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
▼ 058000 Excellent In-Home Care, Inc. 22041 Clarendon Street Suite 100 Woodland Hills CA 9 (San Francisco) 08/02/2019 BY5O11 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
▼ 058004 Jola Home Health Service, Inc 323 N Prairie Ave Suite 425 Inglewood CA 9 (San Francisco) 02/09/2023 5EF0C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0590 Promptly alert relevant physician of changes Element
G0610 Patients receive education and training Element
G0616 Patient medication schedule/instructions Element
G0716 Preparing clinical notes Element
▼ 058004 Jola Home Health Service, Inc 323 N Prairie Ave Suite 425 Inglewood CA 9 (San Francisco) 05/13/2019 T3UO11 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
▼ 058005 Visiting Home Nurses, Inc 10630 Town Center Drive, Suite 120 Rancho Cucamonga CA 9 (San Francisco) 06/05/2025 664AE-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
G0536 A review of all current medications Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 058005 Visiting Home Nurses, Inc 10630 Town Center Drive, Suite 120 Rancho Cucamonga CA 9 (San Francisco) 05/12/2022 38A45-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0658 Performance improvement projects Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0436 Receive all services in plan of care Element
G0450 Access to auxiliary aids and language service Element
G0536 A review of all current medications Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 058005 Visiting Home Nurses, Inc 10630 Town Center Drive, Suite 120 Rancho Cucamonga CA 9 (San Francisco) 04/05/2018 R1E111 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
G0510 Comprehensive Assessment of Patients Condition
E0009 Local, State, Tribal Collaboration Process Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0032 Primary/Alternate Means for Communication Standard
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0512 Standard: Initial assessment visit. Standard
G0526 Content of the comprehensive assessment Standard
G0544 Update of the comprehensive assessment Standard
G0658 Performance improvement projects Standard
G1010 Contents of clinical record Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0550 At discharge Element
G1022 Discharge and transfer summaries Element
▼ 058008 Immaculate Heart Of Mary Home Health, Inc 14329 Woodruff Ave Suite A Bellflower CA 9 (San Francisco) 04/16/2023 5F8E4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
G0608 Coordinate care delivery Element
▼ 058008 Immaculate Heart Of Mary Home Health, Inc 14329 Woodruff Ave Suite A Bellflower CA 9 (San Francisco) 07/01/2019 WI5Q11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
▼ 058010 Erg Home Health Providers, Inc 11700 South Street Suite 200 Artesia CA 9 (San Francisco) 06/10/2023 5FFC9-H1 Recertification
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
G0848 Compliance with Federal, State, Local Law Condition
G1008 Clinical records Condition
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0682 Infection Prevention Standard
G0860 Licensing Standard
G0862 Laboratory services/CLIA waivers Standard
G1024 Authentication Standard
G0520 5 calendar days after start of care Element
G0522 Eligibility for Medicare home health benefit Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0602 Communication with all physicians Element
G0952 Ensure that HHA employs qualified personnel Element
G1022 Discharge and transfer summaries Element
▼ 058010 Erg Home Health Providers, Inc 11700 South Street Suite 200 Artesia CA 9 (San Francisco) 07/15/2019 78I511 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0860 Licensing Standard
G0434 Participate in care Element
G0536 A review of all current medications Element