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
▼ 157705 Age In Place Home Services Llc 288 Home Street Huntington IN 5 (Chicago) 12/09/2025 1DD627-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
G0590 Promptly alert relevant physician of changes Element
▼ 157708 Healing Hands Home Health Llc 216 E 9th Street Anderson IN 5 (Chicago) 01/13/2023 5E69D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0030 Names and Contact Information Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0620 Other pertinent instructions Element
G0706 Interdisciplinary assessment of the patient Element
▼ 157710 Prairie Healthcare Services Llc 5920 Hohman Avenue Hammond IN 5 (Chicago) 01/11/2024 6196E-H2 Complaint
Deficiency Tag Deficiency Description Tag Type
G0574 Plan of care must include the following Element
▼ 157710 Prairie Healthcare Services Llc 5920 Hohman Avenue Hammond IN 5 (Chicago) 12/01/2023 6196E-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
G0570 Care planning, coordination, quality of care 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
E0033 Methods for Sharing Information Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0714 Patient and caregiver education Element
▼ 157711 Ability Home Health Llc 4555 Northwestern Dr Ste 1a Zionsville IN 5 (Chicago) 04/15/2024 629C2-H1 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
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0424 Exercise of rights Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0460 Patient refuses services Element
G0520 5 calendar days after start of 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
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0954 Ensures qualified pre-designated person Element
G1012 Required items in clinical record Element
▼ 157713 Scott's Home Healthcare Llc 3208 S. Lafountain Street Kokomo IN 5 (Chicago) 02/26/2019 SEGS11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
G0372 Encoding and transmitting OASIS Standard
G0526 Content of the comprehensive assessment Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0438 Have a confidential clinical record Element
G0480 Treatment or care Element
G0514 RN performs assessment Element
G0530 Strengths, goals, and care preferences Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0984 In accordance with current clinical practice Element
G1022 Discharge and transfer summaries Element
▼ 157715 Union Healthcare Services Inc 62501 La Pas Trail Ste 110 Indianapolis IN 5 (Chicago) 07/03/2024 637C2-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
G0710 Provide services in the plan of care Element
▼ 157715 Union Healthcare Services Inc 62501 La Pas Trail Ste 110 Indianapolis IN 5 (Chicago) 06/22/2023 5E9F3-H5 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0578 Conformance with physician orders Standard
▼ 157715 Union Healthcare Services Inc 62501 La Pas Trail Ste 110 Indianapolis IN 5 (Chicago) 01/11/2023 5E9F3-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
E0001 Establishment of the Emergency Program (EP) Condition
G0370 Reporting OASIS information Condition
G0406 Patient rights Condition
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
G0940 Organization and administration of services Condition
G0372 Encoding and transmitting OASIS Standard
G0512 Standard: Initial assessment visit. Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0438 Have a confidential clinical record Element
G0440 Payment from federally funded programs Element
G0516 Skilled professional performs assessment Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager 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
G0946 Administrator appointed by governing body Element
G0954 Ensures qualified pre-designated person Element
G0962 Coordinate patient care Element
G0966 Assure patient needs are continually assessed Element
G1022 Discharge and transfer summaries Element
▼ 157717 Givingback 3 Inc 1905 N Monroe Street Bloomington IN 5 (Chicago) 02/23/2023 5F0D3-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
G0578 Conformance with physician orders Standard
G0860 Licensing Standard
G0942 Governing body Standard
G1028 Protection of records Standard
G0414 HHA administrator contact information Element
G0436 Receive all services in plan of care Element
G0448 Freedom from discrimination or reprisal Element
G0466 Make efforts to resolve the problem(s) Element
G0718 Communication with physicians Element
G0946 Administrator appointed by governing body Element
G0954 Ensures qualified pre-designated person Element
G0972 Report all branch locations to SA Element