Every finding on record at Yale New Haven Health at Home, Inc.

It is required that the Interdisciplinary Group (IDG), in collaboration with the individual's attending physician (if any), reviews, revises, and documents the individualized care plan as frequently as the patient's condition requires, but no less frequently than every 15 calendar days. A revised plan of care includes information from the patient’s updated comprehensive assessment and record of the patient’s progress toward the outcomes and goals specified in the plan of care. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the IDG updated the individualized plan of care with changes in the patient's condition. CLINICAL RECORD 1/HOME VISIT 1: The patient elected the hospice benefit and was admitted on 12/31/2025. The Plan of Care (POC) dated 12/31/2025 included an order for Routine level of care. The initial comprehensive assessment dated 12/31/2025 documented that the patient was receiving care at home. An observation visit was conducted with the Registered Nurse (RN - Personnel Record 5) on 01/27/2026 in a facility where the patient was receiving General Inpatient (GIP) care for symptom management. The RN was interviewed during the observation visit and stated that the patient was admitted to GIP level of care on 01/23/2026. There was no documentation in the clinical record indicating that the patient's individualized POC was updated to reflect the GIP level of care. The RN, during the interview, validated that the POC was not updated. The Manager of Clinical Services (Personnel Record 3) was interviewed on 01/27/2026. After reviewing the clinical record, the Manager also validated that the POC was not updated to reflect the GIP level of care.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene, use of gloves, mask, eye protection, or face shield depending on anticipated exposure, safe handling of equipment in the patient’s care environment if it is likely to have been contaminated with body fluids, safe handling of soiled items in the patient’s care environment, and other requirements of applicable state and federal law and regulation. This standard was not met as evidenced by document review, interview and observation. In 1 of 4 (25%) home observation visits, the agency did not ensure that clinical staff performed hand hygiene in accordance with the agency's policy. The agency's policy titled "Hand Hygiene Compliance in the Home Health Setting" (dated 02/27/2024) stated in relevant part, "A. Indications for Performing Hand Hygiene: 8. Upon entering clinical bag." HOME VISIT 3: A home observation visit was performed with the Registered Nurse (RN - Personnel Record 5) on 01/29/2026. During the visit, the RN was observed entering the clinical bag without performing hand hygiene on several occasions when returning disinfected equipment to the bag. The Manager of Clinical Services (Personnel Record 3) was interviewed on 01/29/2026 and stated, "All clinical staff are provided education on hand hygiene every year. The nurse should not have entered the bag without disinfecting her hands."

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 5 of 10 (50%) records reviewed, where the patient received hospice aide (HA) services, the agency did not ensure there were specific, written patient care instructions for a hospice aide prepared by a Registered Nurse (RN) who is responsible for the supervision of the hospice aide. CLINICAL RECORD 3: The patient elected the hospice benefit and was admitted on 01/14/2026. The Plan of Care (POC) dated 01/14/2026 included orders for HA services with a frequency of 2 visits per week. The HA care plan dated 01/14/2026 included the following assignments: "Assist Foot Care Frequency: Each visit. Assist patient with foot care; Assist Shampoo, Frequency PRN. Assist patient with shampooing hair." The HA care plan did not include specific instructions related to "foot care". Additionally, the HA care plan did not specify a frequency for shampooing the patient's hair. CLINICAL RECORD 4: The patient elected the hospice benefit and was admitted on 01/15/2026. The POC dated 01/15/2026 included orders for HA services with a frequency of 2 visits per week. The HA care plan dated 01/22/2026 included the following assignments: "Assist with Bed or Bathroom Bath. Acceptable bath location: Wherever tolerated." The RN did not include documented guidance that the patient/caregiver was able to make a functional and cognitive choice between the types of bathing. CLINICAL RECORD 7: The patient elected the hospice benefit and was admitted on 04/15/2025. The POC dated 12/11/2025 included orders for HA services with a frequency of 1 visit per week. The HA care plan dated 06/30/2025 included the following assignment: "Assist Bath: Assist with sponge, bed bath or shower. Frequency: Every visit; Acceptable locations are shower room or bedroom; Assist shower: Full assist with shower or bathing." The RN did not include documented guidance that the patient/caregiver was able to make a functional and cognitive choice between the types of bathing. CLINICAL RECORD 9: The patient elected the hospice benefit and was admitted on 04/09/2025. The POC dated 12/11/2025 included orders for HA services with a frequency of 1 visit per week. The HA care plan dated 04/09/2025 included the following assignments: "Assist Shower: Full assist with shower using bed bath; Assist shampoo: PRN Assist patient with shampooing hair in bed." The HA care plan did not specify a frequency for shampooing the patient's hair. Additionally, the bathing instructions indicated that the patient may shower or have a bed bath. The RN did not include documented guidance that the patient/caregiver was able to make a functional and cognitive choice between the types of ordered bathing. CLINICAL RECORD 17: The patient elected the hospice benefit and was admitted on 11/11/2025. The POC dated 11/11/2025 included orders for HA services with a frequency of 7 visits per week. The HA care plan dated 11/11/2025 included the following assignment: "Assist shampoo: Frequency: PRN; Assist patient with shampooing hair in bed; or at bathroom sink." The HA care plan did not specify a frequency for shampooing the patient's hair. Additionally, the instructions indicated that the patient may receive assistance with shampooing in bed or at the bathroom sink. The RN did not include documented guidance that the patient/caregiver was able to make a functional and cognitive choice between the types of ordered bathing. The Manager of Clinical Services (Personnel Record 3) was interviewed on 01/30/2026 and stated, "The aide plan of care needs to be individualized and specific."

It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services and, as necessary, provides in-service training and education programs where required. The hospice has written policies and procedures describing the method(s) of assessing competency and maintains a written description of the in-service training provided during the previous 12 months. This standard was not met as evidenced by document review, interview and personnel record review. In 1 of 14 (7%) personnel records reviewed, the agency did not ensure that all staff received a competency assessment when hired in a new role and attended annual competency in-services The agency's "Required Training, Education, and Competency" policy (dated 10/17/2022) stated in part, "A. 2. Department heads or their management designee are responsible for conducting an assessment of an employee's initial competence in a new role to establish baseline performance." PERSONNEL RECORD 13: A review of this Nurse Practitioner's (NP - DOH 08/02/2021) personnel record revealed that no competency evaluations were documented at hire into the NP role in accordance with the agency's policy. Additionally, there was no documentation that the NP attended any of the annual competency evaluation inservices for the nursing clinical staff. The Alternate Administrator (Personnel Record 2) was interviewed on 01/29/2026 and stated, "We have annual competencies for all clinical staff. All staff are required to attend. We didn't realize that the nurse practitioner needed an initial competency and needed to attend the nursing competencies just like the hospice nurses do." The Alternate Administrator also stated that the NP worked for the hospital system and began allocating time to hospice when the agency was acquired by the system in 2022.

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 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 13 (8%) clinical records reviewed it was revealed that the agency did not ensure that all medications prescribed to the patient were included in the medication list. Clinical Record 2: Election of hospice benefit was on 10/26/22 with a diagnosis of "Small Cell Lung Cancer". Documentation on an RN clinical note dated 10/26/22 stated that the patient was using 2-4 liters of oxygen as needed. There was no documented evidence that oxygen was entered on the medication list during the period of 10/26/22 through the patient's revocation of hospice on 12/2/22. During an interview on 3/16/23 the Quality Review Nurse said that oxygen was left off the medication list and that was "in error".

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions such as hand hygiene. This standard was not met as evidenced by document review, interview and observation. In 1 of 3 (33%) home visit observations it was revealed that the agency did not ensure that clinical staff adhered to the agency's policy addressing hand hygiene in the patient's home. The agency's policy, "Cleaning and Disinfection of Reusable Medical Equipment & Bag Technique in the Home Health Setting", effective 7/1/21, stated in relevant parts: " B. Bag Technique 1. Place the bag, computer and/or computer case, and any other equipment on a clean, washable surface. All items should be placed on a paper barrier to avoid contamination. 2. Perform Hand Hygiene prior to entering the bag. 3. Remove necessary items for use and place on a clean paper barrier Perform hand hygiene each time the bag is entered to obtain equipment. 4. Perform Hand Hygiene before replacing equipment in bag." Home Visit 1: During the home visit (Record 4) on 3/15/23, it was observed that the RN did not perform hand hygiene when retrieving and replacing items in their clinical bag in accordance with the agency's policy. During the visit, the RN was observed touching the patient and entering her clinical bag to retrieve gloves without first sanitizing her hands. The RN then removed her gloves, performed hand hygiene, and touched the patient before removing her thermometer from the visit bag, again without sanitizing her hands before reaching into the clinical bag. The RN was also observed cleaning the thermometer after use with the patient and returned it to the visit bag without performing hand hygiene. The RN removed the pulse oximeter from the visit bag, without sanitizing their hands, and later returned the cleaned oximeter to the bag without first performing hand hygiene before entering the clinical bag. The RN was also observed removing the blood pressure cuff and stethoscope from the visit bag without performing hand hygiene before entering the bag. After completing the assessment with the patient, the RN cleaned the blood pressure cuff and stethoscope and returned them to the visit bag without performing hand hygiene before entering the bag. The RN was then observed removing the stethoscope again without performing hand hygiene before reaching into the bag. In an interview on 3/15/23, the Hospice Program Director confirmed that the agency's policy, "Cleaning and Disinfection of Reusable Medical Equipment & Bag Technique", specifically hand hygiene, was not followed by the nurse.

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 an 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 8 (12%) applicable records of patients who received aide services it was revealed that the agency did not ensure that the RN provided specific patient care instructions for the aide to follow in the hospice aide plan of care. Clinical Record 7: Date of hospice election was 12/28/22 with a diagnosis of "Malignant Neoplasm of the Glottis". The hospice aide care plan that was current as of 3/15/23 stated that the aide was to "Provide Transfer" without specific instructions that described how the aide was to complete the intervention. The Program Director stated in an interview on 3/17/23 that specific instructions to provide transfers and how the aide was to transfer the patient should have been included in the aide plan of care.

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 record review and interview. In 2 of 8 (25%) applicable clinical records reviewed of patients who received hospice aide services, it was revealed that the agency did not ensure the aide provided services as assigned on the aide plans of care. Clinical Record 5: Date of hospice election was 2/22/22 with a diagnosis of "Severe Protein-Calorie Malnutrition". The current hospice aide care plan dated 3/15/22 assigned the aide to complete interventions to, "Provide Dressing" and "Provide Linen Change". The Quality Review Nurse stated in interview that the interventions listed were to be provided every visit. These tasks were not documented as completed on the aide visit note dated 2/24/23 and there was no documentation that the patient and/or caregiver refused the intervention, or that the case manager or supervisor was notified that they were not performed. In addition, documentation on the aide visit notes dated 2/27/23, 2/28/23, 3/3/23, 3/6/23, and 3/7/23 stated the aide provided "Transfer Assist". The aide plan of care dated 2/22/23 did not include an assigned intervention for the aide to provide "Transfer Assist" or documentation of specific instructions on how to transfer the patient. Clinical Record 7: Date of hospice election was 12/28/22 with a diagnosis of "Malignant Neoplasm of the Glottis". The current hospice aide plan of care dated 3/16/22 did not assign the aide to complete interventions related to oral hygiene. Documentation on the aide visit notes dated 2/5/23 and 2/17/23 included documentation that oral care was provided. During an interview on 3/17/23 the Hospice Program Director confirmed the aide had provided interventions that were not listed in the patient's aide plan of care. In addition, the Program Director stated the aide should have notified the nurse or supervisor when interventions were unable to be performed.