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
▼ 237222 Gentiva Certified Healthcare Corp 625 Kenmoor Ave. Se, Ste 306 Grand Rapids MI 5 (Chicago) 03/05/2025 656BD-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
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G0528 Health, psychosocial, functional, cognition Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0800 Services provided by HH aide Element
▼ 237222 Gentiva Certified Healthcare Corp 625 Kenmoor Ave. Se, Ste 306 Grand Rapids MI 5 (Chicago) 03/03/2022 385A0-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
G0528 Health, psychosocial, functional, cognition Element
G0574 Plan of care must include the following Element
G1016 Goals in the patient's plans of care Element
G1018 Contact information for the patient Element
▼ 237222 Gentiva Certified Healthcare Corp 625 Kenmoor Ave. Se, Ste 306 Grand Rapids MI 5 (Chicago) 07/26/2019 Z31K11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0030 Names and Contact Information Standard
G0798 Home health aide assignments and duties Standard
G0480 Treatment or care Element
G0534 Patient's needs Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G1016 Goals in the patient's plans of care Element
G1022 Discharge and transfer summaries Element
▼ 237222 Gentiva Certified Healthcare Corp 625 Kenmoor Ave. Se, Ste 306 Grand Rapids MI 5 (Chicago) 03/20/2018 DTII11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0428 Property and person treated with respect Element
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
G0486 Protect patient during investigation Element
▼ 237239 St Francis Hospital 901 North Lincoln Rd Escanaba MI 5 (Chicago) 10/20/2023 6139B-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
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
G0800 Services provided by HH aide Element
G0946 Administrator appointed by governing body Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 237239 St Francis Hospital 901 North Lincoln Rd Escanaba MI 5 (Chicago) 10/29/2020 90R111 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
G0798 Home health aide assignments and duties Standard
G0528 Health, psychosocial, functional, cognition Element
▼ 237242 Lutheran Home Care Agency 100 Mayer Rd Frankenmuth MI 5 (Chicago) 08/23/2019 JJOM11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0468 Provide contact info other services Element
G0530 Strengths, goals, and care preferences Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0718 Communication with physicians Element
G1022 Discharge and transfer summaries Element
▼ 237243 Northern Home Care, Inc 42 W 2nd St #3 Pentwater MI 5 (Chicago) 01/25/2024 61F7B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0414 HHA administrator contact information Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G1022 Discharge and transfer summaries Element
▼ 237243 Northern Home Care, Inc 42 W 2nd St #3 Pentwater MI 5 (Chicago) 01/07/2021 THJN11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0526 Content of the comprehensive assessment Standard
G1024 Authentication Standard
G0574 Plan of care must include the following Element
▼ 237243 Northern Home Care, Inc 42 W 2nd St #3 Pentwater MI 5 (Chicago) 05/04/2020 HCZT11 Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0686 Infection control education Standard