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
▼ 058242 Sierra Home Healthcare Services, Inc 2064 Marengo St # 400 Los Angeles CA 9 (San Francisco) 05/08/2022 38A65-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
G0432 Make complaints to the HHA Element
G0580 Only as ordered by a physician Element
G0608 Coordinate care delivery Element
▼ 058242 Sierra Home Healthcare Services, Inc 2064 Marengo St # 400 Los Angeles CA 9 (San Francisco) 12/17/2018 KR4F11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0574 Plan of care must include the following Element
G0948 Responsible for all day-to-day operations Element
▼ 058245 Prime Choice Home Health, Inc 12611 Hiddencreek Way, Suite I Cerritos CA 9 (San Francisco) 02/21/2019 MMRY11 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
E0017 HHA Comprehensive Assessment in Disaster Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G0806 Supervision of home health aides Standard
G1024 Authentication Standard
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
G0528 Health, psychosocial, functional, cognition Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0588 Reviewed, revised by physician every 60 days Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
G1022 Discharge and transfer summaries Element
▼ 058248 Healthwise Home Care Solutions Inc 1100 N Ventura Rd Ste 102 Oxnard CA 9 (San Francisco) 03/12/2021 079H11 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0806 Supervision of home health aides Standard
G0530 Strengths, goals, and care preferences Element
G0536 A review of all current medications Element
G0550 At discharge 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
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0718 Communication with physicians Element
▼ 058248 Healthwise Home Care Solutions Inc 1100 N Ventura Rd Ste 102 Oxnard CA 9 (San Francisco) 01/31/2018 SKEY11 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0122 ORGANIZATION, SERVICES & ADMINISTRATION Condition
G0156 ACCEPTANCE OF PATIENTS, POC, MED SUPER Condition
G0330 COMPREHENSIVE ASSESSMENT OF PATIENTS Condition
G0118 COMPLIANCE WITH FED, STATE, LOCAL LAWS Standard
G0123 ORGANIZATION, SERVICES & ADMINISTRATION Standard
G0137 ADMINISTRATOR Standard
G0138 SUPERVISING PHYSICIAN OR REGIS. NURSE Standard
G0139 SUPERVISING PHYSICIAN OR REGIS. NURSE Standard
G0144 COORDINATION OF PATIENT SERVICES Standard
G0158 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
G0159 PLAN OF CARE Standard
G0165 CONFORMANCE WITH PHYSICIAN ORDERS Standard
G0166 CONFORMANCE WITH PHYSICIAN ORDERS Standard
G0236 CLINICAL RECORDS Standard
G0331 INITIAL ASSESSMENT VISIT Standard
G0332 INITIAL ASSESSMENT VISIT Standard
G0337 DRUG REGIMEN REVIEW Standard
▼ 058258 Quincy Home Medical Services 535 Lawrence Street Quincy CA 9 (San Francisco) 03/28/2025 65ACD-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0942 Governing body Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
▼ 058258 Quincy Home Medical Services 535 Lawrence Street Quincy CA 9 (San Francisco) 07/14/2022 4EF7F-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0680 Infection prevention and control Condition
E0004 Develop EP Plan, Review and Update Annually Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0514 RN performs assessment Element
G0584 Verbal orders Element
G0706 Interdisciplinary assessment of the patient Element
▼ 058262 Golden Age Home Healthcare, Inc 9029 Reseda Blvd, Suite 101 Northridge CA 9 (San Francisco) 03/05/2023 5F2F1-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
G0586 Review and revision of the plan of care Standard
G0642 Program scope Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0686 Infection control education Standard
G0942 Governing body Standard
G0536 A review of all current medications Element
▼ 058262 Golden Age Home Healthcare, Inc 9029 Reseda Blvd, Suite 101 Northridge CA 9 (San Francisco) 04/12/2019 NC8C11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
▼ 058264 American Health Associates, Inc 930 Oak Street Bakersfield CA 9 (San Francisco) 07/18/2024 63900-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G1024 Authentication Standard
G0536 A review of all current medications Element
G0542 Incorporate OASIS items Element
G0588 Reviewed, revised by physician every 60 days Element