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
▼ 248033 Jb Kummer Enterprises Llc 916 Eighth Street Farmington MN 5 (Chicago) 03/20/2023 5F45E-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
▼ 248033 Jb Kummer Enterprises Llc 916 Eighth Street Farmington MN 5 (Chicago) 10/28/2020 KXP711 Complaint, 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
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 248037 Home Health Care Inc 800 Boone Avenue North Suite 200 Golden Valley MN 5 (Chicago) 10/17/2025 1D8C65-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
E0007 EP Program Patient Population Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0030 Names and Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0036 EP Training and Testing Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0658 Performance improvement projects Standard
G0702 Services by skilled professionals Standard
G0418 Patient's or legal representative's signature Element
G0528 Health, psychosocial, functional, cognition 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
G0606 Integrate all services Element
G0608 Coordinate care delivery Element
G0716 Preparing clinical notes Element
G0804 Aides are members of interdisciplinary team Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
▼ 248037 Home Health Care Inc 800 Boone Avenue North Suite 200 Golden Valley MN 5 (Chicago) 12/05/2024 64B02-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
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
▼ 248037 Home Health Care Inc 800 Boone Avenue North Suite 200 Golden Valley MN 5 (Chicago) 04/25/2024 62F41-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0984 In accordance with current clinical practice Element
▼ 248037 Home Health Care Inc 800 Boone Avenue North Suite 200 Golden Valley MN 5 (Chicago) 11/10/2021 37E73-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0700 Skilled professional services Condition
G0454 HHA can no longer meet the patient's needs Element
G0710 Provide services in the plan of care Element
▼ 248037 Home Health Care Inc 800 Boone Avenue North Suite 200 Golden Valley MN 5 (Chicago) 10/04/2021 19725-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
▼ 248037 Home Health Care Inc 800 Boone Avenue North Suite 200 Golden Valley MN 5 (Chicago) 09/11/2020 B51W11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
G0374 Accuracy of encoded OASIS data Standard
G0608 Coordinate care delivery Element
G0710 Provide services in the plan of care Element
▼ 248038 New Dimensions Home Health Care Inc. 312 North Tower Road Fergus Falls MN 5 (Chicago) 06/10/2025 66561-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
▼ 248038 New Dimensions Home Health Care Inc. 312 North Tower Road Fergus Falls MN 5 (Chicago) 01/05/2022 381B5-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0488 Immediate reporting of abuse by all staff Element