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
▼ 239290 1st State Home Healthcare, Inc 138 Harrow Ln, Suite 2 Saginaw MI 5 (Chicago) 07/08/2026 25C490-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0434 Participate in care Element
G0446 Contact info Federal/State-funded entities 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
G1022 Discharge and transfer summaries Element
▼ 239290 1st State Home Healthcare, Inc 138 Harrow Ln, Suite 2 Saginaw MI 5 (Chicago) 03/17/2023 5F3D0-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
G0700 Skilled professional services Condition
G1008 Clinical records Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
G0544 Update of the comprehensive assessment Standard
G0578 Conformance with physician orders Standard
G0658 Performance improvement projects Standard
G0724 Supervise skilled professional assistants Standard
G1024 Authentication Standard
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0538 Primary caregiver(s), if any Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge 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
G0716 Preparing clinical notes Element
G0966 Assure patient needs are continually assessed Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
G1022 Discharge and transfer summaries Element
▼ 239291 Revival Home Health Care, L L C 32969 Hamilton Ct, Ste 138-C Farmington Hills MI 5 (Chicago) 03/07/2025 6578D-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
G0570 Care planning, coordination, quality of care Condition
G0680 Infection prevention and control Condition
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0798 Home health aide assignments and duties Standard
G0982 Skilled services furnished Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0446 Contact info Federal/State-funded entities Element
G0514 RN performs assessment Element
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
G0580 Only as ordered by a physician Element
G0592 Revised plan of care Element
G0622 Name/contact information of clinical manager Element
G0706 Interdisciplinary assessment of the patient Element
G1014 Interventions and patient response Element
▼ 239291 Revival Home Health Care, L L C 32969 Hamilton Ct, Ste 138-C Farmington Hills MI 5 (Chicago) 03/10/2022 385EC-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
G0446 Contact info Federal/State-funded entities Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 239291 Revival Home Health Care, L L C 32969 Hamilton Ct, Ste 138-C Farmington Hills MI 5 (Chicago) 06/03/2020 KC8111 Focused Infection Control, Other-Fed
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
E0004 Develop EP Plan, Review and Update Annually Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
▼ 239291 Revival Home Health Care, L L C 32969 Hamilton Ct, Ste 138-C Farmington Hills MI 5 (Chicago) 03/22/2019 DWYE11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
▼ 239292 Kalamazoo Home Health Care, Inc 251 N Rose St, Suite 218 Kalamazoo MI 5 (Chicago) 05/14/2026 230FF4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0724 Supervise skilled professional assistants Standard
G1024 Authentication Standard
G0446 Contact info Federal/State-funded entities Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G1022 Discharge and transfer summaries Element
▼ 239292 Kalamazoo Home Health Care, Inc 251 N Rose St, Suite 218 Kalamazoo MI 5 (Chicago) 02/10/2023 5EF01-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
G0510 Comprehensive Assessment of Patients Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0030 Names and Contact Information Standard
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0684 Infection control Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
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
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 239292 Kalamazoo Home Health Care, Inc 251 N Rose St, Suite 218 Kalamazoo MI 5 (Chicago) 09/03/2020 JYJQ11 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
G0940 Organization and administration of services Condition
G0526 Content of the comprehensive assessment Standard
G0944 Administrator must: Standard
G0710 Provide services in the plan of care Element
▼ 239295 American Advantage Home Care, Inc 2040 Monroe St, Suite 208 Dearborn MI 5 (Chicago) 06/03/2024 6342E-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0962 Coordinate patient care Element