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
▼ 557774 Ideal Home Care Inc 2117 Foothill Blvd Suite J La Verne CA 9 (San Francisco) 07/26/2022 4F154-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
G0572 Plan of care Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 557774 Ideal Home Care Inc 2117 Foothill Blvd Suite J La Verne CA 9 (San Francisco) 02/14/2019 9K0R11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0716 Preparing clinical notes Element
G0984 In accordance with current clinical practice Element
▼ 557784 Assisted Home Recovery, Inc 1126 N Grand Ave Suite 205 West Covina CA 9 (San Francisco) 01/31/2023 5ED72-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0536 A review of all current medications Element
▼ 557784 Assisted Home Recovery, Inc 1126 N Grand Ave Suite 205 West Covina CA 9 (San Francisco) 03/15/2020 IKG911 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 557789 Caremax Home Health 980 Enchanted Way Simi Valley CA 9 (San Francisco) 09/25/2025 1D2531-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0434 Participate in care Element
G0606 Integrate all services Element
G0808 Onsite supervisory visit every 14 days Element
▼ 557789 Caremax Home Health 980 Enchanted Way Simi Valley CA 9 (San Francisco) 09/02/2022 4F421-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0704 Responsibilities of skilled professionals Standard
G0460 Patient refuses services Element
G0584 Verbal orders Element
G0602 Communication with all physicians Element
G1014 Interventions and patient response Element
▼ 557790 Precautionary Home Health Services,Inc. 11011 Crenshaw Blvd Suite 203 Inglewood CA 9 (San Francisco) 02/17/2023 5F033-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
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
G0574 Plan of care must include the following Element
G0610 Patients receive education and training Element
G0616 Patient medication schedule/instructions Element
G0714 Patient and caregiver education Element
▼ 557790 Precautionary Home Health Services,Inc. 11011 Crenshaw Blvd Suite 203 Inglewood CA 9 (San Francisco) 04/29/2019 UKEF11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0572 Plan of care Standard
G0702 Services by skilled professionals Standard
G0484 Document complaint and resolution Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
▼ 557792 Quality Care Home Health Specialists Inc 1414 S Azusa Ave, Unit B-26 West Covina CA 9 (San Francisco) 02/05/2023 5EE9B-H1 Recertification
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
G0572 Plan of care Standard
G0522 Eligibility for Medicare home health benefit Element
G0536 A review of all current medications Element
▼ 557792 Quality Care Home Health Specialists Inc 1414 S Azusa Ave, Unit B-26 West Covina CA 9 (San Francisco) 12/05/2019 G03G11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0412 Written notice of patient's rights Element
G0522 Eligibility for Medicare home health benefit Element
G0536 A review of all current medications Element