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
▼ 157141 Bethany Holding Llc 2670 Michigan Rd Madison IN 5 (Chicago) 09/29/2020 T39811 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
G0940 Organization and administration of services Condition
G0490 Accessibility Standard
G0682 Infection Prevention Standard
G0942 Governing body Standard
G0944 Administrator must: Standard
G1028 Protection of records Standard
G0438 Have a confidential clinical record Element
G0606 Integrate all services Element
G0706 Interdisciplinary assessment of the patient Element
G0714 Patient and caregiver education Element
G0754 A qualified HH aide successfully completed: 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
G0966 Assure patient needs are continually assessed Element
G0978 Must have a written agreement Element
G0984 In accordance with current clinical practice Element
▼ 157143 Margaret Mary Community Hospital 108 N Elm St Batesville IN 5 (Chicago) 10/24/2018 YDVW11 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
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G1012 Required items in clinical record Element
▼ 157152 Baptist Health Home Care In, Llc 1915 Bono Rd New Albany IN 5 (Chicago) 04/01/2022 3869D-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
G0612 Written instructions to patient include: Standard
G0536 A review of all current medications Element
G0614 Visit schedule Element
G0946 Administrator appointed by governing body Element
▼ 157157 Dekalb Memorial Hospital Inc 400 Erie Pass Auburn IN 5 (Chicago) 05/15/2019 375S11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0706 Interdisciplinary assessment of the patient Element
G0716 Preparing clinical notes Element
▼ 157158 Indiana University Health Inc 950 N Meridian St Ste 700 Indianapolis IN 5 (Chicago) 10/01/2019 JKFK11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0436 Receive all services in plan of care Element
G0514 RN performs assessment Element
G0516 Skilled professional performs assessment Element
G0590 Promptly alert relevant physician of changes Element
G0706 Interdisciplinary assessment of the patient Element
▼ 157163 Anchor Health Systems Inc 7855 E. 108th Avenue Crown Point IN 5 (Chicago) 05/01/2024 62B7C-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
G0570 Care planning, coordination, quality of care Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0428 Property and person treated with respect Element
G0454 HHA can no longer meet the patient's needs Element
G0484 Document complaint and resolution 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
G0546 Last 5 days of every 60 days unless: 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
G0610 Patients receive education and training Element
G0614 Visit schedule Element
G0618 Treatments and therapy services Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0984 In accordance with current clinical practice Element
G1014 Interventions and patient response Element
G1016 Goals in the patient's plans of care Element
▼ 157163 Anchor Health Systems Inc 7855 E. 108th Avenue Crown Point IN 5 (Chicago) 10/12/2021 196FD-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
G0572 Plan of care Standard
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0704 Responsibilities of skilled professionals Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0458 Outcomes/goals have been achieved Element
G0468 Provide contact info other services 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
G0596 Revisions communicated to patient and MDs Element
G0602 Communication with all physicians Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0800 Services provided by HH aide Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 157163 Anchor Health Systems Inc 7855 E. 108th Avenue Crown Point IN 5 (Chicago) 05/23/2019 07GQ11 Complaint, 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
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
E0029 Development of Communication Plan Standard
G0372 Encoding and transmitting OASIS Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0644 Program data Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0798 Home health aide assignments and duties Standard
G0806 Supervision of home health aides Standard
G0860 Licensing Standard
G1024 Authentication Standard
G1028 Protection of records Standard
G0428 Property and person treated with respect Element
G0436 Receive all services in plan of care Element
G0438 Have a confidential clinical record Element
G0440 Payment from federally funded programs Element
G0444 State toll free HH telephone hotline Element
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
G0514 RN performs assessment Element
G0516 Skilled professional performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0550 At discharge 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
G0598 Discharge plans communication Element
G0602 Communication with all physicians Element
G0604 Integrate all orders Element
G0606 Integrate all services Element
G0706 Interdisciplinary assessment of the patient Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
G0960 Make patient and personnel assignments, Element
G0962 Coordinate patient care Element
G0984 In accordance with current clinical practice Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 157172 Family Hospice Of Northeast Indiana, Inc 108 South Jefferson Street Berne IN 5 (Chicago) 12/19/2018 8A6H11 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
G0462 Before discharge for cause HHA must: Element
G0580 Only as ordered by a physician Element
G0808 Onsite supervisory visit every 14 days Element
▼ 157180 Centerwell Certified Healthcare Corp 400 N High Street Suite 202 Muncie IN 5 (Chicago) 12/20/2023 61AD8-H1 Complaint
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
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0462 Before discharge for cause HHA must: Element
G0484 Document complaint and resolution Element
G0590 Promptly alert relevant physician of changes Element
G0598 Discharge plans communication Element