08-003693 Tehc, Llc vs. Agency For Health Care Administration Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, August 26, 2008.

I D

STATE OF FLORIDA MICA I V

AGENCY FOR HEALTH CARE ADMINISTRATION t G I i i 1 i CLERI

ZOOq SEP 2lt A 8 II

TEHC LLC

Petitioner

DOAH NO 08 3693

vs AHCA NO 2008007748

STATE OF FLORIDA AGENCY FOR

HEALTH CARE ADMINISTRATION

Respondent

AMENDED FINAL ORDER

Having reviewed the Notice of Intent to Deny the renewal license application for a

home health agency attached hereto and incorporated herein Ex 1 and other matters of

records the Agency for Health Care Administration Agency finds and concludes as

follows

1 By Order dated August 26 2008 the Administrative Law Judge closed its

files in the above styled case Petitioner filed a status report withdrawing the application for

renewal oflicense on August 20 2009 attached hereto and incorporated herein Ex 2

2 The denial of renewal application for a home health agency is deemed moot as

the application has been withdrawn

Upon consideration of the foregoing it is ORDERED that the Agency s file is hereby

closed

DONE and ORDERED at Tallahassee Leon County Florida this y of

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED

TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF

A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA AND A SECOND

COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW WITH THE DISTRICT

COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY

MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES REVIEW

PROCEEDING SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA

APPELLATE RULES THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY

30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED

Copies furnished to

Monica L Rodriguez

Attorney for Petitioner

Dresnick Rodriguez P A

One Datran Center

91 South Dadeland Blvd Suite 1610

Miami Florida 33156

U S Mail

Nelson E Rodney

Assistant General Counsel

Agency for Health Care Administration

8350 NW 52nd Terrace Suite 103

Miami Florida 33166

Interoffice Mail

Home Care Unit

Agency for Health Care Administration

2727 Mahan Drive MS 34

Tallahassee Florida 32308

Interoffice Mail

Stuart M Lerner

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee Florida 32399 3060

U S Mail

J an Mills

Agency for Health Care Administration

2727 Mahan Drive Bldg 3 MS 3

Tallahassee Florida 32308

Interoffice Mail

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true copy of the foregoing was sent to the above named

f

addressees by U S Mail or the method designated on this day of ork 2009

Richard Shoop Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive Building 3

Tallahassee Florida 32308 5403

850 922 5873

2 00 roO 77 iI

IL

r 1 0 I

CHARLIE CRIST HOll Y BE e T 0 4

GOVERNOR v SECRET t

U

June 23 2008 IIi 4

CERTIFIED MAIL I RETIJRN RECEIPT REQUESTED j

t S j f t t

Kelly Marie Damas Administrator Jr r ll e J

TEHC LLC i J License Number 204390961

3317NW 10thTerr Ste404 JL 21U3

Fort Lauderdale FI 33309 f Case 2008007748

l J i tr

N9 j O N O DENY

It is the decision of this Agency that the application for renewal licensure as a home health

agency for TEHC LLC located at 3317 NW lOth Terrace Suite 404 Fort Lauderdale FI

33309 is DENIED

The basis for this action is pursuant to authority of Section 120 60 Florida Statutes F S and

Section 408 815 1 c and d F S which states as follows

I In addition to the grounds provided in authorizing statutes grounds that may be used by the

agency for denying and revoking a license include any of the following actions by a

controlling interest

c A violation of this part authorizing statutes or applicable rules

d A demonstrated pattern of deficient performance

The home health agency did not demonstrate compliance with Chapter 400 Part III F S and the

state home health agency rules Chapter 59A 8 Florida Administrative Code F A c at the

home health agency licensure survey conducted May 5 through May 8 2008 The plan of

correction due June 7 2008 as submitted to the Agency s Field Office was not acceptable Non

compliance was found in the follow g areas

1 The home health agency failed to ensure the Director of Nursing established and

conducted an on going quality assurance program that evaluated the effectiveness of all

the provided service for consistency with professional standards and anticipated

outcomes H 224

The pertinent statutes and rules that apply include the following

59A 8 0095 2 c F A C Director of Nursing

c The director of nursing shall establish and conduct an ongoing quality assurance

program which assures

2727 Mahan Drive MS 34 EXHIBIT VisitAHCA online at

Tallahassee Florida 32308 http ahca myflorida com

I d

Tehc LLC

q Page 2

June23 2008

1 Case assignment and management is appropriate adequate and consistent vlith the

plan of care medical regimen and patient needs

2 Nursing and other services provided to the patient are coordinated appropriate

adequate and consistent with plans of care

3 All services and outcomes are completely and legibly documented dated and signed in

the clinical service record

4 Confidentiality of patient data is maintained and

5 Findings of the quality assurance program are used to improve services

2 The home health agency failed to ensure that the Registered Nurse RN provide case

managementfor 5 of 17 nursing and therapy patients This was evidenced by failure to

provide an assessment prior to documenting a start of care comprehensive assessment for

one patient failure to provide supervision for the Licensed Practical Nurse LPN in the

performance of duties for two patients and failure to assure progress reports were made to

the physician for patients receiving nursing services when the patient s condition changed

for two patients

The pertinent statutes and rules that apply include the following

59A 8 0095 3 a F A C Registered Nurse

a A registered nurse shall be currently licensed in the state pursuant to Chapter 464

F S and

1 Be the case manager in all cases involving nursing or both nursing and therapy care

2 Be responsible for the clinical record for each patient receiving nursing care and

3 Assure that progress reports are made to the physician for patients receiving nursing

services when the patient s condition changes or there are deviations from the plan of

care

3 The home health agency failed to ensure that the RN retained full responsibility for the

care given and making supervisory visits to the patient s home for 3 of 17 sampled

patients as evidenced by failure to provide supervision for the LPN in the performance of

duties for two patients failure to provide supervision for the Home Health Aide Aide

and failed to prepare a written Aide assignment instructions for services to be provided to

the patient for 3 patients H 231

The pertinent statutes and rules that apply include the following

u

59A 8 0095 3 b F A C Registered Nurse

b A registered nurse may assign selected portions of patient care to licensed practical

nurses and home health aides but always retains the full responsibility for the care given

and for making supervisory visits to the patient s home

4 The home health agency failed to provide supervision for the LPN in the perfonnance of

duties for 2 of 17 patients H 235

Tehc LLC

Page 3

une zOO8 25

The pertinent statutes and ndes that apply include the following

59A 8 0095 4 a F A C Licensed Practical Nurse

a A licensed practical nurse shall be currently licensed in the state pursuant to Chapter

464 F S and provide nursing care assigned by and under the direction of a registered

nurse who provides on site supervision as needed based upon the severity of patients

medical condition and the nurse s training and experience Supervisory visits will be

documented in patient files Provision shall be made in agency policies and procedures

for annual evaluation of the LPN s performance of duties by the registered nurse

5 The home health agency failed to ensure the LPN reported any changes in the patient s

condition to the RN and document the changes in the patient s clinical record for 1 of 17

sampled patients H 236

The pertinent statutes and rules that apply include the following

59A 8 0095 4 b F A C Licensed Practical Nurse A licensed practical nurse shall

1 Prepare and record clinical notes for the clinical record

2 Report any changes in the patient s condition to the registered nurse with the reports

documented in the clinical record

3 Provide care to the patient including the administration of treatments and medications

ano

4 Other duties assigned by the registered nurse pursuant to Chapter 464 F S

6 The home health agency failed to ensure that the care provided followed the plan of

treatment for 11 of 17 sampled patients The home health agency also failed to ensure a

verbal order obtained by a home health agency nurse was put into writing and signed by

the attending physician for 1 of 17 sampled patients H 302

The pertinent statutes and rules that apply include the following

Section 400 487 2 F S When required by the provisions of chapter 464 part I part

Ill or part V of chapter 468 or chapter 486 the attending physician physician assistant

or advanced registered nurse practitioner acting within his or her respective scope of

practice shall establish treatment orders for a patient who is to receive skilled care The

treatment orders mustbe signed by the physician physician assistant or advanced

registered nurse practitioner before a claim for payment for the skilled services is

submitted by the home health agency If the claim is submitted to a managed care

organization the treatment orders must be signed within the time allowed under the

provider agreement The treatment orders shall be reviewed as frequently as the patient s

illness requires by the physician physician assistant or advanced registered nurse

practitioner in consultation with the home health agency

Tehc LLC

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1une 23 r2Q O u

o

Chapter 59A 8 0215 2 F A C Home health agency staff must follow the physician

physician assistant or advanced registered nurse practitioner s treatment orders that are

contained in the plan of care If the orders cannot be followed and must be altered in

some way the patient s physician physician assistant or advanced registered nurse

practitioner must be notified and must approve of the change Any verbal changes are put

in writing and signed and dated with the date of receipt by the nurse or therapist who

talked with the physician physician assistant or advanced registered nurse practitioner s

office

7 The home health agency failed to ensure 9 of 17 patients were advised of the payment for

home health agency services before care was started and were clear about the payor

source arid any charges required from the patient H 304

The pertinent statutes and rules that apply include the following

Section 400 487 1 F S Services provided by a home health agency must be covered

by an agreement between the home health agency and the patient or the patient s legal

representative specifying the home health services to be provided the rates or charges for

services paid with private funds and the sources of payment which may include

Medicare Medicaid private insurance personal funds or a combination thereof A home

health agency providing skilled care must make an assessment of the patient s needs

within 48 hours after the start of services

Chapter 59A 8 020 2 F A C At the start of services a home health agency must

establish a written agreement between the agency and the patient or client or the patient s

or client s legal representative including the information described in Section

400 487 1 F S This written agreement must be signed and dated by a representative of

the home health agency and the patient or client or the patient s or client s legal

representative A copy of the agreement must be given to the patient or client and the

original must be placed in the patient s or client s file

Chapter 59A 8 020 3 F A C The written agreement as specified in subsection 2

above shall serve as the home health agency s service provision plan pursuant to Section

400 491 2 F s for clients who receive homemaker and companion services or home

health aide services which do not require a physician physician assistant or advanced

registered nurse practitioner s treatment order The written agreement for these clients

shall be maintained for one year after termination of services

8 The home health agency failed to demonstrate effective communication between

interdisciplinary team members to coordinate services as outlined in the plan of care for 3

of 17 patients and failed to ensure that 8 of 17 sampled patients received the skilled

nursing services in accordance with the physician s written plan of care H 306

The pertinent statutes and rules that apply include the following

Tehc LLC

Page 5

June2J 20

Section 400 487 6 F S 1l1e skilled care services provided by a home health agency

directly or under contract must be supervised and coordinated in accordance with the

plan of care

9 The home health agency failed to ensure the registered nurse completed the initial

evaluation visit for I of 17 patients The Director of Nursing who signed the initial

evaluation visit never made a home visit to the patient H 307

The pertinent statutes and rules that apply include the following

59A 8 008 1 F A C In cases of patients requiring only nursing or in cases requiring

nursing and physical respiratory occupational or speech therapy services or nursing and

dietetic and nutrition services the agency shall provide case management by a licensed

registered nurse directly employed by the agency

10 The home health agency failed to provide written notice for terminating home health

services to I of 3 sampled patients There was no written notification regarding the date

of termination reason for termination or a referral to another agency with a plan for

continued services prior to the termination H 316

The pertinent statutes and rules that apply include the following

Chapter 59A 8 020 4 F A C When the agency terminates services for a patient or

client needing contiriuing home health care as determined by the patient s physician

physician assistant or advanced registered nurse practitioner for patients receiving care

under a physician physician assistant or advanced registered nurse practitioner s

treatment order or as determined by the client or caregiver for clients receiving care

without a physician physician assistant or advanced registered nurse practitioner s

treatment order a plan must be developed and a referral made by home health agency

staff to another home health agency or service provider prior to termination The patient

or client must be notified in writing of the date of termination the reason for termination

pursuant to Section 400 491 F S and the plan for continued services by the agency or

service provider to which the patient or client has been referred pursuant to Section

400 497 6 F S This requirement does not apply to patients paying through personal

funds or private insurance who default on their contract through non payment The home

health agency should provide social work assistance to patients to help them detennine

their eligibility for assistance from government funded programs if their private funds

have been depleted or will be depleted

II The home health agency failed to develop a plan of care for 6 of 17 sampled patients that

included all of the required items needed to appropriately serve patients including goals

to support the physician s treatment orders level of staff to provide the services to reach

the goals and the frequency of visits to conduct the services by appropriate home health

agency staff H 320

Tehc LLC

Page 6

June 23 2008

The pertinent statutes and rules that apply include the following

Seclion 400 487 2 F S When required by the provisions of chapter 464 part I part

III or part V of chapter 468 or chapter 486 the attending physician physician assistant

or advanced registered nurse practitioner acting within his or her respective scope of

practice shall establish treatment orders for a patient who is to receive skilled care

Chapter 59A 8 0215 I F A C A plan of care shall be established in consultation with

the physician physician assistant or advanced registered nurse practitioner pursuant to

Section 400 487 F S and the home health agency staff who are involved in providing

the care and services required to carry out the physician physician assista nt or advanced

registered nurse practitioner s treatment orders The plan must be included in the clinical

record and available for review by all staff involved in providing care to the patient The

plan of care shall contain a list of individualized specific goals for each skilled discipline

that provides patient care with implementation plans addressing the level of staff who

will provide care the frequency of home visits to provide direct care and case

management

12 The home health agency failed to demonstrate evidence that patients were informed in

advance about any changes to the plan of care prior to implementation of the changes for

1 of 17 patients H 321

The pertinent statutes and rules that apply include the following

Chapter 59A 8 0215 3 F A C The patient caregiver or guardian must be informed by

the home health agency personnel that

a He has the right to be informed of the plan of care

b He has the right to participate in the development of the plan of care and

c He may have a copy of the plan if requested

13 The home health agency failed to maintain a clinical record in accordance with accepted

professional standards for 12 of 17 patients H 350

The pertinent statutes and rules that apply include the following

Section 400 491 1 F S The home health agency must maintain for each patient who

receives skilled care a clinical record that includes pertinent past and current medical

nursing social and other therapeutic information the treatment orders and other such

information as is necessary for the safe and adequate care of the patient When home

health services are terminated the record must show the date and reason for

termination

Tehc LLC

Page 7

June 23 2008

14 The home health agency failed to include all of the items in the

clinical required discharged

patient records for 3 of 3 patients There were no termination swnmaries as

required H 356

The pertinent statutes and rules that apply include th

following

Chapter 59A 8 022 5 F A C Clinical records must contain the following

a Source of referral

b Physician physician assistant or advanced registered nurse practitioner s verbal

orders initiated by the physician physician assistant or advanced nurse

practitioner to start of care registered

prior and signed by the physician physician assistant or

advanced registered nurse practitioner as required in Section 400 487 2 F S

c Assessment of the patient s needs

d Statement of patient or caregiver problems

e Statement of patient s and caregiver s ability to provide interim services

f Identification sheet for the patient with name address telephone number date of

birth sex agency case number caregiver next of kin or guardian

g Plan of care or service provision plan and all subsequent updates and changes

h Clinical and service notes signed and dated by the staff member providing the service

which shall include

1 Initial assessments and progress notes with changes in the person s condition

2 Services rendered

3 Observations

4 Instructions to the patient and caregiver or guardian including administration of and

adverse reactions to medications

i Horne visits to patients for supervision of staff providing services

j Reports of case conferences

k Reports to physicians physician assistants or advanced registered nurse practitioners

1 Tennination summary including the date of first and last visit the reason for

termination of service an evaluation of established goals at time of temrination the

condition of the patient on discharge and the disposition of the patient

15 The home health agency failed to submit their comprehensive

to the local health emergency management

plan county department for review and approval H 376

The pertinent statutes and rules that apply include the following

Section 400 497 8 c F S Preparation ofa comprehensive emergency management

plan pursuant to s 400 492

c The plan is subject to review and approval by the county health its

review the department During

county health department shall contact state and local health and medical

stakeholders when necessary The county health department shall complete its review to

Tchc LLC

Page 8

June 23 2008

ensure that the plan is in accordance with the criteria in the Agency for Health Care

Administration rules within 90 days after receipt of the plan and shall approve the plan or

advise the home health agency of necessary revisions If the home health agency fails to

submit a plan or fails to submit the requested information or revisions to the county

health department within 30 days after written notification from the county health

department the county health department shall notify the Agency for Health Care

Administration The agency shall notify the home health agency that its failure

constitutes a deficiency subject to a fine of 5 000 per occurrence If the plan is not

submitted information is not provided or revisions are not made as requested the agency

may impose the fine

Chapter 59A 8 027 2 F A C The plan once completed will be forwarded

electronically for approval to the contact designated by the Department of Health

Section 400 492 F s Each home health agency shall prepare and maintain a

comprehensive emergency management plan that is consistent with the standards adopted

by national or state accreditation organizations and consistent with the local special needs

plan The plan shall be updated

annually

Chapter 59A 8 027 3 and 4 F S The agency shall review its emergency

management plan on an annual basis and make any substantive changes

4 Changes in the telephone numbers of those staff who are coordinating the agency s

emergency response must be reported to the agency s county office of Emergency

Management and to the local County Health Department For agencies with multiple

counties on their license the changes must be reported to each County Health

Department d each county Emergency Management office The telephone numbers

must include numbers where the coordinating staff can be contacted outside of the

agency s regular office hours All home health agencies must report these changes

whether their plan has been previously reviewed or not as defmed in subsection 2

above

16 The home health agency failed to renew the application for a Certificate of Exemption

that authorizes the performance of waived laboratory tests H 390

The pertinent statutes and rules that apply include the following

Section483 091 F S Clinical laboratory license Apersonmaynot conduct maintain

or operate a clinical laboratory in this state except a laboratory that is exempt under s

483 031 unless the clinical laboratory has obtained a license from the A

license is valid for the or to whom it is issued and not be sold agency

only person persons may

assigned or transferred voluntarily or involuntarily and is not valid for any premises

other than those for which the license is issued 483 031 Application of part

exemptions This part applies to all clinical laboratories within this state except 1 A

clinical laboratory operated by the United States Government 2 A clinical laboratory

Tehc LLC

Page 9

June 23 2008

u n

that performs only waived tests and has received a certificate of exemption from the

agency under s 483 106 3 A clinical laboratory operated and maintained exclusively

for research and teaching purposes that do not involve patient or public health service

483 106 Application for a certificate of exemption An application for a certificate of

exemption must be made under oath by the owner or director of a clinical laboratory that

performs only waived tests as defmed in s 483 041 A certificate of exemption authorizes

a clinical laboratory to perform waived tests Laboratories maintained on

and under separate

premises operated the same management may apply for a single certificate of

exemption or multiple certificates of exemption

EXPLANATION OF RIGHTS

Pursuant to Section 120 569 F S you have the ri t to request an administrative hearing In cirder to

obtain a formal proceeding before the Division of Administrative Hearings under Section 57 120 1 F S

your request for an administrative hearing must conform to the requirements in Section 28 106 201

Florida Administrative Code F A C and must state the material facts you dispute

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS

Anne Menard Manager

Home Care Unit

cc Agency Clerk Mail Stop 3

Legal Intake Unit Mail Stop 3

Arlene Mayo David AHCA Delray Beach Field Office Manager

0

r l 0 t r rl t t t1 i c

TrIck a Confirm

Search ResuIIs

Label Receipt Number 7160 3901 984547436663

Status Delivered ti iliilr

Your item was delivered at 11 36 AM on June 26 2008 in FORT Enter LabellReceipt Number

LAUDERDALE FL 33309 L 1

o tions

Track Confirm by email

Get current event information or updates for your item sent to you or others by email

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CopyrightC 1999 2007 usps All Rights Reserved No FEAR Act EEO Data FOIA l l a l lmi blilMlm kfli Jt 1 1 tn h t A1 n rlsr

http trkcnfrmI smi usps com PTSlntemetWeb InterLabelInquiry do 7 21 2008

08 20 2009 1551 FAX [phone] DRESHICK RODRIGUEZ PA III 002 003

STA TE OF FLORlDA

AGENCY fOR HEALTH CARE ADMINISTRA nON

In RE T ioensure Renewal Application of

TEHC r Le AHCA No 2008007748

2008007491

License No 204390961

WITHDRA W AL OF REOUEST FOR FORMAL HEARING AND

WITHDRAWAL OF APPLICATION FOR RENEWAL OF LICENSE

TEHC LLC by and through undersigned counsel hereby withdraws its request for a

formal hearing in the above referenced matters and withdraws its application for renewal of

its home health agency license 204390961

TEHC LLC understands that by withdrawing the licensure renewal application

license 204390961 becomes null and void and may not be renewed

Respectfully submitted

DRESNICK RODRIGUEZ P A

Attorneys for TEIlC LLC

One Datran Center

9100 South Dadeland Blvd Suite 1610

Miami FL 33156

Off 305 670 9800

Fax [phone]

v l 2

Monica L Rodriguez J

Florida Bar No 986283

EXHIBIT

j z

O ESNICK OO lauE2 P ONE OATil CE TE SU TE 1810 GlOO SOUTH OAOI LANO GOULC AIIlD A II L 33IS I 130111 70 100

09 20 2009 15 51 FAX 305 S70 9933 DRESHICK Ilt RODRIGUEZ PA faJ 003 003

AHCA No 2008007748

2008007491

License No 204390961

CERTIFICATE OF SERVICE

I I IEREB Y CERTIFY that the original of the foregoing has been furnished tclcfax

by

and U S Mail on August 20 2009 to Nelson Rodney Assistant General Counsel Agency

for Health Care Administration 8350 N W 52nd Terrace Suite 103 Miami FL 33166 with a

copy via elctax and U S Mail to Richard Shoop Agency Clerk 2727 Mahan Drive Mail

Stop 3 TaJlaha see Florida 32308

W eo

Monica L Rodriguez a

STATE OF FLORIDA N

AGENCY FOR HEALTH CARE ADMINISTRATION

0 4 0

201 SEA 1 A

TEHC LLC

Petitioner

DOAH NO 08 3693

VS AHCA NO 2008007748

STATE OF FLORIDA AGENCY FOR

HEALTH CARE ADMINISTRATION

Respondent

FINAL ORDER

Having reviewed the Notice of Intent to Deny the renewal license application for a

home health agency attached hereto and incorporated herein Ex 1 and other matters of

records the Agency for Health Care Administration Agency finds and concludes as

follows

1 By Order dated August 26 2008 the Administrative Law Judge closed its

files in the above styled case Petitioner filed a status report withdrawing the application for

renewal of license on August 20 2009 attached hereto and incorporated herein Ex 2

2 The denial of the renewal application for Petitioner home health agency is

upheld and the application for license renewal has been withdrawn

Upon consideration of the foregoing it is ORDERED that the Agency s file is hereby

closed

DONE and ORDERED at Tallahassee Leon County Florida this day of

2009

Holly Ben on Secretary

Agenc r Health Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED

TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF

A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA AND A SECOND

COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW WITH THE DISTRICT

COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY

MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES REVIEW

PROCEEDING SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA

APPELLATE RULES THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY

30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED

Copies furnished to

Monica L Rodriguez

Attorney for Petitioner

Dresnick Rodriguez P A

One Datran Center

91 South Dadeland Blvd Suite 1610

Miami Florida 33156

U S Mail

Nelson E Rodney

Assistant General Counsel

Agency for Health Care Administration

8350 NW 52nd Terrace Suite 103

Miami Florida 33166

Interoffice Mail

Home Care Unit

Agency for Health Care Administration

2727 Mahan Drive MS 34

Tallahassee Florida 32308

Interoffice Mail

Stuart M Lerner

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee Florida 32399 3060

U S Mail

Jan Mills

Agency for Health Care Administration

2727 Mahan Drive Bldg 3 MS 3

Tallahassee Florida 32308

Interoffice Mail

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true copy of the foregoing was sent to the above named

addressees by U S Mail or the method designated on thisof 2009

Richard Shoop Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive Building 3

Tallahassee Florida 32308 5403

850 5873 922

Zoosfo 17 HY

7160 39D1 9645 4

CHARLIE CRIST AGENCY FOR HFAJTH CAR E ADMINISTRr TF HOLLY BEN f

GOVERNOR y

SECRET4R iC

June 23 2008 CERTIFIED MAIL RETURN RECEIPT REQUESTED

Kelly Marie Darnas Administrator

TEHC LLC License Number 204390961

3317 NW 10th Terr Ste 404

Fort Lauderdale Fl 33309 Case 2008007748

N4h Off NTENVTO DENY

It is the decision of this Agency that the application for renewal licensure as a home health

agency for TEHC LLC located at 3317 NW 10th Terrace Suite 404 Fort Lauderdale Fl

33309 is DENIED

The basis for this action is pursuant to authority of Section 120 60 Florida Statutes F S and

Section 408 815 1 c and d F S which states as follows

1 In addition to the grounds provided in authorizing statutes grounds that may be used by the

agency for denying and revoking a license include any of the following actions by a

controlling interest

c A violation of this part authorizing statutes or applicable rules

d A demonstrated pattern of deficient performance

The home health agency did not demonstrate compliance with Chapter 400 Part III F S and the

state home health agency rules Chapter 59A 8 Florida Administrative Code F A C at the

home health agency licensure survey conducted May 5 through May 8 2008 The plan of

correction due June 7 2008 as submitted to the s Agency Field Office was not acceptable Non

compliance was found in the following areas

1 The home health agency failed to ensure the Director of Nursing established and

conducted an on going quality assurance Trogram that evaluated the effectiveness of all

the provided service for consistency with professional standards and anticipated

outcomes H 224

The pertinent statutes and rules that apply include the following

59A 8 0095 2 c F A C Director of Nursing

c The director of nursing shall establish and conduct an ongoing quality assurance

program which assures

2727 Mahan Drive MS 34 EXHIBIT Visit AHCA online at

Tallahassee Florida 32308 http ahca myflorida com

I I

Tehc LLC

Page 2

June 2008 23

1 Case assignment and management is appropriate adequate and consistent with the

plan of care medical regimen and patient needs

2 Nursing and other services provided to the patient are coordinated appropriate

adequate and consistent with plans of care

3 All services and outcomes are completely and legibly documented dated and signed in

the clinical service record

4 Confidentiality of patient data is maintained and

5 Findings of the quality assurance program are used to improve services

2 The home health agency failed to ensure that the Registered Nurse RN provide case

management for 5 of 17 nursing and therapy patients This was evidenced by failure to

provide an assessment prior to documenting a start of care comprehensive assessment for

one patient failure to provide supervision for the Licensed Practical Nurse LPN in the

performance of duties for two patients and failure to assure progress reports were made to

the physician for patients receiving nursing services when the patient s condition changed

for two patients

The pertinent statutes and rules that apply include the following

59A 8 0095 3 a F A C Registered Nurse

a A registered nurse shall be currently licensed in the state pursuant to Chapter 464

F S and

1 Be the case manager in all cases involving nursing or both nursing and therapy care

2 Be responsible for the clinical record for each patient receiving nursing care and

3 Assure that progress reports are made to the physician for patients receiving nursing

services when the patient s condition changes or there are deviations from the plan of

care

3 The home health agency failed to ensure that the RN retained full responsibility for the

care given and malting supervisory visits to the patient s home for 3 of 17 sampled

patients as evidenced by failure to provide supervision for the LPN in the performance of

duties for two patients failure to provide supervision for the Home Health Aide Aide

and failed to prepare a written Aide assignment instructions for services to be provided to

the patient for 3 patients H 231

The pertinent statutes and rules that apply include the following

59A 8 0095 3 b F A C Registered Nurse

b A registered nurse may assign selected portions of patient care to licensed practical

nurses and home health aides but always retains the full responsibility for the care given

and for making supervisory visits to the patient s home

4 The home health agency failed to provide supervision for the LPN in the performance of

duties for 2 of 17 patients H 235

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The pertinent statutes and rules that apply include the following

59A 8 0095 4 a F A C Licensed Practical Nurse

a A licensed practical nurse shall be currently licensed in the state pursuant to Chapter

464 F S and provide nursing care assigned by and under the direction of a registered

nurse who provides on site supervision as needed based upon the severity of patients

medical condition and the nurse s training and experience Supervisory visits will be

documented in patient files Provision shall be made in agency policies and procedures

for annual evaluation of the LPN s performance of duties by the registered nurse

5 The home health agency failed to ensure the LPN reported any changes in the s patient

condition to the RN and document the changes in the patient s clinical record for 1 of 17

sampled patients H 236

The pertinent statutes and rules that apply include the following

59A 8 0095 4 b F A C Licensed Practical Nurse A licensed practical nurse shall

1 Prepare and record clinical notes for the clinical record

2 Report any changes in the patient s condition to the registered nurse with the reports

documented in the clinical record

3 Provide care to the patient including the administration of treatments and medications

4 Other duties assigned by the registered nurse pursuant to Chapter 464 F S

6 The home health agency failed to ensure that the care provided followed the plan of

treatment for 11 of 17 sampled patients The home health agency also failed to ensure a

verbal order obtained by a home health agency nurse was put into writing and signed by

the attending physician for 1 of 17 sampled patients H 302

The pertinent statutes and rules that apply include the following

Section 400 487 2 S F When required by the provisions of chapter 464 part I part

III or part V of chapter 468 or chapter 486 the attending physician physician assistant

or advanced registered nurse practitioner acting within his or her respective scope of

practice shall establish treatment orders for a patient who is to receive skilled care The

treatment orders must be signed by the physician physician assistant or advanced

registered nurse practitioner before a claim for payment for the skilled services is

submitted by the home health agency If the claim is submitted to a managed care

organization the treatment orders must be signed within the time allowed under the

provider agreement The treatment orders shall be reviewed as frequently as the patient s

illness requires by the physician physician assistant or advanced registered nurse

practitioner in consultation with the home health agency

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Chapter 59A 8 0215 2 F A C Home health agency staff must follow the physician

physician assistant or advanced registered nurse practitioner s treatment orders that are

contained in the plan of care If the orders cannot be followed and must be altered in

some way the patient s physician physician assistant or advanced registered nurse

practitioner must be notified and must approve of the change Any verbal changes are put

in writing and signed and dated with the date of receipt by the nurse or who

talked with the therapist

physician physician assistant or advanced registered nurse practitioner s

office

7 The home health agency failed to ensure 9 of 17 patients were advised of the payment for

home health agency services before care was started and were clear about the payor

source and any charges required from the patient H 304

The pertinent statutes and rules that apply include the following

Section 400 487 1 F S Services provided by a home health agency must be covered

by an agreement between the home health agency and the patient or the patient s legal

representative specifying the home health services to be provided the rates or charges for

services paid with private funds and the sources of payment which may include

Medicare Medicaid private insurance personal funds or a combination thereof A home

health agency providing skilled care must make an assessment of the patient s needs

within 48 hours after the start of services

Chapter 59A 8 020 2 F A C At the start of services a home health agency must

establish a written agreement between the agency and the patient or client or the patient s

or client s legal representative including the information described in Section

400 487 1 F S This written agreement must be signed and dated by a representative of

the home health agency and the patient or client or the s patient or s client legal

representative A copy of the agreement must be given to the patient or client and the

original must be placed in the patient s or client s file

Chapter 59A 8 020 3 F A C The written agreement as specified in subsection 2

above shall serve as the home health agency s service provision plan pursuant to Section

400 491 2 F S for clients who receive homemaker and companion services or home

health aide services which do not require a physician physician assistant or advanced

registered nurse practitioner s treatment order The written agreement for these clients

shall be maintained for one year after termination of services

8 The home health agency failed to demonstrate effective communication between

interdisciplinary team members to coordinate services as outlined in the plan of care for 3

of 17 patients and failed to ensure that 8 of 17 sampled patients received the skilled

nursing services in accordance with the physician s written plan of care H 306

The pertinent statutes and rules that apply include the following

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tune 23 2008

Section 400 487 6 F S The skilled care services provided by a home health agency

directly or under contract must be supervised and coordinated in accordance with the

plan of care

9 The home health agency failed to ensure the registered nurse completed the initial

evaluation visit for 1 of 17 patients The Director of Nursing who signed the initial

evaluation visit never made a home visit to the patient H 307

The pertinent statutes and rules that apply include the following

59A 8 008 1 F A C In cases of patients requiring only nursing or in cases requiring

nursing and physical respiratory occupational or speech therapy services or nursing and

dietetic and nutrition services the agency shall provide case management by a licensed

registered nurse directly employed by the agency

10 The home health agency failed to provide written notice for terminating home health

services to 1 of 3 sampled patients There was no written notification regarding the date

of termination reason for termination or a referral to another agency with a plan for

continued services prior to the termination H 316

The pertinent statutes and rules that apply include the following

Chapter 59A 8 020 4 F A C When the agency terminates services for a patient or

client needing continuing home health care as determined by the patient s physician

physician assistant or advanced registered nurse practitioner for patients receiving care

under a physician physician assistant or advanced registered nurse practitioner s

treatment order or as determined by the client or caregiver for clients receiving care

without a physician physician assistant or advanced registered nurse practitioner s

treatment order a plan must be developed and a referral made by home health agency

staff to another home health agency or service provider prior to termination The patient

or client must be notified in writing of the date of termination the reason for termination

pursuant to Section 491 400 S F and the plan for continued services by the agency or

service provider to which the patient or client has been referred pursuant to Section

400 497 6 F S This requirement does not apply to patients paying through personal

funds or private insurance who default on their contract through non payment The home

health agency should provide social work assistance to patients to help them determine

their eligibility for assistance from government funded programs if their private funds

have been depleted or will be depleted

11 The home health agency failed to develop a plan of care for 6 of 17 sampled patients that

included all of the required items needed to appropriately serve patients including goals

to support the physician s treatment orders level of staff to provide the services to reach

the goals and the frequency of visits to conduct the services by appropriate home health

agency staff H 320

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June 23 2008

The pertinent statutes and rules that apply include the following

Section 400 487 2 S F When required by the provisions of chapter 464 part I part

III or part V of chapter 468 or chapter 486 the attending physician physician assistant

or advanced registered nurse practitioner acting within his or her respective scope of

practice shall establish treatment orders for a patient who is to receive skilled care

Chapter 0215 8 59A 1 F A C A plan of care shall be established in consultation with

the physician physician assistant or advanced registered nurse practitioner pursuant to

Section 400 487 F S and the home health agency staff who are involved in providing

the care and services required to carry out the physician physician assistant or advanced

registered nurse practitioner s treatment orders The plan must be included in the clinical

record and available for review by all staff involved in providing care to the patient The

plan of care shall contain a list of individualized specific goals for each skilled discipline

that provides patient care with implementation plans addressing the level of staff who

will provide care the frequency of home visits to provide direct care and case

management

12 The home health agency failed to demonstrate evidence that patients were informed in

advance about any changes to the plan of care prior to implementation of the changes for

1 of 17 patients H 321

The pertinent statutes and rules that apply include the following

Chapter 0215 59A 8 3 C A F The patient caregiver or guardian must be informed by

the home health agency personnel that

a He has the right to be informed of the plan of care

b He has the right to participate in the development of the plan of care and

c He may have a copy of the plan if requested

13 The home health agency failed to maintain a clinical record in accordance with accepted

professional standards for 12 of 17 patients H 350

The pertinent statutes and rules that apply include the following

Section 400 491 1 F S The home health agency must maintain for each patient who

receives skilled care a clinical record that includes pertinent past and current medical

nursing social and other therapeutic information the treatment orders and other such

information as is necessary for the safe and adequate care of the patient When home

health services are terminated the record must show the date and reason for

termination

Tehc LLC

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Tune 2008 23

14 The home health agency tailed to include all of the required items in the

clinical records 3 discharged

patient for of 3 patients There were no termination summaries as

required H 356

The pertinent statutes and rules that apply include the following

Chapter 59A 8 022 5 F A C Clinical records must contain the following

a Source of referral

b Physician physician assistant or advanced registered nurse practitioner s verbal

orders initiated by the physician physician assistant or advanced registered nurse

practitioner prior to start of care and signed by the physician physician assistant or

advanced registered nurse practitioner as required in Section 400 487 2 F S

c Assessment of the patient s needs

d Statement of patient or caregiver problems

e Statement of patient s and caregiver s ability to provide interim services

f Identification sheet for the patient with name address telephone number date of

birth sex agency case number caregiver next of kin or guardian

g Plan of care or service provision plan and all subsequent updates and changes

h Clinical and service notes signed and dated by the staff member providing the service

which shall include

1 Initial assessments and progress notes with changes in the person s condition

2 Services rendered

3 Observations

4 Instructions to the patient and caregiver or guardian including administration of and

adverse reactions to medications

i Home visits to patients for supervision of staff providing services

0 Reports of case conferences

k Reports to physicians physician assistants or advanced registered nurse practitioners

1 Termination summary including the date of first and last visit the reason for

termination of service an evaluation of established goals at time of termination the

condition of the patient on discharge and the disposition of the patient

15 The home health agency failed to submit their comprehensive emergency management

plan to the local county health department for review and approval H 376

The pertinent statutes and rules that apply include the following

Section 400 497 8 c F S Preparation of a comprehensive emergency management

plan pursuant to s 400 492

c The plan is subject to review and approval by the county health department During its

review the county health department shall contact state and local health and medical

stakeholders when necessary The county health department shall complete its review to

Te1ic LLC

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ensure that the plan is in accordance with the criteria in the Agency for Health Care

Administration rules within 90 days after receipt of the plan and shall approve the plan or

advise the home health agency of necessary revisions If the home health agency fails to

submit a plan or fails to submit the requested information or revisions to the county

health department within 30 days after written notification from the county health

department the county health department shall notify the Agency for Health Care

Administration The agency shall notify the home health agency that its failure

constitutes a deficiency subject to a fine of 5 000 per occurrence If the plan is not

submitted information is not provided or revisions are not made as requested the agency

may impose the fine

Chapter 59A 8 027 2 F A C The plan once completed will be forwarded

electronically for approval to the contact designated by the Department of Health

Section 400 492 F S Each home health agency shall prepare and maintain a

comprehensive emergency management plan that is consistent with the standards adopted

by national or state accreditation organizations and consistent with the local special needs

plan The plan shall be updated annually

Chapter 59A 8 027 3 and 4 F S The agency shall review its emergency

management plan on an annual basis and make any substantive changes

4 Changes in the telephone numbers of those staff who are coordinating the agency s

emergency response must be reported to the agency s county office of Emergency

Management and to the local County Health Department For agencies with multiple

counties on their license the changes must be reported to each County Health

Department and each county Emergency Management office The telephone numbers

must include numbers where the coordinating staff can be contacted outside of the

agency s regular office hours All home health agencies must report these changes

whether their plan has been previously reviewed or not as defined in subsection 2

above

16 The home health agency failed to renew the application for a Certificate of Exemption

that authorizes the performance of waived laboratory tests H 390

The pertinent statutes and rules that apply include the following

Section 483 091 F S Clinical laboratory license A person may not conduct maintain

or operate a clinical laboratory in this state except a laboratory that is exempt under s

483 031 unless the clinical laboratory has obtained a license from the agency A

license is valid only for the person or persons to whom it is issued and may not be sold

assigned or transferred voluntarily or involuntarily and is not valid for any premises

other than those for which the license is issued 483 031 Application of part

exemptions This part applies to all clinical laboratories within this state except 1 A

clinical laboratory operated by the United States Government 2 A clinical laboratory

that performs only waived tests and has received a certificate of exemption from the

agency under s 483 106 3 A clinical laboratory operated and maintained exclusively

for research and teaching purposes that do not involve patient or public health service

483 106 Application for a certificate of exemption An application for a certificate of

exemption must be made under oath by the owner or director of a clinical laboratory that

performs only waived tests as defined in s 483 041 A certificate of exemption authorizes

a clinical laboratory to perform waived tests Laboratories maintained on separate

premises and operated under the same management may apply for a single certificate of

exemption or multiple certificates of exemption

EXPLANATION OF RIGHTS

Pursuant to Section 120 569 F S you have the right to request an administrative hearing In order to

obtain a formal proceeding before the Division of Administrative Hearings under Section 120 57 1 F S

your request for an administrative hearing must conform to the requirements in Section 28 106 201

Florida Administrative Code F A C and must state the material facts you dispute

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS

Anne Menard Manager

Home Care Unit

cc Agency Clerk Mail Stop

Legal Intake Unit Mail Stop 3

Arlene Mayo David AHCA Delray Beach Field Office Manager

jTEV

Home I Help I Sign In

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Label Receipt Number 7160 3901 9845 4743 6663

Status Delivered 7 k t t

Your item was delivered at 36 11 AM on June 26 2008 in FORT Enter Receipt Label Number

LAUDERDALE FL 33309

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http trkcnfrm l smi usps com PTSIntemetWeb InterLabellnquiry do 7 21 2008

RECEIVED

GENERA P

STATE OF FLORIDA JUL 17 2008

AGENCY FOR HEALTH CARE ADMINISTRATION

Agent

We Am

In RE Licensure Renewal Application of

TEHC LLC AHCA No 2008007748

License No 204390961

REQUEST FOR FORMAL HEARING

The law firm of Dresnick Rodriguez P A notices its appearance as counsel for

TEHC LLC in conjunction with the above referenced matter All pleadings documents

and other communications should be provided to TEHC s counsel at the address below

TEHC disputes the allegations of fact contained in the Notice of Intent to Deny and

requests that this pleading be considered a demand for a formal hearing pursuant to Sections

120 569 and 120 57 1 Florida Statutes and pursuant to Rule 28 106 2015 Florida

Administrative Code before an Administrative Law Judge appointed by the Division of

Administrative Hearings

In support of this Petition TEHC states the following

1 The Petitioner is TEHC LI C 3317 NW 10th Terrace Suite 404 Fort

Lauderdale FL 33309 TEHC s telephone number is 954 351 1895 and the facsimile

number is 954 351 1820

2 TEHC s counsel should be contacted at the address and fax number below

3 TEHC disputes allegations of fact including but not limited to those in

paragraphs 1 6 7 8 9 11 12 15 and 16 of the Notice of Intent to Deny and requests an

Administrative Hearing regarding these allegations In addition TEHC disputes that they

DRESNICK RODRIGUEZ A P ONE DATRAN CENTER SUITE 1610 9100 SOUTH DADELAND BOULEVARD MIAMI FL 33156 7817 305 670 9800

AHCA No 2008007748

License No 204390961

have demonstrated a pattern of deficient performance and that the plan of correction

submitted in June 2008 was not acceptable

4 TEHC received the Notice of Intent to Deny on June 26 2008

5 The Agency s file number in this case is 2008007748

Respectfully submitted

DRESNICK RODRIGUEZ P A

Attorneys for TEHC LLC

One Datran Center

9100 South Dadeland Blvd Suite 1610

Miami FL 33156

Off 305 670 9800

Fax [phone]

Monica L Rodriguez

Florida Bar No 986283

2

DRESNICK S RODRIGUEZ P A ONE DATRAN CENTER SUITE 1610 9100 SOUTH DADELAND BOULEVARD MIAMI FL 33 1 56 7 8 1 7 670 305 9800

AHCA No 2008007748

License No 204390961

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that the original of the foregoing has been furnished by telefax

and U S Mail on July 16 2008 to Nelson Rodney Assistant General Counsel Agency for

Health Care Administration 8350 N W 52 d Terrace Suite 103 Miami FL 33166 with a

copy via telefax and U S Mail to Richard Shoop Agency Clerk 2727 Mahan Drive Mail

Stop 3 Tallahassee Florida 32308

P Z

Monica L Rodriguez

DRESNICK RODRIGUEZ A P ONE DATRAN CENTER SUITE 1610 9100 SOUTH DADELAND BOULEVARD MIAMI FL 33156 7817 305 670 9800

09 20 2009 15 51 FAX [phone] DRE NICK RODRIG UEZ PA 10002 003

STATE OF FLORIDA

AGENCY FOR ITf ALTH CARE ADMINISTRATION

In RE Lieensure Renewal Application of

TEHC T T C AHCA No 2008007748

2008007491

License No 204390961

WITHDRAWAL OF REQUEST FOR FORMAL HEARING AND

WITHDRAWAL OF APPLICATION FOR RENEWAL OF LICENSE

TFHC ILLC by and through undersigned counsel hereby withdraws its request for a

formal hearing in the above referenced matters and withdraws its application for renewal of

its home health agency license 204390961

TEFIC LLC understands that by withdrawing the licensure renewal application

license 204390961 becomes null and void and may not be renewed

Respectfully submitted

DRESNICK RODRIGUEZ P A

Attorneys for TEI IC LLC

One Datran Center

9100 South Dadeland Blvd Suite 1610

Miami FL 33156

Off 305 670 9800

Fax [phone]

Monica L Rodriguez

Florida Bar No 986283

EXHIBIT

DRESNICK B RODRIGUEZ A P ONE DATRAN CENTER SUITE 1610 0100 SOUTH DAOELANO 90ULEVAAO MIAMI FL 7817 33136 13061 e70 9800

08 20 2003 15 51 FAQ 305 670 9333 OPH NICK RODRIGUEZ PA R 003 003

AHCA No 2008007748

2008007491

License No 204390961

CERTIFICATE OF SERVICE

1 i TERE13Y CERTIFY that the original of the foregoing has been furnished telefax

by

and U S Mail on August 20 2009 to Nelson Rodney Assistant General Counsel Agency

for I lealth Care Administration 8350 W N 52nd Terrace Suite 103 Miami FL 33166 with a

copy via telefax and U S Mail to Richard Shoop Agency Clerk 2727 Mahan Drive Mail

Stop 3 Tallahassee Florida 32308

Monica L Rodriguez

2

ORESNICK 6 RODRIOUE2 P A OATRAN ONE CENTER SUITE 1610 9100 SOUTH DADELAND BOULEVARD MIAMI FL 33 1 7 66 8 17 308 670 8800