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
▼ 368166 Takang Abunaw 5237 Renwyck Drive Toledo OH 5 (Chicago) 04/23/2025 6578C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
▼ 368166 Takang Abunaw 5237 Renwyck Drive Toledo OH 5 (Chicago) 01/11/2024 61E51-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0031 Emergency Officials Contact Information Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
▼ 368166 Takang Abunaw 5237 Renwyck Drive Toledo OH 5 (Chicago) 02/13/2020 DLQ711 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
▼ 368166 Takang Abunaw 5237 Renwyck Drive Toledo OH 5 (Chicago) 08/01/2019 H60S11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
▼ 368166 Takang Abunaw 5237 Renwyck Drive Toledo OH 5 (Chicago) 06/06/2019 RQXV11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0798 Home health aide assignments and duties Standard
G0514 RN performs assessment Element
G0754 A qualified HH aide successfully completed: Element
G0814 Non-skilled direct observation every 60 days Element
▼ 368166 Takang Abunaw 5237 Renwyck Drive Toledo OH 5 (Chicago) 01/17/2019 ZPE711 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0478 Investigate complaints made by patient Element
▼ 368166 Takang Abunaw 5237 Renwyck Drive Toledo OH 5 (Chicago) 10/31/2018 R70L11 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
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
▼ 368168 Cambridge Home Health Care, Inc 4140 Holiday Street Nw Canton OH 5 (Chicago) 02/09/2023 5EE94-H1 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
▼ 368168 Cambridge Home Health Care, Inc 4140 Holiday Street Nw Canton OH 5 (Chicago) 07/11/2019 N2TR11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 368168 Cambridge Home Health Care, Inc 4140 Holiday Street Nw Canton OH 5 (Chicago) 06/21/2018 WXTI11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0640 Quality assessment/performance improvement Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G0642 Program scope Standard
G0644 Program data Standard
G0654 Track adverse patient events Standard
G0454 HHA can no longer meet the patient's needs Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0590 Promptly alert relevant physician of changes Element
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G0948 Responsible for all day-to-day operations Element
G0974 Direct support and administrative control Element