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
▼ 15K166 Home Sweet Home Health Care Llc 6795 S State Road 1 Hamilton IN 5 (Chicago) 09/24/2021 196E0-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0768 Competency evaluation Standard
G0800 Services provided by HH aide Element
▼ 15K166 Home Sweet Home Health Care Llc 6795 S State Road 1 Hamilton IN 5 (Chicago) 11/24/2020 PZTV11 Complaint, Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0592 Revised plan of care Element
G0608 Coordinate care delivery Element
G0948 Responsible for all day-to-day operations Element
▼ 15K166 Home Sweet Home Health Care Llc 6795 S State Road 1 Hamilton IN 5 (Chicago) 03/20/2018 XPYD11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0430 Be free from abuse Element
G0514 RN performs assessment Element
G0576 All orders recorded in plan of care Element
G0804 Aides are members of interdisciplinary team Element
G1022 Discharge and transfer summaries Element
▼ 15K167 Adaptive Nursing And Healthcare Services, Llc 6602 E 75th Street Ste 230 Indianapolis IN 5 (Chicago) 08/17/2021 06UR11 Complaint
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
G0942 Governing body Standard
G0482 Mistreatment, neglect or abuse Element
G0484 Document complaint and resolution Element
G0590 Promptly alert relevant physician of changes Element
G0948 Responsible for all day-to-day operations Element
▼ 15K167 Adaptive Nursing And Healthcare Services, Llc 6602 E 75th Street Ste 230 Indianapolis IN 5 (Chicago) 09/13/2019 MO5T11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0350 Release of patient identifiable OASIS info. Condition
G0406 Patient rights Condition
G0510 Comprehensive Assessment of Patients 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
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0768 Competency evaluation Standard
G0774 12 hours inservice every 12 months Standard
G0798 Home health aide assignments and duties Standard
G0982 Skilled services furnished Standard
G1024 Authentication Standard
G0410 Information to patient Element
G0414 HHA administrator contact information Element
G0438 Have a confidential clinical record Element
G0446 Contact info Federal/State-funded entities Element
G0454 HHA can no longer meet the patient's needs Element
G0482 Mistreatment, neglect or abuse Element
G0484 Document complaint and resolution Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0754 A qualified HH aide successfully completed: Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
G0962 Coordinate patient care Element
G0964 Coordinate referrals; Element
G0968 Assure implementation of plan of care Element
G0978 Must have a written agreement Element
G1012 Required items in clinical record Element
G1018 Contact information for the patient Element
G1022 Discharge and transfer summaries Element
▼ 15K168 Homefront Home Health Llc 6821 Lima Road Fort Wayne IN 5 (Chicago) 10/25/2024 647F3-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
G0710 Provide services in the plan of care Element
▼ 15K168 Homefront Home Health Llc 6821 Lima Road Fort Wayne IN 5 (Chicago) 08/27/2021 19662-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G1030 Retrieval of records Standard
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0946 Administrator appointed by governing body Element
▼ 15K169 Together Homecare Of Evansville Llc 4004 E Morgan Ave Ste 201 Evansville IN 5 (Chicago) 05/17/2024 628E8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0612 Written instructions to patient include: Standard
▼ 15K169 Together Homecare Of Evansville Llc 4004 E Morgan Ave Ste 201 Evansville IN 5 (Chicago) 09/16/2021 196A2-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G1024 Authentication Standard
G0436 Receive all services in plan of care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0592 Revised plan of care Element
G0606 Integrate all services Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
G0804 Aides are members of interdisciplinary team Element
▼ 15K169 Together Homecare Of Evansville Llc 4004 E Morgan Ave Ste 201 Evansville IN 5 (Chicago) 01/05/2021 UOG111 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0436 Receive all services in plan of care Element