Every finding on record at Bristol Home Care and Hospice Agency Inc

An unannounced survey visit concluded at Bristol Home Care & Hospice on 07/09/2025 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

An unannounced survey visit concluded at Bristol Home Care & Hospice on 07/09/2025, for the purpose of reviewing the Federal Regulations at §484.0, Condition of Participation for Home Health Agencies (HHA), and a State of Connecticut Re-Licensure. Standard-level deficiencies were identified.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on clinical record reviews, interview with agency personnel, and review of an agency policy, for one of two patients (Patient #10) who required wound care, the agency failed to perform the necessary assessments. The findings include: Patient #10 had a start of care date of 06/13/2025 with diagnoses that included muscle weakness, falls and hypertension. The certification orders for 06/13/2025 to 08/11/2025 included nursing services three times per week for nine weeks for nursing assessments and wound care to stage II (a partial thickness loss of skin, and appears as a shallow open sore) pressure ulceration to the right buttocks which included cleansing the wound with soap and water, applying skin preparation to the peri-wound and covering with a foam dressing three times per week. Review of Patient #10’s nursing notes dated 06/16/2025, 06/18/2025, 06/20/2025, 06/23/2025, 06/25/2025, 06/27/2025, 06/30/2025, 07/02/2025 and 07/04/2025 failed to identify the Patient’s wound was measured at least weekly. Interview with the Supervisor of Clinical Services (SCS) on 07/08/2025 at 11:45 AM, identified the home health agency nurses failed to follow the Wound Assessment policy which directed staff to measure wounds at least weekly. Review of the agency’s Wound Assessments policy identified wounds would be measured length, width, and depth at least weekly but more frequently if deterioration was noted

Unannounced visits were concluded at Bristol Home Care & Hospice on 7/27/2022 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits concluded at Bristol Home Care & Hospice on 7/27/2022 for the purpose of recertification and re-licensure. Standard-level deficiencies were identified.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record review, review of agency policies and interview with agency personnel, for nine of seventeen patients (Patient’s #1, #4, #7, #8, #13, #14, #15, #16 and #17) in the survey sample, the agency nurses failed to ensure the plan of care addressed the patient’s individual needs. The finding includes: 3. Patient #4 had a start of care date of 07/15/2022 with diagnoses that included multiple sclerosis, type II diabetes mellitus, wound to right lower leg and hypertension. The physician's orders dated 07/15/2022 included nursing services for assessments and wound care, physical and occupational therapy evaluations. Interview and review of the initial nursing assessment dated 07/15/2022 with the Administrator and SCS on 07/27/2022 at 11:35 AM failed to identify upon Patient #4's admission, a comprehensive care plan was developed to address the Patient's diagnosis of type II diabetes mellitus and the need for blood glucose monitoring. 4. Patient #7 had a start of care date of 07/15/2022 with diagnoses that included type II diabetes mellitus with neuropathy, atrial fibrillation and lung cancer. The physician's orders dated 07/15/2022 included nursing services for assessments, physical and occupational therapy evaluations. Interview and review of the initial nursing assessment dated 07/15/2022 with the Administrator and SCS on 07/27/2022 at 11:35 AM failed to identify upon Patient #7's admission, a comprehensive care plan was developed to address the Patient's diagnosis of type II diabetes mellitus and the need for blood glucose monitoring. 5. Patient #13 had a start of care date of 01/10/2022 with diagnoses that included type II diabetes mellitus, wounds to the lower extremities and lymphedema. The physician's orders dated 01/10/2022 included nursing services for assessments and wound care, physical and occupational therapy evaluations. Interview and review of the initial nursing assessment dated 01/10/2022 with the Administrator and SCS on 07/27/2022 at 11:35 AM failed to identify upon Patient #13's admission, a comprehensive care plan was developed to address the Patient's diagnosis of type II diabetes mellitus and the need for blood glucose monitoring. 6. Patient #14 had a start of care date of 11/21/2021 with diagnoses that included type II diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease and dementia. The physician's orders dated 11/21/2021 included nursing services for assessments, physical and occupational therapy evaluations. Interview and review of the initial nursing assessment dated 11/21/2021 with the Administrator and SCS on 07/27/2022 at 11:35 AM failed to identify upon Patient #14's admission, a comprehensive care plan was developed to address the Patient's diagnosis of type II diabetes mellitus and the need for blood glucose monitoring. 7. Patient #16 had a start of care date of 10/09/2021 with diagnoses that included type II diabetes mellitus, hypertension, and gastric bypass surgery. The physician's orders dated 10/09/2021 included nursing services for assessments, surgical incision care, physical and occupational therapy evaluations. Interview and review of the initial nursing assessment dated 10/09/2021 with the Administrator and SCS on 07/27/2022 at 11:35 AM failed to identify upon Patient #16's admission, a comprehensive care plan was developed to address the Patient's diagnosis of type II diabetes mellitus and the need for blood glucose monitoring. 8. Patient #17 had a start of care date of 11/24/2021 with diagnoses that included chronic kidney disease, stage II pressure ulceration and peritoneal dialysis. The physician's orders dated 11/24/2021 included nursing services for assessments and wound care, physical, occupational and speech therapy evaluations. Interview and review of the initial nursing assessment dated 11/24/2021 with the Administrator and SCS on 07/27/2022 at 11:35 AM failed to identify upon Patient #17's admission, a comprehensive care plan was developed to address the Patient's peritoneal dialysis which was performed by a caregiver daily in the home. Review of the agency's policy for Clinical Record and Documentation, identified the Patient assessments included an initial comprehensive assessment by a registered nurse (RN) or a therapist in therapy only cases. The Patient care plan based on the assessment and Patient input would consist of identification of problems and/or diagnoses, interventions and measurable outcomes. The care plan would be reviewed and revised every sixty (60) days and as necessary. 1. Patient #1 had a start of care date of 3/25/22 and diagnoses that included non-pressure chronic ulcer of the left lower leg, peripheral vascular disease and hypertensive heart disease with heart failure. The physician's orders dated 3/25/22 included nursing services for wound care and assessments, physical therapy and occupational therapy evaluations. Interview and review of the initial nursing assessment dated 1/24/22 with the Administrator and Supervisor of Clinical Services/SCS on 7/27/22 at 11:30 AM failed to identify the need for weight monitoring with a diagnosis of congestive heart failure. 2. Patient #15 had a start of care date of 5/05/22 and diagnoses that included type II diabetes mellitus, dementia and hypertensive chronic kidney disease. The physician's orders dated 5/05/22 included nursing services for assessments, physical therapy and occupational therapy evaluations. Interview and review of the initial nursing assessment dated 5/05/22 with the Administrator and SCS on 7/27/22 at 11:35 AM failed to identify the need for blood glucose monitoring with a diagnosis of type II diabetes mellitus.