S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 058334 Lavanda Home Health Care Agency, Inc 3033 N Avon Street Suite A Burbank CA 9 (San Francisco) 07/12/2018 2SCE11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0684 Infection control Standard
G0514 RN performs assessment 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
G0610 Patients receive education and training Element
G0984 In accordance with current clinical practice Element
▼ 058335 Hollywood Home Health Services, Inc 1253 North Vine Street Suite 20 Los Angeles CA 9 (San Francisco) 10/17/2018 0I7811 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0510 Comprehensive Assessment of Patients Condition
G0572 Plan of care Standard
G0522 Eligibility for Medicare home health benefit Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 058336 Maxim Healthcare Services Inc 23421 South Pointe Drive, Suite 200 Laguna Hills CA 9 (San Francisco) 02/19/2020 CUSL11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0037 EP Training Program Standard
G0572 Plan of care Standard
G1024 Authentication 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
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
G1022 Discharge and transfer summaries Element
▼ 058341 Pinnacle Health Corporation 520 N Main Street Ste 200 Santa Ana CA 9 (San Francisco) 06/27/2023 600FC-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
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
G0578 Conformance with physician orders Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0798 Home health aide assignments and duties Standard
G1024 Authentication Standard
G0478 Investigate complaints made by patient Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0550 At discharge Element
G0574 Plan of care must include the following Element
G0606 Integrate all services Element
G0614 Visit schedule Element
G0710 Provide services in the plan of care 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
▼ 058341 Pinnacle Health Corporation 520 N Main Street Ste 200 Santa Ana CA 9 (San Francisco) 11/09/2018 3RUE11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0037 EP Training Program Standard
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0806 Supervision of home health aides Standard
G1024 Authentication Standard
G0484 Document complaint and resolution Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0608 Coordinate care delivery Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0800 Services provided by HH aide Element
G0948 Responsible for all day-to-day operations Element
G1022 Discharge and transfer summaries Element
▼ 058342 Rc Home Healthcare Inc 1934 W. 9th Street Upland CA 9 (San Francisco) 05/22/2025 662D7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0798 Home health aide assignments and duties Standard
G0536 A review of all current medications Element
G0800 Services provided by HH aide Element
G1022 Discharge and transfer summaries Element
▼ 058342 Rc Home Healthcare Inc 1934 W. 9th Street Upland CA 9 (San Francisco) 05/05/2022 389C4-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0032 Primary/Alternate Means for Communication Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0644 Program data Standard
G0660 Executive responsibilities for QAPI Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
▼ 058342 Rc Home Healthcare Inc 1934 W. 9th Street Upland CA 9 (San Francisco) 10/04/2018 V6V311 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0037 EP Training Program Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0606 Integrate all services Element
▼ 058346 High Quality Home Health Agency, Inc 21707 Hawthorne Blvd Suite 202 Torrance CA 9 (San Francisco) 04/05/2023 5F717-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0700 Skilled professional services Condition
G0572 Plan of care Standard
G0600 Coordination of Care Standard
G0704 Responsibilities of skilled professionals Standard
G0536 A review of all current medications Element
▼ 058352 Maxim Healthcare Services Inc 300 E Esplanade Drive, Suite 1500 Oxnard CA 9 (San Francisco) 09/22/2023 6106B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0952 Ensure that HHA employs qualified personnel Element