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
▼ 167109 Washington County Public Health And Home Care 2175 Lexington Blvd Building #2 Washington IA 7 (Kansas City) 02/08/2018 DRH711 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
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
G0718 Communication with physicians Element
▼ 167110 County Of Webster 723 1st Avenue South, Suite 220 Fort Dodge IA 7 (Kansas City) 02/11/2026 1E32AA-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
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
G1022 Discharge and transfer summaries Element
▼ 167110 County Of Webster 723 1st Avenue South, Suite 220 Fort Dodge IA 7 (Kansas City) 02/08/2023 5ED95-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
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
▼ 167110 County Of Webster 723 1st Avenue South, Suite 220 Fort Dodge IA 7 (Kansas City) 02/06/2020 427411 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0037 EP Training Program Standard
G1024 Authentication 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
G0580 Only as ordered by a physician Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 167111 County Of Van Buren 404 Dodge Street Keosauqua IA 7 (Kansas City) 11/30/2023 615DA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0031 Emergency Officials Contact Information Standard
E0033 Methods for Sharing Information Standard
G0572 Plan of care Standard
G0548 Within 48 hours of the patient's return Element
G0576 All orders recorded in plan of care Element
▼ 167111 County Of Van Buren 404 Dodge Street Keosauqua IA 7 (Kansas City) 11/18/2020 MMUO11 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
G0798 Home health aide assignments and duties 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
G0580 Only as ordered by a physician Element
G0604 Integrate all orders Element
G1014 Interventions and patient response Element
▼ 167111 County Of Van Buren 404 Dodge Street Keosauqua IA 7 (Kansas City) 08/26/2020 7TD511 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0037 EP Training Program Standard
▼ 167118 Franklin General Hospital 1600 Central Avenue E Hampton IA 7 (Kansas City) 10/30/2024 6435B-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
G1022 Discharge and transfer summaries Element
▼ 167118 Franklin General Hospital 1600 Central Avenue E Hampton IA 7 (Kansas City) 12/15/2021 37F9D-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
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G1022 Discharge and transfer summaries Element
▼ 167118 Franklin General Hospital 1600 Central Avenue E Hampton IA 7 (Kansas City) 12/18/2018 9D0B11 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
E0037 EP Training Program Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
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
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G1022 Discharge and transfer summaries Element