Every finding on record at Vitas Healthcare Corporation of Georgia

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy entitled "Initial and Comprehensive Assessment" (dated 06/06/2024), stated in part, "Initial Assessment (RN)... as soon as possible but no greater than forty-eight hours after the effective date of the hospice election... In the event of the rare circumstance that the patient or caregiver refuses the RN Initial Comprehensive Assessment or the Psychosocial/Spiritual Initial Comprehensive Assessment within the regulatory required timeframe, then it should be documented clearly in the medical record that the visit was postponed per the requires of the patient or caregiver and the hospice physician is aware of the delay ...Initial Comprehensive Assessment (RN) consists of RN-Initial Comprehensive Assessment ... The RN may be the only discipline completing the Initial Comprehensive Assessment under certain conditions such as ... refusal of assessment visits by other disciplines by the patient/family, IDG determination that additional assessment is not necessary based on discussion/collaboration with RN following the RN Initial Comprehensive Assessment .. " In 1 of 19 (6%) clinical records reviewed, the agency did not ensure that the Interdisciplinary Group completed the initial comprehensive assessment within five (5) calendar days after the patient's election of hospice care. Clinical Record 11: The patient elected the hospice benefit on 11/14/2023. The initial psychosocial assessment was completed by the social worker (SW) on 11/22/2023, eight (8) days after the patient's election of hospice care. The late initial comprehensive assessments were confirmed during a joint record review and interview with the Team Manager and the National Patient Care Administrator.

It is required that hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any); the patient or patient representative if any of them so desire; [and] the primary caregiver in accordance with the patient’s needs if any of them so desire. This standard was not met, as evidenced by clinical record review, document review, and interview. Agency policy "Frequency" (dated 08/15/2023) read in part, "Frequency is based on the IDG/patient care plan week and starts the day after team meeting ... A patient or family may choose to decline or re-schedule a visit. Document the declination and reason if known in the clinical record. Communicate the declination with the IDG as appropriate to determine if a change in the POC is warranted. Attempted visits do not count towards frequency. Every effort should be made to reschedule the visit during the same IDG/Care Plan week. Documentation should reflect visit attempts and efforts to reschedule...If a patient accepts SW or Chaplain ... once the assessment is completed ... document the ongoing visit frequency for the assigned discipline/clinician ... " In 8 of 19 (42%) clinical records reviewed, the agency did not ensure that care and services furnished to patients and their families followed the plan of care (POC) established by the hospice interdisciplinary group. Clinical Record 1: The patient elected the hospice benefit on 04/03/2024 with the diagnosis of chronic obstructive pulmonary disease (COPD). The patient's team meetings occurred on 04/24/2024, 05/08/2024, 05/22/2024, and 06/05/2024. The POC for the benefit period dated 04/03/2024 to 07/02/2024 ordered Skilled Nursing (SN) services twice (2) times for the week of 05/09/2024 and one (1) time a week for the week of 05/16/2024. A review of the clinical record revealed one (1) SN visit was documented on 05/13/2024 for the week of 05/09/2024, and no SN visits were documented for the week of 05/16/2024. A clinical record review revealed no evidence of documented missed visits or communication with the physician to change the SN visit frequency. Clinical Record 3: The patient elected the hospice benefit on 02/26/2024 with a diagnosis of severe protein-calorie malnutrition. The patient's team meetings occurred on 04/17/2024, 05/01/2024, 05/14/2024, and 05/28/2024. The POC for the benefit period dated 02/26/2024 to 05/25/2024 ordered SN services one (1) time a week for the week of 03/27/2024, three (3) times a week for the week of 04/26/2024, and four (4) times a week for the week of 05/01/2024. A review of the clinical record revealed there was no documented SN visit for the week of 03/27/2024, one (1) SN visit documented for the week of 04/25/2024, and two (2) SN visits documented (05/02/2024 and 05/07/2024) for the week of 05/01/2024. A clinical record review revealed no evidence of documented missed visits or communication with the physician to change the SN visit frequency. Clinical Record 5: The patient elected the hospice benefit on 02/14/2024 with a diagnosis of cerebral atherosclerosis. The patient team meetings occurred on 04/03/2024, 04/17/2024, 05/01/2024, 05/15/2024, and 05/29/2024. The POC for the benefit period dated 02/14/2024 to 05/13/2024 ordered SN services four (4) times a week for the week of 04/25/2024. A clinical record review revealed two SN visits (04/29/2024 and 04/30/2024) documented for the week of 04/25/2024. For the benefit period dated 05/14/2024 to 08/12/2024, the POC ordered SN services five (5) times a week for the week of 05/02/2024. One SN visit was documented on 05/07/2024. For the week of 06/06/2024, the POC ordered SN service two (2) times a week. There were no nurse visits documented from 06/06/2024 to 06/12/2024. A clinical record review revealed no evidence of documented missed visits or communication with the physician to change the SN visit frequency. Clinical Record 6: The patient elected the hospice benefit on 02/02/2024 with a diagnosis of congestive heart failure. The patient's team meetings occurred on 04/03/2024, 04/17/2024, 05/01/2024, 05/15/2024, and 05/29/2024. The POC for the benefit period dated 05/02/2024 to 07/31/2024 ordered SN services three (3) times a week for the week of 05/02/2024. There were no SN visits documented for the week of 05/02/2024 to 05/08/2024. For the week of 05/09/2024, the POC ordered SN visits seven (7) times a week and Chaplain visits one (1) time weekly. A clinical record review revealed two (2) SN visits documented (05/09/2024 and 05/15/2024), and no Chaplain visit from 05/09/2024 to 05/15/2024. The Social Worker (SW) documented one (1) visit on 05/22/2024. For the week of 05/16/2024, the POC did not order a SW visit. For the week of 05/23/2024, the POC ordered SN services twice (2) weekly. No SN visits were documented from 05/23/2024 to 05/29/2024. A clinical record review revealed no evidence of documented missed visits or communication with the physician to change the SN, Chaplain, or SW visit frequency. Clinical Record 7: The patient elected the hospice benefit on 01/19/2024 with a diagnosis of Parkinson's. The patient's team meetings occurred on 03/27/2024, 04/10/2024, 04/24/2024, 05/08/2024, and 05/22/2024. The POC for the benefit periods 03/19/2024 to 05/18/2024 ordered seven (7) SN visits for the week of 04/25/2024. Two (2) SN visits were documented (04/25/2024 and 04/30/2024) for the week of 04/25/2024. The POC for the benefit period dated 05/19/2024 to 07/17/2024 ordered one (1) SN visit for the week of 05/16/2024. No SN visit was documented from 05/16/2024 to 05/22/2024. One SW visit was documented on 05/14/2024. There were no POC orders for SW services for the week of 05/09/2024. A clinical record review revealed no evidence of documented missed visits or communication with the physician to change the SN and SW visit frequency. Clinical Record 8: The patient elected the hospice benefit on 04/15/2024 with the diagnosis of malignant neoplasm of the brain. The patient's team meetings occurred on 04/24/2024, 05/08/2024, 05/22/2024, and 06/05/2024. The POC for the benefit period dated 04/15/2024 to 07/14/2024 ordered SN services two (2) times a week for the week of 05/09/2024. One SN visit was documented for the week of 05/09/2024. A clinical record review revealed no evidence of a documented missed visit or communication with the physician to change the SN visit frequency. Clinical Record 9: The patient elected the hospice benefit on 02/29/2024 with the diagnosis of Alzheimer's. The patient's team meetings occurred on 04/18/2024, 05/02/2024, 05/16/2024, and 05/30/2024. The POC for the benefit period 02/29/2024 to 5/29/2024 ordered SN services two times weekly for the week of 05/03/2024. One SN was documented on 05/08/2024 for the week of 05/03/2024. A clinical record review revealed no evidence of a documented missed visit or communication with the physician to change the SN visit frequency. Clinical Record 13: The patient elected the hospice benefit on 11/14/2023 with the diagnosis of cerebral atherosclerosis. The patient's team meetings occurred on 04/10/2024, 04/24/2024, 05/08/2024, and 05/22/2024. The POC for the benefit period 04/12/2024 to 06/11/2024 ordered SN services two (2) times a week for the week of 05/16/2024. One SN was documented on 05/21/2024. A clinical record review revealed no evidence of a documented missed visit or communication with the physician to change the SN visit frequency. Additionally, one Social Worker (SW) visit was documented on 05/20/2024. The POC did not include an order for the SW visit. During a joint record review and interview on 06/28/2024, the Team Manager and the National Patient Care Administrator confirmed the missed visit and extra visit findings and that all available documentation for the patient visits was provided.

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, but no less frequently than every 15 calendar days. This standard was not met as evidenced by clinical record review, document review and interview. Agency policy "IDG POC Meeting" (dated 02/15/2023) read in part, "Each patient shall be reviewed at least every 15 days ... Bi-weekly review of each patient POC ... Discussion and Plan of Care Review (POCR) ... ensure Plans of Care are updated including a review an update of each patient's visit frequency. The physician-ordered frequency changes per the POC ... Regulatory Documentation ... IDG Agenda/Attendance indicating attendees and their participation in the patient review and discussion; indicates patients discussed during the IDG meeting... POC Review form should be completed as documentation of the IDG discussion..." In 3 of 19 (16%) clinical records reviewed, the agency did not ensure that the Interdisciplinary Group (IDG) reviewed, revised, and documented the patient's care plan no less frequently than every 15 calendar days. Clinical Record 3: The patient elected the hospice benefit on 02/26/2024 with the diagnosis of protein-calorie malnutrition. A review of the clinical record revealed no documented Plan of Care Review/Interdisciplinary Group Meetings from 03/27/2024 through 04/17/2024, with 21 days outstanding. Clinical Record 5: The patient elected the hospice benefit on 02/14/2024 with the diagnosis of cerebral atherosclerosis. A review of the clinical record revealed no documented Plan of Care Review/Interdisciplinary Group Meetings from 02/21/2024 to 03/20/2024, with 28 days outstanding. Clinical Record 18: The patient elected the hospice benefit on 12/21/2023 with the diagnosis of cerebral atherosclerosis. A review of the clinical record revealed no documented Plan of Care Review/Interdisciplinary Group Meetings from 12/21/2023 to 01/17/2024, with 27 days outstanding. During a joint record review and interview on 06/28/2024, the Team Manager and the National Patient Care Administrator confirmed the missing Plan of Care Reviews/Interdisciplinary Group Meetings and that all available patient documentation had been provided including all Team Meeting Agendas with team members present and patients presented with the collaboration of the attending physician.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to: assess the quality of care and services provided by the hospice aide; [and] ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 3 of 12 (25%) clinical records reviewed in which Hospice Aide (HA) services were accepted, the agency did not ensure that the Registered Nurse (RN) documented supervision of the Hospice Aide no less frequently than every 14 days. Clinical Record 6: The patient elected the hospice benefit on 02/02/2024. The plans of care (POC) for the benefit periods dated 02/02/2024 to 05/01/2024 and 05/02/2024 to 07/31/2024, ordered HA services twice (2) times a week. A review of the clinical record revealed no documented RN supervision of the HA from 03/21/2024 to 04/29/2024, with 39 days outstanding. Clinical Record 8: The patient elected the hospice benefit on 04/15/2024. The POC for the benefit period 04/15/2024 to 07/14/2024, ordered HA services twice (2) times a week. The first HA visit was documented on 04/26/2024. A review of the clinical record revealed no documented RN supervision of the HA from 05/09/2024 to 05/24/2024, with 15 days outstanding, and 05/24/2024 to 06/21/2024, with 28 days outstanding. Clinical Record 9: The patient elected the hospice benefit on 02/29/2024. The POC for the benefit period 02/29/2024 to 05/29/2024, ordered HA services three (3) times a week. A review of the clinical record revealed no RN documented supervision of the HA from 03/21/2024 to 04/10/2024, with 20 days outstanding, and 04/23/2024 to 05/08/2024, with 15 days outstanding. During a joint clinical record review and interview on 06/28/2024, the Team Manager confirmed the gaps in HA supervision.