Survey Report for 101543

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
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION	101543	A. BUILDING __________ B. WING ______________	11/05/2020
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
ACCENTCARE HOSPICE & PALLIATIVE CARE OF SOUTHERN F	5200 NE 2ND AVE, MIAMI, FL, 33137
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)
L0545
L0545	36646 Based on record reviews and interview, the Hospice failed to develop a plan of care based on a problem identified on 1 out of 13 sample patients (SP). SP # 3. Findings include: Review of the IDT (Interdisciplinary Team) Care Plan updated on 9/10/2020 showed Patient is free from any known communicable disease at this time; No updated care plan related to identified communicable disease; Review of the Shift/ Continuous Care Visit Note contact date 8/28/2020, page 9 of 9 showed at 1800 Patient denies pain, patient positive for COVID - 19; Review of SP # 3 Medication list on page 4 of 9 showed Zithromycin 250 mg 1 tablet oral 1 time a day; 500 mg ( milligrams) first day, then 250 mg daily for 4 days. start date 8/28/2020; Medrol 4 mg 4 mg oral 4 times a day - Medrol dose pack as directed, start date 8/28/2020; Review of the Shift/ Continuous Care Visit Note contact date 9/6/2020, page 9 of 9, showed Patient is COVID 19 positive, on contact and droplet precautions isolation. Sampled patient #3 already received tx ( treatment) with azithromycin and methylprednisolone PO (Oral). Above findings acknowledged by the Vice President of Operations, and the Senior Director of Clinical Operations on 11/5/2020 at 1:30 PM, that the care plan had not been updated to reflect SP #3's identified communicable disease.
L0552
L0552	36646 Based on record reviews and interview, the Hospice interdisciplinary group must review, revise and document the individualized plan as frequently as the patient's condition requires on 1 out of 13 sample patients.(SP). SP #3. Findings include: Record review showed SP #3 was admitted on 8/25/2020. Review of the IDT (Interdisciplinary Team) Care Plan updated on 9/10/2020 showed Patient is free from any known communicable disease at this time; No written updated care plan related to identified communicable disease; Review of the Shift/ Continuous Care Visit Note contact date 8/28/2020, page 9 of 9 showed at 1800 Patient positive for COVID - 19; Review of SP # 3 Medication list on page 4 of 9 showed Zithromycin 250 mg 1 tablet oral 1 time a day; 500 mg ( milligrams) first day, then 250 mg daily for 4 days. start date 8/28/2020; Medrol 4 mg 4 mg oral 4 times a day - Medrol dose pack as directed, start date 8/28/2020; Review of the Shift/ Continuous Care Visit Note contact date 9/6/2020, page 9 of 9, showed Patient is COVID 19 positive, on contact and droplet precautions isolation. Sampled patient #3 already received tx ( treatment) with azithromycin and methylprednisolone PO (Oral). Above findings acknowledged by the Vice President of Operations, and the Senior Director of Clinical Operations on 11/5/2020 at 1:30 PM, that the provider failed to revise the plan of care.