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
▼ 157077 American Nursing Care Inc 4550 Middle Rd Ste B Columbus IN 5 (Chicago) 03/03/2026 1F193A-H1 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
G0414 HHA administrator contact information Element
G0948 Responsible for all day-to-day operations Element
G0962 Coordinate patient care Element
G1014 Interventions and patient response Element
▼ 157078 Community Home Care Services Inc 1909 South Heaton Street Knox IN 5 (Chicago) 06/11/2024 6340D-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
G0940 Organization and administration of 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
G0644 Program data Standard
G0646 Program activities Standard
G0682 Infection Prevention Standard
G1028 Protection of records Standard
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0538 Primary caregiver(s), if any Element
G0574 Plan of care must include the following 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
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0984 In accordance with current clinical practice Element
G1012 Required items in clinical record Element
▼ 157078 Community Home Care Services Inc 1909 South Heaton Street Knox IN 5 (Chicago) 12/09/2021 Z9IY-H2 Complaint, Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
E0030 Names and Contact Information Standard
G0374 Accuracy of encoded OASIS data Standard
G0948 Responsible for all day-to-day operations Element
▼ 157078 Community Home Care Services Inc 1909 South Heaton Street Knox IN 5 (Chicago) 08/18/2021 Z9IY11 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
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0374 Accuracy of encoded OASIS data Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0642 Program scope Standard
G0644 Program data Standard
G0654 Track adverse patient events Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0686 Infection control education Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G1028 Protection of records Standard
G0412 Written notice of patient's rights Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0458 Outcomes/goals have been achieved Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0598 Discharge plans communication Element
G0602 Communication with all physicians Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager Element
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
G0656 Improvements are sustained Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0722 Participate in HHA-sponsored in-service Element
G0948 Responsible for all day-to-day operations Element
G0952 Ensure that HHA employs qualified personnel Element
G0954 Ensures qualified pre-designated person Element
G0960 Make patient and personnel assignments, Element
G0962 Coordinate patient care Element
G0968 Assure implementation of plan of care Element
G0984 In accordance with current clinical practice Element
G1022 Discharge and transfer summaries Element
▼ 157081 Acme Health Services Inc 6302 N Rucker Rd Ste J Indianapolis IN 5 (Chicago) 02/12/2024 621DE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0534 Patient's needs Element
G0538 Primary caregiver(s), if any Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G0962 Coordinate patient care Element
G0966 Assure patient needs are continually assessed Element
G1022 Discharge and transfer summaries Element
▼ 157083 St Vincent Home Care, Llc 8909 Purdue Road Suite 107 Indianapolis IN 5 (Chicago) 09/14/2021 1967F-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0682 Infection Prevention 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
G0608 Coordinate care delivery Element
G0706 Interdisciplinary assessment of the patient Element
G1022 Discharge and transfer summaries Element
▼ 157083 St Vincent Home Care, Llc 8909 Purdue Road Suite 107 Indianapolis IN 5 (Chicago) 12/05/2018 M9YU11 Complaint, 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
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
E0033 Methods for Sharing Information Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0704 Responsibilities of skilled professionals Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0436 Receive all services in plan of care Element
G0438 Have a confidential clinical record Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications 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
G0584 Verbal orders Element
G0598 Discharge plans communication Element
G0604 Integrate all orders Element
G0608 Coordinate care delivery Element
G0610 Patients receive education and training Element
G0706 Interdisciplinary assessment of the patient Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0946 Administrator appointed by governing body Element
G0952 Ensure that HHA employs qualified personnel Element
G0962 Coordinate patient care Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
G0978 Must have a written agreement Element
G1012 Required items in clinical record Element
▼ 157090 Heritage Home Health Services Llc 432 S Emerson Ave Ste 220 Greenwood IN 5 (Chicago) 09/20/2024 6424F-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0942 Governing body Standard
G0948 Responsible for all day-to-day operations Element
G0974 Direct support and administrative control Element
▼ 157090 Heritage Home Health Services Llc 432 S Emerson Ave Ste 220 Greenwood IN 5 (Chicago) 09/21/2023 61066-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0564 Discharge or Transfer Summary Content Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
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
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
G0984 In accordance with current clinical practice Element
▼ 157090 Heritage Home Health Services Llc 432 S Emerson Ave Ste 220 Greenwood IN 5 (Chicago) 11/18/2020 4BT911 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0848 Compliance with Federal, State, Local Law Condition
E0013 Development of EP Policies and Procedures Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0852 Information to the state survey agency Standard
G0860 Licensing Standard
G0942 Governing body Standard
G1010 Contents of clinical record Standard
G0416 OASIS privacy notice Element
G0434 Participate in care Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0536 A review of all current medications 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
G0590 Promptly alert relevant physician of changes Element
G0598 Discharge plans communication Element
G0608 Coordinate care delivery Element
G0708 Development and evaluation of plan of care Element
G0716 Preparing clinical notes Element
G0854 All persons with ownership interest Element
G0856 Officer, a director, agent, managing employee Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0974 Direct support and administrative control Element