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 ______________ 		05/12/2022
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)
L0555      
35478 Based on record review and interview, the provider failed to ensure that the care and services are provided in accordance with the plan of care (physician's order) for 1 out of 12 Sampled Patients (SP). SP#8 Findings include: Clinical record review conducted on 05/05/22 to 05/06/22 of SP#8 revealed the patient was admitted on 08/26/21 in the inpatient unit of the provider. On 08/27/21 a fall with injury was documented by the staff of the inpatient unit at approximately 9:20 am. The physician ordered on 08/27/21 at 4:30 PM for SP#8 to receive a sitter for safety precautions. The provider commence the sitter on 08/30/21 at 4:00 PM. Interview conducted with the Patient Care Administrator (PCA) on 05/06/22 at 5:09 PM stated that sitter staff started on 08/30/21 because there was no staff available. Policy Review - titled " Policy Review - titled "Care Planning" reads "5. Coordination of Services - The Core IDG (interdisciplinary group) must coordinate all services provided to patient directly or via contract. Coordination is accomplished by: Care planning based on assessment which identifies needed interventions. Ensuring care planned interventions are provided directly or via contract. Ensuring contractors provide care according to the POC (plan of care)."
L0556      
35478 Based on record review and interviews, the provider failed to ensure that the care and services provided are based on all assessments of the patient and family needs for 2 out 12 Sampled Patients (SP). SP#5 and SP#6 Findings include: Clinical record review conducted on 05/03/22 to 05/05/22 revealed that SP#5 was visited at home and evaluated by a Registered Nurse on 04/30/22 at approximately 4:00 PM to 6:00 PM for "change in LOC (level of consciousness) / VS (vital signs)". The Registered Nurse contacted the physician and Continuous Care was ordered for SP#5 to commence. Record review revealed that the Continuous Care service note was started on 05/08/22 at 8:00 am. Telephone interview was conducted on 05/05/22 from 3:29 PM to 3:35 PM with SP#5's caregiver. The caregiver confirmed that the registered nurse went out on 04/30/22 at approximately 4:00 PM and evaluated SP#5 due to having presented with a blood sugar episode and offered to have SP#5 be placed on Continuous Care but was informed that no staff was available to start the Continuous Care until the next day. The caregiver added that a nurse started the Continuous Care on 05/01/22 a little after 7:00 am. Interview conducted with the General Manager on 05/06/22 at 9:41 am confirmed that SP#5's side bed care started for Continuous Care on 05/01/22 at 8 am and not on 04/30/22 as written by the nurse obtaining order from the physician to commence the Continuous Care. The General Manager acknowledged is was due to no staff available. Interview with the Patient Care Administrator (PCA) on 05/06/22 at 10:23 am stated that the nurse that placed SP#5 on Continuous Care informed the caregiver to call if any delay in staff and notify. The PCA then added that the caregiver never called and the Continuous Care started as scheduled for 05/01/22. Closed Clinical record review conducted on 05/03/22 to 05/05/22 revealed that SP#6 was visited at home and evaluated by a Registered Nurse on 10/07/21 at approximately 3:35 PM to 5:00 PM for "change in LOC (level of consciousness) and SOB (shortness of breath)". The Registered Nurse contacted the physician and Continuous Care was ordered for SP#6 to commence. An additional Registered Nurse visit was made on 10/07/21 at approximately 6:15 PM and noted "IPU (inpatient unit) offered to the family because continuous care nurse is not available, but family refused it". Record review revealed that the Continuous Care service note was started on 10/08/21 at 8:00 am. Further review of the clinical record revealed that patient was on Continuous Care service from 10/08/21 to 10/12/21 with a shift notation missing for date 10/10/21 from 8 PM to 8 am. Interview with the Patient Care Administrator (PCA) on 05/06/22 at 4:21 PM stated that Continuous Care was not provided on 10/10/21 after 8 PM due to no staff available and that caregiver was informed. Policy Review - titled "Care Planning" reads "5. Coordination of Services - The Core IDG (interdisciplinary group) must coordinate all services provided to patient directly or via contract. Coordination is accomplished by: Care planning based on assessment which identifies needed interventions. Ensuring care planned interventions are provided directly or via contract. Ensuring contractors provide care according to the POC (plan of care)."
L0558      
36646 Based on record reviews and interviews, the Hospice failed to demonstrate an ongoing sharing of information with other non- hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions on 1 out of 12 sample patients (SP). SP #1. Findings include: A review of physician's order dated 2/17/2022 - showed Team Hospice Physician - B took over; assessed the patient and discontinued the following medications: Lantus, Jentadueto, Pioglitazone, Lipitor, Fenofibrate, Citolopram. There was no order to monitor the blood sugar. Record review of the form Addendum Interdisciplinary Note date 2/18/2022, primary nurse wrote on 2/17/2022 received a message from the Physician - B to stop above medications. No note indicating coordination with the Home Health Nurse regarding blood sugar monitoring after discontinuing the diabetic medications. In an interview with the Medical Director on 5/5/2022 at 4:10 PM, she stated: "(name of Team Hospice Physician - B) told me he had to put them on hold and yes we have to monitor the patient." There was no order to monitor the patient. Record review of SP #1's clinical record from Hospital A revealed: Time seen: 3/20/2022 at 1506. Chief complaint of hyperglycemia. Past Medical History (PMH) including diabetes and Alzheimer's presents to the Emergency Department (ED) accompanied by family with a chief complaint of high blood sugar and altered mental status. Patient's family reports that the patient lives in an Assisted Living Facility (ALF) where the patient hadn't been given insulin all week. The family reports that the patient had been groggy and barely speaking or walking. Initial blood glucose result: 392 mg/dl (high). Transfer to Hospital-B arranged for higher level of care. Record review of SP #1's clinical record from Hospital-B showed Registration time: 3/20/2022 20:40; Discharge date/ time: 3/21/2022 at 18:06. Admit reason: Diabetic Ketoacidosis (DKA). Phone Interview with Team Hospice Physician - A on 5/4/2022 at 10:50 AM stated: " that the patient's Primary Care Physician (PCP) is responsible for ordering the blood sugar monitoring. When (name of the Team Hospice Physician -B) came in, he took over the role of the PCP management of diabetes." Phone interview with Owner of the ALF on 5/5/2022 at 12:45 PM stated the following: " (SP#1) blood sugar had been checked since July of 2020. It is being checked by the nurse from the Home Health Agency. The insulin injection had been given by the same Home Health Agency." The phone interview on 5/11/2022 at 10: 37 AM with the Home Health Agency Licensed Practical Nurse (LPN) revealed the following: She confirmed that she took care of the blood sugar monitoring of patient (SP #1) for about 2 months. " When the patient's insurance was changed, she stopped seeing the patient. The last day of service from the Home Health Agency was February 26, 2022." Record review of facility Policy 9:89 Number 1 of 5, Title: Physician Job descriptions. It states the Physician has responsibility for the medical care and treatment of patients rendered by the hospice interdisciplinary team (IDT) and shall consult and cooperate with the patient's attending physicians. The physician provides direction and guidance to the staff and volunteers of the hospice IDT to assume the maintenance of quality standards of care for patients and families. Included in their job description is the provision for the general medical needs of the patients on their team to the extent that these needs are not met by the attending physician. The Hospice provider failed to demonstrate the Hospice Physician provided any direction or guidance for the need to monitor the blood sugar with the hospice nurse. The HHA which comes in to monitor the blood sugar stopped providing the service. There was no evidence of coordination with the PCP who had been managing the patient's diabetes and with the Team Hospice Physician - B. Team Hospice Physician - B in a phone interview on 5/5/2022 at 1:45 PM revealed: He did not know SP #1 had Balanitis at that time. No one reported to him SP#1 had Balanitis. Nothing on the patient's groins, back, and legs. What was reported to Physician B by the family was that the patient had an Urinary Tract Infection (UTI) and pyelonephritis. The ALF staff reported he was okay.
L0672      
35478 Based on record review and interview, the provider failed to include in the clinical record updated plan of care reviews for 1 out of 12 Sampled Patients (SP). SP#10 Findings include: Clinical record review conducted on 05/03/22 of SP#10 revealed no documentation of the Interdisciplinary Group (IDG) Interdisciplinary Group plan of care reviews for date(s) 07/22/21 to 08/04/21; 11/18/21 to 12/01/21 and 12/16/21 to 12/23/21. On 05/03/22 at 3:13 PM interview was conducted with the Patient Care Administrator (PCA) regarding the missing IDG's for SP#10. The PCA reviewed in presence of the surveyor the IDG's for SP#10 in the clinical record. The PCA confirmed that at present time of survey the IDG's for SP#10 date(s) 07/22/21 to 08/04/21; 11/18/21 to 12/01/21 and 12/16/21 to 12/23/21 are not present in the clinical record. Policy Review - titled "Care Planning" reads "4. Review of the Plan of Care - The plan of care is reviewed and revised at every visit and at least every 15 days."
L0674      
35478 Based on record review and interview, the provider failed to maintain a clinical record that contain each patient's responses to medications, symptom management, treatments, and services for 1 out 12 Sampled Patients (SP). SP#8 Findings include: Clinical record review conducted on 05/03/22 to 05/06/22 of SP#8 revealed the patient was admitted to service on 08/26/21 at the inpatient unit. Further review of the clinical record contained a physician order dated 08/27/21 at 4:30 PM that read "place sitter at bedside". Further review of the clinical record revealed that Certified Nursing Assistant commenced sitter service on date 08/30/21 at 4 PM and no service note present in the clinical record. Interview conducted with the General Manager on 05/06/22 at 5:46 PM confirmed that no service note found for sitter service commenced on 8/30/21 at 4:00 PM. Policy Review - titled "Clinical Documentation Tracking" under 1. (iv) Documentation is to be available in the office no more than 7 calendar days after the care or services are provided. (v) Documentation will be filed in the patient medical record no later than 14 calendar days after the care or services are provided."