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
▼ 157313 St Mary Medical Center Inc 1310 S Wisconsin St Hobart IN 5 (Chicago) 08/27/2025 1D4574-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
▼ 157313 St Mary Medical Center Inc 1310 S Wisconsin St Hobart IN 5 (Chicago) 07/26/2019 Z8K111 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0716 Preparing clinical notes Element
▼ 157318 Preferred Home Health Care, Inc 6920 Parkdale Place, Suite 110 Indianapolis IN 5 (Chicago) 04/04/2025 65C1C-H1 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
G0942 Governing body Standard
G0988 Institutional planning Standard
G0444 State toll free HH telephone hotline Element
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0952 Ensure that HHA employs qualified personnel Element
G0972 Report all branch locations to SA Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 157318 Preferred Home Health Care, Inc 6920 Parkdale Place, Suite 110 Indianapolis IN 5 (Chicago) 06/09/2022 4EC1D-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
E0001 Establishment of the Emergency Program (EP) Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0682 Infection Prevention Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0602 Communication with all physicians Element
G0772 Documentation of competency evaluation Element
▼ 157318 Preferred Home Health Care, Inc 6920 Parkdale Place, Suite 110 Indianapolis IN 5 (Chicago) 12/06/2021 37FA6-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0852 Information to the state survey agency Standard
G0942 Governing body Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0416 OASIS privacy notice Element
G0434 Participate in care Element
G0440 Payment from federally funded programs Element
G0514 RN performs assessment Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0608 Coordinate care delivery Element
G0706 Interdisciplinary assessment of the patient Element
G0718 Communication with physicians Element
G0948 Responsible for all day-to-day operations Element
▼ 157318 Preferred Home Health Care, Inc 6920 Parkdale Place, Suite 110 Indianapolis IN 5 (Chicago) 08/28/2020 0X9811 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
▼ 157318 Preferred Home Health Care, Inc 6920 Parkdale Place, Suite 110 Indianapolis IN 5 (Chicago) 08/20/2019 500411 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0374 Accuracy of encoded OASIS data Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties 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
G0616 Patient medication schedule/instructions Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
▼ 157401 Tendercare Home Health Services Inc 6308 Rucker Rd Suite D Indianapolis IN 5 (Chicago) 06/23/2021 PZ6X11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0644 Program data Standard
G1028 Protection of records Standard
G0438 Have a confidential clinical record Element
G0710 Provide services in the plan of care Element
▼ 157401 Tendercare Home Health Services Inc 6308 Rucker Rd Suite D Indianapolis IN 5 (Chicago) 04/22/2019 V91U11 Complaint, 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
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
▼ 157423 Parkview Health At Home Llc 1900 Carew St Ste 5 Fort Wayne IN 5 (Chicago) 04/09/2026 22E382-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0436 Receive all services in plan of care Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care 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
G0808 Onsite supervisory visit every 14 days Element