Nobel Care Hospice Inc.

“Based on interview and record review, the hospice agency failed to meet the certification requirement to organize and manage its’ resources when it failed to have an Administrator on staff to manage the day-to-day operation of the hospice and failed to be engaged primarily in providing hospice care and services. This had the potential to affect four of four former patients (Patient (P) 1, P2, P3, and P4) and all potential patients. Findings include: 1. The hospice failed to have an Administrator on staff to manage the day-to-day operation of the hospice and failed to have evidence of a governing body. This had the potential to affect four of four former patients (Patient (P) 1, P2, P3, and P4) and all potential patients. Cross Reference: L651, 2. The hospice failed to be primarily engaged in providing hospice care and services. There was no documented evidence that the hospice agency had any patients since 2024. There were no clinical staff, there was no system for patient records, and there were no policies or procedures. Cross Reference: L652.”

“Based on interview and record review, the hospice failed to meet the certification requirement of designating a physician to serve as medical director. This had the potential to affect four of four patients (Patient (P) 1, P2, P3, and P4) and any future patients. Findings include: On 03/04/26 at 10:00 AM upon entrance to the hospice agency, Billing Clerk (BC)1 informed the surveyor there were no patients or patient records at the agency. During an interview on 03/04/26 at 11:17 AM, the Owner stated in a telephone interview that he/she was the owner of the hospice agency. The Owner was asked who the Medical Director was. He/She stated, “I don’t know remember [sic] [his/her] name, but I am working on getting another Medical Director right now.” The Owner was asked if he/she was in California, and he/she stated, “Yes.” The Owner was asked if there was any staff at this agency. The Owner stated, “None other than [BC1] and [he/she] is the billing clerk.” During an interview on 03/04/26 at 11:45 AM, BC1 stated he/she found papers with what appeared to be patient information. BC1 provided the documents to the surveyor. Review of the documents revealed: a. For Patient (P) 1:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/30/24- Patient Acknowledgement, dated 03/30/24- Safety Guidelines for Hospice, dated 03/30/24- Hospice Election Statement, dated 03/30/24- Individual Patient Emergency Preparedness Plan, dated 03/30/24 and listing a primary diagnosis of chronic obstructive pulmonary disease. b. For P2:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/30/24- Patient Acknowledgement, dated 03/30/24- Safety Guidelines for Hospice, dated 03/30/24- Hospice Election Statement, dated 03/30/24- Individual Patient Emergency Preparedness Plan, dated 03/30/24 and listing a primary diagnosis of chronic obstructive pulmonary disease. c. For P3:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/03/24- Patient Acknowledgement, dated 03/03/24- Safety Guidelines for Hospice, dated 03/03/24- Hospice Election Statement, dated 03/03/24- Individual Patient Emergency Preparedness Plan, dated 03/03/24 and listing a primary diagnosis of congestive heart failure. d. For P4:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/30/24- Patient Acknowledgement, dated 03/30/24- Safety Guidelines for Hospice, dated 03/30/24- Hospice Election Statement, dated 03/30/24- Individual Patient Emergency Preparedness Plan, dated 03/30/24 and listing a primary diagnosis of liver disease. Review of the documents revealed no documented evidence of who the Medical Director was or that the physician had been involved in the patients’ care. All the documents were signed by Administrator/RN/Dietician/Volunteer Coordinator 1.”

“Based on interview and record review, the hospice agency failed to maintain clinical records for four of four patients (Patient (P) 1, P2, P3, and P4) whose administrative records were reviewed. This had the potential for breaches in protected health information (PHI) and personal identifying information (PII). Findings include: The hospice failed to maintain secure control of clinical records for four of four patients (Patient (P) 1, P2, P3, and P4) when Owner stated the records should be in the hospice office or in a storage building. The owner stated he did not know the exact address of the storage building but could “provide it later.” Cross Reference: L680”

“Based on interview and record review, the hospice failed to have an Administrator on staff to manage the day-to-day operation of the hospice and failed to have evidence of a governing body. This had the potential to affect four of four former patients (Patient (P) 1, P2, P3, and P4) and all potential patients. Findings include: 1. On 03/04/26 at 10:00 AM upon entrance to the hospice agency, Billing Clerk (BC)1 was asked who the Administrator was. BC1 stated, “I just know who my supervisor is. [His/Her] name is [Owner]. Let me call [him/her] and you can speak to [him/her] about this.” During an interview on 03/04/26 at 11:17 AM, the Owner stated in a telephone interview that he/she was the owner of the hospice agency. The Owner was asked if there was any staff at this agency. The Owner stated, “None other than [BC1] and [he/she] is the billing clerk.” Review of an undated organizational chart, provided by BC1, revealed Administrator/RN/Dietician/Volunteer Coordinator 1 was listed as the Administrator. Review of administrative records for P1, P2, P3, and P4 revealed signatures by Administrator/RN/Dietician/Volunteer Coordinator 1 during 03/2024. No other documentation establishing the Administrator’s presence and management of the hospice agency after 03/2024 was provided. 2. During an interview on 03/04/26 at 11:30 AM, BC1, who was the only staff member of the agency, was asked to provide Governing Body meeting minutes for the past 12 months. BC1 stated he/she did not know what a governing body was or the purpose of the governing body.”

“Based on observation, interview, and record review, the hospice failed to be primarily engaged in providing hospice care and services. There was no documented evidence that the hospice agency had any patients since 2024. There were no clinical staff, there was no system for patient records, and there were no policies or procedures. This had the potential to affect four of four former patients (Patient (P) 1, P2, P3, and P4) and all potential patients. Findings include: On 03/04/26 at 10:00 AM upon entrance to the hospice agency, Billing Clerk (BC)1 was asked who the Administrator was. BC1 stated, “I just know who my supervisor is. [His/Her] name is [Owner]. Let me call [him/her] and you can speak to [him/her] about this.” During an interview on 03/04/26 at 10:06 AM, BC1 telephoned the owner using his/her personal cell phone. No office phone was observed. BC1 was asked if there was an office phone. He/She stated, “No, I have to use my cell phone to make any calls.” Three tables were put together to make a desk. There was a desktop computer with a printer. There were no patient records observed in the office. BC1 was asked what computer system the agency had for medical records. He/She stated, “We don’t have one yet. I guess since we haven’t had any patients, we haven’t needed one yet. I know they are working on a billing system right now.” BC1 stated he/she had interviewed for the Billing Clerk position during February 2025 and started working 12/08/25. BC1 was asked what his/her job duties were at present since there should be no billing to process without patients. He/She stated, “I am taking care of the Indeed account and trying to hire nurses and aides right now so we can get some patients.” During an observation on 03/04/26 at 10:20 AM, a business license was observed hanging on the wall. The license was issued by the Wyoming Department of Health Aging Division Healthcare Licensing and Surveys and was dated as issued on 04/01/24 and expired on 06/30/24. A Certificate of Accreditation, issued by the Accreditation Commission for Health Care, with Accreditation #91550 and dated 04/09/24 through 04/09/27, was on the wall. During an interview on 03/04/26 at 11:17 AM, the Owner stated in a telephone interview that he/she was the owner of the hospice agency. The Owner was asked who the Medical Director was. He/She stated, “I don’t know remember [sic] [his/her] name, but I am working on getting another Medical Director right now.” The Owner was asked if he/she was in California, and he/she stated, “Yes.” The Owner was asked if there was any staff at this agency. The Owner stated, “None other than [BC1] and [he/she] is the billing clerk.” The Owner was asked about the agency’s accredited status. He/She stated, “We were surveyed back in 2023.” The Owner was asked how many patients the agency had at that time. He/She stated, “We had four or five patients at that time. I don’t remember their names.” The Owner was asked if the agency had any patients since 2023. He/She stated, “Not to my knowledge.” During an interview on 03/04/26 at 11:30 AM, BC1 was asked to provide the policies and procedures for the agency. He/She stated, “I have not received any of these, and I do not know where they would be at.” At 11:35 AM, BC1 continued searching the drawers of the file cabinet and stated, “I have found these two notebooks with just dividers in it and the other one had statements from [Pharmacy name withheld].” BC1 stated the statements were made to this hospice agency but had no specific patient names. BC1 stated the statement was dated 05/31/24. BC1 did not provide these statements for review. Continuing with the interview on 03/04/26 at 11:45 AM, BC1 stated he/she found papers with what appeared to be patient information. BC1 provided the documents to the surveyor. Review of the documents revealed: a. For Patient (P) 1:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/30/24- Patient Acknowledgement, dated 03/30/24- Safety Guidelines for Hospice, dated 03/30/24- Hospice Election Statement, dated 03/30/24- Individual Patient Emergency Preparedness Plan, dated 03/30/24 and listing a primary diagnosis of chronic obstructive pulmonary disease. b. For P2:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/30/24- Patient Acknowledgement, dated 03/30/24- Safety Guidelines for Hospice, dated 03/30/24- Hospice Election Statement, dated 03/30/24- Individual Patient Emergency Preparedness Plan, dated 03/30/24 and listing a primary diagnosis of chronic obstructive pulmonary disease. c. For P3:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/03/24- Patient Acknowledgement, dated 03/03/24- Safety Guidelines for Hospice, dated 03/03/24- Hospice Election Statement, dated 03/03/24- Individual Patient Emergency Preparedness Plan, dated 03/03/24 and listing a primary diagnosis of congestive heart failure. d. For P4:- Consent for Hospice -Release of Information and Consent for Patient, dated 03/30/24- Patient Acknowledgement, dated 03/30/24- Safety Guidelines for Hospice, dated 03/30/24- Hospice Election Statement, dated 03/30/24- Individual Patient Emergency Preparedness Plan, dated 03/30/24 and listing a primary diagnosis of liver disease. All the documents were signed by Administrator/RN/Dietician/Volunteer Coordinator 1, and none were dated later than 03/30/24.”

“Based on interview and record review, the hospice failed to maintain secure control of clinical records for four of four patients (Patient (P) 1, P2, P3, and P4). This had the potential for breaches in protected health information (PHI) and personal identifying information (PII). Findings include: On 03/04/26 at 10:00 AM upon entrance to the hospice agency, a computer and printer were noted on a desk made of three tables. There were no patient records observed. During an interview on 03/04/26 at 10:06 AM, Billing Clerk (BC)1 was asked what computer system the agency had for medical records. He/She stated, “We don’t have one yet. I guess since we haven’t had any patients, we haven’t needed one yet . . .” During an interview on 03/04/26 at 11:17 AM, the Owner stated in a telephone interview that he/she was the owner of the hospice agency. The Owner was asked where the medical records were for the patients who were on services at the time of the survey. He/She stated, “They should be in the office. In the office, but [BC1] won’t have access to them. They either expired or were discharged to another hospice agency.” During the conversation, BC1 was looking through the filing cabinet but could not find any records. The Owner was informed of this. The Owner stated, “Then they could be in a storage building. I can provide that information to you later. I don’t know the exact address of the storage building.””