S&C QCOR HHA 2567s
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HHAs 2567s
Selection Criteria ▸

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
▼ 057645 Western Health Resources 2796 Sycamore Dr. Suite 100, Simi Valley, Ca, 93065 Simi Valley CA 9 (San Francisco) 08/12/2019 0QON11 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
G0710 Provide services in the plan of care Element
▼ 057657 Jsi Acquisitions, Inc. 5805 Sepulveda Blvd Suite 605 Van Nuys CA 9 (San Francisco) 02/14/2025 65596-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
G1008 Clinical records Condition
G0572 Plan of care Standard
G0590 Promptly alert relevant physician of changes Element
G0592 Revised plan of care Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 057657 Jsi Acquisitions, Inc. 5805 Sepulveda Blvd Suite 605 Van Nuys CA 9 (San Francisco) 07/28/2022 4F1A3-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0984 In accordance with current clinical practice Element
▼ 057657 Jsi Acquisitions, Inc. 5805 Sepulveda Blvd Suite 605 Van Nuys CA 9 (San Francisco) 12/17/2018 8Y0H11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 057659 Cp Napa Valley N-Ca Hh, Llc 980 Trancas St, Suite 9 Napa CA 9 (San Francisco) 02/09/2023 5EF23-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0468 Provide contact info other services Element
▼ 057659 Cp Napa Valley N-Ca Hh, Llc 980 Trancas St, Suite 9 Napa CA 9 (San Francisco) 09/12/2019 WZ7N11 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
G0684 Infection control Standard
G1022 Discharge and transfer summaries Element
▼ 057661 Enloe Medical Center Home Health Agency 1390 E Lassen Ave Chico CA 9 (San Francisco) 08/07/2020 EQR911 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
▼ 057679 Butte Home Health And Hospice 10 Constitution Drive Chico CA 9 (San Francisco) 01/12/2024 61D3A-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0444 State toll free HH telephone hotline Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
▼ 057679 Butte Home Health And Hospice 10 Constitution Drive Chico CA 9 (San Francisco) 04/21/2022 38891-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
G0576 All orders recorded in plan of care Element
▼ 057679 Butte Home Health And Hospice 10 Constitution Drive Chico CA 9 (San Francisco) 10/11/2019 H7VC11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0418 Patient's or legal representative's signature Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0808 Onsite supervisory visit every 14 days Element