S&C QCOR HHA 2567s
d QCOR: Quality, Certification and Oversight Reports. S&C QCOR  
Home  |  Help  |  Resources  |  FAQs  |  Site Map  
   
HHAs 2567s
Selection Criteria ▸

Time Interval

Please select the calendar year or years for which you would like data.

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 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
▼ 15K182 Personal Care Concepts Inc 3802 South Adams Street Marion IN 5 (Chicago) 07/01/2022 4EE72-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0798 Home health aide assignments and duties Standard
G1030 Retrieval of records Standard
G0446 Contact info Federal/State-funded entities Element
G0528 Health, psychosocial, functional, cognition Element
G0764 HH aide training program topics Element
G0800 Services provided by HH aide Element
▼ 15K182 Personal Care Concepts Inc 3802 South Adams Street Marion IN 5 (Chicago) 07/08/2019 D0MV11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0584 Verbal orders Element
▼ 15K187 Servant's Heart Home Health Services, Inc 1714 Dividend Drive Logansport IN 5 (Chicago) 07/16/2025 66786-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
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0700 Skilled professional services Condition
G0750 Home health aide services Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0033 Methods for Sharing Information Standard
E0039 EP Testing Requirements Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0768 Competency evaluation Standard
G0798 Home health aide assignments and duties Standard
G1028 Protection of records Standard
G0414 HHA administrator contact information Element
G0432 Make complaints to the HHA Element
G0514 RN performs assessment Element
G0534 Patient's needs Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0800 Services provided by HH aide Element
▼ 15K188 Allegiance Home Health Agency Inc 5103 Madison Ave, Suite A Indianapolis IN 5 (Chicago) 11/03/2023 61613-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0760 Classroom and supervised practical training Element
G0858 Responsible for the management of the HHA Element
▼ 15K189 Team Select Home Care Of Indiana, Llc 413 N Washington St, Ste 1 Kokomo IN 5 (Chicago) 03/11/2026 1F3728-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0031 Emergency Officials Contact Information Standard
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G0580 Only as ordered by a physician Element
G0598 Discharge plans communication Element
G0616 Patient medication schedule/instructions Element
G0800 Services provided by HH aide Element
▼ 15K189 Team Select Home Care Of Indiana, Llc 413 N Washington St, Ste 1 Kokomo IN 5 (Chicago) 01/11/2024 6137F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0033 Methods for Sharing Information Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0436 Receive all services in plan of care Element
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0588 Reviewed, revised by physician every 60 days Element
▼ 15K190 Advantage Home Health Care Inc 4008 Wheeling Ave Muncie IN 5 (Chicago) 05/16/2025 66311-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G1024 Authentication Standard
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0706 Interdisciplinary assessment of the patient Element
G1018 Contact information for the patient Element
G1022 Discharge and transfer summaries Element
▼ 15K192 Golden Care Home Health Services Llc 3905 Vincennes Road Indianapolis IN 5 (Chicago) 03/25/2026 1F57B1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
G0754 A qualified HH aide successfully completed: Element
G0766 HHA maintains documentation of training Element
G0802 Duties of a HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
▼ 15K196 Always Care Home Health Llc 450 E 96th St Ste 500 Indianapolis IN 5 (Chicago) 11/25/2024 64C1B-H1 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
▼ 15K197 Nx Generation Health, Llp 8645 Keystone Crossing Ste 150 Indianapolis IN 5 (Chicago) 11/07/2024 64A3A-H1 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard