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
▼ 058026 Ethical Home Health Care 550 North Euclid Avenue Upland CA 9 (San Francisco) 01/17/2020 SE1D11 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
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0684 Infection control Standard
▼ 058027 All Med Home Health Srvs 16661 Ventura Blvd Ste 503 Encino CA 9 (San Francisco) 06/26/2022 4EAA2-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0660 Executive responsibilities for QAPI Standard
G0446 Contact info Federal/State-funded entities Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0616 Patient medication schedule/instructions Element
G0984 In accordance with current clinical practice Element
▼ 058032 Progressive 2000 Hhc 948 North Fairfax Ave, Suite 200 Los Angeles CA 9 (San Francisco) 03/13/2020 990R11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0532 Continuing need for home care Element
▼ 058034 Nevada Gem Home Health 17418 Chatsworth Street Suite 200 Granada Hills CA 9 (San Francisco) 01/20/2026 1E11CF-H1 Complaint, 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
G0640 Quality assessment/performance improvement Condition
G1008 Clinical records Condition
E0004 Develop EP Plan, Review and Update Annually Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G1024 Authentication Standard
G0446 Contact info Federal/State-funded entities Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0598 Discharge plans communication Element
G0808 Onsite supervisory visit every 14 days Element
G1012 Required items in clinical record Element
G1022 Discharge and transfer summaries Element
▼ 058034 Nevada Gem Home Health 17418 Chatsworth Street Suite 200 Granada Hills CA 9 (San Francisco) 03/27/2022 38701-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
G0684 Infection control Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 058037 Las Posas Home Health Services 1601 Carmen Drive, Suite 202 Camarillo CA 9 (San Francisco) 07/31/2025 1D219E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0942 Governing body Standard
G0536 A review of all current medications Element
G0726 Nursing services supervised by RN Element
▼ 058037 Las Posas Home Health Services 1601 Carmen Drive, Suite 202 Camarillo CA 9 (San Francisco) 07/08/2022 4EF6C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0602 Communication with all physicians Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 058038 Act Home Health , Inc. 12431 Lewis Street, Suite 101 Garden Grove CA 9 (San Francisco) 02/18/2025 654B4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0602 Communication with all physicians Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
G0984 In accordance with current clinical practice Element
G1012 Required items in clinical record Element
▼ 058038 Act Home Health , Inc. 12431 Lewis Street, Suite 101 Garden Grove CA 9 (San Francisco) 04/13/2022 38769-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0376 Transmittal of OASIS data Standard
G0544 Update of the comprehensive assessment Standard
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0574 Plan of care must include the following Element
G0602 Communication with all physicians Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
▼ 058038 Act Home Health , Inc. 12431 Lewis Street, Suite 101 Garden Grove CA 9 (San Francisco) 11/27/2018 GI2511 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0036 EP Training and Testing Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0484 Document complaint and resolution Element
G0546 Last 5 days of every 60 days unless: Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G1022 Discharge and transfer summaries Element