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
▼ 157687 Maxim Healthcare Services Inc 233 Quartermaster Court Jeffersonville IN 5 (Chicago) 10/10/2024 63DA8-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
G0514 RN performs assessment Element
▼ 157687 Maxim Healthcare Services Inc 233 Quartermaster Court Jeffersonville IN 5 (Chicago) 12/03/2021 37F84-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0414 HHA administrator contact information Element
G0550 At discharge Element
G0590 Promptly alert relevant physician of changes Element
G0622 Name/contact information of clinical manager Element
G0800 Services provided by HH aide Element
▼ 157687 Maxim Healthcare Services Inc 233 Quartermaster Court Jeffersonville IN 5 (Chicago) 08/10/2020 7FFE11 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
▼ 157687 Maxim Healthcare Services Inc 233 Quartermaster Court Jeffersonville IN 5 (Chicago) 02/20/2019 BM2U11 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
G0798 Home health aide assignments and duties Standard
G0800 Services provided by HH aide Element
▼ 157688 United Home Healthcare Inc 7212 N Shadeland Ave Ste 100 Indianapolis IN 5 (Chicago) 06/26/2019 MBUW11 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
G0942 Governing body Standard
G0436 Receive all services in plan of care Element
G0800 Services provided by HH aide Element
▼ 157691 Premier Home Health Indiana, Llc 11595 Meridian St Ste 515 Carmel IN 5 (Chicago) 01/21/2026 1E1804-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process Standard
G0946 Administrator appointed by governing body Element
▼ 157691 Premier Home Health Indiana, Llc 11595 Meridian St Ste 515 Carmel IN 5 (Chicago) 01/10/2025 65074-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
G0940 Organization and administration of services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0958 Clinical manager Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0462 Before discharge for cause HHA must: 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
G0528 Health, psychosocial, functional, cognition 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
G0588 Reviewed, revised by physician every 60 days 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
G0772 Documentation of competency evaluation Element
G0950 Ensure clinical manager is available Element
G0952 Ensure that HHA employs qualified personnel 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
G1022 Discharge and transfer summaries Element
▼ 157692 Elite Home Rehab And Healthcare Corp 645 W Carmel Dr Suite 115 Carmel IN 5 (Chicago) 12/12/2023 61936-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0434 Participate in care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
▼ 157692 Elite Home Rehab And Healthcare Corp 645 W Carmel Dr Suite 115 Carmel IN 5 (Chicago) 02/10/2023 5EF16-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G0682 Infection Prevention Standard
G0580 Only as ordered by a physician Element
▼ 157694 Lasik Home Health Care Inc 9723 S Prairie Avenue Highland IN 5 (Chicago) 03/11/2026 1D6429-H3 Recertification
Deficiency Tag Deficiency Description Tag Type
G0962 Coordinate patient care Element
G0968 Assure implementation of plan of care Element