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
▼ 167042 Mitchell County 415 Pleasant Street, Suite 100 Osage IA 7 (Kansas City) 11/10/2020 DKL611 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
G0572 Plan of care Standard
G0702 Services by skilled professionals Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 167043 Worth County Public Health 95 Ninth Street North Northwood IA 7 (Kansas City) 07/31/2024 6338E-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
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
▼ 167043 Worth County Public Health 95 Ninth Street North Northwood IA 7 (Kansas City) 07/22/2021 WH7N11 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
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
G0572 Plan of care Standard
G0768 Competency evaluation Standard
G1024 Authentication Standard
G0546 Last 5 days of every 60 days unless: 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
G0590 Promptly alert relevant physician of changes Element
G0800 Services provided by HH aide Element
G0814 Non-skilled direct observation every 60 days Element
▼ 167043 Worth County Public Health 95 Ninth Street North Northwood IA 7 (Kansas City) 09/19/2018 331611 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
G0798 Home health aide assignments and duties Standard
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
▼ 167045 Wayne County Treasury 105 N Lafayette St Corydon IA 7 (Kansas City) 01/31/2024 61C18-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0768 Competency evaluation Standard
G0528 Health, psychosocial, functional, cognition Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0954 Ensures qualified pre-designated person Element
G1022 Discharge and transfer summaries Element
▼ 167045 Wayne County Treasury 105 N Lafayette St Corydon IA 7 (Kansas City) 01/21/2021 4YOC11 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
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0037 EP Training Program Standard
G0684 Infection control Standard
G1024 Authentication Standard
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
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
G1014 Interventions and patient response Element
▼ 167045 Wayne County Treasury 105 N Lafayette St Corydon IA 7 (Kansas City) 01/03/2018 81OT11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0202 HOME HEALTH AIDE SERVICES Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0114 PATIENT LIABILITY FOR PAYMENT Standard
G0121 COMPLIANCE W/ ACCEPTED PROFESSIONAL STD Standard
G0159 PLAN OF CARE Standard
G0165 CONFORMANCE WITH PHYSICIAN ORDERS Standard
G0170 SKILLED NURSING SERVICES Standard
G0172 DUTIES OF THE REGISTERED NURSE Standard
G0176 DUTIES OF THE REGISTERED NURSE Standard
G0210 HHA TRAINING - DOCUMENTATION Standard
G0212 COMPETENCY EVALUATION & IN-SERVICE TRAI Standard
G0214 COMPETENCY EVALUATION & IN-SERVICE TRAI Standard
G0224 ASSIGNMENT & DUTIES OF HOME HEALTH AIDE Standard
G0225 ASSIGNMENT & DUTIES OF HOME HEALTH AIDE Standard
G0322 ACCURACY OF ENCODED OASIS DATA Standard
G0334 COMPLETION OF THE COMPREHENSIVE ASSESSMENT Standard
G0339 UPDATE OF THE COMPREHENSIVE ASSESSMENT Standard
G0341 UPDATE OF THE COMPREHENSIVE ASSESSMENT Standard
G0342 INCORPORATION OF OASIS DATA ITEMS Standard
▼ 167046 Harrison County Home & Public Health 122 W 8th St Logan IA 7 (Kansas City) 08/21/2024 63A7E-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
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0813 Basis and Scope Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
▼ 167046 Harrison County Home & Public Health 122 W 8th St Logan IA 7 (Kansas City) 10/06/2021 HU5X11 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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0037 EP Training Program Standard
G0768 Competency evaluation Standard
G1024 Authentication Standard
G0536 A review of all current medications 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
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
G0800 Services provided by HH aide Element
G1012 Required items in clinical record Element
▼ 167046 Harrison County Home & Public Health 122 W 8th St Logan IA 7 (Kansas City) 10/11/2018 IUK511 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
E0017 HHA Comprehensive Assessment in Disaster Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0724 Supervise skilled professional assistants Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
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
G0548 Within 48 hours of the patient's return 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
G0814 Non-skilled direct observation every 60 days Element