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
▼ 057704 Mercy-Memorial Home Health 1600 D Street, Suite 202 Bakersfield CA 9 (San Francisco) 06/08/2023 5FDC1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0412 Written notice of patient's rights Element
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
▼ 057704 Mercy-Memorial Home Health 1600 D Street, Suite 202 Bakersfield CA 9 (San Francisco) 12/18/2019 B3IL11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0536 A review of all current medications Element
G0708 Development and evaluation of plan of care Element
G0718 Communication with physicians Element
▼ 057710 Western Health Resources 9245 Highway 53 Lower Lake CA 9 (San Francisco) 03/14/2019 NTV611 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0017 HHA Comprehensive Assessment in Disaster Standard
G0514 RN performs assessment Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G0978 Must have a written agreement Element
▼ 057713 Mountain Communities Healthcare District 60 Easter Avenue Weaverville CA 9 (San Francisco) 06/01/2018 UVZ611 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
G0718 Communication with physicians Element
▼ 057734 Usa Home Health, Inc 1415 E Colorado Street, Suite 206 Glendale CA 9 (San Francisco) 02/20/2022 38513-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
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0610 Patients receive education and training Element
G1014 Interventions and patient response Element
▼ 057734 Usa Home Health, Inc 1415 E Colorado Street, Suite 206 Glendale CA 9 (San Francisco) 07/12/2018 H3SZ11 Recertification
Deficiency Tag Deficiency Description Tag Type
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
G0618 Treatments and therapy services Element
▼ 057736 Emanate Health Hospice 820 N Phillips Ave West Covina CA 9 (San Francisco) 06/05/2022 4EC96-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0544 Update of the comprehensive assessment Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
▼ 057736 Emanate Health Hospice 820 N Phillips Ave West Covina CA 9 (San Francisco) 01/11/2019 VTL311 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G1010 Contents of clinical record Standard
G0616 Patient medication schedule/instructions Element
▼ 057746 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 9 (San Francisco) 08/15/2024 63DB7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
G0726 Nursing services supervised by RN Element
▼ 057746 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 9 (San Francisco) 02/15/2018 VQ1P11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G0588 Reviewed, revised by physician every 60 days Element