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
▼ 167054 Cerro Gordo County Department Of Public Health 2570 4th St Sw Suite 1 Mason City IA 7 (Kansas City) 02/16/2022 38404-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
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care 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) 02/28/2019 JYWU11 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
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G1024 Authentication Standard
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
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0706 Interdisciplinary assessment of the patient Element
G0728 Rehab services supervised by PT, OT Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G0818 HH aide supervision elements Element
▼ 167055 Lee County Auditor 5001 Avenue O Fort Madison IA 7 (Kansas City) 08/29/2024 63A82-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
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
▼ 167055 Lee County Auditor 5001 Avenue O Fort Madison IA 7 (Kansas City) 10/06/2021 HJZH11 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
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties 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
G0576 All orders recorded in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0622 Name/contact information of clinical manager Element
G0800 Services provided by HH aide Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167055 Lee County Auditor 5001 Avenue O Fort Madison IA 7 (Kansas City) 10/04/2018 NJ0311 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
G0572 Plan of care Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties 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
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
G0800 Services provided by HH aide Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167056 Greenbelt Home Care 1707 21st St Eldora IA 7 (Kansas City) 01/07/2026 1DF74B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
▼ 167056 Greenbelt Home Care 1707 21st St Eldora IA 7 (Kansas City) 12/07/2022 5E483-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
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0800 Services provided by HH aide Element
▼ 167056 Greenbelt Home Care 1707 21st St Eldora IA 7 (Kansas City) 12/12/2019 CT7N11 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
E0039 EP Testing Requirements Standard
G0682 Infection Prevention Standard
G0724 Supervise skilled professional assistants Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G1014 Interventions and patient response Element
▼ 167057 Ringgold County (Board Of Health) 109 W Madison Street Mount Ayr IA 7 (Kansas City) 10/22/2020 PDKA11 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
G0412 Written notice of patient's rights Element
G0576 All orders recorded in plan of care Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0808 Onsite supervisory visit every 14 days Element
G1014 Interventions and patient response Element
▼ 167058 Visiting Nurse Association 600 Gunder Road Ne Elkader IA 7 (Kansas City) 01/10/2018 2NKE11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0158 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0159 PLAN OF CARE Standard
G0211 COMPETENCY EVALUATION & IN-SERVICE TRAI Standard
G0224 ASSIGNMENT & DUTIES OF HOME HEALTH AIDE Standard
G0225 ASSIGNMENT & DUTIES OF HOME HEALTH AIDE Standard
G0229 SUPERVISION Standard
G0236 CLINICAL RECORDS Standard
G0322 ACCURACY OF ENCODED OASIS DATA Standard
G0337 DRUG REGIMEN REVIEW Standard
G0339 UPDATE OF THE COMPREHENSIVE ASSESSMENT Standard
G0340 UPDATE OF THE COMPREHENSIVE ASSESSMENT Standard