STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR. HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2010008042 SENIOR SOLUTIONS HOME HEALTH CARE, LLC, Respondent, / - ADMINISTRATIVE COMPLAINT COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Agency” or “Petitioner”), by and through the undersigned counsel, and files this Administrative Complaint against SENIOR SOLUTIONS HOME HBALTH CARE, LLC, (hereinafter “Respondent” of “Facility”), pursuant to §§120. 569 and 120.57 Florida Statutes (2010), and alleges: NATURE OF THE ACTION This is an action to impose a fine in the amount of two thousand dollars ($2,000.00) pursuant to § 400.484, Florida Statutes (2010) for two (2) uncorrected State Class III deficiency violations. JURISDICTION AND VENUE L The Agency has jurisdiction over the Respondent pursuant to Chapters 4 400, Part MH, and 408, Part Il, Florida Statutes, (2010). 2. Venue lies pursuant to’ 120.57, Florida Statutes (2010), and Chapter 28, Florida Administrative Code. a a Filed January 5, 2011 4:28 PM Division of Administrative Hearings PARTIES 3. The Agency is the licensing and enforcing authority with regard to Home Health Agencies pursuant to Chapters 400, Part Ill, and 408, Part II, Florida Statutes (2010) and Chapter 59A-8, Florida Administrative Code. 4. Respondent is a home health agency (hereafter “HHA”) located at 13049 West Linebaugh Ave., Suite 101, Tampa, FL 33626, having been issued license number 299992484. 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I (Tag H236) 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. . 7. That pursuant to Florida law, ““Licensed practical nurse’ means any person licensed in this state to practice practical nursing.” See § 464.003(16), Fla. Stat. (2010). , 8. That pursuant to Florida law, personnel standards for licensed practical nurses require, inter alia, the following: (b) A licensed practical nurse shall: 1, Prepare and record clinical notes for the clinical record; 2. Report any changes in the patient’s condition to the registered nurse with the reports documented in the clinical record; 3. Provide care to the patient including the administration of treatments and medications; and 4. Other duties assigned by the registered nurse, pursuant to Chapter 464, FS. _ ; Fla, Admin. Code R. 59A-8.0095(4)(b). 9, That pursuant to Florida law: “Practice of practical nursing” means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others.under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed Page 2 of 14 dentist. A practical nurse is responsible and accountable for making decisions that are based- upon the individual’s educational preparation and experience in nursing. See § 464.003(19), Fla, Stat. (2010). 10. That pursuant to Florida law: “Practice of professional nursing” means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: (a) The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others. (b) The administration of medications and treatments as prescribed or authorized by. a duly licensed practitioner authorized by the laws of this State to prescribe such medications and treatments. . (c) The supervision and teaching of other personnel in the theory and performance of any of the acts described in this subsection. A professional nurse is responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing. See § 464.003(20), Fla. Stat. (2010). 11. . That on 05/11/10 - 05/13/10, the Agency conducted a Recertification Survey of the Respondent’s Facility. 12. That based upon interview and record review, the Respondent failed or refused to ensure the Licensed Practical Nurse (hereafter “LPN”) completed wound care for one (1) of five (5) home visits completed for Patient No. 4, hereafter “P4”, 13. That an observation of an agency LPN, Employee No. 5, performing wound care for P4, was performed on 05/11/10 at 1:45 p.m. / a. This was the HHA’s first visit for the week; and b. During the observation, the LPN failed to measure the wound. 14. That a memo to Respondent's staff dated 10/21/07, indicated: Wound measurements must be performed upon the first scheduled visit weekly, and must be documented on the Wound Page 3 of 14 Assessment Form. 15, That record review for-P4 revealed a Start of Care (hereafter “SOC”) date of 03/16/09, “with a certification period of 03/11/10 to 05/9/10. The LPN had also seen P4 on 04/21/10 without the wound being measured. 16. That in an interview with the LPN (Employee No. 5) on 05/11/10 at approximately 2:00 p.m., she confirmed she neglected to measure P4’s wound. 17. That during an interview and record review with Respondent’s Administrator on 05/13/10 at 10:40 a.m., she confirmed Respondent's policy is for the nutse to measure the patient’s wound during the first visit of the week. She further confirmed P4’s wound was not measured on 04/21/10 or 05/11/10. 18. That these failures, collectively and individually, constitute a deficient practice of Respondent by Respondent failing or refusing to ensure proper wound care for patients under Respondent’s care. 19, That the Agency determined that these failures relate to an act, omission, or practice that has an indirect, adverse effect on the health, safety, or security of a patient and cited Respondent for this deficient practice as a State Class Ill deficiency. 20. That the Agency provided Respondent with a mandatory correction date of 06/10/10. 21. That on 07/14/10, the Agency conducted a re-visit to the Recertification Survey of the Respondent. 22. That based upon review of clinical records, policies and procedures, and staff interview, the Respondent failed or refused to ensure that the LPN provided services according to the patients’ respective Plans of Care in three (3) of five (5) clinical records reviewed for Patient No. 1, Patient No. 4, and Patient No. 5, hereafter “P1”, “P4”, and “PS”. Page 4 of 14 23. That clinical record review for Pl revealed an SOC date of 06/04/10 and certification period of 06/04/10 through 08/02/10 with physician’s orders for skilled nursing to “visit as of 06/07/10, 1 time a week for 1 week, re-evaluation.” ; a. An addendum order dated 06/04/10 signed by the physician states, “Skilled nutse to see client weekly for 3 weeks as of 6/6/10 to assess C/V status due to recent exacerbation of HTN for physical therapist.” b. Nursing visit notes dated 07/02/10 and 07/07/10. revealed the LPN failed to document that she/he had obtained respirations as part of patient’s assessment. c. Policy and procedure review revealed policy titled Vital Sign Requirements, Revised 05/18/10: “Policy: Nursing vital signs required - Blood Pressure, - Pulse, - Respirations, -Temp, - May take O2 saturations if indicated.” 24. That clinical record review for P4 revealed an SOC date of 06/15/10 and certification period of 06/15/10 through 08/13/10 with physician’s orders for “SN [skilled nurse] to teach - patient/caregiver and perform wound care as follows: Cleanse left foreatm wound with wound wash, apply skin prep, xeroform, 4 x 4 gauze, cover with Kerlix, stretch net, may use Tegaderm or transparent dressing.” There was no documentation the LPN who provided care to the patient on 06/29/10, 07/02/10 and 07/05/10 used skin prep as ordered/required. 25.. That clinical record review for PS revealed an SOC date of 04/23/10 and certification period of 06/22/10: through 08/20/10 with physician’s orders for “SN [skilled nurse] to teach patient/caregiver and perform wound care as follows: cleanse scabbed areas to upper and lower [sic] with soap and water - may use wound wash, apply skin protectant/Calmoseptine.” Page 5 of 14 a. There was no documentation the LPN cleansed the wound on 06/29/10. b. Interview and review of clinical records of P1, P4 and P5 with the Administrator on 07/14/10 at approximately 2:00 p.m. through 2:45 p.m. confirmed the above findings. i. Respondent’s Administrator agreed that: (a) The LPN failed to document the P1’s respirations; (b) She could find no documentation the nurse applied skin prep pursuant to the physician’s order for P4; and (c) Failed to evidence the wound had been cleansed prior to applying skin protectant for PS. 26. That the above facts show, inter alia, that Respondent consistently failed or refused to provide adequate wound care or failed to perform or document wound care as required, which is a deficient practice placing residents at potentially great risk of not receiving proper care, the failure of which is contrary to law. 27. That Respondent failed or refused to take action to correct the deficient practice despite a previous citation for the violation. See Section § 429.19(3){c), Fla. Stat. (2009). 28. That the Agency determined that these failures relate to an act, omission, or practice that has an indirect, adverse effect on the health, safety, or security of a patient and cited Respondent for this uncorrected deficient practice as a State Class III deficiency. 29, . That the Agency provided Respondent with a mandatory correction date of 08/13/10. 30: That the same constitites grounds for an uncorrected Class III deficiency violation as defined by law. WHEREFORE, the Agency secks to impose an administrative fine in the amount-of one thousand doflars ($1,000.00) against Respondent, an HHA in the State of Florida, pursuant to § Page 6 of 14 400.484(2)(c), Fla. Stat. (2010) and costs related to an investigation that results in a successful prosecution, excluding costs associated with an attorney’s time pursuant to § 400.484(3), Fla. Stat. (2010). COUNT II (Tag H302) 31. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 32. That pursuant to Florida law, “[w]hen required by the provisions of chapter 464; part I, part III, or part V of chapter 468; or chapter 486, the attending physician, physician assistant, or advanced registered nurse practitioner, acting within his or her respective scope of practice, shall establish treatment orders for a patient who is to receive skilled care. The treatment orders must be signed by the physician, physician assistant, or advanced registered nurse practitioner before a claim for payment for the skilled services is submitted by the home health agency. If the claim is submitted to a managed care organization, the treatment orders must be signed within the time allowed under the provider agreement, The treatment orders shall be reviewed, as frequently as the patient's illness requires, by the physician, physician assistant, or advanced registered nurse practitioner in consultation with the home health agency.” See § 400.487(2), Fla. Stat. (2010). 33. That pursuant to Florida law, “[hJome 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.” Fla. Admin. Code R. 59A-8.0215(2) (emphasis added). Page 7 of 14 34. That on 05/11/10 - 05/13/10, the Agency conducted a Recertification Survey of Respondent. 35. That based upon record review and staff interview, Respondent failed or refused to ensure the physician was notified of changes to the Plan of Care (hereafter “POC”) for two (2) of fifteen (15) medical records reviewed for Patient No. 5 and Patient No. 12, hereafter “P5” and “P12”. . 36. That record review for P5 revealed an SOC date of 03/11/10, a certification period from 03/11/10 to 05/09/10, and a physician’s order for the nurse to perform orthostatic (sitting and standing) blood pressures. a. Review of the nurses notes reveal the nurse visited PS on 3/19, 4/2, 4/ 17, ‘4/23, 4/27, and 04/30/10. b. However, no. documentation could be found, in the medical record that indicated the nurse performed an orthostatic blood pressure check during these visits, 37. That record review for P12 revealed a POC dated 04/05/10 to 06/03/10 and a physician’s order for the skilled nurse to obtain vital signs inclusive of pulse ox as needed at each visit. a. Review of the nursing visit notes failed to reveal documentation of the inclusion of a temperature reading during the visits on 04/08/10 and 04/15/10. b. The nursing narrative note of 04/08/10 stated the vital signs were within normal limits although the documentation did not indicate a temperature had | been taken. - 38. That during an interview and record review with the Administrator on 05/13/ 10 at 11:52 am., she confirmed the nurse did. not take the physician-ordered blood pressures, and the temperature had-not-been taken as described herein above. Page 8 of 14 39. That these failures, collectively and individually, constitute a deficient practice of Respondent by Respondent failing or refusing to follow physician orders. 40. That the Agency determined that these failures relate to an act, omission, or practice that has an indirect, adverse effect on the health, safety, or security of a patient and cited Respondent for this deficient practice as a State Class III deficiency. 41. That the Agency provided Respondent with a mandatory correction date of 06/10/10. 42. That on 07/14/10, the Agency conducted a re-visit to the Recertification Survey of the Respondent’ s Facility. : 43. That based upon review of clinical records, policies and procedures, and staff interview, Respondent failed or refused to ensure the POC was followed in four (4) of five (5) clinical records reviewed for Patient No. 1, Patient No. 2, Patient No. 4, and Patient No. 5, hereafter “PI”, “P2”, “P4”, and “psy, 44, That an HHA must follow treatment orders/POC, and it cannot be followed, there must be evidence in the HHA’s records indicating that: a. The treatment orders could not be followed; or b. The treatment orders needed to be changed; and c. If altered, that the physician, advanced registered nurse practitioner or physician’s assistant was notified of said change and approved said change; or d. If verbal change orders were given, whether said verbal orders were put in writing by the nurse or therapist. 45. That regarding P1: a That clinical record review for P1 revealed an SOC date of 06/04/10 and certification period of 06/04/10 through 08/02/10 with physician’s orders for skilled: nursing to “visit: as of 06/07/10, 1-time a week for 1- week, re- Page 9 of 14 evaluation.” An addendum order dated 06/04/10 signed by the physician states, “Skilled nurse to see client weekly for 3 weeks as of 6/6/10 to assess C/V status due to recent exacerbation of HTN for physical therapist.” Skilled nursing services were provided to the patient on 06/04/10 which is not according to the plan of care. Additionally, nursing visit notes dated 07/02/10 and 07/07/10 revealed the LPN failed to obtain respirations as part of nursing vital signs/assessment. Policy and procedure review revealed policy titled Vital Sign Requirements, Revised 5/18/10: “Policy: Nursing vital signs required - Blood Pressure, - Pulse, - Respirations, -Temp, - May take O2 saturations if indicated.” 46. That regarding P2: a. Clinical record review for P2 revealed an SOC date of 06/09/10 and certification period of 06/09/10 through 08/07/10 with physician’s orders for Peg Tube: “#4. Peg Tube Care: Cleanse with peroxide and dress site twice daily. Apply Betadine or neosporin ointment to peg site with each dressing.” Nursing visit notes dated 06/10/10 and 06/11/10 revealed the LPN applied bacitracin instead_of Betadine or neosporin_as ordered. There was no documentation in the nursing visit notes written by the registered nurse who provided peg tube care that Betadine or Neosporin was applied on 06/ 17/0 or 07/01/10. 47. That regarding P4: a. Clinical record review for P4 revealed an SOC date of 06/15/10 and certification period of 06/15/10 through 08/13/10 with physician’s orders for Page 10 of 14 “SN [skilled nurse] to teach patient/caregiver and perform wound care as follows: i. Cleanse left forearm wound with wound wash, apply skin prep, xeroform, 4 x 4 gauze, cover with Kerlix, stretch net, may use Tegaderm or transparent dressing.” ii. There was no documentation the LPN who provided care to the patient on 06/29/10, 07/02/10 and 07/05/10 had used skin prep as ordered. 48. That regarding PS: a. Clinical record review for P5 revealed an SOC date of 04/23/10 and certification period of 06/22/10 through 08/20/10 with physician’s orders for “SN. [skilled nurse] to teach patient/caregiver and perform wound care as follows: cleanse scabbed areas to upper and lower (sic) with soap and water ~ may use wound wash, apply skin protectant/Calmoseptine.” b. There was no documentation the registered nurse had cleansed the wound on 06/25/10 nor the LPN had cleansed the wound on 06/29/10. 49, That: an interview and review of clinical records of Pl, P2, P4, and P5 with the Administrator on 07/14/10 at approximately 2:00 p.m. through 2:45 p.m. confirmed findings. 50. That during said interview, Respondent’s Administrator: a. Agreed the LPN failed to document the patient’s respirations; b. That there was no order covering the skilled nurse visit on 06/04/10; c. Agreed the nurse failed to document that she had used’Betadine or Neosporin as ordered on P2; d. Could find no documentation that the nurse applied skin prep as the physician ordered for P4; and Page 11 of 14 e. Failed to evidence the wound had been cleansed prior to applying skin protectant for PS. 51. That-despite the POCs not being followed by Respondent, there was no evidence in the Respondent’s records indicating that: a. The treatment orders could not be followed; or b. The treatment orders needed to be changed; and c. If altered, that the physician, advanced registered nurse practitioner or physician’s assistant was notified of said change and approved said change; or d. If verbal change orders were given, whether said verbal orders were put in writing by the nurse or therapist. 52. That the above facts show, inter alia, that Respondent consistently failed or refused to ensure the POC was followed or that procedures for change orders (if applicable) were followed, which is a deficient practice placing residents at potentially great risk of not receiving proper care, 53. That in the case at bar, the above reflect, inter alia, that Respondent disregarded physician’s orders for multiple patients, failed to take vitals when required, failed or refused to follow peg tube cleaning requirements, and failed or refused to follow wound care requirements per physician’s orders, the failure of which is contrary to law. 54. That Respondent failed or refused to take action to correct the deficient practice despite a previous citation for the violation. See Section § 429.19(3)(c), Fla, Stat. (2009). 55, That the Agency determined that these failures relate to an act, omission, or practice that has an. indirect, adverse effect on the health, safety, or security of'a patient and cited Respondent for this uncorrected deficient practice as a State Class III deficiency. 56. ‘That the Agency provided Respondent with a mandatory correction date of 08/13/10. Page 12 of 14 57. That the same constitutes grounds for an uncorrected Class III deficiency violation as defined by law. WHEREFORE, the Agency seeks to impose an administrative fine in the amount of one thousand dollars ($1,000.00) against Respondent, an HHA in the State of Florida, pursuant to § 400.484(2)(c), Fla. Stat. (2010) and costs related to an investigation that results in a successful prosecution, excluding costs associated with an attorney’s time pursuant to § 400.484(3), Fla. Stat. (2010). Respectfully submitted this ©* day of November, 2010. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION The Sebring Building 525 Mirror Lake Dr. N., Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 55271942 Flal Bat No. 567523 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 attention of: The Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 412-3630. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Page 13 of 14 CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt No. 7010 0780 0001 9835 6618 on this “CZ day of November, 2010 to Senior Solutions Home Health Care, LLC, | ATTN: Daniel Costello, Registered Agent and Managing Member, 13049 West Linebaugh Ave., Suite 101, Tampa, FL 33626. Copies furnished to: Senior Solutions Home Health Care, LLC ATTN: Daniel Costello, Registered Agent and Managing Member- 13049 West Linebaugh Ave., Suite 101 Tampa, FL 33626 U.S. Certified Mail Patricia Caufman Field Office Manager 525 Mirror Lake Dr., 4th Floor St. Petersburg, Florida 33701 (Interoffice) : Thomas F. Asbury, Esq. Senior Attorney Agency for Health Care Admin. 525 Mirror Lake Dr, 330 St. Petersburg, Florida 33701 Interoffice Page 14 of 14 i 86 that’ we @ Attach thi ving, la Savannah Co ‘Att: Dennis fagner, Regi [4661 John: 1, { i i ! fi (

Docket for Case No: 11-000024