OT-371 07 STATE OF FLORIDA Aug 2/ AGENCY FOR HEALTH CARE ADMINISTRATION Dy AbKL i: STATE OF FLORIDA, AGENCY FOR HEALTH Hees CARE ADMINISTRATION, Petitioner, AHCA No.: 2007005046 Return Receipt Requested: v. 7002 2410 0001 4232 2132 7002 2410 0001 4232 2149 STAR MULTI CARE SERVICES, INC. d/b/a 7002 2410 0001 4232 2347 STAR MULTI CARE SERVICES, INC., 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 Star Multi Care Services, Inc. d/b/a Star Multi Care Services, Inc. (hereinafter “Star Multi Care Services, Inc.”), 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 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 Broward 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. Star Multi Care Services, Inc. operates a home health agency located at 2221 N. University Drive, Pembroke Pines, Florida 33024. Star Multi Care Services, Inc. is licensed as a home health agency under license number 21133096. Star Multi Care Services, Inc. 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 STAR MULTI CARE SERVICES, INC. FAILED TO ENSURE THAT THE PLAN OF CARE COVERS ALL PERTINENT DIAGNOSES, MEDICATION, AND OTHER APPROPRIATE ITEMS. RULE 59A-8.0215 (1) FLORIDA ADMINISTRATIVE CODE. (PLAN OF CARE) CLASS III 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Star Multi Care Services, Inc. was cited with two (2) Class III deficiencies due to licensure surveys that were conducted on December 14, 2006 and February 13, 2007. 8. A licensure survey was conducted on December 14, 2006. Based on record review, observation and interview, it was determined the Agency failed to ensure the Plan of Care covers all pertinent diagnoses, medications and other appropriate items for 9 of 16 patients in the sample (Patient #1, #2, #3, #6, #7, #10, #13, #14, #15 and #17). The findings include the following. 9. A review of Patient #1's Plan of Care revealed the patient was admitted 12/07/2006 with the diagnosis of Dental Operation and with Physician orders for Skilled Nurse for 7 days to administer Lovenox 80 mg SQ (subcutaneously) . 10. A continued review of the Plan of Care revealed Locator 10 for Medication lists only "Lovenox 80 mg (milligrams) subq (subcutaneous) 2 x (2 times a) day" and states "See Med Profile". A review of the Medication Profile, dated 12/07/06, lists a total of 10 medications including the Lovenox, but only the Lovenox is listed on the Plan of Care. Interview with the Director of Patient Services (DOPS) on 12/11/06 at 2 PM, revealed the DOPS acknowledged the Plan of Care notation to "See Med Profile" and told the surveyor that most of the records in the sample will have the same notation to see the medication profile (for a list of medications). 11. A review of Patient #3's Plan of Care revealed the patient was admitted 02/03/06 with diagnoses of Catheter Infection, Pneumonia and Renal Disease and with Physician orders for the Skilled Nurse for 4-6 times a week for 1 week for Rocephin one gm (gram) daily. Additional Orders list Rocephin one gm via peripheral (IV), no frequency. A continued review of the Plan of Care locator 10 for Medications states "See Profile". 12. A review of the Medication Profile lists Rocephin 2 gm Iv daily (not lgm as listed on the first page of the Plan of Care) and Percocet PRN (as needed) for back pain (no dosage or frequency). Interview with the DOPS on 12/11/06 at 2:30 PM, revealed the DOPS acknowledged the medications were not contained in the Plan of Care as required. 13. A review of Patient #6's Plan of Care revealed the patient was admitted 12/08/2006 with diagnosis of, in part, Pneumonia. Physician orders included Skilled Nurse daily for 2 weeks to provide wound care. A continued review of the Plan of Care revealed wound care orders for Betadine, dry sterile dressing and Hypafix tape to the chest wound. 14. A review of the Comprehensive Assessment and nursing notes revealed the patient had a Pneumothorax, had a chest tube inserted and also had a pleurovac (chest suction device) in place. There was no evidence of documentation on the Plan of Care that these Surgical Procedures and the Other Pertinent Diagnosis of Pneumothorax were included on the Plan of Care. 15. In addition, there was no evidence of documentation of an Other Pertinent Diagnosis which would include the wound in the chest. Interview with the DOPS on 12/14/06 at 2 PM determined that the DOPS acknowledged the omission of the diagnosis, but no other information was obtained. 16. A review of Patient #7's Plan of Care revealed the patient was admitted 12/05/06 with the diagnosis of Right Knee Osteoarthritis. Continued review of the Plan of Care and Physical Therapy orders revealed the patient had a Right Total Knee Replacement prior to admission to the Home Health Agency. 17. There was no evidence of documentation that the Total Knee Replacement was included on the Plan of Care as a Surgical Procedure. The DOPS was informed on 12/11/06 at 11:45 am, but no other information was provided. 18. A review of Patient #10's Plan of Care revealed the patient was admitted 10/24/2006 with diagnoses of Osteomyelitis, Hypertension, and Diabetes Mellitus. A continued review of the Plan of Care at Locator 10 for Medications revealed Locator 10 was blank with a directive to "See Profile". 19. A review of the Medication Profile documented 6 medications, including 2 IV (Intravenous) medications. During a home visit on 12/12/06 at 1 PM, accompanied by the DOPS, it was observed that there was no Medication Profile in the home. Interview with Patient #10 at 1:15 PM revealed 2 new medications had been ordered, but were not documented on a medication list in the home folder. 20. A review of Patient #13's Plan of Care revealed the patient was admitted 10/8/2006 with diagnoses of Pneumonia and Cystic Fibrosis and a Surgical Procedure listed as Port-a- Catheter Insertion. A continued review of the Plan of Care revealed Locator !0 for Medications was blank, except for a notation to "See Med Profile". 21. A review of the Medication Profile revealed a listing of 19 medications, 2 of which were IV infusions. A review of the Comprehensive Assessment determined the patient was using Oxygen 2 liters per minute at night, but there was no evidence of documentation of Oxygen on the Medication Profile or on the Plan of Care. Interview with the DOPS on 12/11/06 at 12 Noon determined the DOPS acknowledged the omissions on the Plan of Care and Medication Profile but no other information was provided. 22. A review of Patient #14's Plan of Care revealed the patient was admitted 01/26/2006 with diagnoses of SMA type I (Spinal Muscular Atrophy) and Vomiting. A continued review of the Plan of Care revealed Locator 10 for Medications listed one medication only, Ceftazidime 550 mg Q (every) 8 hours (no route or duration). 23. A review of the Medication Profile (no date) showed a list of 5 medications, including the Ceftazidime. The DOCS was informed on 12/14/05, but no other information was provided. 24. A review of Patient #15's Plan of Care revealed the patient was admitted 02/27/2006 with the diagnoses of Seizure Disorder, Cerebral Vascular Accident, and Diabetes Mellitus. A continued review of the Plan of Care revealed Locator 10 for Medications was blank except for a notation to "See Med Profile". 25. A review of the Medication Profile showed a listing of 10 medications that had not been transferred to. the Plan of Care. The DOPS was informed on 12/11/06 at 12:15 am, but no further information was provided. 26. A review of Patient #17's Plan of Care revealed the patient was admitted 12/01/2006 with the diagnosis of Right Lacrimal Gland Cancer. A continued review of the Plan of Care revealed Locator 10 for Medications was blank except for a notation to "See Med Profile". 27. A review of the Medication Profile listed 5 medications, none of which were transferred to the Plan of Care. The DOPS was informed on 12/14/06 at 3 PM, but no further information was provided. 28. A review of Patient #2's Plan of Care revealed the patient was admitted 10/27/2006 with the diagnosis of Klebsiella and procedure of Insertion of Groshong. A continued review of the Plan of Care revealed Locator 10 for Medications was blank, except for a notation to "See Attached". 29. A review of the Medication Profile revealed 11 medications, none of which were transferred to the Plan of Care. Interview with the DOPS on 12/14/06 at 2:30 PM revealed the DOPS acknowledged the Plan of Care omission, but no other information was provided. 30. The mandated date of correction was designated as January 13, 2007. 31. A follow-up survey was conducted on February 13, 2007. Based on record review and interview, it was determined that the Agency failed to ensure the Plan of Care, established in consultation with the Physician, covers all treatment orders and other pertinent information including medications for 1 of 4 patients in the sample (Patient #4 ).The findings include the following. 32. A review of Patient a's Plan of Care (POC) revealed the patient was admitted 01/04/2006 with the diagnosis of Colon Cancer and the surgical procedure of Colon Resection. Continued review of the POC revealed Physician orders for the Skilled Nurse daily times 3 and PRN (as needed) to administer the intravenous chemotherapy, 5 FU, via the patient's port (port-a- catheter). 33. A review of Locator 10 on the POC for medications, dose/frequency/route/New/Changed, listed 3 medications: 5 Fu Chemo IV over 22 hours Day 1 & Day 2, NS (normal saline) flush pre/post infusion with 10 cc (cubic centimeters), and Heparin flush follow-up 100 Units post infusion. No other medications were listed. 34. A review of the Medication Profile, completed by the Registered Nurse at the start of care, showed 4 medications, one of which was Compazine 10 mg (milligrams) PO (by mouth) every 6 hours PRN for nausea. Compazine was not listed on the poc Locator 10 for medications. During an interview with the Director of Patient Services, on 02/13/2007, at 2 PM, the Director acknowledged the omission but no other information was obtained. This is an uncorrected deficiency from the survey of December 14, 2006. 35. Based on the foregoing facts, Star Multi Care Services, Inc. violated Rule 59A-8.0215(1), Florida Administrative Code, herein classified as an uncorrected Class III deficiency, which warrants an assessed fine of $500.00. COUNT II STAR MULTI CARE SERVICES, INC. FAILED TO REVIEW THE COMPREHENSIVE ASSESSMENT TO INCLUDE INSTRUCTIONS TO THE PATIENT/CAREGIVER IN ADMINISTRATION OF AND IDENTIFICATION OF POTENTIAL ADVERSE EFFECTS. RULE 59A-8.022(5), FLORIDA ADMINISTRATIVE CODE. (CLINICAL RECORDS CONTENTS) CLASS III 36. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 37. A licensure survey was conducted on December 14, 2006. Based on record review and interview, it was determined the Agency failed to review the comprehensive assessment to include all medications the patient was currently receiving and instructions to the patient/caregiver in administration of and identification of potential adverse side effects for 3 of 16 patients in the sample (Patient #1, #7 and #13). The findings include the following. 38. A review of Patient #1's Plan of Care lists the Medication, Lovenox 80 mg SQ (subcutaneous) 2 times a day, anda 10 note that says "see med sheet". A review of the Medication Profile, completed by the RN (Registered Nurse) on 12/07/06, listed 9 other medications that were not included on the Plan of Care. 39. In addition, there was no evidence of documentation that the 10 medications were classified according to potential adverse side effects. Interview with the Director of Patient Services (DOPS) on 12/11/06 at 2 PM determined the DOPS acknowledged the omission on the Plan of Care, but did not provide other information. 40. A review of Patient #7's Plan of Care listed one medication, Endocet 7.5 mg every 4-6 hours PRN (as needed) . During a home visit on 12/12/06, at 10:40 am, accompanied by the Director of Patient Services (DOPS), the patient reviewed the medication on the Plan of Care and stated another medication, Fragmin 40 mg SQ was administered by the patient's spouse. 41. There was no evidence of a medication profile in the patient's home. 42. A review of Patient #13's Plan of Care lists no medications on the Plan of Care, but notes "See Med Profile". A review of the Medication Profile completed by the RN (Registered Nurse) on 10/18/06 contained 19 medications currently being taken by the patient. il 43. During a review of the clinical record, it was determined the patient was using Oxygen 2 liters per minute via nasal canula at night. There is no evidence of documentation that Oxygen is listed on the Medication Profile or on the Plan of Care. Interview with the DOPS on 12/11/06, at 12 Noon, revealed the DOCS acknowledged the medications were not listed on the Plan of Care and that Oxygen was not listed on the Plan of Care and Medication Profile. 44, The mandated date of correction was designated as January 13, 2007. 45. A follow-up survey was conducted on February 13, 2007. Based on record review and interview, it was determined that the Agency failed to ensure all medications the patient was currently receiving and instructions to the patient/caregiver included identification of any potential adverse side effect for 1 of 4 patients in the sample (Patient #3). The findings include the following. 46. A review of Patient #3's Plan of Care revealed the patient was admitted 01/19/2007, with the diagnosis of Ulcer, Right Lower Extremity, and with physician orders for the Skilled Nurse to provide daily wound care. Continued review of the clinical record revealed the Medication Profile, completed by the Registered Nurse on 01/19/07, listed 14 medications, 8 of which were not classified as to potential adverse side effects. 12 47. During an interview with the Director of Patient Services, on 02/13/2007 at 11:30 AM, the Director acknowledged the Medication Profile was not complete but no other information was provided. This is an uncorrected deficiency from the survey of December 14, 2007. 48. Based on the foregoing facts, Star Multi Care Services, Inc. violated Rule 59A-8.022(5), Florida Administrative Code, 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 Star Multi Care Services, Inc. on Counts I and II. 2. Assess against Star Multi Care Services, Inc. an administrative fine of $1,000.00 on Counts I and II for violations 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 Counts I through III. 13 Respondent is notified that it has a vight 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 Yves, Ue Cac ney, Lourdes A. Naranjo, Esq. Fla. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Karen Davis 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 Rebecca McClaren, Administrator, Star Multi Care Services, Inc., 2221 N. University Drive, Pembroke Pines, Florida 33024; Star Multi Care Services, Inc., 33 Walt Whitman Road, Suite 302, Huntington Station, New York 11746; cT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324 on this 22 Th esay of , 2007. rdes A. Naranjo, Esq. -ED O7AUG 21 PM 4: 34 DIVISION oF ADMINISTRATIV HEARINGS © \ weet cnt tn ema aes ES - - SELIVER L U.S. Postal Service: SENDER: COMPLETE THIS SECTION ‘ —_ ‘A. Signature DPA OR UTEMIEL et compete tore 2, ana, Aso conoite SNVFRED SINGER Oger | in (Domestic Mail Only; No Insurance item 4 if Restricted Delvory dens reverse x ff } C..bete of Delive | mu For delivery information visit our websi fil eo that we can return he card 10 YOU. iece. ;. Recgwed ¥ ger | a ru this card to the back of the mailpiece, : _—— 2 “DD Yes m 8) F F i Cc IA | m Attach this card to the back D, Is delivery address different from Iter 1 LINo \ fu or ol address below: L > Postage | $ 1. Article Addressed to: “: if YES, enter delivery ( Pe] certifed . i a i Fee : CT | Sl endisaran Sekinss wots Duna. Sts ' Fy Erdorssnront Ren res i PP nm tetuen « FLoriad : 3. Service Type ox j O Certitied Mai (1 Express Mail : TU Total Postage & Fees | $ CO Registered (C1 Retum Receipt for Merchandise mU . . insured Mait_ £1 C.0.D. | a WO Neo Aug 7 estricted Delivery? (Extra Fes) O Yes i nt “oO . 234 : op 00. tla Peon ne 2OD2 244 OOO} NEE Oe nF ~ Da (Transfer from service label) m PS Form 3800, June 2002 uo : ' Conan : Ginn

Docket for Case No: 07-003771

Orders for Case No: 07-003771