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
▼ 239295 American Advantage Home Care, Inc 2040 Monroe St, Suite 208 Dearborn MI 5 (Chicago) 07/28/2023 60915-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
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G0642 Program scope Standard
G0644 Program data Standard
G0654 Track adverse patient events Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0442 Written notice for non-covered care Element
G0514 RN performs assessment Element
G0534 Patient's needs 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
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0720 Participate in the HHA's QAPI program; Element
G0722 Participate in HHA-sponsored in-service Element
G0800 Services provided by HH aide Element
G0950 Ensure clinical manager is available Element
G0968 Assure implementation of plan of care Element
G1022 Discharge and transfer summaries Element
▼ 239301 Aunova, Llc 950 Trade Centre Way Ste 140 Portage MI 5 (Chicago) 11/17/2023 617BC-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
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
G1022 Discharge and transfer summaries Element
▼ 239304 Great Lakes Home Healthcare Specialists Llc 3281 Racquet Club Dr, Suite A Traverse City MI 5 (Chicago) 03/29/2018 65HN11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0640 Quality assessment/performance improvement Condition
G0750 Home health aide services Condition
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0642 Program scope Standard
G0646 Program activities Standard
G0654 Track adverse patient events Standard
G0774 12 hours inservice every 12 months Standard
G0798 Home health aide assignments and duties Standard
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0602 Communication with all physicians Element
G0614 Visit schedule Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0980 Primary HHA is responsible for patient care Element
▼ 239305 Giva Tillman 1723 Pucker Street Road Niles MI 5 (Chicago) 06/06/2024 633AB-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
G0434 Participate in care Element
G0962 Coordinate patient care Element
▼ 239305 Giva Tillman 1723 Pucker Street Road Niles MI 5 (Chicago) 02/08/2024 621F9-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
G0640 Quality assessment/performance improvement Condition
E0039 EP Testing Requirements Standard
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0642 Program scope Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0514 RN performs assessment 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
G0716 Preparing clinical notes Element
G1012 Required items in clinical record Element
G1020 Contact info for primary care practitioner Element
G1022 Discharge and transfer summaries Element
▼ 239305 Giva Tillman 1723 Pucker Street Road Niles MI 5 (Chicago) 05/11/2023 5FC58-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
▼ 239305 Giva Tillman 1723 Pucker Street Road Niles MI 5 (Chicago) 01/29/2021 V5YF11 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
E0001 Establishment of the Emergency Program (EP) Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G1008 Clinical records Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0642 Program scope Standard
G0644 Program data Standard
G0646 Program activities Standard
G0774 12 hours inservice every 12 months Standard
G0798 Home health aide assignments and duties Standard
G1010 Contents of clinical record Standard
G1028 Protection of records Standard
G0434 Participate in care Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0648 High risk, high volume, or problem-prone area Element
G0726 Nursing services supervised by RN Element
G0808 Onsite supervisory visit every 14 days Element
G1016 Goals in the patient's plans of care Element
G1022 Discharge and transfer summaries Element
▼ 239306 Maxim Healthcare Services Inc 5300 Patterson Ave Se, Suite 100e Grand Rapids MI 5 (Chicago) 08/23/2018 69RM11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G1022 Discharge and transfer summaries Element
▼ 239311 Magic Home Care, Llc 32910 W 13 Mile Rd Farmington Hills MI 5 (Chicago) 10/17/2024 6463C-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
G0686 Infection control education Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G0534 Patient's needs 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
G1022 Discharge and transfer summaries Element
▼ 239312 Parallel Home Care Services, Inc 1600 Mill Creek Court Marquette MI 5 (Chicago) 06/27/2024 63647-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0434 Participate in care Element
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
G1022 Discharge and transfer summaries Element