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
▼ 167076 County Of Chickasaw 260 East Prospect New Hampton IA 7 (Kansas City) 09/17/2025 1D4A58-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0528 Health, psychosocial, functional, cognition Element
G0808 Onsite supervisory visit every 14 days Element
▼ 167076 County Of Chickasaw 260 East Prospect New Hampton IA 7 (Kansas City) 10/06/2022 4F70A-H1 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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
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
▼ 167076 County Of Chickasaw 260 East Prospect New Hampton IA 7 (Kansas City) 10/03/2019 NICO11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0768 Competency evaluation Standard
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
▼ 167077 Regional Health Services Of Howard County 402 2nd Ave Se Cresco IA 7 (Kansas City) 12/03/2025 1DC374-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
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
▼ 167077 Regional Health Services Of Howard County 402 2nd Ave Se Cresco IA 7 (Kansas City) 10/20/2022 4F70C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
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
G0590 Promptly alert relevant physician of changes Element
G0800 Services provided by HH aide Element
▼ 167077 Regional Health Services Of Howard County 402 2nd Ave Se Cresco IA 7 (Kansas City) 10/30/2019 LFLX11 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
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
▼ 167079 County Of Iowa 185 West Dillin Street, Suite #1 Marengo IA 7 (Kansas City) 02/19/2025 65475-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0802 Duties of a HH aide Element
▼ 167079 County Of Iowa 185 West Dillin Street, Suite #1 Marengo IA 7 (Kansas City) 09/11/2024 6400E-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
G1024 Authentication Standard
G0580 Only as ordered by a physician Element
▼ 167079 County Of Iowa 185 West Dillin Street, Suite #1 Marengo IA 7 (Kansas City) 10/12/2023 61139-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
▼ 167079 County Of Iowa 185 West Dillin Street, Suite #1 Marengo IA 7 (Kansas City) 11/16/2022 5E138-H1 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
G0750 Home health aide services Condition
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
E0007 EP Program Patient Population Standard
E0013 Development of EP Policies and Procedures Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0452 Transfer and discharge Standard
G0768 Competency evaluation Standard
G0850 Disclosure of ownership and management info. Standard
G0852 Information to the state survey agency Standard
G0942 Governing body Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0416 OASIS privacy notice Element
G0430 Be free from abuse Element
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0462 Before discharge for cause HHA must: Element
G0514 RN performs assessment 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
G0622 Name/contact information of clinical manager Element
G0800 Services provided by HH aide Element
G0856 Officer, a director, agent, managing employee Element
G0948 Responsible for all day-to-day operations Element
G0952 Ensure that HHA employs qualified personnel Element
G1022 Discharge and transfer summaries Element