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
▼ 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
▼ 147207 Adventist Midwest Health 5101 Willow Springs Rd, Bldg 2, Flr 2 La Grange IL 5 (Chicago) 06/12/2026 233EBB-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0622 Name/contact information of clinical manager Element
▼ 147211 Glhha, Llc 202 S Greenleaf St, Suite C Gurnee IL 5 (Chicago) 01/20/2023 5EBD0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0774 12 hours inservice every 12 months Standard
G0808 Onsite supervisory visit every 14 days Element
▼ 147211 Glhha, Llc 202 S Greenleaf St, Suite C Gurnee IL 5 (Chicago) 01/16/2020 OVHL11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0444 State toll free HH telephone hotline Element
G0818 HH aide supervision elements Element
▼ 147214 Home Healthcare Renewal Services, Inc 105 E Main Str, Ste 206 Morris IL 5 (Chicago) 05/22/2026 22F87D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
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
G0684 Infection control Standard
G0656 Improvements are sustained Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element