10-001502 National Nursing Pool, Inc. vs. Agency For Health Care Administration Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Friday, July 22, 2011.

1. The Agency has jurisdiction over the above- named Provider (" the Provider")

pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and

administrative code provisions.

2. The Agency issued the attached Notices of Intent to Deem Application

Incomplete and Withdrawn from Further Review, Administrative Complaint, Notice of Intent to

Deny, and Election of Rights forms to the Provider. ( Composite Ex. 1) The Election of Rights

forms advised of the right to an administrative hearing.

3. The parties have since entered into the attached Settlement Agreement. ( Ex. 2)

Based upon the foregoing, it is ORDERED:

1. The Settlement Agreement is adopted and incorporated by reference into this

Final Order. The parties shall comply with the terms of the Settlement Agreement.

2. The Provider shall pay the Agency an administrative fee of $ 500. 00 in connection

with AHCA No. 2010009638 and $ 6, 00 000. in administrative fines in connection with AHCA

No. 2010005631. If full payment has been made, the cancelled check acts as receipt of payment

and no further payment is required. If full payment has not been made, payment is due within 30

days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to

collections. A check made payable to the " Agency for Health Care Administration" and

containing the AHCA ten- digit case numbers should be sent to:

Office of Finance and Accounting

Revenue Management Unit

Agency for Health Care Administration

2727 Mahan Drive, MS 14

Tallahassee, Florida 32308

ORDERED in Tallahassee, Florida, on this pw day of 2012.

Eli abeth D dek, Secretary

Agency for Health Care Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

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

of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of

Appeal must be filed within 30 days of rendition of the order to be reviewed.

CERTIFICATE OF SERVICE

I CERTIFY that a true and correct copy oft Final Order was served on the below-

named persons by the method designated on this2ay of l 2012.

Richard Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Bldg. 43, Mail Stop # 3

Tallahassee, Florida 32308- 5403

Telephone: ( 850) 412- 3630

Jan Mills Finance & Accounting

Facilities Intake Unit Revenue Management Unit

Electronic Mail) Electronic Mail)

D. Carlton Enfinger, Senior Attorney Michael P. Gennett, Esquire

Office of the General Counsel Akerman Senterfitt

Agency for Health Care Administration 1 Southeast 3rd Avenue, Floor 25

Electronic Mail) Miami, Florida 33131- 1700

U. S. Mail)

Alba M. Rodriguez, Senior Attorney Yehia Abdelmonem, Administrator

Office of the General Counsel National Nursing Pool, Inc.

Agency for Health Care Administration 1620 West Oakland Boulevard

Electronic Mail) Oakland Park, Florida 33311

U. S. Mail)

June C. McKinney

Administrative Law Judge

Division Of Administrative Hearings

Electronic Mail)

CHARLIE CRIST FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

GOVERNOR , Better Health Care for all Floridians THOMAS W. ARNOLD

j SECRETARY

S

January 24, 2010 CERTIFIED MAfL / RETURN RECEIPT REQUESTED

11 r EMIL

ADMINISTRATOR

National Nursing Pool Inc 7160 3901 9848 4934 5366 Anse Number: 20743096

1620 W Oakland Park Blvd, Ste

Oakland Park, FL 33311 ase 2010000783

NOTICE OF INTENT TO DEEM APPLICATION INCOMPLETE AND WITHDRAWN FROM

FURTHER REVIEW

Your application for license is deemed incomplete and withdrawn from further consideration pursuant to

Section 408. 3)( 806( b), Florida Statutes, which states that " Requested information omitted from an

application for licensure, license renewal, or change of ownership, other than an inspection, must be filed

with the agency within 21 days after the agency' s request for omitted information or the application shall

be deemed incomplete and shall be withdrawn from further consideration and the fees shall be forfeited".

You were notified by correspondence dated July 28, 2009 to provide further information addressing

identified apparent errors or omissions within twenty- one days from the receipt of the Agency' s

correspondence. Our records indicate you received this correspondence by certified mail on August 4,

2009. As this requested information was not timely received by the Agency, your application is deemed

incomplete and withdrawn from further consideration. The outstanding issues remaining for licensure are:

1. The applicant did not name an administrator for the home health agency. No resume or name

for the administrator was submitted in response to the omission letter. The administrator is a

required position for home health agencies. Kurt Joseph, one of the sellers, sent a letter dated

December 28, 2009 and received by the Agency on January 8, 2010 stating that he was

stepping down as the administrator. Mr. Joseph had been the administrator of record;

however, his name was never entered in the application as the administrator.

The pertinent statutes and rules that apply include the following;

Section 400. 462 ( 1), Florida Statutes ( F. S.), " Administrator" means a direct employee, as

defined in subsection ( 9), who is a licensed physician, physician assistant, or registered nurse

licensed to practice in this state or an individual having at least l year of supervisory or

administrative experience in home health care or in a facility licensed under chapter 395,

under part II of this chapter, or under part I of chapter 429."

Section 408. 806 ( 1), F. S., " An applic. ltion for licensure must be made to the agency on forms

furnished by the agency, submitted under oath, and accompanied by the appropriate fee in

order to be accepted and considered timely. The application must contain information

required by authorizing statutes and applicable rules..."

Section 400. 476 ( 1) ( a), F. S., " ADMINISTRATOR.--

2727 Mahan Drive, 34 MS# 8 5 Visit AHCA online at

Tallahassee, Florida 32308 b http:// myflorida. ahca. com

tiCOD N' E tn' .

EXHIBIT 1

National Nursing Pool Inc

January 24, 2010

a) An administrator may manage only one home health agency, except that an administrator

may manage up to five home health agencies if all five home health agencies have identical

controlling interests as defined in s. 408. 803 and are located within one agency geographic

service area or within an immediately contiguous county. If the home health agency is

licensed under this chapter and is part of a retirement community that provides multiple

levels of care, an employee of the retirement community may administer the home health

agency and up to a maximum of four entities licensed under this chapter or chapter 429 which

all have identical controlling interests as defined in s. 408. 803. An administrator shall

designate, in writing, for each licensed entity, a qualified alternate administrator to serve

during the administrator' s absence."

Section 59A- 003 ( 8. 10) ( a) through ( c), Florida Administrative Code ( F. C.), " A. A home

health agency has the following responsibility in terms of hours of operation:

a) The home health agency administrator and director of nursing, or their alternates, must be

available to the public for any eight consecutive hours between 7: 00 a. m. and 6: 00 p. m.,

Monday through Friday of each week, excluding legal and religious holidays. Available to

the public means being readily available on the premises or by telecommunications.

b) When the administrator and the director of nursing are not on the premises during

designated business hours, a staff person must be available to answer the phone and the door

and must be able to contact the administrator and the director of nursing by

telecommunications. This individual can be a clerical staff person.

c) If an AHCA surveyor arrives on the premises to conduct an unannounced survey and the

administrator, the director of nursing, or a person authorized to give access to patient records,

are not available on the premises they, or the designated alternate, must be available on the

premises within an hour of the arrival of the surveyor. A list of current patients must be

provided to the surveyor within two hours of arrival if requested."

2. The applicant' s alternate administrator/ director of nursing left the agency while the

application was still under review. The applicant stated that the alternate director of nursing

would assume the position of director of nursing until a replacement could be found in a letter

to the Agency dated August 27, 2009. The response to the omission letter was received

August 24, 2009 and contained the resume for the individual that left the home health agency

as the proposed alternate administrator/ director of nursing. No replacement resume was ever

submitted.

Their application did contain the name of an RN Delegate. The applicant was requested in the

omission letter to submit a resume for the RN Delegate. Since the applicant did not send in a

resume, it was not possible to determine if the individual named to be the alternate director of

nursing was the RN Delegate and if that individual qualified for the position.

The pertinent statutes and rules that apply include the following;

Section 408. 806 ( 1) F. S., " An application for licensure must be made to the agency on forms

furnished by the agency, submitted under oath, and accompanied by the appropriate fee in

order to be accepted and considered timely. The application must contain information

required by authorizing statutes and applicable rules..."

Section 400. l 462( 0), F. S., " Director of nursing" means a registered nurse who is a direct

employee, as defined in subsection ( 9), of the agency and who is a graduate of an approved

school of nursing and is licensed in this state; who has at least 1 year of supervisory

experience as a registered nurse; and who is responsible for overseeing the professional

nursing and home health aid delivery of services of the agency."

national Nurstng Pool Inc

January 24, 2010

Section 59A- 0095( 8. 2), Florida Administrative Code ( F. C.), " A. Director of Nursing.

a) The director of nursing of the agency shall:

1. Meet the criteria as defined in Section 400. l 462( 0), F. S.;

2. Supervise or manage, directly or through qualified subordinates, all personnel who provide

direct patient care;

3. Ensure that the professional standards of community nursing practice are maintained by all

nurses providing care;

4. Maintain and adhere to agency procedure and patient care policy manuals; and

b) If the administrator is not a physician or registered nurse, the director of nursing shall:

1. Establish service policies and procedures in compliance with Chapter 64E- 16, F. C., A. and

state health statutes and administrative rules pursuant to Section 381. 4), 0011( F. S., which

generally conform to recommended Centers for Disease Control ( CDC) and Occupational

Safety and Health Agency ( OSHA) guidelines for safety, universal precautions and infection

control procedures;

2. Employ and evaluate nursing personnel;

3. Coordinate patient care services; and

4. Set or adopt policies for, and keep records of criteria for admission to service, case

assignments and case management.

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

which assures:

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."

3. The applicant was requested to provide a resume for the alternate administrator. The resume

submitted was for the individual that left the home health agency on August 27, 2009, four

days after the receipt of the response to the omission letter. No replacement resume for the

alternate administrator was received.

The pertinent statutes and rules that apply include the following:

Section 400. 462 ( 1), F. S., " Administrator" means a direct employee, as defined in subsection

9), who is a licensed physician, physician assistant, or registered nurse licensed to practice in

this state or an individual having at least 1 year of supervisory or administrative experience in

home health care or in a facility licensed under chapter 395, under part 11 of this chapter, or

under part I of chapter 429."

Section 400. 476 ( 1) ( a) Staffing requirements; notifications; limitations on staffing services.

1) ADMINISTRATOR.--

a) An administrator may manage only one home health agency, except that an administrator

may manage up to five home health agencies if all five home health agencies have identical

controlling interests as defined in s. 408. 803 and are located within one agency geographic

service area or within an immediately contiguous county. If the home health agency is

licensed under this chapter and is part of a retirement community that provides multiple

levels of care, an employee of the retirement community may administer the home health

JNational Nursing cool Inc

January 24, 2010

agency and up to a maximum of four entities licensed under this chapter or chapter 429 which

all have identical controlling interests as defined in s. 408. 803. An administrator shall

designate, in writing, for each licensed entity, a qualified alternate administrator to serve

during the administrator' s absence.

Section 408. 806 ( 1), F. S., " An application for licensure must be made to the agency on forms

furnished by the agency, submitted under oath, and accompanied by the appropriate fee in

order to be accepted and considered timely. The application must contain information

required by authorizing statutes and applicable rules..."

Section 59A- 0095 ( 8. a) 2., F. C., A. Administrator.

a) The administrator of the agency shall:

2. Designate, in writing a direct employee or an individual covered under a management

company contract to manage the home health agency or an employee leasing contract,

pursuant to Section 468. 520, F. S., that provides the agency with full control over all

operational duties and responsibilities to serve as an on- site alternate administrator during

absences of the administrator. This person will be available during designated business

hours, when the administrator is not available. Available during designated business hours

means being readily available on the premises or by telecommunications. During the absence

of the administrator, the on- site alternate administrator will have the responsibility and

authority for the daily operation of the agency. The alternate administrator must meet

qualifications as stated in Section 400. 1), 462( F. S.

Section 59A- 003( 8. 10), F. C., " A. A home health agency has the following responsibility in

terms of hours of operation:

a) The home health agency administrator and director of nursing, or their alternates, must be

available to the public for any eight consecutive hours between 7: 00 a. m. and 6: 00 p. m.,

Monday through Friday of each week, excluding legal and religious holidays. Available to

the public means being readily available on the premises or by telecommunications.

b) When the _ administrator and the director of nursing are not on the premises during

designated business hours, a staff person must be available to answer the phone and the door

and must be able to contact the administrator and the director of nursing by

telecommunications. This individual can be a clerical staff person.

c) If an AHCA surveyor arrives on the premises to conduct an unannounced survey and the

administrator, the director of nursing, or a person authorized to give access to patient records,

are not available on the premises they, or the designated alternate, must be available on the

premises within an hour of the arrival of the surveyor. A list of current patients must be

provided to the surveyor within two hours of arrival if requested.

4. The applicant did not send evidence of current insurance. They submitted a binder which

indicates an intent to purchase insurance.

The pertinent statutes and rules that apply include the following;

Section 408. 806 ( 1), F. S., " An application for licensure must be made to the agency on forms

furnished by the agency, submitted under oath, and accompanied by the appropriate fee in

order to be accepted and considered timely. The application must contain information

required by authorizing statutes and applicable rules..."

Section 400. 471 ( 3) ( a) ( b), F. S., " In addition to the requirements of s. 408. 810, the home

health agency must also obtain and maintain the following insurance coverage in an amount

ivauunai ivursing roof inc

January 24, 2010

of not less than $ 250, 000 per claim, and the home health agency must submit proof of

coverage with an initial application for licensure and with each application for license

renewal:

a) Malpractice insurance as defined in s. 624. 1)( 605( k).

b) Liability insurance as defined in s. 624. 1)( 605( b)."

5. The applicant did not submit a Certificate of Status as requested in the omission letter.

The pertinent statutes and rules that apply include the following:

Section 408. 806 ( 1) F. S., " An application for licensure must be made to the agency on forms

furnished by the agency, submitted under oath, and accompanied by the appropriate fee in

order to be accepted and considered timely. The application must contain information

required by authorizing statutes and applicable rules..."

Section 59A- 004 ( 8. 2), F. A. C., " A corporate applicant shall identify the state of

incorporation, its legal name, its business name, and the names and addresses of corporate

officers and directors, the name and address of each person having at least a 5% equity

interest in the corporation. For initial and change of ownership applications and corporate

name changes, a current certificate of status or authorization pursuant to Chapter 607, F. S., is

required."

6. The applicant has two outstanding fines that have not been paid. Complaint # 2009002480 for

a Quarterly Report not submitted in July 2008 and Complaint # 2009004830 for repeat survey

deficiencies is outstanding and has not been paid. A license cannot be issued if there are any

outstanding fines to be paid by the home health agency.

The pertinent statutes and rules that apply include the following;

Section 408. 831 Denial, suspension, or revocation of a license, registration, certificate, or

application.--

1) In addition to any other remedies provided by law, the agency may deny each application

or suspend or revoke each license, registration, or certificate of entities regulated or licensed

by it:

a) If the applicant, licensee, or a licensee subject to this part which shares a common

controlling interest with the applicant has failed to pay all outstanding fines, liens, or

overpayments assessed by final order of the agency or final order of the Centers for Medicare

and Medicaid Services, not subject to further appeal, unless a repayment plan is approved by

the agency; or

b) For failure to comply with any repayment plan.

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. 1), 57( F. S.,

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

Florida Administrative Code ( F. C), A. and must state the material facts you dispute.

January 24, 2010

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

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

RE: National Nursing Pool Inc

CASE NO: 201. 0000783

ELECTION OF RIGHTS

This Election of Rights form is attached to a proposed Notice of Intent to Deem Incomplete and

Withdraw from Further Review of the Agency for Health Care Administration ( AHCA). The

title may be Notice of Intent to Deem Incomplete and Withdraw from Further Review or

some other notice of intended action by AHCA.

An Election of Rights must be returned by mail or by fax within 21 days of the day you

receive the attached Notice of Intent to Deem Incomplete and Withdraw from Further

Review or any other proposed action by AHCA.

If an Election of Rights with your selected option is not received by AHCA within twenty-

one ( 21) days from the date you received this notice of proposed action, you will have given up

your right to contest the Agency' s proposed action and a final order will be issued.

Please reply using this Election of Rights form unless you, your attorney or your representative

prefer to reply according to Chapter 120, Florida Statutes ( 2006) and Rule 28, Florida

Administrative Code.)

Please return your ELECTION OF RIGHTS to:

Agency for Health Care Administration

Attention: Agency Clerk

2727 Mahan Drive, Mail Stop 93

Tallahassee, Florida 32308

Phone: ( 850) 922- 5873 Fax: ( 850) 921- 0158

PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS:

OPTION ONE ( 1) I admit to the allegations of facts and law contained in the

Notice of Intent to Deem Incomplete and Withdraw from Further Review, or other notice

of intended action by AHCA and I waive my right to object and have a hearing. I

understand that by giving up my right to a hearing, a final order will be issued that adopts the

proposed agency action and imposes the proposed penalty, fine or action.

OPTION TWO ( 2) I admit to the allegations of facts contained in the Notice of

Intent to Deem Incomplete and Withdraw from Further Review, or other proposed action

by AHCA, but I wish to be heard at an informal proceeding ( pursuant to Section 120. 2), 57(

Florida Statutes) where I may submit testimony and written evidence to the Agency to show that

the proposed administrative action is too severe or that the fine should be reduced.

OPTION THREE ( 3) I dispute the allegations of fact contained in the Notice of

Intent to Deem Incomplete and Withdraw from Further Review or other proposed action

by AHCA, and I request a formal hearing ( pursuant to Section 120. 1), 57( Florida Statutes)

before an Administrative Law Judge appointed by the Division of Administrative Hearings.

PLEASE NOTE: Choosing OPTION THREE ( 3), by itself, is NOT sufficient to obtain a formal

hearing. You also must file a written petition in order to obtain a formal hearing before the

Division of Administrative Hearings under Subsection 120. 1),- 57( Florida Statutes. It must be

received by the Agency Clerk at the address above within 21 days of receipt of this proposed

administrative action. The request for formal hearing must conform to the requirements of Rule 28-

106. 201, Florida Administrative Code, which requires that it contain:

1. The name and address of each agency affected and each agency' s file or

identification number, if known;

2. Your name, address, and telephone number, and the name, address, and telephone

number of your representative or lawyer, if any;

3. An explanation of how your substantial interests will be affected by the Agency' s

proposed action;

4. A statement of when and how you received notice of the Agency' s proposed action;

5. A statement of all disputed issues of material fact. If there are none, you must state

that there are none;

6. A concise statement of the ultimate facts alleged, including the specific facts you

contend warrant reversal or modification of the Agency' s proposed action;

7. A statement of the specific rules or statutes you claim require reversal or modification

of the Agency' s proposed action; and

8. A statement of the relief you are seeking, stating exactly what action you wish the

Agency to take with respect to its proposed action.

Mediation under Section 120. 573, Florida Statutes, may be available in this matter if the Agency

agrees.)

License type: Home Health Agency License number: 20743096

Licensee Name: National Nursing Pool Inc

Contact person:

Name Title

Address:

Street and number City Zip Code

Telephone No. Fax No. Email ( optional)

I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the

Agency for Health Care Administration on behalf of the licensee referred to above.

Silzned: Date:

Print Name: Title:

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH

CARE ADMINISTRATION,

Petitioner,

AHCA No.: 2010005631

V. Return Receipt Requested:

7002 2410 0001 4236 3876

NATIONAL NURSING POOL INC. d/ a b/

NATIONAL NURSING POOL, INC.,

Respondent.

ADMINISTRATIVE COMPLAINT

COMES NOW the State of Florida, Agency for Health Care

Administration AHCA"), by and through the undersigned counsel,

and files this administrative complaint against National Nursing

Pool Inc. d/ a b/ National Nursing Pool Inc. hereinafter

National Nursing Pool, Inc."), pursuant to Chapter 400, Part

III, and Section 120. 60, Florida Statutes 2009), and herein

alleges:

NATURE OF THE ACTION

1. This is an action to impose an administrative fine of

6, 00 000. pursuant to Section 400. 484, Florida Statutes 2009),

for the protection of public health, safety and welfare.

t

JURISDICTION AND VENUE

2. AHCA has jurisdiction pursuant to Chapter 400, Part

III, Florida Statutes 2009).

3. Venue lies pursuant to. Rule 28. 207, 106. Florida

Administrative Code.

PARTIES

4. AHCA is the regulatory authority responsible for

licensure and enforcement of all applicable statutes and rules

governing home health agencies, pursuant to Chapter 400, Part

III, Florida Statutes 2009), and Chapter 59A- 8 Florida

Administrative Code..

5. National Nursing Pool Inc. operates a home health

agency located at 1620 W. Oakland Park Blvd, Suite 302, Oakland

Park, Florida 33311. National Nursing Pool Inc. is licensed as a

home health agency under license number 20743096. National

Nursing Pool Inc. was at all times material hereto a licensed

facility under the licensing authority of AHCA and was required

to comply with all applicable rules and statutes.

COUNT I

NATIONAL NURSING POOL INC. FAILED TO ENSURE THAT THE CLINICAL,

RECORD WAS AVAILABLE, ACCURATE, AND COMPLETE.

SECTION 400. 491, FLORIDA STATUTES

CLINICAL RECORDS STANDARDS)

CLASS III

6. AHCA re- alleges and incorporates paragraphs 1)

through ( 5) as if fully set forth herein.

7. National Nursing Pool Inc. was cited with one 1)

Class. III deficiency as a result of certification surveys

conducted on March 26, 2010 and May 10, 2010.

8. A certification survey was conducted on March 26,

2010. Based on clinical record review, observation, and

interview, it was determined that the Home - Health Agency HHA)

failed to ensure the clinical record was available, accurate,

and complete for 5 of 11 sampled patients as evidenced by no

clinical record available in the home for Patients 6 and 9;

oxygen treatment not documented on the plan of care for Patient

8; medication record not available in the clinical record for

Patient 4; and 3 weeks of clinical records not available for

review for Patient # 11. The findings include the following.

9. Patient 4 was admitted to the HHA on 02/ 10 27/ with

diagnoses to include cerebral palsy and quadriplegia. Review of

the plan of care reveals the patient is on 5 medications. Review

of the clinical record revealed no medication record for review

documenting the medications indications for use and side

effects.

10. An interview was conducted with the HHA' Assistant s,

Director of Nursing on 03/ 10 25/ at approximately 2: 30 PM who

stated he used the HHA' s Intake Information Form dated 02/ 10 22/

to generate the plan of care but has. not got around to

completing the HHA' s Medication Record sheet.

11. Patient 6 was admitted to the HHA on 07/ 09 30/ with a

diagnosis of diabetes, schizophrenia, and wound to the right

ankle. Review of the Physician ordered plan of care includes a

Home Health Aide to visit the patient 2 times a day, 7 days a

week, to assist with activities of daily living. Additionally

the patient is receiving skilled nursing services 6 days a week

for wound care to the right ankle.

12. During an in- home visit, conducted on 03/ 10 24/ at

10: 45 AN, at. the patient' s home in an Assisted Living Facility

ALF), the clinical record was requested for review from the ALF

Administrator and the ALF Administrator stated he has never seen

a chart for this patient but. checked the shelf where all the

other Horne Health Agency charts were stored and was unable to

locate the patient' s chart.

13. He then proceeded to check,\\ in the ALF record and the

was

patient' s quarters but no chart was located. An.' interview

conducted with the HHA Administrator on 03/ 10 24/ at

approximately 1: 00 PM and he was unable to explain why the

patient did not have a chart in the ALF.

14. The HHA Administrator during the interview on 03/ 10 24/

at approximately 1: 00 PM stated there should be a chart in the

home because the patient is receiving wound care and if the

nurse' s schedule changed the next nurse would have to be able to

know what the treatment was.

15. Patient 8 was admitted to the HHA on 07/ 09 27/ with

diagnoses to include failure to thrive, respiratory distress,

and tracheostomy. Review of the plan of care reveals the patient

is receiving skilled nursing care 16 hours a day Monday through

Friday, and 12 hours on the weekend to do in part vital sign

monitoring including respiratory status.

16. During a home visit, conducted on 03/ 10 25/ at 10: 50 AM

accompanied by the Assistant Director of Nurses, an oxygen

concentrator and, oxygen was observed in the patient' s room. An

interview was conducted on 03/ 10 25/ at 11: 00 AM with the skilled

nurse taking care of the patient who stated the patient requires

oxygen at 2 liters per minute during sleeping hours with

continuous oxygen saturation monitoring and she stated during

the interview on 03/ 10 25/ at 11: 00 AM, the patient uses oxygen

prn as needed) if the patient is having respiratory distress.

17. Review of the patient' s plan of care reveals under DME

Durable Medical Equipment) and Supplies documentation of oxygen

concentrator and oxygen tank. There is no evidence of

documentation of amount or frequency for use.

18. Patient 9 was admitted to the HHA on 05/ 09 27/ with a

re- certification period of 02/ 10. 02/ The principal diagnosis on

the plan of care is documented as open wound and other pertinent

diagnosis as paraplegia. Review of the plan of care reveals the

patient is receiving Home Health Aide services 8 hours a day 7

days a week to assist with activities of daily living and a

skilled nursing visit every 60 days for a complete asse. ssment,

review of medications and to reevaluate the plan of care.

19. During a home visit conducted on 03/ 10 24/ at 10: 00 AM

accompanied by the HHA Administrator and Assistant Director of

Nurses the home clinical record was requested from the Home

Health Aide. She stated, during an interview, on 03/ 10 24/ at

10: 00 AM that there is no chart in the home and hands in her

sheets to the office. The patient stated, on 03/ 10 24/ at 10: 00

AM, during an interview, there was a chart a long time ago but

s/ s he' not sure where it might be and the patient stated s/ he

did have a pressure ulcer to the buttocks area but it healed

months ago.

20. An interview was- conducted with the qHA Administrator

on 03/ 10 24/ at approximately 10: 15 AM who stated there should be

6 r

a chart in the, home so if a different Aide came in she would

know what the plan of care would be. Additionally, he stated

during the interview on 03/ 10 24/ at approximately 10: 15 AM, when

the nurse comes in to do an assessment they need to know if

there are any changes in treatment or medications.

21. Patient 11 was admitted to the HHA on 06/ 09 19/ with

diagnosis to include osteomyelitis to the right thigh requiring

intravenous antibiotics 3 times daily. Review of the Physician

ordered plan of care revealed the patient was to have skilled

nursing visits 2 times a day 7 days a week to take vital signs,

check incision area, and check for any signs of infection; to

teach patient and caregiver how to push intravenous antibiotics

using sterile technique; clean intravenous site using sterile

technique and to inform the supervisor and physician of any

changes.

22. Review of the clinical record on 03/ 10 23/ revealed no

Skilled Nursing Notes available for review from 06/ 09 20/ through

07/ 09. 10/ On 03/ 10 23/ at approximately 2: 00 PM, a request was

made to the HHA Administrator for the missing Skilled Nursing

Notes for the period 06/ 09 20/ through 07/ 09. 10/ At 5: 00 PM, on

03/ 10 23/ the HHA Administrator stated the Home Health Agency has

recently gone through a staff turnover and they are still unable

Ito locate the missing notes stating they may have been misfiled.

23. An interview was conducted on 03/ 10 24/ at 12: 15 PM

with the HHA Administrator who stated they are looking in

storage for the missing notes. As of exit on 03/ 10 26/ at 11: 00

AM, the Skilled Nursing Notes were not forthcoming.

24. The mandated date of correction was designated as

April 25, 2010.

25. A follow- up survey was conducted on May 15, 2010.

Based on record review and interview, it was determined that the

Home Health Agency failed to maintain a complete and accurate

clinical record for 6 of 6 sampled patients reviewed Patient

1, 2, 3, 4, 5 and # 6) as evidenced by: incomplete physician

orders for oxygen for Patient 1; need for skilled care not

evident for Patient # 2, diet order not clarified and no evidence

of documentation of BID twice daily) HHA Home Health Aide)

visits as ordered; incomplete physician orders for Pulse

Oximetry and Oxygen and an inaccurate diagnosis of Gastrostomy

with lack of diet clarification for Patient 3; evidence of

inaccurate HHA documentation for Patient 4; no evidence of

documentation of QID four times daily) HHA physician visits for

Patient 5 and incomplete physician' s orders for Pulse Oximetry

and Oxygen for Patient # 6. The findings include the following.

26. Record review for Patient 1 reveals a POC dated

05/ 10 01/ through 06/ 10 29/ with physici4n' s orders to include SN

Skilled Nursing) 6 hours daily. 02 Oxygen) is listed under DME

1

Durable Medical Equipment) and supplies though there is no

evidence of a physician' s order on the POC as to when the oxygen

is to be used, at what rate or by what means. During an

interview with the DON Director of Nursing) on 05/ 10 10/ at 1: 15

PM, she could give no explanation.

27. Record review for Patient 2 reveals a start of care

date of 01/ 09. 16/ The POC dated 03/ 10 12/ through 05/ 10 10/

includes physician' s orders for SN twice daily to administer

tube feeding and HHA Home Health Aide) to assist with personal

care needs twice daily, 7 days a week. The POC also specifies

that the patient is to receive a Pure po by mouth) diet in

addition to the tube feeding.

28: Review of the clinical documentation reveals a

caregiver teaching sheet which documents that the patient' s

caregiver is competent in administering the patient' s tube

feeding. During an interview with the DON on 05/ 10 10/ at 1: 15

PM, she was asked why a SN is needed twice daily to administer

the patient' s tube feeding if the caregiver is competent in the

task; she responded that she does not think that the caregiver

is able to administer the patient' s tube feeding; she could not

explain why the caregiver teaching sheet in the clinical record

documents that the caregiver is competent in this task and she

was asked what a Pure po" diet is, as listed on the", POC; she

responded that this should have been puree.

29. Further review of the HHA visit documentation reveals

only 1 visit entry per day rather than the twice daily visits as

ordered and the time of the visits is not documented. During the

05/ 10, 10/ 1: 15 PM interview with the DON, she states that the

HHA is using one visit entry to document both visits for the

day; she agreed that each visit should be documented separately.

30, Record review for Patient 3 reveals a POC f rom

03/ 10 19/ through 05/ 10 17/ for SN 16 hours daily Monday through

Friday and 12 hours daily on Saturday and Sunday with

physician' s orders to include Tracheostomy care and

administration of medications and nebulizer treatments.

31. Under DME/ supplies on the POC is listed a Pulse

Oximeter and 02 concentrator and. tank. There is no evidence of a

physician' s order on the POC as to when the Pulse Oximeter is to

be used or when the oxygen is to be used, at what rate or by

what. means. This was confirmed during the 5/ 10, 10/ 1: 15 PM

interview with the DON. There is a diagnosis of Gastrostomy on

the POC and nutritional requirements include Pediasure 4 cans

daily. There is no evidence of documentation of a physician' s

order to indicate how the Pediasure is to be administered.

32. During the 5/ 10, 10/ 1: 15 PM, interview with the DON,

she states that the patient' s Gastrostomy has been closed for a

while " land the Pediasure is given by mouth and she agrees - that

the Gastrostomy diagnosis should have been removed from the POC.

Further review reveals that there is a March 2010 medication

administration record in the clinical record that documents that

the patient is taking medications and the Pediasure by mouth and

Oxygen is administered at 2 liters per minute via trash

Tracheostomy) as needed for an oxygen saturation level below

92%.

33. Record review for Patient 4 reveals a POC dated

04/ 10 14/ through 06/ 10 12/ with physician' s orders for a HHA 8

hours daily Monday through Friday and 12 hours daily on Saturday

and Sunday to assist the patient with personal care needs.

Documentation on the POC and the medication sheet indicate that

the patient takes no medications.

34. Review of the HHA visit documentation from 04/ 10 09/

through 04/ 10 23/ reveals indications that the HHA is just

checking off boxes down the HHA visit form rather than

documenting what was actually performed during the visit; this

is indicated by the tact that the HHA is documenting a bed bath,

chair bath and shower each visit, a shave, and a pedicure each

visit and a reminder to the patient to take medications each

visit there is evidence of documentation that the patient is on

no medication.) This was confirmed during the 05/ 10 10/ 1: 15 PM

interview with the DON.

35. Record review for Patient 5 reveals a POC dated

04/ 10 09/ through 06/ 10 07/ with physician' s orders for a HHA to

assist the patient with personal care needs 4 times daily, 7

days a week. Review of the HHA visit documentation reveals only

1 visit entry per day rather than the four daily visits as

ordered.

36. During the 05/ 10, 10/ 1: 15 PM interview with the DON,

she states that the HHA is using one visit entry to document all

visits for the day; she agreed that each visit should be

documented separately. Continued review reveals that there is a-

communication note in the clinical record that the patient left

for Jamaica on 04/ 10 17/ and would be gone for 1 month. During

the 05/ 10 . 10/ 1: 15 PM interview with the DON, she was asked why

the patient requires a HHA 4 x daily, if the patient is able to

travel to Jamaica and she responded that the patient has never

done this before and that there was some kind of family

emergency. There is no evidence of documentation in the clinical

record as to the reason for the patient.' s trip, how the patient

was able to travel, who escorted the patient or how the

patient' s care needs would be met while away.

37. Record review for Patient 6 reveals a POC dated

04/ 10 24/ through 06/ 10 22/ with physician orders for SN 24 hours

daily. DME/ supplies on the POC include a Pulse Oximeter and 02

concentrator. There is no evidence of documentation of a

physician' s order to specify when a pulse oximeter reading is to

be done and 02 orders only specify, as needed to maintain 02

saturation levels above 90%. The orders do not include the rate

of oxygen administration or means. This was confirmed during the

5/ 10, 10/ 1: 15 PM interview with the DON. This is an uncorrected

deficiency from the survey of March 26, 2010.

38. Based on the foregoing facts, National Nursing Pool

Inc. violated Section 400. 491, Florida Statutes, herein

classified as an uncorrected Class III deficiency, which

warrants an assessed fine of 6, 00 000. pursuant to Section

400. 2)( 484( c), Florida Statutes.

CLAIM FOR RELIEF

WHEREFORE, the Agency requests the Court to order the

following relief:

1. Enter a judgment in favor of the Agency for Health

Care Administration against National Nursing Pool Inc. on Count

I.

2. Assess against National Nursing Pool Inc. an

administrative fine of 6, 00 000. on Count I for the violation

cited above.

3. Assess costs related to the investigation and

prosecution of this matter, if applicable.

4. Grant such other relief as the court deems is just and

proper on Count I.

Respondent is notified that it has a right to request an

administrative hearing pursuant to Sections 120. 569 and 120. 57,

Florida Statutes. Specific options for administrative action are

set out in the attached Election of Rights. All requests for

hearing shall be made to the Agency for Health Care

Administration and delivered to the Agency Clerk, Agency for

Health Care Administration, 2727. Mahan Drive, Ms 3,

Tallahassee, Florida 32308.

RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A

REQUEST FOR A HEARING WITHIN TWENTY- ONE 21) DAYS OF RECEIPT OF

THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED

IN THE COMPLAINT AND THE ENTRY OF- A FINAL ORDER BY THE AGENCY.

IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE

REPRESENTED BY AN ATTORNEY IN THIS MATTER

QA- CL t

Alba M. Rodr~. g - e z q

Fla. Bar No.: 0880175

Assistant General Counsel

Agency for Health Care

Administration

8350 N. W. 52 Terrace - # 103

Miami, Florida 33166

Copies furnished to:

Arlene Mayo- Davis

Field Office Manager

Agency for Health Care Administration

5150 Linton Blvd. Suite 500

Delray Beach, Florida 33484

U. S. Mail)

CERTIFICATE OF. SERVICE

I HEREBY CERTIFY that a true and correct copy of the

foregoing has been furnished by U. S. Certified Mail, Return

Receipt Requested to Administrator, National Nursing Pool Inc.,

1620 W. Oakland Park Blvd. Suite 302, Oakland Park, Florida

33311 on this 20th day of July, 2010.

G~

Alba M. Rodrig ez, Esq.

COMPLETE THIS SECTION ON DFLIVERY

Kai e • soul 10 11111 A I' I' m M U fiery d 3. Is Also desired. complete A• C1

m e dress on the reverse X Addressee Agent

fie card to you, B. Recely d W( Pt, a mel C. to of

rn m jj a • wk of the mall p iece, Delivery

f' iJ F F i L UE __ 1 _ p ermits. D. Is address different J~

Postage $ If delivery from Bern 1 ? Yes

O r9 Certified YES, enter delivery address below; 1: 3 No

C3 Fee

O RelumReclepiFee 1'~ 73i~ . 0 L~ 1L

EndorsementRequhed) Postmarky!(, here

r'• R ( Endorsement Restricted 1) My Fee Y L 1/ Yt Ci ~( i 1 1~

Required) 3.

rU Total Postage & Fees Service Type

t ( wihcu 31311 O Certified Registered Mail O C] Express Return Recelpt M for Merchandise

Q o ent o I] Insured Mall b c. D. o.

grraet, Or PC) apt ` riflo~' f - ~ 1 0 10ted Delivery? ( Extra Fee) O Yes

sre" ; n._ c PAML... i0 0001 4236 3876 lt7

CU..

2004 Domestic Return Receipt t^ „ 108595. M- 02- 1540

tax: Uct 21 ZUIU UZ: 42pm NU 13/ 1Y9 1.

7160 3901 4646 6606 3230.

700, l

CHARILIE CRIST gatbr Flrrlth Can for aN EUZABETH DU 9

GOVERNOR Florldlona INTERIM SEq P~

F~ AAi~ EI` Y„

October 3, 2010

ADMINISTRATOR LICENSE NUMBER; . 211743096

NATIONAL NURSING POOL INC CASE 2, 010009639

16M W OAKLAND PARK BLVD STE 302

OAKLAND PARK, FL 33311

NM CE OF NT TO DENY

The application for license renewal for National Nursing Pool Inc located at 1620 W. Oakland Park Blvd.,

Ste 302, Oakland Park, F133311. is DENg: D. The reasons for the denial is a pattern of deficient practice

and individuals who are not the owners of record attempting to renew the license of the home health

agency. .

The basis for this action is pursuant to autbority of 120. 60 Florida Statutes ( F. S.), 408. 815 ( 1)'( a), ( c), and

d), P. S.; Section 400 474 ( 1) ( 2) ( a), F. S. and Section 408. 807 ( 3) ( a), F. S. which states as follows:

400. 813. ( 1).( a), ( c); ( d), F. S., ( 1) " In addi0oa to the grounds provided in authorizing statutes,.

grounds that ' may be used by the agncy for denying and revoking a license , include any of the

following actims by a contmooM* iater esr

a) False representation of a material fact in the license application or omission of any material .

fact from the application.

c) A violation of this part, authorizing statutes, or applicable rules,

d) A demonstrated pattern of deficient perfoomance."

400. 474 ( 1) ( 2) ( a), F. S., " The agency may deny, revoke, and suspend a license and impose an

administrative fine in the manner provided in chapter 120.

2) Any of the following actions by a home health agency or its emiployee is grounds for

disciplinary. acdon by the agency:

a) Violation of this part, part II of chapter 408, or of applicable rules. "

L The home health agency has not demonstrated compliance with Chapter 400; Part III, F. S. and the

state home health agency rules, Chapter 59A- 8, F- C. in A. a combined total of four home health

agency hcensure and complaint surveys dating back to March of 2008, Below are the deficiencies

from the surveys which clearly demonstrate a pattesa of deficient performance.

A. A survey conducted on March 11, 2008 through Munch 13, 2008 had three deficiencies. Non-

compliance wort found in the following areas:

2727 Mahan Drlve, 1019e34 Visit AMCA online at

Tallahaesse, Florida 32308 ahoa. com myflorlda.

Fax: Oct 21 2010 02: 42on P014/ 029

National Nursing Pool Inc

October 3, 2010

H 204 The home health agency failed to conduct level l statewide

5 of the 8 employees sampled. The home health background screening for

notarized Affidavits of Good Moral agency also did not have signed and

Character for 7 of 8 employees sampled.

H 302 The home health agency failed to establish and/ or ensure the of

followed or that the physician was nodfred that the patient' s plan care was

11 patients included were plan of care could not be followed for 5 of

instances sampled, multiple missed skilled nursing visits and multiple

of not checking blood sugar of diabetic patients. This was a repeat Non-

compliance was found in a survey in 2005. The home health deficiency.

AHCA cane 2008005200. April agency was & ne $ 1, 500 in

H360 The home health agency failed to maintain a clinical record with infatuation

for the safe and adequate care of the patients for 9 of 11 necessary

multiple instances of not sampled patients. Included were

comprehensivd conducting medication reviews and lack of evidence of a

assessment being conducted prior to start of care or 60 day follow up visits.

I A complaint investigation conducted on March 3, 2009 found two

compliance was found in the deficiencies. Non

following area:

H204, The home health agency failed to maintain personnel files that contained and .

notarized Affidavits of Good Moral Character foams for 2 of 10 signed

a repeat deficiency from March 13, 2008. A $ fine employees sampled. H204 is

1, 500 was unposed by case 2009004830.

H 215 The hone health agency failed to submit and have documentation in

employee' s persounal files for 4 of 10 required the

that a Level 1 files reviewed. Two. of the files contained no evidence

frames. background screen bad been requested in accordance with required time

Two of the files contained no evidence of a Level 1 background screening being

conducted for the two new employees.

It should be noted that the.

C. A complaint investigation conducted car February 25, 2010 found four one

which was a repeat deficiency from the deficiencies, of

in the areas: Mareh. 13, 2008 survey. Non ' compiiance. was found

following

H 302 The home health. agency failed to provide the' home visits with the and

amount of hours ordered by the physician for 4• of 9 frequency

to be made, of the patients sampled. When changes needed

approve changes were not obtained from the physician. This was. a repeat

deficiency.

H 315 The home health agency failed to provide staff to conduct' visits to

physicians orders for 2 of 5 according

patients sampled.

H 320 The home health agency failed to provide the home visits with ordered.

by the physician as contained in the of care far 4 of 9 the. frequency

plan padents' sampled.

H 331 The home health agency documented. and billed. Medicaid for additional. hours of home

visit care that was not ordered by the physician for 4 of 9 patients. This patient records of

these individuals contained fraudulent information with regard to the actual' viihs delivered.

rax: uct Zi Zuiu uGa[ vm Mlb/ UZy

National Nursing Pool Inc

October 3, 2010

D. A home health agency licensure survey conducted on March 23- 2010 26, found five

deficiencies. In the follow up visit conducted oa May 10, 2010, one of the deficiencies was

repeated and an additional now deficiency was: also cited. Non compliance was found n the

following areas:

H 230 The home health agency' s registered nurse failed to ensure the physician was notified

of a delay and deviation of the plan of care for 2 of 11 sampled patieats.

H 240 The home health agency failed to ensure RN supervisory visits were conducted for the

home health tide for 1 of 5 sampled patients receiving ' home health aide visits

H350 The home health agency failed to ensure the clinical record was available, accurate and

complete for 5 of 11 sampled patients.

H 373 The home health agency' s Comprehensive 13mergeacy Management Plan did not

contain how the home health agency would continue to provide services to patients who

evacuate to special mods shelters.

H 375 The home health agency did not maintain ' a cut Tent and prioritized list of patients in the

event of an emergency or disaster siwation. There was no information on how services

would be continued, what services would be provided and the patient' s medication and

equipment nerds.

In the follow up visit conducted on May 10, 2010, H 350 was unconncted in the follow up

visit and an additional deficiency H 320 was cited-

H 350 was uncorrected in the follow up visit, conducted on May 10, 2010. The home health

Agency failed to maintain a complete and accurate ellnical record for 6 of 6 sampled patients

reviewed,

H 320 The home health agency failed to ensure that the plan of care included complete

physician cadets for all services required for 3 of 6 sampled patients reviewed

2. The owners of zecord, Kurt Josaph and Jose Urena did not apply for the renewal of the National

Nursing Pool Inc home health agency license. The proposed buyers of the home health agency,

Yehia Abdelmonem and Linda Vmh submitted the apPplicatioa for renewal of the home health

igency. license. A change of ownership. Application for this provider was. deemed' incomplete and

withdrawn from further consideration on January 24, 2010. The change of ownership has not

beta approved by AHCA. Therefore only the owner of record can renew the home health agency

license.

The pertinent statutes and rules that apply include the following:

Section 408.$ 07 ( 1) through ( 3), Florida Statutes ( F. S.)

Section 400. 8); 471( F. S.

Section 408. 815 ( 1) ( c). F. S.

Section 400. 474 ( 1X2Xa), F. S.

Section 59A- 993 ( 8. 6) ( a), Florida Administrative Code ( F. C.) A.

Section 59A- 0086 ( 8. 1) ( d), F. C. A.

Fax: Oct 21 2010 02. 42pm P016/ 029 i

National Nursing Pool Inc

October 3, 2010

E20ANATION OF RI

Pursuant to Section 120. 569, P. S., you have the right to request an administrative In order to

obtain a formal proceeding before the Division of hearing.

your request for an Administrative Hearings under Section 120. 1), S., 57( 1~.

Florida administrative hearing must conform to the requirements in Section 28- 201, 106.

Administrative Code ( F. C), A. and must state the material face you dispute.

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS.

Anne Menard, Manager

Home cue unit

Cc: Agency Clerk, MS # 3

Legal Intake, MS # 3

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

NATIONAL NURSING POOL, INC.,

Petitioner, DOAH NO: 10- 1502

AHCA NO: 2010000783

VS.

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Respondent.

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner, CASE NO: 10- 515PH

AHCA NO: 2010005631

VS.

NATIONAL NURSING POOL, INC.,

Respondent.

NATIONAL NURSING POOL, INC.,

Petitioner, DOAH NO: 10- 9952

AHCA NO: 2010009639

VS.

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Respondent.

SETTLEMENT AGREEMENT

State of Florida, Agency for Health Care Administration ( hereinafter the " Agency"),

through its undersigned representatives, and National Nursing Pool, Inc. ( hereinafter " National

Nursing"), pursuant to Section 120. 4), 57( Florida Statutes, each individually, a " party,"

collectively as " parties," hereby enter into this Settlement Agreement (" Agreement") and agree

as follows:

EXHIBIT 2

WHEREAS, National Nursing is an applicant for a Change of Ownership for a Home

Health Agency licensed pursuant to § 400, Part III, Florida Statutes, and Fla. Admin. Code R.

59A- 8; and

WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing

authority over Home Health Agencies, pursuant to § 400, Part III, Florida Statutes; and

WHEREAS, the Agency served National Nursing with a Notice of Intent to Deem

Application Incomplete and Withdrawn from Further Review on or about January 24, 2010

AHCA # 2010000783); and

WHEREAS, the Agency served National Nursing Pool, Inc. with an administrative

complaint on or about July 20, 2010, notifying National Nursing Pool, Inc. of its intent to impose

an administrative fine in the amount of six thousand dollars ($ 6, 00) ( 000. AHCA # 2010005631);

and

WHEREAS, the Agency served National Nursing Pool, Inc. with a Notice of Intent to

Deny an application for renewal of licensure on or about October 3, 2010 ( AHCA #

2010009639); and

WHEREAS, National Nursing requested formal administrative proceedings by selecting

Option 3 on the Election of Rights form for AHCA # 2010000783 and AHCA # 2010009639 ;

and

WHEREAS, National Nursing requested an informal administrative proceedings by

selecting Option 2 on the Election of Rights form for AHCA # 2010005631; and

WHEREAS, the parties have negotiated and agreed that the best interest of all the parties

will be served by a settlement of this proceeding; and

NOW THEREFORE, in consideration of the mutual promises and recitals herein, the

parties intending to be legally bound, agree as follows:

I . All recitals herein are true and correct and are expressly incorporated herein.

2. Both parties agree that the " whereas" clauses incorporated herein are binding

findings of the parties.

3. Upon full execution of this Agreement, National Nursing. agrees to waive any and

all appeals and proceedings to which it may be entitled including, but not limited to, an informal

proceeding under Subsection 120. 2), 57( Florida Statutes, a formal proceeding under Subsection

120. 1), 57( Florida Statutes, appeals under Section 120. 68, Florida Statutes; and declaratory and

all writs of relief in any court or quasi- court of competent jurisdiction; and agrees to waive

compliance with the form of the Final Order ( findings of fact and conclusions of law) to which it

may be entitled, provided, however, that no agreement herein shall be deemed a waiver by either

party of its right to judicial enforcement of this Agreement.

4. Upon full execution of this Agreement, National Nursing agrees to pay an

administrative fee of Five Hundred Dollars ($ 500. 00) in connection with AHCA# 2010009639

and an administrative fine of Six Thousand Dollars ($ 6, 00) 000. in administrative fines to the

Agency in connection with AHCA# 2010005631 within thirty ( 30) days of the entry of the Final

Order.

5. Upon full execution of this Agreement, the Agency agrees to rescind the Notice of

Intent to Deny issued on October 3, 2010, and process the renewal application filed for License

20743096, which is the subject of AHCA# 2010009639, and to rescind the Notice of Intent to

Deem Application Incomplete and Withdrawn issued on January 24, 2010, and process the

CHOW application, which is the subject of ACHA# 2010000783 with an effective date of June

21, 2012.

6. Venue for any action brought to enforce the terms of this Agreement or the Final

Order entered pursuant hereto shall lie in Circuit Court in Leon County, Florida.

7. By executing this Agreement National Nursing does not admit, and the Agency

continues to assert, the validity of the allegations set forth in the administrative complaint and

Notices of Intent referenced herein. The Agency agrees that it will not impose any further

penalty against National Nursing as a result of the survey identified in the administrative

complaint in AHCA# 2010005631 or the Notices of Intent. However, no agreement made herein

shall preclude the Agency from imposing a penalty against National Nursing for any

deficiency/ violation of statute or rule identified in a future survey of National Nursing which

constitutes a " repeat" or " uncorrected" deficiency from surveys identified in the administrative

complaint. The parties agree that in such a " repeat" or " uncorrected" case, the deficiencies from

the surveys identified in the administrative complaint shall be deemed found without further

proof.

8. No agreement made herein shall preclude the Agency from using the deficiencies

from the surveys identified in the administrative complaint in any decision regarding licensure of

National Nursing including, but not limited to, licensure for limited mental health, limited

nursing services, extended congregate care, or a demonstrated pattern of deficient performance.

The Agency is not precluded from using the subject events for any purpose within the

jurisdiction of the Agency. Further, National Nursing Pool, Inc. acknowledges and agrees that

this Agreement shall not preclude or estop any other federal, state, or local agency or office from

pursuing any cause of action or taking any action, even if based on or arising from, in whole or

in part, the facts raised in the administrative complaint. This agreement does not prohibit the

Agency from taking action regarding National Nursing' s Medicaid provider status, conditions,

requirements or contract.

9. Upon full execution of this Agreement, the Agency shall enter a Final Order

adopting and incorporating the terms of this Agreement and closing the above- styled cases.

10. Each party shall bear its own costs and attorney' s fees.

11. This Agreement shall become effective on the date upon which it is fully executed

by all the parties.

12. National Nursing for itself and for its related or resulting organizations, its

successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge

the State of Florida, Agency for Health Care Administration, and its agents, representatives, and

attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses, and

expenses, of any and every nature whatsoever, arising out of or in any way related to this matter

and the Agency' s actions, including, but not limited to, any claims that were or may be asserted

in any federal or state court or administrative forum, including any claims arising out of this

agreement, by or on behalf of National Nursing or related facilities.

13. This Agreement is binding upon all parties herein and those identified in

paragraph twelve ( 12) of this Agreement.

14. In the event that National Nursing was a Medicaid provider at the subject time of

the occurrences alleged in the complaint herein, this settlement does not prevent the Agency

from seeking Medicaid overpayments related to the subject issues or from imposing any

sanctions pursuant to Rule 59G- 070, 9. Florida Administrative Code.

15. National Nursing. agrees that if any funds to be paid under this agreement to the

Agency are not paid within thirty- one ( 31) days of entry of the Final Order in this matter, the

Agency may deduct the amounts assessed against National Nursing in the Final Order, or any

portion thereof, owed by National Nursing to the Agency from any present or future funds owed

to National Nursing by the Agency, and that the Agency shall hold a lien against present and

future funds owed to National Nursing by the Agency for said amounts until paid.

16. The undersigned have read and understand this Agreement and have the authority

to bind their respective principals to it.

17. This Agreement contains and incorporates the entire understandings and

agreements of the parties.

18. This Agreement supersedes any prior oral or written agreements between the

parties.

19. This Agreement may not be amended except in writing. Any attempted

assignment of this Agreement shall be void.

20. All parties agree that a facsimile signature suffices for an original signature.

THE REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK

voivirZv1c IC i. LS 7V606brbl! URUCK101OURNTTURE 41838 P. 001l001

The following epresentatives hereby acknowledge that they ire duly authorized to enter

into this Ageernent.

Molly stry eltia Ab a on m

Deputy Secretary Administrator

National Nursing Pool, Inc.

1620 West Oakland Blvd.

Oakland Park, Florida 33311

DATED: U TBD;

William H. Roberts, squire Mi iael P. Gennett

Deputy General Cow el orida Bar No. ) 7871

Florida Bar No. 5866 7 Al` n ei= Sente~ ltt

1 Southeast 3rd Avenue, Floor 25

Miami, Florida 33131- 1700

DATED: DATED: l1 f r

J

ar ton ! 1rf" rgea; r~

Assis tant. General Co

Florida Bar No.: 793 Fnsel

DATED:

r

Alba M. Rodriguez, s ire

Assistant General Cep inset

Florida Bar No. 9301 5

DATED: o Z

Agency for Heals C' e- A inistration

2727 Malian Drive, A S # 3