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Home Health Care of Ksb Hospital

No longer in CMS list This agency is not in CMS's current list of Medicare-certified home health agencies (file dated 2026-09-21), but it has federal inspection records. It may have closed, changed ownership, or changed its certification number. Address shown is from its inspection records.
403 East 1ST Street, Dixon, IL 61021
CMS Certification Number 147131
16deficiencies since 2018
0serious
2inspections
n/aCMS quality stars
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-21; CMS agency list file dated 2026-09-21. What the labels mean

Inspection 2023-08-03

· Recertification · 7 deficiencies · CMS source report (PDF)
Moderate Plan Based On All Hazards Risk Assessment

The Agency failed to ensure the plan was established based on an updated risk assessment utilizing an all-hazards approach.

Source: CMS Form 2567, inspection 2023-08-03, tag E0006 · view on CMS
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Moderate Names And Contact Information

The Agency failed to have a communication plan that included the required names and contact information.

Source: CMS Form 2567, inspection 2023-08-03, tag E0030 · view on CMS
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Moderate Ep Testing Requirements

The Agency failed to ensure the Agency conducted the required Agency and community exercises bi-annually to ensure the effectiveness of the Agency's Emergency Preparedness Plan.

Source: CMS Form 2567, inspection 2023-08-03, tag E0039 · view on CMS
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Minor Plan Of Care Must Include The Following

The Agency failed to ensure Plans of Care included all the requirements.

Source: CMS Form 2567, inspection 2023-08-03, tag G0574 · view on CMS
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Minor Influenza And Pneumococcal Vaccines

The Agency failed to fully assess Patients' Influenza and/or Pneumococcal vaccine status at the SOC, as required by the Agency.

Source: CMS Form 2567, inspection 2023-08-03, tag G0582 · view on CMS
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Minor Name/Contact Information Of Clinical Manager

The Agency failed to ensure Pts. were given the name and contact information of the Clinical Manager.

Source: CMS Form 2567, inspection 2023-08-03, tag G0622 · view on CMS
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Minor Discharge And Transfer Summaries

The Agency failed to ensure the Physician was sent a copy of the Discharge Summary.

Source: CMS Form 2567, inspection 2023-08-03, tag G1022 · view on CMS
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Inspection 2020-09-17

· Focused Infection Control, Other-Fed, Recertification · 9 deficiencies · CMS source report (PDF)
Moderate Plan Of Care

For 1 of 7 (Pt #7) patients, the Agency failed to ensure visits were conducted in accordance with the physician ordered plan of care.

Source: CMS Form 2567, inspection 2020-09-17, tag G0572 · view on CMS
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Moderate Infection Control

For 3 of 3 (Pt #4, Pt #5, Pt #6) patient records reviewed and 1 home visit (Pt #4), the Agency failed to ensure patients were appropriately screened for signs/symptoms or exposure to COVID-19 prior to home visits, per its policy.

Source: CMS Form 2567, inspection 2020-09-17, tag G0684 · view on CMS
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Moderate Home Health Aide Assignments And Duties

For 1 of 3 (Pt #2) patients receiving home health aide services, the Agency failed to ensure the Aide Care Plan accurately reflected the care and services to be provided.

Source: CMS Form 2567, inspection 2020-09-17, tag G0798 · view on CMS
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Minor Hha Administrator Contact Information

The Agency failed to ensure patients received all elements of contact information for the Agency administrator, in order to receive complaints.

Source: CMS Form 2567, inspection 2020-09-17, tag G0414 · view on CMS
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Minor Written Notice Within 4 Business Days

The Agency failed to ensure patients, or patient representatives, received written notice of the Agency's transfer and discharge policies within 4 business days of the initial evaluation visit.

Source: CMS Form 2567, inspection 2020-09-17, tag G0422 · view on CMS
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Minor Contact Info Federal/State-Funded Entities

The Agency failed to ensure patients received the required contact information for the Federally-funded and state-funded entities that serve the area where the patient resides.

Source: CMS Form 2567, inspection 2020-09-17, tag G0446 · view on CMS
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Minor Plan Of Care Must Include The Following

For 1 of 7 (Pt#7) patients, the Agency failed to ensure the plan of care included the frequency and duration of all disciple's visits.

Source: CMS Form 2567, inspection 2020-09-17, tag G0574 · view on CMS
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Minor Promptly Alert Relevant Physician Of Changes

For 1 of 1 (Pt #5) patient record reviewed who had a change in condition, the Agency failed to ensure the physician was notified of the change in the patient's condition.

Source: CMS Form 2567, inspection 2020-09-17, tag G0590 · view on CMS
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Minor Services Provided By Hh Aide

For 1 of 3 (Pt #2) patients receiving home health aide services, the Agency failed to ensure the the Aide accurately documented the care and services provided.

Source: CMS Form 2567, inspection 2020-09-17, tag G0800 · view on CMS
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