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
▼ 148328 Complete Home Health Care, Llc 309 W 23rd St Chicago IL 5 (Chicago) 10/10/2024 64495-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
G0948 Responsible for all day-to-day operations Element
G0968 Assure implementation of plan of care Element
G1022 Discharge and transfer summaries Element
▼ 148328 Complete Home Health Care, Llc 309 W 23rd St Chicago IL 5 (Chicago) 09/09/2021 19639-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0582 Influenza and pneumococcal vaccines Element
▼ 148331 Reliable Medical Services, Inc 2500 S Highland Ave, Ste 102 Lombard IL 5 (Chicago) 11/07/2024 64822-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
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0582 Influenza and pneumococcal vaccines Element
G0592 Revised plan of care Element
▼ 148335 Ico Care Home Health, Inc 4410 Roosevelt Road, Suite 201 Hillside IL 5 (Chicago) 05/22/2026 230A16-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0550 At discharge Element
G1014 Interventions and patient response Element
▼ 148335 Ico Care Home Health, Inc 4410 Roosevelt Road, Suite 201 Hillside IL 5 (Chicago) 05/25/2023 5FB73-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
G0444 State toll free HH telephone hotline Element
G0582 Influenza and pneumococcal vaccines Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
▼ 148336 Grace Health Systems, Inc. 900 Skokie Blvd Ste 205 Northbrook IL 5 (Chicago) 09/20/2024 63FF4-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
G0606 Integrate all services Element
G0964 Coordinate referrals; Element
▼ 148336 Grace Health Systems, Inc. 900 Skokie Blvd Ste 205 Northbrook IL 5 (Chicago) 08/05/2021 RUE911 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G1014 Interventions and patient response Element
▼ 148337 Iris Home Health Services, Llc 7150 North University Street Peoria IL 5 (Chicago) 07/14/2020 Q4DJ11 Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0684 Infection control Standard
▼ 148337 Iris Home Health Services, Llc 7150 North University Street Peoria IL 5 (Chicago) 11/15/2018 HU6Y11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0750 Home health aide services Condition
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
G0642 Program scope Standard
G0684 Infection control Standard
G0768 Competency evaluation Standard
G0806 Supervision of home health aides Standard
G0942 Governing body Standard
G0988 Institutional planning Standard
G1010 Contents of clinical record Standard
G1030 Retrieval of records Standard
G1072 Registered Nurse Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0610 Patients receive education and training Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0812 Direct observation every 12 months Element
G0952 Ensure that HHA employs qualified personnel Element
G0978 Must have a written agreement Element
▼ 148340 Dayspring Healthcare Services, Inc 18221 Torrence Ave, Unit 1b Lansing IL 5 (Chicago) 01/30/2025 64F86-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0013 Development of EP Policies and Procedures Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0414 HHA administrator contact information Element
G0422 Written notice within 4 business days Element
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element