Survey Report for 141574

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	141574	A. BUILDING __________ B. WING ______________	06/23/2021
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION OF ILLINOIS	1340 SOUTH DAMEN AVENUE, STE A, CHICAGO, IL, 60608
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)
L0650
L0650	37373 . A. Based on staff interview, clinical record review, review of Agency's complaint log report and Agency's Policy, it was determined that the Agency failed to provide care that optimize comfort and dignity consistent with patient / family needs. Findings include: 1. During the entrance interview with the General Manager (GM) and Patient Care Administrator (PCA), the PCA stated that if a patient or family member calls the office during regular business hours or after hours, the call gets "triaged" and directed to the appropriate team manager, who then manages the issue appropriately. 2. Pt.#1 SOC 01/28/2021 Diagnosis- Acute on Chronic Diastolic (Congestive) Heart Failure. The clinical record was reviewed on 06/23/2021 at 12:00 PM. The clinical record contained a Spiritual assessment visit note dated 02/15/2021 with no documentation of changes to patient status. The clinical record also contains a SN visit note dated 02/15/2021 with documentation of patient as oriented x 2, sleeping. The visit summary section contains no indication of change in patient condition. The record also contained a "Phone visit note" dated 02/16/2021, 7:19 AM, indicating change in condition, described as "restless". Another note at 7:40 AM, indicating Patient Care Giver (PCG) upset due to patient being restless . The record lacked an in-person visit note for 02/16/2021. The record contains a "Report of Death" visit note from SN dated 02/17/2021 with visit time of 12:43 PM. The time of death of the patient was recorded as 12:49 PM. 3. The Agency's Policy titled "Organization and Administration of Services" was reviewed on 06/23/2021 at 2:45 PM. The policy required ...(c) Standard Services ...Nursing Services, physician services, and drugs and biologicals must be made routinely on 24-hour basis 7 days a week." 4. An interview with the PCA was conducted on 6/25/21 via phone, at 03:50 PM. confirming the above findings.