DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
051590 A. BUILDING __________
B. WING ______________ 		03/24/2021
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION OF CALIFORNIA 7888 MISSION GROVE PARKWAY S, SUITE 200, RIVERSIDE, CA, 92508
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE

 TITLE

 (X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0554      
29623 Based on interview and record review, the agency failed to ensure Registered Nurse (RN) 2 communicated and updated the primary caregiver (PCG) of the patient's medical and nursing conditions during the nursing visit on May 13, 2020, for one of three patients reviewed (Patient) 1. This failure resulted in not meeting the PCG's request of knowing Patient 1's condition on May 13, 2020. In addition, the PCG had expressed feeling of disappointment when Patient 1 passed away on May 14, 2020 without having a chance to have a virtual communication with the patient. Findings: On September 3, 2020, at 9:40 a.m. an unannounced visit to the agency was conducted to investigate one complaint. On September 3, 2020, at 9:50 a.m. a concurrent record review and interview, was conducted with the agency's Patient Care Administrator (PCA) for Patient 1. Patient 1 was admitted to the hospital on May 11, 2020, with diagnoses including acute hypoxic respiratory failure (not enough oxygen in the blood) due to COVID-19 pneumonitis (corona virus infection - respiratory disease). On May 12, 2020, Patient 1 was admitted to the hospice agency. The physician's initial certification of terminal illness dated May 13, 2020, indicated the following: - "...Severe acute respiratory failure syndrome due to COVID-19 infection; - Lethargic (drowsy), muscular wasting (a decrease in muscle mass due to lack of activity or proper nutrition), shortness of breath at rest, that requires the continued use of oxygen; - Do not resuscitate (DNR- not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating), no tube feeding (special liquid food mixture given through a tube into the stomach); and - Admitted to hospice under General Inpatient (GIP - pain control or symptom management provided in an inpatient facility that cannot be managed in other settings) for end-of-life care and symptom management..." On May 12, 2020, RN 1 conducted a hospital visit for Patient 1 from 3 p.m. to 4 p.m. The initial nursing visit notes indicated the following: - "...Patient 1's blood pressure (BP) 102/67, pulse rate (PR) 68, respiration rate (RR) of 6, and temporal temperature of 98.8 degrees (body temperature taken at the forehead); - On Morphine (medication used for pain) drip at 5 mg/hr (milligram - a unit of measurement, per hour); - Oxygen at 2 L (liters - a unit of measurement) via nasal cannula (a device used to deliver supplemental oxygen or increased airflow to a patient); - Dyspnea (difficult or labored breathing) - DNR; - Initiated GIP level of care; and - Family and staff verbalized understanding of Plan of Care (POC)..." The hospital Social Worker (SW) report dated May 12, 2020, indicated: - "...Social Worker received a call from RN 1 that Patient 1's family wanted to FaceTime (virtual platform of communication) with Patient 1 due to not being able to come to the hospital; - SW contacted Patient 1' PCG at home. PCG would like to FaceTime with Patient 1 at 4:20 p.m.; - SW contacted Patient 1's bedside RN and coordinated FaceTime with tablet available; and - RN reports they will be able to facilitate FaceTime..." The agency's chaplain's note dated May 12, 2020, with visit time between 4:15 p.m. through 4:55 p.m. indicated: - "...Chaplain phoned PCG, who reported they were doing FaceTime with Patient 1, requested to phone later; - Chaplain spoke with PCG, they just completed face time with Patient 1..." On May 13, 2020, at 2:45 p.m. to 3:15 p.m., the agency's Medical Social Worker (MSW) 1 conducted her initial psychosocial assessment of Patient 1's PCG and family. MSW 1's note indicated: - "...Unable to visit patient due to being COVID -19 positive; and - PCG stated family coping well and will like a nurse visit to follow up with a call to see how patient is doing as she can not see patient..." On May 13, 2020, at 1 p.m. to 2 p.m. RN 2 conducted her hospital visit for Patient 1. RN 2's nursing note indicated; - "...Non responsive, BP = 110/60, PR = 90, RR = 8, Temp = 98..: - Pt. (patient) on continuous Morphine drip 5 mg/hr, no titration needed all shift. Pt is comfortable; - Oxygen at 2L/m (liters/minute) via nc (nasal cannula) continuous; and - VM (voice mail) to CG (care giver)..." The PCA stated RN 2's notes did not indicate the name of the caregiver she contacted or left the voice message during her hospital visit for Patient 1. The agency's cell phone log of RN 2 was reviewed. The log dated May 13, 2020, indicated there was no outgoing call to Patient 1's PCG's cell phone number. Hospital and agency's record indicated Patient 1 expired on May 14, 2020 at 3:25 a.m. The PCA stated the agency's best standard of practice was for RN 2 to call Patient 1's PCG prior to and after the nursing visit. PCA further stated RN 2 should have attempted to communicate with Patient 1's PCG and not just left a voice message one time. On May 4, 2021, at 10:57 a.m., RN 2 was interviewed and stated she did not call Patient 1's PCG prior to her hospital visit. She stated she would only call patient's PCG after her visit. RN 2 stated she left a voice mail to Patient 1's PCG. She was not sure if she used the hospital's telephone or her cell phone. She further stated she did not attempt to make a call again to notify PCG of Patient 1's condition and status on May 13, 2020. RN 2 further stated, "I should have done that". On May 11, 2021, at 9:42 a.m. RN 1's Team Manager was interviewed. The Team Manager stated on May 13, 2020, she sent an email to RN 2, regarding PCG's request for Patient 1's clinical update and wanted to have FaceTime. The Team Manager further stated she was not aware RN 2 was not able to contact Patient 1's PCG and the request for FaceTime did not happen on May 13, 2020. She further stated RN 2 did not communicate to her of any problem contacting Patient 1's PCG. She stated RN 2 should have attempted multiple times to call Patient 1's PCG. The agency's policy and procedure titled, "...VITAS Standard...," dated July 15, 2019, was reviewed. The policy indicated, "...The hospice must designate an interdisciplinary group or groups composed of individuals who work together to meet the physical, medical,, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement...The hospice must designate a registered nurse that is a member of the disciplinary group to provide coordination of care and to ensure continuous assessment of each patient's and family's needs and implementation of the interdisciplinary plan of care..." The agency's policy and procedure titled, "...General Inpatient Level of Care," dated August 29, 2019, was reviewed. The policy indicated, "...Overview of GIP RN daily visit...Collaborate changes in condition and POC... Family/Caregiver/Legal Representative... Report at the end of each shift visit:... Facility staff, Patient, Family/Caregiver/Legal Representative..."