S&C QCOR HHA 2567s
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HHAs 2567s
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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
▼ 157668 Indiana Home Care Services, Llc 8455 Keystone Crossing Indianapolis IN 5 (Chicago) 05/18/2026 232180-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G1022 Discharge and transfer summaries Element
▼ 157668 Indiana Home Care Services, Llc 8455 Keystone Crossing Indianapolis IN 5 (Chicago) 07/05/2023 602FB-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
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0528 Health, psychosocial, functional, cognition Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0984 In accordance with current clinical practice Element
▼ 157668 Indiana Home Care Services, Llc 8455 Keystone Crossing Indianapolis IN 5 (Chicago) 10/08/2020 CS4M11 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
G0374 Accuracy of encoded OASIS data Standard
G0452 Transfer and discharge Standard
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0644 Program data Standard
G0654 Track adverse patient events Standard
G0684 Infection control Standard
G0434 Participate in care Element
G0440 Payment from federally funded programs Element
G0514 RN performs assessment Element
G0530 Strengths, goals, and care preferences 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
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0802 Duties of a HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G1014 Interventions and patient response Element
G1016 Goals in the patient's plans of care Element
▼ 157669 Wellpoint Home Health Inc 9245 Calumet Avenue Suite 103b Munster IN 5 (Chicago) 11/21/2018 006M11 Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0576 All orders recorded in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0610 Patients receive education and training Element
▼ 157669 Wellpoint Home Health Inc 9245 Calumet Avenue Suite 103b Munster IN 5 (Chicago) 08/28/2018 HMI811 Complaint, 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
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0774 12 hours inservice every 12 months Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0410 Information to patient Element
G0438 Have a confidential clinical record Element
G0440 Payment from federally funded programs Element
G0444 State toll free HH telephone hotline Element
G0458 Outcomes/goals have been achieved Element
G0514 RN performs assessment Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following 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
G0604 Integrate all orders Element
G0606 Integrate all services Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager 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
G0754 A qualified HH aide successfully completed: Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
G0960 Make patient and personnel assignments, Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
▼ 157670 Majestic Home Health Llc 777 E Main Street, Suite 211 Westfield IN 5 (Chicago) 06/02/2026 233A1D-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
G0406 Condition of Participation: Patient rights. Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
G0372 Encoding and transmitting OASIS Standard
G0452 Transfer and discharge Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0958 Clinical manager Standard
G1024 Authentication Standard
G1030 Retrieval of records Standard
G0416 OASIS privacy notice Element
G0418 Patient's or legal representative's signature Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0444 State toll free HH telephone hotline Element
G0458 Outcomes/goals have been achieved Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
G0610 Patients receive education and training Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0716 Preparing clinical notes Element
G0954 Ensures qualified pre-designated person Element
G0960 Make patient and personnel assignments, Element
G0962 Coordinate patient care Element
G0964 Coordinate referrals; Element
G1022 Discharge and transfer summaries Element
▼ 157671 Simply Home Health, Llc 813 Westfield Rd Suite 200 Noblesville IN 5 (Chicago) 08/28/2018 VPPU11 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
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery 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
G0716 Preparing clinical notes Element
G0808 Onsite supervisory visit every 14 days Element
G0984 In accordance with current clinical practice Element
▼ 157676 Larris-Ify Home Care 5445 Lafayette Road Indianapolis IN 5 (Chicago) 12/04/2023 61985-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
G1026 Retention of records Standard
G0536 A review of all current medications Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager Element
▼ 157676 Larris-Ify Home Care 5445 Lafayette Road Indianapolis IN 5 (Chicago) 07/05/2018 Q1NG11 Complaint, 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
G0640 Quality assessment/performance improvement 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
G0572 Plan of care Standard
G0600 Coordination of Care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0660 Executive responsibilities for QAPI Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0514 RN performs assessment Element
G0516 Skilled professional performs assessment Element
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0592 Revised plan of care Element
G0606 Integrate all services Element
G0656 Improvements are sustained Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
G1022 Discharge and transfer summaries Element
▼ 157679 Maxim Healthcare Services Inc 5265 Commerce Drive, Ste E Crown Point IN 5 (Chicago) 08/07/2020 OWIW11 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
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0686 Infection control education Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G1028 Protection of records Standard
G0434 Participate in care 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
G0606 Integrate all services Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element