S&C QCOR HHA 2567s
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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
▼ 248147 Sefertt Health Care Llc 3621 85th Avenue North Ste 103 Brooklyn Park MN 5 (Chicago) 06/01/2020 EHX411 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
G0684 Infection control Standard
▼ 248149 Pediatric Home Respiratory Services, Llc 2800 Cleveland Avenue North Roseville MN 5 (Chicago) 04/24/2018 FJT811 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
▼ 248151 Bethany Board And Lodge 903 Hillgoss Blvd Se Fosston MN 5 (Chicago) 01/22/2019 174C11 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
▼ 248151 Bethany Board And Lodge 903 Hillgoss Blvd Se Fosston MN 5 (Chicago) 06/08/2018 931G11 Initial Certification
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
G0582 Influenza and pneumococcal vaccines Element
▼ 248152 Aplus Health Care Llc 5701 Shingle Creek Parkway, #608 Minneapolis MN 5 (Chicago) 05/15/2026 22F9D9-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0325 Basis and Scope Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS 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
G0660 Executive responsibilities for QAPI Standard
G0686 Infection control education Standard
G0860 Licensing Standard
G0982 Skilled services furnished Standard
G1026 Retention of records Standard
G0416 OASIS privacy notice Element
G0418 Patient's or legal representative's signature Element
G0432 Make complaints to the HHA Element
G0434 Participate in care Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0538 Primary caregiver(s), if any Element
G0540 The patient's representative (if any); Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0588 Reviewed, revised by physician every 60 days Element
G0656 Improvements are sustained Element
G0716 Preparing clinical notes Element
G1012 Required items in clinical record Element
G1016 Goals in the patient's plans of care Element
G1022 Discharge and transfer summaries Element
▼ 248152 Aplus Health Care Llc 5701 Shingle Creek Parkway, #608 Minneapolis MN 5 (Chicago) 06/15/2023 5FD52-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0982 Skilled services furnished Standard
▼ 248154 Olidia Care Inc 7530 Market Place Drive Eden Prairie MN 5 (Chicago) 04/20/2023 5F7C3-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
G0434 Participate in care Element
G0574 Plan of care must include the following Element
G0950 Ensure clinical manager is available Element
G0960 Make patient and personnel assignments, Element
▼ 248154 Olidia Care Inc 7530 Market Place Drive Eden Prairie MN 5 (Chicago) 02/27/2023 5EF35-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0848 Compliance with Federal, State, Local Law Condition
G0430 Be free from abuse Element
G0488 Immediate reporting of abuse by all staff Element
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0710 Provide services in the plan of care Element
▼ 248154 Olidia Care Inc 7530 Market Place Drive Eden Prairie MN 5 (Chicago) 11/14/2022 5E280-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
G0430 Be free from abuse Element
G0482 Mistreatment, neglect or abuse Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
▼ 248154 Olidia Care Inc 7530 Market Place Drive Eden Prairie MN 5 (Chicago) 08/30/2022 4F495-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0436 Receive all services in plan of care Element
G0608 Coordinate care delivery Element