S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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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
▼ 059367 Optimal Home Health 19634 Ventura Blvd Suite 218 Tarzana CA 9 (San Francisco) 05/11/2022 38A35-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0370 Reporting OASIS information Condition
G0570 Care planning, coordination, quality of care Condition
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
E0013 Development of EP Policies and Procedures Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0660 Executive responsibilities for QAPI Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0704 Responsibilities of skilled professionals Standard
G0774 12 hours inservice every 12 months Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
G0656 Improvements are sustained Element
G0710 Provide services in the plan of care Element
G0722 Participate in HHA-sponsored in-service Element
G0726 Nursing services supervised by RN Element
G0952 Ensure that HHA employs qualified personnel Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 059367 Optimal Home Health 19634 Ventura Blvd Suite 218 Tarzana CA 9 (San Francisco) 01/17/2020 KDLJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0708 Development and evaluation of plan of care Element
G1012 Required items in clinical record Element
▼ 059367 Optimal Home Health 19634 Ventura Blvd Suite 218 Tarzana CA 9 (San Francisco) 01/02/2018 UXK211 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0156 ACCEPTANCE OF PATIENTS, POC, MED SUPER Condition
G0158 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0164 PERIODIC REVIEW OF PLAN OF CARE Standard
G0165 CONFORMANCE WITH PHYSICIAN ORDERS Standard
▼ 059371 Prohealth Homecare Agency, Inc 11755 Victory Blvd, Suite 290 North Hollywood CA 9 (San Francisco) 02/09/2018 GZE011 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0542 Incorporate OASIS items Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G1012 Required items in clinical record Element
▼ 059373 Mohave Healthcare, Inc 149350 Ukiah Trail, Suite 102 Big River CA 9 (San Francisco) 05/21/2026 2321B8-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
G0612 Written instructions to patient include: Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
▼ 059373 Mohave Healthcare, Inc 149350 Ukiah Trail, Suite 102 Big River CA 9 (San Francisco) 05/19/2023 5FA97-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
G0536 A review of all current medications Element
▼ 059373 Mohave Healthcare, Inc 149350 Ukiah Trail, Suite 102 Big River CA 9 (San Francisco) 01/26/2018 T73P11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0158 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0176 DUTIES OF THE REGISTERED NURSE Standard
G0236 CLINICAL RECORDS Standard
▼ 059381 Amity Home Health Care Inc 27171 Calaroga Avenue, Suites 100, 4 & 5 Hayward CA 9 (San Francisco) 07/05/2019 XGJY11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 059385 Healthy Living At Home, Llc 2450 Venture Oaks Way, Suite 220 Sacramento CA 9 (San Francisco) 10/24/2024 64732-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0550 At discharge Element
G1022 Discharge and transfer summaries Element
▼ 059387 Bridge Home Health 5090 Shoreham Place, Suite 109 San Diego CA 9 (San Francisco) 05/23/2024 61571-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0550 At discharge Element