Vitas Healthcare Corporation of Florida

“It is required that the documented comprehensive assessment includes 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 medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measures are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at 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, document review, observation, and interview. Agency policy, “Long Term Care Facility” (dated 12/03/2025) stated in part, “General Instructions: LTC Visit Overview...Review the patient chart...Check to see if there are any new orders. Review the LTC Plan of Care (POC): Are there any changes? Is it consistent with the (hospice) POC...Coordinate the changes in the POC...with the appropriate facility staff...Professional Management: (hospice) is responsible for the professional management of all hospice services provided to LTC facility patients...Ongoing assessment, monitoring, and coordinating care...” 1 of 1 (100%) home visits observed and clinical records reviewed for a patient residing in a nursing facility (NF), the agency did not ensure the comprehensive assessment included a drug profile listing the patient’s current medications. HOME VISIT 3/CLINICAL RECORD 3: The patient elected hospice care on 10/15/2025 with a primary diagnosis of cerebral atherosclerosis. The patient resided in a nursing facility. During the home visit with the Registered Nurse (RN)(Personnel Record 5) on 12/17/2025, a printed medication profile from the facility’s electronic medical record (EMR) was obtained. A review of the NF medication profile and the hospice medication profile revealed medications appeared on the NF medication profile that were listed as discontinued as of 10/20/2025 in the hospice medication profile: amlodipine besylate oral tablet 10mg, one tablet by mouth once daily for hypertension (start date 08/14/2025); metformin hcl oral tablet 500mg, one tablet by mouth once daily for diabetes melilites (start date 08/14/2025); and valsartan oral tablet 160mg, one tablet by mouth once daily for hypertension. In addition, the hospice medication profile documented Zofran 4mg oral disintegrating tablet, one tablet by mouth every 6 hours as needed (PRN) for nausea or vomiting (start date 11/04/2025), which did not appear on the NF medication profile. The RN returned to the NF on 12/17/2025 and documented in the visit note, “Medication list discussed with Dr. (hospice MD) and Dr. (attending MD). Orders received to profile Valsartan, Metformin...FN (facility nurse) confirms patient continues to receive Metformin and Valsartan. Order given to RN, reviewed orders, and paper order given...” The hospice and NF medication profiles were updated to include the patient’s Metformin and Valsartan. Amlodipine was discontinued in the NF and the hospice medication profiles. The NF updated medication profile did not document the PRN Zofran order. During a joint review of the NF and hospice medication profiles and an interview on 12/18/2025, the National Patient Care Administrator (NPCA) confirmed a discrepancy between the active medications on the medication profiles. The NPCA stated that the nurse returned to the facility the same afternoon to bring the two lists into compliance and that she should check and compare NF and hospice medications at her visits.”

“It is required that the nursing care and services are provided by or under the supervision of a registered nurse and per the patient plan of care. Nursing services ensure that the nursing needs of the patient are met as identified in the patient’s initial assessment, comprehensive assessment, and any updated assessments. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Frequency” (dated 11/10/2025) stated in part, “Frequency is part of the Plan of Care (POC)...POC Frequency is documented on...Addendum to the General Plan of Care...Frequency is based on the IDG/patient care plan week, starts the day after team meeting, ends on the next team meeting...Frequency is individualized based on assessed patient and family needs...Declined Visits...Document the declination...in the clinical record. Communicate the declination with the IDG as appropriate...” In 4 of 19 (21%) clinical records reviewed, the agency did not ensure that nursing care and services were provided in accordance with the plan of care. CLINICAL RECORD 7: The patient elected hospice care on 01/08/2025 with a primary diagnosis of Huntington’s disease. For the benefit period from 11/04/2025 to 01/03/2026, the plan of care ordered the Skilled Nurse (SN) to visit twice the week of 11/09/2025. One visit was completed on 11/13/2025. A clinical record review revealed no second visit completed and no documented missed visit. For the week of 11/23/2025, the plan of care ordered SN services once a week. No visit was completed, and no missed visit was documented. CLINICAL RECORD 8: The patient elected hospice care on 08/12/2025 with a primary diagnosis of end-stage renal disease. For the benefit period from 11/10/2025 to 02/08/2026, the plan of care ordered SN services twice a week, the week of 11/30/2025. One visit was completed on 12/04/2025 for the week of 11/30/2025. A clinical record review revealed no second visit completed and no documented missed visit. CLINICAL RECORD 9: The patient elected hospice care on 06/30/2025 with a primary diagnosis of chronic systolic congestive heart failure. For the benefit period from 09/28/2025 to 12/27/2025, the plan of care ordered SN services twice a week, the week of 11/16/2025. One visit was completed on 11/19/2025 for the week of 11/16/2025. A clinical record review revealed no second visit completed and no documented missed visit. CLINICAL RECORD 14: The patient elected hospice care on 08/08/2025 with a primary diagnosis of pulmonary fibrosis. For the benefit period from 11/06/2025 to 02/04/2025, the plan of care ordered SN services three times, the week of 11/16/2025. Two visits were completed on 11/17/2025 and 11/19/2025 for the week of 11/16/2025. A clinical record review revealed no third visit completed and no documented missed visit. During a joint clinical record review and interview on 12/19/2025, the National Patient Care Administrator (NPCA) confirmed a discrepancy between the ordered number of visits and the actual visits documented in clinical records 6, 7, 8, 9, and 14. No documented reason was found for why the visit frequencies had not been met, although the NPCA stated it was difficult to track in the electronic medical record system and in the scheduling system the hospice utilizes.”

“It is required that medical social services are provided by a qualified social worker: per the plan of care. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Frequency” (dated 11/10/2025) stated in part, “Frequency is part of the Plan of Care (POC)...POC Frequency is documented on...Addendum to the General Plan of Care...Frequency is based on the IDG/patient care plan week, starts the day after team meeting, ends on the next team meeting...Frequency is individualized based on assessed patient and family needs...Declined Visits...Document the declination...in the clinical record. Communicate the declination with the IDG as appropriate...” In 1 of 12 (8%) clinical records reviewed for patients receiving medical social services, the agency did not ensure that services were provided per the plan of care. CLINICAL RECORD 6: The patient elected hospice care on 10/19/2024 with a primary diagnosis of liver cell carcinoma. For the benefit period from 10/15/2025 to 12/14/2025, the plan of care ordered that the Social Worker (SW) visit the patient once the week of 11/20/2025. A clinical record review revealed that no visit was made and no missed visit was documented. During a joint clinical record review and interview on 12/19/2025, the National Patient Care Administrator (NPCA) confirmed a discrepancy between the ordered number of visits and the actual visits documented in clinical record 6. No documented reason was found for why the visit frequency had not been met, although the NPCA stated it was difficult to track in the electronic medical record system and in the scheduling system the hospice utilizes.”

“It is required that a hospice aide provides services: ordered by the Interdisciplinary Group. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Frequency” (dated 11/10/2025) stated in part, “Frequency is part of the Plan of Care (POC)...POC Frequency is documented on...Addendum to the General Plan of Care...Frequency is based on the IDG/patient care plan week, starts the day after team meeting, ends on the next team meeting...Frequency is individualized based on assessed patient and family needs...Declined Visits...Document the declination...in the clinical record. Communicate the declination with the IDG as appropriate...” In 4 of 14 (29%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide provided services ordered by the Interdisciplinary Group (IDG). CLINICAL RECORD 6: The patient elected hospice care on 10/19/2024 with a primary diagnosis of liver cell carcinoma. For the benefit periods from 10/15/2025 to 12/14/2025 and 12/14/2025 to 02/11/2026, the plans of care ordered for the Hospice Aide to visit the patient one time during the weeks of 12/11/2025 and 12/15/2025. No visit was completed either week, and no missed visits were documented. CLINICAL RECORD 8: The patient elected hospice care on 08/12/2025 with a primary diagnosis of end-stage renal disease. For the benefit period from 11/10/2025 to 02/08/2026, the plans of care ordered HA services twice a week for the weeks of 11/16/2025 and 12/07/2025. One visit was completed on 11/19/2025 for the week of 11/16/2025; no second visit was completed, and no missed visit was documented. One visit was completed on 12/10/2025 for the week of 12/07/2025; no second visit was completed, and no missed visit was documented. CLINICAL RECORD 9: The patient elected hospice care on 06/30/2025 with a primary diagnosis of chronic systolic congestive heart failure. For the benefit period from 09/28/2025 to 12/27/2025, the plan of care ordered HA services twice the week of 11/02/2025. One visit was completed on 11/06/2025; no second visit was completed, and no missed visit was documented. CLINICAL RECORD 14: The patient elected hospice care on 08/08/2025 with a primary diagnosis of pulmonary fibrosis. For the benefit period from 08/08/2025 to 11/06/2025 and from 11/06/2025 to 02/04/2025, the plans of care ordered HA services three times a week for the week of 10/19/2025. One visit was completed on 10/20/2025; no second or third visit was completed, and no missed visits were documented. For the week of 10/26/2025, the plan of care ordered HA services twice a week. One visit was completed on 10/29/2025; no second visit was completed, and no missed visit was documented. For the week of 11/02/2025, the plan of care ordered HA services five times a week. Three visits were completed on 11/03/2025, 11/04/2025, and 11/06/2025; no fourth or fifth visits were completed, and no missed visits were documented. For the week of 11/23/2025, the plan of care ordered HA services twice a week. One visit was completed on 11/25/2025; no second visit was completed, and no missed visit was documented. During a joint clinical record review and interview on 12/19/2025, the National Patient Care Administrator (NPCA) confirmed a discrepancy between the ordered number of visits and the actual visits documented in clinical records 6, 8, 9, and 14. No documented reason was found for why the visit frequencies had not been met, although the NPCA stated it was difficult to track in the electronic medical record system and in the scheduling system the hospice utilizes.”