Every finding on record at Brighton Hospice Connecticut, LLC

Based on clinical record reviews, review of agency documentation and interviews with agency personnel, for sixteen of twenty patients (Patients #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #15, #16, #17, #18, #19 and #20) in the survey sample, the agency failed to ensure the availability of volunteer services for patients and families. The findings include: --- a. Patient #1 elected the Hospice benefit on 12/27/2024. Patient #1s diagnoses included Alzheimer's disease, weight loss, and falls. The physicians orders for the certification period from 12/27/2024 to 02/24/2025 included nursing services one to two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided in an Assisted Living Facility. b. Patient #2 elected the Hospice benefit on 12/20/2024. Patient #2s diagnoses included Alzheimer's disease, weight loss, and falls. The physicians orders for the certification period from 12/20/2024 to 03/19/2025 included nursing services one to two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided in a Skilled Nursing Facility. c. Patient #3 elected the Hospice benefit on 01/09/2025. Patient #3s diagnoses included heart failure, chronic kidney disease, malnutrition and high blood pressure. The physicians orders for the certification period from 01/09/2025 to 04/08/2025 included nursing services one to two times a week for assessments and symptom management, hospice aide services, social work services, and chaplain services. The patient resided at home. d. Patient #4 elected the Hospice benefit on 01/14/2025. Patient #4s diagnoses included Alzheimer's disease, weight loss, and falls. The physicians orders for the certification period from 01/14/2025 to 04/13/2025 included nursing services one to two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided in a Skilled Nursing Facility. e. Patient #5 elected the Hospice benefit on 01/17/2025. Patient #5s diagnoses included Alzheimer's disease, pneumonia, anxiety and congestive heart failure. The physicians orders for the certification period from 01/17/2025 to 04/16/2025 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided in an Assisted Living Facility. f. Patient #6 elected the Hospice benefit on 11/21/2024. Patient #6s diagnoses included amnesia, dementia, depression and high blood pressure. The physicians orders for the certification period from 11/21/2024 to 02/18/2025 included nursing services one to two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided in an Assisted Living Facility. g. Patient #7 elected the Hospice benefit on 05/28/2024. Patient #7s diagnoses included Alzheimer's disease, anorexia and dementia. The physicians orders for the certification period from 01/19/2025 to 04/19/2025 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided in an Assisted Living Facility. h. Patient #8 elected the Hospice benefit on 12/18/2024. Patient #8s diagnoses included dementia, weight loss, and falls. The physicians orders for the certification period from 12/18/2024 to 03/17/2025 included nursing services one to two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided at home. i. Patient #9 elected the Hospice benefit on 01/24/2024. Patient #9s diagnoses included Alzheimer's disease, weight loss, and falls. The physicians orders for the certification period from 11/17/2024 to 01/15/2025 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided in an Assisted Living Facility. j. Patient #10 elected the Hospice benefit on 10/17/2024. Patient #10s diagnoses included malignant brain tumor, pneumonia, weight loss, and falls. The physicians orders for the certification period from 10/17/2024 to 01/14/2025 included nursing services three times a week for assessments and symptom management, hospice aide services, social work services and chaplain services. The patient resided at home. k. Patient #15 elected the Hospice benefit on 10/06/2023. Patient #15s diagnoses included Alzheimer's disease, unweight, falls and hypothyroidism. The physicians orders for the certification period from 10/06/2023 to 01/03/2024 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility. l. Patient #16 elected the Hospice benefit on 03/12/2024. Patient #16's diagnoses included dementia, weight loss, and high blood pressure. The physicians orders for the certification period from 03/12/2024 to 05/10/2024 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility. m. Patient #17 elected the Hospice benefit on 02/25/2024. Patient #17's diagnoses included cancer of the right kidney, falls, blood in the urine, and anxiety. The physicians orders for the certification period from 02/25/2024 to 05/24/2024 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility. n. Patient #18 elected the Hospice benefit on 10/06/2023. Patient #18's diagnoses included dementia, falls, and weight loss. The physicians orders for the certification period from 10/06/2023 to 01/03/2024 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility. o. Patient #19 elected the Hospice benefit on 09/19/2024. Patient #19's diagnoses included malnutrition, weakness and chronic kidney disease. The physicians orders for the certification period from 09/19/2024 to 12/17/2024 included nursing services one to two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Skilled Nursing Facility. p. Patient #20 elected the Hospice benefit on 03/10/2024. Patient #20's diagnoses included dementia, falls, and weight loss. The physicians orders for the certification period from 03/10/2024 to 06/07/2024 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility. i. Interview and review of agency documentation during the entrance conference with the Administrator and the Director of Hospice on 02/04/2025 at 09:30 AM, identified from 01/01/2025 to 02/04/2025 the hospice agency failed to ensure the availability of volunteer services for current Patients #1, #2, #3, #4, #5, #6, #7, #8, #9 and #10. Additionally, the Administrator identified the hospice agency failed to provide volunteer services in accordance with physician's orders and in response to the needs of Patients' #15, #16, #17, #18, #19 and #20 in 2024. Review of the agency's Volunteer Program policy identified the program was to assist the agency in meeting the needs of the patients and their families. Hospice volunteer services are based on initial and ongoing assessments of patient and family needs.

Based on review of agency documentation and interviews with agency personnel, the agency failed to ensure volunteers provided day-to-day administrative and/or direct patient care services in an amount that, at a minimum, equaled 5 percent of the total patient care hours of all paid hospice employees and contract staff for the year 2024. The findings include: --- Review of the hospice agency's total volunteer hours and cost savings from 01/01/2024 to 12/31/2024, identified a total of 7.71 hours and 0.13% savings. Interview and review of agency documentation with the Administrator and Volunteer Coordinator on 02/04/2025 at 11:15 AM, failed to identify volunteers were available in order to provide day-to day administrative, non-direct and direct patient care services in an amount that, at a minimum, equaled 5 percent of the total patient care hours of all paid hospice employees and contract staff for the year 2024.

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 measurements 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 #MM:2, "Medication Profile" (effective 6/15/2022), stated in part, "The agency performs a Medication Profile at the time of admission and evaluates the medication profile on an on-going basis...Patients will be asked at each visit if there have been any new medications or changes with their medication to include OTC and herbals." Agency policy # PC 21 " Comprehensive Assessment" (effective 6/14/2022) stated in part, "The nursing assessment tool assesses … components of the patient's care...drug profile including prescription, over-the-counter drugs, herbal remedies, and alternative treatments." In 2 of 3 (67%) home visits observed, the agency did not ensure that the comprehensive assessment included a drug profile that contained the patient's current prescriptions, over-the-counter (OTC) drugs, and supplements. Home Visit 2/Clinical Record 3: The patient elected hospice care on 8/30/2023 and resided in an Assisted Living Facility (ALF). During the home visit on 9/27/2023 with the Registered Nurse (RN) [Personnel Record 3], a medication reconciliation was performed comparing the agency's and the ALF's medication profiles. The agency's medication profile dated 9/27/2023 documented, "Senexon-S 50-8.6 mg. tab, take two (2) tabs orally (PO) once a day at bedtime for constipation. The Assisted Living Facility Medication Profile (ALF) medication profile stated in part, "Senexon-S 50-8.6 mg. tab, take two (2) tabs orally (PO) once a day as needed (PRN) for constipation." The agency's medication profile documented, "Olanzapine 2.5mg. take one (1) tablet daily for anxiety; give at 0800. The ALF medication profile did not contain the medication Olanzapine. The patient was not currently taking Olanzapine. The ALF medication profile stated in part, "Trazadone 50 mg. take one half (0.5) tablet every eight (8) hours as needed (PRN) for Insomnia. The hospice agency profile did not contain the medication order for the Trazadone. There was no evidence that Trazadone was reviewed as part of the patient's medication regimen. Home Visit 3/Clinical Record 4: The patient elected hospice care on 9/20/2023 and resided in an ALF. During the home visit on 9/27/2023 with the Social Worker (SW) [Personnel Record 6], a medication reconciliation was performed comparing the agency's and the ALF's medication profiles. The agency's medication profile dated 9/27/2023 documented, "Torsemide 10 mg. take two (2) tabs orally daily for CHF... Two (2) tabs equals 20 mg." The ALF medication profile documented, "Torsemide 10 mg. take three (3) tablets by mouth once daily." The ALF medication profile dated 9/27/2023 documented, "Multi-vitamin one (1) daily take one (1) tablet by mouth daily, Vitamin D3 25 mcg. take one (1) tablet by mouth daily and Ferrous Sulfate 220 mg. per five (5) ml. take 6.8 ml. by mouth once daily. The agency's medication profile did not include documentation of the Multi-vitamin, Vitamin D3, and Ferrous Sulfate." There was no evidence the medications were reviewed as part of the patient's medication regimen. During a joint record review and interview on 9/27/2023, the Director of Clinical Services confirmed the agency medication profiles did not match the patient's current ALF medication regimen.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, observation, and interview. In 2 of 10 (20%) clinical records reviewed, the hospice did not ensure all drugs needed for the palliation and management of the patient were included in the patient's plan of care. Clinical Record 3/Home Visit 2: The patient elected hospice care on 8/30/2023 and resided in an Assisted Living Facility (ALF). A medication reconciliation was performed during the home visit on 9/27/2023, comparing the agency's and the ALF's medication profiles. The ALF medication profile documented, "Trazadone 50 mg. take one half (0.5) tablet every eight (8) hours as needed (PRN) for Insomnia." The plan of care did not include documentation of Trazadone. Clinical Record 4/Home Visit 3: The patient elected hospice care on 9/20/2023 and resided in an ALF. A medication reconciliation was performed during the home visit on 9/27/2023, comparing the agency's and the ALF's medication profiles. The ALF medication profile dated 9/27/2023 documented, "Multi-vitamin one (1) daily take one (1) tablet by mouth daily, Vitamin D3 25 mcg. take one (1) tablet by mouth daily and Ferrous Sulfate 220 mg. per five (5) ml. take 6.8 ml. by mouth once daily." The plan of care did not include documentation of the Multi-vitamin, Vitamin D3, and Ferrous Sulfate." During a joint record review and interview on 9/27/2023, the Director of Clinical Services confirmed the patient's plan of care did not contain all of the medications.

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, document review, and interview. Agency policy #PC:22 "Plan of Care" (effective 6/14/2022) stated in part, "The care services and treatment provided is in accordance with the plan of care that may include ancillary staff that may be provided by the agency's employees, volunteers, or contracted staff." In 2 of 9 (22%) clinical records reviewed of patients that accepted hospice aide services, the agency did not ensure the hospice aide provided services ordered by the Interdisciplinary Group and included in the plan of care. Clinical Record 2: The patient elected hospice care on 8/15/2023. The plan of care dated 8/15/2023 through 11/11/2023 ordered hospice aide services five (5) times weekly. For the week of 9/3/2023 through 9/9/2023, the hospice aide documented visits completed on 9/5/2023, 9/6/2023, 9/7/2023, and 9/8/2023. The hospice aide visit note dated 9/4/2023 documented in part, "visit missed due to Holiday." A clinical record review revealed no documented evidence that the hospice aide notified the Registered Nurse (RN) and the interdisciplinary Group (IDG) regarding the missed hospice aide visit on 9/4/2023. Clinical Record 3: The patient elected hospice care on 8/30/2023. The plan of care dated 8/30/2023 through 11/26/2023 ordered hospice aide services five (5) times weekly. For the week of 9/3/2023 through 9/9/2023, the hospice aide documented visits completed on 9/5/2023. 9/6/2023, 9/7/2023, and 9/8/2023. The hospice aide visit note dated 9/4/2023 documented in part, "visit missed due to Holiday." A clinical record review revealed no documented evidence that the hospice aide notified the Registered Nurse (RN) and the interdisciplinary Group (IDG) regarding the missed hospice aide visit on 9/4/2023. During a joint record review and interview on 9/26/2023, the Director of Clinical Services confirmed that the record did not contain any evidence the hospice aide notified the Registered Nurse and IDG about the missed visits. The Director of Clinical Services confirmed that 9/4/2023 was a holiday and that staff were not scheduled to see patients on 9/4/2023; the on-call hospice nurse could have completed the hospice aide visits if the facility had requested.