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
▼ 15K004 Scroggins Nursing And Home Services 8525 Sw Jennings St Commiskey IN 5 (Chicago) 12/18/2019 QX7611 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0574 Plan of care must include the following Element
▼ 15K005 Ohio Valley Medex Inc 204 Pearl Street Ste 201 New Albany IN 5 (Chicago) 01/27/2023 5EC75-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0562 Discharge Planning Standard
G0586 Review and revision of the plan of care Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0616 Patient medication schedule/instructions Element
▼ 15K005 Ohio Valley Medex Inc 204 Pearl Street Ste 201 New Albany IN 5 (Chicago) 11/04/2020 H1D111 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
▼ 15K005 Ohio Valley Medex Inc 204 Pearl Street Ste 201 New Albany IN 5 (Chicago) 12/31/2019 S1H511 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
G0848 Compliance with Federal, State, Local Law Condition
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0528 Health, psychosocial, functional, cognition 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
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
▼ 15K007 Horizons Community Care, Inc 1202 West Buena Vista Rd Suite 204 Evansville IN 5 (Chicago) 02/24/2022 38543-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0612 Written instructions to patient include: Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0944 Administrator must: Standard
G0414 HHA administrator contact information Element
G0444 State toll free HH telephone hotline Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
▼ 15K007 Horizons Community Care, Inc 1202 West Buena Vista Rd Suite 204 Evansville IN 5 (Chicago) 02/01/2019 NTCU11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0436 Receive all services in plan of care Element
G0454 HHA can no longer meet the patient's needs Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0598 Discharge plans communication Element
G0606 Integrate all services Element
G0802 Duties of a HH aide Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
G1022 Discharge and transfer summaries Element
▼ 15K008 Nurse Care Inc 790 E Marley Dr Terre Haute IN 5 (Chicago) 01/09/2018 JWAV11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0135 ADMINISTRATOR Standard
G0157 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0158 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0229 SUPERVISION Standard
G0236 CLINICAL RECORDS Standard
G0332 INITIAL ASSESSMENT VISIT Standard
G0340 UPDATE OF THE COMPREHENSIVE ASSESSMENT Standard
▼ 15K009 Home Care With A Heart Inc 1220 W Main St Ste D Greenfield IN 5 (Chicago) 11/16/2023 617FF-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0642 Program scope Standard
G0682 Infection Prevention Standard
G0982 Skilled services furnished Standard
G0956 Available during all operating hours Element
▼ 15K009 Home Care With A Heart Inc 1220 W Main St Ste D Greenfield IN 5 (Chicago) 08/27/2018 NW8K11 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
G0574 Plan of care must include the following Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
▼ 15K011 Best Home Health Care Services, Inc 325 N Eastern Ave Connersville IN 5 (Chicago) 06/21/2023 60099-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element