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
▼ 157563 Home Health Agency Indiana Llc 215 Industrial Parkway Richmond IN 5 (Chicago) 10/26/2023 61362-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0562 Discharge Planning Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0550 At discharge Element
G0598 Discharge plans communication Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
▼ 157565 Deaconess Home Health, Llc 6500 Interchange Road S, Suite A Evansville IN 5 (Chicago) 04/21/2026 1DDAA1-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
G1030 Retrieval of records Standard
G0622 Name/contact information of clinical manager Element
▼ 157565 Deaconess Home Health, Llc 6500 Interchange Road S, Suite A Evansville IN 5 (Chicago) 07/17/2025 669A5-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0520 5 calendar days after start of care Element
▼ 157565 Deaconess Home Health, Llc 6500 Interchange Road S, Suite A Evansville IN 5 (Chicago) 06/26/2023 6019C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0013 Development of EP Policies and Procedures Standard
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0484 Document complaint and resolution Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0766 HHA maintains documentation of training Element
G0818 HH aide supervision elements Element
▼ 157565 Deaconess Home Health, Llc 6500 Interchange Road S, Suite A Evansville IN 5 (Chicago) 11/02/2020 N0W311 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
G0940 Organization and administration of services Condition
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0704 Responsibilities of skilled professionals Standard
G0942 Governing body Standard
G0958 Clinical manager Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0436 Receive all services in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0708 Development and evaluation of 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
G0966 Assure patient needs are continually assessed Element
G0984 In accordance with current clinical practice Element
G1014 Interventions and patient response Element
▼ 157568 Home Health Agency Indiana Llc 600 N Weinbach Ave Ste 610 Evansville IN 5 (Chicago) 03/09/2021 29KD12 Complaint
Deficiency Tag Deficiency Description Tag Type
G1024 Authentication Standard
G0710 Provide services in the plan of care Element
▼ 157568 Home Health Agency Indiana Llc 600 N Weinbach Ave Ste 610 Evansville IN 5 (Chicago) 11/18/2020 29KD11 Complaint
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
G0702 Services by skilled professionals Standard
G0942 Governing body Standard
G0484 Document complaint and resolution Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
▼ 157569 Eh Home Health Of The Midwest, Llc 20 East Us Highway 30 Schererville IN 5 (Chicago) 02/11/2026 1E0A06-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
▼ 157569 Eh Home Health Of The Midwest, Llc 20 East Us Highway 30 Schererville IN 5 (Chicago) 08/11/2023 60AB4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0940 Organization and administration of services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0586 Review and revision of the plan of care Standard
G0644 Program data Standard
G0646 Program activities Standard
G0654 Track adverse patient events Standard
G0942 Governing body Standard
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0438 Have a confidential clinical record Element
G0458 Outcomes/goals have been achieved Element
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services 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
G0652 Activities lead to an immediate correction Element
G0716 Preparing clinical notes Element
G0946 Administrator appointed by governing body Element
G0954 Ensures qualified pre-designated person Element
G0960 Make patient and personnel assignments, Element
G0978 Must have a written agreement Element
▼ 157569 Eh Home Health Of The Midwest, Llc 20 East Us Highway 30 Schererville IN 5 (Chicago) 01/19/2021 PC8611 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
G0682 Infection Prevention Standard
G0442 Written notice for non-covered care 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