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
▼ 157470 Sj Home Care Llc 5718 Coventry Lane Fort Wayne IN 5 (Chicago) 09/29/2023 5F995-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
G0572 Plan of care Standard
G0446 Contact info Federal/State-funded entities Element
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0598 Discharge plans communication Element
G0606 Integrate all services Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0728 Rehab services supervised by PT, OT Element
G0962 Coordinate patient care Element
▼ 157471 Home Health Crusaders Inc 3191 Willowcreek Road Portage IN 5 (Chicago) 07/26/2022 4EF79-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0560 Discharge Planning Condition
G0570 Care planning, coordination, quality of care Condition
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
G0544 Update of the comprehensive assessment Standard
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0958 Clinical manager Standard
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
G0592 Revised plan of care Element
G0706 Interdisciplinary assessment of the patient Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0948 Responsible for all day-to-day operations Element
▼ 157471 Home Health Crusaders Inc 3191 Willowcreek Road Portage IN 5 (Chicago) 06/21/2021 XJIU11 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
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0606 Integrate all services Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
▼ 157471 Home Health Crusaders Inc 3191 Willowcreek Road Portage IN 5 (Chicago) 08/22/2019 XYIW11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0640 Quality assessment/performance improvement Condition
E0013 Development of EP Policies and Procedures Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
G0372 Encoding and transmitting OASIS Standard
G0512 Standard: Initial assessment visit. Standard
G0526 Content of the comprehensive assessment Standard
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
G1028 Protection of records Standard
G0410 Information to patient Element
G0412 Written notice of patient's rights Element
G0418 Patient's or legal representative's signature Element
G0436 Receive all services in plan of care Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences 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
G0576 All orders recorded in plan of care Element
G0584 Verbal orders Element
G0606 Integrate all services Element
G0616 Patient medication schedule/instructions Element
G0706 Interdisciplinary assessment of the patient Element
G0808 Onsite supervisory visit every 14 days Element
G0984 In accordance with current clinical practice Element
G1022 Discharge and transfer summaries Element
▼ 157477 Adair Associates Inc 751 E Porter Avenue, Suite 9 Chesterton IN 5 (Chicago) 12/17/2021 37EAE-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
G0406 Patient rights Condition
G0510 Comprehensive Assessment of Patients Condition
G0560 Discharge Planning Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0452 Transfer and discharge Standard
G0544 Update of the comprehensive assessment Standard
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0416 OASIS privacy notice Element
G0432 Make complaints to the HHA Element
G0434 Participate in care Element
G0444 State toll free HH telephone hotline Element
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0538 Primary caregiver(s), if any Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes 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
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0984 In accordance with current clinical practice Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 157477 Adair Associates Inc 751 E Porter Avenue, Suite 9 Chesterton IN 5 (Chicago) 07/26/2019 S1B711 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
G0608 Coordinate care delivery Element
▼ 157483 Friends Home Health Care Inc 110 N 15th St Vincennes IN 5 (Chicago) 02/07/2022 3839D-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
G0570 Care planning, coordination, quality of care Condition
G0680 Infection prevention and control Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0030 Names and Contact Information Standard
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0944 Administrator must: Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0574 Plan of care must include the following Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0652 Activities lead to an immediate correction Element
G0984 In accordance with current clinical practice Element
▼ 157483 Friends Home Health Care Inc 110 N 15th St Vincennes IN 5 (Chicago) 01/07/2019 BRAP11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
E0039 EP Testing Requirements Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0436 Receive all services in plan of care Element
G0546 Last 5 days of every 60 days unless: Element
G0576 All orders recorded in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0610 Patients receive education and training Element
G0706 Interdisciplinary assessment of the patient Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G0726 Nursing services supervised by RN Element
G0800 Services provided by HH aide Element
G0964 Coordinate referrals; Element
▼ 157487 Munster Medical Research Foundation Inc 901 Ridge Road Munster IN 5 (Chicago) 07/22/2019 JYS111 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
G0600 Coordination of Care Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0418 Patient's or legal representative's signature Element
G0428 Property and person treated with respect Element
G0434 Participate in care Element
G0442 Written notice for non-covered care Element
G0484 Document complaint and resolution 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
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
G0604 Integrate all orders Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0728 Rehab services supervised by PT, OT Element
G0948 Responsible for all day-to-day operations Element
G1014 Interventions and patient response Element
▼ 157496 Bmo Home Health Care Inc 1970 Grant St Gary IN 5 (Chicago) 11/02/2022 4EF10-H3 Recertification
Deficiency Tag Deficiency Description Tag Type
G1024 Authentication Standard
G0948 Responsible for all day-to-day operations Element
G0964 Coordinate referrals; Element