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
▼ 157428 Home Care Network Inc 8580 Cedar Place Drive, Suite 115a Indianapolis IN 5 (Chicago) 09/21/2018 C5L611 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
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0852 Information to the state survey agency Standard
G0414 HHA administrator contact information Element
G0436 Receive all services in plan of care Element
G0454 HHA can no longer meet the patient's needs Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available Element
G0962 Coordinate patient care Element
G0968 Assure implementation of plan of care Element
G1012 Required items in clinical record Element
▼ 157430 Henry County Memorial Hospital 798 N 16th Street New Castle IN 5 (Chicago) 07/31/2024 63BF1-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
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G1022 Discharge and transfer summaries Element
▼ 157430 Henry County Memorial Hospital 798 N 16th Street New Castle IN 5 (Chicago) 10/13/2021 19765-H1 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
▼ 157430 Henry County Memorial Hospital 798 N 16th Street New Castle IN 5 (Chicago) 12/06/2018 QMD911 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
E0036 EP Training and Testing Standard
G0682 Infection Prevention Standard
G0574 Plan of care must include the following Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0800 Services provided by HH aide Element
G0954 Ensures qualified pre-designated person Element
▼ 157436 Hrs Home Health Of Indiana, Llc 11037 Broadway, Suite C Crown Point IN 5 (Chicago) 05/17/2022 38A21-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
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
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0039 EP Testing Requirements Standard
G0564 Discharge or Transfer Summary Content 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
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G1024 Authentication Standard
G0412 Written notice of patient's rights Element
G0478 Investigate complaints made by patient 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
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
G0604 Integrate all orders Element
G0606 Integrate all services Element
G0610 Patients receive education and training 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
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
G0652 Activities lead to an immediate correction Element
G0656 Improvements are sustained Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0720 Participate in the HHA's QAPI program; Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available 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
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 157436 Hrs Home Health Of Indiana, Llc 11037 Broadway, Suite C Crown Point IN 5 (Chicago) 07/19/2021 3CS011 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0414 HHA administrator contact information Element
G0444 State toll free HH telephone hotline Element
G0534 Patient's needs Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
▼ 157436 Hrs Home Health Of Indiana, Llc 11037 Broadway, Suite C Crown Point IN 5 (Chicago) 04/19/2021 2IZE11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0468 Provide contact info other services Element
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
▼ 157436 Hrs Home Health Of Indiana, Llc 11037 Broadway, Suite C Crown Point IN 5 (Chicago) 08/02/2019 76ML11 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
G0572 Plan of care Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0602 Communication with all physicians Element
G0710 Provide services in the plan of care Element
▼ 157442 Community Hca, Inc 4640 W Jefferson Blvd Fort Wayne IN 5 (Chicago) 11/12/2024 64A20-H1 Recertification
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
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
▼ 157442 Community Hca, Inc 4640 W Jefferson Blvd Fort Wayne IN 5 (Chicago) 04/01/2022 381CB-H2 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0576 All orders recorded in plan of care Element