S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 157022 Laporte Home Care Services, Llc 300 Legacy Plaza West La Porte IN 5 (Chicago) 10/13/2023 61311-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
E0009 Local, State, Tribal Collaboration Process Standard
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0654 Track adverse patient events Standard
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0606 Integrate all services Element
G0716 Preparing clinical notes Element
G0984 In accordance with current clinical practice Element
▼ 157034 Valparaiso Home Care Services, Llc 502 Marquette Street Valparaiso IN 5 (Chicago) 04/11/2023 5F761-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G0608 Coordinate care delivery Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
▼ 157034 Valparaiso Home Care Services, Llc 502 Marquette Street Valparaiso IN 5 (Chicago) 02/02/2023 5ECD2-H1 Recertification
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
E0017 HHA Comprehensive Assessment in Disaster Standard
G0374 Accuracy of encoded OASIS data Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0586 Review and revision of the plan of care Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0652 Activities lead to an immediate correction Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
▼ 157046 Community Health At Home 8034 Castleway Ct W Ste 100 Indianapolis IN 5 (Chicago) 04/24/2026 1F57B7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0528 Health, psychosocial, functional, cognition Element
G0534 Patient's needs Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
G1022 Discharge and transfer summaries Element
▼ 157046 Community Health At Home 8034 Castleway Ct W Ste 100 Indianapolis IN 5 (Chicago) 08/10/2023 60A74-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
▼ 157046 Community Health At Home 8034 Castleway Ct W Ste 100 Indianapolis IN 5 (Chicago) 01/18/2018 HVLL12 Recertification
Deficiency Tag Deficiency Description Tag Type
G0121 COMPLIANCE W/ ACCEPTED PROFESSIONAL STD Standard
G0159 PLAN OF CARE Standard
G0337 DRUG REGIMEN REVIEW Standard
▼ 157048 Northern Indiana Interim Healthcare Company Llc 605 W Edison Rd Ste H Mishawaka IN 5 (Chicago) 03/03/2022 3845F-H1 Complaint, Focused Infection Control, Recertification
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
G0560 Discharge Planning Condition
G0570 Care planning, coordination, quality of care Condition
G0680 Infection prevention and control Condition
G0750 Home health aide services Condition
G0544 Update of the comprehensive assessment Standard
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G1024 Authentication Standard
G1028 Protection of records Standard
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0602 Communication with all physicians Element
G0610 Patients receive education and training Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
G0972 Report all branch locations to SA Element
▼ 157048 Northern Indiana Interim Healthcare Company Llc 605 W Edison Rd Ste H Mishawaka IN 5 (Chicago) 08/15/2019 D48611 Complaint, 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
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
▼ 157050 Kosciusko Home Care & Hospice Inc 1515 Provident Dr Ste 250 Warsaw IN 5 (Chicago) 03/11/2022 385F7-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
▼ 157050 Kosciusko Home Care & Hospice Inc 1515 Provident Dr Ste 250 Warsaw IN 5 (Chicago) 05/14/2019 Z9H811 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
G0682 Infection Prevention Standard
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care Element
G0808 Onsite supervisory visit every 14 days Element