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
391632 A. BUILDING __________
B. WING ______________ 		10/29/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION ATLANTIC 2009 MACKENZIE WAY, SUITE 110, CRANBERRY TOWNSHIP, PA, 16066
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)
L0538      
31759 Based on review of a clinical record (CR) and hospice policy and procedure, and interviews with staff (EMP), the hospice interdisciplinary team (IDT) failed to ensure the plan of care specified care and service necessary to meet the patient's and family's specific needs identified on the comprehensive assessment as such needs relate to the terminal illness and related conditions for one (1) of one (1) clinical record reviewed with a cardiac defibrillator (CR1). Findings included: Review of policy and procedure on 10/29/2020 at 3 p.m. showed, "TITLE: INTERDISCIPLINARY TEAM POLICIES CARE PLANNING POLICY NUMBER: 5:17 ... POLICY All hospice care and services ... shall follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with ... the patient ... and the primary caregiver in accordance with the patient's needs ... OBJECTIVE(S) To specify hospice care and services necessary to meet the patient and family specific needs identified in the comprehensive assessment as such needs relate to the terminal illness and related conditions. ... PROCEDURE(S) ... The interdisciplinary group ... Provides the care and services offered by the hospice, and the group, in its entirety. Supervises the care and services. Content of the plan of care. ... Anticipated discharge ... needs of patient/family."" Review of CR1 was conducted on 10/28/2020 at 9:40 a.m., and again on 10/29/2020 at 9:30 a.m. CR1 was admitted to hospice on 5/31/2020 for heart failure, and was discharged from hospice on 9/6/2020. According to the "RN [registered nurse]-Initial Comprehensive Assessment," completed on 5/31/2020, the patient had a cardiac defibrillator (a device that delivers a electrical signal to the patient's heart when an irregular heart rate is detected). The defibrillator was installed sometime between 2012 and 2013 due to cardiac arrest. The RN documented that the patient and the patient's family were competent in the defibrillator's use, that they were aware of the consequences of discontinuing the device, and that there was no plan to "deactivate or discontinue." The "Interdisciplinary Care Plan" was also completed on 5/31/2020. It contained plans and interventions for "End of Life Choices," and "End of Life General Needs." However, the IDT plan of care did not address (plan for with interventions) the patient's cardiac defibrillator as it related to end of life choices and needs. Further review of CR1's IDT plans of care updates for the remainder of his admission, conducted at least every 2 week, did not show the hospice IDT addressed, planned for, or developed interventions for the patient's cardiac defibrillator. Review of skilled nursing visit notes from 6/1/2020 to 9/6/2020 showed nursing staff were noting the presence of the patient's defibrillator. The agency provided continuous care to CR1 twice-- once on 8/17/2020, and again beginning on 9/4/2020. On 9/5/2020, with no plan in place for patient's defibrillator, nursing notes from the most recent continuous care episode showed the caregiver had concerns about not having a magnet to deactivate patient's defibrillator, "Date of visit: 9/5/20 ... Visit start time: 3:30 pm Visit end time: 5:00 pm ... Pulse: Apical [heart rate] 134 [60-100 beats per minute is usually considered normal] ... irregular heart rate; [caregiver] stated pt [patient] has a defibrillator and doesn't have a magnet. ... Comments/Shift Report: pt has a defibrillator but doesn't have a magnet per [caregiver]." Interview with EMP2 on 10/29/2020, at 9:45 a.m. confirmed above findings, and no documentation to show hospice included the patient's defibrillator in the plan of care to allow for the availability of a magnet at end-of-life.