STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, — Petitioner, _ vs. : Case No. 2009010006 BEAM MANAGEMENT, LL.C. _ d/b/a SPECTRUM HEALTHCARE 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, BEAM MANAGEMENT, LLC d/b/a SPECTRUM HEALTHCARE SERVICES (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2009), and alleges as follows: NATURE OF THE ACTION This is an administrative action against a home health agency to impose an administrative fine in the amount of FIVE THOUSAND DOLLARS ($5,000.00) pursuant . to Section 400.474(5), Florida Statutes (2009) based on one qd) Class III deficiency. ’ JURISDICTION AND VENUE 1. -This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2009). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 1 Filed February 12, 2010 11:22 AM Division of Administrative Hearings. 120.60, Florida Statutes (2009); Chapters 408, Part II, and 400, Part I, Florida Statutes (2009), 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, and Chapter 400, Part III, Florida Statutes (2009), 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 Sections 400.474, and 400.464, Florida Statutes (2009), and Rules 59A-8.003, and 59A-8.0086, Florida Administrative Code. , . 5. The Respondent was issued a license by the Agency (License No. 299992525) to operate a home health agency located at 5968 Clark Center Avenue, Sarasota, Florida 34238, 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 The Reasonable Expectation That Services Will Be Provided Safely To Accepted Patients In Violation Of Section 400.474(5), Florida Statutes (2009), And Rule 59A-8.020(1)-(3), Florida Administrative Code 6. The Agency re-alleges and incorporates by reference patagraphs one qd) through five (5). 7. Pursuant to Florida law, the agency shall impose a fine of $5,000 against a home health agency that demonstrates a pattern of failing to provide a service specified in the home health agency's written agreement with a patient or'the patient's légal representative, or the plan of care for that patient, unless a reduction in service is mandated by Medicare, Medicaid, or a state program or as provided in Section 400.4920), Florida Statutes (2009). A pattern may be demonstrated by a showing of at least thrée (3) incidences, regardless of the patient or service, where the home health agency did not provide a service specified in a written agreement or plan of care duting a 3-month period. The agency shall impose the fine for each occurrence. The agency may also impose additional administrative fines under Section 400.484, Florida Statutes (2009), for the direct or indirect harm to a patient, or deny, revoke, or suspend the license of the home health agency for a pattern of failing to provide a service specified in the home health agency's written agreement with a patient or-the plan of care for that patient. Section 400.47. 4(5), Florida Statutes (2009). Pursuant to Florida law, provided safely to the patient or client in his place of residence. This includes being able to communicate with the patient, or with another person designated by the patient, either through a staff person or interpreter that speaks the same language, or through technology ‘that translates so that the services can be provided. The responsibility of the agency is also to assure that the patient or client receives services as defined ina specific plan of care, for those patients receiving care under a physician, physician assistant, or advanced registered nurse practitioner’s treatment orders, or in a written agreement, as described in subsection (3) below, for clients receiving care without a physician, physician assistant, or advanced registered nurse practitioner’s orders. This responsibility includes assuring the patient receives all assigned visits... (2) At the start of services a home health agency must establish a written agreement between the agency and the patient or client or the patient’s or client’s legal representative, including the information described in Section 400.487(1), Florida Statutes (2009). This written agreement must be signed and dated by a representative of the home health agency and the patient or client or the patient’s or client’s legal representative. A copy of the agreement must be given to the patient or client and the original must be placed in the patient’s or client’s file... (3) The written agreement, as specified in subsection (2) above, shall serve as the home health agency’s service provision plan, pursuant to Section 400.491(2), Florida Statutes (2009), for clients who receive homemaker and companion services or home health aide services which do not require a physician, physician assistant, or advanced registered nurse practitioner’s treatment order. The written agreement for these clients shall be maintained for one year after termination of services, Rule § 8A-8,020(1)-(3), Flotida Administrative Code. _ ) 8. On or about July 8, 2009 through July 9, 2009 the Agency conducted a Complaint Survey (CCR# 2009007591) of the Respondent’s facility. 9. Based on record review and interview, the home health agency. failed to: 1) inform the physician ‘of missed visits for two (2) of eight (8) records reviewed, specifically Patient number two (2) and Patient number five (5); and 2) update the comprehensive assessment upon discharge for two’(2) of two (2) closed records reviewed, ‘specifically Patient number seven (7) and Patient number eight (8). This resulted in the home health agency failing to meet the reasonable expectation that services will be provided safely to accepted patients. 10. A review of a clinical record for Patient number two (2) documented he/she was recently diagnosed with cancer and was receiving chemotherapy. The physician had ordered home health to observe and monitor for side effects of chemotherapy, nutrition, hydration and elimination and to monitor cardiopulmonary status. 11. A review of the plan of care, dated May 8, 2009 - July 6, 2009, for Patient number two (2) documented on May 14, 2009, the Skilled Nurse was to visit three (3) times a week for seven (7) weeks. A review of the record revealed no nursing visits for week number six (6) and one (1) visit for week number seven (7). There was not a Registered Nurse visit before the plan of care ended to determine the need for continuation of services or discharge. There is no documentation in the record the physician was notified of the change in the Plan of Care, not completing Skilled Nurse visits as ordered. 12, A phone interview with Patient number two (2) and patient's spouse on July 9, 2009 at 9:47 a.m. revealed the nurse stopped coming because the nurse was not getting paid. The patient's spouse stated having called the home health agency at least five (5) times to find out what was going on with the nurse visits. The spouse said Patient number two (2) was having pain issues from cancer and was currently getting chemotherapy and needed someone to come to the home. oe 13, An interview with the owner of the home health agency on July 9, 2009 at 10:00 a.m., revealed he was not aware staff had stopped making visits to the patient. ‘The home health agency attempted to make a visit today, but was told by Patient number two (2) and spouse they were getting another home health agency and did not want the nurse to come to the home. | 14. A review of the clinical record for Patient number five (5) revealed a plan of care for June 12, 2009 — August 10, 2009, The physician had ordered skilled nursing visits once a week for nine (9) weeks to observe for complications of lung cancer and wound care. The patient was seen by therapy status post ankle fractire, A review of the clinical record revealed there had been no nursing visits completed during this certification period. 15. An interview with the owner on July 9, 2009 at 10:15 a.m. revealed Patient number five (5) had requested discharge from the home health agency, there is no documentation ~ this was discussed with the physician and there was not a discharge assessment in the record. 16. A-review of the clinical record for Patient number seven (7) noted the last nursing visit was on June 19, 2009, and the discharge date was June 30, 2009. There is no documentation the comprehensive assessment was updated upon discharge, This was confirmed by the owner of the home health agency on July 9, 2009, at 11:00 a.m. 17. _ A review of the clinical record for Patient number eight (8) doctimented the patient was discharged on June 25, 2009. There is no documentation the comprehensive assessment was updated upon discharge. 18. An interview with the owner of the home health agency on July 9, 2009 at 11:00 aim, stated, "The Director of Nursing walked out and did not complete the assessments upon discharge", 19. The Respondent’s act, omission, or practice had a direct adverse effect on the health, safety, or security of a patient and constituted a Class III violation in accordance with Section 400.474(5), Florida Statutes (2009). 20. Upon finding a Class III deficiency, the Agency shall impose an administrative fine in the amount of five thousand dollars ($5,000.00) pursuant to Section 400.474(5), Florida Statutes (2009). , . 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 THOUSAND DOLLARS ($5,000.00) pursuant to Section 400.474(5), Florida Statutes (2009). . CLAIMFORRELIEK 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 FIVE THOUSAND DOLLARS ($5,000.00). 3. Enter any other relief that this court deems just and appropriate. Respectfully submitted on this 44% dayof_ Oe ce ember 2009. Andrea M. Lang, Assistant General Cotnlsel 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 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, : IT/HE/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. JHE 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: Rivka H. Gelbtuch, Registered Agent for Beam Management, L.L.C. d/b/a Spectrum Healthcare Services, 2600 Courtland Street, Sarasota, Florida 34237, United States Certified Mail, Return Receipt No: 7008 2810 0002 2372 9522, and to Philip Elk, Alternate Administrator, Beam Management, L.L.C. d/b/a Spectrum Healthcare Services, 5968 Clark Center’ Avenue, Sarasota, Florida 34238, United States Certified Mail, Return Receipt No. 7008 2810 0002 2372 9515 on this $ Gay of _{ ye ce mec _, 2009. Copies furnished to: QUA an . Sanreg- Andrea M. Lang, Assistant General 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 Philip Elk, Alternate Administrator Beam Management, L.L.C. d/b/a Spectrum Healthcare Services 5968 Clark Center Avenue Sarasota, Florida 33901 (U.S. Certified Mail) ; (Interoffice Mail) Rivka H. Gelbtuch, Registered Agent for Harold Williams Field Office Manager Beam Management, L.L.C. d/b/a Spectrum Healthcare Services 2600 Courtland Street Sarasota, Florida 34237 (U. S. Certified Mail) Andrea M. Lang Assistant General Counsel . Agency for Health Care Administration Office of the General ‘Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (nteroffice Mail) - USPS - Track & Confirm . Page 1 of 1 P= a ee % ay Sign In Track & Gonfirm Track & Confirm Search Results Label/Receipt Number: 7008 2810 0002 2372 9522 npeeereeareenananenereieireri Service(s): Certified Mail™ Track & Confirm Status: Delivered Enter Label/Receipt Number. 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Docket for Case No: 10-000750