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
▼ 15K171 Your Healing Touch, Llc 8801 N Meridian Street, Suite 209 Indianapolis IN 5 (Chicago) 03/30/2022 386F0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
▼ 15K172 Adaptive Nursing And Healthcare Services, Llc 400 N Main St Kokomo IN 5 (Chicago) 01/25/2022 3853F-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0798 Home health aide assignments and duties Standard
G0706 Interdisciplinary assessment of the patient Element
▼ 15K172 Adaptive Nursing And Healthcare Services, Llc 400 N Main St Kokomo IN 5 (Chicago) 06/23/2020 OR8W11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0686 Infection control education Standard
G0768 Competency evaluation Standard
G0772 Documentation of competency evaluation Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 15K172 Adaptive Nursing And Healthcare Services, Llc 400 N Main St Kokomo IN 5 (Chicago) 04/13/2020 9K5Z11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0686 Infection control education Standard
G0804 Aides are members of interdisciplinary team Element
▼ 15K173 Adaptive Nursing And Healthcare Services, Llc 938 Mezzanine Drive, Suite A Lafayette IN 5 (Chicago) 12/28/2020 KJOS11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services 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
G0478 Investigate complaints made by patient 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
G0550 At discharge 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
G0592 Revised plan of care Element
G0620 Other pertinent instructions Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0960 Make patient and personnel assignments, Element
G0974 Direct support and administrative control Element
G0978 Must have a written agreement Element
G0980 Primary HHA is responsible for patient care Element
▼ 15K173 Adaptive Nursing And Healthcare Services, Llc 938 Mezzanine Drive, Suite A Lafayette IN 5 (Chicago) 12/28/2020 RG1211 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services 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
G0478 Investigate complaints made by patient 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
G0550 At discharge 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
G0592 Revised plan of care Element
G0620 Other pertinent instructions Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0960 Make patient and personnel assignments, Element
G0974 Direct support and administrative control Element
G0978 Must have a written agreement Element
G0980 Primary HHA is responsible for patient care Element
▼ 15K174 Adaptive Nursing And Healthcare Services, Llc 1015 Professional Blvd Suite B Evansville IN 5 (Chicago) 03/22/2022 37FC3-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0612 Written instructions to patient include: Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G1024 Authentication Standard
G1052 Administrator Standard
G0436 Receive all services in plan of care Element
G0470 Document efforts to resolve problems Element
G0474 HHA ceases to operate Element
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
G0754 A qualified HH aide successfully completed: Element
G0788 Org. had partial/extended survey Element
G0800 Services provided by HH aide Element
G0952 Ensure that HHA employs qualified personnel Element
G0978 Must have a written agreement Element
G0984 In accordance with current clinical practice Element
▼ 15K174 Adaptive Nursing And Healthcare Services, Llc 1015 Professional Blvd Suite B Evansville IN 5 (Chicago) 12/14/2021 37FC3-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0852 Information to the state survey agency Standard
G0942 Governing body Standard
G0944 Administrator must: Standard
G0856 Officer, a director, agent, managing employee Element
G0858 Responsible for the management of the HHA Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0972 Report all branch locations to SA Element
▼ 15K177 Monarch Home Health Inc 711 Highlander Point Drive Floyds Knobs IN 5 (Chicago) 05/12/2023 5F92F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0039 EP Testing Requirements Standard
G0578 Conformance with physician orders Standard
G0644 Program data Standard
G0682 Infection Prevention Standard
G1024 Authentication Standard
G0436 Receive all services in plan of care Element
G0576 All orders recorded in plan of care Element
G0608 Coordinate care delivery Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
▼ 15K182 Personal Care Concepts Inc 3802 South Adams Street Marion IN 5 (Chicago) 04/10/2025 65C01-H1 Complaint, 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
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
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
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0382 Transmit data using compliant software 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
G0468 Provide contact info other services Element
G0470 Document efforts to resolve problems 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
G0584 Verbal orders Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element