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
▼ 15K065 Help At Home Llc 1015 Professional Blvd Suite B Evansville IN 5 (Chicago) 11/04/2019 LZ6J11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
▼ 15K069 Guardian Home Health Llc 5958 W State Rd 340 Brazil IN 5 (Chicago) 02/13/2018 C64O11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0376 Transmittal of OASIS data Standard
G0544 Update of the comprehensive assessment Standard
G0586 Review and revision of the plan of care Standard
G0378 OASIS data transmission format Element
G0514 RN performs assessment Element
G0530 Strengths, goals, and care preferences Element
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
▼ 15K074 Aged, Llc 1017 14th Street Bedford IN 5 (Chicago) 12/20/2023 61A9C-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
▼ 15K074 Aged, Llc 1017 14th Street Bedford IN 5 (Chicago) 09/20/2023 6102F-H1 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
G0574 Plan of care must include the following Element
G0588 Reviewed, revised by physician every 60 days Element
G0616 Patient medication schedule/instructions Element
G0804 Aides are members of interdisciplinary team Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 15K074 Aged, Llc 1017 14th Street Bedford IN 5 (Chicago) 11/09/2021 37D9C-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
G0710 Provide services in the plan of care Element
▼ 15K076 Heaven Sent Home Health Care Llc 716 South Park Avenue Alexandria IN 5 (Chicago) 03/12/2025 65976-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
▼ 15K076 Heaven Sent Home Health Care Llc 716 South Park Avenue Alexandria IN 5 (Chicago) 10/28/2024 647DC-H1 Recertification
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
G1024 Authentication Standard
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0590 Promptly alert relevant physician of changes Element
G0800 Services provided by HH aide Element
▼ 15K076 Heaven Sent Home Health Care Llc 716 South Park Avenue Alexandria IN 5 (Chicago) 01/24/2022 382C2-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0528 Health, psychosocial, functional, cognition Element
G0532 Continuing need for home care Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0964 Coordinate referrals; Element
▼ 15K076 Heaven Sent Home Health Care Llc 716 South Park Avenue Alexandria IN 5 (Chicago) 05/30/2019 QHN911 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0768 Competency evaluation Standard
G0828 Medicaid personal care aide-only services Standard
G0754 A qualified HH aide successfully completed: Element
G0772 Documentation of competency evaluation Element
▼ 15K076 Heaven Sent Home Health Care Llc 716 South Park Avenue Alexandria IN 5 (Chicago) 01/16/2019 6OLY11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
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
G1008 Clinical records Condition
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G1010 Contents of clinical record Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0438 Have a confidential clinical record Element
G0448 Freedom from discrimination or reprisal Element
G0450 Access to auxiliary aids and language service Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: 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
G0602 Communication with all physicians Element
G0606 Integrate all services Element
G0616 Patient medication schedule/instructions Element
G0620 Other pertinent instructions 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
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0800 Services provided by HH aide Element
G0984 In accordance with current clinical practice Element