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
111553 A. BUILDING __________
B. WING ______________ 		08/27/2021
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION OF GEORGIA 2000 RIVER EDGE PARKWAY, STE GL-100, ATLANTA, GA, 30328
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)
L0523      
38966 Based on review of clinical records, it was determined the interdisciplinary group failed to ensure that the initial comprehensive assessment was completed within 5 days of admission for one (1) of six (6) (P#6) patients who were current hospice beneficiaries. The findings include: 1. Review of the clinical record for P#6, who was admitted on 7/31/21, revealed that the initial psychosocial assessment was done on 8/25/21, after the patient's admission. The clinical record lacked documentation regarding the staff's delay in completing the assessments. 2. Review of the clinical record for P#6, who was admitted on 7/31/21, revealed that the initial spiritual assessment and psychosocial assessment was done on 8/6/21, after the patient's admission. The clinical record lacked documentation regarding the staff's delay in completing the assessments. In an interview on 8/25/21, at 11:45 a.m., the Administrator stated that two employees resigned, and confirmed that the surveyor has been provided with all available documentation for the patients' records.
L0547      
38966 Based on observations, clinical record reviews, and staff interviews, the agency failed to ensure that patient's plan of care for two (2) of six (6) patients (P#1 and P#5) was updated to reflect current frequency visits as needed (PRN) at the time of the comprehensive assessments. The findings include: 1. Reviewed P#1 plan of care record certification period for 6/12/21 to 8/11/21, with a diagnosis of chronic congestive heart failure revealed skilled nurse frequency was one time per week. There was no physician's order for as needed (PRN) visit. Hospice agency nurses visited P#1 on 6/27/21, 6/28/21, 7/5/21, 7/9/21, 7/12/21 and 7/13/21. Hospice nurses visited on 6/28/21, 7/9/21, and 7/12/21, without physician's order. Skilled Nurses did not follow the plan of care as ordered and signed by physician. 2. Reviewed of P#5 plan of care record certification period of 5/27/21 to 8/25/21, with a diagnosis of Malignant Neoplasm of endometrium, Diabetes, hypertension, and chronic obstructive pulmonary disease revealed that skilled nurse frequency was once every 14 days. There was no physician's order for PRN's visit. The hospice nurses visited P#5 on 7/30/21, 8/10/21, 8/12/21, 8/13/21, and 8/19/21, out of these visits three PRN's visits were done without a physician's order on 8/10/21, 8/12/21, and 8/19/21. Skilled Nurses did not follow plan of care as ordered and signed by physician. 3. Reviewed of P#5 plan of care record certification period of 5/27/21 to 8/25/21, with a diagnosis of Malignant Neoplasm of endometrium, Diabetes, hypertension, and chronic obstructive pulmonary disease. It was revealed that Master Social Worker (MSW) was to conduct an initial visit according to hospice agency's record. The MSW called P#5 twice on 5/28/21 and 5/31/21, without obtaining a physician's order to discontinue the service nor followed up with the patient and patient's family. The MSW did not follow P#5's plan of care as ordered and signed by physician. 4. On 8/27/21, at 11:10 a.m., an interview was conducted with Director of Nursing (DON), stated that their staff (MSW) resigned, and as they were struggling with shortage of staff.
L0555      
38966 Based on clinical record review, it was determined that the interdisciplinary group failed to ensure that the frequency of visits for the hospice aide, and the nurse was provided in accordance with the patient's plan of care for two (2) of six (6) (P#1 and P#4) sampled patients who were current hospice beneficiaries. The findings Include: 1. The interdisciplinary care plan review for P#1 required the hospice aide to visit the patient two times per week. The interdisciplinary care plan reviews dated 6/12/21 to 8/11/21, with a diagnosis of chronic congestive heart failure. It was reflected that there were no changes in the visit frequency for the hospice aide. Documentation of hospice aide visits revealed that the aide visited the patient only once during the week of 6/27/21-7/3/21. 2. The interdisciplinary care plan review for P#4 required the hospice nurse to visit the patient one time per week. The interdisciplinary care plan reviews dated 7/19/21 to 9/17/21, with a diagnosis of non-traumatic intracerebral hemorrhage, embolism, and thrombosis. It reflected that there were no changes in the visit frequency for the hospice nurse. Documentation of hospice nurse visits revealed that the nurses only visited the P#4 five times (7/1/21, 7/15/21, 7/21/21, 7/23/21 and 8/12/21) during the period 7/1/21 to 8/24/21. 3. The interdisciplinary care plan review for P#4 required the hospice aide to visit the patient two times per week. The interdisciplinary care plan reviews dated 7/19/21 to 9/17/21 reflected that there were no changes in the visit frequency for the hospice aide. Documentation of hospice aide visits revealed that the aide only visited the patient four times (7/5/21, 7/7/21, 7/12/21 and 7/30/21) during the period 7/1/21 to 8/24/21. 4. In an interview on 8/25/21 at 11:15 a.m., the Director of Nursing (DON) confirmed that the missed visits were due to resignations by staff and shortage of employees, and that the surveyor was provided all available documentation of patient visits.