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
▼ 05K101 247 Allstaff West Llc 2450 Venture Oaks Way Sacramento CA 9 (San Francisco) 05/14/2025 652B5-H2 Recertification
Deficiency Tag Deficiency Description Tag Type
G0540 The patient's representative (if any); Element
▼ 05K101 247 Allstaff West Llc 2450 Venture Oaks Way Sacramento CA 9 (San Francisco) 01/29/2025 652B5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0406 Condition of Participation: Patient rights. Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
G0848 Compliance with Federal, State, Local Law Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G1050 Personnel qualifications Condition
G0424 Exercise of rights Standard
G0452 Transfer and discharge Standard
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0642 Program scope Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0702 Services by skilled professionals Standard
G0862 Laboratory services/CLIA waivers Standard
G0942 Governing body Standard
G0982 Skilled services furnished Standard
G0988 Institutional planning Standard
G1024 Authentication Standard
G1052 Administrator Standard
G1060 Licensed Practical (Vocational) Nurse Standard
G0410 Information to patient Element
G0412 Written notice of patient's rights Element
G0414 HHA administrator contact information Element
G0418 Patient's or legal representative's signature Element
G0422 Written notice within 4 business days Element
G0428 Property and person treated with respect Element
G0430 Be free from abuse Element
G0432 Make complaints to the HHA Element
G0434 Participate in care Element
G0436 Receive all services in plan of care Element
G0438 Have a confidential clinical record Element
G0440 Payment from federally funded programs Element
G0442 Written notice for non-covered care Element
G0444 State toll free HH telephone hotline Element
G0446 Contact info Federal/State-funded entities Element
G0448 Freedom from discrimination or reprisal Element
G0450 Access to auxiliary aids and language service Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0532 Continuing need for home care Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0538 Primary caregiver(s), if any 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
G0584 Verbal orders Element
G0588 Reviewed, revised by physician every 60 days Element
G0602 Communication with all physicians Element
G0604 Integrate all orders Element
G0608 Coordinate care delivery Element
G0610 Patients receive education and training Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0618 Treatments and therapy services Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G0726 Nursing services supervised by RN Element
G0946 Administrator appointed by governing body Element
G0948 Responsible for all day-to-day operations Element
G0954 Ensures qualified pre-designated person Element
G1014 Interventions and patient response Element
G1016 Goals in the patient's plans of care Element
G1018 Contact information for the patient Element
G1022 Discharge and transfer summaries Element
▼ 05K101 247 Allstaff West Llc 2450 Venture Oaks Way Sacramento CA 9 (San Francisco) 05/30/2023 5FCFD-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0546 Last 5 days of every 60 days unless: Element
G0588 Reviewed, revised by physician every 60 days Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
▼ 05K101 247 Allstaff West Llc 2450 Venture Oaks Way Sacramento CA 9 (San Francisco) 03/11/2022 385E6-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
G0940 Organization and administration of services Condition
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G1030 Retrieval of records Standard
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0716 Preparing clinical notes Element
G0950 Ensure clinical manager is available Element
G0954 Ensures qualified pre-designated person Element
G0962 Coordinate patient care Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 05K101 247 Allstaff West Llc 2450 Venture Oaks Way Sacramento CA 9 (San Francisco) 09/11/2020 378M11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0726 Nursing services supervised by RN Element
▼ 05K101 247 Allstaff West Llc 2450 Venture Oaks Way Sacramento CA 9 (San Francisco) 07/12/2019 4P3811 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G1010 Contents of clinical record Standard
G1028 Protection of records Standard
G0438 Have a confidential clinical record Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0588 Reviewed, revised by physician every 60 days Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available Element
G1012 Required items in clinical record Element
▼ 05K104 Ro Health, Llc 1867 Whipple Road Hayward CA 9 (San Francisco) 09/12/2024 641BE-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0560 Discharge Planning Condition
G0564 Discharge or Transfer Summary Content Standard
G0434 Participate in care Element
G0580 Only as ordered by a physician Element
G0602 Communication with all physicians Element
▼ 05K104 Ro Health, Llc 1867 Whipple Road Hayward CA 9 (San Francisco) 09/29/2022 5E073-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0970 Parent-branch relationship Standard
▼ 05K124 Atlus Health, Inc. 151 N Sunrise Ave Roseville CA 9 (San Francisco) 11/20/2024 64B44-H1 Initial Certification
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
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
▼ 05K132 Maxim Healthcare Services, Inc 27555 Ynez Road Temecula CA 9 (San Francisco) 03/25/2026 22C07B-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0702 Services by skilled professionals Standard
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care Element