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
▼ 058297 Cne Home Health Services, Inc 10600 Magnolia Avenue, Suite G Riverside CA 9 (San Francisco) 06/04/2019 IQTG11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0602 Communication with all physicians Element
▼ 058297 Cne Home Health Services, Inc 10600 Magnolia Avenue, Suite G Riverside CA 9 (San Francisco) 05/31/2018 OZ2C11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0418 Patient's or legal representative's signature Element
G1012 Required items in clinical record Element
▼ 058298 True Care Home Health Agency, Inc 1755 Huntington Drive Suite 201 Duarte CA 9 (San Francisco) 01/22/2023 5ECBB-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
G0444 State toll free HH telephone hotline Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
▼ 058299 Guardian Angel Home Health Agency Inc 980 Enchanted Way, Suite #206 Simi Valley CA 9 (San Francisco) 04/10/2019 TYVS11 Complaint, Sample Validation
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
G0680 Infection prevention and control Condition
G0700 Skilled professional services Condition
G0940 Organization and administration of services Condition
G1008 Clinical records Condition
G0526 Content of the comprehensive assessment Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0958 Clinical manager Standard
G1024 Authentication Standard
G0514 RN performs assessment Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
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
G0608 Coordinate care delivery Element
G0616 Patient medication schedule/instructions Element
G0706 Interdisciplinary assessment of the patient Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0718 Communication with physicians Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
▼ 058301 Bueno And Sons, Inc 924 Buena Vista St. Suite 102 Duarte CA 9 (San Francisco) 04/21/2023 5F925-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G1028 Protection of records Standard
G0536 A review of all current medications Element
G0722 Participate in HHA-sponsored in-service Element
G0772 Documentation of competency evaluation Element
▼ 058301 Bueno And Sons, Inc 924 Buena Vista St. Suite 102 Duarte CA 9 (San Francisco) 02/21/2020 TTYQ11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
▼ 058303 Montrose Home Healthcare, Inc 230 N Maryland Avenue, Suite 104 Glendale CA 9 (San Francisco) 04/30/2023 5FAAB-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
G0684 Infection control 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
▼ 058303 Montrose Home Healthcare, Inc 230 N Maryland Avenue, Suite 104 Glendale CA 9 (San Francisco) 11/03/2019 XZIS11 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
▼ 058313 A's Home Health Care, Inc 11030 Arrow Route, Suite 202 Rancho Cucamonga CA 9 (San Francisco) 04/26/2023 5F94C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
▼ 058313 A's Home Health Care, Inc 11030 Arrow Route, Suite 202 Rancho Cucamonga CA 9 (San Francisco) 01/18/2023 5E960-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0520 5 calendar days after start of care Element
G0550 At discharge Element
G0580 Only as ordered by a physician Element
G0716 Preparing clinical notes Element