S&C QCOR HHA 2567s
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HHAs 2567s
Selection Criteria ▸

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
▼ 387074 Providence Health And Services - Oregon 570 South Main Street Mount Angel OR 10 (Seattle) 03/15/2018 617N11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
▼ 387075 Sky Lakes Home Health 2421 Washburn Way, Suite F Klamath Falls OR 10 (Seattle) 05/24/2022 4EC56-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
G0574 Plan of care must include the following Element
▼ 387075 Sky Lakes Home Health 2421 Washburn Way, Suite F Klamath Falls OR 10 (Seattle) 11/13/2018 GECH11 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0590 Promptly alert relevant physician of changes Element
▼ 387075 Sky Lakes Home Health 2421 Washburn Way, Suite F Klamath Falls OR 10 (Seattle) 10/11/2018 KOBE11 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
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0682 Infection Prevention Standard
G0444 State toll free HH telephone hotline Element
G0514 RN performs assessment Element
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
▼ 387076 Three Rivers Homecare, Llc 1867 Williams Highway, Suite 109b Grants Pass OR 10 (Seattle) 06/26/2019 RXLW11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
▼ 387077 Three Rocks Healthcare Llc 798 Se Highway 101 Lincoln City OR 10 (Seattle) 06/06/2018 XBBN11 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
G0574 Plan of care must include the following Element
G1014 Interventions and patient response Element
▼ 387086 Samaritan North Lincoln Hospital 3011 Ne 28th Street Lincoln City OR 10 (Seattle) 11/30/2018 XJJI11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0514 RN performs assessment Element
▼ 387087 Coastal Home Health & Hospice, Inc 585 5th Street Brookings OR 10 (Seattle) 08/09/2019 YNOH11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0376 Transmittal of OASIS data Standard
G0682 Infection Prevention Standard
G0514 RN performs assessment Element
▼ 387090 Good Shepherd Health Care Systems 645 Nw Orchard Avenue, Suite 500 Hermiston OR 10 (Seattle) 07/28/2022 4F281-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0438 Have a confidential clinical record Element
G0446 Contact info Federal/State-funded entities Element
G0574 Plan of care must include the following Element
G0706 Interdisciplinary assessment of the patient Element
▼ 387090 Good Shepherd Health Care Systems 645 Nw Orchard Avenue, Suite 500 Hermiston OR 10 (Seattle) 03/20/2019 FJDJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0372 Encoding and transmitting OASIS Standard
G0536 A review of all current medications Element