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
▼ 058439 Celebrity Homecare 942 W Foothill Blvd Suite B Upland CA 9 (San Francisco) 10/12/2023 61013-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0462 Before discharge for cause HHA must: Element
▼ 058439 Celebrity Homecare 942 W Foothill Blvd Suite B Upland CA 9 (San Francisco) 09/06/2019 TLZA11 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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0032 Primary/Alternate Means for Communication Standard
E0039 EP Testing Requirements Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
▼ 058442 Summit Home Health Inc 2139 Tapo St Ste 210 Simi Valley CA 9 (San Francisco) 06/25/2021 508211 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0610 Patients receive education and training Element
▼ 058442 Summit Home Health Inc 2139 Tapo St Ste 210 Simi Valley CA 9 (San Francisco) 07/26/2018 NQ4611 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0572 Plan of care Standard
G0642 Program scope Standard
G0644 Program data Standard
G0646 Program activities Standard
G0658 Performance improvement projects Standard
G0660 Executive responsibilities for QAPI Standard
G0682 Infection Prevention Standard
G0852 Information to the state survey agency Standard
G0418 Patient's or legal representative's signature Element
G0438 Have a confidential clinical record Element
G0444 State toll free HH telephone hotline 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
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0598 Discharge plans communication Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0716 Preparing clinical notes Element
G0950 Ensure clinical manager is available Element
▼ 058443 Best Care Home Health Agency 2204 Torrance Blvd Suite 104a Torrance CA 9 (San Francisco) 02/13/2023 5EF7C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0518 Completion of the comprehensive assessment Standard
G0586 Review and revision of the plan of care Standard
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0952 Ensure that HHA employs qualified personnel Element
G1022 Discharge and transfer summaries Element
▼ 058443 Best Care Home Health Agency 2204 Torrance Blvd Suite 104a Torrance CA 9 (San Francisco) 12/16/2019 4IRX11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
G0544 Update of the comprehensive assessment Standard
G0536 A review of all current medications Element
G0550 At discharge Element
▼ 058450 Nurse Resource Home Health, Inc 535 N Brand Blvd, Suite 200 Glendale CA 9 (San Francisco) 11/16/2022 5E440-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
E0037 EP Training Program Standard
G0612 Written instructions to patient include: 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
G0602 Communication with all physicians Element
G0710 Provide services in the plan of care Element
G1018 Contact information for the patient Element
▼ 058450 Nurse Resource Home Health, Inc 535 N Brand Blvd, Suite 200 Glendale CA 9 (San Francisco) 07/12/2019 SSDQ11 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0612 Written instructions to patient include: Standard
G0768 Competency evaluation Standard
G0536 A review of all current medications Element
G0604 Integrate all orders Element
G0606 Integrate all services Element
G0766 HHA maintains documentation of training Element
▼ 058451 Family Home Health Agency, Llc 1200 E Route 66 Suite 206a Glendora CA 9 (San Francisco) 04/28/2023 5FA19-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0682 Infection Prevention Standard
G0702 Services by skilled professionals Standard
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0610 Patients receive education and training Element
G0616 Patient medication schedule/instructions Element
▼ 058451 Family Home Health Agency, Llc 1200 E Route 66 Suite 206a Glendora CA 9 (San Francisco) 10/27/2019 GY5111 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0600 Coordination of Care Standard
G0710 Provide services in the plan of care Element