S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 157626 Amore Home Health Care Services, Inc 9167 Wicker Avenue Ste 7 Saint John IN 5 (Chicago) 06/24/2020 U00Y11 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
▼ 157626 Amore Home Health Care Services, Inc 9167 Wicker Avenue Ste 7 Saint John IN 5 (Chicago) 12/17/2019 TRKD11 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
G0640 Quality assessment/performance improvement Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0584 Verbal orders Element
G0608 Coordinate care delivery Element
▼ 157627 Northern Indiana Interim Healthcare Company Llc 111 E. Ludwig Road, Suite 105 Fort Wayne IN 5 (Chicago) 12/29/2022 5E261-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G1024 Authentication Standard
G0710 Provide services in the plan of care Element
▼ 157627 Northern Indiana Interim Healthcare Company Llc 111 E. Ludwig Road, Suite 105 Fort Wayne IN 5 (Chicago) 11/10/2022 5E261-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
G0700 Skilled professional services Condition
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0031 Emergency Officials Contact Information Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0528 Health, psychosocial, functional, cognition 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
G0706 Interdisciplinary assessment of the patient Element
G0728 Rehab services supervised by PT, OT Element
▼ 157627 Northern Indiana Interim Healthcare Company Llc 111 E. Ludwig Road, Suite 105 Fort Wayne IN 5 (Chicago) 10/29/2019 61NH11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0848 Compliance with Federal, State, Local Law 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
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0800 Services provided by HH aide Element
▼ 157629 Loving Care Agency Inc 2600 Roosevelt Rd, Suite 200-1 Valparaiso IN 5 (Chicago) 08/27/2020 3BO111 Complaint, 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
G0406 Patient rights Condition
G0570 Care planning, coordination, quality of care Condition
G0680 Infection prevention and control Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G1028 Protection of records Standard
G0434 Participate in care Element
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
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
G0528 Health, psychosocial, functional, cognition 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
G0606 Integrate all services Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0800 Services provided by HH aide Element
G0802 Duties of a HH aide Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 157633 Hope Home Health Care Inc 3800 W 80th Ln Merrillville IN 5 (Chicago) 06/25/2024 63536-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0560 Discharge Planning Condition
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0644 Program data Standard
G0646 Program activities Standard
G0658 Performance improvement projects Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0430 Be free from abuse Element
G0458 Outcomes/goals have been achieved Element
G0528 Health, psychosocial, functional, cognition Element
G0538 Primary caregiver(s), if any Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0620 Other pertinent instructions Element
G0716 Preparing clinical notes Element
G0818 HH aide supervision elements Element
▼ 157633 Hope Home Health Care Inc 3800 W 80th Ln Merrillville IN 5 (Chicago) 07/22/2022 4F048-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
▼ 157634 Sunrise Home Health Care Services Inc 2711 W Lincoln Highway Merrillville IN 5 (Chicago) 01/23/2026 1D8C4F-H1 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
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
G0642 Program scope Standard
G0528 Health, psychosocial, functional, cognition Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0808 Onsite supervisory visit every 14 days Element
▼ 157634 Sunrise Home Health Care Services Inc 2711 W Lincoln Highway Merrillville IN 5 (Chicago) 02/02/2023 5ED71-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
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0374 Accuracy of encoded OASIS data Standard
G0564 Discharge or Transfer Summary Content Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0686 Infection control education Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0418 Patient's or legal representative's signature Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0652 Activities lead to an immediate correction Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0984 In accordance with current clinical practice Element