S&C QCOR HHA 2567s
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HHAs 2567s
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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
▼ 527275 Bay At Woodlands Home Health Llc 425 Manor Drive Suring WI 5 (Chicago) 02/27/2024 624EA-H1 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
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
G0574 Plan of care must include the following Element
▼ 527275 Bay At Woodlands Home Health Llc 425 Manor Drive Suring WI 5 (Chicago) 04/11/2018 9ZRE11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0023 Policies/Procedures for Medical Documentation Standard
E0033 Methods for Sharing Information Standard
G0574 Plan of care must include the following Element
▼ 527279 Quality Assurance Staffing, Llc 5678 W Brown Deer Rd Ste 200 Milwaukee WI 5 (Chicago) 10/08/2020 MNLR11 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
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0940 Organization and administration of services Condition
G0660 Executive responsibilities for QAPI Standard
G0684 Infection control Standard
G0942 Governing body Standard
G0944 Administrator must: Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0430 Be free from abuse Element
G0436 Receive all services in plan of care Element
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0574 Plan of care must include the following Element
▼ 527280 Ls Professional Comfort Homes 14665 W Lisbon Rd Ste 1a Brookfield WI 5 (Chicago) 02/21/2018 X1B911 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
G0726 Nursing services supervised by RN Element
G0814 Non-skilled direct observation every 60 days Element
▼ 527281 Hha Of Wisconsin, Llc 3615 N. Hastings Way, Suite 100a Eau Claire WI 5 (Chicago) 05/08/2024 62F82-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
▼ 527281 Hha Of Wisconsin, Llc 3615 N. Hastings Way, Suite 100a Eau Claire WI 5 (Chicago) 05/19/2021 RRHC11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
▼ 527283 Regal Home Health Services 11805 W Hampton Ave, Suite 100 Milwaukee WI 5 (Chicago) 06/04/2024 633C5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0436 Receive all services in plan of care Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
▼ 527283 Regal Home Health Services 11805 W Hampton Ave, Suite 100 Milwaukee WI 5 (Chicago) 07/17/2018 SYHL11 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
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
G0682 Infection Prevention Standard
G0726 Nursing services supervised by RN Element
G0808 Onsite supervisory visit every 14 days Element
G1016 Goals in the patient's plans of care Element
▼ 527290 Maxim Healthcare Services, Inc. 5100 Eastpark Blvd, Suite 100 Madison WI 5 (Chicago) 06/29/2021 BPRN11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0454 HHA can no longer meet the patient's needs Element
▼ 527297 Moore Genuine Care, Llc 711 Anderson St Lower Level Augusta WI 5 (Chicago) 02/27/2018 Q9JY11 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
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0642 Program scope Standard
G0644 Program data Standard
G0646 Program activities Standard
G0654 Track adverse patient events Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0944 Administrator must: Standard
G0486 Protect patient during investigation Element
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
G0652 Activities lead to an immediate correction Element
G0656 Improvements are sustained Element