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
▼ 167295 Wesley At Home, Llc 4328 114th Street Urbandale IA 7 (Kansas City) 04/24/2019 QV3N11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0418 Patient's or legal representative's signature Element
G0440 Payment from federally funded programs Element
G0442 Written notice for non-covered care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
▼ 167299 Above And Beyond Home Health Care, Inc 417 East 1st Street Monticello IA 7 (Kansas City) 12/23/2024 64C15-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0608 Coordinate care delivery Element
▼ 167299 Above And Beyond Home Health Care, Inc 417 East 1st Street Monticello IA 7 (Kansas City) 10/13/2021 KCTH11 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
G0768 Competency evaluation Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return Element
G0576 All orders recorded in plan of care Element
G0800 Services provided by HH aide Element
▼ 167299 Above And Beyond Home Health Care, Inc 417 East 1st Street Monticello IA 7 (Kansas City) 10/18/2018 YMYI11 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
G0798 Home health aide assignments and duties Standard
G0516 Skilled professional performs assessment Element
G0536 A review of all current medications Element
G0548 Within 48 hours of the patient's return 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
G0800 Services provided by HH aide Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167305 Recover Health Of Iowa, Inc 2020 Indian Hills Drive, Suite 100 Sioux City IA 7 (Kansas City) 07/13/2022 4ED3A-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0580 Only as ordered by a physician Element
▼ 167306 Family Care Solutions, Llc 4893 Utica Ridge Road Davenport IA 7 (Kansas City) 02/04/2025 651CA-H1 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
G1012 Required items in clinical record Element
▼ 167306 Family Care Solutions, Llc 4893 Utica Ridge Road Davenport IA 7 (Kansas City) 06/29/2022 38959-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
G0576 All orders recorded in plan of care Element
G0800 Services provided by HH aide Element
▼ 167306 Family Care Solutions, Llc 4893 Utica Ridge Road Davenport IA 7 (Kansas City) 07/11/2019 YYGM11 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
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
▼ 167313 Recover Health Of Iowa, Inc. 1089 Longfellow Dr Hiawatha IA 7 (Kansas City) 07/12/2022 4ED3B-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0580 Only as ordered by a physician Element
▼ 167313 Recover Health Of Iowa, Inc. 1089 Longfellow Dr Hiawatha IA 7 (Kansas City) 02/06/2019 8ZWF11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0484 Document complaint and resolution Element
G0486 Protect patient during investigation Element
G0608 Coordinate care delivery Element
G0622 Name/contact information of clinical manager Element