S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 237609 Supreme Rehab, Inc. 29930 W 12 Mile Rd, Suite 3 Farmington Hills MI 5 (Chicago) 05/04/2022 386A1-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
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0940 Organization and administration of services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
G0642 Program scope Standard
G0644 Program data Standard
G0646 Program activities Standard
G0660 Executive responsibilities for QAPI Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0942 Governing body Standard
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
▼ 237609 Supreme Rehab, Inc. 29930 W 12 Mile Rd, Suite 3 Farmington Hills MI 5 (Chicago) 04/19/2019 M13B11 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
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0017 HHA Comprehensive Assessment in Disaster 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
E0029 Development of Communication Plan Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0774 12 hours inservice every 12 months Standard
G0798 Home health aide assignments and duties Standard
G0982 Skilled services furnished Standard
G0414 HHA administrator contact information Element
G0446 Contact info Federal/State-funded entities Element
G0536 A review of all current medications Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
G0706 Interdisciplinary assessment of the patient Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0812 Direct observation every 12 months Element
G1022 Discharge and transfer summaries Element
▼ 237611 Unity Home Health Care, Llc 575 Court Street Suite C West Branch MI 5 (Chicago) 04/04/2018 C5ZA11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0532 Continuing need for home care Element
▼ 237616 Patient First Home Care, Inc. 2660 Horizon Dr Se, Suite 130 Grand Rapids MI 5 (Chicago) 10/15/2020 Q3KG11 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
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
▼ 237617 Omni Home Health Care, Inc 25932 Dequindre Rd, Suite A Warren MI 5 (Chicago) 07/25/2024 63B44-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0686 Infection control education Standard
G0768 Competency evaluation Standard
G0442 Written notice for non-covered 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
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0808 Onsite supervisory visit every 14 days Element
G1022 Discharge and transfer summaries Element
▼ 237617 Omni Home Health Care, Inc 25932 Dequindre Rd, Suite A Warren MI 5 (Chicago) 07/22/2021 HFCK11 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
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
▼ 237619 Affinity Home Care Agency, Inc 2655 E Oakley Park Rd, Ste 106 Commerce Township MI 5 (Chicago) 09/12/2024 64144-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0682 Infection Prevention Standard
G0434 Participate in 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
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 237619 Affinity Home Care Agency, Inc 2655 E Oakley Park Rd, Ste 106 Commerce Township MI 5 (Chicago) 02/02/2022 196A5-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0578 Conformance with physician orders Standard
▼ 237619 Affinity Home Care Agency, Inc 2655 E Oakley Park Rd, Ste 106 Commerce Township MI 5 (Chicago) 09/17/2021 196A5-H1 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
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
G0706 Interdisciplinary assessment of the patient Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 237619 Affinity Home Care Agency, Inc 2655 E Oakley Park Rd, Ste 106 Commerce Township MI 5 (Chicago) 09/27/2018 TXLY11 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
G0976 Services under arrangement Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
G0772 Documentation of competency evaluation Element
G0978 Must have a written agreement Element
G1022 Discharge and transfer summaries Element