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
▼ 167405 Great Plains Healthcare, Inc. 201 1st Street Sw Suite A Clarion IA 7 (Kansas City) 04/13/2022 3852F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0510 Comprehensive Assessment of Patients Condition
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
G0440 Payment from federally funded programs Element
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
G0468 Provide contact info other services Element
G0470 Document efforts to resolve problems 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
G0576 All orders recorded in plan of care Element
G1022 Discharge and transfer summaries Element
▼ 167405 Great Plains Healthcare, Inc. 201 1st Street Sw Suite A Clarion IA 7 (Kansas City) 05/01/2019 TXGU11 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
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0772 Documentation of competency evaluation Element
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
G1022 Discharge and transfer summaries Element
▼ 167407 Good Samaritan Society Home Care 802 N Rolff Street Davenport IA 7 (Kansas City) 02/12/2026 1E25CD-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
G0574 Plan of care must include the following Element
G1012 Required items in clinical record Element
▼ 167407 Good Samaritan Society Home Care 802 N Rolff Street Davenport IA 7 (Kansas City) 03/02/2023 5F036-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
▼ 167407 Good Samaritan Society Home Care 802 N Rolff Street Davenport IA 7 (Kansas City) 01/26/2023 5E973-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
G0528 Health, psychosocial, functional, cognition Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following 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
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167407 Good Samaritan Society Home Care 802 N Rolff Street Davenport IA 7 (Kansas City) 01/22/2020 GRLH11 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
G0682 Infection Prevention Standard
G1024 Authentication Standard
G0548 Within 48 hours of the patient's return Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0818 HH aide supervision elements Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 167410 Lutheran Home For The Aged 1413 2nd Avenue Vinton IA 7 (Kansas City) 01/07/2026 1E009C-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
G0580 Only as ordered by a physician Element
G0800 Services provided by HH aide Element
▼ 167410 Lutheran Home For The Aged 1413 2nd Avenue Vinton IA 7 (Kansas City) 12/14/2022 5E480-H1 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
E0037 EP Training Program Standard
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
▼ 167410 Lutheran Home For The Aged 1413 2nd Avenue Vinton IA 7 (Kansas City) 12/31/2019 7HSG11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process 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
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0037 EP Training Program Standard
G0702 Services by skilled professionals Standard
G0798 Home health aide assignments and duties 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
G0800 Services provided by HH aide Element
G0818 HH aide supervision elements Element
G1014 Interventions and patient response Element
▼ 167411 Recover Health Of Iowa, Inc 5235 Grand Ave Davenport IA 7 (Kansas City) 08/12/2019 BAUR11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element