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
361562 A. BUILDING __________
B. WING ______________ 		10/14/2021
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION OF OHIO 11500 NORTHLAKE DRIVE, SUITE 400, CINCINNATI, OH, 45249
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)
L0591      
19966 Based on record review and interview, the facility failed to ensure the nursing needs of the patient were met as identified in the patient's initial assessment and updated assessments for one of three medical records reviewed (Patient #3). The current patient census was 182. Findings include: Review of the admission orders for Patient #3 revealed he/she was living at home and admitted to hospice on 06/14/21. The primary diagnoses included chronic obstructive pulmonary disorder (COPD) and congestive heart failure (CHF). The medical record also included a diagnosis for Type 2 diabetes mellitus without complications. Review of the initial comprehensive assessment dated 06/15/21 revealed medications for Lantus (long acting insulin) 60 units at bedtime, Lispro (also know as Humalog - fast acting insulin) 22 to 24 units prior to meals and Metformin (anti-diabetic) 1000 milligrams (mg) two times a day. Patient #3 also wore a blood sugar monitoring device. Patient #3's blood sugar range was 100 milligrams/deciliter (mg/dL) to 150 mg/dL. The medical record revealed from 08/22/21 to 08/31/21 Patient #3 was in the general hospice inpatient unit (IPU). Review of the active medication list/signed physician orders dated 08/22/21 revealed orders for Humalog 100 milliliter (ml) vial, short acting, inject 22 to 24 units (0.22 to 0.24 ml) subcutaneous before meals for controlling blood sugars. Review of the medication administration record (MAR) revealed on 08/23/21 orders for Humalog to be given subcutaneously 22 to 24 units before meals. There was a line drawn through the 7:00 AM time and there was no blood sugar documented. Further review of the MAR for 08/23/21 revealed Humalog was signed off as being given at 11:00 AM and 4:00 PM but there was no blood sugar documented for these times. Interview with Staff B on 10/14/21 at 2:24 PM stated the expectation was that the nurses would document the blood sugar readings. Further interview with Staff B on 10/14/21 at 3:05 PM revealed they could not locate the blood sugar readings being documented. Interview with Staff B on 10/14/21 at 2:48 PM revealed the reader that stayed in the patient's arm or belly was a free style monitoring device which was the blood glucose monitor. It kept track of the patient's previous blood sugars and the current blood sugar. Based the current blood sugar compared to the previous blood sugar, an arrow would indicate the need to give the insulin on the higher or lower spectrum. The doctor could pull the tracking record up on a computer for any given date to determine how the blood sugars were trending. Further interview with Staff B on 10/14/21 at 3:00 PM revealed the nurses should have clarified with the physician how to give the Humalog 22 to 24 units before each meal based on the free style monitoring system.