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Sioux Center Home Health and Hospice

(712) 722-81081400 7TH Avenue SE, Sioux Center, IA 51250
CMS Certification Number 167164 · Government Operated · Medicare-certified since 06/21/1985
14deficiencies since 2018
0serious
2inspections
2.5CMS 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 2023-11-27

· Recertification · 8 deficiencies · CMS source report (PDF)
Moderate Ep Training Program

The agency failed to ensure training in emergency preparedness to all existing staff, including staff employed under arrangement of contract, consistent with their expected roles.

Source: CMS Form 2567, inspection 2023-11-27, tag E0037 · view on CMS
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Minor Payment From Federally Funded Programs

The agency failed to ensure agency staff advised the patient of the extent to which payment for agency services may be expected and the charges for services that may not be covered from Medicare, Medicaid, or any other federally-funded or federal aide program known to the agency and the charges the…

Source: CMS Form 2567, inspection 2023-11-27, tag G0440 · view on CMS
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Minor State Toll Free Hh Telephone Hotline

The agency failed to provide contact information for the state agency, Department of Inspections, Appeals, and Licensing (DIAL), complaint department on admission to home health services for 5 of 7 sampled patients (Patients #1, #2, #3, #4 and #6).

Source: CMS Form 2567, inspection 2023-11-27, tag G0444 · view on CMS
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Minor Health, Psychosocial, Functional, Cognition

The agency failed to ensure clinicians followed agency policies and procedures when assessing wounds to agency patients for 2 of 4 sampled patients with wounds (Patient #1 and #4).

Source: CMS Form 2567, inspection 2023-11-27, tag G0528 · view on CMS
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Minor A Review Of All Current Medications

The agency failed to complete a drug regimen review within the required time frames as part of the update to the comprehensive assessment at discharge for 2 of 2 sampled patients requiring discharge from agency services (Patients #6 and #7).

Source: CMS Form 2567, inspection 2023-11-27, tag G0536 · view on CMS
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Minor Last 5 Days Of Every 60 Days Unless:

The agency failed to ensure accurate completion of the recertification comprehensive assessments between day 56 and 60 of each 60 day certification period for 1 of 2 sampled patients for recertification requiring a recertification assessment (Patient #5).

Source: CMS Form 2567, inspection 2023-11-27, tag G0546 · view on CMS
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Minor Plan Of Care Must Include The Following

The agency failed to include all Durable Medical Equipment (DME) in Plans of Care for 3 of 7 sampled patients (Patients #2, #6, and #7).

Source: CMS Form 2567, inspection 2023-11-27, tag G0574 · view on CMS
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Minor Verbal Orders

The facility failed to obtain orders for nursing procedures for 3 of 7 patient reviewed (Patients #3, #4, and #5).

Source: CMS Form 2567, inspection 2023-11-27, tag G0584 · view on CMS
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Inspection 2020-11-18

· Focused Infection Control, Other-Fed, Recertification · 6 deficiencies · CMS source report (PDF)
Moderate Hha- Procedures For Follow Up Staff/Pts.

The agency failed to complete a written emergency preparedness plan that included procedures to inform State and local officials of any on duty staff and patients they are unable to contact in the event of an interruption of services related to an emergency.

Source: CMS Form 2567, inspection 2020-11-18, tag E0021 · view on CMS
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Moderate Competency Evaluation

The agency failed to ensure 6 of 6 sampled home health aides (Staff F, G, H, I, J and K), assigned to perform tasks requiring extra skills exceeding the level of basic home health skills for 3 sampled patients (Patients #2, #5 and #7), had documented evidence of competency by a registered nurse…

Source: CMS Form 2567, inspection 2020-11-18, tag G0768 · view on CMS
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Moderate Home Health Aide Assignments And Duties

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 1 of 6 sampled patients receiving home health aide services (Patient #5).

Source: CMS Form 2567, inspection 2020-11-18, tag G0798 · view on CMS
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Minor Payment From Federally Funded Programs

The agency failed to ensure agency staff advised the patient of the extent to which payment for agency services may be expected and the charges for services that may not be covered from Medicare, Medicaid, or any other federally-funded or federal aide program known to the agency and the charges the…

Source: CMS Form 2567, inspection 2020-11-18, tag G0440 · view on CMS
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Minor A Review Of All Current Medications

The agency failed to accurately complete a drug regimen review (DRR), including completion of all required components and identification of any findings within the required time frames as part of the comprehensive assessment for 7 of 7 sampled patients (Patients #1, #2, #3, #5, #6, #7 and #8).

Source: CMS Form 2567, inspection 2020-11-18, tag G0536 · view on CMS
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Minor Plan Of Care Must Include The Following

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including medications, and/or equipment/supplies used to meet the patient's individualized needs for 3 of 7 sampled patients (Patients #3, #5 and #6).

Source: CMS Form 2567, inspection 2020-11-18, tag G0574 · view on CMS
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