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
▼ 15K115 Hands At Home Llc 329 S Landmark Avenue Bloomington IN 5 (Chicago) 09/20/2024 641CA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0436 Receive all services in plan of care Element
▼ 15K115 Hands At Home Llc 329 S Landmark Avenue Bloomington IN 5 (Chicago) 08/24/2022 4F308-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0704 Responsibilities of skilled professionals Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0588 Reviewed, revised by physician every 60 days Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
G1012 Required items in clinical record Element
▼ 15K115 Hands At Home Llc 329 S Landmark Avenue Bloomington IN 5 (Chicago) 08/25/2021 OCDG11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
▼ 15K115 Hands At Home Llc 329 S Landmark Avenue Bloomington IN 5 (Chicago) 12/05/2019 2O3C11 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
G0804 Aides are members of interdisciplinary team Element
▼ 15K116 Rhm Services Llc 737 East 86th St Indianapolis IN 5 (Chicago) 04/23/2024 62D8F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
▼ 15K116 Rhm Services Llc 737 East 86th St Indianapolis IN 5 (Chicago) 02/25/2021 7B5H11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0564 Discharge or Transfer Summary Content Standard
G0462 Before discharge for cause HHA must: Element
▼ 15K116 Rhm Services Llc 737 East 86th St Indianapolis IN 5 (Chicago) 03/27/2018 LZBT11 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
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0542 Incorporate OASIS items Element
G0574 Plan of care must include the following Element
G0606 Integrate all services Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0984 In accordance with current clinical practice Element
G1022 Discharge and transfer summaries Element
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 08/21/2025 1D4B50-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
E0013 Development of EP Policies and Procedures Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0033 Methods for Sharing Information Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
G1024 Authentication Standard
G0412 Written notice of patient's rights Element
G0436 Receive all services in plan of care Element
G0464 Advise the patient of discharge for cause Element
G0466 Make efforts to resolve the problem(s) Element
G0520 5 calendar days after start of care Element
G0530 Strengths, goals, and care preferences Element
G0550 At discharge 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
G0592 Revised plan of care Element
G0804 Aides are members of interdisciplinary team Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 02/06/2025 652B2-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
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 04/11/2023 5DF7E-H4 Recertification
Deficiency Tag Deficiency Description Tag Type
G0578 Conformance with physician orders Standard