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
▼ 147159 Hancock County Health Department 671 Wabash Ave Carthage IL 5 (Chicago) 01/16/2025 65013-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
▼ 147159 Hancock County Health Department 671 Wabash Ave Carthage IL 5 (Chicago) 01/06/2022 37FAE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
G0512 Standard: Initial assessment visit. Standard
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
▼ 147159 Hancock County Health Department 671 Wabash Ave Carthage IL 5 (Chicago) 02/07/2019 0TM611 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0036 EP Training and Testing Standard
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0952 Ensure that HHA employs qualified personnel Element
G0978 Must have a written agreement Element
▼ 147161 Perry County Health Department 907 South Main Pinckneyville IL 5 (Chicago) 04/11/2024 62932-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G1012 Required items in clinical record Element
▼ 147161 Perry County Health Department 907 South Main Pinckneyville IL 5 (Chicago) 03/31/2021 XYRY11 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
G0526 Content of the comprehensive assessment Standard
▼ 147178 Henderson County Health Depart 208 W. Elm Street Gladstone IL 5 (Chicago) 07/28/2023 6027B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0702 Services by skilled professionals Standard
G0590 Promptly alert relevant physician of changes Element
G0716 Preparing clinical notes Element
G0808 Onsite supervisory visit every 14 days Element
G1022 Discharge and transfer summaries Element
▼ 147178 Henderson County Health Depart 208 W. Elm Street Gladstone IL 5 (Chicago) 09/10/2020 SQH311 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
G0578 Conformance with physician orders Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0576 All orders recorded in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0726 Nursing services supervised by RN Element
G0800 Services provided by HH aide Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 147202 Mason District Hospital Home Health 741 East Laurel Havana IL 5 (Chicago) 01/29/2026 1DF1DC-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
G0684 Infection control Standard
▼ 147202 Mason District Hospital Home Health 741 East Laurel Havana IL 5 (Chicago) 02/24/2023 5EE2C-H1 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
G0592 Revised plan of care Element
▼ 147202 Mason District Hospital Home Health 741 East Laurel Havana IL 5 (Chicago) 02/27/2020 LNDE11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0432 Make complaints to the HHA Element