07977 ars4 STATE OF FLORIDA Ny & a) AGENCY FOR HEALTH CARE ADMINISTRATION _ 19 pb AGENCY FOR HEALTH CARE ; My Sioy ADMINISTRATION, Meg stp 4 Petitioner, AHCA No.: 2007002495 v. Return Receipt Requested: 7002 2410 0001 4235 6083 UNITED HOME CARE SERVICES, INC., 7002 2410 0001 4235 6090 d/b/a UNITED HOME CARE SERVICES, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against United Home Care Services, Inc., d/b/a United Home Care Services, Inc. (hereinafter “United Home Care Services”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes (2006), and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $1,000.00 pursuant to 400.484(2)(c), Florida Statutes (2006), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, 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 III, Florida Statutes, and Chapter 59A-8 Florida Administrative Code. 5. United Home Care Services operates a home health agency located at 5255 N.w. 87% Avenue, Miami, Florida 33178. United Home Care Services is. licensed as a home health agency under license number 299991265 with an expiration date of 7/26/08. United Home Care Services 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 UNITED HOME CARE SERVICES FAILED TO PROVIDE A CURRENT PRIORITIZED LIST OF PATIENTS WHO NEED CONTINUED SERVICES DURING AN EMERGENCY Section 400.492(2), Florida Statutes (2006) (EMERGENCY PRIORITIZED LIST) UNCORRECTED CLASS III DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the annual Medicare/Medicaid and State Re- licensure survey conducted on 9/13-14/06 and based on record review and interview the home health agency failed to provide a current prioritized list of patients who need continuous services during an emergency. The emergency management plan revealed 443 patients listed from 2003, 2004, and 2005, and 2006. Therefore, the prioritized list had not been updated. 8. Interview with the Administrator on 9/13/06 at 1 PM confirmed the findings. 9. During the follow-up conducted on 01/25/07 and based on record review and interview, the agency failed to provide a current prioritized list of patients who need continued services during an emergency. 10. The surveyor reviewed the D section of the emergency management plan manual to verify that the list was up-to-date. The record review revealed 4 names of patients on intake referral forms. The 4 POCs (plan of care) found in the D section did not belong to the 4 names found on the intake referral forms. Also, the POCs were for certification periods that ended in either November or December of 2006. Therefore, the prioritized list of patients was not current. 11. According to the Plan of Correction 9/29/06, “each week the On-Call book will be updated with current POCs for EACH patient and a current prioritized patient listing report." 12. Interview with the Assistant Administrator on 01/25/07 at 4 PM revealed that he/she was unaware of the above discrepancy. 13. Based on the foregoing facts, United Home Care Services violated Section 400.492(2), Florida Statutes (2006), herein an uncorrected Class III deficiency, which carries in this case an assessed fine of $500.00. COUNT. IT UNITED HOME CARE SERVICES FAILED TO PROVIDE A LIST OF PATIENT- SPECIFIC MEDICATIONS, SUPPLIES AND EQUIPMENT REQUIRED FOR SPECIAL NEEDS, PATIENTS FOR CONTINUING CARE AND SERVICES Rule 59A-8.027(16), Florida Administrative Code (EMERGENCY LIST OF MEDICATIONS) UNCORRECTED CLASS III VIOLATION 14. AHCA re-alleged and incorporates paragraphs (1) through (5) as if fully set forth herein. 15. During the annual Medicare/Medicaid Re-certification and Re-licensure survey conducted on 9/13-14/06 and based on record review and interview, the agency failed to provide the required list of patient-specific medications, supplies and equipment required for continuing care and services during a hurricane or emergency disaster. The list should include the name of all medications, dosage, frequency, route, time of day and special considerations for administration. The list should also include the patient's allergies; the physician's name and phone number; the name, phone number, and address of the pharmacy. The findings. include: 16. The emergency management plan revealed a list of patients that was prioritized for 2003 through 2006. There was no evidence of patient specific medications, patient's allergies, the physician's name and phone number; the name, phone number, and address. of the pharmacy. 17. An interview with the Administrator on 9/13/06 at 2 PM revealed that he/she was unaware of the necessity of the patient specific medications, patient's allergies, the physician's name and phone number; the name, phone number, and address of the pharmacy, as part of the information for each individual patient as. part of the emergency management plan. 18. During the follow-up conducted on 01/25/07 and based on record review and interview the agency failed to provide a list of patient-specific medications, supplies and equipment required for special needs patients for continuing care and services if the patient is evacuated during an emergency for any patient of the agency that had special needs. 19. The surveyor reviewed the D section of the emergency management plan manual to verify that the list was up-to-date. The record review revealed 4 names of patients on intake referral forms. The 3 POCs (plan of care) found in the D section did not belong to the 4 names found on the intake referral forms. Also, the POCs were for certification periods that ended in either November or December of 2006. Therefore, the POCs were not for current patients. 20. According to the Plan of Correction 9/29/06, "each week the On-Call book will be updated with current POCs for EACH patient and a current prioritized patient listing report which was not done. 21. Also, the Plan of correction stated that the agency would revise the Disaster Preparedness Questionnaire to include the pharmacy information, but this form was not revised or used as stated. 22. The original form was found in sampled patient #2's clinical record, but portion #5; in case of evacuation, would patient go to: was not filled out. 23. An interview with the Assistant Administrator on 1/25/07 at 4 PM revealed that he/she was unaware of the above discrepancy. 24. Based on the foregoing facts, United Home Care Services violated Rule 59A-8.027(16), Florida Administrative Code, herein an uncorrected Class III deficiency, which carries in this case an assessed fine of $500.00. 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 United Home Care Services on Counts I and II. 2. Assess against United Home Care Services an administrative fine of $1,000.00 on Counts I and II, for the violations cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 6 4. Grant such other relief as the court deems is just and proper on Counts I and II. 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. Nélson E. Rodney, Assistant General fYounsel Agency for Health Care Administration Copies furnished to: Harold Williams Field Office Manager Agency for Health Care Administration 8355 NW 53™¢ Street, First Floor 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 Roberta D’Angola, Administrator, United Home Care Services, Inc. 5255 NW 87*® Avenue, Miami, Florida 33178, and to Jose R. Fox, Registered Agent 5255 NW 87" Avenue, Suite we ¢ #400, Miami, Florida 33178 on this day of Aowk , 2007. crt ot pac pes SENDER: COMPLE? = Complete items 1, 2.ans Aen corel item 4 if Restricted Delivery Is desired. : a Print your name and address on the reverse so that we can return the-card.to you. i Attach this card to the back of the mailpiece, d or on the front if space permits. - 5 oe 1. Article Addressed to: se S25 EWUL 57 Boer)" Geaiioinet OQ sanoenat | sfizcte,