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
▼ 059649 Cdm Health Care, Inc. 3665 Ruffin Road, Suite 100 San Diego CA 9 (San Francisco) 05/03/2018 AK0411 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually 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
G0608 Coordinate care delivery Element
G0772 Documentation of competency evaluation Element
G1022 Discharge and transfer summaries Element
▼ 059651 California Care Home Health Agency, Inc 315 Pondera Street, Suite F Lancaster CA 9 (San Francisco) 02/15/2023 5EFEB-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G1008 Clinical records Condition
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0642 Program scope Standard
G0644 Program data Standard
G1024 Authentication Standard
G1026 Retention of records Standard
G1028 Protection of records Standard
G0436 Receive all services in plan of care Element
G0446 Contact info Federal/State-funded entities Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0592 Revised plan of care Element
G0606 Integrate all services Element
G0726 Nursing services supervised by RN Element
G0952 Ensure that HHA employs qualified personnel Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 059651 California Care Home Health Agency, Inc 315 Pondera Street, Suite F Lancaster CA 9 (San Francisco) 12/20/2019 Q4E011 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0710 Provide services in the plan of care Element
▼ 059678 Pacific Health Services, Inc 2501 West Burbank Blvd Suite 309 Burbank CA 9 (San Francisco) 12/05/2025 1DD21C-H1 Complaint, 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
G0488 Immediate reporting of abuse by all staff 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
G0708 Development and evaluation of plan of care Element
G0778 Documentation of inservice training Element
G1012 Required items in clinical record Element
▼ 059678 Pacific Health Services, Inc 2501 West Burbank Blvd Suite 309 Burbank CA 9 (San Francisco) 01/24/2022 38309-H1 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
G0682 Infection Prevention Standard
G0532 Continuing need for home care 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
G0716 Preparing clinical notes Element
G0778 Documentation of inservice training Element
▼ 059684 Maxim Healthcare Services, Inc. 2000 Powell Street Emeryville CA 9 (San Francisco) 08/30/2018 LJ7Q11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0710 Provide services in the plan of care Element
▼ 059686 Healthy Living At Home- Modesto, Llc 3600 Sisk Rd., Suite 1c Modesto CA 9 (San Francisco) 04/04/2019 1JFO11 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0806 Supervision of home health aides Standard
G0410 Information to patient Element
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0416 OASIS privacy notice Element
G0418 Patient's or legal representative's signature Element
G0434 Participate in care Element
G0488 Immediate reporting of abuse by all staff Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 059691 Trusted Healthcare, Inc 310 E. Rowland St. Suite B Covina CA 9 (San Francisco) 05/23/2022 4EBAA-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
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0710 Provide services in the plan of care Element
▼ 059695 Healthy Living At Home - Palm Desert, Llc 36953 Cook Street, Suite 102, Bldg B Palm Desert CA 9 (San Francisco) 01/05/2018 7OUX11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0164 PERIODIC REVIEW OF PLAN OF CARE Standard
▼ 059697 Care Dimensions Of The Desert, Llc 74130 Country Club Drive, Suite 104 Palm Desert CA 9 (San Francisco) 08/03/2023 608C0-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0606 Integrate all services Element
G0710 Provide services in the plan of care Element