S&C QCOR Hospice 2567s
d QCOR:  Quality, Certification and Oversight Reports.
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
521540 Grant County Hospice 111 S Jefferson St Floor 2 Lancaster WI 5 (Chicago) 08/27/2025 State Agency 668C7-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
L0000 Initial Comments Memo
L0559 Quality Assessment & Performance Improvement Condition
L0561 Program Scope Standard
L0562 Program Scope Standard
L0574 Executive Responsibilities Standard
L0579 Prevention Standard
L0662 Training Standard
L0774 Hospice Plan Of Care Standard
521547 Tomah Memorial Hospital 501 Gopher Drive Tomah WI 5 (Chicago) 06/22/2022 TJC 437586635 Reaccreditation
Deficiency Tag Deficiency Description Tag Type
L0529 Content Of Comprehensive Assessment Standard
L0545 Content Of Plan Of Care Standard
L0546 Content Of Plan Of Care Standard
L0549 Content Of Plan Of Care Standard
L0579 Prevention Standard
L0625 Hospice Aide Assignments And Duties Standard
L0629 Supervision Of Hospice Aides Standard
L0674 Content Standard
L0702 Use And Mintenance Of Equipment And Supplies Standard
L0728 Fire Protection Standard
521547 Tomah Memorial Hospital 501 Gopher Drive Tomah WI 5 (Chicago) 06/19/2025 TJC 457012585 Reaccreditation
Deficiency Tag Deficiency Description Tag Type
L0530 Content Of Comprehensive Assessment Standard
L0555 Coordination Of Services Standard
L0663 Training Standard
L0674 Content Standard
L0702 Use And Mintenance Of Equipment And Supplies Standard
521549 Upland Hills Hospice 109 W Fountain St Dodgeville WI 5 (Chicago) 12/17/2025 State Agency 1DD6B4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0774 Hospice Plan Of Care Standard
521553 Vitas Healthcare Corporation Midwest 12000 W Park Place Suite 200 Milwaukee WI 5 (Chicago) 07/26/2022 State Agency RGUJ21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0025 Arrangement With Other Facilities Standard
E0033 Methods For Sharing Information Standard
K0000 Initial Comments Memo
K0345 Fire Alarm System - Testing And Maintenance Standard
K0711 Evacuation And Relocation Plan Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator Or Alternate Source Standard
K0919 Electrical Equipment - Other Standard
K0920 Electrical Equipment ? Power Cords And Extension Cords Standard
521553 Vitas Healthcare Corporation Midwest 12000 W Park Place Suite 200 Milwaukee WI 5 (Chicago) 07/28/2022 State Agency RGUJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0719 Hospices That Provide Inpatient Care Directly Condition
L0728 Fire Protection Standard
521553 Vitas Healthcare Corporation Midwest 12000 W Park Place Suite 200 Milwaukee WI 5 (Chicago) 09/14/2022 State Agency RGUJ22 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0025 Arrangement With Other Facilities Standard
E0033 Methods For Sharing Information Standard
K0000 Initial Comments Memo
K0345 Fire Alarm System - Testing And Maintenance Standard
K0711 Evacuation And Relocation Plan Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator Or Alternate Source Standard
K0919 Electrical Equipment - Other Standard
K0920 Electrical Equipment ? Power Cords And Extension Cords Standard
521553 Vitas Healthcare Corporation Midwest 12000 W Park Place Suite 200 Milwaukee WI 5 (Chicago) 09/14/2022 State Agency RGUJ12 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0719 Hospices That Provide Inpatient Care Directly Condition
L0728 Fire Protection Standard
521555 Rainbow Hospice Care 147 W Rockwell St Jefferson WI 5 (Chicago) 08/01/2022 State Agency BLEI21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
K0000 Initial Comments Memo
K0345 Fire Alarm System - Testing And Maintenance Standard
K0353 Sprinkler System - Maintenance And Testing Standard
K0712 Fire Drills Standard
K0918 Essential Electrical Systems ? Generator Or Alternate Source Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
521555 Rainbow Hospice Care 147 W Rockwell St Jefferson WI 5 (Chicago) 08/02/2022 State Agency BLEI11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
L0000 Initial Comments Memo
L0724 Physical Environment Standard
L0728 Fire Protection Standard