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

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
▼ 15L021 Gibault Inc - Gibson West Private Secure 6401 S Us 41 Terre Haute IN 5 (Chicago) 02/12/2020 DEE011 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0006 Plan based on all hazards risk assessment Standard
E0009 Local, state, tribal collaboration process Standard
E0018 Procedures for tracking of staff and patients 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
E0037 Ep training program Standard
E0039 Ep testing requirements Standard
▼ 15L022 Gibault, Inc 7403 Cline Ave Schererville IN 5 (Chicago) 10/03/2022 74C111 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0126 Protection of residents Element
N0132 Protection of residents Element
▼ 15L022 Gibault, Inc 7403 Cline Ave Schererville IN 5 (Chicago) 03/22/2022 J14U11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0207 Facility reporting Element
N0209 Facility reporting Element
N0210 Facility reporting Element
▼ 15L022 Gibault, Inc 7403 Cline Ave Schererville IN 5 (Chicago) 05/02/2019 NP9D11 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
N0140 Orders for use of restraint or seclusion Standard
N0115 Individual plan of care Element
N0143 Orders for use of restraint or seclusion Element
N0179 Notification of parent(s) or legal guardian Element
N0197 Medical treatment for injuries Element
N0199 Medical treatment for injuries Element
▼ 16L006 Hillcrest Family Servies-Molitore House 2445 Hillcrest Road Dubuque IA 7 (Kansas City) 02/04/2025 FB7H11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0108 Active treatment Element
N0115 Individual plan of care Element
N0137 Protection of residents Element
N0207 Facility reporting Element
▼ 16L006 Hillcrest Family Servies-Molitore House 2445 Hillcrest Road Dubuque IA 7 (Kansas City) 07/23/2019 Z25W11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0188 Post intervention debriefings Standard
N0145 Orders for use of restraint or seclusion Element
▼ 16L007 Four Oaks Family & Children's Services Of Iowa - Mcintyre Center-Pmic 5400 Kirkwood Boulevard Sw Cedar Rapids IA 7 (Kansas City) 04/15/2026 RRZD11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0149 Orders for use of restraint or seclusion Element
▼ 16L007 Four Oaks Family & Children's Services Of Iowa - Mcintyre Center-Pmic 5400 Kirkwood Boulevard Sw Cedar Rapids IA 7 (Kansas City) 09/14/2022 NMES11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0006 Plan based on all hazards risk assessment Standard
E0009 Local, state, tribal collaboration process Standard
E0039 Ep testing requirements Standard
N0101 General requirement for prtf Standard
N0120 Covid-19 vaccination of facility staff Standard
N0140 Orders for use of restraint or seclusion Standard
N0188 Post intervention debriefings Standard
N0136 Protection of residents Element
N0137 Protection of residents Element
N0145 Orders for use of restraint or seclusion Element
N0222 Education and training Element
▼ 16L008 Four Oaks Family & Children's Services Of Iowa -Smith Center-Pmic 5400 Kirkwood Boulevard Sw Cedar Rapids IA 7 (Kansas City) 05/14/2026 E85P11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0214 Education and training Standard
N0149 Orders for use of restraint or seclusion Element
N0189 Post intervention debriefings Element
▼ 16L008 Four Oaks Family & Children's Services Of Iowa -Smith Center-Pmic 5400 Kirkwood Boulevard Sw Cedar Rapids IA 7 (Kansas City) 12/08/2025 VKZ411 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0126 Protection of residents Element