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
▼ 167188 Palmer Lutheran Health Center Inc 200 Jefferson St West Union IA 7 (Kansas City) 11/05/2020 2U3211 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
G0576 All orders recorded in plan of care Element
G1022 Discharge and transfer summaries Element
▼ 167192 Sioux Valley Memorial Hospital Association 212 E Bow Drive Cherokee IA 7 (Kansas City) 09/18/2024 63A83-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
G0536 A review of all current medications Element
G0818 HH aide supervision elements Element
▼ 167192 Sioux Valley Memorial Hospital Association 212 E Bow Drive Cherokee IA 7 (Kansas City) 10/27/2021 37D41-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
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
G0580 Only as ordered by a physician Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
G0814 Non-skilled direct observation every 60 days Element
G1022 Discharge and transfer summaries Element
▼ 167192 Sioux Valley Memorial Hospital Association 212 E Bow Drive Cherokee IA 7 (Kansas City) 10/25/2018 6XIX11 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
E0036 EP Training and Testing Standard
G0702 Services by skilled professionals Standard
G0768 Competency evaluation Standard
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
G0576 All orders recorded in plan of care Element
G0710 Provide services in the plan of care Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167207 St Anthony Regional Hospital And Nursing Home 1524 E Us Highway 30 Carroll IA 7 (Kansas City) 10/18/2023 61135-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
G0706 Interdisciplinary assessment of the patient Element
▼ 167207 St Anthony Regional Hospital And Nursing Home 1524 E Us Highway 30 Carroll IA 7 (Kansas City) 10/21/2020 PLHS11 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
E0023 Policies/Procedures for Medical Documentation Standard
E0037 EP Training Program Standard
G0798 Home health aide assignments and duties Standard
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
▼ 167213 Carroll Area Nursing Services, Inc. 603 West 8th Street Carroll IA 7 (Kansas City) 11/06/2024 648C5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0536 A review of all current medications 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
G0800 Services provided by HH aide Element
G1014 Interventions and patient response Element
▼ 167213 Carroll Area Nursing Services, Inc. 603 West 8th Street Carroll IA 7 (Kansas City) 02/09/2022 38403-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication 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
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G1012 Required items in clinical record Element
▼ 167213 Carroll Area Nursing Services, Inc. 603 West 8th Street Carroll IA 7 (Kansas City) 02/04/2020 6PMX11 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
G0750 Home health aide services Condition
G0848 Compliance with Federal, State, Local Law Condition
E0007 EP Program Patient Population Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0031 Emergency Officials Contact Information Standard
E0037 EP Training Program Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0982 Skilled services furnished 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
G0710 Provide services in the plan of care Element
G0764 HH aide training program topics Element
G0772 Documentation of competency evaluation Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
G1014 Interventions and patient response Element
▼ 167220 Pella Regional Health Center 505 Union Street Pella IA 7 (Kansas City) 01/28/2026 1E19FC-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0596 Revisions communicated to patient and MDs Element
G0710 Provide services in the plan of care Element
G1022 Discharge and transfer summaries Element