Bright Horizon Hospice Services

“Observed in Patient Home. In 1 of 4 home visits conducted, the RN failed to assess the patient’s pain during the home visit. The patient grimaced and moaned a number of times during the home visit and the RN never asked the patient if she had pain per the Pain Assessment Policy 1-032.1 which states that the RN will assess pain with each visit. This was reviewed and validated with the DON. Observed in Record Review. In 4 of 16 patient records reviewed, the agency process required wounds to be measured weekly, but they were not done monthly or only with recertification. In HOSRRHV #2 there were no wound measurements for the last 3 months. In HOSRRHV #4 the RN completed one wound measurement one month after admission. In HOSRRNHV #8, and HOSRRNHV #9 there were no measurements done for 8 months. This was reviewed and validated with the DON. Observed in Record Review. In 8 of 16 patient records reviewed, the organization failed to assesses and reassess the patients pain per their policy. In HOSRRHV #1, HOSRRHV #2, HOSRRHV #3, HOSRRHV #4 , and HOSRRNHV #10 an observational pain tool was used and per the organizational Pain Assessment 2-032.1 if the patient is unable to communicate pain using the rating scale, is cognitively impaired, the clinician will assess behavioral factors that signal pain or discomfort and include this information in the assessment. In all five patients the nurse documented that the patient will have an acceptable level for pain, this was not assessed in any of the patients as the observational tool was used. In HOSRRNHV #4, HOSRRNHV #7 and HOSRRNHV #8 pain was not assessed per the organizational Pain Assessment Policy. Pain care plan states that patient will have an acceptable level of pain. This was reviewed and validated with the DON.”

“Observed in Record Review. In 7 of 16 patient records reviewed, the organization’s records included discrepancies regarding hospice covered medications in patient records. In HOSRRHV #3 the Patient Notification of Hospice Non-Covered Items, Services, and Drugs the RN documented that the Atorvastatin, and Plavix were not related to the terminal illness and would not be covered. The medication list states they are both covered items. The nurse leaders thought the organization was not covering the medications. In HOSRRHV #4 the Addendum states that Losartan would not be covered as it was not related to the terminal illness but on the medication list it shows that it is covered. In HOSRRNHV #2 the Glucagon is not covered on the addendum but it is covered on the medication list. In HOSRRNHV #5 the Addendum states Propranolol was not covered but on the Medication list it states it is covered. In HOSRRNHV #6 Toprol is not covered in the Addendum but it is covered in the Medication List. In HOSRRNHV #7 the Memantine, Ketoconazole shampoo, Calcium, and Donepezil were not covered on the Medication List and not listed on Addendum as not covered. In HOSRRNHV #10 the Addendum states that Dorzolamide, Latanoprost, Folic Acid, Losartan, Metoprolol, and Clopidogrel are not covered but on the Medication list they are covered. This was reviewed and validated with the DON.”

“Observed in Record Review. In 3 of 16 patient records reviewed, the organization failed to plan the patient’s care. The hospice nurse surveyor noted that in HOSRRHV #1, HOSRRHV #2, and HOSRRHV #3 where an observational tool was used to assess pain but the Plan of Care included a verbal descriptor was used. Per the agency policy Pain Assessment 2-032.1 if the patient is unable to communicate pain using the rating scale, is cognitively impaired, the clinician will assess behavioral factors that signal pain or discomfort and include this information in the assessment. In all three patients the nurse document that the patient will have an acceptable level for pain, this was not assessed as both patient’s are nonverbal. This was reviewed and validated with the DON.”

“Observed in Patient Home. In 2 of 4 home visits conducted, the medication list did not contain all required elements such as dose, strength, frequency, and route. The Hospice nurse surveyor observed in HOSRRHV #1 that the patient had an order for Jevity 1 can four times per day via G tube with a 50 ml water flush, before and after feeding. Per the patient’s daughter she is using a 30 ml flush before and after feeding. This patient has severe dysphagia and is unable to swallow so she receives all of her medications via her G tube. She was just ordered Amoxicillin-Pot Clavulanate 875-125 mg twice daily for 10 days and the route was per mouth. The daughter states that she crushed the antibiotic and gave it to the patient via the G tube. In HOSRRHV #2 the patient had an order for Gentamycin Sulfate ophthalmic drops and in the route it states 2 drops to the affected eye, the drops were for the right eye only. This patient also had an order for senna plus and Hyoscyamine Sulfate 0.125 mg with no route entered. This was reviewed and validated with the DON.”

“Observed in Tracer Activities. In 8 of 16 patient records reviewed, the surveyor noted that in HOSRRHV #3 that the patient was on Plavix 75 mg and ASA 81 mg daily and the aide care plan did not include safety precautions such as bleeding. Additionally, this patient was deemed a fall risk and this too was missing from the aide care plan. In HOSRRNHV # 1, HOSRRNHV #5, HOSRRNHV #7 and HOSRRNHV #9 the patient is on ASA 81 mg and there is no bleeding precaution in the Home Health Aide care plan. In HOSRRNHV #6 the patient is on Clopidogrel and there is no bleeding precaution aide care plan. In HOSRRNHV #3 and HOSRRNHV #8 the patient has seizures and there is no seizure precautions listed for the Home Health Aide. This was reviewed and validated with the DON.”

“Observed in Record Review. In 3 of 16 patient records reviewed, there were no foley change orders obtained by the nurse. In HOSRRHV #2 the patient has had a foley catheter for three years. The patient has gone from a 16 French to a 26 French catheter and there are only two orders for foley catheter changes . One was in 2022 for a 16 French and the other was June 2025 for a change from a 22 French to a 26 French catheter. Both the RN and the DON state that the patient has progressed up to the 26 French catheter, from a 18 French, 20, and 22 French catheter.. There were no orders found for these catheter changes or the type of fluid and amount to instill in the balloon. In HOSRRHV #8 the patient has a wound to the bilateral heels and shins and there is no wound care order. This patient also has a foley catheter and there is no order for catheter changes, what to instill in the balloon, or any securement device. In HOSRRNHV #9 the patient had a wound to the right trochanter and there are no orders for the dressing change. This was reviewed and validated with the DON. Observed in Record Review. In 9 of 16 patient records reviewed, the organization failed to plan the patient’s care. In HOSRRHV #3 the patient was on Plavix 75 mg and ASA 81 mg every day. The RN did not include a bleeding risk care plan. This patient was also on Oxygen 3 Liter via nasal cannula continuous, titrate to 5 Liters as needed. The RN failed to document when the caregiver should use 3, 4, or 5 liters of oxygen. HOSRRNHV #1, HOSRRNHV #5, HOSRRNHV #7, and HOSRRNHV #9 patient on ASA 81 mg no care plan for bleeding precautions for RN. In HOSRRNHV #6 and HOSRRNHV #10 the patient is on Clopidogrel 75 mg, no bleeding precautions care plan. In HOSRRNHV #3 and HOSRRNHV #8 the patient was diagnosed with seizures and on medications and there was no seizure precaution care plan. This was reviewed and validated with the DPCS.”

“Observed in Patient Home. In 1 of 4 home visits conducted, the Hospice surveyor observed that the home health aide performed a bed bath on HOSRRHV #3. The home health aide used the same pair of gloves for washing the perineal and she then dressed the patient with the same gloves. This was reviewed and validated with the DON. Observed in Patient Home. In 1 of 4 home visits conducted, the nurse failed to follow the manufacturer’s guidelines for equipment cleaning. In HOSRRHV #2 the nurse cleansed the pulse oximeter with a Caviwipe which is not an approved cleaner per manufacture’s guidelines. This was reviewed and validated with the DON.”

“Observed in Record Review. In 2 of 16 patient records reviewed, treatments performed such as dressing changes or foley catheter changes were not fully described in the record. In HOSRRHV #2 the patient has been on service for 3 years and the foley catheter change and the wound care provided were not fully described in the medical record. The staff documented that wound care was provided as ordered and the foley catheter change was documented as foley catheter changed per order. The nurse did not document the size of the foley catheter used, the amount or type of fluid used to inflate the balloon or if a securement device was used. In HOSRRHV #4 the patient had wound care performed and in the last 2 months of visits the RN documented wound care provided per orders. This was reviewed and validated with the DON”