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
▼ 15K083 Purpose Home Health Llc 5455 Harrison Park Lane Ste B Indianapolis IN 5 (Chicago) 01/31/2024 62163-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0942 Governing body Standard
G0946 Administrator appointed by governing body Element
▼ 15K083 Purpose Home Health Llc 5455 Harrison Park Lane Ste B Indianapolis IN 5 (Chicago) 03/08/2023 5F2A4-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0478 Investigate complaints made by patient Element
G0486 Protect patient during investigation Element
G0488 Immediate reporting of abuse by all staff Element
▼ 15K083 Purpose Home Health Llc 5455 Harrison Park Lane Ste B Indianapolis IN 5 (Chicago) 03/18/2022 383C7-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0708 Development and evaluation of plan of care Element
▼ 15K083 Purpose Home Health Llc 5455 Harrison Park Lane Ste B Indianapolis IN 5 (Chicago) 03/29/2019 YTBC11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G1022 Discharge and transfer summaries Element
▼ 15K086 Forte Home Health Care Inc 120 S Lake Street Ste 50 Warsaw IN 5 (Chicago) 08/08/2024 63CB2-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
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
▼ 15K086 Forte Home Health Care Inc 120 S Lake Street Ste 50 Warsaw IN 5 (Chicago) 12/07/2021 37FA7-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0484 Document complaint and resolution 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
G0946 Administrator appointed by governing body Element
G0968 Assure implementation of plan of care Element
G1014 Interventions and patient response Element
▼ 15K086 Forte Home Health Care Inc 120 S Lake Street Ste 50 Warsaw IN 5 (Chicago) 02/21/2019 GA4P11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0684 Infection control 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
G0592 Revised plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0962 Coordinate patient care Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
▼ 15K091 Help At Home Inc 9025 Coldwater Rd Ste 400 Fort Wayne IN 5 (Chicago) 10/28/2022 5E1A8-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0454 HHA can no longer meet the patient's needs Element
G0478 Investigate complaints made by patient Element
▼ 15K091 Help At Home Inc 9025 Coldwater Rd Ste 400 Fort Wayne IN 5 (Chicago) 06/10/2022 4EB97-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0446 Contact info Federal/State-funded entities Element
▼ 15K091 Help At Home Inc 9025 Coldwater Rd Ste 400 Fort Wayne IN 5 (Chicago) 02/09/2022 38383-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G1028 Protection of records Standard
G1030 Retrieval of records Standard
G0592 Revised plan of care Element
G0706 Interdisciplinary assessment of the patient Element
G1012 Required items in clinical record Element