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
▼ 148157 Total Health Home Care Services, Inc 19150 S Kedzie Ave, Suite 202 Flossmoor IL 5 (Chicago) 01/28/2022 38132-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
▼ 148160 Kingsway Home Health Services, Inc 7042 N. Milwaukee Ave Niles IL 5 (Chicago) 04/17/2025 65C06-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
G0572 Plan of care Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0574 Plan of care must include the following Element
G1022 Discharge and transfer summaries Element
▼ 148160 Kingsway Home Health Services, Inc 7042 N. Milwaukee Ave Niles IL 5 (Chicago) 02/09/2022 38337-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0036 EP Training and Testing Standard
G1026 Retention of records Standard
G0946 Administrator appointed by governing body Element
G0950 Ensure clinical manager is available Element
G0952 Ensure that HHA employs qualified personnel Element
G0954 Ensures qualified pre-designated person Element
G0968 Assure implementation of plan of care Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
G1016 Goals in the patient's plans of care Element
G1018 Contact information for the patient Element
G1020 Contact info for primary care practitioner Element
G1022 Discharge and transfer summaries Element
▼ 148171 Fidelity Health Care, Inc 3112 W 95th St Suite B Evergreen Park IL 5 (Chicago) 06/14/2019 P67411 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
G0726 Nursing services supervised by RN Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
G1022 Discharge and transfer summaries Element
▼ 148172 Anjumohsi Inc 1707 N. Randall Rd. Suite 165 Elgin IL 5 (Chicago) 03/08/2019 M0G411 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
▼ 148174 Alpha Home Health Care, Inc 11509 South Elizabeth Street Chicago IL 5 (Chicago) 07/23/2025 66884-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
E0030 Names and Contact Information Standard
E0039 EP Testing Requirements Standard
G0582 Influenza and pneumococcal vaccines Element
G0622 Name/contact information of clinical manager Element
▼ 148174 Alpha Home Health Care, Inc 11509 South Elizabeth Street Chicago IL 5 (Chicago) 04/08/2022 387CD-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0550 At discharge Element
G0710 Provide services in the plan of care Element
▼ 148174 Alpha Home Health Care, Inc 11509 South Elizabeth Street Chicago IL 5 (Chicago) 05/30/2019 SQOT11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0036 EP Training and Testing Standard
▼ 148176 Spectrum Nurses, Inc 280 S Schmidt Rd Bolingbrook IL 5 (Chicago) 07/23/2025 66885-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
G0572 Plan of care Standard
G1024 Authentication Standard
G0514 RN performs assessment Element
G0582 Influenza and pneumococcal vaccines Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
▼ 148176 Spectrum Nurses, Inc 280 S Schmidt Rd Bolingbrook IL 5 (Chicago) 04/07/2022 387F0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
G0572 Plan of care Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G1024 Authentication 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
G0574 Plan of care must include the following Element
G0582 Influenza and pneumococcal vaccines Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element