S&C QCOR HHA 2567s
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HHAs 2567s
Selection Criteria ▸

Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific HHA deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 527178 Prohealth Home Care, Inc. N17w24100 Riverwood Dr., Suite 200 Waukesha WI 5 (Chicago) 03/06/2019 FN0D11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
▼ 527191 Beaver Dam Community Hospitals, Inc. 707 S University Ave Beaver Dam WI 5 (Chicago) 02/13/2018 KC1J11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
▼ 527194 Supportive Home Services, Inc. 1181 N 4th Avenue Park Falls WI 5 (Chicago) 07/08/2024 63C61-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0325 Basis and Scope Condition
▼ 527195 Spooner Health System, Inc 801 Oak Street Spooner WI 5 (Chicago) 10/14/2020 O48P11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0013 Development of EP Policies and Procedures Standard
G0952 Ensure that HHA employs qualified personnel Element
▼ 527208 Flambeau Hospital Inc. 133 N Lake Ave Phillips WI 5 (Chicago) 02/05/2019 L3K011 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
▼ 527215 International Quality Homecare Of Wisconsin, Llc 5600 Woodland St, Suite 1 Stevens Point WI 5 (Chicago) 10/07/2020 UU7311 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0029 Development of Communication Plan Standard
E0042 Integrated EP Program Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0646 Program activities Standard
G0654 Track adverse patient events Standard
G0658 Performance improvement projects Standard
G0574 Plan of care must include the following Element
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
G0720 Participate in the HHA's QAPI program; Element
G0974 Direct support and administrative control Element
G1012 Required items in clinical record Element
▼ 527215 International Quality Homecare Of Wisconsin, Llc 5600 Woodland St, Suite 1 Stevens Point WI 5 (Chicago) 03/11/2019 TVMP11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
G0974 Direct support and administrative control Element
▼ 527225 Avanti Home Health Services, Llc 1601 Beaser Ave Ashland WI 5 (Chicago) 11/05/2020 OTFG11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G1030 Retrieval of records Standard
G0446 Contact info Federal/State-funded entities Element
▼ 527234 Interim Healthcare Of Ne Wi Inc. 110 Packerland Dr., Suite D Green Bay WI 5 (Chicago) 01/13/2026 1D7F2C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G1016 Goals in the patient's plans of care Element
▼ 527234 Interim Healthcare Of Ne Wi Inc. 110 Packerland Dr., Suite D Green Bay WI 5 (Chicago) 04/16/2025 65E22-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
G0590 Promptly alert relevant physician of changes Element
G0706 Interdisciplinary assessment of the patient Element
G0952 Ensure that HHA employs qualified personnel Element