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
101543 A. BUILDING __________
B. WING ______________ 		04/15/2021
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)
L0672      
35478 Based on record review and interview, the hospice failed to include in the clinical record updated plans of care for 1 out of 20 Sampled Patients (SP). SP#10 Findings include: Clinical record review conducted on 04/14/21 to 04/15/21 of SP#10 for date range of 02/19/21 to 04/12/21 revealed no documentation for a scheduled IDG (Interdisciplinary Group Meeting) for date 03/04/21 in the clinical record. On 04/15/21 at 3:33 PM interview conducted with the Senior Director, Clinical Operations. The Senior Director, Clinical Operations reviewed with surveyor the IDG's for SP#10 present in the clinical record, then stated that in the electronic system the input was done incorrectly reflecting only IDG's for dates 02/25/21 and 03/18/21.