Vitas Healthcare Corporation of California

“The hospice registered nurse must complete an initial assessment within 48 hours after the election of hospice care unless the physician, patient, or representative requests that the initial assessment be completed in less than 48 hours. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed, the hospice did not ensure that the hospice Registered Nurse (RN) completed an initial assessment within 48 hours of the patient’s election of hospice care. Clinical Record 19: The patient elected the hospice care on 09/28/2023 with a terminal diagnosis of heart failure. On 09/29/2023 the RN attempted to admit the patient. The patient’s son declined and stated he preferred a visit on Monday 10/02/2023. The RN completed the initial assessment on 10/02/2023, four (4) days after the patient elected hospice care. There was no evidence that the physician was notified of the delay in care or updated physician orders for admission. There was no evidence of an updated election of hospice care. During an interview and a joint record review on 05/17/2024, the Patient Care Administrator/RN confirmed the finding, stating they thought if the patient/family chose the visit date it would be within the standard. In 1 of 23 (4%) clinical records reviewed the hospice did not ensure that the RN initial comprehensive assessment was completed within 48 hours of the election of hospice care.”

“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 and interview. In 3 of 23 (13%) clinical records reviewed, the hospice did not ensure that the interdisciplinary group completed an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. Clinical Record 5: The patient elected the hospice care on 06/28/2023 with a terminal diagnosis of pulmonary fibrosis. The Registered Nurse (RN) documented the need for a Medical Social Worker (MSW) evaluation in the initial comprehensive assessment. The MSW documented their initial assessment on 07/05/2023, six (6) days after the patient’s election of hospice care. There was no documentation as to why the initial MSW assessment was not completed within five (5) calendar days after the election of hospice care. Clinical Record 10: The patient elected the hospice benefit on 02/09/2024 with a terminal diagnosis of unspecified severe protein-calorie malnutrition. The RN documented the need for a MSW evaluation in the initial comprehensive assessment. The MSW documented their initial assessment on 02/21/2024, twelve (12) days after the patient’s election of hospice care. There was no documentation as to why the initial MSW assessment was not completed within five (5) calendar days after the election of hospice care. Clinical Record 12: The patient elected the hospice benefit on 02/14/2024 with a terminal diagnosis of cerebral atherosclerosis. The RN documented the need for a MSW and spiritual care (SC) evaluation in the initial comprehensive assessment. The SC and MSW documented their initial assessments on 02/22/2024, eight (8) days after the patient’s election of hospice care. There was no documentation as to why the initial MSW and SC assessments were not completed within five (5) calendar days after the election of hospice care. During an interview and a joint record review on 05/13/2024 and 05/16/2024, the Patient Care Administrator/RN confirmed the findings. In 3 of 23 (13%) clinical records reviewed revealed the hospice did not ensure that the interdisciplinary group completed the comprehensive assessment within 5 calendar days after the election of hospice care.”

“It is required that a hospice aide provides services: ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; [and] consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA provided services included in the plan of care. Clinical Record 9: The patient elected hospice care on 02/15/2023 with a terminal diagnosis of cerebral atherosclerosis. The HA care plan dated 03/23/2023 assigned the HA the relevant tasks: activity allowed, bedbound. The HA visit notes dated 04/30/2024, 05/01/2024, 05/02/2024, 05/08/2024, and 05/09/2024, documented “wheelchair used-performed.” The HA care plan did not assign the task of “wheelchair used-performed.” During an interview and a joint record review on 05/16/2024, the Patient Care Administrator/Registered Nurse (RN) confirmed the finding, stating that the facility staff are the ones who get the patient up into the wheelchair and the HA should not have documented “wheelchair used” task was performed as the HA was not the one completing it. In 1 of 18 (6%) clinical records reviewed with aide services provided, the agency did not ensure the hospice aide (HA) provided services as ordered by the IDG and included in the plan of care.”