STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2011006475 : Return Receipt Requested: v. 7009 0080 0000 0586 2005 ANA HOME CARE, INC. d/b/a ANA HOME CARE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA” or “Agency”), by and through the undersigned counsel, and files this administrative complaint against Ana Home Care, Inc. d/b/a Ana Home Care (hereinafter “Ana Home Care”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2010), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the assisted living facility license [License No.: 11559], pursuant to Section 408.815(c) &(d), Florida Statutes, and Section 429.14(1) (e), Florida Statutes, and to impose an administrative fine of $30,000.00 pursuant to Sections 429.14 and 429.19, Florida Filed October 26, 2011 12:30 PM Division of Administrative Hearings Statutes (2010), and Section 408.813, Florida Statutes, for the protection of public health, safety and welfare. Section 429.14(1)(e), Florida Statutes, provides that the Agency can revoke or deny a license if one or more Class I deficiencies have been cited. The Agency has considered the factors outlined in Section 429.19(3), Florida Statutes, in imposing the penalty and in fixing the amount of the fine. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2010), and Chapter 28-106, Florida Administrative Code (2010). 3. Venue lies pursuant to Rule = 28-106.207, Florida Administrative Code (2010). PARTIES 4, AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 429, Part I, Florida Statutes (2010), and Chapter 580-5 Florida Administrative Code (2010). 5. Ana Home Care operates a 6-bed assisted living facility located at 20555 S. W. 187 Avenue, Miami, Florida 33187. Ana Home Care is licensed as an assisted living facility under license number 11559. Ana Home Care was at all times ‘material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I ANA HOME CARE FAILED TO PROVIDE LIMITED NURSING SERVICES FOR RESIDENT WITH A PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE. RULE 58A-5.031(2) (d) &(3), FLORIDA ADMINISTRATIVE CODE (STAFFING STANDARDS) CLASS I VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Ana Home Care was cited with three (3) Class I deficiencies as a result of a monitoring visit survey that was conducted on April 1, 2011. 8. A monitoring visit survey was conducted on April 1, 2011. Based on observation, record review, and interview, it was determined that the facility failed to provide limited nursing services for 1 of 1 previously sampled resident (#4) with a Percutaneous Endoscopic Gastrostomy (PEG) tube. 9. This is a nursing skill that requires specific knowledge of the human body for proper positioning of the resident and correct placement to ensure the tube has not become dislodged or clogged. Aspiration of residual stomach contents must be checked prior to instilling additional feedings in order to prevent potential aspiration of stomach contents into the lungs. Aspiration of stomach contents into the lungs can result in development of pneumonia that may lead to the death of the resident. 10. Administration of medications through a PEG tube requires either a liquid form of the medication or that the medication be crushed and dissolved in a specific amount of water with patency of the tube assured before and after each medication by flushing the tube with an additional 30 Milliliters of water. This also assures that the medications are passed into the stomach. Failure to complete this procedure correctly can lead to decreased absorption and effectiveness of the medications resulting in harm to the resident. These potential effects of improper use of a PEG tube pose a clear imminent threat to the well-being of the resident and it is why a licensed nurse is required to provide the service in an assisted living facility. The findings include the following. ll. Observation on 4/1/2011 at 7:45AM revealed resident #4 was sitting in a geri-chair in room #4. There was a PEG tube in place to the upper left abdomen. 12. Interview with C.N.A. from hospice at 7:45 AM on 4/1/2011 revealed "the hospice nurse" is providing the medications and feedings for the resident. 13. Interview with facility caregiver at 8:00 AM on 4/1/2011 revealed "the hospice nurse" is providing the medications and feedings for the resident. 14. Record review of the facility's record and the hospice chart. for resident #4 found no documentation of feeding or medication administrations being provided by a licensed nurse. The hospice communication log documents a Registered Nurse is visiting once a week. 15. The facility continues to operate. 16. Based on the foregoing facts, Ana Home Care violated Rule 58A-5.031(2) (d)&(3), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $10,000.00 and gives rise to the revocation of the assisted living facility license. COUNT II ANA HOME CARE FAILED TO DISCHARGE RESIDENT WHO NO LONGER MEETS ADMISSION CRITERIA, SPECIFICALLY A RESIDENT WITH A PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE RULE 58A-5.0181(5), FLORIDA ADMINISTRATIVE CODE (ADMISSION CRITERIA STANDARDS) CLASS I VIOLATION 17. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 18. A monitoring visit survey was conducted on April 1, 2011. Based on observation, record review, and interview, it was determined that the facility failed to discharge 1 of 1 previously sampled resident(#4) who no longer meets admission criteria, specifically a resident with a Percutaneous Endoscopic Gastrostomy (PEG) tube that the facility is not caring for under its LNS component. 19. This is a nursing skill that requires specific knowledge of the human body for proper positioning of the resident and correct placement to ensure the tube has not become dislodged or clogged. Aspiration of residual stomach contents must be checked prior to instilling additional feedings in order to prevent potential aspiration of stomach contents into the lungs. Aspiration of stomach contents into the lungs can result in development of pneumonia that may lead to the death of the resident. 20. Administration of medications through a PEG tube requires either a liquid form of the medication or that the medication be crushed and dissolved in a specific amount of water with patency of the tube assured before and after each medication by flushing the tube with an additional 30 Milliliters of water. This also assures that the medications are passed into the stomach. Failure to complete this procedure correctly can lead to decreased absorption and effectiveness of the medications resulting in harm to the resident. These potential effects of improper use of a PEG tube pose a clear imminent threat to the well-being of the resident and it is why a licenséd nurse is required to provide the service in the Assisted Living Facility. The findings include the following. 21. Observation on 4/1/2011 at 7:45AM revealed resident #4 was. sitting in a geri-chair in room #4. There was a PEG tube in place to the upper left abdomen. 22. Interview with C.N.A. from hospice at 7:45 AM on 4/1/2011 revealed "the hospice nurse" is providing the medications and feedings for the resident. 23. Interview with facility caregiver at 8:00 AM on 4/1/2011 revealed "the hospice nurse" is providing the medications and feedings for the resident. 24. Record review of the facility's record and the hospice chart for resident #4 found no documentation of feeding or medication administrations being provided by a licensed nurse. The hospice communication log documents a Registered Nurse is visiting once a week. 25. Based on the foregoing facts, Ana Home Care violated Rule 58A-5.0181(5), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $10,000.00 and gives rise to the revocation of the assisted living facility license. 7 COUNT III ANA HOME CARE FAILED TO PROVIDE CARE AND SERVICES TO RESIDENT WITH A PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE RULE 58A-5.016(8) (a), FLORIDA ADMINISTRATIVE CODE RULE 58A-5.0182, FLORIDA ADMINISTRATIVE CODE RULE 58A-5.0181(4) (c), FLORIDA ADMINISTRATIVE CODE RULE 58A-5.031(1) (m), FLORIDA ADMINISTRATIVE CODE RULE 58A-5.031(2) (c) &(d) &(e) , FLORIDA ADMINISTRATIVE CODE RULE 58A-5.031(3), FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE STANDARDS) CLASS I VIOLATION 26. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. - 27. A monitoring visit survey was conducted on April 1, 2011 Based on observation, record review, and interview, it was determined that the facility failed to provide care and services to 1 of 1 sampled resident with a Percutaneous Endoscopic Gastrostomy (PEG) tube. 28. This is a nursing skill that requires specific knowledge of the human body for proper positioning of the resident and correct placement to ensure the tube has not become dislodged or clogged. Aspiration of residual stomach contents must be checked prior to instilling additional feedings in order to prevent potential aspiration of stomach contents into the lungs. Aspiration of stomach contents into the lungs can result in development of pneumonia that may lead to the death of the resident. 29. Administration of medications through a PEG tube requires either a liquid form of the medication or that the medication be crushed and dissolved in a specific amount of water with patency of the tube assured before and after “each medication by flushing the tube with an additional 30 Milliliters of water. This also assures that the medications are passed into the stomach. Failure to complete this procedure correctly can lead to decreased absorption and effectiveness of the medications resulting in harm to the resident. These potential effects of improper use of a PEG tube pose a clear imminent threat to the well-being of the resident and it is why a licensed nurse is required to provide the service in an assisted living facility. The findings include the following. Cross refer to A0428. 30. Based on the foregoing facts, Ana Home Care violated Rule 58A-5.016(8) (a), Florida Administrative Code, Rule 58aA- 5.0182, Florida Administrative Code, Rule 58A-5.0181(4)(c), Florida Administrative Code, Rule 58A-5.031(1) (m), Florida Administrative Code, Rule 58A-5.031(2) (c) &(d) &(e), Florida Administrative Code, and Rule S8A~-5.031(3), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $10,000.00 and gives rise to the revocation of the assisted living facility license. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Ana Home Care on Counts I through II. 2. Assess “an administrative fine of $30,000.00 against Ana Home Care on Counts I through III for the violations cited above. 3. Revoke the assisted living facility license [License No.t 11559] of Ana Home Care based on Counts I through III for the violations cited above. 4. Assess costs) related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2010). 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 the Agency Clerk, Agency for 10 Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER haar Lourdes A. Naranjo, Esq. Fla. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8333 N.W. 53%¢ Street Suite 300 Miami, Florida 33166 305-718-5906 Copies furnished to: Field Office Manager Agency for Health Care Administration 8333 N. W. 53 Street — Suite 300 Miami, Florida 33166 (Interoffice Mail) 11 CERTIFICATE OF SERVICE I. HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Armando Hidalgo, Administrator, Ana / Care, 20555 S.W, 187 Avenue, Miami, Florida 33187 on this go" day of bay Pee 9011. e282, Blencmses) Lourdes A. Naranjo, Esq 12 October 19, 2011 Re: Ana Home Care, Inc. d/b/a Ana Home Care AHCA No.: 2011006475 Hi Amy - We do not have a green card or USPS tracking confirmation for this case. The post office claims they were not able to deliver the package.

Docket for Case No: 11-005480