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
▼ 058264 American Health Associates, Inc 930 Oak Street Bakersfield CA 9 (San Francisco) 02/16/2021 J6KE11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
G0580 Only as ordered by a physician Element
G0602 Communication with all physicians Element
▼ 058266 Citywide Home Care, Inc. 301 E Glenoaks Blvd, Suite 4 Glendale CA 9 (San Francisco) 12/05/2022 5E670-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0612 Written instructions to patient include: Standard
G0752 Home health aide qualifications Standard
G0514 RN performs assessment Element
G0590 Promptly alert relevant physician of changes Element
G0616 Patient medication schedule/instructions Element
G1018 Contact information for the patient Element
▼ 058266 Citywide Home Care, Inc. 301 E Glenoaks Blvd, Suite 4 Glendale CA 9 (San Francisco) 10/10/2019 EPG711 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
G0710 Provide services in the plan of care Element
▼ 058267 Family Home Health Care, Inc 4201 Wilshire Blvd, Suite 334 Los Angeles CA 9 (San Francisco) 03/30/2019 12JY11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G1012 Required items in clinical record Element
▼ 058269 Green Valley Home Health 19031 Highway 18 Suite 180 Apple Valley CA 9 (San Francisco) 04/17/2025 65DFB-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0774 12 hours inservice every 12 months Standard
G1028 Protection of records Standard
G0808 Onsite supervisory visit every 14 days Element
G0952 Ensure that HHA employs qualified personnel Element
G1022 Discharge and transfer summaries Element
▼ 058269 Green Valley Home Health 19031 Highway 18 Suite 180 Apple Valley CA 9 (San Francisco) 03/30/2022 38662-H1 Complaint, 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
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0036 EP Training and Testing Standard
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0576 All orders recorded in plan of care Element
G0614 Visit schedule Element
▼ 058269 Green Valley Home Health 19031 Highway 18 Suite 180 Apple Valley CA 9 (San Francisco) 01/24/2020 DWVB11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
▼ 058269 Green Valley Home Health 19031 Highway 18 Suite 180 Apple Valley CA 9 (San Francisco) 11/08/2019 J7D411 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0644 Program data Standard
G0682 Infection Prevention Standard
G0686 Infection control education Standard
G0434 Participate in care Element
G0580 Only as ordered by a physician Element
G0706 Interdisciplinary assessment of the patient Element
▼ 058273 Central Home Health Care, Inc 221 S Verdugo Road Glendale CA 9 (San Francisco) 06/05/2022 4ECB7-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
G0580 Only as ordered by a physician Element
G0710 Provide services in the plan of care Element
▼ 058273 Central Home Health Care, Inc 221 S Verdugo Road Glendale CA 9 (San Francisco) 03/15/2019 VOLJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0954 Ensures qualified pre-designated person Element