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
▼ 05K083 California Homecare Pharmacy 2501 Cherry Ave Suite 130 Signal Hill CA 9 (San Francisco) 03/15/2023 5F441-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0612 Written instructions to patient include: Standard
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
G0610 Patients receive education and training Element
G0710 Provide services in the plan of care Element
▼ 05K083 California Homecare Pharmacy 2501 Cherry Ave Suite 130 Signal Hill CA 9 (San Francisco) 09/10/2019 3DUF11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0600 Coordination of Care Standard
G0536 A review of all current medications Element
▼ 05K084 Maxim Healthcare Services Inc 500 S Main Street, Suite 600 Orange CA 9 (San Francisco) 11/17/2023 61704-H1 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
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0029 Development of Communication Plan Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
G0572 Plan of care Standard
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
G1022 Discharge and transfer summaries Element
▼ 05K084 Maxim Healthcare Services Inc 500 S Main Street, Suite 600 Orange CA 9 (San Francisco) 07/08/2019 KCIT11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0031 Emergency Officials Contact Information Standard
E0033 Methods for Sharing Information Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0478 Investigate complaints made by patient Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
▼ 05K085 Maxim Healthcare Services Inc 1260 North Dutton Ave, Suite 230 Santa Rosa CA 9 (San Francisco) 04/20/2018 Q10O11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0032 Primary/Alternate Means for Communication Standard
G0578 Conformance with physician orders Standard
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
▼ 05K092 Maxim Healthcare Services, Inc 4540 California Ave., Suite 400 Bakersfield CA 9 (San Francisco) 08/01/2024 63B16-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
G0702 Services by skilled professionals Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0592 Revised plan of care Element
G0604 Integrate all orders Element
G1014 Interventions and patient response Element
▼ 05K095 Coastal Kids Home Care 427 Pajaro Street #1 Salinas CA 9 (San Francisco) 11/17/2025 1D80BC-H1 Focused Infection Control, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0848 Compliance with Federal, State, Local Law Condition
G0572 Plan of care Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0942 Governing body Standard
G0444 State toll free HH telephone hotline Element
G0576 All orders recorded in plan of care Element
G0592 Revised plan of care Element
G0716 Preparing clinical notes Element
▼ 05K095 Coastal Kids Home Care 427 Pajaro Street #1 Salinas CA 9 (San Francisco) 03/18/2022 383E6-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0710 Provide services in the plan of care Element
G0948 Responsible for all day-to-day operations Element
▼ 05K097 Maxim Healthcare Services, Inc 1070 Concord Avenue, Suite 110 Concord CA 9 (San Francisco) 01/03/2018 4X1914 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0143 COORDINATION OF PATIENT SERVICES Standard
G0172 DUTIES OF THE REGISTERED NURSE Standard
G0173 DUTIES OF THE REGISTERED NURSE Standard
G0175 DUTIES OF THE REGISTERED NURSE Standard
G0176 DUTIES OF THE REGISTERED NURSE Standard
▼ 05K101 247 Allstaff West Llc 2450 Venture Oaks Way Sacramento CA 9 (San Francisco) 06/24/2025 6679E-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0560 Discharge Planning Condition
G0562 Discharge Planning Standard