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
▼ 167294 Skyline Center Inc Home Health 2600 North Fourth Street Clinton IA 7 (Kansas City) 12/05/2019 0E7Z11 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
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0702 Services by skilled professionals Standard
G0724 Supervise skilled professional assistants Standard
G1024 Authentication Standard
G0520 5 calendar days after start of care Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge 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
G0764 HH aide training program topics Element
G0772 Documentation of competency evaluation Element
G0812 Direct observation every 12 months Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 11/18/2025 1D768E-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Condition of Participation: Patient rights. Condition
G0462 Before discharge for cause HHA must: Element
G0464 Advise the patient of discharge for cause Element
G0466 Make efforts to resolve the problem(s) Element
G0470 Document efforts to resolve problems Element
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 08/28/2025 1D5089-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 04/09/2025 65B75-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0598 Discharge plans communication Element
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 01/29/2025 650B2-H1 Complaint, 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
G0528 Health, psychosocial, functional, cognition Element
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
G0706 Interdisciplinary assessment of the patient Element
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 10/01/2024 640C9-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 07/10/2024 63730-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 05/15/2024 62FE2-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 02/02/2022 3823A-H1 Focused Infection Control, 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
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
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 02/27/2020 S6PU11 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
G0940 Organization and administration of services Condition
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0036 EP Training and Testing Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0414 HHA administrator contact information Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0604 Integrate all orders Element
G0622 Name/contact information of clinical manager Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G0818 HH aide supervision elements Element
G0974 Direct support and administrative control Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element