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
▼ 287133 Hillcrest Home Care Inc. 1820 Hillcrest Drive Suite A Bellevue NE 7 (Kansas City) 10/31/2024 649E5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
▼ 287133 Hillcrest Home Care Inc. 1820 Hillcrest Drive Suite A Bellevue NE 7 (Kansas City) 10/21/2021 37D2F-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
G0520 5 calendar days after start of care Element
▼ 287133 Hillcrest Home Care Inc. 1820 Hillcrest Drive Suite A Bellevue NE 7 (Kansas City) 03/26/2019 Q52U11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0592 Revised plan of care Element
G0808 Onsite supervisory visit every 14 days Element
▼ 287136 Nebraska Home Health Care, Llc 9001 Arbor St Suite 206 Omaha NE 7 (Kansas City) 07/23/2019 MH8T11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0940 Organization and administration of services Condition
G0572 Plan of care Standard
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
▼ 287137 Ambi's Home Health Care, Llc 806 Hogan Dr Papillion NE 7 (Kansas City) 03/11/2025 65989-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0774 12 hours inservice every 12 months Standard
G0798 Home health aide assignments and duties Standard
G0958 Clinical manager Standard
G1024 Authentication Standard
G0520 5 calendar days after start of care Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
▼ 287137 Ambi's Home Health Care, Llc 806 Hogan Dr Papillion NE 7 (Kansas City) 04/27/2022 389FB-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0798 Home health aide assignments and duties Standard
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
G0656 Improvements are sustained Element
▼ 287137 Ambi's Home Health Care, Llc 806 Hogan Dr Papillion NE 7 (Kansas City) 04/08/2021 0GY311 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0033 Methods for Sharing Information Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0684 Infection control Standard
G0768 Competency evaluation Standard
G0982 Skilled services furnished Standard
G0478 Investigate complaints made by patient Element
G0528 Health, psychosocial, functional, cognition Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care Element
G0726 Nursing services supervised by RN Element
G0754 A qualified HH aide successfully completed: Element
G0948 Responsible for all day-to-day operations Element
G0968 Assure implementation of plan of care Element
G1022 Discharge and transfer summaries Element
▼ 287137 Ambi's Home Health Care, Llc 806 Hogan Dr Papillion NE 7 (Kansas City) 05/09/2019 RO3511 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G1022 Discharge and transfer summaries Element
▼ 287137 Ambi's Home Health Care, Llc 806 Hogan Dr Papillion NE 7 (Kansas City) 05/30/2018 NFSM11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0412 Written notice of patient's rights Element
G0590 Promptly alert relevant physician of changes Element
▼ 287139 Zutan Home Healthcare, Inc. 3909 Cuming Street, Suite 203 Omaha NE 7 (Kansas City) 06/09/2026 235598-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0004 Develop EP Plan, Review and Update Annually Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0576 All orders recorded in plan of care Element