S&C QCOR Hospice 2567s
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Hospice 2567s
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Time Interval

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Note: Hospice 2567s data begin starting October 2021.

Provider Characteristics

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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.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 151526 Good Samaritan Hospital 520 S 7th St Vincennes IN 5 (Chicago) 03/05/2024 62468-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments Memo
E0039 Ep Testing Requirements Standard
L0000 Initial Comments Memo
L0520 Initial & Comprehensive Assessment Of Patient Condition
L0524 Content Of Comprehensive Assessment Standard
L0533 Update Of Comprehensive Assessment Standard
L0543 Plan Of Care Standard
L0547 Content Of Plan Of Care Standard
L0615 Competency Evaluation Standard
L0626 Hospice Aide Assignments And Duties Standard
L0629 Supervision Of Hospice Aides Standard
L0651 Governing Body And Administrator Standard
L0662 Training Standard
L0684 Discharge Or Transfer Of Care Standard
▼ 151526 Good Samaritan Hospital 601 South 9th Street Vincennes IN 5 (Chicago) 05/09/2025 1266070 Reaccreditation
Deficiency Tag Deficiency Description Tag Type
L0520 Initial & Comprehensive Assessment Of Patient Condition
L0522 Initial Assessment Standard
L0523 Timeframe For Completion Of Assessment Standard
L0529 Content Of Comprehensive Assessment Standard
L0536 Idg, Care Planning, Coordination Of Services Condition
L0546 Content Of Plan Of Care Standard
L0549 Content Of Plan Of Care Standard
L0555 Coordination Of Services Standard
L0564 Program Data Standard
L0617 Competency Evaluation Standard
L0619 Competency Evaluation Standard
L0629 Supervision Of Hospice Aides Standard
L0648 Organizational Environment Condition
L0651 Governing Body And Administrator Standard
L0655 Professional Management Responsibility Standard
L0678 Content Standard
L0682 Discharge Or Transfer Of Care Standard
L0774 Hospice Plan Of Care Standard
L0781 Coordination Of Services Standard
L0781 Coordination Of Services Standard
▼ 151526 Good Samaritan Hospital 601 South 9th Street Vincennes IN 5 (Chicago) 06/17/2025 1270665 Follow-Up
Deficiency Tag Deficiency Description Tag Type
L0529 Content Of Comprehensive Assessment Standard
L0549 Content Of Plan Of Care Standard
▼ 151527 Goshen Hospital Association, Inc. 1147 Professional Dr. Goshen IN 5 (Chicago) 05/07/2025 1266152 Reaccreditation
Deficiency Tag Deficiency Description Tag Type
L0555 Coordination Of Services Standard
L0557 Coordination Of Services Standard
L0678 Content Standard
L0702 Use And Mintenance Of Equipment And Supplies Standard
L0710 Inpatient Care For Respite Purposes Standard
L0781 Coordination Of Services Standard
▼ 151529 Jackson County Schneck Memorial Hospital Hospice 415 S. Walnut St., 1st & 3rd Floor Seymour IN 5 (Chicago) 02/21/2025 1257389 Reaccreditation
Deficiency Tag Deficiency Description Tag Type
L0536 Idg, Care Planning, Coordination Of Services Condition
L0545 Content Of Plan Of Care Standard
L0546 Content Of Plan Of Care Standard
L0553 Review Of The Plan Of Care Standard
L0559 Quality Assessment & Performance Improvement Condition
L0575 Executive Responsibilities Standard
L0581 Control Standard
L0625 Hospice Aide Assignments And Duties Standard
L0648 Organizational Environment Condition
L0651 Governing Body And Administrator Standard
L0652 Services Standard
L0663 Training Standard
L0679 Authentication Standard
L0682 Discharge Or Transfer Of Care Standard
L0781 Coordination Of Services Standard
L0795 Criminal Background Checks Standard
▼ 151537 Hospice Preferred Choice, Inc. 8910 Purdue Road, Suite 130 Indianapolis IN 5 (Chicago) 07/03/2024 1234794 Initial with CCN
Deficiency Tag Deficiency Description Tag Type
L0513 Rights Of The Patient Standard
L0530 Content Of Comprehensive Assessment Standard
L0540 Approach To Service Delivery Standard
L0545 Content Of Plan Of Care Standard
L0549 Content Of Plan Of Care Standard
L0550 Content Of Plan Of Care Standard
L0555 Coordination Of Services Standard
L0579 Prevention Standard
L0596 Counseling Services Standard
L0625 Hospice Aide Assignments And Duties Standard
L0626 Hospice Aide Assignments And Duties Standard
L0679 Authentication Standard
L0773 Hospice Plan Of Care Standard
▼ 151540 Main Street Hospice Llc 10 Highland Avenue Franklin IN 5 (Chicago) 05/25/2022 1136984 Reaccreditation
Deficiency Tag Deficiency Description Tag Type
L0663 Training Standard
L0679 Authentication Standard
L0781 Coordination Of Services Standard
▼ 151540 Main Street Hospice Llc 10 Highland Avenue Franklin IN 5 (Chicago) 06/18/2025 1268523 Reaccreditation
Deficiency Tag Deficiency Description Tag Type
L0679 Authentication Standard
L0683 Discharge Or Transfer Of Care Standard
L0684 Discharge Or Transfer Of Care Standard
▼ 151544 Traditions Hospice Of Crown Point, Llc 1229 Arrowhead Court Crown Point IN 5 (Chicago) 01/10/2023 5EAF6-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
L0000 Initial Comments Memo
L0512 Rights Of The Patient Standard
L0520 Initial & Comprehensive Assessment Of Patient Condition
L0524 Content Of Comprehensive Assessment Standard
L0533 Update Of Comprehensive Assessment Standard
L0536 Idg, Care Planning, Coordination Of Services Condition
L0538 Idg, Care Planning, Coordination Of Services Standard
L0539 Approach To Service Delivery Standard
L0543 Plan Of Care Standard
L0544 Plan Of Care Standard
L0545 Content Of Plan Of Care Standard
L0553 Review Of The Plan Of Care Standard
L0557 Coordination Of Services Standard
L0558 Coordination Of Services Standard
L0569 Program Activities Standard
L0651 Governing Body And Administrator Standard
L0692 Administration Of Drugs And Biologicals Standard
▼ 151544 Traditions Hospice Of Crown Point, Llc 1229 Arrowhead Court Crown Point IN 5 (Chicago) 03/02/2023 5EAF6-H2 Complaint
Deficiency Tag Deficiency Description Tag Type
L0000 Initial Comments Memo
L0524 Content Of Comprehensive Assessment Standard
L0536 Idg, Care Planning, Coordination Of Services Condition
L0539 Approach To Service Delivery Standard
L0543 Plan Of Care Standard
L0545 Content Of Plan Of Care Standard
L0553 Review Of The Plan Of Care Standard
L0557 Coordination Of Services Standard
L0569 Program Activities Standard