 2007	Letter to M. Gennett from R. Shoop regarding receipt of Petitioner for Formal Administrative Hearing filed.
May 02, 2007	Administrative Complaint filed.
May 02, 2007	Amended Petition for Formal Administrative Hearing filed.
May 02, 2007	Notice (of Agency referral) filed.