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
▼ 058133 Care Providers, Inc 3325 Wilshire Blvd., Suite 950 Los Angeles CA 9 (San Francisco) 04/17/2022 388E6-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
G0590 Promptly alert relevant physician of changes Element
▼ 058133 Care Providers, Inc 3325 Wilshire Blvd., Suite 950 Los Angeles CA 9 (San Francisco) 03/15/2019 2KH711 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0942 Governing body Standard
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care Element
G0946 Administrator appointed by governing body Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 058137 Legacy Homecare, Inc 11036 Washington Blvd Suite A Whittier CA 9 (San Francisco) 11/18/2022 5E49D-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0610 Patients receive education and training Element
▼ 058137 Legacy Homecare, Inc 11036 Washington Blvd Suite A Whittier CA 9 (San Francisco) 09/13/2019 V0X911 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0522 Eligibility for Medicare home health benefit Element
G0536 A review of all current medications Element
G0710 Provide services in the plan of care Element
▼ 058142 Legacy Homecare Plus Unlimited, Inc 642 South Second Avenue, Suite A Covina CA 9 (San Francisco) 07/29/2019 8HIY11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0522 Eligibility for Medicare home health benefit Element
G0536 A review of all current medications Element
G1012 Required items in clinical record Element
▼ 058144 Professional Home Health Services 2155 Egary Ave, N, Suite B-12 West Covina CA 9 (San Francisco) 01/08/2023 5EAC2-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
G0610 Patients receive education and training Element
▼ 058145 Always Stay Home Nursing Services, Inc 11633 Hawthorne Blvd Suite 220 Hawthorne CA 9 (San Francisco) 02/28/2020 Q6PQ11 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
G0532 Continuing need for home care Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
▼ 058146 Valley Care Home Health Services, Inc. One Ridgegate Drive, Suite #115 Temecula CA 9 (San Francisco) 06/14/2024 634B5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0952 Ensure that HHA employs qualified personnel Element
G0984 In accordance with current clinical practice Element
▼ 058146 Valley Care Home Health Services, Inc. One Ridgegate Drive, Suite #115 Temecula CA 9 (San Francisco) 10/10/2019 MPNI11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0808 Onsite supervisory visit every 14 days Element
▼ 058148 Quality Home Health Agency 4375 E Lowell Street Suite I Ontario CA 9 (San Francisco) 05/19/2023 5FCA3-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element