S&C QCOR HHA 2567s
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HHAs 2567s
Selection Criteria ▸

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
▼ 15K035 Trinity Home Health Care Inc 3502 Stellhorn Road Fort Wayne IN 5 (Chicago) 11/19/2021 7RM8-H2 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G1030 Retrieval of records Standard
G0436 Receive all services in plan of care Element
G0446 Contact info Federal/State-funded entities Element
G0528 Health, psychosocial, functional, cognition Element
G1012 Required items in clinical record Element
▼ 15K035 Trinity Home Health Care Inc 3502 Stellhorn Road Fort Wayne IN 5 (Chicago) 08/06/2021 7RM811 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0510 Comprehensive Assessment of Patients Condition
G0560 Discharge Planning Condition
G0570 Care planning, coordination, quality of care Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G0544 Update of the comprehensive assessment Standard
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0414 HHA administrator contact information Element
G0416 OASIS privacy notice Element
G0422 Written notice within 4 business days Element
G0428 Property and person treated with respect Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0440 Payment from federally funded programs Element
G0446 Contact info Federal/State-funded entities Element
G0514 RN performs assessment 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
G0540 The patient's representative (if any); Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0610 Patients receive education and training Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager Element
G0708 Development and evaluation of plan of care Element
G0726 Nursing services supervised by RN Element
G0754 A qualified HH aide successfully completed: Element
G0760 Classroom and supervised practical training Element
G0800 Services provided by HH aide Element
G0802 Duties of a HH aide Element
G0948 Responsible for all day-to-day operations Element
G0952 Ensure that HHA employs qualified personnel Element
G0960 Make patient and personnel assignments, Element
G0984 In accordance with current clinical practice Element
▼ 15K035 Trinity Home Health Care Inc 3502 Stellhorn Road Fort Wayne IN 5 (Chicago) 01/25/2019 B9GC11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
▼ 15K035 Trinity Home Health Care Inc 3502 Stellhorn Road Fort Wayne IN 5 (Chicago) 08/27/2018 W5QD11 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
G1052 Administrator Standard
G1058 Home Health Aide Standard
G0520 5 calendar days after start of care Element
G0716 Preparing clinical notes Element
G0802 Duties of a HH aide Element
G0948 Responsible for all day-to-day operations Element
▼ 15K039 Life's Touch Home Health Inc 4701 Keystone Ave Ste 505 Indianapolis IN 5 (Chicago) 02/12/2025 65339-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1058 Home Health Aide Standard
G0952 Ensure that HHA employs qualified personnel Element
▼ 15K039 Life's Touch Home Health Inc 4701 Keystone Ave Ste 505 Indianapolis IN 5 (Chicago) 06/06/2024 6341B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
▼ 15K039 Life's Touch Home Health Inc 4701 Keystone Ave Ste 505 Indianapolis IN 5 (Chicago) 04/04/2022 3877D-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 15K039 Life's Touch Home Health Inc 4701 Keystone Ave Ste 505 Indianapolis IN 5 (Chicago) 03/12/2021 HL1911 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0590 Promptly alert relevant physician of changes Element
▼ 15K039 Life's Touch Home Health Inc 4701 Keystone Ave Ste 505 Indianapolis IN 5 (Chicago) 04/13/2018 YQRH11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0572 Plan of care Standard
G0644 Program data Standard
G0682 Infection Prevention Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0422 Written notice within 4 business days Element
G0430 Be free from abuse Element
G0434 Participate in care Element
G0438 Have a confidential clinical record Element
G0444 State toll free HH telephone hotline Element
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0592 Revised plan of care Element
G0608 Coordinate care delivery Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0800 Services provided by HH aide Element
G0856 Officer, a director, agent, managing employee Element
G0948 Responsible for all day-to-day operations Element
G0962 Coordinate patient care Element
G0968 Assure implementation of plan of care Element
G0984 In accordance with current clinical practice Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
G1022 Discharge and transfer summaries Element
▼ 15K060 Bethany Cares Inc D/B/A 3637 S Sr 3 New Castle IN 5 (Chicago) 04/03/2023 5EC29-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0706 Interdisciplinary assessment of the patient Element
G0708 Development and evaluation of plan of care Element
G0788 Org. had partial/extended survey Element