Brighton Hospice Connecticut, 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 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 and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the drug profile was updated at minimum, at the time of each comprehensive assessment and/or when new medication was added or changes were made to existing medication. CLINICAL RECORD 12: This patient elected the hospice benefit on 05/14/2026 with a terminal diagnosis of endometrial cancer and diabetes. The clinical record was reviewed and included documentation that a skilled nursing visit was conducted on 06/08/2026 and stated that the patient’s medications included: Humalog Kwik pen 100 units inject 10 units 3 times a day (morning, noon, and night) Humalog Kwik pen 100U 2-12 units injectable per sliding scale Lantus Solostar Pen 100 units SQ 38 units once a day, and Baqsimi one pack 3 mg nasal powder intranasally as needed for hypoglycemia. A review of the drug profile for the dates of 05/14/2026-06/10/2026 revealed no documented evidence of the Humalog Kwik pen. Lantus Solostar pen and Baqsimi. During joint clinical record review and interview on 08/27/2026, the Senior Director of Clinical Quality stated, “The most factual information I can give you is there were no diabetes medications on the drug profile until 06/11/2026.”

“Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any); the patient or patient representative if any of them so desire; and the primary caregiver in accordance with the patient’s needs if any of them so desire. 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 services were provided in accordance with the plan of care. CLINICAL RECORD 1: This patient elected the hospice benefit on 07/17/2026 with a terminal diagnosis of senile degeneration of the brain. The hospice plan of care for the dates of 07/17/2026-10/15/2026 was reviewed and included orders for skilled nursing visits 2XW (two times a week). The clinical record was reviewed and revealed that the week of 08/02/2026-08/08/2026, one skilled nursing visit was completed on 08/04/2026. There was no evidence that the ordered second skilled visit was provided. There was no documented evidence of a missed visit or the reason the ordered visit was not provided. During joint clinical record review and interview on 08/27/2026, the Senior Director of Clinical Quality stated that there was a missed nursing visit with no explanation for why it was missed.”

“It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and observation. In 3 of 19 (16%) clinical records reviewed, the agency did not ensure that each patient’s individualized written plan of care reflected patient and family goals and identified planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 7: This patient elected the hospice benefit on 01/08/2026 with a terminal diagnosis of senile degeneration of the brain. The skilled nurse note dated 04/06/2026 documented the following: Left lower posterior leg blister: L 0.9cm X W0.5cm wound/peri wound skin intact, pink, and normal temperature. Wound care was provided as per the care plan. Left lower posterior calf blister: L 2.1cm X W 2.0cm; wound care documented as provided per care plan. Right anterior foot, forth toe; missing toenail; care provided as per care plan. The plans of care were reviewed for the dates of 01/08/2026-8/27/2026 and revealed no interventions were documented for the left lateral/inferior foot blister, left lower posterior calf blister, or the right anterior foot, fourth toe missing toenail. CLINICAL RECORD 9: This patient elected the hospice benefit on 01/16/2026 with a terminal diagnosis of COPD. The drug profile was reviewed for the dates of 01/16/2026-08/27/2026 and included Macrobid 100mg oral capsule take 1 cap 2XD for 5 days for infection which was ordered on 08/22/2026 and Macrodantin 100 mg take 1 capsule 2XD (two times a day) for 5 days for urinary tract infection on 06/29/2026. A review of the plan of care for the dates of 06/29/2026-08/27/2026 did not reflect the patient’s documented infection-related condition or include interventions, monitoring, or goals addressing the condition for which the antibiotics were prescribed. CLINICAL RECORD 12: This patient elected the hospice benefit on 05/14/2026 with a terminal diagnosis of endometrial cancer. The RN initial comprehensive assessment dated 05/14/2026 stated the patient had a diagnosis of Type II diabetes mellitus and documented that the patient used a blood glucose monitor as needed. The assessment also documented sharp, shooting pain in the patient’s left lower extremity that was chronic, occurred daily and intermittently with movement, and was relieved with a non-narcotic analgesic. An Opioid was initiated. A review of the plan of care for the dates of 05/14/2026-08/27/2026 revealed no identified problem, interventions, measurable goals, or monitoring related to the patient’s diabetes or left lower extremity pain. During joint clinical record review and interview on 08/27/2026, the Senior Director of Clinical Quality stated the plans of care did not include the required goals and interventions, and this would be corrected immediately.”

“It is required that the hospice’s policies and procedures define a system of communication and integration that sustains coordination of services and provides documentation of exchange of information. The policies and procedures ensure that sharing of information occurs between all disciplines providing care and services in all settings and is ongoing whether or not the care and services are provided directly or under arrangement. 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 coordination of services and provided documentation of exchange of information. CLINICAL RECORD 12: This patient elected the hospice benefit 05/14/2026 with a terminal diagnosis of endometrial cancer. On 08/20/2026, the Chaplain visited the patient with the Hospice Aide. The patient reported she wanted to take all her insulin because she did not want to live like she was living. The Chaplain immediately contacted the MSW and Administrator for guidance. 911 was called. The chaplain stayed with the patient until EMS and her son arrived. The patient refused treatment and emergency transport. Documentation indicated there would be a discussion in an IDT meeting. Documentation revealed the RN called the patient on 08/21/2026 and the patient declined a visit as she said she was having visitors. The RN was able to complete a visit on 08/22/2026 and stated that the patient was able to walk from the porch to her living room with the assistance of a Rollator. The RN also stated that the family had hired a caregiver to be present with the patient when the son was working. There was no documentation that the IDG took place or that sharing of information occurred between all disciplines providing care. During an interview conducted with the Supervisor of Clinical Services on 08/27/2026, it was stated that a case conference was held to address the concerns on 08/20/2026, but there was no documentation present in the clinical record. It was also stated that interventions were put in place to ensure the safety of the patient, including a paid caregiver.”

“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 and use of gloves, mask, eye protection, or face shield depending on anticipated exposure. This standard was not met as evidenced by document review, interview and observation. In 1 of 4 (25%) home visit observations, the agency did not ensure that proper hand hygiene was followed. DOCUMENT 1: Agency Policy, “Infection Control” stated, in part: Perform hand hygiene before having direct contact with patients, before donning sterile gloves, after contact with body fluids,”. CLINICAL RECORD 2: This patient elected the hospice benefit on 01/12/2026 with a terminal diagnosis of Neurocognitive Disorder with Lewy Bodies. A home visit was conducted in an assisted living facility on 08/25/2026 to observe the Registered Nurse (RN) [Personnel Record 2] perform wound care with the RN Director of CNA Services in attendance. The RN was observed cleansing an open wound. The RN then placed a clean 4X4 dressing directly on the wound without changing gloves after cleansing the wound. During an interview with the Senior Director of Clinical Quality, it was stated that the RN did not follow the infection control procedures.”

“It is required that the hospice documents and maintains an effective infection control program that protects patients, families, visitors, and hospice staff by preventing and controlling infections and communicable diseases. The infection control program includes education of employees, contracted providers, patients, families, and other caregivers in infection control. This standard was not met as evidenced by interview and personnel record review. In 1 of 11 (11%) personnel records reviewed, the agency did not ensure that the infection control program included education of employees, contracted providers, patients, families, and other caregivers in infection control. PERSONNEL RECORD 6: This Hospice Medical Director was hired 07/05/2022. In review of the personnel records, it was revealed that the record did not include documentation of education for infection control for the years of 2024 and 2025. An interview was conducted with the Senior Director of Clinical Quality who stated that there was no evidence in the personnel record of education for infection control for the Hospice Medical Director.”

“It is required that the bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. In 2 of 3 (67%) clinical records reviewed in which bereavement services were provided, the agency did not ensure that there was documentation of a bereavement care plan. CLINICAL RECORD 17: This patient elected the hospice benefit on 10/01/2025 with a terminal diagnosis of senile degeneration of the brain. The patient died on 10/20/2025. The clinical record contained evidence of bereavement-related mailings and telephone contacts; however, there was no documented bereavement plan of care addressing the bereavement needs of the bereaved. CLINICAL RECORD 18: This patient elected the hospice benefit on 12/04/2025 with a terminal diagnosis of senile degeneration of the brain. The clinical record contained evidence of bereavement-related mailings and telephone contacts; however, there was no documented bereavement plan of care addressing the bereavement needs of the bereaved. During joint clinical record review and interview with the Bereavement Coordinator on 08/27/2026, it was stated that the documentation for the bereavement care plan was not present in the record. The Bereavement Coordinator stated they stuff had been sending the cards and letters but had not entered a plan of care.””

“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 2 of 18 (11%) clinical records in which hospice aide services were provided, the agency did not ensure that all written patient care instructions for the hospice aide were clear and consistent with the patient’s current needs. CLINICAL RECORD 4: This patient elected the hospice benefit on 07/17/2026 with a terminal diagnosis of Alzheimer’s Disease. The hospice plan of care for the dates of 07/17/2026-10/09/2026 included orders for hospice aide (HA) visits 5XW (5 times a week). The HA care plan dated 07/17/2026 stated that nail care was to be provided “specific days for clean”. The HA care plan did not provide the specific dates the nail care was to be provided. CLINICAL RECORD 7: This patient elected the hospice benefit on 01/08/2026 with a terminal diagnosis of senile degeneration of the brain. The hospice plan of care for the dates of 01/08/2026-08/27/2026 included orders for hospice aide (HA) visits 5XW (5 times a week). The skilled nurse note dated 04/06/2026 documented the following: Left lower posterior leg blister: L 0.9cm X W0.5cm wound/peri wound skin intact, pink, and normal temperature. Wound care was provided as per the care plan. Left lower posterior calf blister: L 2.1cm X W 2.0cm; wound care documented as provided per care plan. Right anterior foot, forth toe; missing toenail; care provided as per care plan. The hospice aide care plan for the dates of 04/06/2026-08/27/2026 was reviewed and did not contain instructions or precautions related to the identified wounds. During joint clinical record review and interview on 08/27/2026, it was stated by the Senior Director of Clinical Quality that the HA care plans needed to be more complete to include individualized instructions related to the needs of the patient.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. During an interview with the Volunteer Coordinator on 08/26/2026, and review of the Volunteer Services Annual reports for calendar years 2024 and 2025, it was revealed that the agency did not ensure hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The Volunteer Services Annual Reports documented volunteer hours of 0.13% for 2024 and 0.766% for 2025. During an interview with the Volunteer Coordinator on 08/26/2026, and review of the Volunteer Services Annual reports for calendar years 2024 and 2025, it was revealed that the agency did not ensure hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The Volunteer Services Annual Reports documented volunteer hours of 0.13% for 2024 and 0.766% for 2025.”

“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: the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes including the care and services provided. 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 complete and current documentation. CLINICAL RECORD 6: This patient elected the hospice benefit on 02/03/2026 with a terminal diagnosis of Alzheimer’s Disease. The initial RN assessment completed 02/03/2026 documented that the patient was admitted with a Stage III pressure injury. The initial order identified in the clinical record was dated 06/01/2026 and described the wound as a Stage II wound. The order directed the hospice SN to use aseptic technique, cleanse the wound with wound cleanser, pat dry, apply barrier cream to the wound bed 2XW (two times a week) and prn soilage; and the caregiver (CG) was to complete all other days and prn soilage/dislodgement. On 06/18/2026, the plan of care included an intervention for the hospice SN to measure and assess wound size, location, characteristics, etc. 1XW (once a week) on Mondays. The hospice plan of care was updated on 07/02/2026 with an intervention to use aseptic technique cleanse with soap and water, pat dry, apply Calmol lotion to wound bed every visit and prn soilage/dislodgement. Hospice SN was to perform wound care 2XW (two times a week) and the C/G was to complete all other days and prn soilage/dislodgement. Review of the wound care flow sheets showed nursing visits on 06/22/2026, 06/29/2026, and 07/06/2026. Wound measurements were documented on 06/01/2026, 06/22/2026, 06/29/2026, and 07/06/2026. There was no documented evidence of wound measurements, wound assessments, or wound care after 07/06/2026. During an interview on 08/27/2026, the RN Case Manager stated she had continued to provide wound care and obtain wound measurements after 07/01/2026. The RN Case Manager provided the Site Visitor with wound care assessments and measurements from her notebook and acknowledged that she had not entered the information into the patient’s clinical record. The RN Case Manager corrected the clinical record with late entries the same day it was noted. During joint clinical record review and interview on 08/27/2026, the Senior Director of Clinical Quality stated that the patient’s clinical record did not contain documentation of the wound assessments and measurements.”

“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: responses to medications, symptom management, treatments, and services. 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 each patient’s record included, at a minimum: responses to medications, symptom management, treatments, and services. CLINICAL RECORD 19: This patient elected the hospice benefit on 12/12/2025 with a terminal diagnosis of heart failure. During clinical record review, the skilled nursing note for 12/30/2025 documented that the patient appeared grossly uncomfortable. The RN documented that Morphine and acetaminophen 650 mg suppository was administered for dyspnea and pain, and the patient was repositioned for the management of secretions. However, the nursing note did not document the patient’s response to these interventions, including whether the patient’s pain, dyspnea, or secretions improved; whether the patient became comfortable, or the patient’s condition at the conclusion of the visit. During joint clinical record review and interview on 08/27/2026, the Senior Director of Clinical Quality stated that the patient’s clinical record did not contain responses to medications, symptom management, treatments, and services.”

“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.”