S&C QCOR PRTF 2567s
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PRTF 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 PRTF 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
▼ 14L007 Cornell Interventions Woodridge 2221 64th Street Woodridge IL 5 (Chicago) 04/19/2018 PSR111 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0109 Individual plan of care Element
N0111 Individual plan of care Element
N0114 Individual plan of care Element
N0115 Individual plan of care Element
N0118 Team developing individual plan of care Element
N0135 Protection of residents Element
N0136 Protection of residents Element
N0137 Protection of residents Element
▼ 14L013 Rosecrance, Inc 1601 University Drive Rockford IL 5 (Chicago) 01/16/2025 08IE11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0110 Individual plan of care Element
▼ 14L013 Rosecrance, Inc 1601 University Drive Rockford IL 5 (Chicago) 01/30/2019 KQYO11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0110 Individual plan of care Element
N0115 Individual plan of care Element
N0135 Protection of residents Element
▼ 15L002 Crossroad Child & Family Services Inc 1825 Beacon Street Fort Wayne IN 5 (Chicago) 11/15/2023 AG1H11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0214 Education and training Standard
N0109 Individual plan of care Element
N0156 Orders for use of restraint or seclusion Element
▼ 15L002 Crossroad Child & Family Services Inc 1825 Beacon Street Fort Wayne IN 5 (Chicago) 08/19/2020 V60811 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0132 Protection of residents Element
▼ 15L002 Crossroad Child & Family Services Inc 1825 Beacon Street Fort Wayne IN 5 (Chicago) 01/09/2020 39WF11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0188 Post intervention debriefings Standard
N0115 Individual plan of care Element
N0118 Team developing individual plan of care Element
N0145 Orders for use of restraint or seclusion Element
▼ 15L002 Crossroad Child & Family Services Inc 1825 Beacon Street Fort Wayne IN 5 (Chicago) 04/03/2019 YFU911 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0007 Ep program patient population Standard
E0009 Local, state, tribal collaboration process Standard
E0020 Policies for evac. and primary/alt. comm. Standard
E0022 Policies/procedures for sheltering in place Standard
E0024 Policies/procedures-volunteers and staffing Standard
E0030 Names and contact information Standard
E0033 Methods for sharing information Standard
E0034 Information on occupancy/needs Standard
N0165 Monitoring during and after restraint Standard
N0170 Monitoring during and after seclusion Standard
N0188 Post intervention debriefings Standard
N0115 Individual plan of care Element
N0118 Team developing individual plan of care Element
N0148 Orders for use of restraint or seclusion Element
N0189 Post intervention debriefings Element
▼ 15L004 Fayette Bhc, Llc 450 Erie Ave Connersville IN 5 (Chicago) 11/20/2019 KEMY11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
E0007 Ep program patient population Standard
E0015 Subsistence needs for staff and patients Standard
E0018 Procedures for tracking of staff and patients Standard
E0020 Policies for evac. and primary/alt. comm. Standard
E0022 Policies/procedures for sheltering in place Standard
E0024 Policies/procedures-volunteers and staffing Standard
E0029 Development of communication plan Standard
E0030 Names and contact information Standard
E0032 Primary/alternate means for communication Standard
E0033 Methods for sharing information Standard
N0160 Consultation with treatment team physician Standard
N0188 Post intervention debriefings Standard
N0111 Individual plan of care Element
N0115 Individual plan of care Element
N0136 Protection of residents Element
N0137 Protection of residents Element
N0147 Orders for use of restraint or seclusion Element
N0150 Orders for use of restraint or seclusion Element
N0151 Orders for use of restraint or seclusion Element
N0152 Orders for use of restraint or seclusion Element
N0155 Orders for use of restraint or seclusion Element
N0189 Post intervention debriefings Element
N0209 Facility reporting Element
▼ 15L009 St Vincent Madison County Health System Inc 2210 Jackson St Anderson IN 5 (Chicago) 05/17/2018 ID1211 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
E0007 Ep program patient population Standard
E0018 Procedures for tracking of staff and patients Standard
E0020 Policies for evac. and primary/alt. comm. Standard
E0025 Arrangement with other facilities Standard
E0033 Methods for sharing information Standard
E0039 Ep testing requirements Standard
▼ 15L011 Columbus Behavioral Center For Children And Adolescents 2223 Poshard Dr Columbus IN 5 (Chicago) 12/21/2024 2U0N11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0143 Orders for use of restraint or seclusion Element
N0145 Orders for use of restraint or seclusion Element
N0149 Orders for use of restraint or seclusion Element