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
▼ 157504 Premier Home Health Care Llc 504 N Bradner Ave Marion IN 5 (Chicago) 08/22/2022 4EADE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0800 Services provided by HH aide Element
▼ 157504 Premier Home Health Care Llc 504 N Bradner Ave Marion IN 5 (Chicago) 08/09/2019 2FP011 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
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
▼ 157510 Johnson Memorial Hospital 86 Drake Road Franklin IN 5 (Chicago) 10/27/2020 WSO711 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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
▼ 157511 Home Health Services Of Gary Inc 1281 W Ridge Rd Gary IN 5 (Chicago) 09/15/2023 60F81-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
▼ 157511 Home Health Services Of Gary Inc 1281 W Ridge Rd Gary IN 5 (Chicago) 01/20/2021 SNYG11 Complaint, 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
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G1026 Retention of records Standard
G0444 State toll free HH telephone hotline 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
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0610 Patients receive education and training Element
G0614 Visit schedule 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
G0804 Aides are members of interdisciplinary team Element
G0818 HH aide supervision elements Element
G1014 Interventions and patient response Element
▼ 157511 Home Health Services Of Gary Inc 1281 W Ridge Rd Gary IN 5 (Chicago) 09/24/2018 4HIF11 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
G0682 Infection Prevention Standard
G0546 Last 5 days of every 60 days unless: Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
▼ 157523 Pediatric Infant And Family Home Heatlh Care Specialists Inc. 1512 Burr St Gary IN 5 (Chicago) 01/02/2026 1D6410-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0646 Program activities Standard
▼ 157523 Pediatric Infant And Family Home Heatlh Care Specialists Inc. 1512 Burr St Gary IN 5 (Chicago) 09/15/2025 1D6410-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0372 Encoding and transmitting OASIS Standard
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care 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
G0538 Primary caregiver(s), if any Element
G0542 Incorporate OASIS items Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0584 Verbal orders Element
G0604 Integrate all orders Element
G0608 Coordinate care delivery Element
▼ 157523 Pediatric Infant And Family Home Heatlh Care Specialists Inc. 1512 Burr St Gary IN 5 (Chicago) 07/29/2022 4EFF6-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
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
G0716 Preparing clinical notes Element
▼ 157523 Pediatric Infant And Family Home Heatlh Care Specialists Inc. 1512 Burr St Gary IN 5 (Chicago) 06/17/2020 1FIN11 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