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
▼ 157538 Broadway Physical Therapy Inc 8300 Broadway Street Ste B1 Merrillville IN 5 (Chicago) 01/19/2018 NT6X12 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0121 COMPLIANCE W/ ACCEPTED PROFESSIONAL STD Standard
G0133 ADMINISTRATOR Standard
G0134 ADMINISTRATOR Standard
G0143 COORDINATION OF PATIENT SERVICES Standard
G0157 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0158 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0159 PLAN OF CARE Standard
G0165 CONFORMANCE WITH PHYSICIAN ORDERS Standard
G0170 SKILLED NURSING SERVICES Standard
G0173 DUTIES OF THE REGISTERED NURSE Standard
G0180 DUTIES OF THE LICENSED PRACTICAL NURSE Standard
G0225 ASSIGNMENT & DUTIES OF HOME HEALTH AIDE Standard
G0236 CLINICAL RECORDS Standard
G0337 DRUG REGIMEN REVIEW Standard
▼ 157541 Allpoints Home Health Care Inc 9801 Prairie Ave Highland IN 5 (Chicago) 09/20/2024 6423B-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
G0510 Comprehensive Assessment of Patients Condition
G0560 Discharge Planning Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0940 Organization and administration of services Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0813 Basis and Scope Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0458 Outcomes/goals have been achieved Element
G0514 RN performs assessment 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
G0550 At discharge 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
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0800 Services provided by HH aide Element
▼ 157543 Prime Care Home Health Services 2632 W 81st Ave Merrillville IN 5 (Chicago) 04/19/2023 4F7F3-H4 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0017 HHA Comprehensive Assessment in Disaster Standard
G0374 Accuracy of encoded OASIS data Standard
G0564 Discharge or Transfer Summary Content Standard
G0458 Outcomes/goals have been achieved Element
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0538 Primary caregiver(s), if any Element
G0710 Provide services in the plan of care Element
G0804 Aides are members of interdisciplinary team Element
G0960 Make patient and personnel assignments, Element
G0968 Assure implementation of plan of care Element
G0984 In accordance with current clinical practice Element
▼ 157543 Prime Care Home Health Services 2632 W 81st Ave Merrillville IN 5 (Chicago) 02/15/2023 4F7F3-H3 Complaint
Deficiency Tag Deficiency Description Tag Type
G0940 Organization and administration of services Condition
G0562 Discharge Planning Standard
G0658 Performance improvement projects Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0536 A review of all current medications Element
G0598 Discharge plans communication Element
G0604 Integrate all orders Element
G0606 Integrate all services Element
G0652 Activities lead to an immediate correction Element
G0720 Participate in the HHA's QAPI program; Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
G0964 Coordinate referrals; Element
▼ 157543 Prime Care Home Health Services 2632 W 81st Ave Merrillville IN 5 (Chicago) 12/22/2022 4F7F3-H2 Complaint
Deficiency Tag Deficiency Description Tag Type
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0716 Preparing clinical notes Element
▼ 157543 Prime Care Home Health Services 2632 W 81st Ave Merrillville IN 5 (Chicago) 10/07/2022 4F7F3-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
G0434 Participate in care 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
G0590 Promptly alert relevant physician of changes 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
G1016 Goals in the patient's plans of care Element
▼ 157550 Rest Haven Illiana Christian Convalescent Home 10700 Park Place Saint John IN 5 (Chicago) 03/11/2022 382AE-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0592 Revised plan of care Element
G0620 Other pertinent instructions Element
▼ 157550 Rest Haven Illiana Christian Convalescent Home 10700 Park Place Saint John IN 5 (Chicago) 01/25/2022 382AE-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
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0654 Track adverse patient events Standard
G0682 Infection Prevention Standard
G0704 Responsibilities of skilled professionals Standard
G1024 Authentication Standard
G0442 Written notice for non-covered care Element
G0468 Provide contact info other services 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
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
▼ 157550 Rest Haven Illiana Christian Convalescent Home 10700 Park Place Saint John IN 5 (Chicago) 05/31/2019 IQDE11 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0033 Methods for Sharing Information Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0438 Have a confidential clinical record Element
G0520 5 calendar days after start of care 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
G0550 At discharge 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
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0706 Interdisciplinary assessment of the patient Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
▼ 157551 Interim Healthcare Of Se Indiana Inc 3200 North National Road Columbus IN 5 (Chicago) 07/25/2025 6676C-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
G0590 Promptly alert relevant physician of changes Element
G0602 Communication with all physicians Element
G0716 Preparing clinical notes Element