11-004457 Agency For Health Care Administration vs. Faith Home Health, Inc.
 Status: Closed
Recommended Order on Thursday, April 19, 2012.


View Dockets  
Summary: Petitioner established by clear and convincing evidence that Respondent failed to provide home health services in accordance with patients' plan of care. Recommend that administrative fine and cost be imposed.

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 mutually–agreeable 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.

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 06/06/2012
Proceedings: Agency Final Order filed.
PDF:
Date: 06/05/2012
Proceedings: Agency Final Order
PDF:
Date: 04/19/2012
Proceedings: Recommended Order
PDF:
Date: 04/19/2012
Proceedings: Recommended Order (hearing held February 10, 2012). CASE CLOSED.
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.
PDF:
Date: 03/20/2012
Proceedings: Agency's Proposed Recommended Order 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: 01/23/2012
Proceedings: Respondent's Notice of Filing Proposed Exhibits filed.
PDF:
Date: 01/23/2012
Proceedings: Amended Administrative Complaint filed.
PDF:
Date: 01/19/2012
Proceedings: Notice of Filing Agency's (Proposed) Trial Exhibits filed.
PDF:
Date: 01/18/2012
Proceedings: Order Granting Unopposed Motion to Amend Administrative Complaint.
PDF:
Date: 01/18/2012
Proceedings: Pre-hearing Stipulation filed.
PDF:
Date: 01/13/2012
Proceedings: Respondent's Supplemental Response to Agency's First Request for Production of Documents filed.
PDF:
Date: 01/13/2012
Proceedings: Unopposed Motion to Amend Administrative Complaint 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: 10/28/2011
Proceedings: Joint Notice of Available Trial Dates filed.
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: 10/20/2011
Proceedings: Respondent's Motion for Continuance filed.
PDF:
Date: 10/14/2011
Proceedings: Notice of Telephonic Deposition (of J. Peabody) filed.
PDF:
Date: 10/13/2011
Proceedings: Respondent's Notice of Filing Responses to Agency's First Request for Admissions filed.
PDF:
Date: 10/13/2011
Proceedings: Notice of Appearance (Thomas Caufman) filed.
PDF:
Date: 09/09/2011
Proceedings: Order of Pre-hearing Instructions.
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).
PDF:
Date: 09/08/2011
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 09/02/2011
Proceedings: Initial Order.
PDF:
Date: 09/02/2011
Proceedings: Agency's First Request for Production of Documents filed.
PDF:
Date: 09/02/2011
Proceedings: First Request For Admissions filed.
PDF:
Date: 09/02/2011
Proceedings: Notice of Service of Agency's First Set of Interrogatories to Faith Home Health, Inc filed.
PDF:
Date: 09/01/2011
Proceedings: Election of Rights filed.
PDF:
Date: 09/01/2011
Proceedings: Notice (of Agency referral) filed.
PDF:
Date: 09/01/2011
Proceedings: Petition for Formal Administrative Hearing filed.
PDF:
Date: 09/01/2011
Proceedings: Administrative Complaint filed.

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

Related DOAH Cases(s) (1):

Related Florida Statute(s) (10):

Related Florida Rule(s) (2):