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
▼ 057200 Tahoe Forest Hhs 10875 Pioneer Trail Truckee CA 9 (San Francisco) 04/11/2024 62B14-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
▼ 057203 Gentiva Health Services 805 Aerovista Place San Luis Obispo CA 9 (San Francisco) 04/07/2023 5F7C7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0860 Licensing Standard
G0856 Officer, a director, agent, managing employee Element
G0984 In accordance with current clinical practice Element
▼ 057205 St. Elizabeth Comm Hosp Hha 1425 Vista Way Red Bluff CA 9 (San Francisco) 04/28/2023 5F8E5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0710 Provide services in the plan of care Element
▼ 057205 St. Elizabeth Comm Hosp Hha 1425 Vista Way Red Bluff CA 9 (San Francisco) 03/28/2019 RECQ11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0574 Plan of care must include the following Element
▼ 057212 Port City Operating Company, Llc 3555 Deer Park Drive Stockton CA 9 (San Francisco) 05/15/2025 661A2-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
G0412 Written notice of patient's rights Element
G0436 Receive all services in plan of care Element
G0514 RN performs assessment Element
G0536 A review of all current medications Element
▼ 057212 Port City Operating Company, Llc 3555 Deer Park Drive Stockton CA 9 (San Francisco) 08/25/2022 4F404-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
G0574 Plan of care must include the following Element
G0616 Patient medication schedule/instructions Element
▼ 057212 Port City Operating Company, Llc 3555 Deer Park Drive Stockton CA 9 (San Francisco) 06/22/2018 7YSK11 Recertification
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
G0616 Patient medication schedule/instructions Element
G1014 Interventions and patient response Element
▼ 057214 Inhome Healthcare Services 5105 E Dakota Ave Suite 101 Fresno CA 9 (San Francisco) 08/30/2018 LXDI11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0774 12 hours inservice every 12 months Standard
G0520 5 calendar days after start of care Element
G0584 Verbal orders Element
G0608 Coordinate care delivery Element
G0804 Aides are members of interdisciplinary team Element
G0808 Onsite supervisory visit every 14 days Element
▼ 057234 John C Fremont H C Dist Hha 5108 Highway 140, Ste C Mariposa CA 9 (San Francisco) 09/25/2023 5F0D1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0862 Laboratory services/CLIA waivers Standard
G0536 A review of all current medications Element
▼ 057246 Anchor Healthcare, Llc 280 Atlantic Ave Long Beach CA 9 (San Francisco) 07/15/2022 4F034-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
G0572 Plan of care 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
G0984 In accordance with current clinical practice Element
G1022 Discharge and transfer summaries Element