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
▼ 053134 Maxim Healthcare Services, Inc 27555 Ynez Rd Temecula CA 9 (San Francisco) 11/02/2021 37D9E-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0430 Be free from abuse Element
G0486 Protect patient during investigation Element
▼ 053135 Maxim Healthcare Services, Inc 34250 Gateway Drive, Ste 100 Palm Desert CA 9 (San Francisco) 12/20/2023 61C43-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0430 Be free from abuse Element
▼ 053135 Maxim Healthcare Services, Inc 34250 Gateway Drive, Ste 100 Palm Desert CA 9 (San Francisco) 06/14/2021 R06711 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0684 Infection control Standard
▼ 053137 Blc Homehealth Inc 14850 Wicks Blvd. San Leandro CA 9 (San Francisco) 10/11/2023 5FD8A-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1024 Authentication Standard
▼ 053140 Alaphia Care Home Health Services, Inc. 8300 Utica Ave. Rancho Cucamonga CA 9 (San Francisco) 07/20/2023 605BD-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0700 Skilled professional services Condition
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0702 Services by skilled professionals Standard
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0522 Eligibility for Medicare home health benefit Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0726 Nursing services supervised by RN Element
▼ 053149 Mission Home Health Of Irvine, Llc 2860 Michelle Drive, Suite 130 Irvine CA 9 (San Francisco) 09/03/2026 343098-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0602 Communication with all physicians Element
G0604 Integrate all orders Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
▼ 053155 Tengora Corporation 26522 La Alameda Ste 205 Mission Viejo CA 9 (San Francisco) 07/21/2026 285854-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
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
G0584 Verbal orders Element
G0602 Communication with all physicians Element
G0606 Integrate all services Element
G0614 Visit schedule Element
▼ 053159 Desire Home Care, Llc 3742 Tibbetts Street Ste 203 Riverside CA 9 (San Francisco) 10/16/2018 H3E711 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0438 Have a confidential clinical record Element
G0454 HHA can no longer meet the patient's needs Element
▼ 053168 Your Choice Home Health, Inc 2001 Zinfandel Drive, Suite A3 Rancho Cordova CA 9 (San Francisco) 03/08/2019 XHJR11 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
G1050 Personnel qualifications Condition
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0600 Coordination of Care Standard
G0702 Services by skilled professionals Standard
G0724 Supervise skilled professional assistants Standard
G0942 Governing body Standard
G0958 Clinical manager Standard
G1028 Protection of records Standard
G1052 Administrator Standard
G1056 Clinical Manager Standard
G0514 RN performs assessment Element
G0532 Continuing need for home care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G0602 Communication with all physicians Element
G0706 Interdisciplinary assessment of the patient Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0726 Nursing services supervised by RN Element
G0808 Onsite supervisory visit every 14 days Element
G0856 Officer, a director, agent, managing employee Element
G0858 Responsible for the management of the HHA Element
G0948 Responsible for all day-to-day operations Element
G0950 Ensure clinical manager is available Element
G0962 Coordinate patient care Element
G1012 Required items in clinical record Element
▼ 053170 Sovereign Home Health Care Agency, Inc. 15707 East Imperial Highway, Suite D La Mirada CA 9 (San Francisco) 08/18/2023 60C32-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0600 Coordination of Care Standard
G1010 Contents of clinical record Standard