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
▼ 058428 Goodwill Plus, Inc 233 E Pomona Blvd Monterey Park CA 9 (San Francisco) 04/07/2019 QRTR11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0710 Provide services in the plan of care Element
▼ 058432 Legacy Home Health, Inc 7365 Carnelian Street, Suite 116a Rancho Cucamonga CA 9 (San Francisco) 05/22/2025 662DA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0658 Performance improvement projects Standard
G0682 Infection Prevention Standard
G1028 Protection of records Standard
G0438 Have a confidential clinical record Element
G0952 Ensure that HHA employs qualified personnel Element
▼ 058432 Legacy Home Health, Inc 7365 Carnelian Street, Suite 116a Rancho Cucamonga CA 9 (San Francisco) 04/28/2022 3896C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0798 Home health aide assignments and duties Standard
G0446 Contact info Federal/State-funded entities Element
G0450 Access to auxiliary aids and language service Element
G0484 Document complaint and resolution Element
G0580 Only as ordered by a physician Element
▼ 058432 Legacy Home Health, Inc 7365 Carnelian Street, Suite 116a Rancho Cucamonga CA 9 (San Francisco) 11/30/2018 564H11 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
G0510 Comprehensive Assessment of Patients Condition
G0640 Quality assessment/performance improvement Condition
G0680 Infection prevention and control Condition
G0750 Home health aide services Condition
G0940 Organization and administration of services 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
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0578 Conformance with physician orders Standard
G0642 Program scope Standard
G0644 Program data Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G0536 A review of all current medications Element
G0808 Onsite supervisory visit every 14 days Element
G0946 Administrator appointed by governing body Element
G0954 Ensures qualified pre-designated person Element
▼ 058433 Er Home Health, Inc 2001 W Beverly Blvd Unit B Montebello CA 9 (San Francisco) 12/07/2022 5E704-H1 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
G0580 Only as ordered by a physician Element
G0710 Provide services in the plan of care Element
G0714 Patient and caregiver education Element
G0718 Communication with physicians Element
▼ 058433 Er Home Health, Inc 2001 W Beverly Blvd Unit B Montebello CA 9 (San Francisco) 05/03/2019 1UWH11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 058434 Gentle Care, Inc 13101 W Washington Blvd. Suite 142 Los Angeles CA 9 (San Francisco) 09/02/2022 385D9-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
▼ 058434 Gentle Care, Inc 13101 W Washington Blvd. Suite 142 Los Angeles CA 9 (San Francisco) 09/17/2018 2R3H11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G1012 Required items in clinical record Element
▼ 058438 Kindness Care Home Health 1220 W Hemlock Way Suite 202 Santa Ana CA 9 (San Francisco) 10/02/2024 64511-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0564 Discharge or Transfer Summary Content Standard
G0520 5 calendar days after start of care Element
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0584 Verbal orders Element
G0588 Reviewed, revised by physician every 60 days Element
G0602 Communication with all physicians Element
G0606 Integrate all services Element
▼ 058439 Celebrity Homecare 942 W Foothill Blvd Suite B Upland CA 9 (San Francisco) 03/08/2024 62758-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0536 A review of all current medications Element
G0952 Ensure that HHA employs qualified personnel Element