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
▼ 157752 Elders Journey Home Care Llc 4334 E 3rd Street Ste 100 Bloomington IN 5 (Chicago) 06/18/2024 634B0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Condition of Participation: Patient rights. Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
G1008 Clinical records Condition
E0036 EP Training and Testing Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0644 Program data Standard
G0682 Infection Prevention Standard
G0436 Receive all services in plan of care Element
G0464 Advise the patient of discharge for cause Element
G0468 Provide contact info other services Element
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
G0776 Inservice training supervised by RN Element
G0800 Services provided by HH aide Element
G0802 Duties of a HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0948 Responsible for all day-to-day operations Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 157752 Elders Journey Home Care Llc 4334 E 3rd Street Ste 100 Bloomington IN 5 (Chicago) 04/27/2022 38700-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
▼ 157752 Elders Journey Home Care Llc 4334 E 3rd Street Ste 100 Bloomington IN 5 (Chicago) 08/03/2021 RZLT11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
▼ 157752 Elders Journey Home Care Llc 4334 E 3rd Street Ste 100 Bloomington IN 5 (Chicago) 02/05/2019 OHQB11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0592 Revised plan of care Element
▼ 157753 Gant Family Home Health Care Llc 3418 East 20th Street Indianapolis IN 5 (Chicago) 04/22/2025 65F43-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
E0030 Names and Contact Information Standard
E0039 EP Testing Requirements Standard
G0564 Discharge or Transfer Summary Content Standard
G0682 Infection Prevention Standard
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
G1022 Discharge and transfer summaries Element
▼ 15K002 Shas Inc. 302 E Jefferson Blvd Fort Wayne IN 5 (Chicago) 04/21/2022 388C8-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
▼ 15K002 Shas Inc. 302 E Jefferson Blvd Fort Wayne IN 5 (Chicago) 11/16/2020 OHSX11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0768 Competency evaluation Standard
G0478 Investigate complaints made by patient Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0534 Patient's needs 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
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0946 Administrator appointed by governing body Element
G0978 Must have a written agreement Element
G0980 Primary HHA is responsible for patient care Element
▼ 15K004 Scroggins Nursing And Home Services 8525 Sw Jennings St Commiskey IN 5 (Chicago) 06/10/2025 66524-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
G0564 Discharge or Transfer Summary Content Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0414 HHA administrator contact information Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care 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
G1022 Discharge and transfer summaries Element
▼ 15K004 Scroggins Nursing And Home Services 8525 Sw Jennings St Commiskey IN 5 (Chicago) 10/03/2022 4F666-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0452 Transfer and discharge Standard
G0644 Program data Standard
G0654 Track adverse patient events Standard
G0658 Performance improvement projects Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G1026 Retention of records Standard
G0574 Plan of care must include the following Element
G1012 Required items in clinical record Element
▼ 15K004 Scroggins Nursing And Home Services 8525 Sw Jennings St Commiskey IN 5 (Chicago) 02/04/2021 2C7B11 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
G0682 Infection Prevention Standard