11-004344 Agency For Health Care Administration vs. Guardian Angel Adult Care Services Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, November 1, 2011.

FILED

leA

STATE OF FLORIDA AGENCY CLERK

AGENCY FOR HEALTH CARE ADMINISTRATION

2011 DEC 21 A 10:

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION, DOAH NOs.: 11-4344

11-4545

Petitioner, 11-3384

v. AHCA NOs.: 2011004274

2011004026

GUARDIAN ANGEL ADULT CARE 2011006078

SERVICES, LLC d/b/a GUARDIAN ANGEL RENDITION NO.: AHCA-ll- It.1tp() -S-OLC

ADULT I CARE SERVICES

Respondent.

----------------_---:/

FINAL ORDER

Having reviewed all matters of record, the Agency for Health Care Administration finds and

concludes as follows:

I

1. The Agency has jurisdiction over the above-named Respondent pursuant to Chapter 408,

Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions.

2. The Agency issued the attached two Notices of Intent (Case Nos. 2011004026 &

2011006078) and an Administrative Complaint (Case No. 2011004274), each with an Election of Rights

form to the Respondent (Ex. 1,2 & 3 respectively). The Election of Rights forms advised of the right to

administrati ve hearings.

3. The parties herein entered into the attached Settlement Agreement (Ex. 4).

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 Respondent's application for relicensure to operate as a homemaker and companion

service is hereby denied.

3. The Respondent's application for a nurse registry license is hereby denied.

4. The Respondent shall pay the Agency $6,000.00. The first two thousand five hundred

($2,500.00) shall be due and payable within thirty (30) days of the date of the Final Order; the remainder

shall be due on or before May 30, 2012. If full payment has been made, the cancelled checks act as

1

Filed December 21, 2011 4:46 PM Division of Administrative Hearings

receipts of payment and no further payment is required. Overdue amounts are subject to statutory

interest and may be referred to collections. All checks shall contain all three ten-digit AHCA case

numbers, shall be made payable to the "Agency for Health Care Administration" and be shall be sent to:

Office of Finance and Accounting

Revenue Management Unit

Agency for Health Care Administration

2727 Mahan Drive, MS 14

Tallahassee, Florida 32308

5. The Respondent is responsible for any refunds that may be due to any clients.

6. The Respondent is responsible for retaining and appropriately distributing client records

as prescribed by Florida law. The Respondent is advised of Section 408.810, Florida Statutes. The

Respondent should also consult the applicable authorizing statutes and administrative code provisions as

well as any other statute that may apply to health care practitioners regardingclient records.

7. The Respondent is given notice of Florida law regarding unlicensed activity and advised

of Section 408.804 and Section 408.812, Florida Statutes. The Respondent should also consult the

applicable authorizing statutes and administrative code provisions. The Respondent is notified that the

cancellation of an Agency license may have ramifications potentially affecting accrediting, third party

billing including but not limited to the Florida Medicaid program, and private contracts.

ORDERED at Tallahassee, Florida, on this day , 2011.

ry

dministration

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..s2,Py of this Final Order was served on the below-named

persons by the method designated on this of , 2011.

Agency for Health Care Administration

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

Tallahassee, Florida 32308-5403

Telephone: [phone]

Copies:

Jan Mills Finance & Accounting

Facilities Intake Unit Revenue Management Unit

(Electronic Mail) (Electronic Mail)

Nicole Stone Bernadine Stone

Guardian Angel Adult Care Services, LLC Guardian Angel Adult Care Services, LLC

1899 Murrell Road, Ste. 100 1899 Murrell Road, Ste. 100

Rockledge, FL 32955 Rockledge, FL 32955

(U.S. Mail) (U.S. Mail)

Suzanne Suarez Hurley, Attorney George Indest, Esquire

Office of the General Counsel The Health Law Firm

Agency for Health Care Administration 1101 Douglas Avenue

(Electronic Mail) Altamonte Springs, FL 32714

(U.S. Mail)

Shawn McCauley Katrina Derico- Harris

Medicaid Contract Management Medicaid Accounts Receivable

Agency for Health Care Administration Agency for Health Care Administration

(Electronic Mail) (Electronic Mail)

Anne Menard, Unit Manager J. D. C. Newton, II

Home Care Unit Administrative Law Judge

Agency for Health Care Administration Division of Administrative Hearings

(Electronic Mail) (Electronic Mail)

Theresa DeCanio, Field Office Manager J. D. Parrish

Area 7- Orlando Administrative Law Judge

Agency for Health Care Administration Division of Administrative Hearings

(Electronic Mail) (Electronic Mail)

NOTICE OF FLORIDA LAW

408.804 License required; display.--

(1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers

or provides services that require licensure, without first obtaining from the agency a license authorizing

the provision of such services or the operation or maintenance of such provider.

(2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address

that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not

be sold, assigned, or otherwise transferred,voluntarily or involuntarily. The license is valid only for the

licensee, provider, and location for which the license is issued.

408.812 Unlicensed activity.--

(1) A person or entity may not offer or advertise services that require licensure as defined by this part,

authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency.

A licenseholder may not advertise or hold out to the public that he or she holds a license for other than

that for which he or she actually holds the license.

(2) The operation or maintenance of an unlicensed provider or the performance of any services that

require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed

activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or

any state attorney may, in addition to other remediesprovided in this part, bring an action for an

injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed

provider or the performance of any services in violation of this part and authorizing statutes, until

compliance with this part, authorizing statutes, and agency rules has been demonstrated to the

satisfaction of theagency.

(3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after

receiving notification from the agency, such person or entity fails to cease operation and apply for a

license under this part and authorizing statutes, the person or entity shall be subject to penalties as

prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate

offense.

(4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for

each day of noncompliance.

(5) When a controlling interest or licensee has an interest in more than one provider and fails to license

a provider rendering services that require licensure, the agency may revoke all licenses and impose

actionsunder s. 408.814 and a fine of$l,OOO per day, unless otherwise specified by authorizing statutes,

against each licensee until such time as the appropriate license is obtained for the unlicensed operation.

(6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a

person or entity is operating or maintaining a provider without obtaining a license and determines that a

condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person

or entity is subject to the same actions and fines imposed against a licensee as specified in this part,

authorizing statutes, and agency rules.

(7) Any person aware of the operation of an unlicensed provider must reportthat provider to the

agency.

900a 9111 0976 8947

JNiCA

RICK SCOTT Better FlallDl\\AGENCY Health FOR Care HEAlTH for CARE/>DMINISTRATlON a/l Floridians ELIzABETH DUDEK

GOVERNOR SECRETARY

April 18, 2011 2011 APR I q P 12: 2W CERTIFIED MAIL

RECEIVED

GUARDIAN ANGELADULT HOME CARR AHCA

SERVICES LLC GENERAL COUNSEL·

550 LEE AVE

SATELLITE BEACH, FL 32937

FILE #: 39963777

CASE #: 2011004026

NOTICE OF INTENT TO DENY

The Agency for Health Care Administration intends to deny the application for a renewal

registration for homemaker companion services for Guardian Angel Adult Home Care Services

LLC, located at 1899 Murrell Road, Suite 100, Rockledge, Florida 32955.

Guardian Angel Adult Home Care Services LLC was found to be providing services that require

a nurse registry license on an April 6, 2011 complaint visit to Guardian Angel Adult Home Care

Services by a surveyor from the Agency's Orlando Field Office.

1. On this visit, three of three sampled clients were found to be receiving personal care

services including bathing, toileting, dressing, physical transfers, and incontinence care,

as described in the violations of state law that were cited in the survey report.

2. The office was found to be advertising and offering services beyond the scope of its

homemaker companion registration as follows:

Two poster boards advertised the services offered, including personal care assistance

with bathing and dressing. The lettering on the poster boards was large enough to

read while standing outside looking through the large picture window at the front

entrance to the office.

Brochures were located in visible locations inside the front door of the office and also

visible through the window. The text of the brochure stated that Guardian Angel

Adult Home Care Services provides "Out-patient Assistance/Post-op Care" for

"ChemotherapylDialysis/Surgery", "Physical Therapy/Cardiac Rehab" - "Whatever

out-patient procedure you may undergo, Guardian Angel can assist you with

transportation to and from your procedures; as well as provide before and after

care ... " This is the same brochure that was included in the previous Notice of Intent

to Deny, case 2010012272. Nicole Stone, owner of Guardian Angel Adult Care

2727 Mahan Drive,MS#34

Tallahassee, Florida 32308

GUARDIAN ANGEL Af 'JT HOME CARE SERVICES LLC

Page 2

APli118,20ll

Services, had submitted a statement on March 8, 2011 that she would refrain from

using the brochure until legally licensed to perform personal care.

The basis for this action is pursuant to 408.815(l)(c), FIOlida Statutes:

"(1) In addition to the grounds provided in authorizing statutes, grounds that may be used by the

agency for denying and revoking a license or change of ownership application include any of the

following actions by a controlling interest: ...

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

The laws violated are 408.812(1) and (2); 400.462(7), (16), (12), (14),(15), (21), (24); and

400.509(1), Flolida Statutes

EXPLANATION OF RIGHTS

Pursuant to Section 120.569, F.S., you have. the light to request an administrative hearing. In

order to obtain a fonnal proceeding before the Division of Administrative Hearings under

Section 120.57(1), F.S., your request for an administrative hearing must confOlm to the

requirements in Section 28-106.201, PIOlida 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

Bureau of Health Facility Regulation

Cc: Agency Clerk, Mail Stop 3

Legal Intake Unit, Mail Stop 3

AHCA Orlando Field Office Manager

02 11 02: lOa Stone 321-773-<7254>

5T ATE OF FLORIDA FOILED

AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY AHCA CLERK

RE: GUARDIAN ANGEL ADULT HOME CARE SERVICES LLC lOll NAY -2 A q. 50 '

CASE NO: 2011004026

ELECTION OF RIGHTS

This Efection 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 bv 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 cont(lst the Agency's

prop,psed 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 #3

Tallahassee, Florida 32308

Phone: (850) 412·3630 Fax: [phone]

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 120.57(2), 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 120.57(1), Florida Statutes) before an Administrative Law Judge appointed

by the Division of Administrative Hearings.

02 11 02:10a Nir"\\le Stone 321-773-")254 p.4

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

You also must file a writlen petition in order to obtain a formal hearing before the Division of Administrative

Hearings under Subsection 120.57(1), 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 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: Homemaker Companion Service License number: 229370

Licensee Name: GUARDIAN ANGEL ADULT HOME CARE SERVICES LLC

Contact person: \\ co le f'). j±Q oe !b)a-oo.t"j E r"'"I P loyee..-

,Name Tit!

Address: \\W\\q «)4trd\\ 5=te. 10D j:"J.. 3i<>

Street and number 1 City Zip Code

3at,,_ 3,11- .

Telephone No. 1l13?r-Q136Fax No. (optional) N\\eole. Sto oe--t8-klboutl).. neT

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.

Signed: & l1. M=- Date: 4 -d9- II

Print Name: Nicole £'1\\ . .5tD..e

.- .i etLAUi '" .. '''''( N'lJ L"};;

7:li9b 1')008 CJ:hJ.1 0975 7637 "

RICK SCOTT Better flORlOAAGfNCY Health fOR Care HfA-ni for all Floridians ELIZABETH DUDEK

GOVERNOR SECRETARY

June 23, 2011 CERTIFIED MAIL

BERNADINE STONE LICENSE NUMBER:

GUARDIAN ANGEL ADULT CARE SERVICES, LLC CASE NUMBER: 2011006078

1899 MURRELL RD, 8TH 100

ROCKLEDGE, FL 32955

NOTICE OF INTENT TO DENY

Your application fOI" initial license as a Nurse Registry located at 1899 Mun-ell Rd., Ste 100, Rockledge,

F13295S is DENIED. The issues resulting itt the decision to deny the application are outlined below:

1. The applicant was delivering services without the appropriate license. investigations into

unlicensed activity were substantiated on April 6, 2011.The applicant holds a

Homemaker/Companion registration that prohibits any hands on care. However, the applicant

was adveltising the provision of post-operative care in tl1eir brochure and delivering personal care

to clients. The personal care services they were providing were outside the scope of a

and com,panion agency and constituted unlicensed activity. They do not have a license to provide

hands on service to clients.

The pertinent statutes and rules that apply include the following:

" Chapter 408.812 (2), Florida Statutes

Chapter 408.815 (1), (a)-(c) Florida Statutes

2. The applicant listed Bernadine Stone as the administrator and residing at 505 McGuire Blvd,

Indian Harbour Beach, F132937.While Ms. Stone was represented in the application as Jiving in

Florida, all other supporting documentation on Ms. Stone indicated her residenoe is actually 4405

Summertime Dr., Nashville, Tennessee 37207. Her State of Florida RN license # RN270869

(Exhibit 1) listed her residence in Nashville, Tennessee. This same Tennessee address was the

return address on the envelope u'ansmitting the application to the (See Exhibit 2) as well

as the address given on the bank statements used to show proof of funding for the operation of the

regarding this application for licensure. (See exhibits 3·7). In a search for Ms. Stone's

Nashville Tennessee connections she was found under "Linkedln" on the Internet as the current

Manager of Operations at AmeriChoice in the Insurance Department located in the Greater

Nashville Area. (See Exhibit 8).

The position of administrator in a nurse registry must be full time. Ms. Stone could not be a full

time administrator and reside in Nashville, Tennessee.

The pertinent statutes and rules that apply include the following:

Chapter 408.815 (1) (a) & (c), Florida Statutes

Chapter 59A-18.006, (5) Florida Administrative Code

2727 Mahan Visit AHCA online at

Tallahassee, Florida 32308 a hca.myflorlda.com

EXHIBIT 2

" , Guardian Angel Adult Care S)es, LLC ,I "

Page 2

June 24, 2011

3. The applicant listed Ms. Nicole Stone as the alternate administrator. Ms. Stone indicated on

application that she llad one year of experience as a Medical Secretary at St Thomas Hospital in

Nashville, Tennessee. The Employee Service Center at the hospital was contacted to verifY the

experience. The response was that Ms. Stone was a Clerical Associate for just under 10 months

from January 19, 2004 to October 10,2004. (See Exhibit 9).The administrator of a nurse registry

is required to name a qualified alternate administrator. The qualifications required for the

alternate administrator are the same as the administrator: licensed physician, a registered nurse, 01'

an individual with training and experience in health service administration and at least one year of

supervisory or administrative experience in the health care field. Ms. Nicole Stone does 110t meet

the required qualifications for the position.

TIle pertinent statutes al1d rules that apply include the following:

Chaptet' 59A-18.006 (1) &(6) Florida Administrative Code

EXPLANATION OF RIGIITS

Pursuant to Section 120.569, F.S., you have the right to request an administrative hearing. In order to

obtain afannal proceeding before the Division of Administrative Hearings under Section 120.57(1), F;S.,

your request for an administrative hearing must confol'm to the'requirements in Section 28-106.20 I,

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

SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS •

...

Anne Menard, Mallager

Home Care Unit

cc: Agency Clerk, Mail Stop 3

Legal Intake Unit, Mail Stop 3

· .

J 'I

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

BE: Guardian Angel Adult Care Services, LLC

CASE NO: 2011006078

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 (ARCA). The

title may be Notice of Intent to Deem Incomplete and Withdraw from Furth'er Review or

some other notice ofintended action by ARCA.

All 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 ARCA 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 #3

Talfahassee, Florida 32308

Phone: [phone] Fax: [phone]

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 ARCA 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, fme 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 AReA, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2),

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 AHeA, and I request a formal hearing (pursuant to Section 120.57(1), Florida Statutes)

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

) ., j

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 120.57(1), 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, ifknown;

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

number ofyouf i'epresentative or lawyer. If any;

3. An explanation of how your substantial· Interests will be affected by the Agencis

proposed action;

4. A statement of when and how you received notice ofthe 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 afthe specific rules Ol' statutes you claim rcquirelreversal or modification

of the Agency's proposed action; and . :

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

Agency to take with respect to its proposed action. ;

(Mediation undei' Section 120.573. Florida Statutes. may be available in matter if the Agency

agrees.) .

License type: Nurse Registry License number:

Licensee Name: Guardian Angel Adult Care Services, LLC

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 on behalfofthe licensee referred to above.

Signed: Date:

Print Name: Title:, _