S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 167034 Home Care Services Of Boone County 105 South Marshall Boone IA 7 (Kansas City) 11/06/2019 GHA711 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
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
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0710 Provide services in the plan of care Element
G1014 Interventions and patient response Element
▼ 167035 Winnebago County Public Health Nursing Service 216 South 4th Street Forest City IA 7 (Kansas City) 01/16/2025 650AD-H1 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
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 167035 Winnebago County Public Health Nursing Service 216 South 4th Street Forest City IA 7 (Kansas City) 02/24/2022 38405-H1 Focused Infection Control, 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
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
▼ 167035 Winnebago County Public Health Nursing Service 216 South 4th Street Forest City IA 7 (Kansas City) 02/06/2019 8QQR11 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
G0848 Compliance with Federal, State, Local Law Condition
G0768 Competency evaluation Standard
G1024 Authentication Standard
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0710 Provide services in the plan of care Element
G0814 Non-skilled direct observation every 60 days Element
G0818 HH aide supervision elements Element
▼ 167038 Wapello County Public Health Nursing Services 108 East Main Street Ottumwa IA 7 (Kansas City) 05/30/2018 7H4411 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0542 Incorporate OASIS items Element
G0546 Last 5 days of every 60 days unless: Element
G0548 Within 48 hours of the patient's return Element
G0550 At discharge Element
G0710 Provide services in the plan of care Element
▼ 167039 Winneshiek County Public Health Nursing Service 305 Montgomery Street Decorah IA 7 (Kansas City) 04/11/2022 38406-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
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0942 Governing body Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0954 Ensures qualified pre-designated person Element
▼ 167039 Winneshiek County Public Health Nursing Service 305 Montgomery Street Decorah IA 7 (Kansas City) 04/25/2019 P5LS11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0007 EP Program Patient Population Standard
E0013 Development of EP Policies and Procedures Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0033 Methods for Sharing Information Standard
E0037 EP Training Program Standard
G0768 Competency evaluation Standard
G0440 Payment from federally funded programs Element
G0514 RN performs assessment Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
G1012 Required items in clinical record Element
▼ 167041 Cedar County 400 Cedar Street Tipton IA 7 (Kansas City) 11/08/2023 615D6-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G0818 HH aide supervision elements Element
▼ 167041 Cedar County 400 Cedar Street Tipton IA 7 (Kansas City) 10/15/2020 5K8B11 Focused Infection Control, Other-Fed, 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
G1024 Authentication Standard
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
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
G0576 All orders recorded in plan of care Element
G0582 Influenza and pneumococcal vaccines Element
G0710 Provide services in the plan of care Element
▼ 167042 Mitchell County 415 Pleasant Street, Suite 100 Osage IA 7 (Kansas City) 11/08/2023 615D7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element