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
▼ 177003 Cloud County Home Health Agency 910 W 11th Concordia KS 7 (Kansas City) 05/12/2021 72QT11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0412 Written notice of patient's rights Element
G0430 Be free from abuse Element
G0432 Make complaints to the HHA Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0442 Written notice for non-covered care Element
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0454 HHA can no longer meet the patient's needs 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
G0800 Services provided by HH aide Element
▼ 177017 Salina-Saline County Health Department 125 W Elm St Salina KS 7 (Kansas City) 08/14/2025 1D3A99-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0642 Program scope Standard
G0422 Written notice within 4 business days Element
G0442 Written notice for non-covered care Element
G0808 Onsite supervisory visit every 14 days Element
G1012 Required items in clinical record Element
▼ 177017 Salina-Saline County Health Department 125 W Elm St Salina KS 7 (Kansas City) 11/08/2018 EK4M11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0704 Responsibilities of skilled professionals Standard
G1010 Contents of clinical record Standard
G0574 Plan of care must include the following Element
▼ 177021 Washington County Hha 104 East 2nd Street Washington KS 7 (Kansas City) 03/07/2018 OTS411 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0410 Information to patient Element
G0514 RN performs assessment 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
G0588 Reviewed, revised by physician every 60 days Element
G0814 Non-skilled direct observation every 60 days Element
▼ 177030 Jefferson Co Home Health Agency 1212 Walnut St, Hwy 59 Oskaloosa KS 7 (Kansas City) 09/19/2024 642DA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
G0580 Only as ordered by a physician Element
G1022 Discharge and transfer summaries Element
▼ 177030 Jefferson Co Home Health Agency 1212 Walnut St, Hwy 59 Oskaloosa KS 7 (Kansas City) 10/06/2021 56CV11 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
G0536 A review of all current medications Element
▼ 177031 Northeast Kansas Multi County Health Department Inc 907 S 2nd St. Hiawatha KS 7 (Kansas City) 08/30/2023 60D6C-H1 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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
G0434 Participate in care Element
G0580 Only as ordered by a physician Element
G1022 Discharge and transfer summaries Element
▼ 177031 Northeast Kansas Multi County Health Department Inc 907 S 2nd St. Hiawatha KS 7 (Kansas City) 04/11/2019 T09L11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0704 Responsibilities of skilled professionals Standard
G1010 Contents of clinical record Standard
G0574 Plan of care must include the following Element
G0604 Integrate all orders Element
▼ 177034 Douglas County Visiting Nurses Association Inc 200 Maine St, Ste C Lawrence KS 7 (Kansas City) 08/07/2025 1D160A-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
G0682 Infection Prevention Standard
G0774 12 hours inservice every 12 months Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 177034 Douglas County Visiting Nurses Association Inc 200 Maine St, Ste C Lawrence KS 7 (Kansas City) 09/21/2023 6104B-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0958 Clinical manager Standard
G1056 Clinical Manager Standard
G0954 Ensures qualified pre-designated person Element