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
▼ 287019 Chi National Home Care, Llc 10101 Maple St. Omaha NE 7 (Kansas City) 03/29/2022 387B4-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
G0544 Update of the comprehensive assessment Standard
G0578 Conformance with physician orders Standard
G0702 Services by skilled professionals Standard
G0798 Home health aide assignments and duties Standard
G0434 Participate in care Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
▼ 287019 Chi National Home Care, Llc 10101 Maple St. Omaha NE 7 (Kansas City) 02/13/2019 VMOP11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0512 Standard: Initial assessment visit. Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
▼ 287020 Vsl Vetter Home Health Care Of North Platte Llc 904 S Linden Drive North Platte NE 7 (Kansas City) 07/22/2024 63B5E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0520 5 calendar days after start of care Element
G0576 All orders recorded in plan of care Element
G1022 Discharge and transfer summaries Element
▼ 287028 Delmar Gardens Of Omaha, Llc 825 Dorcas St Omaha NE 7 (Kansas City) 03/26/2025 65BD0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0592 Revised plan of care Element
▼ 287028 Delmar Gardens Of Omaha, Llc 825 Dorcas St Omaha NE 7 (Kansas City) 03/17/2021 W03Z11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0572 Plan of care Standard
G0642 Program scope Standard
G0592 Revised plan of care Element
G0948 Responsible for all day-to-day operations Element
G1022 Discharge and transfer summaries Element
▼ 287028 Delmar Gardens Of Omaha, Llc 825 Dorcas St Omaha NE 7 (Kansas City) 05/24/2019 EO0P11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0570 Care planning, coordination, quality of care Condition
G0940 Organization and administration of services Condition
E0017 HHA Comprehensive Assessment in Disaster Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0418 Patient's or legal representative's signature Element
G0514 RN performs assessment Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0814 Non-skilled direct observation every 60 days Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G1022 Discharge and transfer summaries Element
▼ 287037 Jefferson Community Health Center, Inc. 825 22nd Street Fairbury NE 7 (Kansas City) 01/08/2026 1E1075-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
▼ 287037 Jefferson Community Health Center, Inc. 825 22nd Street Fairbury NE 7 (Kansas City) 12/14/2022 5E867-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0592 Revised plan of care Element
G0602 Communication with all physicians Element
▼ 287038 Centerwell Certified Healthcare Corp. 1045 N. 115th St., Ste. 350 Omaha NE 7 (Kansas City) 03/25/2026 22C6CE-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G0576 All orders recorded in plan of care Element
G0808 Onsite supervisory visit every 14 days Element
▼ 287038 Centerwell Certified Healthcare Corp. 1045 N. 115th St., Ste. 350 Omaha NE 7 (Kansas City) 03/14/2023 5F48E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element