S&C QCOR Hospice 2567s
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Hospice 2567s
Selection Criteria ▸

Time Interval

Please select the calendar year or years for which you would like data.

Note: Hospice 2567s data are available from October 2021 through March 2026.

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 Hospice 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

Use these filters if you want to search by a specific CMS Certification Number (CCN).

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. Surveys can also be filtered by surveyor type - State Agency or Accrediting Organization - and by whether immediate jeopardy was cited.

CMS Certification Number Facility Name Address City State CMS Region Survey Date Surveyed By Survey Event ID Survey Type Statement of Deficiencies Report
▼ 161591 Evangelical Lutheran Good Samaritan Society 2035 Chester Ave Ottumwa IA 7 (Kansas City) 06/08/2023 State Agency 5FAC0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0503 Notice Of Rights And Responsibilities Standard
L0530 Content Of Comprehensive Assessment Standard
L0533 Update Of Comprehensive Assessment Standard
L0596 Counseling Services Standard
L0613 Hospice Aide Training Standard
L0625 Hospice Aide Assignments And Duties Standard
L0626 Hospice Aide Assignments And Duties Standard
L0633 Supervision Of Hospice Aides Standard
L0679 Authentication Standard
L0781 Coordination Of Services Standard
▼ 161592 Care Initiatives, Inc 4301 Sergeant Road, Suite 110 Sioux City IA 7 (Kansas City) 09/27/2023 State Agency 611EE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0530 Content Of Comprehensive Assessment Standard
L0554 Coordination Of Services Standard
L0625 Hospice Aide Assignments And Duties Standard
L0696 Label Dispose Storage Drugs Standard
L0778 Coordination Of Services Standard
▼ 161592 Care Initiatives, Inc 4301 Sergeant Road, Suite 110 Sioux City IA 7 (Kansas City) 03/06/2024 State Agency 621C0-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
L0000 Initial Comments Memo
L0696 Label Dispose Storage Drugs Standard
▼ 161593 Care Initiatives, Inc 6915 Chancellor Drive Suite A Cedar Falls IA 7 (Kansas City) 07/06/2023 State Agency 5F663-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0549 Content Of Plan Of Care Standard
L0613 Hospice Aide Training Standard
L0626 Hospice Aide Assignments And Duties Standard
L0796 Criminal Background Checks Standard
▼ 161593 Care Initiatives, Inc 6915 Chancellor Drive Suite A Cedar Falls IA 7 (Kansas City) 10/22/2025 State Agency 1D90BD-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
L0000 Initial Comments Memo
L0543 Plan Of Care Standard
L0555 Coordination Of Services Standard
▼ 161594 Care Initiatives, Inc 7055 Vista Drive West Des Moines IA 7 (Kansas City) 03/21/2023 State Agency 5ED99-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0520 Initial & Comprehensive Assessment Of Patient Condition
L0524 Content Of Comprehensive Assessment Standard
L0530 Content Of Comprehensive Assessment Standard
L0533 Update Of Comprehensive Assessment Standard
L0549 Content Of Plan Of Care Standard
L0550 Content Of Plan Of Care Standard
L0554 Coordination Of Services Standard
L0759 Residents Of Snf/Nf Or Icf/Mr Condition
L0778 Coordination Of Services Standard
L0781 Coordination Of Services Standard
L0782 Orientation And Training Of Staff Standard
▼ 161594 Care Initiatives, Inc 7055 Vista Drive West Des Moines IA 7 (Kansas City) 05/03/2023 State Agency 5ED99-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
L0000 Initial Comments Memo
L0520 Initial & Comprehensive Assessment Of Patient Condition
L0524 Content Of Comprehensive Assessment Standard
L0530 Content Of Comprehensive Assessment Standard
L0533 Update Of Comprehensive Assessment Standard
L0549 Content Of Plan Of Care Standard
L0550 Content Of Plan Of Care Standard
L0554 Coordination Of Services Standard
L0759 Residents Of Snf/Nf Or Icf/Mr Condition
L0778 Coordination Of Services Standard
L0781 Coordination Of Services Standard
L0782 Orientation And Training Of Staff Standard
▼ 161594 Care Initiatives, Inc 7055 Vista Drive West Des Moines IA 7 (Kansas City) 11/04/2025 State Agency 1D9DFC-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
E0037 Ep Training Program Standard
L0000 Initial Comments Memo
L0503 Notice Of Rights And Responsibilities Standard
L0530 Content Of Comprehensive Assessment Standard
L0543 Plan Of Care Standard
L0545 Content Of Plan Of Care Standard
L0550 Content Of Plan Of Care Standard
L0554 Coordination Of Services Standard
L0625 Hospice Aide Assignments And Duties Standard
L0626 Hospice Aide Assignments And Duties Standard
L0655 Professional Management Responsibility Standard
L0682 Discharge Or Transfer Of Care Standard
L0778 Coordination Of Services Standard
L0781 Coordination Of Services Standard
▼ 161595 Care Initiatives, Inc 122 Public Square Greenfield IA 7 (Kansas City) 05/25/2023 State Agency 5FDD3-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0530 Content Of Comprehensive Assessment Standard
L0549 Content Of Plan Of Care Standard
L0626 Hospice Aide Assignments And Duties Standard
L0781 Coordination Of Services Standard
▼ 161595 Care Initiatives, Inc 122 Public Square Greenfield IA 7 (Kansas City) 10/15/2025 State Agency 1D8AEE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
E0037 Ep Training Program Standard
L0000 Initial Comments Memo
L0522 Initial Assessment Standard
L0530 Content Of Comprehensive Assessment Standard
L0533 Update Of Comprehensive Assessment Standard
L0549 Content Of Plan Of Care Standard
L0555 Coordination Of Services Standard
L0625 Hospice Aide Assignments And Duties Standard
L0626 Hospice Aide Assignments And Duties Standard
L0629 Supervision Of Hospice Aides Standard
L0672 Content Standard
L0679 Authentication Standard
L0778 Coordination Of Services Standard