Caring Hospice Services of Connecticut LLC

“Based on clinical record reviews, review of agency documentation and interviews with agency personnel, for four of fourteen patients’ (Patient’s #3, 4, 5 & 9) in the survey sample, the hospice agency failed to ensure care and services were provided in accordance with the care plan. The findings include: a. Patient #3 elected the Hospice Benefit on 5/15/25 and resided at home. The patient’s diagnoses included Alsheimer’s disease, protein-calorie malnutrition, dementia and congestive heart failure. The physician’s orders dated 5/15/25 included nursing services once a week, hospice aide services two times a week, medical social worker/MSW, chaplain and volunteer services. Review of the initial nursing assessment visit identified that the family was accepting of all services. Interview and review of Patient #3’s clinical record with the Administrator/Hospice Program Director and Volunteer Coordinator on 8/04/25 at 10:30 AM failed to identify the provision of volunteer services in accordance with the physician’s orders and in response to the patient’s needs. The Administrator indicated volunteer services were requested by Patient #3 but failed to identify volunteer services had been provided to the patient due to volunteer staff not being available in the patient’s service area. b. Patient #4 elected the Hospice Benefit on 4/18/25 and resided in an Assisted Living Facility/ALF. The patient’s diagnoses included end stage chronic obstructive pulmonary disease, asthma, depression and dementia. The physician’s orders for the certification periods from 4/18/25 to 10/14/25 included nursing services two times a week, hospice aide services two times a week, medical social worker/MSW, spiritual and volunteer services. Review of the initial nursing assessment visit dated 4/18/25, identified that the family was accepting all services but failed to identify volunteer services were provided. The subsequent physician’s orders dated 7/17/25 identified volunteer services monthly for companionship. Interview and review of Patient #4’s clinical record with the Administrator/Hospice Program Director and Volunteer Coordinator on 8/05/25 at 11:30 AM failed to identify the provision of volunteer services in accordance with the physician’s orders and in response to the patient’s needs. Subsequent to surveyor inquiry, a missed visit note dated 8/05/25 identified on 8/02/25, a volunteer visit was attempted but the patient was out for lunch with the next of kin. c. Patient #5 elected the Hospice Benefit on 6/26/25 and resided in an Assisted Living Facility/ALF. The patient’s diagnoses included end stage renal disease, congestive heart failure and type II diabetes mellitus. The physician’s orders dated 6/26/25 included nursing services once a week, hospice aide services two times a week, medical social worker/MSW, spiritual and volunteer services. Review of the initial nursing assessment visit identified that the family was accepting of all services. Interview and review of Patient #5’s clinical record with the Administrator/Hospice Program Director and Volunteer Coordinator on 8/06/25 at 11:30 AM failed to identify the provision of volunteer services in accordance with the physician’s orders and in response to the patient’s needs. Review of agency policy for plan of care directed the care and services provided to the patient and their families are in accordance with an individualized, written plan of care established by the hospice Interdisciplinary Group/IDG in collaboration with patient’s attending physician, the patient and/or his or her representative.Review of agency policy for Volunteer Assignment directed that hospice volunteers are assigned in a timely and appropriate manner and assignments are made as soon as possible after notification of the request. Patient #9 elected the Hospice Benefit on 5/13/25 and resided at home. The patient’s diagnoses included hypertensive chronic kidney disease, atherosclerosis of native coronary artery, hyperlipidemia, and macular degeneration. The physician’s orders for the certification period from 5/13/25 through 8/10/25 included nursing services once a week, hospice aide services once a week, medical social worker/MSW, spiritual, and volunteer services.Review of the initial medical social services assessment dated 5/14/25 identified that the family requested volunteer services to provide companionship and stimulation on admission. Interview and review of Patient #9’s clinical record with the Administrator/Hospice Program Director and Volunteer Coordinator on 8/06/25 at 10:45 AM failed to identify the provision of volunteer services in accordance with the physician’s orders and in response to the patient’s needs.Review of the clinical record for Patient #9 reflected no documentation that nursing visits were made to Patient #9 during the week of 5/18/25 through 5/24/25 and no hospice aide services provided during the week of 6/29/25 through 7/5/25.Interview and review of Patient #9’s clinical record with the Administrator/Hospice Program Director on 8/6/25 at 10:50 AM failed to identify the provision of nursing and hospice aid services in accordance with the physician’s orders and in response to the patient’s needs.Subsequent to surveyor inquiry, a missed visit note dated 8/05/25 identified on 7/2/25 a home health aide visit was cancelled because the staff member called out and coverage was refused by the patient/family. Review of the Hospice Aide Missed Visit Note policy dated 3/30/18 directed all Hospice Aide call outs will be covered by the Hospice Aide Coordinator unless services refused by the patient/family, the Hospice Aide Coordinator will complete the “Hospice Aide Missed Visit Form,” and notes should be filed in the patient record at least weekly.”

“Based on clinical record reviews, review of agency policies and interviews with hospice personnel, for one of fourteen patients (Patient #4) who received nursing and hospice aide services, the hospice agency failed to complete hospice aide supervisions no less frequently than every fourteen (14) days to assess the quality of care and services provided by the hospice aide. The findings include: Patient #4 elected the Hospice Benefit on 4/18/25 and resided in an Assisted Living Facility/ALF. The patient’s diagnoses included end stage chronic obstructive pulmonary disease, asthma, depression and dementia. The physician’s orders for the certification periods from 4/18/25 to 10/14/25 included nursing services two times a week, hospice aide services two times a week, medical social worker/MSW, spiritual and volunteer services. Review of the clinical record identified documentation of Registered Nurse/RN supervision of the hospice aides from 4/18/25 to 7/03/25 but failed to identify any further documentation of hospice aide supervisions. Interview and review of the clinical record from 7/9/25 to 8/04/25 (twenty-five days) with the Administrator on 8/06/25 at 12:30 PM failed to identify documentation by the RN’s every fourteen days to assess quality of care and services provided by the hospice aides. Review of agency policy for Hospice Aide Supervision directed the registered nurse makes an on-site visit to the patient’s home no less frequently than every fourteen days to ensure that services ordered and provided by the hospice aide are meeting the patient’s needs.”