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
▼ 157276 Home Care Network Inc 8580 Cedar Place Drive Ste 115c Indianapolis IN 5 (Chicago) 02/12/2024 6222D-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0942 Governing body Standard
G0958 Clinical manager Standard
G0656 Improvements are sustained Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G0980 Primary HHA is responsible for patient care Element
▼ 157276 Home Care Network Inc 8580 Cedar Place Drive Ste 115c Indianapolis IN 5 (Chicago) 09/27/2023 6123A-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
G0518 Completion of the comprehensive assessment Standard
G0526 Content of the comprehensive assessment Standard
G0942 Governing body Standard
G0454 HHA can no longer meet the patient's needs Element
G0528 Health, psychosocial, functional, cognition Element
G0574 Plan of care must include the following Element
G0602 Communication with all physicians Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
G0956 Available during all operating hours Element
▼ 157276 Home Care Network Inc 8580 Cedar Place Drive Ste 115c Indianapolis IN 5 (Chicago) 01/11/2022 3805A-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
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0850 Disclosure of ownership and management info. Standard
G0852 Information to the state survey agency Standard
G0942 Governing body Standard
G0944 Administrator must: Standard
G0982 Skilled services furnished Standard
G1024 Authentication Standard
G1052 Administrator Standard
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0620 Other pertinent instructions Element
G0856 Officer, a director, agent, managing employee Element
G0858 Responsible for the management of the HHA Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
▼ 157276 Home Care Network Inc 8580 Cedar Place Drive Ste 115c Indianapolis IN 5 (Chicago) 01/18/2019 6BMQ11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0350 Release of patient identifiable OASIS info. Condition
G0510 Comprehensive Assessment of Patients Condition
G0940 Organization and administration of services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0036 EP Training and Testing Standard
G0372 Encoding and transmitting OASIS Standard
G0642 Program scope Standard
G0852 Information to the state survey agency Standard
G0982 Skilled services furnished Standard
G1024 Authentication Standard
G0436 Receive all services in plan of care Element
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0576 All orders recorded in plan of care Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0710 Provide services in the plan of care Element
G0948 Responsible for all day-to-day operations Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 157281 St.Mary's At Home, Llc 7321 Eagle Crest Blvd Suite A Evansville IN 5 (Chicago) 12/05/2023 618ED-H1 Complaint
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
G0718 Communication with physicians Element
G1012 Required items in clinical record Element
▼ 157281 St.Mary's At Home, Llc 7321 Eagle Crest Blvd Suite A Evansville IN 5 (Chicago) 09/17/2020 OFIT11 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
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0436 Receive all services in plan of care Element
G0574 Plan of care must include the following Element
G0616 Patient medication schedule/instructions Element
G0716 Preparing clinical notes Element
G1014 Interventions and patient response Element
▼ 157285 Advantage Home Health Care Inc 4008 N Wheeling Ave Muncie IN 5 (Chicago) 03/01/2023 5F253-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0030 Names and Contact Information Standard
▼ 157285 Advantage Home Health Care Inc 4008 N Wheeling Ave Muncie IN 5 (Chicago) 06/16/2020 KYY611 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
▼ 157285 Advantage Home Health Care Inc 4008 N Wheeling Ave Muncie IN 5 (Chicago) 01/07/2020 YPV712 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0980 Primary HHA is responsible for patient care Element
G0984 In accordance with current clinical practice Element
▼ 157285 Advantage Home Health Care Inc 4008 N Wheeling Ave Muncie IN 5 (Chicago) 10/01/2019 YPV711 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
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0454 HHA can no longer meet the patient's needs Element
G0482 Mistreatment, neglect or abuse Element
G0486 Protect patient during investigation Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences 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
G0592 Revised plan of care Element
G0598 Discharge plans communication Element
G0616 Patient medication schedule/instructions Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0978 Must have a written agreement Element