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
▼ 157608 Hoosier Homecare Services Llc 614 East 53rd Street Anderson IN 5 (Chicago) 01/25/2023 5E2B7-H2 Complaint
Deficiency Tag Deficiency Description Tag Type
G0620 Other pertinent instructions Element
▼ 157608 Hoosier Homecare Services Llc 614 East 53rd Street Anderson IN 5 (Chicago) 11/29/2022 5E2B7-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0452 Transfer and discharge Standard
G0512 Standard: Initial assessment visit. Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0622 Name/contact information of clinical manager Element
G0800 Services provided by HH aide Element
▼ 157608 Hoosier Homecare Services Llc 614 East 53rd Street Anderson IN 5 (Chicago) 08/17/2021 ICZ811 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
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G1024 Authentication Standard
G1060 Licensed Practical (Vocational) Nurse Standard
G0436 Receive all services in plan of care Element
G0464 Advise the patient of discharge for cause Element
G0466 Make efforts to resolve the problem(s) Element
G0468 Provide contact info other services Element
G0470 Document efforts to resolve problems Element
G0598 Discharge plans communication Element
G0604 Integrate all orders Element
G0608 Coordinate care delivery Element
▼ 157608 Hoosier Homecare Services Llc 614 East 53rd Street Anderson IN 5 (Chicago) 12/13/2018 U7N811 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
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0582 Influenza and pneumococcal vaccines Element
G0708 Development and evaluation of plan of care Element
G0716 Preparing clinical notes Element
▼ 157610 Home Health Angels Llc 117 N Main St Po Box 283 Winchester IN 5 (Chicago) 10/09/2024 6455A-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
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0682 Infection Prevention Standard
G0958 Clinical manager Standard
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0548 Within 48 hours of the patient's return 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
G0618 Treatments and therapy services Element
G0622 Name/contact information of clinical manager Element
G0708 Development and evaluation of plan of care Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0754 A qualified HH aide successfully completed: Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available Element
G0960 Make patient and personnel assignments, Element
G0962 Coordinate patient care Element
G0964 Coordinate referrals; Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
G1020 Contact info for primary care practitioner Element
▼ 157610 Home Health Angels Llc 117 N Main St Po Box 283 Winchester IN 5 (Chicago) 10/25/2021 37CA6-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0564 Discharge or Transfer Summary Content Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0614 Visit schedule Element
G0618 Treatments and therapy services Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
▼ 157610 Home Health Angels Llc 117 N Main St Po Box 283 Winchester IN 5 (Chicago) 12/21/2018 LT3V11 Complaint, 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
G0724 Supervise skilled professional assistants Standard
G0808 Onsite supervisory visit every 14 days Element
▼ 157611 Northwest Home Health Care Inc 2834 45th Street Unit 5b Highland IN 5 (Chicago) 05/08/2025 6588D-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
G0644 Program data Standard
G0646 Program activities Standard
G1024 Authentication Standard
G0412 Written notice of patient's rights Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
▼ 157611 Northwest Home Health Care Inc 2834 45th Street Unit 5b Highland IN 5 (Chicago) 07/05/2022 4EEC8-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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0031 Emergency Officials Contact Information Standard
G0374 Accuracy of encoded OASIS data Standard
G0544 Update of the comprehensive assessment Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0538 Primary caregiver(s), if any 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
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0808 Onsite supervisory visit every 14 days Element
▼ 157611 Northwest Home Health Care Inc 2834 45th Street Unit 5b Highland IN 5 (Chicago) 08/27/2019 JUGH11 Complaint, 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
G1024 Authentication Standard
G0440 Payment from federally funded programs Element
G0444 State toll free HH telephone hotline Element
G0514 RN performs assessment Element
G0584 Verbal orders Element
G0592 Revised plan of care Element
G0614 Visit schedule Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element