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
▼ 369120 Holistic Life Home Health Care Llc 2101 South Hamilton Road Suite 102 Columbus OH 5 (Chicago) 02/13/2023 5EAB9-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
▼ 369120 Holistic Life Home Health Care Llc 2101 South Hamilton Road Suite 102 Columbus OH 5 (Chicago) 06/06/2018 Z8D611 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0031 Emergency Officials Contact Information Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
▼ 369121 Innovative Home Health Practice Llc 2246 South Hamilton Road, Suite 204 Columbus OH 5 (Chicago) 08/01/2018 Z82O11 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
▼ 369122 Sibling's Home Health Care Services Llc 5330 East Main Street Suite 109 Whitehall OH 5 (Chicago) 08/23/2018 M1IQ11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0588 Reviewed, revised by physician every 60 days Element
G0808 Onsite supervisory visit every 14 days Element
G1012 Required items in clinical record Element
▼ 369122 Sibling's Home Health Care Services Llc 5330 East Main Street Suite 109 Whitehall OH 5 (Chicago) 07/17/2018 ZQJ411 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
G0814 Non-skilled direct observation every 60 days Element
▼ 369123 Special Touch Home Care Llc 207 Pike Street Manchester OH 5 (Chicago) 04/23/2024 62D6B-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0520 5 calendar days after start of care Element
▼ 369124 Quality Care Llc 742 Waycross Road Cincinnati OH 5 (Chicago) 02/06/2019 B90911 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0642 Program scope Standard
▼ 369125 Madison 57 Investments Llc 6434 E. Main Street, Suite 204 Reynoldsburg OH 5 (Chicago) 08/22/2024 63E6A-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0370 Reporting OASIS information Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G1050 Personnel qualifications Condition
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0704 Responsibilities of skilled professionals Standard
G1024 Authentication Standard
G1052 Administrator Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0726 Nursing services supervised by RN Element
G0800 Services provided by HH aide Element
G0954 Ensures qualified pre-designated person Element
▼ 369125 Madison 57 Investments Llc 6434 E. Main Street, Suite 204 Reynoldsburg OH 5 (Chicago) 09/13/2018 C96411 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
▼ 369126 Kayland Partners 12927 Stonecreek Dr, Suite E Pickerington OH 5 (Chicago) 01/16/2024 61EDD-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
G0548 Within 48 hours of the patient's return Element
G0580 Only as ordered by a physician Element
G0604 Integrate all orders Element
G0610 Patients receive education and training Element