S&C QCOR HHA 2567s
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HHAs 2567s
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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
▼ 497626 Sheme Home Healthcare Agency, Inc 4024 Williamsburg Ct, First Floor Fairfax VA 3 (Philadelphia) 07/23/2025 1D1955-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
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0776 Inservice training supervised by RN Element
G1014 Interventions and patient response Element
▼ 497626 Sheme Home Healthcare Agency, Inc 4024 Williamsburg Ct, First Floor Fairfax VA 3 (Philadelphia) 11/16/2021 37E84-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0031 Emergency Officials Contact Information Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0682 Infection Prevention Standard
G0442 Written notice for non-covered care Element
G0446 Contact info Federal/State-funded entities Element
G0574 Plan of care must include the following Element
▼ 497626 Sheme Home Healthcare Agency, Inc 4024 Williamsburg Ct, First Floor Fairfax VA 3 (Philadelphia) 12/12/2018 GVP011 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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0446 Contact info Federal/State-funded entities Element
G0574 Plan of care must include the following Element
▼ 497631 Oasis Hh Operations Llc 44121 Harry Byrd Highway, Suite 180 Ashburn VA 3 (Philadelphia) 08/23/2023 60B8E-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
G0680 Infection prevention and control Condition
G0940 Organization and administration of services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0030 Names and Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0862 Laboratory services/CLIA waivers Standard
G0982 Skilled services furnished Standard
G0412 Written notice of patient's rights Element
G0434 Participate in care Element
G0446 Contact info Federal/State-funded entities Element
G0484 Document complaint and resolution Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0760 Classroom and supervised practical training Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G1022 Discharge and transfer summaries Element
▼ 497631 Oasis Hh Operations Llc 44121 Harry Byrd Highway, Suite 180 Ashburn VA 3 (Philadelphia) 12/09/2020 FYUH11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G1010 Contents of clinical record Standard
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0604 Integrate all orders Element
G0648 High risk, high volume, or problem-prone area Element
G0656 Improvements are sustained Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G0968 Assure implementation of plan of care Element
G1022 Discharge and transfer summaries Element
▼ 497631 Oasis Hh Operations Llc 44121 Harry Byrd Highway, Suite 180 Ashburn VA 3 (Philadelphia) 02/05/2018 N5XS12 Recertification
Deficiency Tag Deficiency Description Tag Type
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0031 Emergency Officials Contact Information Standard
▼ 497635 Visiting Nurse Service Of Fredericksburg 3920 Plank Road, Suite 200 Fredericksburg VA 3 (Philadelphia) 07/24/2019 SPSQ11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0446 Contact info Federal/State-funded entities Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0984 In accordance with current clinical practice Element
G1022 Discharge and transfer summaries Element
▼ 497636 Pavilion Medical Home Care & Staffing, Llc 4115 Annandale Road, Suite 202 Annandale VA 3 (Philadelphia) 08/29/2022 4F441-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0982 Skilled services furnished Standard
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0440 Payment from federally funded programs Element
G0442 Written notice for non-covered care Element
G0580 Only as ordered by a physician Element
▼ 497636 Pavilion Medical Home Care & Staffing, Llc 4115 Annandale Road, Suite 202 Annandale VA 3 (Philadelphia) 08/21/2019 NQL711 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
G0442 Written notice for non-covered care Element
G0574 Plan of care must include the following Element
G1022 Discharge and transfer summaries Element
▼ 497637 Avery Partners Inc 326 Cummings Street Abingdon VA 3 (Philadelphia) 03/28/2018 0I2111 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0612 Written instructions to patient include: Standard
G0862 Laboratory services/CLIA waivers Standard
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0434 Participate in care Element
G0446 Contact info Federal/State-funded entities 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
G0622 Name/contact information of clinical manager Element
G0818 HH aide supervision elements Element
G0952 Ensure that HHA employs qualified personnel Element