S&C QCOR HHA 2567s
d QCOR:  Quality, Certification and Oversight Reports.
HHAs 2567s
Selection Criteria

Time Interval

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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 HHA 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
157681 Indiana Signal Health Group Skilled Inc 2013 Chester Blvd Richmond IN 5 (Chicago) 09/23/2024 642F6-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G1024 Authentication Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0610 Patients receive education and training Element
G0804 Aides are members of interdisciplinary team Element
157681 Indiana Signal Health Group Skilled Inc 2013 Chester Blvd Richmond IN 5 (Chicago) 02/01/2023 5ED01-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0750 Home health aide services Condition
G0518 Completion of the comprehensive assessment Standard
G0544 Update of the comprehensive assessment Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G0788 Org. had partial/extended survey Element
G0804 Aides are members of interdisciplinary team Element
G0822 Ensuring the overall quality of care provided Element
157681 Indiana Signal Health Group Skilled Inc 2013 Chester Blvd Richmond IN 5 (Chicago) 03/21/2022 3863B-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0940 Organization and administration of services Condition
G0682 Infection Prevention Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0702 Services by skilled professionals Standard
G0944 Administrator must: Standard
G0958 Clinical manager Standard
G0546 Last 5 days of every 60 days unless: Element
G0580 Only as ordered by a physician Element
G0788 Org. had partial/extended survey Element
G0792 Deficiencies that endangered health/safety Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0814 Non-skilled direct observation every 60 days Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
G0956 Available during all operating hours Element
G0960 Make patient and personnel assignments, Element
G0962 Coordinate patient care Element
G0964 Coordinate referrals; Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
157681 Indiana Signal Health Group Skilled Inc 2013 Chester Blvd Richmond IN 5 (Chicago) 12/14/2021 3805D-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0454 HHA can no longer meet the patient's needs Element
157681 Indiana Signal Health Group Skilled Inc 2013 Chester Blvd Richmond IN 5 (Chicago) 10/22/2021 19766-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0418 Patient's or legal representative's signature Element
G0484 Document complaint and resolution Element
G0514 RN performs assessment Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
157681 Indiana Signal Health Group Skilled Inc 2013 Chester Blvd Richmond IN 5 (Chicago) 10/02/2018 106K11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0570 Care planning, coordination, quality of care Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services Condition
G0572 Plan of care Standard
G0724 Supervise skilled professional assistants Standard
G0798 Home health aide assignments and duties Standard
G0958 Clinical manager Standard
G0422 Written notice within 4 business days Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0440 Payment from federally funded programs Element
G0480 Treatment or care Element
G0484 Document complaint and resolution Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0602 Communication with all physicians Element
G0606 Integrate all services Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0766 HHA maintains documentation of training Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G1012 Required items in clinical record Element
157683 Aunova Home Care Llc 6910 North Main Street, Suite 23a Granger IN 5 (Chicago) 03/26/2021 BMKH11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G1024 Authentication Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0444 State toll free HH telephone hotline Element
G0454 HHA can no longer meet the patient's needs Element
G0484 Document complaint and resolution Element
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0542 Incorporate OASIS items Element
G0574 Plan of care must include the following Element
G0606 Integrate all services Element
G0610 Patients receive education and training Element
G0618 Treatments and therapy services Element
G0622 Name/contact information of clinical manager Element
G0714 Patient and caregiver education Element
157685 Bayada Home Health Care Inc 2601 Fortune Circle East Ste 105b Indianapolis IN 5 (Chicago) 06/30/2023 5FDB9-H2 Complaint
Deficiency Tag Deficiency Description Tag Type
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0978 Must have a written agreement Element
157685 Bayada Home Health Care Inc 2601 Fortune Circle East Ste 105b Indianapolis IN 5 (Chicago) 05/23/2023 5FDB9-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
G0860 Licensing Standard
G1028 Protection of records Standard
157685 Bayada Home Health Care Inc 2601 Fortune Circle East Ste 105b Indianapolis IN 5 (Chicago) 01/13/2021 W8T911 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard