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
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 02/21/2023 5DF7E-H3 Recertification
Deficiency Tag Deficiency Description Tag Type
G1028 Protection of records Standard
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 12/15/2022 5DF7E-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0644 Program data Standard
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 10/21/2022 5DF7E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0656 Improvements are sustained Element
G0800 Services provided by HH aide Element
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 06/22/2020 PTQ911 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
▼ 15K118 Hometown Home Healthcare Inc 302 E North B Street Gas City IN 5 (Chicago) 10/24/2019 CVFL11 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
G1028 Protection of records Standard
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0574 Plan of care must include the following Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0962 Coordinate patient care Element
G0978 Must have a written agreement Element
G1016 Goals in the patient's plans of care Element
▼ 15K124 Am Home Health Care, Inc 2420 N Coliseum Blvd Ste 100 Fort Wayne IN 5 (Chicago) 08/14/2025 1D2D28-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0766 HHA maintains documentation of training Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 15K124 Am Home Health Care, Inc 2420 N Coliseum Blvd Ste 100 Fort Wayne IN 5 (Chicago) 09/27/2024 644C7-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0782 Eligible training/competency evaluation orgs. Standard
G0760 Classroom and supervised practical training Element
G0762 Minimum hours of training Element
▼ 15K124 Am Home Health Care, Inc 2420 N Coliseum Blvd Ste 100 Fort Wayne IN 5 (Chicago) 07/08/2024 61CB0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0682 Infection Prevention Standard
G0416 OASIS privacy notice Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following 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
G0656 Improvements are sustained Element
G0808 Onsite supervisory visit every 14 days Element
▼ 15K124 Am Home Health Care, Inc 2420 N Coliseum Blvd Ste 100 Fort Wayne IN 5 (Chicago) 08/06/2021 JG6B11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
▼ 15K124 Am Home Health Care, Inc 2420 N Coliseum Blvd Ste 100 Fort Wayne IN 5 (Chicago) 08/15/2018 FXVN11 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
G0798 Home health aide assignments and duties Standard
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
G0604 Integrate all orders Element