S&C QCOR HHA 2567s
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HHAs 2567s
Selection Criteria ▸

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
▼ 167148 Unitypoint At Home 11333 Aurora Avenue Urbandale IA 7 (Kansas City) 09/05/2019 KYKM11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0484 Document complaint and resolution Element
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
▼ 167149 Unitypoint At Home 214 S 25th Street Fort Dodge IA 7 (Kansas City) 10/26/2021 6F7J11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0608 Coordinate care delivery Element
▼ 167151 Mercy Medical Center 2740 First Avenue Ne Cedar Rapids IA 7 (Kansas City) 01/15/2024 615DD-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
▼ 167154 Mercy Home Care & Hospice-Clinton 915 13th Ave N Clinton IA 7 (Kansas City) 08/02/2018 I8KA11 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
G0710 Provide services in the plan of care Element
G1022 Discharge and transfer summaries Element
▼ 167156 Delaware County Memorial Hospital 613 West Main Street Manchester IA 7 (Kansas City) 01/16/2025 650AE-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
G0800 Services provided by HH aide Element
▼ 167156 Delaware County Memorial Hospital 613 West Main Street Manchester IA 7 (Kansas City) 03/09/2022 3852E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
▼ 167156 Delaware County Memorial Hospital 613 West Main Street Manchester IA 7 (Kansas City) 03/25/2019 36LN11 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
G0572 Plan of care Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
▼ 167157 Mobile Nursing Services 705 Avenue G Fort Madison IA 7 (Kansas City) 07/14/2021 VT7C11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G1008 Clinical records Condition
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution 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
G0604 Integrate all orders Element
G0608 Coordinate care delivery Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 167164 Sioux Center Community Hospital And And Health Center 1400 7th Avenue Se Sioux Center IA 7 (Kansas City) 11/27/2023 615D9-H1 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
G0440 Payment from federally funded programs Element
G0444 State toll free HH telephone hotline 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
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
▼ 167164 Sioux Center Community Hospital And And Health Center 1400 7th Avenue Se Sioux Center IA 7 (Kansas City) 11/18/2020 4L1F11 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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0440 Payment from federally funded programs Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element