Every finding on record at Vitas Healthcare Corporation of Florida

It is required that the documented comprehensive assessment include a drug profile that contains the patient's current: prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; [and] other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at a minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review and interview. In 2 of 7 (29%) clinical records reviewed of patients with oxygen, the agency did not ensure that oxygen was added to the drug profile. CLINICAL RECORD 2:The patient elected hospice care on 07/15/2025 with diagnoses of malignant neoplasm of the colon, seizures, diabetes mellitus type 2, and dependence on oxygen. The patient resided in a skilled nursing facility (SNF). A clinical record review revealed a physician's order dated 09/25/2025 ordering "2L of oxygen as needed and spot check oxygen saturations." Oxygen was not included or added to the patient's medication profile. CLINICAL RECORD 6: The patient elected hospice care on 08/11/2025 with a diagnosis of malignant neoplasm of the lung. A clinical record review revealed a physician's order dated 10/13/2025 that ordered, "Inhale oxygen at 2 liters per minute (LPM) via nasal cannula continuous." Oxygen was not included or added to the patient's medication profile. In an interview on 10/29/2025, the National Clinical Manager confirmed that oxygen was not included on the medication profiles and stated, "This helps me. I can see now how they are entering oxygen in the system and why it is not going to the medication profile."

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 13 (15%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide received written patient care instructions from the Registered Nurse (RN) to meet the patient's needs. CLINICAL RECORD 1: The patient elected hospice care on 04/17/2024 with a diagnosis of senile degeneration of the brain. The patient resided in a skilled nursing facility (SNF). The patient started on oxygen at 1 liter per minute via nasal cannula, effective 09/17/2025. As of 10/27/2025, the HA care plan dated 06/24/2025, with HA services twice a week, had not been updated to include oxygen or information related to oxygen for the HA. The patient had a Foley catheter placed on 08/15/2025, and it was discontinued on 09/05/2025. During that time period, the HA continued to see the patient twice per week, but the HA care plan was not updated to reflect that the patient required Foley care. CLINICAL RECORD 2:The patient elected hospice care on 07/15/2025 with diagnoses of malignant neoplasm of the colon, seizures, diabetes mellitus type 2, and dependence on oxygen. The patient resided in a SNF. The skilled nurse (SN) assessment dated 07/15/2025 documented that the patient required a (gastrostomy tube) G-tube, was (nothing by mouth) NPO, and oxygen dependent. The HA care plan developed on 07/15/2025 did not include instructions for the HA regarding the patient's NPO status, G-tube, or oxygen dependence. During an interview on 10/29/2025, the National Clinical Director reviewed the clinical record and confirmed that the clinical records did not contain the required elements of the HA care plan, stating, "Aide care plans will be going on our education plan."

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The agency did not ensure that hospice volunteers provided day-to-day administrative or direct patient care services in an amount that equals five percent (5%) of the total patient care hours. A review of the Volunteer Services scorecard for the parent and branch locations revealed that the rolling percentage of volunteer hours for the parent and the ADS from 09/01/2024 to 08/31/2025 (as reported on 10/22/2025) totaled 1.4%. A performance improvement plan (PIP) for the volunteer hours was initiated on 04/01/2025. The PIP documentation revealed that the volunteer hours between 04/01/2025 and 06/30/2025 were 2.3%, July 2025 1.9%, and August 2025 0.4%. During an interview on 10/29/2025, the Volunteer Service Manager stated that it was difficult to onboard volunteers without having someone in the office at all times. They also stated that the orientation process is lengthy, and if someone is not present when the volunteer is available, they can become lost in the process and drop out. The National Clinical Manager provided data and stated in an interview on 10/29/2025, "We know we are not where we need to be with volunteers, but we have an active PIP." The agency did not ensure that volunteer services equal a total of 5% of patient care hours.

It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services and, as necessary, provides in-service training and education programs where required. The hospice has written policies and procedures describing the method(s) of assessing competency and: maintains a written description of the in-service training provided during the previous 12 months. This standard was not met as evidenced by document review, interview and personnel record review. In 1 of 10 (10%) personnel records reviewed, the agency did not ensure that skills and competencies were assessed on all individuals providing care prior to independent functioning. Personnel Record 2: The Chaplain was hired on 05/25/2025. A personnel record review revealed a 13-page orientation skills checklist initiated on 05/20/2025, but not completed. The Chaplain's self-assessment competency form was not found in the personnel record. During an interview on October 30, 2025, the National Clinical Manager reported that they spoke to the Chaplain, who recalled completing the self-assessment competency and the orientation skills checklist; however, the documented evidence could not be located. The documents were reviewed and recreated on 10/30/2025.

It is required that the hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment, relative to the terminal illness and associated conditions. This standard was not met as evidenced by a review of clinical records and interviews. In 2 of 13 (15%) clinical records reviewed revealed, the agency did not ensure the plan of care addressed the communication and symptom needs of the patient and family identified in the comprehensive assessment. Clinical Record 6: The patient elected the hospice benefit on 11/15/2022. The informed consent and election of benefit signed by the patient were in Spanish, and it was noted the patient admission booklet provided was also in Spanish. The initial comprehensive nursing assessment, completed on 11/15/2022, documented that English was the patient's second language (Spanish is first) and that his wife only communicated in Spanish. It was also documented that the grandson would interpret for them. The plan of care effective from 11/15/2022 to current did not address the communication needs of the patient. Clinical Record 10: The patient elected the hospice benefit on 5/13/2022. On the initial comprehensive nursing assessment, dated 5/13/2022, there was documented 2-3+ (plus) edema in the patient's lower extremities, and the nurse documented the patient reported a 20-pound weight gain due to fluid in the month preceding the hospice admission. Physician orders initiated on 5/19/2022 included Lasix 40mg one time and then beginning 40mg daily. The plan of care, effective 5/13/2022 to the patient's discharge on 6/17/2022, did not contain problems, goals, or interventions to address the patient's edema. In an interview on 12/15/2022, the Administrator confirmed that the plans of care for these patients did not address the specific needs identified on the initial comprehensive assessments.

It is required that the Interdisciplinary Group, in collaboration with the individual's attending physician (if any), reviews, revises, and documents the individualized care plan as frequently as the patient's condition requires. A revised plan of care includes information from the patient’s updated comprehensive assessment. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 13 (8%) clinical records reviewed, the agency did not ensure that the patient's individualized care plan reflected updated information related to changes in the patient's condition. Clinical Record 8: The patient elected the hospice benefit on 10/10/2022. On 12/1/2022, the nurse documented in their assessment that the patient was "experiencing urinary hesitancy with pain and pressure in the lower abdomen." The nurse documented receipt of a physician's order for Cipro 250mg twice a day for seven days to treat a suspected urinary tract infection (UTI). On the plan of care with effective dates 10/10/2022 to 1/7/2023, there was no update to the care plan to reflect interventions or goals related to the UTI. The Administrator confirmed during an interview on 12/15/2022 that the care plan had not been updated and agreed it should have been.

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care or to the patient’s community attending physician upon hospice discharge which includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient's latest physician orders, and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 2 (50%) clinical records reviewed, in which a discharge summary was required, it was revealed that the agency did not ensure that the discharge summary contained all required items, specifically the plan of care and the latest physician orders. Clinical Record 13: The patient elected the hospice benefit on 11/7/2022. On 11/21/2022, the patient/representative revoked the hospice benefit to seek aggressive treatment in the hospital. The hospice discharge summary contained demographic information, however many of the boxed areas were blank or had minimal info; most notably, the care plan area stated, "goals partially met; pt.(patient)/family to resume care" and provided no further details on what goals or interventions were partially met. There were no documented physician orders, medications, or treatments listed on the discharge summary. In an interview with the Administrator conducted on 12/15/22, it was confirmed that the discharge summary had not populated with the full details, and the clinical record did not contain documentation that the plan of care or physician's orders had been attached to the discharge summary or were sent separately.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IDF representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 3 (33%) clinical records reviewed, in which a patient resided in a skilled nursing facility (SNF), the agency did not ensure the plan of care (POC) delineated the responsibilities between the hospice and SNF for the care and services provided. Clinical Record 5: The patient elected the hospice benefit on 9/27/2022 and resided in a skilled nursing facility (SNF) from admission through this review. The initial plan of care orders included wound care with daily dressing changes and did not delineate who was responsible for providing this skill. This order remained active until 12/8/2022 when it decreased to dressing changes three (3) times per week; throughout this time, the hospice nurse visit frequency order was one visit per week. The Administrator reported that the hospice nurse would have been changing the dressing during the visit and the facility nurses would have changed it the other times but agreed this was not delineated clearly in the plan of care. In an interview conducted on 12/14/2022, the Administrator confirmed that the POC did not specify which provider was responsible and voiced that they thought the collaboration documentation within the nursing assessments met this requirement.