OK: D301 ¥ Sfp Om STATE OF FLORIDA “i Tip AGENCY FOR HEALTH CARE ADMINISTRATION oS STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. , Case No. 2008005174 PERSONAL CHOICE HOME HEALTH SERVICES, INC. d/b/a. A PHYSICIAN’S CHOICE HOME HEALTH SERVICES, 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, PERSONAL CHOICE HOME HEALTH SERVICES, INC. d/b/a A PHYSICIAN’S CHOICE HOME HEALTH SERVICES (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 in the amount of ONE THOUSAND FIVE HUNDRED DOLLARS ($1,500.00) against a home health agency pursuant to Section 400.484(2)(c) Florida Statutes (2007), based upon one repeat Class III deficiency. The total fine amount is based upon a $500.00 fine per occurrence with three (3) 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). 2, The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and O49-2 TT/eAd ST9-L -WOHd = TT2T 88,-TT-98 120.60, Florida Statutes (2007); Chapters 408, Part II, and 400, Part HI, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code. 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES . 4, The Agency is the licensing and regulatory authority that oversees home health agencies and enforces the applicable federal and state statutes, regulations and rules governing home health agencies. Chapter 408, Part II, Chapter 400, Part II, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code. The Agency is authorized to deny, revoke, or suspend a license, or impose an administrative fine, for violations as provided for by Section 400.474, Florida Statutes (2007), and Rules 59A-8.003 and 59A-8.0086, Florida Administrative Code. | 5. The Respondent was issued a license by the Agency (License No. 216070961) to operate a home health agency located at 2107 Sunrise Boulevard, Fort Pierce, Florida 34950, and was at all material times required to comply with the applicable federal and state statutes, regulations and rules for home health agencies. COUNT] The Respondent Failed To Ensure That Home Health Aides Were Supervised By A Registered Nurse While Providing Care To Patients In Violation Of Rule 59A- 8.0095(3)(b), Florida Administrative Code 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, a registered nurse may assign selected portions of patient care to licensed practical nurses and home health aides but always retains the full responsibility for the care given and for making supervisory visits to the patient's home. Rule 59A- 8.0095(3)(b), Florida Administrative Code. Q49-1 Tl/Pad ST9-L -WOUS 27:47 88,-TT-98 8. On or about July 18, 2005 through July 21, 2005 the Agency conducted a Licensure Survey of the Respondent’s facility. 9, Based on record reviews and interview, it was determined the home health agency failed to conduct supervisory visits to the patient's home for four (4) of four (4) sampled patients, Patient number seven (7), Patient number nine (9), Patient number ten (10) and Patient number eleven (11). . 10. Patient number seven (7) is receiving services from skilled nursing, physical therapy and a home health aide for the June 5, 2005 — August 3, 2005 certification period. At the time of the survey, the medical record lacked documentation that supervisory visits of the home . health aide had been conducted by a registered nurse. This was confirmed by the administrator on July 20, 2005 at 12:30 p.m. 11. Patient number nine (9) is receiving services ‘from skilled nursing, physical therapy and a home health aide for the July 1, 2005 - August 29, 2005 certification period. At the time of the survey, the medical record Jacked documentation that supervisory visits of the home health aide had been conducted by a registered nurse. 12. Patient number ten (10) was receiving services from skilled nursing, physical therapy, occupational therapy, speech therapy and a home health aide for the March 29, 2005 — May 27, 2005 certification period. At the time of the survey, the medical record lacked documentation that supervisory visits of the home health aide had been conducted by a registered nurse. . 13. Patient number eleven (11) was receiving services from skilled nursing and a home health aide for the May 9, 2005 — July 7, 2005 certification period. At the time of the survey, the medical record lacked documentation that supervisory visits of the home health aide @29- TT/SAd ST9-L -WOHA = 2T: AT 88.-TT-98 had been conducted by a registered nurse. 14. The Respondent’s act, omission or practice had an indirect, adverse effect on the health, safety, or security of a patient constituting a Class III deficiency. Section 400.484(2)(c), Florida Statutes (2006). 15. The Agency cited the Respondent for a Class III violation in accordance with Section 400.484(2)(c), Florida Statutes (2006). 16. The Respondent was given a mandatory correction date of August 21, 2005. 17. On or about October 13, 2006 the Agency conducted a Desk Review of the Licensure Survey and determined that the Respondent had corrected the deficiency. 18. On or about March 24, 2008 through March 27, 2008 the Agency conducted a Relicensure Survey of the Respondent’s facility. 19. Based on observation, record review and interview, the home health agency failed to ensure that the Home Health Aides providing personal care to patients receiving Skilled Nursing Services were supervised by the registered nurse as required by the home health agency's own policy for three (3) of three (3) sampled patients receiving personal care services, Patient number three (3), Patient number four (4), and Patient number five (5). 20. A review of the clinical record of Patient number three (3), start of care December 7, 2006, and recertification January 31, 2008, revealed that in the past five (5) months of home health aide services, the home health aide had only been supervised by the registered nurse on November 16, 2007, December 14, 2007 and March 10, 2008. There was no evidence of the required supervision during the current recertification period in the clinical record. 21. — A review of the clinical record of Patient number four (4), start of care February 19, 2007 and recertification February 14, 2008, revealed that in the past six (6) months of home O29- TT/98d ST9-L -WOHT 27:47 88.-TT-98 health aide services, the home health aide had been supervised by the registered nurse on- October 31, 2007 and December 17, 2007. There was no evidence of supervision during the current recertification period in the clinical record. 22. A review of the clinical record of Patient number five (5), start of care February 22, 2006, and recertification February 12, 2008, revealed that in the past four (4) months of home health aide services, the home health aide had been supervised by the registered nurse on December 13, 2007. There was no evidence of supervision during the current recertification period in the clinical record. 23. . An observation of the registered nurse during home visits to Patient number three (3) on March 26, 2008, at 1:00 p.m.; Patient number four (4) on March 26, 2008, at 2:00 p.m. and Patient number five (5) on March 27, 2008 at 9:00 a.m. revealed that although those visits. were identified on the nurses’ calendar as supervisory visits, the nurse did not supervise any home health aide or inquire about the care and services of those employees from the patients, 24. _ A review of the current home health agency policy for Home Health Aide Services revealed that when the patient was receiving skilled nursing services, the home health aide would be supervised every two (2) weeks by the nurse or appropriate therapist. An interview with the administrator on March 24, 2008 at 1:00 p.m. confirmed that there was no documentation of the required registered nurse supervision in the records of the patients, 25. The Respondent’s act, omission or practice, had an indirect, adverse effect on the health, safety, or security of a patient constituting a Class I deficiency. Section 400.484(2)(c), Florida Statutes (2007). 26. The Respondent’s deficient act, omission or practice constitutes a repeated Class Ill deficiency. Section 400.484(2)(c), Florida Statutes (2007). BL9-N TT/L0d STS-L -WOHd 2T: dT 88,.-TT-98 27. Upon finding an uncorrected or repeated Class III deficiency, the Agency may impose an administrative fine not to exceed five hundred dollars ($500.00) for each occurrence and each day that the uncorrected or repeated deficiency exists. 28. The Respondent was given a mandatory correction date of April 26, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND FIVE HUNDRED DOLLARS ($1,500.00). _ 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: 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 ONE THOUSAND FIVE HUNDRED DOLLARS ($1,500.00). 3. Enter any other relief that this court deems just and appropriate. Respectfully submitted on this Feed _ day of guy, , 2008, ; Martbeies hap fa Senior Attomey Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 O49- TT/8Ad ST9-L -WOHS =2T‘4T 88,-TT-98 NOTICE THE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TOR AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120. 57, FLORIDA STATUTES. IF THE RESPONDENT WANTS TO HIRE AN ATTORNEY, TT/ME/SHE HAS THE RIGHT TO 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, BUILDING 3, MAIL STOP 3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (50) 922-5873. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form have been served to: Colleen Danielle Symanski-Sanders, Administrator, Personal Choice Home Health Services, Inc. d/b/a A Physician’s Choice Home Health Services, 2107 Sunrise Boulevard, Fort Pierce, Florida 34950, United States Certified Mail, Return Receipt No. 7006 2760 0003 1537 3129, and to Vijay K. Gupta, Registered Agent for Personal Choice Home Health Services, Inc. d/b/a A Physician’s Choice Home Health Services, 41 N. Federal Highway, Pompano Beach, Florida 33062, United States Certified Mail, Return Receipt No. 7006 2760 0003 1537 3136 on this Aud iay of Sy , 2008. ton Cxicy Capes Senior Attorney Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 Q49- TT/68d ST9-L -WOHS = 2T:LT 88.-TT-98 Copies furnished to: Colleen Danielle Symanski-Sanders, Administrator Personal Choice Home Health Services, Inc. d/b/a A Physician’s Choice Home Health Services 2107 Sunrise Boulevard Fort Pierce, Florida 34950 8, Certified Mail) Vijay K. Gupta, Registered Agent for Personal Choice Home Health Services, Inc. d/b/a A Physician’s Choice Home Health Services 41 N, Federal Highway Pompano Beach, Florida 33062 (U.S. Certified Mail) Mary Daley Jacobs, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Interoffice Mail Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 : .S. Mail O49-1 TT/@Td ST9-L -WOHA = 2T:2T 88,-TT-98 @6-12-'@8 88:45 FROM- ; T-617 PQ@1/11 U-674 2107 Sunrise Bottlevat ao 6, om Fort Pierce, Florida a ae IVE (772) 468-8686 Fax: (772) 468 - 5958 208 JIN 12 Ag: 3g 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 June 11, 2008 Re: Petition for a Formal Hearing: Case No. 2008005 174 which was signed by a person other than I and then I received the notice on May 27, 2008. ° Please be advised I respectfully dispute the following issues of material fact identified by humeric representation as written in the Agency for Health Care Administration notice of proposed action. They are as follows; Line item 19, line item 20, line item 21, line item 22, line item 23, and line item 24. Please contact me should you require additional information. Respectfully, mevabr. Rj Colleen D. Symanski, RN Administrator 06-12-'08 08:45 FROM- T-617 P@2/11 U-674 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) rasp the allegations of fact and law contained in the Notice of Intent to Impose a [até Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and J 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. A statement 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: Home Hea Ht oof assisted Living Facility, Nursing Home, Medical Equipment, Other) ‘ Licensee Name: ysicians Chyice Hone Hea Hh Sree icense Number; al Lo 104 b | Contact Person: Colleen Symsncls Ben in ishredo , Name Title Address: 2107 Sunrise. Boulevard £4. Pievge Fla, B4ISO Street and Number City State Zip Code 77 - Telephone No. GE bE-¥4Eb Fai No. 1 595% E-Mail (optional) Thereby 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: (alla) D. Aprdteo - Xbarmerchs er Date:_b/n Jaco Print Name:Colleen - StnderS~ Sy maunshi, PA Title: Adpinishwtor @6-12-'@8 88:45 FROM- T-617 P@3/11 U-674 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION omy STATE OF FLORIDA, , AGENCY FOR HEALTH CARE . “ 4 ADMINISTRATION, F ry ee Te Fa : Petitioner, MAES i f Om ¥ a By Me) 7 Ws. Case Wo: 2668005174 PERSONAL CHOICE HOME HEALTH SERVICES, INC. d/b/a A PHYSICIAN’S CHOICE HOME HEALTH SERVICES, 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, PERSONAL CHOICE HOME HEALTH SERVICES, INC. d/b/a A PHYSICIAN’S CHOICE HOME HEALTH SERVICES (hereinafier “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 in the amount of ONE THOUSAND FIVE HUNDRED DOLLARS ($1,500.00) against a home health agency pursuant to Section 400.484(2)(c) Florida Statutes (2007), based upon one repeat Class Il deficiency. The total fine amount is based upon a $500.00 fine per occurrence with three (3) 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). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and @6-12-'@8 88:45 FROM- T-617 P@4/11 U-674 120.60, Florida Statutes (2007); Chapters 408, Part II, and 400, Part III, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code. 3, Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES . 4. The Agency is the licensing and regulatory authority that oversees home health agencies and enforces the applicable federal and state statutes, regulations and rules governing home health agencies. Chapter 408, Part Il, Chapter 400, Part II, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code. The Agency is authorized to deny, -revoke, or suspend a license, or impose an administrative fine, for violations as provided for by Section 400.474, Florida Statutes (2007), and Rules 59A-8.003 and 59A-8.0086, Florida Administrative Code. | 5. The Respondent was issued a license by the Agency (License No. 216070961) to operate a home health agency located at 2107 Sunrise Boulevard, Fort Pierce, Florida 34950, and was at all material times required to comply with the applicable federal and state statutes, regulations and rules for home health agencies. . COUNT I The Respondent Failed To Ensure That Home Health Aides Were Supervised By A Registered Nurse While Providing Care To Patients In Violation Of Rule 59A- 8.0095(3)(b), Florida Administrative Code 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, a registered nurse may assign selected portions of patient care to licensed practical nurses and home health aides but always retains the full responsibility for the care given and for making supervisory visits to the patient’s home. Rule 59A- 8.0095(3}(b), Florida Administrative Code, @6-12-'@8 88:46 FROM- T-617 P@5/11 U-674 8. On or about July 18, 2005 through July 21, 2005 the Agency conducted a Licensure Survey of the Respondent’s facility. . 9. Based on record reviews and interview, it was determined the home health agency failed to conduct supervisory visits to the patient's home for four (4) of four (4) sampled patients, Patient number seven (A, Patient number nine (9), Patient number ten (10) and Patient number eleven (11). ) 10. Patient number seven (7) is receiving services from skilled nursing, physical therapy and a home health aide for the June 5, 2005 — August 3, 2005 certification period. At the time of the survey, the medical record lacked documentation that supervisory visits of the home health aide had been conducted by a registered nurse. This was confirmed by the administrator on July 20, 2005 at 12:30 p.m. 11. Patient number nine (9) is receiving services from skilled nursing, physical therapy and a home health aide for the July 1, 2005 ~ August 29, 2005 certification period. At . the time of the survey, the medical record lacked documentation that supervisory visits of the home health aide had been conducted by a registered nurse. 12. Patient number ten (10) was receiving services from skilled nursing, physical therapy, occupational therapy, speech therapy and a home health aide for the March 29, 2005 — May 27, 2005 certification period. At the time of the survey, the medical record lacked documentation that supervisory visits of the home health aide had been conducted by a registered nurse. 13. Patient number eleven (11) was receiving services from skilled nursing and a home health aide for the May 9, 2005 — July 7, 2005 certification period. At the time of the survey, the medical record lacked documentation that supervisory visits of the home health aide @6-12-'@8 @8:46 FROM- T-617 PW6/11 U-674 had been conducted by a registered nurse. 14. The Respondent’s act, omission or practice had an indirect, adverse effect on the health, safety, or security of a patient constituting a Class Il deficiency. Section 400.484(2)(c), Florida Statutes (2006). 15. The Agency cited the Respondent for a Class III violation in accordance with Section 400.484(2)(c), Florida Statutes (2006). 16. The Respondent was given a mandatory correction date of August 21, 2005. 17. On or about October 13, 2006 the Agency conducted a Desk Review of the Licensure Survey and determined that the Respondent had corrected the deficiency. 18. On or about March 24, 2008 through March 27, 2008 the Agency conducted a Relicensure Survey of the Respondent’s facility. 19, ) Based on observation, record review and interview, the home health agency failed to ensure that the Home Health Aides providing personal care to patients receiving Skilled Nursing Services were supervised by the registered nurse as required by the home health agency's own policy for three (3) of three (3) sampled patients receiving personal care services, Patient number three (3), Patient number four (4), and Patient number five (5). 20. A review of the clinical record of Patient number three (3), start of care December 7, 2006, and recertification January 31, 2008, revealed that in the past five (5) months of home health aide services, the home health aide had only been supervised by the registered nurse on November 16, 2007, December 14, 2007 and March 10, 2008. There was no evidence of the required supervision during the current recertification period in the clinical record. . 21. - A review of the clinical record of Patient number four (4), start of care February 19, 2007 and recertification February 14, 2008, revealed that in the past six (6) months of home @6-12-'88 08:46 FROM- T-617 P@7/11 U-674 health aide services, the home health aide had been supervised by the registered nurse on- October 31, 2007 and December 17, 2007. There was no evidence of supervision during the current recertification period in the clinical record. 22. A review of the clinical record of Patient number five (5), start of care February 22, 2006, and recertification February 12, 2008, revealed that in the past four (4) months of home health aide services, the home health aide had been supervised by the registered nurse on December 13, 2007. There was no evidence of supervision during the current recertification period in the clinical record. 23. . An observation of the registered nurse during home visits to Patient number three (3) on March 26, 2008, at 1:00 pam: Patient number four (4) on March 26, 2008, at 2:00 p.m. and Patient number five (5) on March 27, 2008 at 9:00 a.m. revealed that although those visits were identified on the nurses' calendar as supervisory visits, the nurse did not supervise any home health aide or inquire about the care and services of those employees from the patients. 24. A review of the current home health agency policy for Home Health Aide Services revealed that when the patient was receiving skilled nursing services, the home health aide would be supervised every two (2) weeks by the nurse or appropriate therapist. An interview with the administrator on March 24, 2008 at 1:00 p.m. confirmed that there was no documentation of the required registered nurse supervision in the records of the patients. 25. The Respondent’s act, omission or practice, had an indirect, adverse effect on the health, safety, or security of a patient constituting a Class Ili deficiency. Section 400.484(2)(c), Florida Statutes (2007). 26. The Respondent’s deficient act, omission or practice constitutes a Tepeated Class IH] deficiency, Section 400.484(2)(c), Florida Statutes (2007). @6-12-'@8 88:46 FROM- T-617 P@8/11 U-674 27. Upon finding an uncorrected or repeated Class III deficiency, the Agency may impose an administrative fine not to exceed five hundred dollars ($500.00) for each occurrence and each day that the uncorrected or repeated deficiency exists. 28. The Respondent was given a mandatory correction date of April 26, 2008. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration intends to impose an administrative fine against the Respondent in the amount of ONE. THOUSAND FIVE HUNDRED DOLLARS ($1,500.00). 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: 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 ONE THOUSAND FIVE HUNDRED DOLLARS ($1,500.00). 3. Enter any other relief that this court deems just and appropriate. Respectfully submitted on this need _ day of Sy 2008. Latics apf Senior Attorney Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 @6-12-'@8 @8:46 FROM- T-617 P@9/11 U-674 NOTICE THE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. IF THE RESPONDENT WANTS TO HIRE AN ATTORNEY, TI/HE/SHE HAS THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET QUT 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, BUILDING 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 Administrative Complaint and Election of Rights form have been served to: Colleen Danielle Symanski-Sanders, Administrator, Personal Choice Home Health Services, Inc. d/b/a A Physician’s Choice Home Health Services, 2107 Sunrise Boulevard, Fort Pierce, Florida 34950, United States Certified Mail, Return Receipt No. 7006 2760 0003 1537 3129, and to Vijay K. Gupta, Registered Agent for Personal Choice Home Health Services, Inc. d/b/a A Physician’s Choice Home Health Services, 41 N. Federal Highway, Pompano Beach, Florida 33062, United States Certified Mail, Retum Receipt No. 7006 2760 0003 1537 3136 on this PPwedtay of Guy, , 2008. fon Ciicy ages Senior Attorney Florida Bar No. 0355712 Agency for Health Care Administration, Office of the General Counsel’ 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 @6-12-'@8 @8:46 FROM- T-617 Pl@/11 U-674 Copies furnished to: Colleen Danielle Symanski-Sanders, Administrator Personal Choice Home Health Services, Inc. d/b/a A Physician’s Choice Home Health Services 2107 Sunrise Boulevard Fort Pierce, Florida 34950 -S. Certified Mail) Vijay K. Gupta, Registered Agent for Personal Choice Home Health Services, Inc. d/o/a A Physician’s Choice Home Health Services 41 N. Federal Highway Pompano Beach, Florida 33062 (U.S. Certified Mail) Mary Daley Jacobs, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (ateroffice Mail Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484. (U.S. Mail) @6-12-'88 88:46 FROM- T-617 P11/11 U-674 STATE OF FLORIDA. AGENCY FOR HEALTH CARE ADMINISTRATION "LED STATE OF FLORIDA, te AGENCY FOR HEALTH CARE ADMINISTRATION, 08 JUL -3 PH 4: 92 Petitioner, ADMIN! , , HEA vs Case No. 2008005174 PERSONAL CHOICE HOME HEALTH SERVICES, INC. d/b/a A PHYSICIAN’S CHOICE HOME HEALTH SERVICES, 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 ANCA 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) 1 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. I 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 SENDER: COMPLETE THIS SECTION @ Complete items 1, 2,.and 3. Also complete item 4 if Restricted Delivery is desired. | Print your name and address on the reverse | so that we can return the card to you. / il Attach this card to the back of the mailpiece, "or on the front if space permits. TT. Anticle Addressed to: ZOOBOoS (77 Colleen Danelle Sy manstei- San Adnnis trator ; : A Phy sieran’s Choree Hea lth Services : Zlo7 Sunrise Bovlevad | Fort Prrren, Flonds 34950 _ 2. ArticleNumber =: (Transfer from service label) © PS Form 3811, February 2004 : Home i 200b 276 Domestic Return Receipt COMPLETE THIS SECTION ON DELIVERY A. Signgture y Lipp C) Agent YUL. GLY 1 L) Addressee * feceived by ( Printed Name) C. Date of Delive Q (ay, D. Is delivery address different from item 1? 1 Yes If YES, enter delivery address below: O1No s 3. Service Type O Certified Mail +2) Express Mall C1 Registered 1 Retum Receipt for Merchandise Ci insured Mail 1 0.0.0. 4, Restricted Delivery? (Extra Fee) 0 Yes Boua 2537 3429.

Docket for Case No: 08-003218