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
▼ 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
▼ 148267 Access Life Care, Ltd 601 Skokie Blvd, Ste 300 Northbrook IL 5 (Chicago) 12/04/2020 WKW011 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
▼ 148269 Platinum Healthcare Services, Llc 1420 Renaissance Drive, Ste 207 Park Ridge IL 5 (Chicago) 01/27/2023 5EC70-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
G0572 Plan of care Standard
G1014 Interventions and patient response Element
▼ 148269 Platinum Healthcare Services, Llc 1420 Renaissance Drive, Ste 207 Park Ridge IL 5 (Chicago) 03/05/2020 6KIT11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0582 Influenza and pneumococcal vaccines Element
G0584 Verbal orders Element
G0588 Reviewed, revised by physician every 60 days Element
G0808 Onsite supervisory visit every 14 days Element
▼ 148273 Uchange Inc. 1406 Park Avenue Chicago Heights IL 5 (Chicago) 12/22/2023 61A4E-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
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
G0956 Available during all operating hours Element
▼ 148275 Soul Care Services, Inc. 1645 S River Road Ste 1 Des Plaines IL 5 (Chicago) 10/13/2023 61287-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
▼ 148276 Angel's Care Home Health Services, Inc 5418 N Kedzie Avenue Chicago IL 5 (Chicago) 02/19/2026 1E2993-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
G0574 Plan of care must include the following Element
G1022 Discharge and transfer summaries Element
▼ 148276 Angel's Care Home Health Services, Inc 5418 N Kedzie Avenue Chicago IL 5 (Chicago) 12/15/2022 5E5A4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0030 Names and Contact Information Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0440 Payment from federally funded programs Element