Vitas Healthcare Corporation of Illinois

“It is required that the hospice designates a registered nurse member of the IDG to: ensure the implementation of the interdisciplinary plan of care. 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). 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...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 10 of 19 (53%) clinical records reviewed, the agency did not ensure that services provided to patients followed the individualized plan of care established by the IDG, Clinical Record 1: The patient elected hospice care on 03/13/2024 with a diagnosis of heart failure. The plan of care (POC) for the benefit period dated 03/13/2024 through 06/10/2024 ordered Skilled Nursing (SN) services two (2) times for the week of 05/23/2024. One (1) SN visit was documented on 05/28/2024 for the week of 05/23/2024. The week of 06/06/2024, the POC ordered two (2) SN visits. One (1) SN visit was documented on 06/12/2024 for the week of 06/06/2024. The week of 06/13/2024, the POC ordered one (1) SN visit. No SN visit was documented for the week of 06/13/2024. The week of 06/20/2024, the POC ordered SN visits two (2) times a week. One (1) SN visit was documented on 06/21/2024 for the week of 06/20/2024. The week of 05/30/2024 did not include orders for Chaplain services. One (1) Chaplain visit was documented on 06/04/2024. The SN and the Chaplain did not follow the plan of care visit frequency. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN and Chaplain visit frequency. Clinical Record 4: The patient elected hospice care on 06/21/2024 with a diagnosis of multiple sclerosis. The plan of care for the benefit period dated 06/21/2024 through 09/19/2024 did not order SN services for the week of 06/27/2024. The SN documented two (2) visits (07/01/2024 and 07/03/2024) for the week of 06/27/2024. The POC ordered SN visits two (2) times a week for the week of 07/04/2024. No SN visit was documented for the week of 07/04/2024. The POC did not order SN services for the week of 07/18/2024. One (1) SN visit was documented on 07/19/2024 for the week of 07/18/2024. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN visit frequency. Clinical Record 5: The patient elected hospice care on 03/01/2024 with a diagnosis of severe protein-calorie malnutrition with the comorbid conditions of atherosclerotic heart disease, heart failure, peripheral vascular disease, and chronic kidney disease stage three. The POC for the benefit period dated 05/02/2024 through 08/28/2024 ordered SN services two (2) times a week for the week of 05/30/2024. No SN visits were documented for the week of 05/30/2024. The POC ordered SN services two (2) times a week for the week of 06/13/2024. One (1) SN visit was documented on 06/19/2024 for the week of 06/13/2024. The POC did not order Chaplain services for the week of 06/20/2024. One (1) Chaplain visit was documented on 06/21/2024 for the week of 06/20/2024. The POC ordered SN services one (1) time a week for the week of 06/27/2024. No SN visits were documented for the week of 06/27/2024. The SN and the Chaplain did not follow the plan of care visit frequency. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN and Chaplain visit frequency. Clinical Record 6: The patient elected hospice care on 06/02/2024 with a diagnosis of chronic respiratory failure with comorbid conditions of chronic obstructive pulmonary disease (COPD), emphysema, and congestive heart failure (CHF). The POC for the benefit period dated 06/02/2024 through 08/31/2024 ordered SN services three (3) times for the week of 06/12/2024. Two (2) SN visits were documented (06/12/2024 and 06/17/2024) for the week of 06/12/2024. The POC did not order Social Worker (SW) services for the week of 06/12/2024. One SW visit was documented on 06/12/2024 for the week of 06/12/2024. The POC ordered SN services one (1) time a week for the week of 07/10/2024. No SN visits were documented for the week of 07/10/2024. The SN and the SW did not follow the plan of care visit frequency. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN and SW visit frequency. Clinical Record 7: The patient elected hospice care on 04/29/2024 with a diagnosis of traumatic brain injury with comorbid conditions of seizures and diabetes mellitus type two. The POC for the benefit period dated 04/29/2024 through 07/27/2024 ordered SN services five (5) times for the week of 05/01/2024. Two (2) SN visits were documented (05/02/2024 and 05/03/2024) for the week of 05/01/2024. The POC for the week of 05/08/2024 ordered SN services two (2) times a week. One missed visit was documented on 05/08/2024. The POC ordered SN services one (1) time weekly for the week of 05/22/2024. No SN visit was documented for the week of 05/22/2024. The POC ordered SN services two (2) times a week for the week of 05/29/2024. One SN visit was documented on 05/30/2024 for the week of 05/29/2024. The POC ordered SN services one (1) time weekly for the week of 06/19/2024. No SN visit was documented for the week of 06/19/2024. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN visit frequency. Clinical Record 8: The patient elected hospice care on 01/27/2023 with a diagnosis of cerebral vascular disease with comorbid conditions of a history of hypertension seizures, aphasia, and cerebral infarct. The plan of care for the benefit period dated 05/21/2024 through 07/19/2024 ordered SN services one (1) time a week for the week of 06/20/2024. No SN visit was documented for the week of 06/20/2024. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN visit frequency. Clinical Record 10: The patient elected hospice care on 04/22/2024 with a diagnosis of cerebrovascular disease with comorbid conditions of seizures, vascular dementia, dysphagia, and diabetes mellitus type two. The plan of care for the benefit period dated 04/22/2024 through 07/20/2024 ordered SN services one (1) time a week for the week of 05/01/2024. No SN visit was documented for the week of 05/01/2024. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN visit frequency. Clinical Record 11: The patient elected hospice care on 04/12/2024 with a diagnosis of chronic hepatic failure with comorbid conditions of dysphagia and pneumonitis secondary to aspiration. The plan of care for the benefit period dated 04/12/2024 through 07/10/2024 ordered SN services two (2) times a week for the week of 05/15/2024. One SN visit was documented on 05/18/2024 for the week of 05/15/2024. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN visit frequency. Clinical Record 12: The patient elected hospice care on 10/17/2023 with a diagnosis of heart failure with comorbid conditions of atherosclerotic heart disease and hypertensive cardiomyopathy. The plan of care for the benefit period dated 06/13/2024 through 08/12/2024 ordered SN services one (1) time a week for the week of 06/26/2024. No SN visit was documented for the week of 06/26/2024. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN visit frequency. Clinical Record 13: The patient elected hospice care on 02/26/2024 with a diagnosis of unspecified diastolic congestive heart failure. The plans of care for benefit periods dated 02/26/2024 through 05/25/2024 and 05/25/2024 through 08/24/2024 ordered SN services two (2) times a week for the week of 05/23/2024 and no SN services for the week of 05/30/2024. One SN visit was documented on 05/23/2024 for the week of 05/23/2024, and one was documented on 05/31/2024 for the week of 05/30/2024. The POC ordered SN services three (3) times for the week of 06/13/2024 and two (2) times for the week of 07/04/2023. One SN visit was documented on 06/16/2024 for the week of 06/13/2024, and one was documented on 07/04/2024 for the week of 07/04/2023. A clinical record review revealed no documented missed visits and no evidence that the physician was notified of the missed visits. There was no evidence of communication with the physician to change the SN visit frequency. During a joint clinical record review and an interview on 08/01/2024, the National Patient Care Administrator (NPCA) confirmed that all available documentation had been provided. The NPCA confirmed the missing and additional visits outside the ordered plan of care frequencies.”

“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. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Supervision, Delegation, and Coordination” dated 07/15/2019 read in part that “...The RN must complete an HA Supervisory visit during the nursing visit to the patient at least every 14 days when hospice aide services are on the plan of care ... Best Practice: Complete an HA supervision on each RN visit when HA services are being provided to ensure care is being provided as you delegated and ensure you meet the 14-day requirement. Hospice Aide supervisory visits will be documented on the Visit Summary that accompanies the RN visit...” In 2 of 11 (18%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that a Registered Nurse (RN) made an on-site visit to the patient’s home no less frequently than every 14 days. Clinical Record 13: The patient elected the hospice benefit on 02/26/2024. The plan of care for the benefit period dated 05/25/2024 through 08/24/2024 ordered HA services “4-5 times a week.” The Registered Nurse (RN) documented HA supervision on 05/31/2024. The subsequent HA supervisory visits were documented on 06/16/2024 and 07/04/2024, with 16 and 18 days outstanding, respectively. A HA supervisory visit was documented on 07/12/2024. As of the clinical record review on 07/31/2024, no further HA supervisory visit was documented, with 19 days outstanding. Clinical Record 14: The patient elected the hospice benefit on 04/26/2024. The plan of care for the benefit period dated 04/26/2024 through 07/24/2024 ordered HA services “3 times a week,” except for the week of 06/06/2024, which was twice a week. The RN documented subsequent HA supervisory visits on 05/17/2024, 05/24/2024, and 06/05/2024. As of the clinical record review on 07/30/2024, no further HA supervisory visits were documented, with 55 days outstanding. During a joint clinical record review and interview on 08/01/2024, the National Patient Care Administrator confirmed that all available documentation had been provided and that there were gaps in HA supervision by the RN.”

“It is required that all entries in the patient record are legible, complete, and appropriately authenticated and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. This standard was not met as evidenced by clinical record review and document review. Agency policy “Correcting an Error in the Clinical Record” (dated 05/30/2022) stated in part, “You may not draw several lines, scribble through, or attempt to obliterate an error. You may not attempt to fix an error by writing over something that is already written ...Place a single line through the incorrect documentation. Place your initials and the date you made the change directly above the incorrect documentation you lined out...” In 7 of 19 (37%) clinical records reviewed, the agency did not ensure that all entries in the patient record were legible, appropriately authenticated, and dated in accordance with hospice policy. Clinical Record 1: The patient elected the hospice benefit on 03/13/2024. On page two (2) of the nursing comprehensive assessment dated 06/06/2024, the date was written over and not corrected per the policy. Additionally, on page five (5) of the nursing comprehensive assessment dated 07/15/2024, the date was written over and not corrected per the policy. Clinical Record 3: The patient elected the hospice benefit on 05/02/2024. On page five (5) of the continuous care shift note dated 05/03/2024, the time entry for 0730 was written over and not corrected per the policy. On page one (1) of the continuous care shift note for the Hospice Aide dated 05/03/2024, the start of shift time 0825 was written over and not corrected per the policy. Additionally, the time entries for 1025 and 1805 were not corrected per policy. On page two (2), the shift date was documented as 05/03/2024; the number five (5) was written over and not corrected per the policy. On page one (1) of the nursing comprehensive assessment dated 05/08/2024, the visit date was written over and not corrected per the policy. The visit start time of 4:40 on the supplemental interdisciplinary note dated 05/16/2024 was written over and not corrected per the policy. On page two (2) of the nursing comprehensive assessment dated 05/17/2024, the visit date was written over and not corrected per the policy. On the nursing comprehensive assessment dated 05/23/2024, the visit start and end times were written over and not corrected per the policy. On the nursing comprehensive assessment dated 06/26/2024, page two (2), the patient’s medical record number was written over and not corrected per the policy. On page six (6), the visit date was written over and not corrected per the policy. On the nursing comprehensive assessment dated 07/11/2024, page one (1), the patient’s medical record number and the visit start time (page six (6)) were written over and not corrected per the policy. Clinical Record 10: The patient elected the hospice benefit on 04/22/2024. On page two (2) of the nursing comprehensive assessment dated 06/05/2024, in the section labeled “cardiac,” the skilled nurse (SN) documented, “Has Amlodipine 10 mg daily for HTN...” The “mg” was written over and not corrected per agency policy. Clinical Record 11: The patient elected the hospice benefit on 04/12/2024. The plan of care review dated 05/08/2024, the SN documented “... cinacalcet 30 mg QHS for hypercalcemia...” The “30” was written over and not corrected per agency policy. On page three (3) of the nursing comprehensive assessment dated 06/21/2024, the SN documented that the patient “Has Lactulose 15ml QHS for constipation...” The number “15” was written over and not corrected per agency policy. Clinical Record 12: The patient elected the hospice benefit on 10/17/2023. On page three (3) of the nursing comprehensive assessment dated 05/13/2024, the SN documented that the patient “Has senna syrup 10ml QHS for constipation...” The number “10” was written over and not corrected per agency policy. Clinical Record 13: The patient elected the hospice benefit on 02/26/2024. On page one (1) of the nursing comprehensive assessment dated 04/02/2024, the visit date was written over and not corrected per agency policy. Clinical Record 17: The patient elected the hospice benefit on 06/14/2023. On page one (1) of the nursing comprehensive assessment dated 01/16/2024, the SN documented in the section labeled for pain, “Has Morphine 5mg Q3hrs PRN ...” The “mg” was written over and not corrected per the agency’s policy. On page three (3) of the nursing comprehensive assessment dated 01/23/2024, the patient’s medical record number was written over and not corrected per the agency’s policy. The focus visit note dated 02/26/2024 documented the patient’s blood pressure and respiratory readings that were written over and not corrected per policy. On page two (2) of the nursing comprehensive assessment dated 02/28/2024, the SN documented “...orders to give Morphine STAT 5mg...” The “5” was written over and not corrected per the agency’s policy.”

“It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Discharge” (dated 02/15/2021) stated in part, “The Transfer/Discharge Instructions/Summary form should be completed for all alive discharges...A Transfer/Discharge Summary Instructions Form should be completed...Forward a copy of the Transfer Discharge Summary instructions to the attending physician along with the most recent POC review and latest orders ...Forward a copy of the Transfer Discharge Summary Instructions to the attending physician along with the most recent POC review and latest orders...” In 2 of 2 (100%) clinical records reviewed of patients who were discharged or revoked hospice services, the agency did not ensure that the discharge summary was forwarded to the receiving facility. Clinical Record 15: The patient elected the hospice benefit on 04/25/2024 and was discharged from hospice services on 05/31/2024 due to being admitted to a non-contracted facility. A clinical record review revealed no discharge summary was forwarded to the hospital. Clinical Record 16: The patient elected the hospice benefit on 12/23/2023 and revoked hospice services on 06/19/2024 to seek aggressive treatment. A clinical record review revealed no discharge summary was forwarded to the hospital. During a joint clinical record review and interview on 07/31/2024, the National Patient Care Administrator (NPCA) confirmed that no discharge summary was documented and forwarded to the receiving facility. The NPCA also confirmed that all available documentation was provided by the end of the site visit.”

“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—includes at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, and the patient’s latest physician orders. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Discharge” (dated 02/15/2021) stated in part, “The Transfer/Discharge Instructions/Summary form should be completed for all alive discharges...A Transfer/Discharge Summary Instructions Form should be completed...Forward a copy of the Transfer Discharge Summary instructions to the attending physician along with the most recent POC review and latest orders ...Forward a copy of the Transfer Discharge Summary Instructions to the attending physician along with the most recent POC review and latest orders...” In 2 of 2 (100%) clinical records reviewed of patients discharged from hospice services, the hospice did not ensure that a discharge summary was completed. Clinical Record 15: The patient elected the hospice benefit on 04/25/2024 and was discharged from hospice services on 05/31/2024 due to being admitted to a non-contracted facility. A clinical record review revealed no discharge summary was documented. Clinical Record 16: The patient elected the hospice benefit on 12/23/2023 and revoked hospice services on 06/19/2024 to seek aggressive treatment. A clinical record review revealed no discharge summary was documented. During a joint clinical record review and interview on 07/31/2024, the National Patient Care Administrator (NPCA) confirmed that no discharge summary was documented and forwarded to the receiving facility. The NPCA also confirmed that all available documentation was provided by the end of the site visit.”