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
▼ 157005 Trinity Home Health Services Inc 707 Cedar Street Suite 320 South Bend IN 5 (Chicago) 07/11/2023 60028-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0030 Names and Contact Information Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0414 HHA administrator contact information Element
G0422 Written notice within 4 business days Element
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
G0488 Immediate reporting of abuse by all staff Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0602 Communication with all physicians Element
G0606 Integrate all services Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0648 High risk, high volume, or problem-prone area Element
G0652 Activities lead to an immediate correction Element
G0656 Improvements are sustained Element
G0706 Interdisciplinary assessment of the patient Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
G0960 Make patient and personnel assignments, Element
G0964 Coordinate referrals; Element
▼ 157005 Trinity Home Health Services Inc 707 Cedar Street Suite 320 South Bend IN 5 (Chicago) 07/15/2021 MNN812 Complaint
Deficiency Tag Deficiency Description Tag Type
G0374 Accuracy of encoded OASIS data Standard
G0546 Last 5 days of every 60 days unless: Element
G0592 Revised plan of care Element
▼ 157005 Trinity Home Health Services Inc 707 Cedar Street Suite 320 South Bend IN 5 (Chicago) 03/02/2021 MNN811 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0940 Organization and administration of services Condition
G0544 Update of the comprehensive assessment Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0942 Governing body Standard
G0528 Health, psychosocial, functional, cognition Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0964 Coordinate referrals; Element
G0978 Must have a written agreement Element
▼ 157008 Vns At St Francis, Inc 1300 Albany Street Beech Grove IN 5 (Chicago) 01/17/2020 05GF11 Recertification, Sample Validation
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
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0522 Eligibility for Medicare home health benefit Element
G0530 Strengths, goals, and care preferences Element
G0706 Interdisciplinary assessment of the patient Element
G0948 Responsible for all day-to-day operations Element
▼ 157015 Vna Of The Wabash Valley Inc 400 8th Ave Terre Haute IN 5 (Chicago) 05/15/2026 23181E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0580 Only as ordered by a physician Element
G0706 Interdisciplinary assessment of the patient Element
▼ 157015 Vna Of The Wabash Valley Inc 400 8th Ave Terre Haute IN 5 (Chicago) 03/03/2026 1F20BC-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0468 Provide contact info other services Element
▼ 157015 Vna Of The Wabash Valley Inc 400 8th Ave Terre Haute IN 5 (Chicago) 07/26/2023 60565-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0700 Skilled professional services Condition
G0452 Transfer and discharge Standard
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0702 Services by skilled professionals Standard
G0704 Responsibilities of skilled professionals Standard
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
G0984 In accordance with current clinical practice Element
▼ 157015 Vna Of The Wabash Valley Inc 400 8th Ave Terre Haute IN 5 (Chicago) 05/23/2023 5FC2E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0716 Preparing clinical notes Element
▼ 157015 Vna Of The Wabash Valley Inc 400 8th Ave Terre Haute IN 5 (Chicago) 09/10/2020 V8WH11 Complaint, Focused Infection Control, Other-Fed, 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
G0682 Infection Prevention Standard
G0942 Governing body Standard
G0440 Payment from federally funded programs Element
▼ 157022 Laporte Home Care Services, Llc 300 Legacy Plaza West La Porte IN 5 (Chicago) 11/21/2023 61311-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0826 Ensure training/competency requirements Element
G0966 Assure patient needs are continually assessed Element
G0980 Primary HHA is responsible for patient care Element