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
▼ 148079 Covenant Home Health Care, Inc 9547 Crawford Avenue Evanston IL 5 (Chicago) 07/06/2018 CYPQ11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1012 Required items in clinical record Element
▼ 148080 Guaranteed Medical Services, Inc. 10322 S. Western Ave Chicago IL 5 (Chicago) 05/27/2021 35QK11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0030 Names and Contact Information Standard
G0684 Infection control Standard
G0852 Information to the state survey agency Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0582 Influenza and pneumococcal vaccines Element
G0952 Ensure that HHA employs qualified personnel Element
G1014 Interventions and patient response Element
▼ 148080 Guaranteed Medical Services, Inc. 10322 S. Western Ave Chicago IL 5 (Chicago) 04/27/2018 45N311 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0710 Provide services in the plan of care Element
G0808 Onsite supervisory visit every 14 days Element
▼ 148085 Miranda Home Healthcare Inc 19150 S Kedzie Suite 103a Flossmoor IL 5 (Chicago) 09/27/2024 63FF6-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0007 EP Program Patient Population Standard
E0013 Development of EP Policies and Procedures Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0422 Written notice within 4 business days Element
G0434 Participate in care Element
G0514 RN performs assessment Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0582 Influenza and pneumococcal vaccines Element
G0588 Reviewed, revised by physician every 60 days Element
G0948 Responsible for all day-to-day operations Element
G0952 Ensure that HHA employs qualified personnel Element
G1022 Discharge and transfer summaries Element
▼ 148085 Miranda Home Healthcare Inc 19150 S Kedzie Suite 103a Flossmoor IL 5 (Chicago) 08/13/2021 K54Y11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0808 Onsite supervisory visit every 14 days Element
G1012 Required items in clinical record Element
▼ 148087 Medcore Home Health Care, Inc 1701 E Woodfield Rd, Suite 205 Schaumburg IL 5 (Chicago) 08/01/2024 63735-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G1022 Discharge and transfer summaries Element
▼ 148087 Medcore Home Health Care, Inc 1701 E Woodfield Rd, Suite 205 Schaumburg IL 5 (Chicago) 07/08/2021 UBCO11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0686 Infection control education Standard
G0574 Plan of care must include the following Element
G0582 Influenza and pneumococcal vaccines Element
G1022 Discharge and transfer summaries Element
▼ 148090 Vision Home Health Care, Inc 4528 Oakton St Skokie IL 5 (Chicago) 11/17/2023 6172E-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
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0808 Onsite supervisory visit every 14 days Element
G0946 Administrator appointed by governing body Element
▼ 148090 Vision Home Health Care, Inc 4528 Oakton St Skokie IL 5 (Chicago) 12/17/2020 PXXV11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
G0684 Infection control Standard
G0414 HHA administrator contact information Element
G0574 Plan of care must include the following Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
▼ 148091 Select Home Care, Inc 9933 Lawler Ave, Ste 525a Skokie IL 5 (Chicago) 09/12/2024 6421A-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0418 Patient's or legal representative's signature Element
G0434 Participate in care Element
G0440 Payment from federally funded programs Element
G0514 RN performs assessment Element
G1022 Discharge and transfer summaries Element