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
▼ 167185 The Evangelical Lutheran Good Samaritan Society 1710 Lincoln Avenue, Suite A Spirit Lake IA 7 (Kansas City) 12/14/2022 5E481-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0768 Competency evaluation Standard
G1024 Authentication Standard
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
▼ 167185 The Evangelical Lutheran Good Samaritan Society 1710 Lincoln Avenue, Suite A Spirit Lake IA 7 (Kansas City) 12/05/2019 7T8211 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
G1024 Authentication Standard
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
G0718 Communication with physicians Element
G1014 Interventions and patient response Element
▼ 167186 Covenant Medical Center Inc 2055 Kimball Ave Ste 330 Waterloo IA 7 (Kansas City) 08/16/2021 GGT711 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
G0682 Infection Prevention Standard
G1024 Authentication 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
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
G0590 Promptly alert relevant physician of changes Element
G0800 Services provided by HH aide Element
G1022 Discharge and transfer summaries Element
▼ 167186 Covenant Medical Center Inc 2055 Kimball Ave Ste 330 Waterloo IA 7 (Kansas City) 09/20/2018 0ADF11 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
G0684 Infection control Standard
G0414 HHA administrator contact information Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0614 Visit schedule Element
▼ 167187 Hawkeye Health Services, Inc. 6200 Aurora Avenue, Suite 100e Urbandale IA 7 (Kansas City) 10/23/2024 6452F-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 167187 Hawkeye Health Services, Inc. 6200 Aurora Avenue, Suite 100e Urbandale IA 7 (Kansas City) 01/24/2024 61C19-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
G0528 Health, psychosocial, functional, cognition Element
G0574 Plan of care must include the following Element
▼ 167187 Hawkeye Health Services, Inc. 6200 Aurora Avenue, Suite 100e Urbandale IA 7 (Kansas City) 12/15/2021 37F99-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
▼ 167187 Hawkeye Health Services, Inc. 6200 Aurora Avenue, Suite 100e Urbandale IA 7 (Kansas City) 01/06/2021 VK5Q11 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
G0798 Home health aide assignments and duties Standard
G1024 Authentication 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
G0580 Only as ordered by a physician Element
G1014 Interventions and patient response Element
▼ 167187 Hawkeye Health Services, Inc. 6200 Aurora Avenue, Suite 100e Urbandale IA 7 (Kansas City) 03/21/2018 UCBC11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0410 Information to patient Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 167188 Palmer Lutheran Health Center Inc 200 Jefferson St West Union IA 7 (Kansas City) 11/15/2023 615D8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element