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
▼ 248008 Lakeview Memorial Hospital Association, Inc. 5803 Neal Avenue North Oak Park Heights MN 5 (Chicago) 06/14/2023 5FCC7-H1 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
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
▼ 248008 Lakeview Memorial Hospital Association, Inc. 5803 Neal Avenue North Oak Park Heights MN 5 (Chicago) 09/06/2018 G02Y11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0007 EP Program Patient Population Standard
E0042 Integrated EP Program Standard
▼ 248009 The Evangelical Lutheran Good Samaritan Society 200 St Paul Street Preston MN 5 (Chicago) 01/22/2026 1DE638-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
▼ 248009 The Evangelical Lutheran Good Samaritan Society 200 St Paul Street Preston MN 5 (Chicago) 09/29/2021 1970A-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0430 Be free from abuse Element
G0488 Immediate reporting of abuse by all staff Element
▼ 248009 The Evangelical Lutheran Good Samaritan Society 200 St Paul Street Preston MN 5 (Chicago) 09/19/2019 CNDS11 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
▼ 248028 St Elizabeth Home Health Care 1200 Grant Blvd West Wabasha MN 5 (Chicago) 03/14/2019 947I11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0808 Onsite supervisory visit every 14 days Element
▼ 248030 Tlc Home Care Of The Twin Cities 1919 University Avenue Suite 130 Saint Paul MN 5 (Chicago) 05/12/2026 22FA5F-H1 Complaint
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
G0560 Discharge Planning Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement 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
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures 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
E0030 Names and Contact Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0562 Discharge Planning Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0646 Program activities Standard
G0654 Track adverse patient events Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0958 Clinical manager Standard
G0410 Information to patient Element
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0602 Communication with all physicians Element
G0614 Visit schedule Element
G0656 Improvements are sustained Element
G0714 Patient and caregiver education Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
G0960 Make patient and personnel assignments, Element
G0962 Coordinate patient care Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 248030 Tlc Home Care Of The Twin Cities 1919 University Avenue Suite 130 Saint Paul MN 5 (Chicago) 11/24/2025 1DAC61-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0958 Clinical manager Standard
G0464 Advise the patient of discharge for cause Element
G0550 At discharge Element
▼ 248030 Tlc Home Care Of The Twin Cities 1919 University Avenue Suite 130 Saint Paul MN 5 (Chicago) 05/03/2022 38943-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0430 Be free from abuse Element
G0482 Mistreatment, neglect or abuse Element
▼ 248030 Tlc Home Care Of The Twin Cities 1919 University Avenue Suite 130 Saint Paul MN 5 (Chicago) 02/27/2020 R93511 Complaint, 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
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
G0578 Conformance with physician orders Standard
G0482 Mistreatment, neglect or abuse Element
G0488 Immediate reporting of abuse by all staff Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element