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
▼ 557796 Owen Healthcare, Llc 1109 Vicente Street, Suite 103 San Francisco CA 9 (San Francisco) 06/30/2023 60126-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
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0720 Participate in the HHA's QAPI program; Element
G0972 Report all branch locations to SA Element
▼ 557797 Vip Home Health Care Agency 1224 South Garfield Avenue #204 Alhambra CA 9 (San Francisco) 12/05/2022 5F10A-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
G0640 Quality assessment/performance improvement Condition
E0004 Develop EP Plan, Review and Update Annually Standard
G0374 Accuracy of encoded OASIS data Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0684 Infection control Standard
G0704 Responsibilities of skilled professionals Standard
G0522 Eligibility for Medicare home health benefit Element
G0536 A review of all current medications Element
G0714 Patient and caregiver education Element
▼ 557797 Vip Home Health Care Agency 1224 South Garfield Avenue #204 Alhambra CA 9 (San Francisco) 10/08/2019 O4YB11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0940 Organization and administration of services Condition
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0714 Patient and caregiver education Element
G0984 In accordance with current clinical practice Element
▼ 559003 Elite Health Care Services, Llc 9267 Greenback Lane Suite B-1 Orangevale CA 9 (San Francisco) 05/18/2023 5FB7F-H1 Recertification
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
G0536 A review of all current medications Element
▼ 559016 Sycamore Grove Healthcare Llc 5479 N. Fresno St., Ste. 102 Fresno CA 9 (San Francisco) 09/16/2025 1D63E1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0704 Responsibilities of skilled professionals Standard
G0602 Communication with all physicians Element
G1014 Interventions and patient response Element
▼ 559031 Health Is Wealth Home Health Agency Llc 3135 Clayton Road Suite 101 Concord CA 9 (San Francisco) 05/17/2024 5F71B-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0436 Receive all services in plan of care Element
G0574 Plan of care must include the following Element
G1012 Required items in clinical record Element
▼ 559050 Hand In Heart Home Health Inc 5450 Ralston Street, Unit 202 Ventura CA 9 (San Francisco) 05/20/2024 62ECD-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0942 Governing body Standard
G1028 Protection of records Standard
G0460 Patient refuses services Element
G0472 Death of patient Element
G0576 All orders recorded in plan of care Element
G0584 Verbal orders Element
G0614 Visit schedule Element
G0952 Ensure that HHA employs qualified personnel Element
G0954 Ensures qualified pre-designated person Element
G0962 Coordinate patient care Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 559050 Hand In Heart Home Health Inc 5450 Ralston Street, Unit 202 Ventura CA 9 (San Francisco) 01/12/2023 5DD7C-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0454 HHA can no longer meet the patient's needs Element
G0596 Revisions communicated to patient and MDs Element
▼ 559061 Bellestar Home Health Care, Inc 1568 Creekside Drive Suite #203 Folsom CA 9 (San Francisco) 01/14/2026 1E02B7-H1 Recertification
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
G0520 5 calendar days after start of care Element
G0590 Promptly alert relevant physician of changes Element
▼ 559061 Bellestar Home Health Care, Inc 1568 Creekside Drive Suite #203 Folsom CA 9 (San Francisco) 12/02/2022 5E698-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element