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
▼ 058274 Royale Home Health Care, Inc 2626 Foothill Blvd. Suite 280 La Crescenta CA 9 (San Francisco) 02/14/2022 3840D-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
G0642 Program scope Standard
G0682 Infection Prevention Standard
G0798 Home health aide assignments and duties Standard
G0522 Eligibility for Medicare home health benefit Element
G0710 Provide services in the plan of care Element
▼ 058277 Msj Healthcare, Llc 3452 E Foothill Blvd, Suite 130a Pasadena CA 9 (San Francisco) 01/26/2026 1E18A0-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0536 A review of all current medications Element
G0590 Promptly alert relevant physician of changes Element
▼ 058278 Vn Home Health Care 2528 Qume Drive, #7 San Jose CA 9 (San Francisco) 02/16/2023 5E859-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0984 In accordance with current clinical practice Element
▼ 058281 Renaissance Home Health Care, Inc 3160 Camino Del Rio South Ste 312 San Diego CA 9 (San Francisco) 05/26/2022 4EAF1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0562 Discharge Planning Standard
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0484 Document complaint and resolution Element
▼ 058281 Renaissance Home Health Care, Inc 3160 Camino Del Rio South Ste 312 San Diego CA 9 (San Francisco) 06/03/2021 WX2F11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0602 Communication with all physicians Element
▼ 058281 Renaissance Home Health Care, Inc 3160 Camino Del Rio South Ste 312 San Diego CA 9 (San Francisco) 06/10/2019 UW0T11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1010 Contents of clinical record Standard
G0484 Document complaint and resolution Element
G0608 Coordinate care delivery Element
▼ 058281 Renaissance Home Health Care, Inc 3160 Camino Del Rio South Ste 312 San Diego CA 9 (San Francisco) 06/06/2019 UGVE11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0033 Methods for Sharing Information Standard
G0682 Infection Prevention Standard
G0436 Receive all services in plan of care Element
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0948 Responsible for all day-to-day operations Element
G1012 Required items in clinical record Element
▼ 058284 Infinity Health Services, Inc. 28441 Rancho California Rd, Ste 200 Temecula CA 9 (San Francisco) 07/21/2022 4F03B-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
G0710 Provide services in the plan of care Element
G0984 In accordance with current clinical practice Element
▼ 058287 Nightingale Home Care Inc 4579 Maple Avenue, Suite 2 & 4 La Mesa CA 9 (San Francisco) 12/17/2019 6TIU11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0518 Completion of the comprehensive assessment Standard
▼ 058288 St Martin Home Healthcare 13771 Roswell Avenue, Suite H Chino CA 9 (San Francisco) 06/23/2023 6011B-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
G0684 Infection control Standard
G0536 A review of all current medications Element
G0726 Nursing services supervised by RN Element