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
▼ 15K132 Blessed Hands Home Care Agency Llc 4626 W Western Avenue South Bend IN 5 (Chicago) 11/19/2019 MOXW11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G0572 Plan of care Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G1028 Protection of records Standard
G1056 Clinical Manager Standard
G1058 Home Health Aide Standard
G1072 Registered Nurse Standard
G0436 Receive all services in plan of care Element
G0440 Payment from federally funded programs Element
G0454 HHA can no longer meet the patient's needs Element
G0460 Patient refuses services Element
G0484 Document complaint and resolution Element
G0528 Health, psychosocial, functional, cognition 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
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0788 Org. had partial/extended survey Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G0818 HH aide supervision elements Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
▼ 15K132 Blessed Hands Home Care Agency Llc 4626 W Western Avenue South Bend IN 5 (Chicago) 02/20/2019 J56B11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0372 Encoding and transmitting OASIS Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0432 Make complaints to the HHA Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0462 Before discharge for cause HHA must: Element
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0602 Communication with all physicians Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0754 A qualified HH aide successfully completed: Element
G0800 Services provided by HH aide Element
G0950 Ensure clinical manager is available Element
G0952 Ensure that HHA employs qualified personnel Element
G0960 Make patient and personnel assignments, Element
G0964 Coordinate referrals; Element
G1012 Required items in clinical record Element
▼ 15K133 Tjf Investment Group Inc 2346 S Lynhurst Drive Suite 600 Indianapolis IN 5 (Chicago) 11/25/2025 1D7215-H2 Complaint
Deficiency Tag Deficiency Description Tag Type
G0438 Have a confidential clinical record Element
▼ 15K133 Tjf Investment Group Inc 2346 S Lynhurst Drive Suite 600 Indianapolis IN 5 (Chicago) 09/19/2025 1D7215-H1 Complaint
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
G0372 Encoding and transmitting OASIS Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0798 Home health aide assignments and duties Standard
G0958 Clinical manager Standard
G0574 Plan of care must include the following Element
G0616 Patient medication schedule/instructions Element
G0804 Aides are members of interdisciplinary team Element
G0948 Responsible for all day-to-day operations Element
G1012 Required items in clinical record Element
▼ 15K133 Tjf Investment Group Inc 2346 S Lynhurst Drive Suite 600 Indianapolis IN 5 (Chicago) 07/23/2024 62E5D-H3 Recertification
Deficiency Tag Deficiency Description Tag Type
G0590 Promptly alert relevant physician of changes Element
G0814 Non-skilled direct observation every 60 days Element
▼ 15K133 Tjf Investment Group Inc 2346 S Lynhurst Drive Suite 600 Indianapolis IN 5 (Chicago) 05/02/2024 62E5D-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
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0750 Home health aide services Condition
G0372 Encoding and transmitting OASIS Standard
G0564 Discharge or Transfer Summary Content Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0774 12 hours inservice every 12 months Standard
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0534 Patient's needs Element
G0538 Primary caregiver(s), if any Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
G0802 Duties of a HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
▼ 15K133 Tjf Investment Group Inc 2346 S Lynhurst Drive Suite 600 Indianapolis IN 5 (Chicago) 09/07/2021 1964A-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
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
▼ 15K133 Tjf Investment Group Inc 2346 S Lynhurst Drive Suite 600 Indianapolis IN 5 (Chicago) 01/10/2019 TZRI11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0644 Program data Standard
G0768 Competency evaluation Standard
G0590 Promptly alert relevant physician of changes Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0956 Available during all operating hours Element
▼ 15K137 Master's Touch Home Care Inc, The 7275 N Shadeland Ave Suite 1 Indianapolis IN 5 (Chicago) 08/01/2024 63BB8-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
G0940 Organization and administration of services Condition
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0942 Governing body Standard
G0528 Health, psychosocial, functional, cognition Element
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G1022 Discharge and transfer summaries Element
▼ 15K137 Master's Touch Home Care Inc, The 7275 N Shadeland Ave Suite 1 Indianapolis IN 5 (Chicago) 11/22/2021 37ECE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0706 Interdisciplinary assessment of the patient Element
G0804 Aides are members of interdisciplinary team Element
G0966 Assure patient needs are continually assessed Element