S&C QCOR HHA 2567s
d QCOR:  Quality, Certification and Oversight Reports.
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
147855 Care Solutions, Inc 365 Millennium Drive, Ste D Crystal Lake IL 5 (Chicago) 12/30/2022 5E5A9-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G1024 Authentication Standard
G0440 Payment from federally funded programs Element
G0514 RN performs assessment Element
G0582 Influenza and pneumococcal vaccines Element
G0808 Onsite supervisory visit every 14 days Element
147855 Care Solutions, Inc 365 Millennium Drive, Ste D Crystal Lake IL 5 (Chicago) 02/28/2020 26GT11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0808 Onsite supervisory visit every 14 days Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
147859 Accord Home Health Services, Inc 6871 West 171st Street Tinley Park IL 5 (Chicago) 12/16/2022 5E5A1-H1 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
G0578 Conformance with physician orders Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
147860 Serenity Home Healthcare, Inc 6640 West Touhy Avenue Niles IL 5 (Chicago) 12/06/2024 64C6D-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
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0574 Plan of care must include the following Element
G0622 Name/contact information of clinical manager Element
G1022 Discharge and transfer summaries Element
147860 Serenity Home Healthcare, Inc 6640 West Touhy Avenue Niles IL 5 (Chicago) 10/01/2021 19651-H1 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
E0039 EP Testing Requirements Standard
G1024 Authentication Standard
G0710 Provide services in the plan of care Element
147864 Platinum Home Health Care, Inc 16634 107th Street Orland Park IL 5 (Chicago) 04/16/2026 22C3C6-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0030 Names and Contact Information Standard
G1014 Interventions and patient response Element
147864 Platinum Home Health Care, Inc 16634 107th Street Orland Park IL 5 (Chicago) 01/19/2023 5EA82-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0444 State toll free HH telephone hotline Element
G0622 Name/contact information of clinical manager Element
147865 Prime Home Health Services, Inc 2664 W Dempster St, Ste T-207 Park Ridge IL 5 (Chicago) 07/21/2023 6046A-H1 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
E0039 EP Testing Requirements Standard
G0578 Conformance with physician orders Standard
G1056 Clinical Manager Standard
G0726 Nursing services supervised by RN Element
G0950 Ensure clinical manager is available Element
G1012 Required items in clinical record Element
147865 Prime Home Health Services, Inc 2664 W Dempster St, Ste T-207 Park Ridge IL 5 (Chicago) 09/17/2020 1QIE11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1012 Required items in clinical record Element
147872 Care One Home Health Services, Inc 235 Remington Blvd Suite G7 Bolingbrook IL 5 (Chicago) 08/17/2023 60ACE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0030 Names and Contact Information Standard
E0039 EP Testing Requirements Standard