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
▼ 237289 Three Rivers Health System Inc. 711 S Health Parkway Three Rivers MI 5 (Chicago) 08/21/2024 63E73-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G1012 Required items in clinical record Element
▼ 237289 Three Rivers Health System Inc. 711 S Health Parkway Three Rivers MI 5 (Chicago) 08/13/2021 7TGZ11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0564 Discharge or Transfer Summary Content Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G0442 Written notice for non-covered care Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0616 Patient medication schedule/instructions Element
G0710 Provide services in the plan of care Element
G0808 Onsite supervisory visit every 14 days Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 237289 Three Rivers Health System Inc. 711 S Health Parkway Three Rivers MI 5 (Chicago) 08/21/2018 KWSV11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G0484 Document complaint and resolution Element
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0590 Promptly alert relevant physician of changes Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G0808 Onsite supervisory visit every 14 days Element
G0812 Direct observation every 12 months Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 237292 Dickinson Home Health 722 River Ave Iron Mountain MI 5 (Chicago) 11/28/2018 XMQ211 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0034 Information on Occupancy/Needs Standard
G0704 Responsibilities of skilled professionals Standard
G0798 Home health aide assignments and duties Standard
G1028 Protection of records Standard
G0446 Contact info Federal/State-funded entities Element
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
G0514 RN performs assessment 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
G0946 Administrator appointed by governing body Element
G0954 Ensures qualified pre-designated person Element
G1022 Discharge and transfer summaries Element
▼ 237411 Atrio Home Health Lakeshore 9 E 8th St Holland MI 5 (Chicago) 10/20/2022 5DEE3-H1 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
G0564 Discharge or Transfer Summary Content Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G0484 Document complaint and resolution Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0604 Integrate all orders Element
G0616 Patient medication schedule/instructions Element
G0622 Name/contact information of clinical manager Element
G0708 Development and evaluation of plan of care Element
G0716 Preparing clinical notes Element
G1022 Discharge and transfer summaries Element
▼ 237411 Atrio Home Health Lakeshore 9 E 8th St Holland MI 5 (Chicago) 10/25/2019 ZTM711 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
G0578 Conformance with physician orders Standard
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0800 Services provided by HH aide Element
▼ 237413 Neocare Health Systems, Inc 1000 John R Rd. Suite 211 Troy MI 5 (Chicago) 02/21/2024 62395-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G1008 Clinical records Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0436 Receive all services in plan of care Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications 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
G0718 Communication with physicians Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
G1018 Contact information for the patient Element
G1022 Discharge and transfer summaries Element
▼ 237413 Neocare Health Systems, Inc 1000 John R Rd. Suite 211 Troy MI 5 (Chicago) 02/26/2021 GQWO11 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
G0526 Content of the comprehensive assessment Standard
G0798 Home health aide assignments and duties Standard
G1010 Contents of clinical record Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
G0714 Patient and caregiver education Element
G1022 Discharge and transfer summaries Element
▼ 237414 Ace Home Care Network, Inc 8424 E 12 Mile Rd, Suite B5 Warren MI 5 (Chicago) 03/26/2024 627D1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 237414 Ace Home Care Network, Inc 8424 E 12 Mile Rd, Suite B5 Warren MI 5 (Chicago) 03/26/2021 XFY911 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
G0434 Participate in care Element
G0706 Interdisciplinary assessment of the patient Element