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
▼ 167239 Home Sweet Home Care 16 West Sixth Street Atlantic IA 7 (Kansas City) 07/25/2019 95V011 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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0768 Competency evaluation Standard
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G1022 Discharge and transfer summaries Element
▼ 167239 Home Sweet Home Care 16 West Sixth Street Atlantic IA 7 (Kansas City) 06/06/2018 VZ7K11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1008 Clinical records Condition
G0550 At discharge Element
G0606 Integrate all services Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0948 Responsible for all day-to-day operations Element
▼ 167243 Orange City Area Health System 400 Central Avenue Nw Orange City IA 7 (Kansas City) 01/21/2026 1E11EE-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
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
▼ 167243 Orange City Area Health System 400 Central Avenue Nw Orange City IA 7 (Kansas City) 02/02/2023 5ED65-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
G0580 Only as ordered by a physician Element
▼ 167243 Orange City Area Health System 400 Central Avenue Nw Orange City IA 7 (Kansas City) 02/20/2020 BZAI11 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
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
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
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167245 Kismet Sux, Llc 206 Port Neal Road Sergeant Bluff IA 7 (Kansas City) 03/06/2024 625D9-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
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
G1022 Discharge and transfer summaries Element
▼ 167245 Kismet Sux, Llc 206 Port Neal Road Sergeant Bluff IA 7 (Kansas City) 08/18/2021 SKOY11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G1022 Discharge and transfer summaries Element
▼ 167245 Kismet Sux, Llc 206 Port Neal Road Sergeant Bluff IA 7 (Kansas City) 03/03/2021 LJH211 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
E0037 EP Training Program Standard
G0798 Home health aide assignments and duties 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
G0580 Only as ordered by a physician Element
▼ 167245 Kismet Sux, Llc 206 Port Neal Road Sergeant Bluff IA 7 (Kansas City) 04/05/2018 2PVW11 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
G1024 Authentication Standard
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0622 Name/contact information of clinical manager Element
G0814 Non-skilled direct observation every 60 days Element
G0818 HH aide supervision elements Element
G0856 Officer, a director, agent, managing employee Element
G1022 Discharge and transfer summaries Element
▼ 167247 Heartland Home Care 308 A Ave E Oskaloosa IA 7 (Kansas City) 04/17/2024 62A02-H1 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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0033 Methods for Sharing Information Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element