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
▼ 058352 Maxim Healthcare Services Inc 300 E Esplanade Drive, Suite 1500 Oxnard CA 9 (San Francisco) 12/13/2018 VX0111 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0942 Governing body Standard
G0710 Provide services in the plan of care Element
G0980 Primary HHA is responsible for patient care Element
▼ 058353 Our Lady Of Refuge Home Care, Inc 4000 W Magnolia Blvd, Suite K Burbank CA 9 (San Francisco) 03/24/2023 5F58A-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0684 Infection control Standard
G0536 A review of all current medications Element
▼ 058353 Our Lady Of Refuge Home Care, Inc 4000 W Magnolia Blvd, Suite K Burbank CA 9 (San Francisco) 03/05/2020 E10C11 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
G1028 Protection of records 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
▼ 058354 Focus Health 1245 S Winchester Boulevard, Suite 200 San Jose CA 9 (San Francisco) 02/01/2024 61FF1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0702 Services by skilled professionals Standard
G0444 State toll free HH telephone hotline Element
G0536 A review of all current medications Element
G0710 Provide services in the plan of care Element
▼ 058355 Advantage Health Systems 9663 Tierra Grande Street, Ste 101 San Diego CA 9 (San Francisco) 10/06/2023 604D7-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
▼ 058355 Advantage Health Systems 9663 Tierra Grande Street, Ste 101 San Diego CA 9 (San Francisco) 03/06/2020 VV8311 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0464 Advise the patient of discharge for cause Element
G0466 Make efforts to resolve the problem(s) Element
▼ 058363 Absolute Home Health Agency, Inc 1554 S Sepulveda Blvd Suite 109 Los Angeles CA 9 (San Francisco) 07/27/2024 63BE5-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
▼ 058366 Vital Plus Home Health Care, Inc. 1051 N Maclay Ave San Fernando CA 9 (San Francisco) 05/09/2025 66128-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0490 Accessibility Standard
G0572 Plan of care Standard
G0442 Written notice for non-covered care Element
G0536 A review of all current medications Element
G0616 Patient medication schedule/instructions Element
▼ 058367 United Integrity Home Health Inc 12900-A Garden Grove Blvd, Suite 116 Garden Grove CA 9 (San Francisco) 01/29/2025 652B1-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
E0039 EP Testing Requirements Standard
G0774 12 hours inservice every 12 months Standard
G0798 Home health aide assignments and duties Standard
G0514 RN performs assessment 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
G0548 Within 48 hours of the patient's return 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
G0606 Integrate all services Element
G0614 Visit schedule Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0778 Documentation of inservice training Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
G0984 In accordance with current clinical practice Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 058367 United Integrity Home Health Inc 12900-A Garden Grove Blvd, Suite 116 Garden Grove CA 9 (San Francisco) 01/11/2022 38161-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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development of EP Policies and Procedures Standard
E0017 HHA Comprehensive Assessment in Disaster Standard
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0029 Development of Communication Plan Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0860 Licensing Standard
G1024 Authentication Standard
G0444 State toll free HH telephone hotline Element
G0478 Investigate complaints made by patient Element
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0536 A review of all current medications 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
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element
G1022 Discharge and transfer summaries Element