S&C QCOR HHA 2567s
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HHAs 2567s
Selection Criteria ▸

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
▼ 247158 Hendricks Community Hospital Assn & Retirement Home 503 East Lincoln Street Hendricks MN 5 (Chicago) 04/01/2026 1F4D69-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
▼ 247158 Hendricks Community Hospital Assn & Retirement Home 503 East Lincoln Street Hendricks MN 5 (Chicago) 08/09/2023 60602-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0530 Strengths, goals, and care preferences Element
G0574 Plan of care must include the following Element
▼ 247158 Hendricks Community Hospital Assn & Retirement Home 503 East Lincoln Street Hendricks MN 5 (Chicago) 08/15/2019 MO8J11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
▼ 247160 Sanford Canby Medical Center 213 St Olaf Avenue North, Ste B Canby MN 5 (Chicago) 05/14/2025 65E1D-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
G0574 Plan of care must include the following Element
▼ 247160 Sanford Canby Medical Center 213 St Olaf Avenue North, Ste B Canby MN 5 (Chicago) 04/07/2023 5F477-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
▼ 247161 Comfort Home Health Care Group, Inc. 2746 Superior Dr Nw Suite 200 Rochester MN 5 (Chicago) 06/05/2019 390W11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
▼ 247166 Accentcare Fairiew Home Health - East Llc 3507 Highpoint Drive N, S140 Oakdale MN 5 (Chicago) 10/24/2024 6421C-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Condition of Participation: Patient rights. Condition
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0434 Participate in care Element
G0442 Written notice for non-covered care Element
G0454 HHA can no longer meet the patient's needs Element
G0458 Outcomes/goals have been achieved Element
G0468 Provide contact info other services Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 247166 Accentcare Fairiew Home Health - East Llc 3507 Highpoint Drive N, S140 Oakdale MN 5 (Chicago) 11/02/2021 1971D-H1 Complaint, 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
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0718 Communication with physicians Element
▼ 247168 Ridgeview Medical Center 501 South Maple Street Ste 1 Waconia MN 5 (Chicago) 12/04/2024 64B04-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
▼ 247168 Ridgeview Medical Center 501 South Maple Street Ste 1 Waconia MN 5 (Chicago) 05/02/2018 15EY11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard