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
▼ 157578 Amedisys Sp-In Llc 1332 W Arch Haven Ave Ste E Bloomington IN 5 (Chicago) 10/06/2021 1970D-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
E0039 EP Testing Requirements Standard
G0578 Conformance with physician orders Standard
G0600 Coordination of Care Standard
G0682 Infection Prevention Standard
G0852 Information to the state survey agency Standard
G0942 Governing body Standard
G0970 Parent-branch relationship Standard
G1024 Authentication Standard
G0416 OASIS privacy notice Element
G0442 Written notice for non-covered care Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G0966 Assure patient needs are continually assessed Element
G0974 Direct support and administrative control Element
G0984 In accordance with current clinical practice Element
G1014 Interventions and patient response Element
▼ 157578 Amedisys Sp-In Llc 1332 W Arch Haven Ave Ste E Bloomington IN 5 (Chicago) 02/02/2021 83U511 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
G0988 Institutional planning Standard
G0946 Administrator appointed by governing body Element
G0954 Ensures qualified pre-designated person Element
G0974 Direct support and administrative control Element
▼ 157578 Amedisys Sp-In Llc 1332 W Arch Haven Ave Ste E Bloomington IN 5 (Chicago) 03/22/2018 3WUS11 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
G0478 Investigate complaints made by patient Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0598 Discharge plans communication Element
G0616 Patient medication schedule/instructions Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G1022 Discharge and transfer summaries Element
▼ 157579 Cj's Home Care Inc 1002 Central Avenue Anderson IN 5 (Chicago) 11/01/2024 648AF-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0414 HHA administrator contact information Element
▼ 157579 Cj's Home Care Inc 1002 Central Avenue Anderson IN 5 (Chicago) 02/15/2022 383AB-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
G0706 Interdisciplinary assessment of the patient Element
▼ 157579 Cj's Home Care Inc 1002 Central Avenue Anderson IN 5 (Chicago) 03/01/2019 YRFQ11 Complaint, 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
G0592 Revised plan of care Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 157580 Advanced Home Health Care Incorporated 2834 B 45th St Highland IN 5 (Chicago) 01/31/2022 UCNM-H3 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0700 Skilled professional services Condition
E0030 Names and Contact Information Standard
G0544 Update of the comprehensive assessment Standard
G0564 Discharge or Transfer Summary Content Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G1028 Protection of records Standard
G0414 HHA administrator contact information Element
G0528 Health, psychosocial, functional, cognition Element
G0538 Primary caregiver(s), if any Element
G0588 Reviewed, revised by physician every 60 days Element
G0598 Discharge plans communication Element
G0610 Patients receive education and training Element
G0618 Treatments and therapy services Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0960 Make patient and personnel assignments, Element
G0978 Must have a written agreement Element
G1022 Discharge and transfer summaries Element
▼ 157580 Advanced Home Health Care Incorporated 2834 B 45th St Highland IN 5 (Chicago) 10/18/2021 UCNM-H2 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
G0570 Care planning, coordination, quality of care Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0033 Methods for Sharing Information Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0436 Receive all services in plan of care 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
G0592 Revised plan of care Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0648 High risk, high volume, or problem-prone area 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
G0964 Coordinate referrals; Element
G0968 Assure implementation of plan of care Element
▼ 157580 Advanced Home Health Care Incorporated 2834 B 45th St Highland IN 5 (Chicago) 07/15/2021 UCNM11 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
E0001 Establishment of the Emergency Program (EP) Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0374 Accuracy of encoded OASIS data Standard
G0544 Update of the comprehensive assessment 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
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0702 Services by skilled professionals Standard
G0798 Home health aide assignments and duties Standard
G0958 Clinical manager Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications 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
G0588 Reviewed, revised by physician every 60 days 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
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems 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
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
G0722 Participate in HHA-sponsored in-service Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0818 HH aide supervision elements Element
G0948 Responsible for all day-to-day operations Element
G0960 Make patient and personnel assignments, Element
G0962 Coordinate patient care Element
G0964 Coordinate referrals; Element
G0968 Assure implementation of plan of care Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
G1022 Discharge and transfer summaries Element
▼ 157581 Assured Home Healthcare Inc 1947 Harder Ct Ste B Schererville IN 5 (Chicago) 10/24/2024 64856-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0036 EP Training and Testing Standard
G0564 Discharge or Transfer Summary Content Standard
G1024 Authentication Standard
G1028 Protection of records Standard
G0418 Patient's or legal representative's signature Element
G0484 Document complaint and resolution Element
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0538 Primary caregiver(s), if any 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
G0606 Integrate all services Element
G0808 Onsite supervisory visit every 14 days Element
G0810 If concern identified, direct observation Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element