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
▼ 157719 Independent Home Health Care Llc 1919 E. 52nd Street Indianapolis IN 5 (Chicago) 09/20/2024 641D5-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
G0572 Plan of care Standard
G1024 Authentication Standard
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
G0590 Promptly alert relevant physician of changes Element
G0604 Integrate all orders Element
G0608 Coordinate care delivery Element
G1022 Discharge and transfer summaries Element
▼ 157721 A Passionate Helping Hand Home Health Care Llc 4701 N Keystone Ave Ste 502 Indianapolis IN 5 (Chicago) 02/07/2025 65371-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
▼ 157721 A Passionate Helping Hand Home Health Care Llc 4701 N Keystone Ave Ste 502 Indianapolis IN 5 (Chicago) 03/05/2024 620C7-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 Patient rights Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0518 Completion of the comprehensive assessment Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0660 Executive responsibilities for QAPI Standard
G0780 Instructor qualifications Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G0958 Clinical manager Standard
G1024 Authentication Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0416 OASIS privacy notice Element
G0434 Participate in care Element
G0444 State toll free HH telephone hotline Element
G0446 Contact info Federal/State-funded entities Element
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution 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
G0576 All orders recorded in plan of care 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
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0620 Other pertinent instructions 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
G0718 Communication with physicians Element
G0754 A qualified HH aide successfully completed: Element
G0760 Classroom and supervised practical training Element
G0802 Duties of a HH aide Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G0960 Make patient and personnel assignments, Element
G1012 Required items in clinical record Element
G1018 Contact information for the patient Element
G1020 Contact info for primary care practitioner Element
G1022 Discharge and transfer summaries Element
▼ 157721 A Passionate Helping Hand Home Health Care Llc 4701 N Keystone Ave Ste 502 Indianapolis IN 5 (Chicago) 10/11/2023 612FE-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
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
G0948 Responsible for all day-to-day operations Element
▼ 157724 Clover, Llc 9765 Randall Dr Carmel IN 5 (Chicago) 05/10/2024 62D3D-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
G0436 Receive all services in plan of care Element
G0516 Skilled professional performs assessment Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0550 At discharge 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
G0598 Discharge plans communication Element
▼ 157725 Canary Home Healthcare Of Indiana Inc 9247 Broadway Street Suite A Merrillville IN 5 (Chicago) 04/09/2026 22D862-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
G0680 Infection prevention and control Condition
G0750 Home health aide services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0029 Development of Communication Plan Standard
E0031 Emergency Officials Contact Information Standard
E0037 EP Training Program Standard
G0544 Update of the comprehensive assessment Standard
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G1024 Authentication Standard
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0534 Patient's needs 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
G0584 Verbal orders 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
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
G0962 Coordinate patient care Element
▼ 157725 Canary Home Healthcare Of Indiana Inc 9247 Broadway Street Suite A Merrillville IN 5 (Chicago) 08/03/2023 60B79-H1 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
G0544 Update of the comprehensive assessment Standard
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care 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
G0588 Reviewed, revised by physician every 60 days Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
G1012 Required items in clinical record Element
▼ 157727 Ohio Valley Medex Inc 700 E. Spring St. New Albany IN 5 (Chicago) 01/20/2026 1D17A1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0726 Nursing services supervised by RN Element
G0808 Onsite supervisory visit every 14 days Element
▼ 157735 Divine Healthcare Llc 1743 S Dequincy Street Indianapolis IN 5 (Chicago) 02/05/2025 654C3-H1 Initial Certification
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
▼ 157736 Alternative Care Solutions Pa Llc 525 W Main St Mitchell IN 5 (Chicago) 05/07/2025 66193-H1 Initial Certification
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
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
G1012 Required items in clinical record Element