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
▼ 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
▼ 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