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
▼ 167165 Horn Memorial Hospital 700 East Second Street-Physical Location Ida Grove IA 7 (Kansas City) 05/01/2024 62A00-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
▼ 167165 Horn Memorial Hospital 700 East Second Street-Physical Location Ida Grove IA 7 (Kansas City) 05/05/2021 4YIG11 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
E0019 Homebound HHA/Hospice Inform EP Officials Standard
G0572 Plan of care 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
G0754 A qualified HH aide successfully completed: Element
G0772 Documentation of competency evaluation Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167165 Horn Memorial Hospital 700 East Second Street-Physical Location Ida Grove IA 7 (Kansas City) 05/10/2018 4J3X11 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
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0528 Health, psychosocial, functional, cognition Element
G0550 At discharge 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
G0606 Integrate all services Element
▼ 167166 Kossuth Regional Health Center 1515 South Phillips Algona IA 7 (Kansas City) 02/25/2026 1E4617-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
G0528 Health, psychosocial, functional, cognition Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
▼ 167166 Kossuth Regional Health Center 1515 South Phillips Algona IA 7 (Kansas City) 02/22/2023 5E974-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
G0764 HH aide training program topics Element
G1022 Discharge and transfer summaries Element
▼ 167166 Kossuth Regional Health Center 1515 South Phillips Algona IA 7 (Kansas City) 02/13/2020 VB6511 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0684 Infection control Standard
G0768 Competency evaluation Standard
G0514 RN performs assessment 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
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0718 Communication with physicians Element
G0800 Services provided by HH aide Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167167 Sanford Health Network 118 North Seventh Avenue Sheldon IA 7 (Kansas City) 01/22/2026 1E11F1-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
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
▼ 167167 Sanford Health Network 118 North Seventh Avenue Sheldon IA 7 (Kansas City) 01/12/2023 5E970-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
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
▼ 167167 Sanford Health Network 118 North Seventh Avenue Sheldon IA 7 (Kansas City) 01/09/2020 4Y2211 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0414 HHA administrator contact information Element
G0536 A review of all current medications 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
G0710 Provide services in the plan of care Element
G0818 HH aide supervision elements Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167181 State University Of Iowa 3281 Ridgeway Dr Ste 213 Coralville IA 7 (Kansas City) 04/11/2019 BM0V11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G1008 Clinical records Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0546 Last 5 days of every 60 days unless: Element
G0548 Within 48 hours of the patient's return Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
G0772 Documentation of competency evaluation Element
G0814 Non-skilled direct observation every 60 days Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element