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
101545 A. BUILDING __________
B. WING ______________ 		01/03/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION OF FLORIDA 4450 W EAU GALLIE BLVD STE 250, MELBOURNE, FL, 32934
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)
L0671      
13640 Based on interview and record review, the hospice failed to ensure that up-to-date information in the medical record was available concerning narcotic counts for 1 of 4 sampled patients (#1). Findings: A review of the medical record of patient #1 was performed. The patient was admitted to services on 12/06/18 with a diagnosis of Malignant Neoplasm of the Brain. The patient was started on Roxamol (Morphine) on 1/30/19 at 0.5 milliliters (ml.) orally (PO) every three hours (q3h) as needed (PRN) for pain. This order had been delivered to the home. There were no additional orders for Roxanol until May 2019. Physician orders of 5/15/19 read, "Start ICC (Intensive Continuous Care) respiratory distress. D/C (discontinue) routine home care." Additional orders for Roxanol were issued on 5/15/19, at increasing does throughout the day. Orders on 5/15/19 at 12:23 PM were for 0.5 ml. PO q2h for shortness of breath; order on 5/15/19 at 2:17 PM was for 1 ml. orally q2h for pain; and order on 5/15/19 at 7:48 PM was for 2 ml. PO q2h PRN for pain. A "Continuous Care Shift Care Note - Nurse" of 5/15/19 (first entry at 7 PM, last entry at 12 AM on 5/16/19) by licensed practical nurse (LPN) A read at 7 PM, "Arrived. Received report. Counted meds, measured morphine bottle." The count for morphine at the beginning of the shift was noted as 27 ml." A Continuous Care Shift Care Note - Nurse" entry at 7:30 PM on 5/15/19 by LPN A read, "Morphine 1 ml.... Meds given." This administration of 1 ml. would have reduced the count as documented in the medical record from 27 ml. to 26 ml. A "Continuous Care Shift Care Note - Nurse" at 9:30 PM by LPN A read, "Morphine 2 ml." This administration of 2 ml. would have reduced the count as documented in the medical record from 26 ml. to 24 ml. An entry at 11:30 PM on 5/15/19 in the "Addendum Interdisciplinary Note (Updated Comprehensive Assessment) by LPN A read, "Morphine 2 ml.... Meds given per MD orders." This administration of 2 ml. would have reduced the count as documented in the medical record from 24 ml. to 22 ml. The morphine count for the end of the shift (12 AM) was noted as 24 ml. on the "Continuous Care Shift Care Note - Nurse" by LPN A. However, the record reflected that 5 ml. had been given, which would have left 22 ml. The final count was short by 2 ml. On 1/03/20 at 11:48 AM, the Senior General Manager confirmed that the final count was short by 2 ml.