STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, | Petitioner, ; Case No.: 2011002514 vs. INTERIM HEALTHCARE GULF COAST, INC, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files’ this Administrative Complaint against, Interim Healthcare Gulf Coast, Inc. (hereinafter “Respondent”) and alleges: | NATURE OF THE ACTION This is an action to impose a fine in the amount of ten thousand dollars ($10,000.00) pursuant to Sections 400.474 and 400.484, Florida Statutes (2010) for cited deficient practices. JURISDICTION AND VENUE 1. The Agency has jurisdiction over the Respondent pursuant to Chapters 400, Part TI, and 408, Part II, Florida Statutes, (2010). 2. . Venue lies pursuant to 120.57, Florida Statutes (2010), and Chapter 28, Florida Administrative Code. PARTIES 3. . The Agency is the licensing and enforcing authority with regard to Home Health Agencies pursuant to Chapters 400, Part HI, and 408, Part II, Florida Statutes (2010) and Chapter 59A-8, Florida Administrative Code. Filed May 23, 2011 10:58 AM Division of Administrative Hearings 4. Respondent is a Home Health Agency located at 4730 North Habana Avenue, Suite 304, Tampa, Florida 33614, having been issued license number 20584096. 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 6. The Agency re-alleges and incorporates (1) through (5) as if fully set forth herein. 7. That pursuant to Florida law, when nursing services are ordered, the home health agency - to which a patient has been admitted for care must provide the initial admission visit, all service ' evaluation visits, and the discharge visit by a direct employee, Services provided by others under contractual arrangements to a home health agency must be monitored and managed by the admitting home health agency. The admitting home health agency is fully responsible for ensuring that all care provided through its employees or contract staff is delivered in accordance — with this part and applicable rules... The skilled care services provided by a home health agency, ‘ directly or under’ contract, must be supervised and coordinated in accordance with the plan of care. Section 400.487(5) and (6), Florida Statutes (2010). 8. That pursuant to Florida law, 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 described in subsection (3) below, for clients receiving care Page 2 of 1i without a physician, physician assistant, or advanced registered nurse practitioner’s orders. This responsibility includes assuring the patient receives all assigned visits. Rule 59A-8.020(1), Florida Administrative Code, 9. That 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 legal representative, or the plan of care for that patient, unless a reduction in service is mandated. by Medicare, Medicaid, ora state program or as provided in s, 400,492(3), A pattern may be demonstrated by a showing of at least three inciderices, 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 occutrence. The agency may also impose additional administrative fines under s. 400.484 for the direct or indirect harm toa 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 400.474(5), Florida Statutes (2010). ; 10. That the Petitioner completed a Complaint Survey, CCR number 2011000229, of the Respondent on February 17, 2011. ~~ dL.» That based upon the review of records and interview, Respondent failed to provide services based on the patient’s plan of care or written agreement for two (2) of three (3) patient records reviewed encompassing a total of thirty-two (32) missed visit days for one patient over a period of sixty-one (61) days, September 1 through October 31, 2010, and ten (10) missed visit days for a second patient over a period of thirty-five (35) days, January 1 through February 4, 2011, the same constituting a pattern pursuant to law and in violation of regulatory mandates. 12. That Petitioner’s representative reviewed Respondent’s records, including clinical Page 3 of 11 records, regarding patient number one (1) and noted as follows: .. The patient's payor was through private insurance; . The Home Health Certification and Plan of Care (HHC/POC) indicated the start of care date was August 31, 2010, with certification periods of August 31, through October 29, 2010 and October 30 through December 28, 2010; . During the certification periods, the patient received skilled nursing services to "Assess vital signs and all body systems" and during which tteatment/wound care was to be provided to the patient's sacral and right hip areas; . The patient was discharged from services on November 8, 2010; WA communication note to the attending physician dated August 31, 2010 indicated that Respondent’s staff was advising the physician that the patient had refused the physical therapy, occupational therapy and home health aide services which the Respondent had been referred to provide; Respondent also advised the physician that the patient preferred to have wound care done every three (3) days; . Absent from the records was any documentation that the communication: form had been signed by the physician as acceptable or any indication as to whether the form had been faxed or mailed to the physician; . Absent from the records was any indication that Respondent had completed any follow up discussion or further notification to the physician of this August 31,-2010 communication or any indication of the physicians response regarding to this request; The start of care orders dated August 31, 2010 do not include physical Page 4 of 11 therapy, occupational therapy, or home health aide services, and the skilled nurse visits are ordered to be provided every three (3) days; j. New physician orders dated September 1, 2010 directed: i, Cleanse the wound with normal saline solution,. apply Nystatin { , cream with Trimacinolone around the edges of the sacral and right hip wound daily, apply Silvercel to sacrum and right hip wound, and (emphasis added); ii. Off-Loading orders included a low air loss specialty bed/mattress for pressure reduction, turn every two hours, avoid direct pressure over wound site while limiting side lying position to 30 degree tilt and/or head of bed elevation to 30 degrees in bed; and obtain right trochanteric wound tissue culture; kK, Absent from the records was any documentation of skilled nurse visits on September 2, 4, 6, 8 10, 12, 14, 15, 16, 18, 20, 22, 24, 26, or 28, 2010, a total of fifteen (15) missed ordered visits; 1. Absent from the records was any documentation explaining or clarifying why the above referenced ordered visits and care were not completed; m. Absent from the records was any documentation indicating that the patient's physician had been made aware of the Respondent’s deviation from the physician’s ordered daily wound care; . nh. New physician orders dated September 29, 2010 directed: i, Cleanse wound with normal saline solution, apply Nystatin cream with Trimacinolone around the edges of right hip wound daily, use Nystatin powder to sacrum daily, apply Silvercel to right hip wound, Page 5 of 11 and change every three days (emphasis added); ii. Off-loading orders included a low air loss specialty bed/mattress for pressure reduction, turn every two hours, avoid direct pressure over wound site while limiting side lying position to 30 degree tilt and/or head of the bed elevation to 30 degrees in bed; . Absent from the records was any documentation of skilled nurse visits on October 2, 4, 6, 8, 10, 12, 13, 14, 16, 17, 19, 20, 22, or 23, 2010, a total of fifteen (15) missed ordered visits; . Absent from the records was any documentation explaining or clarifying why the above referenced ordered visits and care were not completed; . Absent from the records was any documentation indicating that the patient’s physician had been made aware of the Respondent’s deviation from the physician’s ordered daily wound care; . New physician orders dated October 24, 2010 directed that effective October 24, 2010, skilled nurses were to provide care every three days for three weeks; . New physician orders dated October 27, 2010 directed: i. Cleanse wound with normal saline solution, apply Nystatin cream with trimacinolone around the edges of right hip wound daily, use Nystatin powder to sacrum daily, apply Silvercel to right hip wound, pack inside wound, leave tail outside wound, and change every three days (emphasis added); ii. Off-loading orders included low air specialty bed/mattress for pressure reduction; turn every two hours, avoid direct pressure over Page 6 of 11 wound site while limiting side lying position to 30 degree tilt and/or head of bed elevation to 30 degrees in bed; t. Absent from the records was any documentation of skilled nurse visits on ” October 28 or 29, 2010, a total of two (2) missed ordered visits; u. Absent from the records was any documentation explaining or clarifying why the above referenced ordered visits and care were not completed; ‘vy, Absent from the records was any documentation indicating that the patient’s physician had been made aware of the Respondent's deviation from the physician’s ordered daily wound care. 13, That Petitioner’s representative interviewed and reviewed Respondent’s records related to patient number one (1) with Respondent's director of nursing and administrator on February 17, 2011 and the director of nursing confirmed the missed visits, the lack of documentation justifying or explaining deviation from ordered care, or notification of the patient’s physician of these deviations to ordered care. 14, That the above represents thirty-two (32) home health agency care visits which were missed between the period of September 1, 2010 through October 31, 2010 for patient number one (1), said missed visits constituting a pattern of failure to provide services mandated by a plan of care or written agreement. 15. That Petitioner’s representative reviewed Respondent’s records regarding patient number three (3) and noted as follows: a. The patient is a blind Medicare patient who also had private insurance; b. The Home Health Certification and Plan of Care (HHC/POC) indicated a start of cate date of November 11, 2010, with a recertification petiod of January 10 through March 10, 2011; Page 7 of 11 . Start of care physician orders included directed services of skilled nursing twice a week, home health aide twice a week, and physical therapy to evaluate and treat patient; . Absent from the records was any documentation of home health aide visits from the January 10,2011 through and including February 4, 2011; Absent from the records was any documentation explaining or clarifying why the above referenced ordered visits and care were not completed; Absent from the records was any documentation indicating that the patient’s physician had been made awate of the Respondent’s deviation from the physician’s ordered home health aide services; Absent from the records was any documentation of any physical therapy visit to evaluate and treat patient as ordered, a single missed ordered visit; Absent from the records was any documentation explaining or clarifying why the above referenced ordered visits and care were not completed; Absent from the records was any documentation indicating that the patient’s physician had been made aware of the Respondent’s deviation from the physician's ordered daily wound care; The patient’s wound care order was revised by the physician on January 18, 2011 to cleansing wound with mild soap and water or normal saline; _ Actiboat Burn or similar silver product to right leg wounds; cover and secure with gauze; wrap Coban II to right leg; change dressing twice a week; use lymphedema pump daily for 30 minutes; Absent from the records was any documentation of a second skilled nurse visit during the week of January 29, 2011 to treat the patient as ordered, a Page 8 of 11 single missed ordered visit; lL Absent from the records was any documentation explaining or clarifying why the above referenced ordered visit and care was not completed; m. Absent from the records was any documentation indicating that the patient’s physician had been made aware of the Respondent's deviation from the physician’s ordered wound care. 16, That Petitioner’s representative interviewed and. reviewed Respondent’s records related to patient number three (3) with Respondent’s director of nursing and administrator on February 17, 2011 and the director of nursing confirmed the missed visits, the lack of « documentation justifying or explaining deviation from ordered care, or notification of the ; patient’s physician of these deviations to ordered care. 17. That. the above represents ten (10) home health care visits which were missed between the petiod of January 11, 2011 and February 4, 2011 for- patient number three (3), said missed visits constituting a pattern of failure to provide services mandated by a plan of care or written agreement. | . 18. _ That 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. Section 400.474(5), Florida Statutes (2010). 19. That the above reflects two (2) distinct patterns of missed visits, one (1) pattern for each Page 9 of 11 identified patient. 20. That the Agency shall impose a fine of five thousand dollars ($5,000.00) for each occurrence of such a violation. Section 400.474(5), Florida Statutes (2010). . WHEREFORE, . the Agency intends to impose a fine in the amount of ten thousand dollars ($10,000.00) for the above recited deficient practice as authorized under Section 400.474, Florida Statutes (2010). Respectfully submitted this _/ sey of April, 2011. Th alsh II, Esq.- ya “No. 566365 unsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1947 (office) 727.552.1440 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the tight 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 heating 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;Telephone (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 USS, Certified Mail, Return Receipt No.7008 0500 0001 9560 6861 on April 2011 to Joanne Doyle, Administrator, Interim Healthcare Gulf Coast, Inc., 4730 North Habaha Avenue, Suite 304, Tampa, Florida 33614 and by Regular U.S. Mail to Patrick M. O’Connor, Esq., I HEREBY CERTIFY that a true and correct copy of the foregoing has Wer by Page 10 of 11 Registered Agent for Interim Healthcare Gulf Coast, Inc., 1250 South Belcher Road, Suite 160, Clearwater, FL 33771. as J. Walsh II, Esquire Copies furnished to: Patrick M, O’Connor, Esq. Registered Agent for Interim Healthcare Gulf Coast, Inc. 1250 South Belcher Road, Suite 160 Clearwater, FL 33771 U.S. Mail Thomas J. Walsh II, Esquire __ Agency for Health Care Admin. 525 Mirror Lake Drive, #330G St. Petersburg, FL 33701 (Interoffice Mail) Kristi R. Lantz, Administrator Interim Healthcare Gulf Coast, Inc. 4730 North Habana Avenue, Suite 304, Tampa, Florida 33614 (U.S. Certified Mail) Patricia R. Caufman Field Office Manager 525 Mirror Lake Drive, 4" Floor St. Petersburg, Florida 33701 (Interoffice) . Page 11 of 11 isti R. Lantz, Administrator interim Healthcare Gulf Coast, Inc. 730 North Habana Avenue, Suite 04, Tampa, Florida 33614... 2008 0500 U00% Sseq Lany i Fabtueiy 2004 °°. +." Bomedtig Return Recepe USPS - Track & Confirm Page 1 of 1 Home | Help | Stan to Track & Confirm FAQs Search Resulie Label/Receipt Number: 7008 0500 0001 9560 6861 agente a Service(s): Certified Mail™ Tradh & Gontitin Status: Dellvered . Enter Label/Recelpt Number, Your item was delivered at 11:38 am on April 19, 2014 in TAMPA, FL. seertmenanrenonre 33614, nn Detalled Results: * Delivered, April 19, 2011, 11:38 am, TAMPA, FL 33644 + Arrival at Unit, April 19, 2041, 8:19 am, TAMPA, FL 33614 Notitivation Options Track & Confirm by email Get current event information or Updates for your item sent to you or others by email. (Gas) SileMex -- Gusfomer Service = Forms =. «= Gavi Services = Caveare = PrivacyPolley = JermsotUse Business Custamer Gateway e Peek eyed Copyright® 2010 USPS. 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Docket for Case No: 11-002587