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
▼ 147416 Summit Home Health Llc 11950 S Harlem Ave. Suite 202-4 Palos Heights IL 5 (Chicago) 12/18/2025 1D82B8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0030 Names and Contact Information Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0414 HHA administrator contact information Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0622 Name/contact information of clinical manager Element
G0808 Onsite supervisory visit every 14 days Element
▼ 147420 Anderson Hospital 2133 Vadalabene Dr Maryville IL 5 (Chicago) 04/30/2025 65A8B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
▼ 147420 Anderson Hospital 2133 Vadalabene Dr Maryville IL 5 (Chicago) 05/18/2022 386DA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0013 Development of EP Policies and Procedures Standard
E0037 EP Training Program Standard
E0042 Integrated EP Program Standard
G0590 Promptly alert relevant physician of changes Element
▼ 147420 Anderson Hospital 2133 Vadalabene Dr Maryville IL 5 (Chicago) 06/12/2019 QL0I11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
▼ 147428 Centerwell Certified Healthcare Corp 2001 52nd Ave, Ste 5 Moline IL 5 (Chicago) 02/01/2024 61C10-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
▼ 147428 Centerwell Certified Healthcare Corp 2001 52nd Ave, Ste 5 Moline IL 5 (Chicago) 02/04/2021 MIH911 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
G0440 Payment from federally funded programs Element
G0542 Incorporate OASIS items Element
▼ 147428 Centerwell Certified Healthcare Corp 2001 52nd Ave, Ste 5 Moline IL 5 (Chicago) 01/04/2018 6O4111 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0143 COORDINATION OF PATIENT SERVICES Standard
G0166 CONFORMANCE WITH PHYSICIAN ORDERS Standard
G0236 CLINICAL RECORDS Standard
G0303 CLINICAL RECORDS Standard
▼ 147430 St. Mary Medical Center 3405 North Seminary Street Galesburg IL 5 (Chicago) 08/19/2022 4F1BF-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 147430 St. Mary Medical Center 3405 North Seminary Street Galesburg IL 5 (Chicago) 10/25/2019 OMPG11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
G0800 Services provided by HH aide Element
▼ 147435 Ucm Home Care Wyman Gordon Bldg 1 Ingalls D Harvey IL 5 (Chicago) 04/05/2024 62AAE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0436 Receive all services in plan of care Element
G0710 Provide services in the plan of care Element
G0946 Administrator appointed by governing body Element
G0962 Coordinate patient care Element