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
▼ 167415 Visiting Nurse Services Of Iowa 3000 Easton Blvd Des Moines IA 7 (Kansas City) 06/21/2023 5FDFE-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
▼ 167416 Good Samaritan Society-Home Care 708 S Jefferson Way Indianola IA 7 (Kansas City) 02/06/2025 651C8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
▼ 167416 Good Samaritan Society-Home Care 708 S Jefferson Way Indianola IA 7 (Kansas City) 02/16/2022 37D85-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
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0440 Payment from federally funded programs 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
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0706 Interdisciplinary assessment of the patient Element
G0800 Services provided by HH aide Element
▼ 167416 Good Samaritan Society-Home Care 708 S Jefferson Way Indianola IA 7 (Kansas City) 02/13/2019 MGGG11 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
G0848 Compliance with Federal, State, Local Law Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0548 Within 48 hours of the patient's return Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
G0818 HH aide supervision elements Element
▼ 167423 Caregivers Home Health, Llc 19999 St Josephs Drive Centerville IA 7 (Kansas City) 02/18/2026 1E3C57-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
G0798 Home health aide assignments and duties Standard
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
▼ 167423 Caregivers Home Health, Llc 19999 St Josephs Drive Centerville IA 7 (Kansas City) 02/15/2023 5ED97-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
▼ 167423 Caregivers Home Health, Llc 19999 St Josephs Drive Centerville IA 7 (Kansas City) 03/05/2020 KP3L11 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
E0037 EP Training Program Standard
G0682 Infection Prevention 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
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
G0800 Services provided by HH aide Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 167426 Recover Health Of Iowa, Inc 2900 Westown Pkwy, Suite 200 West Des Moines IA 7 (Kansas City) 02/15/2024 62301-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0570 Care planning, coordination, quality of care Condition
G0438 Have a confidential clinical record Element
G0462 Before discharge for cause HHA must: Element
G0466 Make efforts to resolve the problem(s) Element
G0468 Provide contact info other services Element
G0470 Document efforts to resolve problems Element
G0590 Promptly alert relevant physician of changes Element
G0706 Interdisciplinary assessment of the patient Element
▼ 167426 Recover Health Of Iowa, Inc 2900 Westown Pkwy, Suite 200 West Des Moines IA 7 (Kansas City) 07/20/2022 4EF3F-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care 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
▼ 167426 Recover Health Of Iowa, Inc 2900 Westown Pkwy, Suite 200 West Des Moines IA 7 (Kansas City) 02/12/2020 3B6911 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
G0598 Discharge plans communication Element