Noble Home Health Care LLC

The Governing Body and Administrator failed to ensure the Medicare Provider met the Condition of Participation for Organization and Administration of Services when they failed to provide skilled services to individuals, eligible to receive skilled home health services under their Medicare benefit…

The agency failed to provide a 15-day discharge notice before the date of discharge in 1 of 1 closed clinical records reviewed due to goals met.

The agency failed to evidence medical information regarding patients course of treatment and outcome was sent to the attending physician in 2 of 2 closed clinical records reviewed.

The agency failed to provide services as directed in the POC in 1 of 2 active clinical records reviewed with a SOC in 2025. (Patient #5) The findings include: A clinical record review for Patient #5 evidenced a POC for the initial certification period 03/24/2025- 05/22/2025 which indicated the…

The agency failed to ensure the Quality Assurance and Performance Improvement (QAPI) program included performance improvement activities for high risk and high frequency areas.

The agency failed to ensure the RN appropriately assigned the HHA to care for the Patient in 1 of 1 active clinical record reviewed with dialysis (medical treatment to filter the blood).

The governing body failed to ensure the administrator adhered to the agencies Medicare agreement to accept and provide services to Medicare eligible beneficiaries and the declination to provide skilled services to Medicare beneficiaries, for 1 of 1 agency.

The agency failed to ensure documentation was completed timely and accurately in 3 of 5 active clinical records reviewed.

The agency failed to ensure the comprehensive assessment included the physical status of the patient in 1 of 1 active clinical record review with a gastrostomy (GT, a feeding tube) (Patient #1) and in 1 of 1 active clinical record reviewed with a wound (Patient #5).

The agency failed to ensure the comprehensive assessment included a medication review of the drug interactions in 1 of 2 active clinical records reviewed with a SOC in 2025. (Patient #4) The findings include: A clinical record review for Patient #4 evidenced a document titled “Medication…

The agency failed to ensure the comprehensive assessment included the assessment of the caregiver’s willingness, ability, and capability to provide care in 3 of 3 active clinical records reviewed with a caregiver.

The agency failed to ensure the plan of care was individualized to include the patient-specific interventions and goals in 4 of 5 active clinical records reviewed.

The agency failed to ensure skin treatment was provided only as ordered by the physician in 1 of 1 observation with a LPN.

The agency failed to ensure verbal orders were written and send to the physician for signature in 1 of 2 active clinical records reviewed with a SOC in 2025. (Patient #4) The findings include: A policy titled “Physician Orders/Plan of Care” updated 04/23/2025 indicated the agency would ensure…

The agency failed to coordinate care with all entities/disciplines providing care to the patient in 3 of 3 active clinical records reviewed with services provided by another agency.

The agency failed to ensure the HHA provided care as directed in the care plan in 1 of 2 active clinical records reviewed with HHA services.

The agency failed to ensure the discharge summary was sent to the physician within 2 business days in 2 of 2 closed clinical records reviewed.

The home health agency failed: to develop and maintain an emergency preparedness plan which was updated and reviewed at least every 2 years (see tag E0004); develop and maintain a comprehensive emergency preparedness plan which included an all-hazards risk assessment based on a facility-based and…

The home health agency failed to ensure: they were able to meet the patient needs (see tag G0570); failed to ensure each patient received home health services written in their plan of care and the plan of care was individualized (see tag G0572); the plan of care contained all medications…

The agency failed to: Based on record review and interview, the agency failed to measure, analyze and track quality indicators such as adverse patient events, and other aspects of performance which would enable the agency to assess processes of care, services and operations (see tag G642); utilize…

The agency failed to develop and maintain an emergency preparedness plan which was updated and reviewed at least every 2 years.

The agency failed to develop and maintain a comprehensive emergency preparedness plan which included an all-hazards risk assessment based on a facility-based and community-based risk assessment; and failed to include strategies for addressing emergency events identified by the risk assessment.

The agency failed to ensure the individualized emergency preparedness plans for each patient included specific patient care information or evacuation locations for 7 of 7 clinical records reviewed.

The agency failed to ensure the policies and procedures for emergency preparedness included procedures to inform state emergency preparedness officials of patients in need of evacuation based on the patient’s medical/psychiatric condition and home environment.

The agency failed to ensure the emergency preparedness policies and procedures included a system of medical documentation that preserved patient information, protected confidentiality, and secured and maintained the availability of records.

The agency failed to ensure the emergency preparedness plan policies included emergency staffing for addressing surge needs.

The agency failed to develop and maintain an emergency preparedness communication plan which included contact information for federal emergency preparedness staff.

The agency failed to maintain documentation of all emergency preparedness training and failed to demonstrate staff knowledge of emergency procedures.

The agency failed to maintain documentation of all drills, tabletop exercises, and emergency events.

The agency failed to ensure the OASIS [outcome and assessment information set] accurately reflected patient’s status at time of assessment in 5 of 7 clinical records reviewed.

The agency failed to update and revise the comprehensive assessment due to a major decline in the patient's health status in for 2 of 2 patients who experienced a decline in health status.

The agency failed to ensure the discharge summary included all information pertinent to patient’s current course of illness and treatment, post-discharge goals of care and treatment preferences in 2 of 2 discharge records reviewed.

The agency failed to ensure patients received the home health services which were written in an individualized plan of care in 5 of 7 clinical records reviewed.

The agency failed to measure, analyze and track quality indicators such as adverse patient events, and other aspects of performance which would enable the agency to assess processes of care, services and operations.

The agency failed to utilize quality indicator data to monitor effectiveness and safety of services and quality of care and identify opportunities for improvement.

The home health agency failed to ensure the performance improvement activities analyzed the causes of adverse patient events and implemented preventive actions.

The home health agency failed to conduct and document a performance improvement project.

The home health agency failed to ensure policies and procedures were developed and implemented to ensure all staff were fully vaccinated for COVID-19. This practice had the potential to affect all agency patients.

The agency failed to ensure the comprehensive assessment accurately reflected the patient’s current health status in 4 of 7 clinical records reviewed.

The home health agency failed to review all medications patients were taking to identify significant drug interactions, duplicative drug therapy, and/or noncompliance with drug therapy in 4 of 5 active clinical records reviewed.

The agency failed to ensure the comprehensive assessment included the patient’s primary caregiver or other available supports including their willingness/ability to provide care and availability/schedules in 1 of 3 home visits conducted.

The agency failed to ensure the plan of care included all medications, diagnoses, type and frequency of services, measurable goals and outcomes, interventions to address underlying risk factors for hospitalization, medical equipment and patient-specific interventions and goals for their patients in…

The agency failed to ensure all patient care orders were recorded in the plan of care in 1 of 5 active clinical records reviewed.

The agency failed to ensure all services and treatments were administered only as ordered by a physician in 1 of 5 active clinical records reviewed.

The agency failed to ensure they promptly alerted the physician to any change in patients’ condition in 5 of 7 clinical records reviewed.

The agency failed to integrate and coordinate services to assure the identification of patient needs or factors that could affect treatment effectiveness in 4 of 7 clinical records reviewed.

The home health agency failed to measure the success of the performance improvement activities and track performance to ensure that improvements were sustained.

The agency failed to ensure skilled professionals accurately and completely prepared clinical notes in 4 of 7 clinical records reviewed.

The home health agency failed to ensure the plan of care was followed as directed, in 3 of 4 clinical records reviewed.

The home health agency failed to ensure all patients had written instructions outlining their care in their home folder, in 1 of 1 home visit conducted.

The home health agency failed to ensure all home health aides followed universal precautions to prevent infectious and communicable diseases in 1 of 1 home visit with a home health aide.

The home health agency failed to ensure all entries were accurate and appropriately authenticated, in 3 of 4 clinical records reviewed.

The home health agency failed to ensure the comprehensive assessment contained all information on the patient’s current health status, in 1 of 4 clinical records reviewed.

The home health agency failed to ensure all medications the patients were prescribed were reconciled by the skilled nurse, in 1 of 4 clinical records reviewed.

The home health agency failed to ensure the physician was notified to changes in the patient’s needs, in 1 of 4 clinical records reviewed.

The home health agency failed to ensure they revised the plan of care based on a change in the patient’s condition and needs, in 1 of 4 clinical records reviewed.

The home health agency failed to ensure a visit schedule was in agency patients home folders, in 1 of 1 home visit conducted.

The home health agency failed to ensure patient medication schedule/instructions were in the agency patients home folder, in 1 of 1 home visit conducted.

The home health agency failed to ensure the home health aides followed the aide care plan established by the registered nurse, in 3 of 4 clinical records reviewed with home health aide services.

The home health agency failed to ensure the supervising nurse for the home health aides followed the aide care plan as directed by the registered nurse in 1 of 4 clinical records reviewed.

The home health agency failed to ensure they were able to meet the patient needs (see tag G0570); failed to ensure each patient received home health services written in their plan of care, the plan of care was individualized, and the plan of care was signed by the patient's physician (see tag…

The agency failed to ensure each patient received home health services written in their plan of care in 2 of 10 records reviewed (#7, #4), failed to ensure the plan of care was individualized in 2 of 10 records reviewed (#9, #10), and failed to ensure plan of care was signed by the patient's…

The agency failed to ensure each home health aide (HHA) completed a competency evaluation prior to furnishing home health services for 1 of 4 HHA's, in a total sample of 8 personnel records reviewed.

The agency failed to ensure the registered nurse provided a complete care plan for the home health aide [HHA] in 3 out of a total sample of 10 clinical records reviewed (#2, #3, #6).

The agency failed to ensure all clinical record entries were legible, clear, complete, and appropriately authenticated in 5 out of 10 total patient records reviewed (#1, #2, #3, #7, #9) The findings include: 1. Record review on 3/2/2021 evidenced an agency policy titled, "Timeliness and Accuracy of…

The agency failed to ensure patients were advised of the state toll free home health telephone hotline contact information for 3 of 3 home visits out of a total sample of 10 patient records reviewed (#2, #3, #7).

The agency failed to ensure a comprehensive assessment was performed within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more in 1 of 1 records of patients with hospitalization reviewed (#2).

The agency failed to ensure the individualized plan of care included all services, safety measures, medications and treatments in 6 out of 8 active patient records out of a total sample of 10 records reviewed (#1, #2, #3, #4, #8, #10).

The agency failed to ensure relevant changes in the patient's plan of care were promptly alerted to the physician in 4 of 10 clinical records reviewed.

The agency failed to ensure the supervising nurse revised the plan of care to reflect the current frequencies that were provided in 2 of 10 clinical records reviewed.

The home health agency failed to ensure discharge plans were communicated to the patient and patient's physician for 2 of 3 discharged patients, in a total sample of 8 clinical records reviewed.

The home health agency failed ensure coordination of care provided by all disciplines who serviced their patients in 1 of 3 clinical records reviewed of patients receiving services from outside agencies out of a total sample of 10 clinical records reviewed.

The agency failed to ensure patients were provided a written schedule of visits in 3 of 3 home visits out of a total sample of 10 patient records reviewed (#2, #3, #7).

The agency failed to ensure patients were provided a current written patient medication list in 3 of 3 home visits conducted (#2, #3, #7).

The agency failed to ensure an on-site home health aide (HHA) supervision was conducted at least every 60 days for 2 of 10 clinical records reviewed.

The agency failed to ensure each home health aide (HHA) followed the care plan as assigned in 4 of 10 clinical records reviewed.

The home health agency failed to ensure all employees practiced standard/universal precautions in 1 of 1 home visit observation with a Registered Nurse (Patient #3, Employee A, Registered Nurse (RN).

The home health agency failed to ensure the home health aide successfully completed a competency evaluation program for 14 of 14 home health aide files reviewed (Employees # G, J - V) for these employees who cared for patients dependent on hoyer lift for transferring (#4, #5, #6, #8).

The Registered Nurse failed to ensure the HHA (home health aide) care plan was individualized and failed to identify safety precautions necessary for safe care for 1 of 1 identified patient receiving incenter hemodialysis (#2).

The agency failed to ensure the plan of care was individualized and specific to the patients' needs for 8 of 10 records reviewed (#1, #2, #4, #5, #6, #7, #8, #10).

The agency failed to ensure the Registered Nurse consistently and accurately reassessed the patient's needs for 1 of 3 closed records reviewed (#7).