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
▼ 157618 Universal Home Healthcare Of Indiana Inc 2420 North Coliseum Blvd Ste 201a Fort Wayne IN 5 (Chicago) 12/09/2025 1DD625-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0444 State toll free HH telephone hotline 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
▼ 157618 Universal Home Healthcare Of Indiana Inc 2420 North Coliseum Blvd Ste 201a Fort Wayne IN 5 (Chicago) 06/19/2025 66785-H1 Complaint
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
G1008 Clinical records Condition
E0031 Emergency Officials Contact Information Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0774 12 hours inservice every 12 months Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0478 Investigate complaints made by patient Element
G0514 RN performs assessment Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: 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
G0620 Other pertinent instructions Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0754 A qualified HH aide successfully completed: Element
G0760 Classroom and supervised practical training Element
G0808 Onsite supervisory visit every 14 days Element
G0810 If concern identified, direct observation Element
G1018 Contact information for the patient Element
G1022 Discharge and transfer summaries Element
▼ 157618 Universal Home Healthcare Of Indiana Inc 2420 North Coliseum Blvd Ste 201a Fort Wayne IN 5 (Chicago) 03/12/2019 VNVK11 Recertification, Sample Validation
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
G0574 Plan of care must include the following Element
G0718 Communication with physicians Element
G0808 Onsite supervisory visit every 14 days Element
▼ 157619 Cornerstone Home Health Care Inc 5 E High Street Mooresville IN 5 (Chicago) 05/18/2022 4EAA4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G1028 Protection of records Standard
▼ 157619 Cornerstone Home Health Care Inc 5 E High Street Mooresville IN 5 (Chicago) 06/08/2020 MEEG11 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
▼ 157619 Cornerstone Home Health Care Inc 5 E High Street Mooresville IN 5 (Chicago) 07/12/2019 5N3U11 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
G0584 Verbal orders Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
▼ 157620 Servant's Heart Home Health Services Inc 1714 Dividend Drive Logansport IN 5 (Chicago) 12/29/2022 4EC9A-H3 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0528 Health, psychosocial, functional, cognition Element
G0608 Coordinate care delivery Element
▼ 157620 Servant's Heart Home Health Services Inc 1714 Dividend Drive Logansport IN 5 (Chicago) 09/02/2022 4EC9A-H2 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
▼ 157620 Servant's Heart Home Health Services Inc 1714 Dividend Drive Logansport IN 5 (Chicago) 07/11/2022 4EC9A-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
G0570 Care planning, coordination, quality of care Condition
G0680 Infection prevention and control Condition
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0942 Governing body Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
▼ 157620 Servant's Heart Home Health Services Inc 1714 Dividend Drive Logansport IN 5 (Chicago) 07/12/2019 UTXH11 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
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0036 EP Training and Testing Standard
G0544 Update of the comprehensive assessment Standard
G0682 Infection Prevention Standard
G0684 Infection control 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
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
G0592 Revised plan of care Element
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0720 Participate in the HHA's QAPI program; Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
G0978 Must have a written agreement Element
G0984 In accordance with current clinical practice Element