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
▼ 15K137 Master's Touch Home Care Inc, The 7275 N Shadeland Ave Suite 1 Indianapolis IN 5 (Chicago) 07/23/2019 RV8411 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0852 Information to the state survey agency Standard
G0948 Responsible for all day-to-day operations Element
▼ 15K137 Master's Touch Home Care Inc, The 7275 N Shadeland Ave Suite 1 Indianapolis IN 5 (Chicago) 03/12/2019 3E3Z11 Complaint, 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
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0608 Coordinate care delivery Element
G0708 Development and evaluation of plan of care Element
G0716 Preparing clinical notes Element
G0962 Coordinate patient care Element
▼ 15K138 At Home Senior Care Services Llc 130 W 8th Street Anderson IN 5 (Chicago) 10/12/2021 19729-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0848 Compliance with Federal, State, Local Law Condition
G0682 Infection Prevention Standard
G0860 Licensing Standard
▼ 15K138 At Home Senior Care Services Llc 130 W 8th Street Anderson IN 5 (Chicago) 01/29/2019 TYUX11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0436 Receive all services in plan of care Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0716 Preparing clinical notes Element
G0802 Duties of a HH aide Element
▼ 15K140 Golden Heart Health Services Llc 3313 S 7th Street Terre Haute IN 5 (Chicago) 05/14/2024 62F40-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0370 Reporting OASIS information Condition
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
E0013 Development of EP Policies and Procedures Standard
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0414 HHA administrator contact information Element
G0436 Receive all services in plan of care Element
G0514 RN performs assessment 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
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0622 Name/contact information of clinical manager Element
G0802 Duties of a HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
G0978 Must have a written agreement Element
G1012 Required items in clinical record Element
▼ 15K140 Golden Heart Health Services Llc 3313 S 7th Street Terre Haute IN 5 (Chicago) 11/19/2021 09DL11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
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
G0640 Quality assessment/performance improvement Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0452 Transfer and discharge Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0416 OASIS privacy notice Element
G0418 Patient's or legal representative's signature Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0440 Payment from federally funded programs Element
G0444 State toll free HH telephone hotline Element
G0484 Document complaint and resolution Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager Element
G0754 A qualified HH aide successfully completed: Element
G0760 Classroom and supervised practical training Element
G0762 Minimum hours of training Element
G0766 HHA maintains documentation of training Element
G0800 Services provided by HH aide Element
G0802 Duties of a HH aide Element
G0948 Responsible for all day-to-day operations Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 15K140 Golden Heart Health Services Llc 3313 S 7th Street Terre Haute IN 5 (Chicago) 04/24/2019 048M11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0484 Document complaint and resolution Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0706 Interdisciplinary assessment of the patient Element
G0804 Aides are members of interdisciplinary team Element
G0818 HH aide supervision elements Element
G0948 Responsible for all day-to-day operations Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
▼ 15K144 Comfort Home Health Llc 1815 S Plate Street Kokomo IN 5 (Chicago) 08/23/2024 63F0E-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
G0592 Revised plan of care Element
▼ 15K144 Comfort Home Health Llc 1815 S Plate Street Kokomo IN 5 (Chicago) 10/25/2018 OJ4I11 Complaint, 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
G0536 A review of all current medications Element
G0574 Plan of care must include the following 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
G0800 Services provided by HH aide Element
G0984 In accordance with current clinical practice Element
G1022 Discharge and transfer summaries Element
▼ 15K150 My Care At Home, Home Health Care Services, Llc 106 W Boggstown Rd Shelbyville IN 5 (Chicago) 11/13/2019 L0BE11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0660 Executive responsibilities for QAPI Standard
G0942 Governing body Standard
G0434 Participate in care Element
G0484 Document complaint and resolution Element
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0710 Provide services in the plan of care Element