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
▼ 368497 Sanctuary Skilled Home Healthcare, Llc 355 West Prospect Road, Suite 116 Ashtabula OH 5 (Chicago) 03/14/2022 38612-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0942 Governing body Standard
G0710 Provide services in the plan of care Element
G0978 Must have a written agreement Element
▼ 368498 Renaissance Home Health Care 5311 Northfield Rd Suite 212 Bedford Heights OH 5 (Chicago) 01/13/2025 64FF0-H1 Complaint
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
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0800 Services provided by HH aide Element
G0814 Non-skilled direct observation every 60 days Element
▼ 368498 Renaissance Home Health Care 5311 Northfield Rd Suite 212 Bedford Heights OH 5 (Chicago) 08/01/2023 609A1-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
G0572 Plan of care Standard
G0516 Skilled professional performs assessment Element
G0522 Eligibility for Medicare home health benefit Element
G0548 Within 48 hours of the patient's return Element
G0590 Promptly alert relevant physician of changes Element
G0804 Aides are members of interdisciplinary team Element
▼ 369001 Diverse Home Care Llc 700 Bryden Road, Suite 121 Columbus OH 5 (Chicago) 09/23/2022 4F4E3-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
▼ 369001 Diverse Home Care Llc 700 Bryden Road, Suite 121 Columbus OH 5 (Chicago) 07/16/2020 F40211 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0464 Advise the patient of discharge for cause Element
G0468 Provide contact info other services Element
▼ 369001 Diverse Home Care Llc 700 Bryden Road, Suite 121 Columbus OH 5 (Chicago) 02/21/2019 WZKH11 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
E0004 Develop EP Plan, Review and Update Annually Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0031 Emergency Officials Contact Information Standard
E0039 EP Testing Requirements Standard
G0642 Program scope Standard
▼ 369005 Relay Home Care Service 3314 Morse Road Suite 216 Columbus OH 5 (Chicago) 03/11/2021 Y41R11 Focused Infection Control, Other-Fed, 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
▼ 369006 Moonlight Home Health Care Inc 102 Javit Court Youngstown OH 5 (Chicago) 10/27/2025 1D9C3B-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
G0798 Home health aide assignments and duties Standard
G0982 Skilled services furnished Standard
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
▼ 369006 Moonlight Home Health Care Inc 102 Javit Court Youngstown OH 5 (Chicago) 12/05/2024 64AD1-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0800 Services provided by HH aide Element
▼ 369006 Moonlight Home Health Care Inc 102 Javit Court Youngstown OH 5 (Chicago) 05/08/2024 62F78-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0574 Plan of care must include the following Element