S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 167270 Intrepid Of Iowa, Inc 699 Walnut Street 4th Floor Des Moines IA 7 (Kansas City) 12/05/2018 GU5S11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0750 Home health aide services Condition
G0848 Compliance with Federal, State, Local Law Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0037 EP Training Program Standard
G0684 Infection control Standard
G0768 Competency evaluation 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
G0574 Plan of care must include the following Element
G0772 Documentation of competency evaluation Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G1022 Discharge and transfer summaries Element
▼ 167281 Fort Madison Community Hospital 5445 Avenue O, Suite 114 Fort Madison IA 7 (Kansas City) 07/21/2021 2JEF11 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
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G1014 Interventions and patient response Element
▼ 167281 Fort Madison Community Hospital 5445 Avenue O, Suite 114 Fort Madison IA 7 (Kansas City) 08/28/2018 62QU11 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
G0684 Infection control Standard
G0702 Services by skilled professionals Standard
G0528 Health, psychosocial, functional, cognition 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
G1022 Discharge and transfer summaries Element
▼ 167282 Kismet Rdk, Llc 1600 Summit Street Red Oak IA 7 (Kansas City) 02/06/2025 651CB-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
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0818 HH aide supervision elements Element
G1012 Required items in clinical record Element
▼ 167282 Kismet Rdk, Llc 1600 Summit Street Red Oak IA 7 (Kansas City) 06/08/2022 4EBB8-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
G0572 Plan of care Standard
G0768 Competency evaluation Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
G1022 Discharge and transfer summaries Element
▼ 167282 Kismet Rdk, Llc 1600 Summit Street Red Oak IA 7 (Kansas City) 06/05/2019 0NI111 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
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G1024 Authentication Standard
G0440 Payment from federally funded programs Element
G0520 5 calendar days after start of care 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
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G1022 Discharge and transfer summaries Element
▼ 167283 Advanced Home Health Care, Inc. 550 Roosevelt Avenue Burlington IA 7 (Kansas City) 09/24/2025 1D4A60-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
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0764 HH aide training program topics Element
G0800 Services provided by HH aide Element
▼ 167283 Advanced Home Health Care, Inc. 550 Roosevelt Avenue Burlington IA 7 (Kansas City) 10/13/2022 4F70D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
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
G0580 Only as ordered by a physician Element
▼ 167283 Advanced Home Health Care, Inc. 550 Roosevelt Avenue Burlington IA 7 (Kansas City) 10/17/2019 LQL811 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
G0768 Competency evaluation 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
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G0764 HH aide training program topics Element
G0800 Services provided by HH aide Element
▼ 167284 South Central Home Health Care 303 Sw Lorraine Leon IA 7 (Kansas City) 08/11/2020 CR5311 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0726 Nursing services supervised by RN Element
G0808 Onsite supervisory visit every 14 days Element