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
▼ 167049 Palo Alto County Hospital 3201 First Street Emmetsburg IA 7 (Kansas City) 11/30/2023 615DC-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
G0528 Health, psychosocial, functional, cognition 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
G0618 Treatments and therapy services Element
▼ 167049 Palo Alto County Hospital 3201 First Street Emmetsburg IA 7 (Kansas City) 12/09/2020 7M9P11 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
G0682 Infection Prevention Standard
G0440 Payment from federally funded programs Element
G0536 A review of all current medications 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
G1022 Discharge and transfer summaries Element
▼ 167050 Louisa County Public Health Nursing Service 12635 County Road G56, Suite 103 Wapello IA 7 (Kansas City) 01/28/2026 1E19F8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0768 Competency evaluation Standard
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0622 Name/contact information of clinical manager Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
▼ 167050 Louisa County Public Health Nursing Service 12635 County Road G56, Suite 103 Wapello IA 7 (Kansas City) 01/18/2023 5E971-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0616 Patient medication schedule/instructions Element
▼ 167050 Louisa County Public Health Nursing Service 12635 County Road G56, Suite 103 Wapello IA 7 (Kansas City) 01/08/2020 V9VH11 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
G0798 Home health aide assignments and duties Standard
G1024 Authentication 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
G1022 Discharge and transfer summaries Element
▼ 167051 County Of Floyd 1003 Gilbert Street Charles City IA 7 (Kansas City) 01/14/2026 1E077B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
G1022 Discharge and transfer summaries Element
▼ 167051 County Of Floyd 1003 Gilbert Street Charles City IA 7 (Kansas City) 01/19/2023 5E484-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
G0684 Infection control Standard
G0574 Plan of care must include the following Element
▼ 167051 County Of Floyd 1003 Gilbert Street Charles City IA 7 (Kansas City) 01/11/2021 14DL11 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
G0406 Patient rights Condition
G0570 Care planning, coordination, quality of care Condition
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0458 Outcomes/goals have been achieved 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
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0602 Communication with all physicians Element
G0800 Services provided by HH aide Element
G0814 Non-skilled direct observation every 60 days Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 167051 County Of Floyd 1003 Gilbert Street Charles City IA 7 (Kansas City) 03/29/2018 3G1T11 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
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0768 Competency evaluation Standard
G1024 Authentication Standard
G0414 HHA administrator contact information Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0616 Patient medication schedule/instructions Element
G0706 Interdisciplinary assessment of the patient Element
G0772 Documentation of competency evaluation Element
G0818 HH aide supervision elements Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 167054 Cerro Gordo County Department Of Public Health 2570 4th St Sw Suite 1 Mason City IA 7 (Kansas City) 12/11/2024 64E0D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0798 Home health aide assignments and duties Standard
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0616 Patient medication schedule/instructions Element
G0764 HH aide training program topics Element
G0800 Services provided by HH aide Element
G1014 Interventions and patient response Element