S&C QCOR HHA 2567s
d QCOR:  Quality, Certification and Oversight Reports.
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
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 11/25/2024 64B96-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 11/06/2024 64915-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0478 Investigate complaints made by patient Element
G0486 Protect patient during investigation Element
G0488 Immediate reporting of abuse by all staff Element
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 06/02/2022 4EC8D-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 02/08/2022 383BE-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
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 05/06/2021 I40F11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0590 Promptly alert relevant physician of changes Element
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 04/23/2021 BY9F11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0570 Care planning, coordination, quality of care Condition
G0430 Be free from abuse Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 03/16/2021 DDSD11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
G0488 Immediate reporting of abuse by all staff Element
G0710 Provide services in the plan of care Element
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 07/07/2020 EYPV11 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
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 05/13/2020 6ZUJ11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0590 Promptly alert relevant physician of changes Element
248136 Provident Home Healthcare 2852 Anthony Lane South St Anthony MN 5 (Chicago) 06/11/2019 N2E011 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
G0710 Provide services in the plan of care Element