Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 757658 (X3) Date Survey Completed 11/30/2023
Name of Provider or Supplier Accentcare Home Health Of California, Inc. Street Address, City, State 2300 Contra Costa Blvd, Suite 240, Pleasant Hill, CA
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
G0000 The following reflects the findings of the California Department of Public Health during a Recertification survey conducted from 11/27/23 through 11/30/23.





Representing the Department: Health Facilities Evaluator Nurses: 32717 and 44946





The unduplicated census was 19.





Sample size was 7.





There were three deficiencies.