STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, CASE NO: 2007012259 08-1466 Vv. RENDITION NO.: AHCA-08-0710-S-OLC SUNRISE HOME HEALTH AND SUPPLIES, LLC, Respondent. / FINAL ORDER Having reviewed the administrative complaint dated January 31, 2008, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Ex. 2) with the other party to these proceedings, and being otherwise well-advised in the premises, finds and concludes as follows: ORDERED: 1. The attached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. Respondent shall pay an administrative fine in the amount of Four Thousand Eight Hundred Seventy Five Dollars ($4,875). The administrative fine is due and payable within thirty (30) days of the date of rendition of this Order. 3. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to these case numbers, should be sent directly to: Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308 4. Unpaid fines pursuant to this Order wil! be subject to statutory interest and may be collected by all methods legally available. 5. Respondent’s petition for formal administrative proceedings is hereby dismissed. 6. Each party shall bear its own costs and attorney’s fees. 7. The above-styled cases are hereby closed. DONE and ORDERED this o@day of uly _, 2008, in Tallahassee, Leon County, Florida. Holly Benson, Secretary Agency for Health Care Administratitn A PARTY WHO IS ADVERSELY AFFECTED BY-THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Frederick E. Hasty, III, Esq. Attorney for Sunrise Home Health and Supplies, LLC Wicker, Smith, O’Hara, McCoy & Ford, P.A. Grove Plaza Building, 5" Floor 2900 Southwest 28" Terrace Miami, Florida 33133 Finance & Accounting Agency for Health Care Administration Revenue Management Unit 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 | (Interoffice Mail) (U. S. Mail) Andrea M. Lang, Esq. Agency for Health Care Administration 2295 Victoria Avenue, Room 346C Ft. Myers, Florida 33901 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 Interoffice Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Daniel M. Kilbride Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 U.S. Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the method designated, on this the 27 day of a, , 2008. Richard Shoop, Agency Cierk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2007012259 SUNRISE HOME HEALTH AND SUPPLIES, L.L.C., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency For Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, SUNRISE HOME HEALTH AND SUPPLIES, L.L.C. (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges as follows: NATURE OF THE ACTION This is an action to impose an administrative fine against a home health agency in the amount of SIX THOUSAND FIVE HUNDRED DOLLARS ($6,500.00) pursuant to Sections 400.474 and 400.484(2)(c), Florida Statutes (2007), based upon two repeat Class ITI deficiencies. The total fine amount is based upon a $500.00 fine per occurrence with thirteen (13) occurrences found. JURISDICTION AND VENUE 1. This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2007). EXHIBIT fi “ tabbies” 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, Florida Statutes (2007), Chapters 408, Part II, and 400, Part III, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code (2007). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2007). PARTIES 4. The Agency is the licensing and regulatory authority that oversees home health agencies in Florida and is responsible for the enforcement of the applicable federal and state regulations, statutes and rules governing home health agencies pursuant to Chapter 408, Part II, and Chapter 400, Part II, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code (2007). The Agency may deny, revoke, or suspend a license, or impose an administrative fine, for violations as provided for by Sections 400.474 and 400.484, Florida Statutes (2007), and Rules 59A-8.003 and 59A-8.0086, Florida Administrative Code (2007). 5. The Respondent was issued a license by the Agency to operate a home health agency in Florida (License Number 299991604) located at 22110 Kimble Avenue, Port Charlotte, Florida 33952, and was at all material times required to comply with the applicable federal and state regulations, statutes and rules governing home health agencies. COUNTI The Respondent Failed To Ensure The Registered Nurse Notified The Physician When The Patient’s Condition Changed And Deviations From The Plan Of Care Occurred In Violation Of Rule 59A-8.0095(3)(a)3., Florida Administrative Code (2007) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, a registered nurse shall be currently licensed in the state, pursuant to Chapter 464, Florida Statutes, and assure that progress reports are made to the physician for patients receiving nursing services when the patient’s condition changes or there are deviations from the plan of care. Rule 59A-8.0095(3)(a)3., Florida Statutes (2006). 8. On or about November 20, 2006 through November 21, 2006, the Agency conducted a Complaint Investigation (CCR# 2006-008117) of the Respondent and the Respondent’s Facility. 9. Based on a record review the agency failed to provide documentation that the skilled nurse assessed patient condition changes or deviations for plan of care for three (3) of six (6) patients, Patient number one (1), Patient number four (4), and Patient number five (5). 10. A review on November 20, 2006 of Patient number one’s (1) record revealed a lack of documentation assessing the removal of the Foley catheter; further review indicates Skilled Nursing services continued for an additional six (6) visits. Assessment for additional : Skill Nursing services was not documented. 11. Patient number four (4) was admitted to the agency on May 19, 2006 with a primary diagnosis of thoracic lumbar/sacral... Per the initial comprehensive assessment dated May 19, 2006, the registered nurse documented Patient number four (4) was able to independently transfer and ambulate with an assistive device. On August 15, 2006, skilled nurse documentation revealed Patient number four (4) voiced his/her concern of decreased muscle tone to the right leg with a lack of documentation an assessment or re-evaluation of the patient's needs was completed. 12. Further documentation on August 22, 2006 revealed a skilled nurse assessment that reported the right leg was flaccid. There was no documentation in the clinieal record the physician was ever notified of these major changes in Patient number four’s (4) condition that could warrant a possible alteration in the plan of care and further treatment orders. 13. Inan interview on November 21, 2006 at approximately 3:30 p.m., the Director of Patient Care and the Administrator confirmed the record did not support that the skilled nurse assessed Patient number four’s (4) needs and notified the physician of these changes in Patient number four’s (4) condition and further agreed the skilled nurse should have promptly communicated with the physician. 14. A review on November 20, 2006 of Patient number five’s (5) record revealed documentation dated October 20, 2005 stating wounds are healed; Skilled Nursing services was continued for an additional two (2) visits. Patient number five’s (5) record is lacking assessments for the additional Skill Nursing services. 15. The Respondent’s act, omission or practice had an indirect, adverse effect on the ” health, safety, or security of a patient constituting a Class II deficiency. Section 400.484(2)(c), Florida Statutes (2007). 16. The Agency provided the Respondent with a mandatory correction date of December 21, 2006. 17. On or about January 2, 2007, the Agency conducted a follow-up survey of the Respondent and the Respondent’s Facility and determined that the above referenced deficiency had been corrected. 18. On or about October 1, 2007, through October 3, 2007 the Agency conducted a relicensure survey of the Respondent and the Respondent’s Facility. 19. Based on Administrative interview and a review of fifteen (15) patient clinical records where skilled nursing care was provided, the Agency failed to ensure the Registered Nurse notified the physician when the patient's condition changed and deviations from the Plan of Care occurred for one patient, Patient number ten (10). 20. Patient number ten (10) was admitted to the Agency on September 14, 2007 with multiple diagnoses including abnormality of gait, lumbago, shortness of breath, and unspecified chest pain. A record review revealed the nurse documented on September 21, 2007 "Phillips MOM q3d pm” and "instructed the patient not to take MOM daily.” A review of the clinical record revealed no evidence of a physician's order and approval for prescribing this medication for constipation. A further review of the record revealed no documentation that the nurse notified the physician about Patient number ten’s (10) condition. During a home visit completed on October 2, 2007 at 10:00 a.m., Patient number ten (10) confirmed that the nurse recommended the use of Phillips Milk of Magnesia as medication to be used for her constipation. 21. Upon. finding an uncorrected or repeated class III deficiency, the Agency may impose an administrative fine not to exceed $500.00 for each occurrence and each day that the uncorrected or repeated deficiency exists. Section 400.484(2)(c), Florida Statute (2007). 22. The Agency provided the Respondent with a mandatory correction date of © November 3, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of FIVE HUNDRED DOLLARS ($500.00) based upon one occurrence of a repeated Class III deficiency pursuant to Sections 400.474 and 400.484(2)(c), Florida Statutes (2007). COUNT The Respondent Failed To Ensure That Care Followed The Plan Of Treatment In Twelve (12) Patient Cases In Violation Of Rule 59A-8.0215(2), Florida Administrative Code (2007) 23. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 24. Pursuant to Florida law, home health agency staff must follow the physician, physician assistant, or advanced registered nurse practitioner’s treatment orders that are contained in the plan of care. If the orders cannot be followed and must be altered in some way, the patient’s physician, physician assistant, or advanced registered nurse practitioner must be notified and must approve of the change. Any verbal changes are put in writing and signed and dated with the date of receipt by the nurse or therapist who talked with the physician, physician assistant, or advanced registered nurse practitioner's office. Rule 59A-8.0215(2), Florida Administrative Code (2007). 25. On or about November 20, 2006 through November 21, 2006, the Agency conducted a Complaint Investigation (CCR# 2006-008117) of the Respondent and the Respondent’s Facility. 26. Based on a review of six (6) records, the agency failed to provide the physician authorized range of visits per week for service as outlined in the plan of care for two (2) patients, Patient number one (1) and Patient number four (4), and failed to follow the established plan. of care for wound care treatment as physician ordered for one (1) patient, Patient number four (4). 27. A record review conducted on November 20, 2006 for Patient number one (1) revealed Skilled Nursing home visits were not followed as physician ordered on the Home Health Certification and Plan of Care specifying the amount, frequency and duration of services. The patient's Home Health Certification and Plan of Care orders indicated on week number two (2) there should have been one Skilled Nursing visit; the patient's record indicated two (2) visits documented (October 23, 2006 and October 25, 2006) without benefit of a physician's order. 28. A further review of the record revealed orders for week three (3) that indicated there should have been one (1) Skilled Nursing visit. However, Patient number one’s (1) record has three (3) Skilled Nursing visits documented (October 29, 2006, October 31, 2006, and November 2, 2006). 29. . Patient number four (4) was admitted to the agency on May 19, 2006. Per a physician’s telephone order dated July 23, 2006, the home health aide was to provide services, two (2) times per week for eight (8) weeks. A record review revealed the home health aide provided services three (3) times during the week of August 6, 2006 through August 12, 2006 on August 7, 2006, August 9, 2006 and August 10, 2006. During the week of August 13, 2006 through August 19, 2006, the home health aide provided visits on August 14, 2006, August 16, 2006 and August 18, 2006. These additional visits were completed without benefit of a physician’s order. There was no documentation of a physician's telephone order to support authorization of these extra visits. 30. On July 11, 2006, a record review for Patient number four (4) revealed skilled nursing received a physician's telephone order for wound care to the left leg as follows: "Wound care to L (left) calf - cleanse with NS (normal saline) Apply Mepitel, secure with transparent cover, change every 3-5 days till healed.". Documentation in the clinical record revealed the skilled nurse used Mepilex instead of Mepitel as ordered. In an interview with the Director of Patient Services at 2:00 p.m., it was shared the two treatments are not the same and are not interchangeable. It was also confirmed the skilled nurse had not completed the wound care as ordered. 31. A further record review revealed the skilled nurse completed a visit on July 11, 2006 with no additional skilled nurse visit documented until July 18, 2006. The skilled nurse had not assessed the wound and changed the dressing every 3-5 days as ordered for Patient number four (4). There was no documentation the skilled nurse contacted the physician for this change to the plan of care and further treatment orders. 32. On July 18, 2006, skilled nursing completed a recertification period with an assessment of the Patient number four’s (4) needs. Per the plan of care dated July 18, 2006 through September 15, 2006, no wound care orders had been established. Documentation in the clinical record revealed skilled nursing provided wound care to the left leg of Patient number four (4) on August 15, 2006 without benefit of a physician's order. There was no documentation the skilled nurse contacted the physician for wound care guidance and treatment orders. 33. The Respondent’s act, omission or practice had an indirect, adverse effect on the health, safety, or security of a patient constituting a class II] deficiency. Section 400.484(2)(c), Florida Statutes (2007). 34. The Agency provided the Respondent with a mandatory correction date of December 21, 2006. 35. On or about January 2, 2007, the Agency conducted a follow-up survey of the Respondent and the Respondent’s Facility and determined that the above referenced deficiency had been corrected. 36. On or about October 1, 2007, through October 3, 2007 the Agency conducted a relicensure survey of the Respondent and the Respondent’s Facility. 37. Based on a review of fifteen (15) clinical records and Administrative interview, care did not follow the plan of treatment in twelve (12) cases, Patient number one (1), Patient number two (2), Patient number three (3), Patient number four (4), Patient number five (5), Patient number six (6), Patient number seven (7), Patient number eight (8), Patient number nine (9), Patient number ten (10), Patient number thirteen (13), and Patient number fourteen (14) . 38. Patient number one (1) was admitted to the Agency on August 4, 2007 with skilled nursing ordered for wound care. Per the Plan of Care, nursing was to provide wound care to the left knee and on August 6, 2007 an order was received for skilled nursing to perform PT/INR every Monday and Thursday for three (3) weeks. The order on the Plan of Care for wound care stated "Wound care to left knee." On August 6, 2007, August 9, 2007, and August 13, 2007, the nurse documented wound care was performed using gauze and an elastic (ACE) wrap without benefit of a physician's order. A review of the record revealed that there was no documentation of the actual orders for the wound care to date or at time of review. The Agency failed to obtain specific wound care orders. A further review of the clinical record revealed the skilled nurse failed to obtain a PT/INR on Monday August 13, 2007 and on August 16, 2007 as ordered. The blood work was obtained on Friday August 17, 2007 without benefit of a physician's order and without notifying the physician there was a change to the Plan of Care. 39. Patient number two (2) was admitted to the Agency on July 20, 2007 with skilled nursing ordered for wound care. Nursing was ordered two (2) times a week for three (3) weeks. The nurse visited Patient number two (2) two (2) times a week for five (5) weeks and once a week for one (1) week. There was no evidence of a physician's order to cover the additional visits. The order on the Plan of Care for wound care stated “per physician protocol." A review of the record revealed that there was no documentation of the actual protocol for the wound care. The Agency failed to obtain specific wound care orders. 40. Patient number three (3) was admitted to the Agency on September 7, 2007. His/her Plan of Care contained orders for a home health aide to provide personal care two (2) times a week for two (2) weeks. A review ofthe clinical record revealed that the aide has continued to see Patient number three (3) two times a week, even though the initial order only covered visits made through September 14,.2007. During a home visit with the aide on October 1, 2007, the aide stated that she believed her last visit to Patient number three (3) would be made on Friday, October 5, 2007. 41. Patient number four (4) was admitted to the Agency on July 23, 2007. The Agency was administering IV Vancomycin via a PICC line. There were orders on the Plan of Care for the nurse to flush the PICC line with 10 ml of normal saline, 10 ml of heparin and 10 ml of normal saline. On a July 25, 2007 note, the nurse documented that she flushed the PICC line with 5 cc of normal saline then 5 cc of heparin. There was no evidence in the chart that the physician was notified that the nurse changed the Plan of Care. 42. Patient number five (5) was admitted to the Agency on August 11, 2007. During _ his/her care with the Agency, he/she was readmitted to the hospital.two times. Each time the Agency failed to obtain orders for care. Following resumption of care on August 21, 2007, the physical therapist saw the patient three (3) times a week for one (1) week. There were no orders to cover these visits. The nurse resumed care on August 22, 2007, even though there were no current orders for her to see Patient number five (5). She visited Patient number five (5) two (2) times a week for one (1) week. Patient number five (5) was re-hospitalized and care was resumed again on August 28, 2007. The Agency again failed to obtain physician's orders for ‘care. Beginning August 28, 2007, the physical therapist saw Patient number five (5) two (2) times a week for one (1) week and three (3) times a week for one (1) week. The nurse saw Patient number five (5) once a week for four (4) weeks. 43. Patient number six (6) was admitted to the Agency on May 23, 2007. A physician's order was received on August 28, 2007 for the nurse to perform a UA (urinalysis). Documentation revealed the nurse completed visits on August 28, 2007, August 31, 2007, September 8, 2007, and September 11, 2007 without obtaining the UA (urinalysis) as ordered. There was no documentation in the record the physician was ever notified of the missed lab and approved the change to the Plan of Care. On September 14, 2007, the nurse obtained a urinalysis 10 for C&S (culture and sensitivity) without benefit of a physician's order. 44. Patient number seven (7) was admitted to the Agency on August 23, 2007. On August 25, 2007, the Physical Therapist completed an evaluation and care plan/goals without benefit of a physician's order prior to the visit. 45. Patient number eight (8) was admitted to the Agency on August 16, 2007. Nursing was ordered once a week for one (1) week, twice a week for one (1) week, and once a week for two Q) weeks. Nursing actually visited Patient number eight (8) one time a week for four weeks. There is no evidence that the physician was notified of the change in the Plan of Care. 46. Patient number nine (9) was admitted to the Agency on September 14, 2007. Frequency for the nurse included once a week for one (1) week, twice a week for two (2) weeks, and twice as needed for Cardiac, Respiratory, and bleeding complications. A review of the clinical record revealed the Licensed Practical Nurse completed a visit on September 14, 2007 ‘prior to the Registered Nurse Initial Assessment OASIS completion on September 15, 2007. A further review of the record revealed nursing actually visited Patient number nine (9) twice a week for one (1) week without benefit of a physician's order. Documentation in the record revealed the nurse was to obtain lab work on September 25, 2007. The Licensed Practical Nurse completed the visit and was unable to obtain a specimen. The nurse completed an additional visit on September 26, 2007 for the missed lab work without benefit of a physician's order and the physician was not notified of the change to the Plan of Care. 47. Patient number ten (10) was admitted to the Agency on September 14, 2007. Per the Plan of Care, physical therapy was to provide ultrasound therapy. The orders were specific and to the frequency, duration, and amount of the treatment. A review of the physical therapy 11 notes for September 19, 2007 and September 21, 2007 failed to include specific documentation for the ultrasound therapy. In the absence of documenting the frequency, amount and duration, it was impossible to ascertain what treatment had been provided. 48, Patient number thirteen (13) was admitted to the Agency on May 13, 2007. On June 27, 2007, an order was received for the nurse to complete a Versive dressing to the right ankle on Friday, June 29, 2007. Documentation in the nursing notes revealed the skilled nurse completed a visit and failed to complete the dressing change to the right ankle as ordered. There was no documentation the physician was notified and approved the change to the Plan of Care. 49. Patient number fourteen (14) was admitted to the Agency on May 21, 2007. He/she was readmitted to the hospital and the Agency resumed care on June 20, 2007. The Agency failed to obtain orders from the physician for the resumption of care. Beginning June 20, 2007, the nurse saw Patient number fourteen (14) once a week for one (1) week; she skipped a week of care and then saw the patient twice a week for one (1) week. There is no evidence that the physician ordered these visits. 50. Upon finding an uncorrected or repeated Class III deficiency, the Agency may impose an administrative fine not to exceed $500.00 for each occurrence and each day that the uncorrected or repeated deficiency exists. Section 400.484(2)(c), Florida Statute (2007). 51. Based on the above referenced facts, the Agency may impose an administrative fine against the Respondent in the amount of SIX THOUSAND DOLLARS ($6,000.00) for the twelve (12) occurrences, ($500.00) each, for repeated Class III deficiencies pursuant to Sections 400.474, and 400.484(2) (c) Florida Statutes (2007). 52. The Agency provided the Respondent with a mandatory correction date of November 3, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of SIX THOUSAND FIVE HUNDRED DOLLARS ($6,500.00) based upon twelve (12) occurrences of a repeated Class III deficiency and one occurrence of a repeat Class III deficiency pursuant to Sections 400.474 and 400.484(2)(c), Florida Statutes (2007). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief against the Respondent, Sunrise Home Health and Supplies, LLC: 1. Make findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of SIX THOUSAND FIVE HUNDRED DOLLARS ($6,500.00). 3. Enter any other relief that this court deems just and appropriate. Respectfully submitted this 3 ist day of _ { \cs a ny, 2008. Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 13 NOTICE THE RESPONDENT IS NOTIFIED THAT IT HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, OF THE FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT HAS THE RIGHT TO RETAIN AND BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS FORM. THE RESPONDENT IS FURTHER NOTIFIED IF THE ELECTION OF RIGHTS FORM IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. THE ELECTION OF RIGHTS FORM SHALL BE MADE TO THE AGENCY FOR HEALTH CARE ADMINISTRATION AND DELIVERED TO: AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG 3, MAIL STOP 3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served to: P.S. Vasantha Nair, Administrator, Sunrise Home Health and Supplies, L.L.C., 22110 Kimble Avenue, Port Charlotte, Florida 33952, U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1536 6657, and P.S. Vasantha Nair, Registered Agent for Sunrise Home Health and Supplies, L.L.C., 203 George Road, Port Charlotte, Florida 33952, by U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1536 6664, this_34St day of _! Jom nny, 2008. QW gee 1, Tone Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 Copies furnished to: P.S. Vasantha Nair, Administrator Sunrise Home Health and Supplies, LLC 22110 Kimble Avenue Port Charlotte, Florida 33952 | (U.S. Certified Mail) Andrea M. Lang, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 P.S. Vasantha Nair, Registered Agent for Sunrise Home Health and Supplies, LLC 203 George Road . Port Charlotte, Florida 33952 (U.S. Certified Mail) Kriste Mennella Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2007012559 SUNRISE HOME HEALTH AND SUPPLIES, L.L.C., Respondent. ELECTION OF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be an Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. - Your Election of Rights must be returned by mail or by fax within twenty-one (21) days of the date you receive the attached Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. If your Election of Rights with your elected Option is not received by AHCA within twenty-one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a Final Order will be issued. Please use this form unless you, your attorney or your representative prefer to reply in accordance with Chapter 120, Florida Statutes (2007) and Rule 28, Florida Administrative Code. PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Phone: 850-922-5873 Fax: 850-921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) __ I admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. | understand that by giving up my right to a hearing, a Final Order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) I admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. OPTION THREE (3) ___I dispute the allegations of fact and law contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative - Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings: PLEASE NOTE: Choosing OPTION THREE (3) by itself is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain: 1. Your name, address, telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4. Astatement of all disputed issues of material fact. If there are none, you must state that there are none. Mediation under Section 120.573, Florida Statutes may be available in this matter if the Agency agrees. License Type: (Assisted Living Facility, Nursing Home, Medical Equipment, Other) Licensee Name: License Number: Contact Person: Name Title Address: Street and Number _ City State Zip Code Telephone No. Fax No. E-Mail (optional) J hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the above licensee. Signature: Date: Print Name: Title: STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No(s): 2007012259 08-1466 SUNRISE HOME HEALTH AND SUPPLIES, LLC, Respondent. SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Respondent, home health agencies (hereinafter “Respondent”), pursuant to Section 120.57(4), Florida Statutes, each individually, a “party,” collectively as “parties,” hereby enter into this Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Respondent is a home health agency licensed pursuant to Chapters 400, Part Ill, and 408, Part II, Florida Statutes, Section 20.42, Florida Statutes and Chapter 59A-8, Florida Administrative Code; and . WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to Chapter 400, Part III, Florida Statutes; and WHEREAS, the Agency served Respondent with an administrative complaint on or . about February 1, 2008, notifying the Respondent of its intent to impose administrative fines in the amount of Six Thousand Five Hundred ($6,500) ; and EXHIBIT 2 tabbies" WHEREAS, Respondent requested a formal administrative proceeding by selecting Option 3 on the Election of Rights form; and WHEREAS, the parties have negotiated and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All recitals herein are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. 3. Upon full execution of this Agreement, Respondent agrees to waive any and all appeals and proceedings to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), Florida Statutes, a formal proceeding under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court of competent jurisdiction; and agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled, provided, however, that no agreement herein shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement. 4. Upon full execution of this Agreement, Respondent agrees to pay Four Thousand Eight Hundred Seventy Five Dollars ($4,875) in administrative fines to the Agency within thirty (30) days of the entry of the Final Order. 5. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in Circuit Court in Leon County, Florida. 6. By executing this Agreement, Respondent neither admits nor denies, and the Agency asserts the validity of the allegations raised in the administrative complaint referenced herein. The Agency agrees that it will not impose any further penalty against Respondent asa result of the surveys identified in the administrative complaint. However, no agreement made herein shall preclude the Agency from imposing a penalty against Respondent for any deficiency/violation of statute or rule identified in a future survey of Respondent, which constitutes a “repeat” or “uncorrected” deficiency from surveys identified in the administrative complaint. The parties agree that in such a “repeat” or “uncorrected” case, the deficiencies from the surveys identified in the administrative complaint shall be deemed found without further proof. 7. No agreement made herein shall preclude the Agency from using the deficiencies from the surveys identified in the administrative complaint in any decision regarding licensure of Respondent, including, but not limited to, licensure for limited mental health, limited nursing services, extended congregate care, or a demonstrated pattern of deficient performance. The Agency is not precluded from using the subject events for any purpose within the jurisdiction of the Agency. Further, Respondent acknowledges and agrees that this Agreement shall not preclude or estop any other federal, state, or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the administrative complaint. 8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case. 9. Each party shall bear its own costs and attorney’s fees. 10. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 11. Respondent for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency’s actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Respondent or related facilities. 12. This Agreement is binding upon all parties herein and those identified in paragraph eleven (1 1) of this Agreement. 13. In the event that Respondent was a Medicaid provider at the subject time of the occurrences alleged in the complaint herein, this settlement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. 14. Respondent agrees that if any funds to be paid under this agreement to the Agency are not paid within thirty-one (31) days of entry of the Final Order in this matter, the Agency may deduct the amounts assessed against Respondent in the Final Order, or any portion thereof, owed by Respondent to the Agency from any present or future funds owed to Respondent by the Agency, and that the Agency shall hold a lien against present and future funds owed to Respondent by the Agency for said amounts until paid. 15. The undersigned have read and understand this Agreement and have the authority to bind their respective principals to it. 16. This Agreement contains and incorporates the entire understandings and agreements of the parties. 17. This Agreement supersedes any prior oral or written agreements between the parties. 18. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 19. All parties agree that a facsimile signature suffices for an original signature. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1 Tallahassee, Florida 32308 DATED: Craig H. Smith, General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: Frederick E. Hasty, III Attorney for Respondent Wicker, Smith, O’Hara, McCoy & Ford, Grover Plaza, 5" Floor 2900 Southwest 28" Terrace . Miami, Florida 33133 DATED: P.S. Vasantha Nair, Administrator Sunrise Home Health and Supplies, LLC 22110 Kimble Avenue Port Charlotte, Floida 33952 DATED: Apr 28 08 01: 39R weer e anne @4-21-'@8 @8:52 FROM- 13. The undersigned have read and understand this Agreernent an have the authority to bind thoir respective principals to it (941) 235-1524 16, This Agreement contains and incorporates the entire underslardings and agreements of the partics. 17. This Agreement supersedes any prior oral or written agrcemer ts between the pasties, 18. This Agroement may noi be amended except in writing. Any ettempted assignraent of this Agreement shall be void. 19. All purties agree that « facsimile signature suffices for an original signature. ‘The folowing representatives herby acknowledge that they are duly authorized to enter into this Agrecment 2727 Mi Trive, Bidg #1 Toliahassee, F.orida 32308 i $ Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahagsce, Floricta 32308 DATE 1/22 erick E. Hasty, 11] Attorney for Respondent Wicker, Smith, O'Haru, M Grover Plaza, 5™ Floor 2900 Southwest 28" Ter. ace Miami, Tlodda 33133 DATED: —_ f) Z CFD » T.. S. Cut LK ENG PS, fair, Administrator Sunrise Home Health anv. Supplies, LLC 22110 Kimble Avenue Port Charlotte, Floida 33°52 DATED: _& Lo op ; p.2 ne ae T-289 POU6/GO7 F-133 Andrea M. Lang, Esq. Agency for Health Care Administration 2295 Victoria Avenue, Room 346C Ft. Myers, Florida 33901 DATED: O/\ | OF

Docket for Case No: 08-001466