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
▼ 148240 Healthy Health Home Health, Inc 4747 Lincoln Mall Drive, Suite 260 Matteson IL 5 (Chicago) 01/06/2023 5E5AA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0030 Names and Contact Information Standard
E0039 EP Testing Requirements Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0958 Clinical manager Standard
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
G0956 Available during all operating hours Element
G1014 Interventions and patient response Element
▼ 148241 St Francis Of Assisi Healthcare, Inc 8205 S. Cass Ave Suite 110 Darien IL 5 (Chicago) 04/29/2026 22C3D4-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
G0514 RN performs assessment Element
G0582 Influenza and pneumococcal vaccines Element
▼ 148241 St Francis Of Assisi Healthcare, Inc 8205 S. Cass Ave Suite 110 Darien IL 5 (Chicago) 01/20/2023 5EA84-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
▼ 148241 St Francis Of Assisi Healthcare, Inc 8205 S. Cass Ave Suite 110 Darien IL 5 (Chicago) 03/12/2020 CJTM11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
G0710 Provide services in the plan of care Element
▼ 148246 Medpro Health Providers 16820 Oak Park Ave Tinley Park IL 5 (Chicago) 07/07/2023 6042B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
▼ 148246 Medpro Health Providers 16820 Oak Park Ave Tinley Park IL 5 (Chicago) 09/17/2020 5QSN11 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0800 Services provided by HH aide Element
▼ 148248 Central Healthcare, Inc 7021 W 153rd St, Ste 2 Orland Park IL 5 (Chicago) 09/01/2023 60ADA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G1012 Required items in clinical record Element
▼ 148248 Central Healthcare, Inc 7021 W 153rd St, Ste 2 Orland Park IL 5 (Chicago) 10/15/2020 H10511 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
▼ 148256 Max Care Home Health Services, Inc. 490 West Lake St, Unit 3 Roselle IL 5 (Chicago) 05/30/2019 G87Z11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0958 Clinical manager Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0514 RN performs assessment Element
G0580 Only as ordered by a physician Element
G0728 Rehab services supervised by PT, OT Element
▼ 148258 Chicago Professional Healthcare, Inc 2604 Dempster St, Ste 207 Park Ridge IL 5 (Chicago) 06/23/2023 60000-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
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0434 Participate in care Element
G0710 Provide services in the plan of care Element