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
▼ 247281 Interim Healthcare 332 W Superior Street Ste 204 Duluth MN 5 (Chicago) 01/28/2022 3830F-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
▼ 247281 Interim Healthcare 332 W Superior Street Ste 204 Duluth MN 5 (Chicago) 05/08/2020 J36B11 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
G0682 Infection Prevention Standard
▼ 247282 Carefocus Corporation 2429 University Ave West #200 Saint Paul MN 5 (Chicago) 09/17/2024 6420A-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0486 Protect patient during investigation Element
G0488 Immediate reporting of abuse by all staff Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 247282 Carefocus Corporation 2429 University Ave West #200 Saint Paul MN 5 (Chicago) 04/29/2024 62E32-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0434 Participate in care Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0602 Communication with all physicians Element
▼ 247282 Carefocus Corporation 2429 University Ave West #200 Saint Paul MN 5 (Chicago) 04/11/2024 62776-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
G0572 Plan of care Standard
G0460 Patient refuses services Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0588 Reviewed, revised by physician every 60 days Element
G0596 Revisions communicated to patient and MDs 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
G1016 Goals in the patient's plans of care Element
▼ 247282 Carefocus Corporation 2429 University Ave West #200 Saint Paul MN 5 (Chicago) 08/11/2023 60AC7-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0484 Document complaint and resolution Element
G0486 Protect patient during investigation Element
G0488 Immediate reporting of abuse by all staff Element
G0710 Provide services in the plan of care Element
▼ 247282 Carefocus Corporation 2429 University Ave West #200 Saint Paul MN 5 (Chicago) 02/26/2020 JCEW11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0023 Policies/Procedures for Medical Documentation Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0039 EP Testing Requirements Standard
G0488 Immediate reporting of abuse by all staff Element
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
▼ 247286 Grand Itasca Clinic And Hospital 111 Se 3rd Street Grand Rapids MN 5 (Chicago) 11/10/2020 VMZC11 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
▼ 247288 Hiawatha Homecare 4920 Moundview Drive Suite B Red Wing MN 5 (Chicago) 03/01/2023 5F16B-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0476 Investigation of complaints Standard
G0430 Be free from abuse Element
G0434 Participate in care Element
G0574 Plan of care must include the following Element
▼ 247288 Hiawatha Homecare 4920 Moundview Drive Suite B Red Wing MN 5 (Chicago) 10/18/2019 3OYS11 Complaint, 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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0013 Development of EP Policies and Procedures Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0582 Influenza and pneumococcal vaccines Element