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
▼ 148260 Waukegan Hospice Llc 36100 N Brookside Dr, Ste 201 Gurnee IL 5 (Chicago) 01/08/2026 1D82C3-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0582 Influenza and pneumococcal vaccines Element
▼ 148260 Waukegan Hospice Llc 36100 N Brookside Dr, Ste 201 Gurnee IL 5 (Chicago) 10/07/2022 5DCE4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 148261 Dcare Home Health Services 18656 Dixie Highway Homewood IL 5 (Chicago) 09/14/2023 60EC4-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
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0582 Influenza and pneumococcal vaccines Element
G1022 Discharge and transfer summaries Element
▼ 148261 Dcare Home Health Services 18656 Dixie Highway Homewood IL 5 (Chicago) 10/21/2020 UY8311 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
E0017 HHA Comprehensive Assessment in Disaster Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0033 Methods for Sharing Information Standard
E0037 EP Training Program Standard
G0684 Infection control Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0582 Influenza and pneumococcal vaccines Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 148262 Advance Rehab Network, Inc 8140 Mccormick Boulevard Suite 128 Skokie IL 5 (Chicago) 12/26/2019 UYBV11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0950 Ensure clinical manager is available Element
▼ 148265 Forest Home Healthcare, Inc 318 Forest Blvd Park Forest IL 5 (Chicago) 09/24/2025 1D57A1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS 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
G0582 Influenza and pneumococcal vaccines Element
G0622 Name/contact information of clinical manager Element
G0800 Services provided by HH aide Element
G1022 Discharge and transfer summaries Element
▼ 148265 Forest Home Healthcare, Inc 318 Forest Blvd Park Forest IL 5 (Chicago) 07/14/2022 4EEE6-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
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
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0958 Clinical manager Standard
G0434 Participate in care Element
G0574 Plan of care must include the following Element
G0582 Influenza and pneumococcal vaccines Element
G0808 Onsite supervisory visit every 14 days Element
G1014 Interventions and patient response Element
▼ 148265 Forest Home Healthcare, Inc 318 Forest Blvd Park Forest IL 5 (Chicago) 09/19/2019 106J11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
G1012 Required items in clinical record Element
▼ 148266 Health First Home Health Inc 2604 Dempster St, Ste 402 Park Ridge IL 5 (Chicago) 10/01/2020 LXZ811 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0774 12 hours inservice every 12 months Standard
G0412 Written notice of patient's rights Element
G0434 Participate in care Element
G0440 Payment from federally funded programs Element
G0582 Influenza and pneumococcal vaccines Element
G1012 Required items in clinical record Element
▼ 148267 Access Life Care, Ltd 601 Skokie Blvd, Ste 300 Northbrook IL 5 (Chicago) 11/09/2023 6172B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard