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
▼ 058188 Jar-Cv Enterprises, Inc. 12362 Beach Blvd, Ste 5 Stanton CA 9 (San Francisco) 03/22/2022 3868C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0034 Information on Occupancy/Needs Standard
E0039 EP Testing Requirements Standard
G0564 Discharge or Transfer Summary Content Standard
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0860 Licensing Standard
G0862 Laboratory services/CLIA waivers Standard
G1024 Authentication Standard
G0412 Written notice of patient's rights Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0596 Revisions communicated to patient and MDs Element
G0608 Coordinate care delivery Element
G0614 Visit schedule Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
▼ 058188 Jar-Cv Enterprises, Inc. 12362 Beach Blvd, Ste 5 Stanton CA 9 (San Francisco) 08/23/2018 2R8Q11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0642 Program scope Standard
G0644 Program data Standard
G0646 Program activities Standard
G0654 Track adverse patient events Standard
G0682 Infection Prevention Standard
G0942 Governing body Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0648 High risk, high volume, or problem-prone area Element
G0650 Incidence, prevalence, severity of problems Element
G0656 Improvements are sustained Element
G0710 Provide services in the plan of care Element
G0722 Participate in HHA-sponsored in-service Element
G0726 Nursing services supervised by RN Element
G0984 In accordance with current clinical practice Element
G1014 Interventions and patient response Element
▼ 058190 Victory Home Health Agency 24490 Sunnymead Boulevard, Suite 108 Moreno Valley CA 9 (San Francisco) 08/17/2023 60B30-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0582 Influenza and pneumococcal vaccines Element
G0584 Verbal orders Element
▼ 058190 Victory Home Health Agency 24490 Sunnymead Boulevard, Suite 108 Moreno Valley CA 9 (San Francisco) 01/11/2018 830Y11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0215 COMPETENCY EVALUATION & IN-SERVICE TRAI Standard
G0337 DRUG REGIMEN REVIEW Standard
▼ 058191 Allsupreme Home Care, Inc. 13110 W Washington Blvd Los Angeles CA 9 (San Francisco) 04/09/2018 Y8DO11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0522 Eligibility for Medicare home health benefit Element
G0532 Continuing need for home care Element
G0536 A review of all current medications Element
G0596 Revisions communicated to patient and MDs Element
G0710 Provide services in the plan of care Element
G0718 Communication with physicians Element
▼ 058195 St Mary's Home Health Services, Inc 3180 E Shields Ave, #105 Fresno CA 9 (San Francisco) 08/24/2021 26VZ11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0530 Strengths, goals, and care preferences Element
▼ 058195 St Mary's Home Health Services, Inc 3180 E Shields Ave, #105 Fresno CA 9 (San Francisco) 10/31/2018 4ZHU11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0704 Responsibilities of skilled professionals Standard
G0548 Within 48 hours of the patient's return Element
G0580 Only as ordered by a physician Element
▼ 058198 Muliti-Skilled Home Care Services, Inc 19608 Camino De Rosa, Suite 201 Walnut CA 9 (San Francisco) 02/06/2022 383F9-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
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
▼ 058198 Muliti-Skilled Home Care Services, Inc 19608 Camino De Rosa, Suite 201 Walnut CA 9 (San Francisco) 01/29/2018 7SMP11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0518 Completion of the comprehensive assessment Standard
G1010 Contents of clinical record Standard
G0576 All orders recorded in plan of care Element
G0710 Provide services in the plan of care Element
G0728 Rehab services supervised by PT, OT Element
G0808 Onsite supervisory visit every 14 days Element
▼ 058200 Sunrise Home Care Services Inc 941 S Atlantic Blvd, Ste 222 Monterey Park CA 9 (San Francisco) 01/13/2023 5E89C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
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
E0004 Develop EP Plan, Review and Update Annually Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
G0590 Promptly alert relevant physician of changes Element
G0610 Patients receive education and training Element
G0616 Patient medication schedule/instructions Element