STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2008000528 Return Receipt Requested: v. 7002 2410 0001 4235 8865 - 7002 2410 0001 4235 8872 PREFERRED NURSING SERVICES, INC. d/b/a PREFERRED NURSING 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 Preferred Nursing Services, Inc. d/b/a Preferred Nursing Services, Inc. (hereinafter “Preferred Nursing 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 $1,500.00 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 Palm Beach 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. Preferred Nursing Services, Inc. operates a home health agency located at 4951 W. Atlantic Avenue, Delray Beach, Florida 33445. Preferred Nursing Services, Inc. is licensed as a home health agency under license number 299991046. Preferred Nursing 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 PREFERRED NURSING SERVICES, INC. FAILED TO ENSURE THAT THE CLINICAL RECORDS WERE ACCURATELY MAINTAINED. RULE 59A-8.022(5) FLORIDA ADMINISTRATIVE CODE. (CLINICAL RECORDS STANDARDS) CLASS IIT 6. AHCA vre-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Preferred Nursing Services, Inc. was cited with one (1) Class III deficiency due licensure surveys conducted on March 10, 2004 and December 13, 2008. 8. A licensure survey was conducted on March 10, 2004. Based on a review of 7 clinical records and an interview with the Don/Administrator, it was determined that the clinical records were not being maintained accurately. The findings include the following. 9. In all 7 records reviewed, there was a lack of documentation between various disciplines. There were no HHA notes, other than checked flow sheets. There was no documentation of communication by the nurse with the HHA, physician, patient or family. 10. Patient #6 who had a start of care date of 1/19/04 had a nurse's note (not dated) stating that the patient had reddened edema from cellulites. There was no care plan to address this problem. 11. Patient #2 had a start of care date of 1/02/03. This patient had bladder cancer and was on a Foley catheter. There was a note stating that this was a hospice patient. There was no indication that there had been any case conferences with the Medicare agency that was doing the hospice care. 12. Patient #3 had a start of care date of 8/12/03. This patient had Diabetes, Chronic Obstructive Pulmonary Disease and was on oxygen. There was no nursing care plan. There was only a HHA plan to assist with Activities of Daily Living. 13.. The Don/Administrator was "new" and had not had an opportunity to review all of the records. 14. The mandated date of correction was designated as April 10. 2004. 15. A licensure survey was conducted on December 13, 2007. Based on clinical record review and administrative staff interview, it was determined that the agency failed to maintain clinical records containing pertinent past and current findings in accordance with accepted professional standards for 3(patient #1, #4 and #9) of 12 active sampled patients receiving home health services. The findings include the following. 16. Patient #1 had a start of care of 10/25/07. The diagnoses included but not limited to Multiple Open Areas, Cellulites and Abscess of the Legs. Per the Plan of Treatment, the skilled nurse was to visit the patient and provide wound care daily for 5 days and then every other day. There was only one visit dated 11/14/07 available for review for the week of 11/10/07 through 11/16/07. The missing documentation was requested from the DON (Director of Nursing) on 12/11/07 at 12:20 p.m. 17. The DON revealed during an interview on 12/11/07 that the Licensed Nurse who cared for the patient had been off 11/12/07 and another nurse had made the visit on 11/12/07 but had not yet submitted the completed note to the agency. 18. After surveyor's intervention, the skilled nurse was contacted and faxed a copy of a note dated 11/12/07 specifying the patient forgot to sign for the services rendered on that day. 19. Patient #4 was admitted to the agency on 11/17/07 with a diagnosis of Multiple Open Wounds. Review of the skilled nurse's notes revealed on 11/19/07 the Registered Nurse made a visit to the patient's home from 11:45 a.m. to 12:20 p.m. and documented supervising the LPN (Licensed Practical Nurse). The Registered Nurse stated in his/her note that the LPN was not present during the supervisory visit. 20. Review of the LPN's note for 11/19/07 placed the LPN at the patient's home from 11:00 a.m. to 12:00 p.m. and would have been present during the supervisory visit from 11:45 a.m. to 12:00 p.m. During an interview with the DON on 12/11/07 at 3:15 p.m. the DON revealed that the Registered Nurse probably documented the wrong time for his/her visit. 21. Interview with the LPN on 12/11/07 at 3:20 p.m. revealed the LPN was not present during the supervisory visit and maybe the Registered Nurse documented the wrong time. 22. Additionally, there was no documentation in the record to support the extra skilled visit provided to the patient on that day. 23. The DON further stated he/she sent the Registered Nurse back to the patient's home to draw blood. There was no written communication that the attending physician had been notified or approved of the extra visit. 24. Patient #9 had a start of care of 10/29/07 and was to receive Physical Therapy services for evaluation and treatment of Lymphedema. Per the Plan of Treatment, the Therapist was to visit the patient twice a week for 1 week then 3 times a week for 3 weeks and once a week for 1 week. The last Physical Therapy note available for review was dated 11/23/07. 25. The DON (Director of Nursing) stated on 12/13/07 at 9:05 a.m. that the Therapist had discharged the patient (date unavailable) but had not yet turned in the discharge assessment. The DON added that the. Therapist was notorious for bringing in notes late. 26. Review of the agency's clinical documentation policy for the agency revealed that documentation of services ordered on the plan of care will be completed the day service is rendered and incorporated into the clinical record within seven (7) days after the care has been provided. This is a repeat deficiency from the survey of March 10, 2004. 14. Based on the foregoing facts, Preferred Nursing Services, Inc. violated Rule 59A-8.022(5), Florida Administrative Code, herein classified as a repeat Class III deficiency, which warrants an assessed fine of $1,500.00. 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 Preferred Nursing Services, Inc. on Count I. ‘2. Assess against Preferred Nursing Services, Inc. an administrative fine of $1,500.00 on Count I for 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. Alba M. Rodriguez? E&Sq. Fla. Bar No.: 0880175 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) 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 Francine Schwab, Administrator, Preferred Nursing Services, Inc., 4951 W. Atlantic Avenue, Delray Beach, Florida 33445; Francine Schwab, Registered Agent, 4886 Tallowood Lane, Boca Raton, Florida 33487 on this 3rd day of ~akeh , 2008. Alba M. tp ho aa Pi COMPLETE THIS SECTION ON DELIVERY ‘US. Post res Ie alServicen | {ICG 2 SENDER: COMPLETE THIS SECTION 3. Service Type Ui Certified Mail 1 Express Mail CO Registered CO Return Receipt for Merchandise Di insured Mail 01 Cp. Hchuasibe eo JA. . a A. Ragtricted Delivery? (Extra Fee) 1 Yes - a 7oo2 2410 O01 423s 46b5 pe tCtSCS*S” | : Piney Neaoumg Aetadcod 402595-02-M-1540 un en CERTIF em (Domestic Bed MAIL. RE . . , o fail Only: No Insuran @ Complete items 1, 2, and 3. Also complete A. Signature ANE For delivery intarmation visi EER item 4 if Restricted Delivery is desired. x Ny EN Agent m career & Print your name and address on the reverse 4 Xx AK i (1 Addressee mu so that we can return the cardto you. B. Réosived by (Printed Name) C. Date pf Ddiivery + Attach this card to the back of the mailpiece, f a or on the front if space permits. ae oQ D. Is delivery address different from item 17, CI Yes o If YES, enter delivery address below: CINo a Return Reci a (Endorsement Hecuiread a Pestiicted D > (Endorsement thie’ mu mu o oa ~ (Transfer from service label) ’ ; (63/21/2688 13:28 5616361188 PREFERREDNURSING SVC PAGE @1 - of ras Gy Se A PREFERRED NURSING SVC.A°ENC “2, * 4951 WEST ATLANTIC AV! oA DELRAY BEACH, FL. 33445" —=