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
▼ 157657 Carefirst Rehab Llc 7225 Novas Landing Sellersburg IN 5 (Chicago) 04/21/2022 388AE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0422 Written notice within 4 business days 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
G0616 Patient medication schedule/instructions Element
G0716 Preparing clinical notes Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 157657 Carefirst Rehab Llc 7225 Novas Landing Sellersburg IN 5 (Chicago) 03/27/2019 H56X11 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
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
▼ 157660 Kort Rehabilitation At Home Llc 3453 E 10th Street Jeffersonville IN 5 (Chicago) 03/04/2019 NPGW11 Complaint, 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
G1012 Required items in clinical record Element
▼ 157662 Peak Home Health, Llc 833 W Lincoln Hwy, Suite 105w Schererville IN 5 (Chicago) 11/08/2023 6153C-H1 Complaint
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
G0940 Organization and administration of services Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0724 Supervise skilled professional assistants Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
G1012 Required items in clinical record Element
▼ 157664 Horizons Home Care Inc 1202 W Buena Vista Road Suite 202 Evansville IN 5 (Chicago) 06/24/2022 4EDC9-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
▼ 157664 Horizons Home Care Inc 1202 W Buena Vista Road Suite 202 Evansville IN 5 (Chicago) 10/25/2019 IMSV11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0440 Payment from federally funded programs Element
G0442 Written notice for non-covered care Element
G0454 HHA can no longer meet the patient's needs Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G1022 Discharge and transfer summaries Element
▼ 157665 Care Plus Homehealth Care Inc 11050 Presbyterian Dr Indianapolis IN 5 (Chicago) 01/07/2026 1DFA8A-H1 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
G0682 Infection Prevention Standard
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
G0802 Duties of a HH aide Element
▼ 157665 Care Plus Homehealth Care Inc 11050 Presbyterian Dr Indianapolis IN 5 (Chicago) 12/14/2022 5E705-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
G1028 Protection of records Standard
G0438 Have a confidential clinical record Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0622 Name/contact information of clinical manager Element
G0714 Patient and caregiver education Element
▼ 157665 Care Plus Homehealth Care Inc 11050 Presbyterian Dr Indianapolis IN 5 (Chicago) 11/22/2019 LJ5T11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G0520 5 calendar days after start of care Element
G0530 Strengths, goals, and care preferences Element
G0536 A review of all current medications Element
G0538 Primary caregiver(s), if any Element
G0574 Plan of care must include the following Element
G0616 Patient medication schedule/instructions Element
G0648 High risk, high volume, or problem-prone area Element
G0800 Services provided by HH aide Element
G0954 Ensures qualified pre-designated person Element
▼ 157667 Favor Healthcare Services Inc 425 Joliet Road Suite 219 Dyer IN 5 (Chicago) 11/23/2022 5E3EA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0017 HHA Comprehensive Assessment in Disaster Standard
G0682 Infection Prevention Standard
G0574 Plan of care must include the following Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element