Inspection Report Summary
The most recent inspection on March 14, 2024, found no deficiencies during a complaint investigation related to complaint CT#37113. Earlier inspections showed a mixed record, with some violations noted in licensing and complaint investigations from 2017 through 2023, primarily involving documentation, staff performance monitoring, and client care issues such as incontinence care and medication administration. Complaint investigations from 2017 and 2019 substantiated failures in service delivery and documentation that affected client care, including pressure ulcer development, while more recent complaint investigations were unsubstantiated. Enforcement actions such as fines or license suspensions were not listed in the available reports. The inspection history suggests some improvement over time, with the most recent inspections showing no deficiencies after prior issues were identified.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
3.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
43% better than Connecticut average
Connecticut average: 5.6 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
170% occupied
Based on a March 2024 inspection.
Occupancy over time
Inspection Report
Complaint Investigation
Census: 63
Capacity: 37
Deficiencies: 0
Date: Mar 14, 2024
Visit Reason
The inspection visit was conducted as a complaint investigation related to complaint CT#37113.
Complaint Details
Complaint investigation CT#37113 was conducted and found no substantiated violations.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection. Verification of Alzheimer's special care units and part-time Infection Prevention and Control Specialist requirements were confirmed.
Report Facts
Census: 63
Total Capacity: 37
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Denise Bilodea | Executive | Personnel contacted during inspection |
| Michael J. Smith | RN | Report submitted by |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 37
Deficiencies: 0
Date: Mar 14, 2024
Visit Reason
The inspection visit was conducted as a complaint investigation related to CT#37113.
Complaint Details
Complaint investigation related to CT#37113; no violations were substantiated.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection. Verification of Alzheimer's special care units and infection prevention requirements were also confirmed.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Denise Bilodea | Executive | Personnel contacted during the inspection. |
| Michael J. Smith | RN | Report submitted by. |
Inspection Report
Renewal
Census: 71
Deficiencies: 0
Date: Aug 1, 2023
Visit Reason
The inspection visit was conducted as a licensing inspection for renewal purposes at the facility.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Lombardi | SALSA | Personnel contacted during the inspection |
| Megan Edison-Sawyer | Survey Team Leader | Survey team leader for the inspection |
| Elizabeth Heiney | Supervisor | Supervisor for the inspection |
Inspection Report
Complaint Investigation
Census: 71
Deficiencies: 0
Date: Mar 10, 2023
Visit Reason
The inspection visit was conducted as a complaint investigation related to complaint #33792.
Complaint Details
Complaint investigation #33792 was the basis for the visit. Violations were substantiated as violations were identified during the inspection.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection, as noted in the attached violation letter dated 3/15/23.
Inspection Report
Renewal
Census: 66
Capacity: 150
Deficiencies: 0
Date: Mar 22, 2022
Visit Reason
The inspection was conducted as a licensing renewal inspection for the facility.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection. Verification of Alzheimer's special care units and full-time Infection Prevention and Control Specialist requirements were confirmed.
Report Facts
Memory Care/Traditional census: 33
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Amy Lombardi | SALSA | Personnel contacted during inspection |
| Deanne Riley | Executive Director | Personnel contacted during inspection |
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Apr 3, 2019
Visit Reason
The inspection was conducted as a complaint investigation related to alleged violations at Brookdale West Hartford Assisted Living Services Agency.
Complaint Details
Complaint Investigation # CT 25177 was conducted. Violations were substantiated as the agency failed to provide required services and proper documentation, resulting in client harm.
Findings
The investigation found that the Assisted Living Services Agency failed to ensure services were provided to Client #1, including failure to provide incontinence care, resulting in the client developing pressure ulcers. The agency also failed to properly document assessments and monitor staff performance.
Deficiencies (4)
ALSA Aide #1 failed to provide incontinence care to Client #1 during the entire shift and failed to enroll assistance of another aide of the opposite gender or report client preferences to ensure delivery of necessary services.
Failure to identify a process to monitor staff performance scheduled to work from 11PM to 6:30AM and ensure proper delivery of services to clients.
Failure to identify documentation of assessments by ALSA nurses prior to 3/22/19 of Client #1's skin condition.
Failure to identify accuracy of nursing documentation regarding initial wound date and skin management.
Report Facts
Inspection dates: Onsite inspection dates were 2019-04-03 and 2019-04-04.
Plan of correction submission deadline: Plan of correction to be submitted by April 23, 2019.
Termination date of ALSA Aide #1: Termination completed on 2019-03-26.
Completion date for random weekly resident interviews: To be implemented by 2019-04-26.
Completion date for in-servicing nursing staff on documentation correction: To be completed by 2019-05-30.
Completion date for meeting with Hospice Agency: By May 15, 2019.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Beata Kozubal | Supervisor of Assisted Living Services Agency | Personnel contacted during inspection. |
| Renata Oycrodrik | Executive Director | Contacted by LPN #1 regarding client condition. |
| Loan Nguyen | Supervising Nurse Consultant | Author of the report and plan of correction letter. |
Inspection Report
Plan of Correction
Deficiencies: 5
Date: Apr 3, 2019
Visit Reason
Unannounced visits were made to Brookdale West Hartford on April 3 and 4, 2019 by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation.
Findings
The Assisted Living Services Agency failed to ensure services were provided to Client #1, including failure to provide incontinence care, failure to monitor staff performance, failure to document skin assessments accurately, and failure to delineate wound care responsibilities, resulting in Client #1 acquiring two pressure ulcers.
Deficiencies (5)
ALSA Aide #1 failed to provide incontinence care to Client #1 during the entire shift and failed to enroll assistance of ALSA Aide #2 of the opposite gender or report client preferences to the ALSA nurse.
SALSA failed to identify a process to monitor staff performance scheduled to work from 11PM to 6:30AM and ensure proper delivery of services to clients.
SALSA failed to identify documentation of assessments by ALSA nurses prior to 3/22/19 of Client #1's skin condition.
Failure to identify delineation of responsibilities for wound care when hospice nurse was not present and client required dressing changes.
Nursing documentation of initial wound date was inaccurate and failed to identify accuracy of nursing documentation.
Report Facts
Dates of visit: April 3 and 4, 2019
Date of incident: 3/23/19
Date of admission to ALSA services: 12/10/16
Pressure ulcer measurements: 2.1cm x 1.6cm x 0.1cm and 2.5cm x 1.8cm x 0.1cm
Completion date for termination of ALSA Aide #1: 3/26/2019
Completion date for random weekly resident interviews: 4/26/19
Completion date for in-servicing nursing staff: 5/30/2019
Completion date for Memorandum of Understanding amendment: 5/15/2019
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Loan Nguyen | Supervising Nurse Consultant | Signed the report as representative of Facility Licensing and Investigations Section |
| Beata Kozubal | Supervisor of Assisted Living Services Agency | Addressee of the report |
Inspection Report
Complaint Investigation
Census: 73
Deficiencies: 7
Date: Mar 2, 2017
Visit Reason
Unannounced visits were made to Brookdale West Hartford on multiple dates in March and April 2017 to conduct multiple complaint investigations related to alleged violations of Connecticut State Agencies regulations.
Complaint Details
The visit was triggered by multiple complaint investigations (#21230, #19133, #20349, #18213, #21548). Violations were substantiated as identified during the inspection.
Findings
The inspection identified multiple violations including failure to ensure effective communication and safe administration of medications, failure to coordinate services with clients and families, failure to document employment of a Resident Service Coordinator, failure to ensure client safety and follow agency policies, failure to maintain proper personnel documentation, failure to hold required meetings, and failure to respond timely to emergency pendant alarms.
Deficiencies (7)
Agency failed to ensure effective communication and safe administration of medications for clients #6 and #10.
Agency failed to coordinate services with client #1, family, and physician.
Agency failed to document employment of a Resident Service Coordinator.
Agency Supervisor of Assisted Living Services failed to ensure client safety and follow agency policy for clients #4 and #5.
Agency failed to ensure proper documentation in personnel files for five ALSA aides and RN designee.
Agency failed to hold required meetings and maintain appropriate documentation.
Agency failed to respond to client #10's emergency pendant alarm in a reasonable amount of time.
Report Facts
Census: 73
Inspection dates: Inspection visits occurred on 2017-03-02, 2017-03-03, 2017-03-07, 2017-03-09, 2017-03-10, 2017-04-27, and 2017-04-28
Completion dates for corrective actions: Various corrective actions to be completed by July 15, 2017, July 30, 2017, September 30, 2017, and other dates as specified
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Loan Nguyen | Supervising Nurse Consultant | Signed the violation letter and approval for issuance of license |
| Beata Kozubel | Supervisor of Assisted Living Services Agency | Named as recipient of violation letter and involved in agency operations |
| Diogo Voccia | RN | Personnel contacted during inspection |
| Zoila Diaz | RN | Personnel contacted during inspection |
| Adrienne Perry | RN | Personnel contacted during inspection and involved in findings |
| Todd Curtiss | Executive Director | Involved in findings and agency management |
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