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
▼ 167127 Community Hospital, Inc. 2967 Us Highway 275 Ste 2 Hamburg IA 7 (Kansas City) 05/28/2019 47J211 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
E0039 EP Testing Requirements Standard
G0768 Competency evaluation Standard
G1024 Authentication Standard
G0536 A review of all current medications 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
G0580 Only as ordered by a physician Element
G0818 HH aide supervision elements Element
G1022 Discharge and transfer summaries Element
▼ 167133 Trinity Home Health Services 500 Sw 7th Street, Suite 104 Des Moines IA 7 (Kansas City) 03/12/2025 65829-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
G0972 Report all branch locations to SA Element
▼ 167133 Trinity Home Health Services 500 Sw 7th Street, Suite 104 Des Moines IA 7 (Kansas City) 12/20/2022 5E5E1-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
▼ 167133 Trinity Home Health Services 500 Sw 7th Street, Suite 104 Des Moines IA 7 (Kansas City) 11/17/2021 37D84-H1 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
G0572 Plan of care Standard
G0942 Governing body Standard
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
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
G0608 Coordinate care delivery Element
G1014 Interventions and patient response Element
▼ 167133 Trinity Home Health Services 500 Sw 7th Street, Suite 104 Des Moines IA 7 (Kansas City) 11/29/2018 XJS811 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
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167134 County Of Wright 115 First Street Se Clarion IA 7 (Kansas City) 12/18/2019 WP2311 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
G0572 Plan of care Standard
G1024 Authentication Standard
G0440 Payment from federally funded programs 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
G0576 All orders recorded in plan of care Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0818 HH aide supervision elements Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167134 County Of Wright 115 First Street Se Clarion IA 7 (Kansas City) 07/18/2019 ZUSY11 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
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
▼ 167136 Southeast Iowa Regional Medical Center Inc. 1306 South Washington Road West Burlington IA 7 (Kansas City) 01/10/2024 61C17-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0590 Promptly alert relevant physician of changes Element
▼ 167136 Southeast Iowa Regional Medical Center Inc. 1306 South Washington Road West Burlington IA 7 (Kansas City) 12/28/2020 059X11 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
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
G0710 Provide services in the plan of care Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167136 Southeast Iowa Regional Medical Center Inc. 1306 South Washington Road West Burlington IA 7 (Kansas City) 01/25/2018 X40C11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0718 Communication with physicians Element
G0772 Documentation of competency evaluation 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