Every finding on record at Brighton Hospice Indiana, LLC

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 and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that all of the patient's current medications were included in the patient's drug profile. CLINICAL RECORD 7: The patient elected the hospice benefit on 10/20/2025. A Skilled Nursing (SN) visit note dated 11/06/2025 documented "MD notified and new orders received for tramadol." Neither the medication profile dated 11/06/2025 nor the current medication profile dated 12/09/2025 included tramadol. During joint record reviews and an interview on 12/10/2025, the Senior Director of Clinical Quality confirmed the above findings, stating, "The tramadol was not included in the medication profile."

It is required that Hospice Aides are assigned to a specific patient by a Registered Nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a Hospice Aide are prepared by a RN who is responsible for the supervision of the Hospice Aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 16 (6%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide received written patient care instructions to meet the patient's needs. CLINICAL RECORD 13: The patient elected the hospice benefit on 08/19/2025. A physician's order dated 09/11/2025 ordered wound care and a dressing for a wound on the patient's second toe of the right foot. A physician's order dated 09/21/2025 ordered "Oxygen via nasal cannula at 2-4 liters as needed for dyspnea." The plans of care for the certification periods dated 08/19/2025 through 11/16/2025 and 11/17/2025 through 02/15/2026 ordered "HA 5 times per week." The Hospice Aide care plan dated 08/19/2025 assigned the HA the relevant tasks of "Bed bath every visit." The Hospice Aide care plan was not updated to include instructions regarding the patient's oxygen until 12/09/2025. The Hospice Aide care plan was not updated to include wound dressing instructions for the wound on the patient's second toe of the right foot, should the dressing become wet or dislodged during the bed bath. During a joint record review and interview on 12/11/2025, the Senior Director of Clinical Quality confirmed the findings, stating, "The aide care plan should have been updated with wound dressing instructions and oxygen instructions when the orders were written."

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. The Hospice Aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 1 of 16 (6%) clinical records reviewed of patients who received Hospice Aide services, the agency did not ensure that Hospice Aide (HA) supervisory visits were completed no less frequently than every 14 days. CLINICAL RECORD 5: The patient elected the hospice benefit on 09/05/2025. The plan of care dated 09/05/2025 through 12/03/2025 ordered "HA 1 time weekly." The first Hospice Aide visit was dated 09/08/2025. Hospice Aide supervisory visits were dated 09/16/2025, 09/23/2025, 09/30/2025, 10/09/2025, 10/21/2025, 10/27/2025, 11/06/2025, and 11/11/2025. The next Hospice Aide supervisory visit was dated 12/02/2025, with 21 days outstanding. During a joint record review and interview on 12/10/2025, the Senior Director of Clinical Quality confirmed that Hospice Aide supervisory visits were completed less frequently than every 14 days.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the patient's clinical record contained all the physician's orders. CLINICAL RECORD 7: The patient elected the hospice benefit on 10/20/2025. The Skilled Nursing visit note dated 11/06/2025 documented "MD notified and new orders received for tramadol." The clinical record did not include documentation of a physician's order for tramadol. During a joint record review and interview on 12/10/2025, the Senior Director of Clinical Quality confirmed the finding, stating, "There is not an order for tramadol in the chart."