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
▼ 157090 Heritage Home Health Services Llc 432 S Emerson Ave Ste 220 Greenwood IN 5 (Chicago) 01/29/2018 WOQH11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
G0574 Plan of care must include the following Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0610 Patients receive education and training Element
G0968 Assure implementation of plan of care Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
▼ 157113 Indiana Home Care Plus 1275 N Jackson Street Greencastle IN 5 (Chicago) 03/22/2021 0FUC11 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
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G0480 Treatment or care Element
G0484 Document complaint and resolution 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
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0602 Communication with all physicians Element
G0608 Coordinate care delivery Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
G0802 Duties of a HH aide 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
G0968 Assure implementation of plan of care Element
G0984 In accordance with current clinical practice Element
▼ 157113 Indiana Home Care Plus 1275 N Jackson Street Greencastle IN 5 (Chicago) 06/05/2018 X00C11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0706 Interdisciplinary assessment of the patient Element
G0718 Communication with physicians Element
G0968 Assure implementation of plan of care Element
G0984 In accordance with current clinical practice Element
G1016 Goals in the patient's plans of care Element
▼ 157115 Centerwell Certified Healthcare Corp 8606 Allisonville Rd Ste 350 Indianapolis IN 5 (Chicago) 06/26/2024 6369A-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
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
▼ 157115 Centerwell Certified Healthcare Corp 8606 Allisonville Rd Ste 350 Indianapolis IN 5 (Chicago) 10/05/2021 196EE-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
G0684 Infection control Standard
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
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0718 Communication with physicians Element
G0948 Responsible for all day-to-day operations Element
G0962 Coordinate patient care Element
G0978 Must have a written agreement Element
▼ 157115 Centerwell Certified Healthcare Corp 8606 Allisonville Rd Ste 350 Indianapolis IN 5 (Chicago) 06/19/2020 BSFT11 Focused Infection Control, Other-Fed
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
G0684 Infection control Standard
G0686 Infection control education Standard
▼ 157115 Centerwell Certified Healthcare Corp 8606 Allisonville Rd Ste 350 Indianapolis IN 5 (Chicago) 02/20/2019 5G4W11 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
E0033 Methods for Sharing Information Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0592 Revised plan of care Element
G0706 Interdisciplinary assessment of the patient Element
G0984 In accordance with current clinical practice Element
▼ 157116 Residential Clinical Services Inc 8102 Georgia Street Merrillville IN 5 (Chicago) 03/07/2023 5F248-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0434 Participate in care Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0818 HH aide supervision elements Element
G0984 In accordance with current clinical practice Element
▼ 157116 Residential Clinical Services Inc 8102 Georgia Street Merrillville IN 5 (Chicago) 09/04/2019 G10H11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0768 Competency evaluation Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0434 Participate in 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
G0590 Promptly alert relevant physician of changes Element
G0598 Discharge plans communication Element
G0604 Integrate all orders Element
G0606 Integrate all services Element
G0610 Patients receive education and training Element
G0614 Visit schedule Element
G0622 Name/contact information of clinical manager Element
G0804 Aides are members of interdisciplinary team Element
G0960 Make patient and personnel assignments, Element
G1022 Discharge and transfer summaries Element
▼ 157141 Bethany Holding Llc 2670 Michigan Rd Madison IN 5 (Chicago) 06/07/2023 5FEAA-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