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
▼ 248089 Summit Home Health Care Inc 800 Boone Avenue North Suite 175 Golden Valley MN 5 (Chicago) 02/12/2020 6D7311 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
G0572 Plan of care Standard
G0488 Immediate reporting of abuse by all staff Element
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0606 Integrate all services Element
G0808 Onsite supervisory visit every 14 days Element
▼ 248089 Summit Home Health Care Inc 800 Boone Avenue North Suite 175 Golden Valley MN 5 (Chicago) 05/10/2019 IOQR11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
G0578 Conformance with physician orders Standard
G0536 A review of all current medications Element
G0710 Provide services in the plan of care Element
▼ 248089 Summit Home Health Care Inc 800 Boone Avenue North Suite 175 Golden Valley MN 5 (Chicago) 10/02/2018 MC9611 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0526 Content of the comprehensive assessment Standard
▼ 248091 Allina Health System 2925 Chicago Avenue Minneapolis MN 5 (Chicago) 04/04/2024 6296B-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Condition of Participation: Patient rights. Condition
G0374 Accuracy of encoded OASIS data Standard
G0682 Infection Prevention Standard
G0430 Be free from abuse Element
G0442 Written notice for non-covered care Element
G0448 Freedom from discrimination or reprisal Element
G0478 Investigate complaints made by patient Element
G0486 Protect patient during investigation Element
G0488 Immediate reporting of abuse by all staff Element
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0602 Communication with all physicians Element
G0808 Onsite supervisory visit every 14 days Element
▼ 248091 Allina Health System 2925 Chicago Avenue Minneapolis MN 5 (Chicago) 02/14/2024 61F32-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
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
▼ 248091 Allina Health System 2925 Chicago Avenue Minneapolis MN 5 (Chicago) 01/24/2020 AK1C11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0576 All orders recorded in plan of care Element
G0598 Discharge plans communication Element
▼ 248091 Allina Health System 2925 Chicago Avenue Minneapolis MN 5 (Chicago) 06/26/2018 D67011 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0454 HHA can no longer meet the patient's needs Element
G0466 Make efforts to resolve the problem(s) Element
G0484 Document complaint and resolution Element
▼ 248092 Pathways To Achievement 114 South 20th Avenue West Suite A Duluth MN 5 (Chicago) 07/09/2020 L66C11 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
▼ 248092 Pathways To Achievement 114 South 20th Avenue West Suite A Duluth MN 5 (Chicago) 01/09/2020 OOSP11 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
G0488 Immediate reporting of abuse by all staff Element
G0536 A review of all current medications Element
G0710 Provide services in the plan of care Element
▼ 248093 The Evangelical Lutheran Good Samaritan Society 24090 Smiley Road Suite 200 Nisswa MN 5 (Chicago) 05/06/2021 19JU11 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
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element