11-004457
Agency For Health Care Administration vs.
Faith Home Health, Inc.
Status: Closed
Recommended Order on Thursday, April 19, 2012.
Recommended Order on Thursday, April 19, 2012.
1STATE OF FLORIDA
4DIVISION OF ADMINISTRATIVE HEARINGS
8AGENCY FOR HEALTH CARE ) )
14ADMINISTRATION, )
16)
17Petitioner, )
19vs. ) Case No. 11-4457
24)
25FAITH HOME HEALTH, INC., )
30)
31Respondent. )
33)
34RECOMMENDED ORDER
36Pursuant to notice, on February 10, 2012, a formal hearing
46in this cause was held in Tampa, Florida, before the Division of
58Administrative Hearings (Division) by its designated
64Administrative Law Judge Lynne A. Quimby-Pennock.
70APPEARANCES
71For Petitioner: James H. Harris, Esquire
77Agency for Health Care Administration
82The Sebring Building, Suite 330D
87525 Mirror Lake Drive, North
92St. Petersburg, Florida 33701
96For Respondent: Thomas W. Caufman, Esquire
102Tammy Stanton, Esquire
105Quintairos, Prieto, Wood and Boyer, P.A.
1114905 West Laurel Street
115Tampa, Florida 33607
118STATEMENT OF THE ISSUES
122Whether Respondent committed the violations alleged in the
130Amended Administrative Complaint, and, if so, what penalty should
139be imposed.
141PRELIMINARY STATEMENT
143Respondent, Faith Home Health, Inc. (Faith Home), operates a
152home health agency located at 3202 North Howard Avenue, Tampa,
162Florida. On February 3, 2011, Petitioner, Agency for Health Care
172Administration (AHCA), conducted a recertification survey of
179Faith Home. On August 1, 2011, AHCA filed a two-count
189Administrative Complaint against Faith Home based on its survey.
198AHCA is seeking $46,000.00 in fines and the investigative cost
209associated with the survey.
213On August 23, 2011, Faith Home filed a Petition for Formal
224Administrative Hearing (Petition). On September 1, 2011, AHCA
232referred the Petition to the Division for a disputed-fact hearing
242and the issuance of a recommended order.
249A Notice of Hearing by Video Teleconference was issued
258setting the case for formal hearing on November 8 and 9, 2011.
270On October 20, 2011, Faith Home filed an uncontested Motion for
281Continuance. On October 21, 2011, an Order granting the
290continuance was issued, and the parties were directed to provide
300three mutuallyagreeable dates for a hearing in January 2012.
309The parties complied with the Order.
315On October 31, 2011, an Order was entered setting the case
326for hearing on January 30 and 31, 2012. On January 13, 2012,
338AHCA filed an unopposed Motion to Amend Administrative Complaint,
347which was granted, and all future references will be to the
358Amended Administrative Complaint (AAC), filed with the Division
366on January 23, 2012.
370On January 30, 2012, Faith Home made an ore tenus motion for
382continuance based on the unavailability of its chief witness due
392to an unexpected illness. The ore tenus motion was granted.
402Although this case was originally scheduled for two hearing days,
412prior to the last Notice of Hearing being issued, the parties
423notified the Division that only one hearing day was required.
433The hearing was re-scheduled to February 10, 2012, and heard as
444scheduled.
445AHCA presented the deposition testimony of Jeanette Peabody
453and the testimony of Joni Miller and Bronson Sievers. AHCA's
463Exhibits 1 through 4 and 6 through 18 were admitted into
474evidence. Faith Home presented the testimony of Beverly Eubanks
483and Celina Okpaleke. Faith Home's Exhibits 1 through 3, 5
493through 9, 11, and 13 through 15 were admitted into evidence. 1/
505A two-volume Transcript of the proceeding was filed with the
515Division on February 21, 2012. The parties timely filed proposed
525recommended orders, and each has been considered in the
534preparation of this Recommended Order.
539FINDINGS OF FACT
5421. At all times material hereto, Faith Home operated as a
553home health agency with its principal place of business located
563at 3202 North Howard Avenue, Tampa, Florida. Faith Home's
572license number is 299991078.
5762. Joni Miller is a registered nurse (RN) surveyor for
586AHCA. Ms. Miller holds an associate of arts degree in nursing
597and practiced as an RN for almost 30 years. She practiced as an
610RN in the areas of coronary care, research, home health,
620cardiology, and sports medicine. Ms. Miller has completed the
629requisite classes in surveyor training and is a certified home
639health surveyor. Ms. Miller was received without objection as an
649expert in nursing.
6523. Jeanette Peabody is an RN who worked for AHCA as an
664RN specialist. Ms. Peabody obtained an associate of arts degree
674in applied science with a major in nursing. In 1995, Ms. Peabody
686was licensed as an RN in Pennsylvania. Thereafter, she worked
696for various health-related entities, including (but not limited
704to) two home health agencies and the Pennsylvania Department of
714Health. She became licensed as an RN in Florida in 2004.
725Ms. Peabody became a certified surveyor after receiving the
734appropriate training. While working for AHCA, Ms. Peabody
742conducted surveys of health care facilities and agencies for
751compliance with the applicable rules and regulations.
758Ms. Peabody was received as an expert in nursing.
7674. Beverly Eubanks is the chief operating officer for Faith
777Home, a position she has held for 15 years. Ms. Eubanks is an
790RN, who received her associate's degree in nursing from Manatee
800Community College in 1990. Faith Home primarily serves the
809underprivileged, low-income families, and public housing
815residents.
8165. Celina Okpaleke is the sole owner of Faith Home and has
828been its owner since 1997. Ms. Okpaleke is a licensed physician
839assistant, having been licensed in 1996. Her duties at Faith
849Home are to oversee its day-to-day management. Prior to the
859February 2011 survey, Ms. Okpaleke had not been going to the
870Faith Home office every day. 2/
8766. The methodology for any survey includes the following:
885the team arrives at the location; the team is introduced to the
897survey entity's staff members; the team explains to the entity's
907staff members the nature of the survey, including a list of items
919required for the team to conduct the survey; and there is a
931request for work space. Upon receipt of the required items, the
942team reviews the material, conducts interviews, conducts visits
950with patients at their various locations, interviews staff, and
959reviews the accumulated information. In the event the surveyors
968have any questions, the surveyors will make requests to the
978appropriate entity staff, and additional materials may be
986provided to the surveyors. The survey findings are reviewed with
996the staff, and, at the end of the survey, the team conducts an
1009exit conference with the appropriate staff. Any entity staff is
1019welcomed to be present. In the event any documentation is
1029missing, the entity is allowed to provide that material after the
1040surveyors have left the facility. In those instances when an
1050agency is out of compliance, AHCA will make a return visit to
1062ensure the agency has corrected the deficiencies. There was
1071credible testimony that this survey procedure was the same
1080procedure used during the Faith Home survey and follow-up survey.
10907. It is recognized as a good nursing practice to document
1101in a patient's record or chart the care, treatment or other
1112services being provided to a patient. This includes all medical
1122and medically-related support services.
11268. Faith Home has numerous policies that govern how it is
1137to be run. A few of the pertinent policies are set forth below.
"1150Patient Visits," last revised on December 1, 2010, provides:
1159All patients will be seen according to
1166physician's orders and in compliance with the
1173plan of treatment. At each visit, a progress
1181or visit note will be completed. On the
1189visit note (progress not [sic]/visit note)
1195the patient's progress toward meeting
1200established goals shall be documented.
1205In addition, the patient's response to
1211treatment will be documented as well as any
1219other pertinent assessment information.
1223All patient visits will be performed
1229according to a pre-established schedule. If
1235there is [sic] any changes in visit schedule,
1243time or staff, the patient will be consulted
1251prior to the change.
"1255Initial Assessment Process for Medicare [P]atients," last
1262revised on December 1, 2010, reflects in pertinent part:
1271Upon admission, each patient will receive
1277initial assessment in order to determine
1283patient's needs. To achieve this goal, the
1290following important processes must be
1295performed:
1296* * *
1299More in depth functional assessments
1304performed by a qualified PT [physical
1310therapist] or OT [occupational therapist] are
1316available to those patients who need one.
1323These assessments are documented on the
1329appropriate PT/OT Evaluation form.
1333* * *
1336Initial assessments will be performed within
134248 hours of referral or within 48 hours of a
1352patient's return home from an impatient [sic]
1359stay, or on the physician-ordered start of
1366care [SOC] date.
1369MSW will make assessments within one (1) week
1377of referral based on the patient's priority
1384level as determined by RN and/or MD, PT, ST,
1393and OT will make evaluations within one (1)
1401week of referral based on the patient's
1408priority level as determined by the RN and/or
1416MD.
1417Administration/start of care assessment
1421data must be completed within five (5)
1428calendar days of the SOC date. The
1435agency then has seven (7) calendar days
1442from the SOC date to encode the data,
1450check for errors and lock the data for
1458transmission. The data will than [sic]
1464be transmitted on a monthly basis; data
1471minimum no later than the month[.]
"1477Oasis Data Set," last revised on December 1, 2010, reflects in
1488pertinent part:
1490The agency has implemented the OASIS data set
1498and is actively collecting data as of March
150615, 1999. Current assessment data and notes
1513utilized by the agency have been incorporated
1520into the OASIS core data.
1525OASIS requirements apply to all patients . .
1533The only exclusions are as follows:
15391. Patients under the age of 18
15462. Patients receiving maternity services
15513 . Patients receiving ONLY no skilled
1558services such as personal care, homemaker,
1564chore, or companion services.
1568OASIS data are collected at the following
1575points:
15761. Start of Care
1580* * *
15832. Resumption of Care following
1588impatient [sic] stay
1591* * *
15943. Follow-up/Recertification
1596* * *
15994. Follow-up/SCIC
1601* * *
16045. Discharges and Death
1608* * *
1611Do not administer OASIS data set as an
1619interview. Questions are meant to be part of
1627the professional opinion of the staff member
1634performing the assessment, based upon the
1640evaluation of the patient.
1644Be sure to incorporate agency assessment
1650material (Discharge Summary, etc.) with the
1656OASIS data set. The OASIS data set does not
1665constitute a complete assessment.
"1669Policies & Procedures for Accectance [sic] of Patients/Cases"
1677last revised on December 1, 2010, reflects in pertinent part:
1687B) Qualifying Criteria for Accepting a
1693Patient
1694* * *
16977) Client must have a telephone or use of
1706phone in close distance for emergency
1712situation. Running water and electricity are
1718also important factors for providing adequate
1724care in the home.
1728* * *
1731D) Criteria for Acceptance of Skilled
1737Nursing Clients
1739* * *
17425) A copy of MD orders may accompany Skilled
1751Nursing Admission. If nurse [is] able to
1758receive a faxed copy of orders, Faith Home
1766Health will fax them. If not, a copy of the
1776order will be sent to patient's residence
1783with supplies.
"1785Policies & Procedures for Admissions," last revised on
1793December 1, 2010, reflects in pertinent part:
1800A) Admission & Assessment Policies &
1806Procedures
1807* * *
18107) All documentation will be kept in the
1818patient's Faith Home Health folder.
"1823Caregiver Job Descriptions," last revised on December 1, 2010,
1832reflects in pertinent part:
1836A) Registered Nurses
1839* * *
1842Activities may include:
1845* * *
184811. Recording pertinent information.
1852* * *
1855B) LICENSED PRACTICAL NURSE
1859* * *
1862Activities
1863may include:
1865* * *
18687. Recording all pertinent observations and
1874treatments[.]
1875* * *
1878C) Certified Nurse Aide
1882* * *
1885Activities may include
1888:
1889* * *
189222. Keeping a record of observations and
1899care given[.]
1901D) Home Health Aide
1905* * *
1908Activities may include :
1912* * *
191510. Maintaining a proper record of
1921activities.
1922The February 2011 Survey
19269. In early February 2011, Ms. Peabody was the lead
1936surveyor in the annual Florida licensure recertification survey
1944conducted at Faith Home (FH survey). Ms. Miller was also a
1955member of the FH survey team. This FH survey team conducted
1966reviews, interviews, home visits, and conferences over the course
1975of three days.
197810. During the February 2011 FH survey, Ms. Peabody
1987requested and was provided Faith Home's records for patient 5.
1997The home health certification and plan of care (HHC/POC) for
2007patient 5 provided the SOC date as December 14, 2010. The
2018HHC/POC ordered skilled nursing visits to occur one to two times
2029a week for nine weeks. According to the HHC/POC, at each visit,
2041the skilled nurse was to perform various treatments with respect
2051to patient 5's multiple medical issues, including assessing vital
2060signs, cleaning a toe wound and applying a dressing, instructing
2070the patient on diet and nutrition, and reporting any changes to
2081the "MD [medical doctor] & supervisor ASAP [as soon as
2091possible]."
209211. Patient 5 did not receive skilled nursing visits during
2102the weeks of December 19 or 26, 2010. During the following
2113skilled nursing visits, patient 5 did not receive wound care
2123treatment: December 13, 2010, and January 6, 13, 18, and 21,
21342011.
213512. Additionally the HHC/POC called for a PT to evaluate
2145and treat patient 5. There were orders that the PT was to
2157administer therapeutic home care exercises in order to increase
2166patient 5's functional abilities. Patient 5 did not have the
2176physical therapy evaluation or treatment as directed. There was
2185no PT evaluation or treatment documentation for patient 5, and
2195there was no documentation that the MD or supervisor was notified
2206that the treatments did not take place.
221313. Following the review of the documentation provided,
2221Ms. Peabody afforded Faith Home the opportunity to provide any
2231additional documentation they had with respect to the care and
2241treatment provided to patient 5. No additional documentation was
2250forthcoming to the surveyors.
225414. Ms. Eubanks contended that patient 5 was seen by a
2265nurse during the week of December 18, 2010. She testified that
2276there was no wound care treatment necessary for patient 5 because
2287the wound had healed. Ms. Eubanks "believe[d]" the wound had
2297resolved by December 9, 2010, and that no PT was ordered because
2309patient 5 was still "refusing it." Ms. Eubanks also testified
2319that no wound care treatment was required because it was not on
2331the OASIS data collection sheet. Ms. Eubanks's testimony is not
2341credible as the HHC/POC is clear as to the physician's order
2352regarding patient 5's toe wound care and the PT evaluation and
2363treatment. The OASIS data form may be the methodology "to track
2374your [Faith Home] benchmarks and your progression to see how you
2385rank" among other home health agencies, but it does not take the
2397place of a HHC/POC executed by a physician. Further, although a
2408patient always has the right to decline a health care service,
2419that response does not preclude the physician from ordering the
2429particular care to be provided.
243415. Based on the violations observed and documented during
2443the February 2011 survey, Ms. Miller went back to Faith Home in
2455June 2011 to follow up on the areas of concern. Ms. Miller
2467reviewed five patients at the June 2011 revisit, one of whom was
2479part of the February 2011 survey, patient 5. 3/
248816. Patient 5J's HHC/POC, signed on April 16, 2011, ordered
2498skilled nursing visits to occur one to two times a week for nine
2511weeks. According to the HHC/POC, at each visit, the skilled
2521nurse was to perform various treatments with respect to
2530patient 5J's multiple medical issues. The HHC/POC included an
2539assessment of patient 5J's vital signs including the endocrine,
2548cardiac, and neuro, with instructions regarding the disease
2556process and management; fall prevention; diet and nutrition; and
2565skin, nail, and foot care. It also included an order to report
"2577any changes or concerns to [the] MD & supervisor ASAP."
258717. This April 16, 2011, HHC/POC also ordered a home health
2598aide (HHA) to provide services two to three times a week for nine
2611weeks for patient 5J. The HHA was to assist patient 5J with the
2624activities of daily living (ADL).
262918. During the follow-up survey, Ms. Miller was unable to
2639find documentation of any nurse's treatment for patient 5J during
2649three of the nine-week certification period. The skilled nursing
2658visit notes on April 21 and May 5, 2011, failed to reflect any
2671assessment of patient 5J's vital signs, including the
2679cardiovascular system. The lines drawn through certain boxes do
2688not indicate review or assessment of patient 5J.
269619. Further, there was no evidence of any HHA visits during
2707the seventh week through the ninth week of the certification
2717period for patient 5J. This totaled six missed HHA visits for
2728patient 5J.
273020. With respect to patient 7, the HHC/POC, with a SOC
2741date of December 18, 2010, ordered a PT to evaluate and treat
2753patient 7. The PT was to administer a therapeutic home care
2764exercise program to patient 7 to increase strengthening. 4/ The
2774HHC/POC also ordered the skilled nurse to "report any changes and
2785or concerns to the MD & RN ASAP."
279321. Patient 7 did not receive the physical therapy
2802evaluation until December 29, 2010, 11 days after it was ordered.
2813The PT's care plan for patient 7 involved physical therapy two
2824times a week for three weeks. At the time of the FH survey,
2837there was no documentation that the physician was notified of the
2848delay or the reason for the delay in performing the PT evaluation
2860on patient 7.
286322. Ms. Eubanks provided a "Communication/Status Report"
2870(C/SR) pertaining to patient 7, dated January 3, 2011. Although
2880this C/SR purports to put Faith Home services (including the PT)
2891on hold until the patient returns from being with the "daughter
2902and family for a couple of weeks," it is at odds with the
2915credible evidence presented by AHCA. The physical therapy
2923documentation reflects that patient 7 was provided PT services
2932twice during the week of January 9, 2011, just one week after
2944Faith Home was "notified" the patient would be gone "for a couple
2956of weeks." Additional physical therapy documentation reflects
2963that service was also provided twice during the week of
2973January 17, 2011. 5/
297723. Ms. Eubanks's contention that this C/SR was faxed to
2987patient 7's physician to notify him/her of the change in plans is
2999not credible. There was no testimony or documentation of the
3009physician's actual fax number or the actual number to which this
3020C/SR was purportedly faxed, nor did the person who actually faxed
3031the C/SR testify.
303424. Patient 11's HHC/POC, signed December 15, 2010, ordered
3043skilled nursing care two to three times a week for nine weeks.
3055At the end of the HHC/POC orders, there is an order to "Report
3068any changes and or concerns to MD & supervisor ASAP." Although
3079it is noted on the HHC/POC that the "Certification period [was]
3090extended due to [a] procedure on [the] left second toe," there
3101was no actual doctor's order to provide wound care to
3111patient 11's left second toe. There is, however, a "60 Day
3122Summary" notation which states:
3126Wound to [the] right great toe healed without
3134complication. Skilled nurse currently caring
3139for left second toe. No S&S of infection
3147noted. Blood pressure and blood sugar has
3154remained stable through out [sic].
3159This summary statement is not an order for care to patient 11's
3171left second toe.
317425. When a nurse observes a new wound in need of care, the
3187nurse should immediately document the toe wound and contact the
3197physician. The burden then falls to the physician to decide
3207what, if any, order is appropriate for the wound care. This
3218recording/reporting process was not followed, and there was no
3227documentation of patient 11's wound to the left second toe.
3237However, the skilled nursing visits record that wound care was
3247provided to patient 11's left second toe.
325426. Ms. Eubanks testified that patient 11's podiatrist,
3262Dr. Rappaport, wrote an order to discontinue wound care to the
3273right great toe because it had healed. Other than the 60-day
3284summary note found in the HHC/POC signed December 15, 2010, there
3295was no order signed by Dr. Rappaport that discontinued care to
3306the right great toe, and no order for care to patient 11's left
3319second toe was introduced at hearing. Although Ms. Eubanks
3328testified that patient 11 had the left second toe nail bed
3339removed, she never testified that she was present when that nail
3350bed was removed or that she was the attending skilled nurse who
3362provided the post nail bed removal care. Her testimony is at
3373odds with the credible evidence presented by AHCA.
338127. Patient 13's HHC/POC, with a SOC date of December 21,
33922010, ordered skilled nursing care one to two times a week for
3404six weeks with specific skilled nursing tasks to be performed.
3414There was no documentation that a skilled nurse provided care
3424during the weeks of December 26, 2010, or January 9, 2011.
343528. Patient 13's HHC/POC also ordered a physical therapy
3444evaluation. As part of the HHC/POC, the PT was to administer
3455therapeutic home care exercises to increase functional strength,
3463range of motion (ROM), balance and endurance, and transfers and
3473to report "any changes and or concerns to [the] MD & RN CM [case
3487manager] ASAP."
348929. Patient 13's physical therapy evaluation was not
3497conducted until January 5, 2011, roughly two weeks after it was
3508ordered. The physical therapy care plan directed that patient 13
3518was to be seen two times a week for the first week and three
3532times a week for the next four weeks. Although there are "missed
3544visit reports" that document a PT's attempt to see the patient on
3556six different January 2011 dates, there is no credible evidence
3566that patient 13's physician was notified of those six missed
3576visits as soon as possible.
358130. Ms. Eubanks points to a January 24, 2011, C/S Report
3592(January note) for the reason the PT missed the visits with
3603patient 13. This January note reflects that patient 13 had gone
3614to Georgia to be with her daughter and would return the end of
3627January 2011 or the first Tuesday in February. This January note
3638prompts more questions than answers because it does not reflect
3648exactly when patient 13 went to Georgia and only asks that the
"3660nursing services" not the physical therapy services be held
3669until patient 13's return.
367331. The missed visit reports indicate that a PT went to the
3685residence and knocked on patient 13's door, but no one came to
3697the door. Although the missed visit reports provide space for
3707the patient's name (appropriately redacted), the date (of
3715service), the discipline (in this case "PT" was checked), the
3725reason (for the missed service; in this case phrases to the
3736effect: drove by, no one answered door, etc.), and who completed
3747the missed visit report (the PT's signature is illegible), none
3757of these missed visit reports have a checkmark (or any
3767indication) next to the "Y," which signifies that the physician
3777was notified. Ms. Eubanks's posturing that these missed visit
3786reports were left in an inbox at a public housing building
3797facility so that the physician was notified is not credible.
380732. Ms. Eubanks also testified that patient 13 did not have
3818a telephone, and "so there was no other way to contact [her] but
3831actual face to face." This statement is in direct contradiction
3841to Faith Home's policy that a client must have a telephone or
3853that a phone be close by for communication purposes.
386233. Further, there was evidence that two skilled nursing
3871visits took place: one on January 26, 2011, and the other on
3883January 29, 2011, just two and five days, respectively, after the
3894January note stating patient 13 would be gone until the end of
3906January or the first of February.
391234. Patient 2's HHC/POC, signed September 13, 2010, ordered
3921skilled nursing visits to occur up to seven days a week, and the
3934nurse was to provide a complete assessment with each shift.
3944According to the HHC/POC, the skilled nurse was to, among other
3955things, monitor patient 2's GI status and provide G-tube care
3965every shift, weigh the child weekly on Mondays when scales became
3976available, and document it in the mom's notebook. Based on
3986patient 2's condition, care had to be taken that the patient did
3998not become dehydrated or lose a lot of weight. There was no
4010documentation of patient 2's weight being recorded by the
4019Faith Home skilled nurses during the scheduled Monday visits.
4028Patient 2's records provided to the surveyors during the
4037February 2011 FH survey failed to reflect documentation as to any
4048G-tube care being provided on every shift.
405535. Ms. Eubanks testified that patient 2 was weighed weekly
4065at his school. Based on the phrase in the HHC/POC "when a scale
4078becomes available," Faith Home took the position it was not
4088obligated to secure a scale to ensure it weighed the patient per
4100the HHC/POC. Rather, Faith Home unilaterally decided that,
4108because the Department of Children and Families (DCF) was having
4118patient 2 weighed weekly at school, Faith Home was meeting its
4129obligation. However, this position flies in the face of the
4139physician's order for patient 2. Patient 2's record does not
4149reflect where patient 2's weight was being recorded, either at
4159home or school, nor does it reflect that the physician was being
4171made aware of patient 2's weight on a regular basis. Faith Home
4183did not document the lack of a scale, did not inform the
4195physician that the weight was being monitored by DCF at
4205patient 2's school and did not ensure that the physician was
4216aware of patient 2's weekly weight status.
422336. Patient 3's HHC/POC, signed November 30, 2011, ordered
4232an RN to be present 20 hours a day up to seven days per week.
4247Additionally, the skilled nurse was to assess the patient and
4257perform other specific care. One specific task was for
4266patient 3's tracheotomy care to be performed twice a day and as
4278needed. 7/ Documentation for patient 3 failed to reflect the
4288tracheotomy care twice a day or as needed between December 20,
42992010, and January 22, 2011.
430437. Ms. Eubanks testified to patient 3's medical
4312circumstances. Although Ms. Eubanks understood that AHCA's
4319surveyors had patient 3's pediatric notes, she only pulled
"4328random notes" for the "period because they had already copied
4338everything that they wanted to take." Of Faith Home's documents
4348that she discussed, Ms. Eubanks only presented two dates (out of
4359the 34 days alleged in the AAC) that recorded some type of
4371tracheotomy care for patient 3. Hence, her testimony lacks
4380credibility in light of the overwhelming evidence AHCA provided.
438938. Patient 6's HHC/POC for the certification period of
4398October 14, 2010, to December 12, 2010, ordered skilled nursing
4408care three to four times a week for nine weeks and also provided
4421for specific disciplines and treatments to be performed. There
4430was evidence that a skilled nurse provided one visit to patient 6
4442on October 15, 2010; yet, there was no evidence that a skilled
4454nurse provided the minimum number of visits to patient 6 during
4465the remainder of the nine-week certification period. It was
4474noted that two skilled nursing visits were made during the week
4485of November 14, 2010. However, the HHC/POC ordered a minimum of
4496three, up to four skilled nursing visits to be made.
450639. Patient 6's HHC/POC also ordered HHA services to be
4516provided two to three times a week for nine weeks. The HHA was
4529to assist patient 6 with ADLs. The HHA failed to provide
4540patient 6 the minimum number of visits during weeks one, two, or
4552three of the certification period.
455740. Ms. Eubanks testified that Faith Home could not provide
4567services to patient 6 after October 14, 2010, as patient 6 was
4579admitted to a local hospital. Further, Ms. Eubanks testified
4588that the HHA documentation "has to be incorrect," although she
4598also testified that the Faith Home documents were "true. There
4608has been an error." 8/ Ms. Eubanks's testimony is at odds with the
4621credible evidence presented by AHCA.
462641. Patient 14's HHC/POC dated January 20, 2011, ordered
4635skilled nursing services to be provided one to two times a week
4647for four weeks then every other week (EOW) for nine weeks. The
4659HHC/POC also ordered that a HHA was to assist patient 14 with
4671ADLs, a PT was to evaluate and treat patient 14, a speech
4683therapist was to evaluate and treat patient 14, and an
4693occupational therapist was to evaluate and treat patient 14. On
4703January 25, 2011, patient 14's medical doctor again ordered the
4713physical therapy and directed the HHA to provide services three
4723times a week for nine weeks.
472942. The evidence regarding patient 14 documented two
4737skilled nursing visits missed during the first two weeks of the
4748certification period (January 16, 2011, to March 16, 2011), and
4758there was no evidence of any HHA service visits for the first two
4771weeks of patient 14's certification period. Additionally,
4778patient 14 did not receive three physical therapy visits.
478743. Ms. Eubanks testified that patient 14 was in an adult
4798day care setting and that Faith Home missed no less than four
4810skilled nursing visits. The "Missed Visit" reports (MVR)
4818provided by Faith Home purport that patient 14 was in an adult
4830day care setting; yet, that same MVR documentation fails to
4840record that patient 14's physician was notified of the lack of
4851services being provided. Further, the MVR dated (Wednesday)
4859January 26, 2011, reflects that patient 14's daughter "made
4868arrangements to have [patient 14] home next on Thursday by 3 p.m.
4880Understands nurse do [sic] not go to day care." This MVP
4891reflects that the date of the next Faith Home service visit will
4903be February 4, 2011, a Friday, not a Thursday.
491244. Also, within the material provided by Faith Home, there
4922is a C/SR dated January 20, 2011. That C/SR records that
4933patient 14 is "requesting a hold on home health aide visit.
4944Daughter will be able to provide service for the next few weeks."
4956Yet, there is also a HHA note dated January 22 or 23, 2011, 9/
4970detailing HHA services provided to patient 14 on that date. The
4981inconsistencies in Faith Home's documentation presented during
4988the hearing are damaging to its credibility as a whole.
499845. Patient 15's HHC/POC, dated December 15, 2010, ordered
5007skilled nursing services to be provided two to three times a week
5019for nine weeks. As part of the skilled nursing services,
5029patient 15 was to have her vital signs assessed along with other
5041specific assessments. The HHC/POC also contained an order to
"5050Report any changes or concerns to [the] MD & supervisor ASAP."
506146. The evidence presented regarding the skilled nursing
5069visits for November 3 and 5, 2010, failed to reflect patient 15's
5081neurological assessments or any observations by the nurse and
5090also failed to provide the "nursing diagnosis/problem." Other
5098portions to these specific records contain words or phrases to
5108provide information, a number with a percentage sign, a zero (Ø),
5119or simple checkmarks indicating a system was observed or treated.
5129These written words or markings provide clarity to patient 15's
5139completed assessments or status. Patient 15's skilled nursing
5147records for December 29 and 31, 2010, and January 2, 12, and 14,
51602011, failed to document one or more of the patient's systems:
5171cardiovascular, genitourinary, neurological, or musculoskeletal.
517647. Ms. Eubanks testified that certain portions of
5184patient 15's skilled nursing notes were completed using a method
5194called "charting by exception." According to this method, when
5203the professional leaves an area of the chart blank, it indicates
5214that nothing is wrong with the patient. A review of patient 15's
5226skilled nursing notes simply does not support the use of this
5237methodology. Specifically as an example, on the November 5,
52462010, skilled nursing visit note, nothing is checked or notated
5256in the neuro-sensory section; yet, at the "PAIN" section, there
5266is a "Ø" marked through all five lines. If the "charting by
5278exception" method was being used, this area should have been left
5289blank as there was no pain. It is impossible to determine when
5301charting by exception is in place when one area of a record has
5314check marks or specific notations regarding an assessment or
5323status and another section (or sections) is left blank even
5333though the HHC/POC specifically ordered that assessment. There
5341is no base line by which the next skilled nurse would know if
5354there had been a change in patient 15's assessment or status such
5366that her attending physician or the supervisor should be
5375appropriately notified. Ms. Eubanks's testimony is not credible
5383in light of the evidence presented by AHCA.
5391The June 2011 Follow up Survey
539748. Both parties presented medical records for Patient 2J.
5406Patient 2J's two HHC/POCs appear to be identical in scope; yet,
5417one was signed on April 25, 2011, while the other was signed on
5430April 27, 2011. Within the HHC/POCs, the doctor ordered skilled
5440nursing services to be provided once in the first week, then one
5452to two times a week for eight weeks. As part of the skilled
5465nursing services, patient 2J was to have her vital signs assessed
5476and other specific assessments completed.
548149. The HHC/POCs also ordered a PT to evaluate and treat
5492patient 2J.
549450. Ms. Eubanks testified that the PT evaluation was
5503ordered on April 8, 2011, when it "came upon [sic] assessment."
5514However, the HHC/POCs ordering the PT evaluation were not signed
5524until April 25 or April 27, 2011. Patient 2J's actual physical
5535therapy evaluation occurred on April 21, 2011, either four or six
5546days before it was ordered. Faith Home either delayed 13 days in
5558having the physical therapy evaluation completed, or Faith Home
5567obtained a physical therapy evaluation prior to having a
5576physician's order to provide the service. In either instance,
5585Faith Home did not follow its own policies for providing
5595services.
559651. Although the PT created a care plan for patient 2J,
5607there is no physician's order directing the physical therapy care
5617plan be used. Further, the physical therapy services were
5626actually performed by a physical therapist assistant (PTA) and
5635provided to patient 2J during weeks four, five, six, and seven of
5647the certification period. An extra PTA visit was noted in week
5658seven. Again, Faith Home provided services that were not in
5668compliance with their own policies.
567352. Patient 3J had an April 5, 2011, order for physical
5684therapy to be provided three times a week for six weeks based on
5697her gait instability, her osteoarthritis in her knees, and her
5707degenerative spinal joint disease. There was no evidence of any
5717physical therapy being provided to patient 3J during the
5726applicable certification period.
572953. Ms. Eubanks testified that patient 3J's actual care
5738started in February 2011, despite the HHC/POC documentation that
5747it started on March 24, 2011. Ms. Eubanks blamed a nursing
5758supervisor for the wrong start date (March 24, 2011) and
5768confirmed that the difference in start dates would make a
5778difference in the dates of Faith Home services. Even if one were
5790to accept the February 2011, order for physical therapy services,
5800that order is incomplete because it fails to enumerate how many
5811times a week and how many weeks the physical therapy services
5822were needed. It is an incomplete order. Ms. Eubanks's testimony
5832is not credible in light of the evidence presented by AHCA.
584354 . Patient 4J's HHC/POC contained a SOC date of April 8,
58552011. Therein it ordered skilled nursing services to be provided
5865two to three times a week for nine weeks. As part of the skilled
5879nursing services, patient 4J was to have her vital signs assessed
5890along with other specific assessments. Additionally, the HHC/POC
5898contained an order for a PT to evaluate and treat.
590855. Ms. Miller was unable to locate any documentation of
5918home health services provided to patient 4J after May 5, 2011
5929(four missed visits), and there was no evidence that any physical
5940therapy services were provided to patient 4J.
594756. Ms. Eubanks testified that patient 4J was in the
5957hospital when Faith Home services were not provided to
5966patient 4J. Although Ms. Eubanks relied on a discharge
5975instruction sheet to make the claim, there is no date on the
5987discharge instruction sheet, and no one testified as to the exact
5998date that patient 4J was admitted to or discharged from the
6009hospital. Ms. Eubanks's testimony is not credible as it relied
6019on an undated discharge instruction sheet.
602557. Further, although the physical therapy referral for
6033patient 4J was faxed to the physical therapy agency, that agency
6044never received the referral and never provided the service.
6053Faith Home failed to have a system in place to ensure services
6065ordered by the physician were obtained.
607158. Ms. Okpaleke, as the owner of Faith Home, engaged an
6082expert to help Faith Home "correct all the cites . . . and
6095implement a plan of correction . . . to make sure that we were in
6110compliance." Ms. Okpaleke terminated the expert's employment
6117after the summer. Ms. Okpaleke then started monitoring Faith
6126Home's practices and ensured that Faith Home returned to
6135compliance with AHCA's regulations.
613959. Ms. Miller's salary at the time of the FH survey was
6151$20.15. Ms. Miller expended approximately 30 hours in conducting
6160the recertification survey of Faith Home. Based on her rate of
6171pay, AHCA expended $1,370.20 for Ms. Miller's services.
618060. Ms. Peabody's salary while employed by AHCA during the
6190FH survey was $21.07 an hour. Ms. Peabody expended approximately
620042 hours preparing for, conducting, and completing the FH survey.
6210Based on her rate of pay, AHCA expended $1,048.23 for
6221Ms. Peabody's services.
622461. Mr. Bronson Sievers is the health facility evaluator
6233supervisor for AHCA. His salary is $19.87 an hour. Mr. Sievers
6244expended approximately ten hours reviewing the statement of
6252deficiencies to determine if the appropriate citations had been
6261used and the appropriate penalty assessed. Based on his rate of
6272pay, AHCA expended $198.70 for Mr. Sieivers services.
628062. Mr. Sievers responsibility included the supervision of
6288several AHCA programs and included the home health agencies.
6297Mr. Sievers determined that the repeated violation warranted a
6306Class III violation, which resulted in a $1,000.00 fine because
6317it may affect the clients' well-being and health.
632563. Mr. Sievers provided AHCA's interpretation of the fine
6334imposed when a home health agency demonstrates a pattern of
6344failing to provide the specified services to its clients or
6354patients.
6355CONCLUSIONS OF LAW
635864. The Division of Administrative Hearings has
6365jurisdiction over the parties and subject matter of this
6374proceeding. §§ 120.569 and 120.57(1), Fla. Stat. (2011). 10/
638365. In the instant case, AHCA has the burden of proving by
6395clear and convincing evidence that Faith Home committed the
6404violations as alleged, and, if there are violations, the
6413appropriateness of any fine resulting from the alleged
6421violations. Dep't of Banking & Fin., Div. of Securities &
6431Investor Prot. v. Osborne, Stern & Co. , 670 So. 2d 932 (Fla.
64431996).
644466. In Slomowitz v. Walker , 429 So. 2d 797, 800 (Fla. 4th
6456DCA 1983), the court held that:
6462Clear and convincing evidence requires that
6468the evidence must be found to be credible;
6476the facts to which the witnesses testify must
6484be precise and explicit and the witnesses
6491must be lacking in confusion as to the facts
6500in issue. The evidence must be of such
6508weight that it produces in the mind of the
6517trier of fact a firm belief or conviction,
6525without hesitancy, as to the truth of the
6533allegations sought to be established.
653867. Section 400.462, Florida Statutes, provides in
6545pertinent part certain definitions as follows:
6551(12) "Home health agency" means an
6557organization that provides home health
6562services and staffing services.
6566* * *
6569(14) "Home health services" means health and
6576medical services and medical supplies
6581furnished by an organization to an individual
6588in the individual's home or place of
6595residence. The term includes organizations
6600that provide one or more of the following:
6608(a) Nursing care.
6611(b) Physical, occupational, respiratory, or
6616speech therapy.
6618(c) Home health aide services.
6623(d) Dietetics and nutrition practice and
6629nutrition counseling.
6631(e) Medical supplies, restricted to drugs
6637and biologicals prescribed by a physician.
6643(15) "Home health aide" means a person who is
6652trained or qualified, as provided by rule,
6659and who provides hands-on personal care,
6665performs simple procedures as an extension of
6672therapy or nursing services, assists in
6678ambulation or exercises, or assists in
6684administering medications as permitted in
6689rule and for which the person has received
6697training established by the agency under s.
6704400.497 (1).
6706* * *
6709(22) "Organization" means a corporation,
6714government or governmental subdivision or
6719agency, partnership or association, or any
6725other legal or commercial entity, any of
6732which involve more than one health care
6739professional discipline; a health care
6744professional and a home health aide or
6751certified nursing assistant; more than one
6757home health aide; more than one certified
6764nursing assistant; or a home health aide and
6772a certified nursing assistant. The term does
6779not include an entity that provides services
6786using only volunteers or only individuals
6792related by blood or marriage to the patient
6800or client.
6802(23) "Patient" means any person who receives
6809home health services in his or her home or
6818place of residence.
6821* * *
6824(25) "Physician" means a person licensed
6830under chapter 458, chapter 459, chapter 460,
6837or chapter 461.
6840* * *
6843(28) "Skilled care" means nursing services
6849or therapeutic services required by law to be
6857delivered by a health care professional who
6864is licensed under part I of chapter 464; part
6873I, part III, or part V of chapter 468; or
6883chapter 486 and who is employed by or under
6892contract with a licensed home health agency
6899or is referred by a licensed nurse registry.
6907(29) "Staffing services" means services
6912provided to a health care facility, school,
6919or other business entity on a temporary or
6927school-year basis pursuant to a written
6933contract by licensed health care personnel
6939and by certified nursing assistants and home
6946health aides who are employed by, or work
6954under the auspices of, a licensed home health
6962agency or who are registered with a licensed
6970nurse registry.
697268. Section 400.464 provides in pertinent part:
6979(1) The requirements of part II of
6986chapter 408 apply to the provision of
6993services that require licensure pursuant to
6999this part and part II of chapter 408 and
7008entities licensed or registered by or
7014applying for such licensure or registration
7020from the Agency for Health Care
7026Administration pursuant to this part. A
7032license issued by the agency is required in
7040order to operate a home health agency in this
7049state
705069. Section 400.474 provides in pertinent part:
7057(1) The agency may deny, revoke, and suspend
7065a license and impose an administrative fine
7072in the manner provided in chapter 120.
7079(2) Any of the following actions by a home
7088health agency or its employee is grounds for
7096disciplinary action by the agency:
7101(a) Violation of this part, part II of
7109chapter 408, or of applicable rules.
7115(b) An intentional, reckless, or negligent
7121act that materially affects the health or
7128safety of a patient.
7132* * *
7135(d) Preparing or maintaining fraudulent
7140patient records, such as, but not limited to,
7148charting ahead, recording vital signs or
7154symptoms that were not personally obtained or
7161observed by the home health agency's staff at
7169the time indicated, borrowing patients or
7175patient records from other home health
7181agencies to pass a survey or inspection, or
7189falsifying signatures.
7191* * *
7194(5) The agency shall impose a fine of $5,000
7204against a home health agency that
7210demonstrates a pattern of failing to provide
7217a service specified in the home health
7224agency's written agreement with a patient or
7231the patient's legal representative, or the
7237plan of care for that patient, unless a
7245reduction in service is mandated by Medicare,
7252Medicaid, or a state program or as provided
7260in s. 400.492 (3). A pattern may be
7268demonstrated by a showing of at least three
7276incidences, regardless of the patient or
7282service , where the home health agency did not
7290provide a service specified in a written
7297agreement or plan of care during a 3-month
7305period. The agency shall impose the fine for
7313each occurrence. The agency may also impose
7320additional administrative fines under
7324s. 400.484 for the direct or indirect harm to
7333a patient, or deny, revoke, or suspend the
7341license of the home health agency for a
7349pattern of failing to provide a service
7356specified in the home health agency's written
7363agreement with a patient or the plan of care
7372for that patient . (emphasis added).
737870. Section 400.484 provides:
7382(1) In addition to the requirements of
7389s. 408.811 , the agency may make such
7396inspections and investigations as are
7401necessary in order to determine the state of
7409compliance with this part, part II of
7416chapter 408, and applicable rules.
7421(2) The agency shall impose fines for
7428various classes of deficiencies in accordance
7434with the following schedule:
7438(a) A class I deficiency is any act,
7446omission, or practice that results in a
7453patient's death, disablement, or permanent
7458injury, or places a patient at imminent risk
7466of death, disablement, or permanent injury.
7472Upon finding a class I deficiency, the agency
7480shall impose an administrative fine in the
7487amount of $15,000 for each occurrence and
7495each day that the deficiency exists.
7501(b) A class II deficiency is any act,
7509omission, or practice that has a direct
7516adverse effect on the health, safety, or
7523security of a patient. Upon finding a class
7531II deficiency, the agency shall impose an
7538administrative fine in the amount of $5,000
7546for each occurrence and each day that the
7554deficiency exists.
7556(c) A class III deficiency is any act,
7564omission, or practice that has an indirect,
7571adverse effect on the health, safety, or
7578security of a patient. Upon finding an
7585uncorrected or repeated class III deficiency,
7591the agency shall impose an administrative
7597fine not to exceed $1,000 for each occurrence
7606and each day that the uncorrected or repeated
7614deficiency exists.
7616(d) A class IV deficiency is any act,
7624omission, or practice related to required
7630reports, forms, or documents which does not
7637have the potential of negatively affecting
7643patients. These violations are of a type
7650that the agency determines do not threaten
7657the health, safety, or security of patients.
7664Upon finding an uncorrected or repeated class
7671IV deficiency, the agency shall impose an
7678administrative fine not to exceed $500 for
7685each occurrence and each day that the
7692uncorrected or repeated deficiency exists.
7697(3) In addition to any other penalties
7704imposed pursuant to this section or part, the
7712agency may assess costs related to an
7719investigation that results in a successful
7725prosecution, excluding costs associated with
7730an attorney's time.
773371. Section 400.487 provides in pertinent part:
7740(2) When required by the provisions of
7747chapter 464; part I, part III, or part V of
7757chapter 468; or chapter 486, the attending
7764physician, physician assistant, or advanced
7769registered nurse practitioner, acting within
7774his or her respective scope of practice,
7781shall establish treatment orders for a
7787patient who is to receive skilled care. The
7795treatment orders must be signed by the
7802physician, physician assistant, or advanced
7807registered nurse practitioner before a claim
7813for payment for the skilled services is
7820submitted by the home health agency. If the
7828claim is submitted to a managed care
7835organization, the treatment orders must be
7841signed within the time allowed under the
7848provider agreement. The treatment orders
7853shall be reviewed, as frequently as the
7860patient's illness requires, by the physician,
7866physician assistant, or advanced registered
7871nurse practitioner in consultation with the
7877home health agency.
7880* * *
7883(4) Each patient has the right to be
7891informed of and to participate in the
7898planning of his or her care. Each patient
7906must be provided, upon request, a copy of the
7915plan of care established and maintained for
7922that patient by the home health agency.
7929(5) When nursing services are ordered, the
7936home health agency to which a patient has
7944been admitted for care must provide the
7951initial admission visit, all service
7956evaluation visits, and the discharge visit by
7963a direct employee. Services provided by
7969others under contractual arrangements to a
7975home health agency must be monitored and
7982managed by the admitting home health agency.
7989The admitting home health agency is fully
7996responsible for ensuring that all care
8002provided through its employees or contract
8008staff is delivered in accordance with this
8015part and applicable rules.
8019(6) The skilled care services provided by a
8027home health agency, directly or under
8033contract, must be supervised and coordinated
8039in accordance with the plan of care .
804772. Florida Administrative Code Rule 59A-8.0215 provides:
8054(1) A plan of care shall be established in
8063consultation with the physician, physician
8068assistant, or advanced registered nurse
8073practitioner, pursuant to Section 400.487,
8078F.S., and the home health agency staff who
8086are involved in providing the care and
8093services required to carry out the physician,
8100physician assistant, or advanced registered
8105nurse practitioner's treatment orders. The
8110plan must be included in the clinical record
8118and available for review by all staff
8125involved in providing care to the patient.
8132The plan of care shall contain a list of
8141individualized specific goals for each
8146skilled discipline that provides patient
8151care, with implementation plans addressing
8156the level of staff who will provide care, the
8165frequency of home visits to provide direct
8172care and case management.
8176(2) Home health agency staff must follow the
8184physician, physician assistant, or advanced
8189registered nurse practitioner's treatment
8193orders that are contained in the plan of
8201care. If the orders cannot be followed and
8209must be altered in some way, the patient's
8217physician, physician assistant, or advanced
8222registered nurse practitioner must be
8227notified and must approve of the change. Any
8235verbal changes are put in writing and signed
8243and dated with the date of receipt by the
8252nurse or therapist who talked with the
8259physician, physician assistant, or advanced
8264registered nurse practitioner's office.
8268(3) The patient, caregiver or guardian must
8275be informed by the home health agency
8282personnel that:
8284(a) He has the right to be informed of
8293the plan of care;
8297(b) He has the right to participate in
8305the development of the plan of care;
8312and
8313(c) He may have a copy of the plan if
8323requested.
832473. Rule 59A-8.003 provides in pertinent part:
8331(5) In addition to any other penalties
8338imposed pursuant to this rule, the agency may
8346assess costs related to an investigation that
8353results in a successful prosecution, pursuant
8359to Section 400.484(3), F.S. The prosecution
8365can be resolved by stipulation settlement or
8372final hearing. The following costs may
8378apply: travel costs related to the
8384investigation; investigative time by AHCA's
8389surveyor or surveyors including travel time;
8395processing time by AHCA's professional staff
8401and administrative support staff of Field
8407Operations, and processing time for
8412administrative support staff and professional
8417staff of the AHCA Licensed Home Health
8424Programs Unit in Tallahassee. The costs
8430related to AHCA's professional staff and
8436support staff will be determined according to
8443the hourly rate of pay for those positions.
845174. AHCA has established by clear and convincing evidence
8460that Faith Home has failed to assure that the plan of care was
8473followed for various patients in its care and/or that Faith Home
8484has failed to implement the plan of care for various patients in
8496its care.
849875. The evidence was overwhelming that Faith Home failed to
8508provide services to patients as enumerated above by: failing to
8518provide skilled nursing visits as ordered; failing to provide
8527home health aide services as ordered; failing to provide timely
8537physical therapy evaluations and/or treatments as ordered;
8544failing to notify physicians when treatment plans were altered or
8554changed unilaterally; and/or failing to record specific
8561assessments or observations as ordered for various patients.
856976. AHCA has established, by clear and convincing evidence,
8578that Faith Home has demonstrated patterns of failures to provide
8588a service specified in the home health agency's written agreement
8598with a patient or the patient's legal representative, or the plan
8609of care for that patient, in that Faith Home failed to provide
8621home health services visits as ordered in various patient's plan
8631of care. This pattern was first demonstrated during the February
86412011 AHCA survey and was also found during the June 2011 AHCA
8653survey re-visit. The fine specified in section 400.474(5) is
8662appropriate.
866377. Faith Home has committed a Class III violation.
8672RECOMMENDATION
8673Based on the foregoing Findings of Fact and Conclusions of
8683Law, it is RECOMMENDED that Petitioner, Agency for Health Care
8693Administration, enter a final order finding that Faith Home:
87021. Violated section 400.484 by committing a Class III
8711violation as identified during the February 2011 survey and found
8721again during the June 2011 survey and imposing an $1,000.00
8732administrative fine;
87342. Violated section 400.474(5) as found in no less than
8744107 instances when Faith Home failed to provide services ordered
8754by an appropriate authority and imposing a $45,000.00
8763administrative fine; and
87663. Pursuant to section 400.484(3), AHCA shall assess and
8775receive $2,617.13 for the investigation costs associated with
8784this case as evidenced by the time expended by the three agency
8796witnesses.
8797DONE AND ENTERED this 19th day of April, 2012, in
8807Tallahassee, Leon County, Florida.
8811S
8812LYNNE A. QUIMBY-PENNOCK
8815Administrative Law Judge
8818Division of Administrative Hearings
8822The DeSoto Building
88251230 Apalachee Parkway
8828Tallahassee, Florida 32399-3060
8831(850) 488-9675
8833Fax Filing (850) 921-6847
8837www.doah.state.fl.us
8838Filed with the Clerk of the
8844Division of Administrative Hearings
8848this 19th day of April, 2012.
8854ENDNOTES
88551/ AHCA objected to the last page of Faith Home's Exhibit 6, an
8868undated, unsigned "Discharge Instructions" sheet for patient 14.
8876Although admitted into evidence, this document is not probative.
88852/ Towards the end of 2010, Ms. Okpaleke had a family member who
8898was hospitalized, and Ms. Okpaleke was not in the office on a
8910daily basis, as she was attending to that circumstance.
89193/ In order to keep the June 2011 survey patients distinct from
8931the February 2011 survey patients, there will be the letter "J"
8942attached to each patient involved in the June 2011 survey.
89524/ Although a skilled nursing visit was ordered, that was not
8963within the AAC and will not be discussed.
89715/ It is noted that patient 7 signed the December 29, 2010, PT
8984evaluation and the four PT revisit notes. Documents completed by
8994Faith Home employees reflect that the patient was "unable to
9004see," "unable to sign" or "the patient is blind" in the signature
9016lines relating to services.
90206/ Faith Home's own policy requires that a "Client must have a
9032telephone or use of [a] phone in close distance for emergency
9043situation."
90447/ A tracheotomy is a surgical incision into a patient's trachea
9055(throat) to keep the airway open (sometimes a tube is inserted
9066therein); it helps facilitate breathing.
90718/ Although not part of this AAC, a review of billing issues
9083based on records in error may be appropriate.
90919/ The actual date is illegible; it is either January 22 or 23,
91042011. Either January day would evidence services provided by a
9114HHA. Such services were rendered during the period Faith Home
9124claimed that the daughter would provide the services.
913210/ All future references to Florida Statutes will be to the 2011
9144version, unless otherwise indicated.
9148COPIES FURNISHED:
9150James H. Harris, Esquire
9154Agency for Health Care Administration
9159The Sebring Building, Suite 330D
9164525 Mirror Lake Drive, North
9169St. Petersburg, Florida 33701
9173Thomas W. Caufman, Esquire
9177Tammy Stanton, Esquire
9180Quintairos, Prieto, Wood and Boyer, P.A.
91864905 West Laurel Street
9190Tampa, Florida 33607
9193Elizabeth Dudek, Secretary
9196Agency for Health Care Administration
92012727 Mahan Drive, Mail Stop 1
9207Tallahassee, Florida 32308
9210William H. Roberts, Acting General Counsel
9216Agency for Health Care Administration
92212727 Mahan Drive, Mail Stop 3
9227Tallahassee, Florida 32308
9230Richard J. Shoop, Agency Clerk
9235Agency for Health Care Administration
92402727 Mahan Drive, Mail Stop 3
9246Tallahassee, Florida 32308
9249NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
9255All parties have the right to submit written exceptions within
926515 days from the date of this Recommended Order. Any exceptions
9276to this Recommended Order should be filed with the agency that
9287will issue the Final Order in this case.
- Date
- Proceedings
- PDF:
- Date: 04/19/2012
- Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
- PDF:
- Date: 03/21/2012
- Proceedings: Respondent's Proposed Findings of Fact and Conclusions of Law filed.
- Date: 02/27/2012
- Proceedings: Respondent's Proposed Exhibits (exhibits not available for viewing)
- Date: 02/21/2012
- Proceedings: Transcript of Proceedings (not available for viewing) filed.
- Date: 02/10/2012
- Proceedings: CASE STATUS: Hearing Held.
- PDF:
- Date: 02/09/2012
- Proceedings: Respondent's Third Notice of Filing Additional Proposed Exhibit (exhibit not available for viewing) filed.
- PDF:
- Date: 01/31/2012
- Proceedings: Notice of Hearing (hearing set for February 10, 2012; 9:00 a.m.; Tampa, FL).
- Date: 01/30/2012
- Proceedings: CASE STATUS: Hearing Partially Held; continued to February 10, 2012; 9:00 a.m.; Tampa, FL.
- PDF:
- Date: 01/30/2012
- Proceedings: Respondent's Second Notice of Filing Additional Proposed Exhibits (exhibits not available for viewing) filed.
- PDF:
- Date: 01/27/2012
- Proceedings: Respondent's Notice of Filing Additional Proposed Exhibits (exhibits not available for viewing) filed.
- Date: 01/26/2012
- Proceedings: Respondent's Notice of Filing Proposed Exhibits (exhibits not available for viewing)
- PDF:
- Date: 01/24/2012
- Proceedings: Notice of Filing Agency's Trial Exhibits (exhibit not available for viewing) filed.
- PDF:
- Date: 01/18/2012
- Proceedings: Order Granting Unopposed Motion to Amend Administrative Complaint.
- PDF:
- Date: 01/13/2012
- Proceedings: Respondent's Supplemental Response to Agency's First Request for Production of Documents filed.
- PDF:
- Date: 12/07/2011
- Proceedings: Notice of Depositions Duces Tecum (of Faith Home Health, Inc.) filed.
- PDF:
- Date: 11/14/2011
- Proceedings: Respondent's Verified Response to Agency's First Set of Interrogatories filed.
- PDF:
- Date: 10/31/2011
- Proceedings: Order Re-scheduling Hearing by Video Teleconference (hearing set for January 30 and 31, 2012; 9:00 a.m.; Tampa and Tallahassee, FL).
- PDF:
- Date: 10/27/2011
- Proceedings: Respondent's Response to Agency's First Request for Production of Documents filed.
- PDF:
- Date: 10/27/2011
- Proceedings: Respondent's Unverified Response to Agency's First Set of Interrogatories filed.
- PDF:
- Date: 10/21/2011
- Proceedings: Order Granting Continuance (parties to advise status by October 31, 2011).
- PDF:
- Date: 10/13/2011
- Proceedings: Respondent's Notice of Filing Responses to Agency's First Request for Admissions filed.
- PDF:
- Date: 09/09/2011
- Proceedings: Notice of Hearing by Video Teleconference (hearing set for November 8 and 9, 2011; 9:00 a.m.; Tampa and Tallahassee, FL).
Case Information
- Judge:
- LYNNE A. QUIMBY-PENNOCK
- Date Filed:
- 09/01/2011
- Date Assignment:
- 09/02/2011
- Last Docket Entry:
- 06/06/2012
- Location:
- Tampa, Florida
- District:
- Middle
- Agency:
- Other
Counsels
-
Thomas W. Caufman, Esquire
Address of Record -
James H. Harris, Esquire
Address of Record -
Peter J. Molinelli, Esquire
Address of Record -
Thomas W Caufman, Esquire
Address of Record