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
▼ 047850 Kah Development 4, Llc 1509 East Main Suite 6 Russellville AR 6 (Dallas) 10/06/2022 5DD37-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0536 A review of all current medications Element
G0596 Revisions communicated to patient and MDs Element
▼ 047850 Kah Development 4, Llc 1509 East Main Suite 6 Russellville AR 6 (Dallas) 09/06/2019 L03T11 Recertification
Deficiency Tag Deficiency Description Tag Type
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
G0616 Patient medication schedule/instructions Element
G0620 Other pertinent instructions Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 047850 Kah Development 4, Llc 1509 East Main Suite 6 Russellville AR 6 (Dallas) 05/04/2018 31ZQ11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G0598 Discharge plans communication Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
▼ 047853 Kah Development 4, Llc 925 N Washington Street Forrest City AR 6 (Dallas) 06/13/2024 634FA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G1022 Discharge and transfer summaries Element
▼ 047853 Kah Development 4, Llc 925 N Washington Street Forrest City AR 6 (Dallas) 11/09/2021 X2XO-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0572 Plan of care Standard
▼ 047853 Kah Development 4, Llc 925 N Washington Street Forrest City AR 6 (Dallas) 10/08/2021 X2XO11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0536 A review of all current medications Element
▼ 047853 Kah Development 4, Llc 925 N Washington Street Forrest City AR 6 (Dallas) 04/24/2018 DTUJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0526 Content of the comprehensive assessment Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
▼ 047855 Kah Development 4, Llc 72 West 2nd Street Waldron AR 6 (Dallas) 07/13/2023 60722-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0808 Onsite supervisory visit every 14 days Element
▼ 047855 Kah Development 4, Llc 72 West 2nd Street Waldron AR 6 (Dallas) 02/21/2020 OG5N11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
▼ 047870 Kah Development 4, Llc 14 Arnold Springs Road, Suite C Melbourne AR 6 (Dallas) 02/29/2024 626FE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element