01: AT TH pp STATE OF FLORIDA Wy “ED AGENCY FOR HEALTH CARE ADMINISTRATION 7) 4 : ADH Sin OF STATE OF FLORIDA, AGENCY FOR HEALTH MEST or CARE ADMINISTRATION, 7 yy Petitioner, AHCA No.: 2007001243 4 Return Receipt Requested: v. 7002 2410 0001 4235 2467 7002 2410 0001 4235 2474 ATENDA HOME NURSING, INC. - DADE 7002 2410 0001 4235 2481 d/b/a ATENDA HOME NURSING INC DADE, Respondent. 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 Atenda Home Nursing, Inc. - Dade d/b/a Atenda Home Nursing Inc. Dade (hereinafter “Atenda Home Nursing Inc. Dade”), 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 $500.00 pursuant to Section 400.484, Florida Statutes (2006), for the protection of public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes (2006). 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 (2006), and Chapter 59A-8 Florida Administrative Code. 5. Atenda Home Nursing Inc. Dade operates a Home health agency located at 15327 N. W. 60° Avenue, Miami Lakes, Florida 33014. Atenda Home Nursing Inc. Dade is licensed as a home health agency under license number 299992093. Atenda Home Nursing Inc. Dade 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 ATENDA HOME NURSING INC. DADE FAILED TO ENSURE THAT SERVICES WERE RENDERED ACCORDING TO THE PLAN OF CARE. SECTION 400.487 (6), FLORIDA STATUTES (PLAN OF CARE) CLASS III 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Atenda Home Nursing Inc. Dade was cited with one (1) Class III deficiency due to a complaint investigation survey conducted on November 7. 2006 and December 21, 2006. 8. A complaint investigation survey was conducted on November 7, 2006. Based on record review and interview, it was determined that the agency failed to ensure that services were rendered according to the plan of care in 3 of 5 sampled patients (#2, #3, #5). The findings include the following. 9. Clinical record review of sampled patient #2 revealed that the patient's 1% admission was on 7/3/2006. The plan of care (POC) documents that the patient orders for time, frequency, and duration is RNE (registered nurse evaluation) + SN (skilled nurse) visits X 60 days. The patient was discharged on 7/10/2006. 10. Patient #2 was seen on 7/1/2006 by the RN, therefore services were rendered before the patient was even admitted to the agency. Review of the authorization from the referral managing company revealed that they only authorized 4 visits: RNE and 3 RN visits. 11. Review of the initial report and request for visits revealed that it is documented that they were going to do the RNE + 3 visits and will discharge after these visits. There is no documentation that the MD was ever notified about these changes or that an MD modification (mod) order was done in order to change the frequency, time and duration documented in the PoC . 12. Review of the new admission done to the patient on 7/20/2006 revealed that the POC frequency, time and duration documents RNE and PT evaluation (PTE) + Treatment. There is no documentation of a mod order done or sent to the MD clarifying the frequency time and duration. 13. Clinical record review of sampled patient #3 revealed that the patient's 1° admission was on 9/23/2006. The POC documents RNE + skilled nursing (SN) visit X 60 days and PTE + Treatment. The PTE was done on 9/25/2006. The patient was discharged on 9/27/2006 because the patient was transferred to the hospital. 14. Review of the initial report and request for visits revealed that the patient had an open incision on the right leg with measurement of 3cm x 1.5cm, however no wound care orders were given. 15. Clinical record review of sampled patient #5 revealed that the patient's SOC was on 7/28/2006. The POC documents that the patient has a wound however it does not document the wound care. 16. Review of all RN daily visit notes revealed that the wound care was done however there is no order for the wound care. 17. Interview with the administrator and Director of Nurses on 11/7/2006 at 2 P.M. confirmed the findings. 18. The mandatory date of correction was designated as December 7, 2006. 19. A follow-up survey was conducted on December 21, 2006. Based on record review and interview, it was determined that the agency failed to ensure that the L.P.N. followed and provided the services according to the plan of care in 1 of 5 sampled patients (#4). The findings include the following. 20. Record review of sample patient #4 clinical record revealed that there was a physician’s telephone order dated 11/21/06 to discontinue Insulin 70/30 34 units S.Q. Q. (every) P.M. , and to give Insulin 70/30 26 units S.Q. Q. P.M. 21. Review of the patient's record at the facility revealed that the patient was receiving an injection of Insulin 70/30 34 units every evening on the following dates: from 11/25/06 to 12/8/06(14 days). 22. A Home’ visit was conducted on 12/21/06. During the home visit, a record review of sample patient #4 clinical record in the home revealed that the patient received Insulin 70/30 34 units on the following dates: from 12/1/06 to 12/11/06(11 days), and then insulin 70/30 15 units on from 12/12/06 to 12/20/06 (9 day). 23. During an interview with the alternate Director Of Nursing (DON) 12/20/06 and 12/21/06, confirmed that sample patient #4 had a physicians telephone order to change the insulin 70/30 dosage to 26 units Q. P.M. and that the clinical record have documented that the patient received an injection of Insulin 70/30 34 units every evening on the following dates: from 11/25/06 to 12/8/06(i4 days) and that the patient received Insulin 70/30 34 units on the following dates: from 12/1/06 to 12/11/06(11 days), and then insulin 70/30 15 units on from 12/12/06 to 12/20/06(9 days). . 24. A home visit was conducted on 11/21/06. During the visit, an observation was made of patient #4 medications he/she was. currently taking. It was discovered that patient #4 had received the following additional medications: Seroquel 25 mg was received on 11/29/06, and Propoxyphene NA/ APAP 100 mg/650mg was received on 11/15/06. Neither, the Plan of Care with the start of care date of 11/14/06 listed the above medications, nor was the medication profile updated to reflect the two new medications. 25. An interview with the ADON (Alternate Director of Nursing) confirmed the above findings. The patient (#4) current medications included Seroquel 25 mg received on 11/29/06, and Propoxyphene NA/ APAP 100 mg/650mg received on 11/15/06. However neither the Plan of Care with the start of care date of 11/14/06 list the above medications, nor was the medication profile updated to reflect the two new medications. 26. During the home visit of patient #4 also revealed that there was no Novolin R insulin available for the insulin sliding scale coverage order by the physician on 11/15/06. 27. Record review of patient #4 clinical record both in the home and at the agency revealed that patient #4 did not receive coverage for his/her P.M. blood sugars above 150. According to the Agency's records the patient did not receive coverage for his/her blood sugars on the following dates: According to the Agency's records, patient #4 blood sugars were as follows: 11/25/06 (213) 11/26/06 (201) 11/29/06 (158) 11/30/06 (238) 12/01/06 (226) 12/02/06 (158) 12/03/06 (197) 12/04/06 (188) 12/05/06 (288) 12/07/06 (232) 12/08/06 (181) 28. According to the records in the home the patient should have received blood sugar coverage on the following dates: 12/09/06 (158) 12/10/06 (284) 12/11/06 (168) 12/12/06 (321) 12/13/06 (330) 12/14/06 (276) 12/15/06 (278) 12/16/06 (318) 12/17/06 (190) 12/18/06 (309) 12/19/06 (192) 12/20/06 (184) 29. An interview with the ADON and the facility's Administrator confirmed patient #4 should have received coverage for his/her blood sugars for the above dates. The administrator also confirmed there was no Novolin R insulin available within the facility to administer to patient #4 to cover the elevated blood sugars. The ADON also confirmed there was no documentation in the patient's clinical record of administration of Novolin R insulin. 30. Professional Standard of Care is defined in Chapter 766.102 as, "the prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers." The Florida Nurse Practice Act, Chapter 464.003 defines the "practice of professional nursing" as "the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: the administrations of medications and treatments a prescribed or authorized by a duly licensed practitioner "practice of practical nursing" as the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirmed and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. This is an uncorrected deficiency from the survey of November 7, 2006. 31. Based on the foregoing facts, Atenda Home Nursing Inc. Dade violated Section 400.487 (6), Florida Statutes, herein classified as an uncorrected Class III deficiency, which warrants 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 Atenda Home Nursing Inc. Dade on Count I. 2. Assess against Atenda Home Nursing Inc. Dade an administrative fine of $500.00 on Count I for the violation cited above. 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 Count I. 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 (ita, M. sates Esq Fla. Bar No.: 0880175 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) 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, Receipt Requested to Elizabeth Hernandez, Administrator, Home Nursing Inc. Dade, 15327 N. W. 60th Avenue, Miami Florida 33014; Atenda Home Nursing, Inc. - Dade, 15712 S. Street - Suite 18, Davie, Florida 33331; Brent D. Registered Agent, 2 Alhambra Plaza, Penthouse 11-B, Return Atenda Lakes, W. 42 Klein, Coral Gables. Florida 33134 on this [ge day of ~M aw _, 2007. Oba) in: Rods spt. Alba M. Rodriguez, Esq. US. Postal Service: CERTIFIED MAIL... RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) For delivery information visit our website at www.usps.coms OFFICIAL USE sd i : 74 -D. Is delivery address different from item 1? |». IL YES, enter delivery address below: OD) Certified Mai’ 0) Express M: OE | O) Registered C1 Retum Receipt for Merchandise w G ~ { Oinsureg Mal 1.0.0. 7002 2410 0001 4235 24b7 PS Form 38 U.S. Postal Service " CERTIFIED MAIL... RECEIPT (Doniestic Mail Only; No Insurance Coverage Provided) For c elivery information visit our website at www.usps.com: te dalivery address eo PRs. enter delivery address below: Ble eee 7002 2410 0001 4235 2474 “Cl insured Mail, 02. C.0.D. ; 2. Sastigted Delivery? (Extra Fee) opo1 4235 e474 | PS Form 3800, June 2002 PS Form 3811, August 2001 Domenic Retim FP 9) Dan Commas _

Docket for Case No: 07-002766