STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Case No.: 2010003535 vs. HEARTFELT HOME CARE, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (the “Agency”) and files this administrative complaint against Heartfelt Home Care, Inc. (“Respondent”), and alleges: NATURE OF THE ACTION This is an action to impose a fine in the amount of five thougand dollars ($5,000.00) pursuant to Section 400.474 Florida Statutes, and Rule 59A-8.0086 Florida Administrative Code for one patterned violation of applicable law. JURISDICTION AND VENUE 1. The Agency has jurisdiction over the Respondent pursuant to Chapters 400, Part III, and 408, Part II, Florida Statutes. 2. Venue lies pursuant to 120.57, Florida Statutes, and Chapter 28, Florida Administrative Code. Filed May 28, 2010 1:15 PM Division of Administrative Hearings. PARTIES 3, The Agency is the licensing and enforcing authority for home health agencies, pursuant to Chapters 400, Part III, and 408, Part II, Florida Statutes, and Chapter 59A-8, Florida Administrative Code, 4. Respondent is a home health agency with a principal place of business located at 2003 Bartow Road, Lakeland, Florida 33801-6556, having been issued license number 299991837. 5. At all times material to the allegations of this administrative complaint, Respondent was required to comply with all statutes and rules applicable to a home health agency licensed in Florida. COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth in this count. 7. Section 400.474(5), Florida Statutes, requires: (5) 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 legal 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 s. 400.492 (3). A pattern may be demonstrated by a showing of at least three 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 during a 3-month period. The agency shall impose the fine for each occurrence. The agency may also impose additional administrative fines under s. 400.484 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. 8. Rule 59A-8.020, Florida Administrative Code, requires: (1) When a home health agency accepts a patient or client for service, there shall be a reasonable expectation that the services can be 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 in a 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 deseribed in subsection (3) below, for ¢lients receiving care without a physician, physician assistant, or advanced registered nurse practitioner’s orders. This responsibility includes assuring the patient receives all assigned visits. 9, Rule 59A-8.0215, Florida Administrative Code, requires: (1) A plan of care shall be established in consultation with the physician, physician assistant, or advanced registered nurse practitioner, pursuant to Section 400.487, F.S., and the home health agency staff who are involved in providing the care and services required to carry out the physician, physician assistant, or advanced registered nurse practitioner’s treatment orders. The plan must be included in the clinical record and available for review by all staff involved in providing care to the patient. The plan of care shall contain a list of individualized specific goals for each skilled discipline that provides patient care, with implementation plans addressing the level of staff who will provide care, the frequency of home visits to provide direct care and case management. (2) 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. (3) The patient, caregiver or guardian must be informed by the home health agency personnel that: (a) He has the right to be informed of the plan of care; (bo) He has the right to participate in the development of the plan of care; and (c) He may have a copy of the plan if requested. 10. On March 2, 2010, the Agency conducted a complaint investigation survey of the Respondent. 11. Based on the Agency surveyor’s record review and staff interview, the Respondent failed to follow the physician ordered plan of care and ensure that services required by the plan of care were provided by Respondent for two of four patients whose records were reviewed, resulting in fourteen missed visits during a two month timeframe, December of 2009 through January of 2010. Of the 14 missed visits, the patients’ health care providers were notified: of six; however, the Respondent delayed notifying the patient’s doctor during a period of from 15 days to 27 days from when the visit was missed. There were a total of eight missed visits during the two months that were not reported to the physicians, and services were not provided in accordance with the physician ordered plan of care. 12. A review of Patient #2's records revealed that Patient #2 had a start of care dated 12/1/09 with ordered services to include skilled nursing (“SN”) 2 times a week for 2 weeks, 1 time a week for 3 weeks, and as of December 28, 2009, 2 times a week for 2 weeks, 1 time a week for 4 weeks, and as of the recertification date of January 30, 2010, 1 time a week for 4 weeks, 1 time a week every other week for 2 weeks. Effective 12/4/09 physical therapy (“PT”) was ordered to be 1 time a week for 1 week and 2 times a week for 7 weeks. Effective 12/1/09 a home health aide (“HHA”) was ordered 2 times a week for 3 weeks. Bffective 12/1/09 a medical social worker ("MSW") was ordered 1 to 3 visits within a 60 day period. 12.a. A review of Patient #2’s record revealed documentation of 2 HHA missed visits dated 12/4/09, and 12/18/09; 2 PT missed visits dated 12/15/09, and 12/17/09; and 2 SN missed visits dated 12/31/09, and 1/7/10. Additional review of the missed visit form revealed that there is no documentation that would indicate that the physician had been notified of the change to the plan of care on these dates. 12.b. Further review of Patient #2's records revealed documentation of 2 HHA missed visits dated 12/9/09, and 12/16/09; 1 PT missed visit dated 12/20/09; and 3 SN missed visits dated 12/8/09, 12/11/09, and 12/15/09. Additional review of the missed visit forms revealed documentation that the physician had been notified of all 6 of these missed visits on 1/5/10. There was no documentation that would. indicate that the physician was aware of the changes to the plan of care as they occurred. 13, Interview with the Director of Nursing ("DON") on 3/2/10 at approximately 11:30 a.m. revealed that the Respondent's policy is for each discipline to submit missed visit forms every 2 days with their time sheets, and that once received by the office this document is to be faxed to the physician's office, Additionally the DON confirmed that a fax stamp is placed on the form with a date, which indicates when the missed visit form was faxed to the physician. 14. Review of the Respondent's record for Patient #1 revealed a Plan of Care with an admission date of 12/9/09 and physician's orders for skilled nursing visits to assess vital signs and all body systems, to impart knowledge of disease process and its associated care and treatment, medication regimen knowledge, and signs and symptoms of complications necessitating medical attention at the time of each visit to the patient's home. 14.a. The physician ordered Plan of Care (CMS Form 485) for Patient #1 revealed orders for skilled nursing visits every day for 3 days; 3 times per week for 1 week; then 2 times per week for 3 weeks, beginning 12/9/09, to provide care, instruction and services relative to gastrostomy, diabetes mellitus, hypertension and tracheostomy care. The physician also ordered home health aide services 1 time per week for 1 week; 3 times per week for 2 weeks; and 2 times per week for 2 weeks to assist the patient with personal care. 14.b. Patient #1's record revealed that during week 4, only one skilled nursing visit and only one home health aide visit had been completed, rather than two visits as per the plan of care. This was confirmed on 3/2/10 at 2:30 p.m. during an interview with the Director of Nursing. 15, The above-recounted facts demonstrate a pattern of failing to provide a service specified in the home health agency's written agreement with a patient or the patient's legal representative, or the plan of care for that patient, and that the failure was not due to a reduction in service mandated by Medicare, Medicaid, or a state program, for purposes of § 400.474(5), Florida Statutes. WHEREFORE, the Agency intends to impose a fine in the amount of five thousand dollars ($5,000.00) for the cited violation, as mandated by Section 400.474, Florida Statutes. NOTICE OF RIGHTS Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes, Respondent 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. All requests for hearing 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, MS #3, Tallahassee, FL 32308; whose telephone number is (850)412~-3630. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7009 3410 0000 0172 5920 to Susan T. McCaskill, Registered ‘Agent for Heartfelt Home Care, Inc., 7485 Conroy Windermere Rd., Ste, C, Orlando FL 32835, on April il , 2010. ¢ \eunse es H. Harris, Esq. sistant General Counsel Fla. Bar. No. 817775 Agency for Health Care Administration 525 Mirror Lake Drive, 330D St. Petersburg, Florida 33701 727-552-1944 (office) 727-552-1440 (facsimile) Copies furnished to: Susan T. McCaskill Registered Agent for Heartfelt Home Care, Inc. 7485 Conroy Windermere Rd. Ste, C Orlando FL 32835 (U.S. Certified Mail) Susan T. McCaskill, Administrator Heartfelt Home Care, Inc. 2003 Bartow Road Lakeland, Florida (U.S. Mail) 33801-6556 James H. Harris, Esquire Agency for Health Care Admin, 525 Mirror Lake Drive, #330H St. Petersburg, FL 33701 (Interoffice Mail) Patricia R. Caufman Field Office Manager 525 Mirror Lake Dr., 4™ Floor St. Petersburg, Florida 33701 (Interoffice) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: HEARTFELT HOME CARE, INC., CASE NO.: 2010003535 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 Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. Your Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. If your Election of Rights with your selected 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 according to Chapter120, Florida Statutes (2006) 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 to the allegations of facts 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 to the allegations of facts contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, 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 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.

Docket for Case No: 10-002979