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
▼ 167105 Floyd Valley Healthcare 1080 Holton Drive Sw Le Mars IA 7 (Kansas City) 06/30/2021 PRGW11 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
G0442 Written notice for non-covered care Element
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
G0590 Promptly alert relevant physician of changes Element
G1022 Discharge and transfer summaries Element
▼ 167105 Floyd Valley Healthcare 1080 Holton Drive Sw Le Mars IA 7 (Kansas City) 09/12/2018 PVFD11 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
G0574 Plan of care must include the following Element
G0718 Communication with physicians Element
▼ 167106 Lakes Regional Healthcare 2301 Hwy 71 Spirit Lake IA 7 (Kansas City) 12/20/2023 61931-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
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 167106 Lakes Regional Healthcare 2301 Hwy 71 Spirit Lake IA 7 (Kansas City) 12/23/2020 VVN811 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
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
G1022 Discharge and transfer summaries Element
▼ 167108 Guthrie County Public Health Nursing Service 2002 State Street Guthrie Center IA 7 (Kansas City) 08/07/2024 63A72-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
G1024 Authentication Standard
G0802 Duties of a HH aide Element
G1022 Discharge and transfer summaries Element
▼ 167108 Guthrie County Public Health Nursing Service 2002 State Street Guthrie Center IA 7 (Kansas City) 10/13/2021 0TI411 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
G0682 Infection Prevention Standard
G1024 Authentication Standard
G0514 RN performs assessment 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
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
▼ 167108 Guthrie County Public Health Nursing Service 2002 State Street Guthrie Center IA 7 (Kansas City) 11/08/2018 7KG011 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0031 Emergency Officials Contact Information Standard
E0037 EP Training Program Standard
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G0710 Provide services in the plan of care Element
▼ 167109 Washington County Public Health And Home Care 2175 Lexington Blvd Building #2 Washington IA 7 (Kansas City) 12/20/2023 6192F-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
▼ 167109 Washington County Public Health And Home Care 2175 Lexington Blvd Building #2 Washington IA 7 (Kansas City) 04/15/2021 GU0D11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0750 Home health aide services Condition
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
G0486 Protect patient during investigation Element
G0528 Health, psychosocial, functional, cognition Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
▼ 167109 Washington County Public Health And Home Care 2175 Lexington Blvd Building #2 Washington IA 7 (Kansas City) 12/17/2020 DESI11 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0039 EP Testing Requirements Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element