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
▼ 167119 Veterans Memorial Hospital City Of Waukon Ia 12 E Main St Se Waukon IA 7 (Kansas City) 10/25/2023 61137-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
G0548 Within 48 hours of the patient's return Element
▼ 167119 Veterans Memorial Hospital City Of Waukon Ia 12 E Main St Se Waukon IA 7 (Kansas City) 10/14/2020 5VOO11 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
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
▼ 167120 Avera At Home 826 North Eighth Street Estherville IA 7 (Kansas City) 01/15/2026 1E0756-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
G0536 A review of all current medications Element
G0706 Interdisciplinary assessment of the patient Element
▼ 167120 Avera At Home 826 North Eighth Street Estherville IA 7 (Kansas City) 12/21/2022 5E482-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
G0622 Name/contact information of clinical manager Element
▼ 167120 Avera At Home 826 North Eighth Street Estherville IA 7 (Kansas City) 12/19/2019 R4V111 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0031 Emergency Officials Contact Information Standard
E0037 EP Training Program 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
G0718 Communication with physicians Element
G0972 Report all branch locations to SA Element
G1012 Required items in clinical record Element
▼ 167124 Gentiva Certified Healthcare Corp 1305 Boyson Loop, Suite B Hiawatha IA 7 (Kansas City) 10/08/2024 64358-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
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
G1014 Interventions and patient response Element
▼ 167124 Gentiva Certified Healthcare Corp 1305 Boyson Loop, Suite B Hiawatha IA 7 (Kansas City) 11/03/2021 37D82-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
G0576 All orders recorded in plan of care Element
G1014 Interventions and patient response Element
▼ 167124 Gentiva Certified Healthcare Corp 1305 Boyson Loop, Suite B Hiawatha IA 7 (Kansas City) 11/26/2019 2UT411 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G1014 Interventions and patient response Element
▼ 167124 Gentiva Certified Healthcare Corp 1305 Boyson Loop, Suite B Hiawatha IA 7 (Kansas City) 11/19/2018 20VG11 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
G0798 Home health aide assignments and duties Standard
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition 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
G0616 Patient medication schedule/instructions Element
G1014 Interventions and patient response Element
▼ 167127 Community Hospital, Inc. 2967 Us Highway 275 Ste 2 Hamburg IA 7 (Kansas City) 05/18/2022 386B7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0037 EP Training Program Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0764 HH aide training program topics Element
G1022 Discharge and transfer summaries Element