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
▼ 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
▼ 058039 Assisted Home Care 4450 Westinghouse Street, Suite #101 Ventura CA 9 (San Francisco) 04/09/2026 22C76B-H1 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
▼ 058039 Assisted Home Care 4450 Westinghouse Street, Suite #101 Ventura CA 9 (San Francisco) 08/31/2023 609E8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
▼ 058039 Assisted Home Care 4450 Westinghouse Street, Suite #101 Ventura CA 9 (San Francisco) 12/31/2019 3FQF11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
G0614 Visit schedule Element
▼ 058042 Capital Home Health Agency Inc 5751 W Adams Blvd Los Angeles CA 9 (San Francisco) 07/04/2022 4EF71-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
G0686 Infection control education Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element