Every finding on record at Noble Choice Home Healthcare Inc

A Recertification/CHOW Survey entrance conference was conducted on 06/10/2021 at approximately 1:25 PM with the Adm (in person). Census: L&C: 0 LHH: 0 PAS: 0 An exit conference was conducted on 06/15/2021 with the Adm (in person) and the DON (in person) at 2:30 PM. The preliminary findings were discussed. The agency was found in compliance with 42 CFR Part 484.22 Medicare Conditions of Participation and no deficiencies were cited. ABBREVIATIONS Adm - Administrator CFR - Code of Federal Regulations CHOW - Change of Ownership DON - Director of Nurses L&C- Licensed and Certified LHH - Licensed Home Health PAS - Personal Assistance Services

A Recertification/CHOW Survey entrance conference was conducted on 06/10/2021 at approximately 1:25 PM with the Adm (in person). Census: L&C: 0 LHH: 0 PAS: 0 An exit conference was conducted on 06/15/2021 with the Adm (in person) and the DON (in person) at 2:30 PM. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. The agency was found in compliance with the Medicare Conditions of Participation. Deficiencies cited at standard level. ABBREVIATIONS Adm - Administrator CHOW - Change of Ownership CFR - Code of Federal Regulations DC - Discharge DON - Director of Nurses EMR: electronic medical record L&C- Licensed and Certified LHH - Licensed Home Health MD- Medical Doctor NOMNC - Notice of Medicare Non-Coverage OASIS- Outcome and Assessment Information Set PAS - Personal Assistance Services SOC - start of care

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide the NOMNC written notice at least two days in advance of terminating on-going care in two of two (Patient 1 and 3) discharged records reviewed. This failure placed the patients at risk of harm due to inadequate or inappropriate continuity of care in the patients' post-discharge needs and could prevent the patients from exercising the right to appeal the discharge decision, if desired. Findings Include: Discharged Patient 1: The agency's DC listed contained a DC date of 11/18/2019. Record review of the EMR contained a SOC date of 09/20/2019 and a DC OASIS assessment completed on 11/16/2019. The record did not contain documentation that Patient 1 received proper written notice of intent to DC no later than two days in advance of terminating on-going care. The record did not include a written NOMNC. Discharged Patient 3: The agency's DC list contained a DC date of 01/08/2020. Record review of the paper record and the EMR contained a SOC date of 09/11/2019 and a DC OASIS assessment completed on 01/08/2020. The records did not contain documentation that Patient 3 received proper written notice of intent to DC no later than two days in advance of terminating on-going care. The record did not include a written NOMNC. In an interview on 06/15/2021 at approximately 2:15 PM with the Adm and the DON, the surveyor discussed the above findings and asked why the agency had not provided written notice of the intent to discharge with the NOMNC form no later than two days in advance of terminating on-going care for Patient 1 and 3. The DON stated, "I don't know." CFR §405.1200(b)(1) Timing of Notice: "A provider must notify the beneficiary of the decision to terminate covered services no later than 2 days before the proposed end of the services."

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to complete and send completed discharge and transfer summaries. In two of two (Patient 1 and 3) records reviewed, a discharge summary was not completed and sent to the primary care practitioner or other health care professional who was responsible for providing care and services to the patient after discharge within 5 business days. In one of one (Patient 2) record reviewed, a transfer summary was not completed and sent to the hospital within two business days after becoming aware of an unplanned transfer and hospital admission. The failure placed patients at risk of negative outcomes, patient/caregiver receiving post-discharge instructions, and the physician and hospital from ensuring patient services were provided and patient needs were met. FINDINGS INCLUDE: Patient 1: The agency's DC listed contained a DC date of 11/18/2019. Record review of the EMR contained a SOC date of 09/20/2019 and a DC OASIS assessment dated 11/16/2019. The EMR included a form titled, "Discharge/Transfer Summary" that was not electronically signed or dated. The form included Patient 1's name and contact information for the physician and agency. The rest of the form was blank and did not indicate the attending physician was sent a discharge summary within five business days of the date of discharge. Patient 2: Record review of the paper record and the EMR contained a SOC date of 02/11/2017. The EMR included an OASIS form titled, "Transfer Inpatient Facility" that included Patient 2 had an unplanned transfer and hospital admission on 12/11/2019 due to a respiratory infection, heart failure and gastrointestinal bleeding, obstruction, constipation, impaction. The record did not include a transfer summary. Patient 3: The agency's DC list contained a DC date of 01/08/2020. Record review of the paper record and the EMR contained a SOC date of 09/11/2019 and a DC OASIS assessment dated 01/08/2020. The EMR included a form titled, "Discharge/Transfer Summary" that was not electronically signed or dated. The form included Patient 3's name and contact information for the physician and agency. The rest of the form was blank and did not indicate the attending physician was sent a discharge summary within five business days of the date of discharge. In an interview on 06/15/2021 at approximately 2:18 PM with the Adm and the DON, the surveyor discussed the above findings and asked why the record for Patient 1 and 3 did not include a discharge summary that was sent within five days to the primary care practitioner or other health care professional who was responsible for providing care and services after discharge and the record for Patient 2 did not include a transfer summary that was completed and sent to the hospital within two business days after becoming aware of an unplanned transfer and hospital admission. The DON stated, "I don't know."