S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 059085 American Home Health, Inc. 11631 Victory Blvd, Ste 205 N Hollywood CA 9 (San Francisco) 08/10/2018 283J11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0374 Accuracy of encoded OASIS data Standard
G0572 Plan of care Standard
G0444 State toll free HH telephone hotline Element
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0606 Integrate all services Element
▼ 059099 Optima Care Home Health Services Inc 3633 Inland Empire Blvd. Ontario CA 9 (San Francisco) 04/16/2026 22E06B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0612 Written instructions to patient include: Standard
G0536 A review of all current medications Element
▼ 059099 Optima Care Home Health Services Inc 3633 Inland Empire Blvd. Ontario CA 9 (San Francisco) 08/09/2018 Z2OD11 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
G1028 Protection of records Standard
G1012 Required items in clinical record Element
▼ 059102 Alliant Health Systems, Inc 2149 E Garvey Ave North, Suite A-4 West Covina CA 9 (San Francisco) 02/07/2022 3845A-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0536 A review of all current medications Element
G0580 Only as ordered by a physician Element
▼ 059102 Alliant Health Systems, Inc 2149 E Garvey Ave North, Suite A-4 West Covina CA 9 (San Francisco) 08/17/2021 U8ZO11 Complaint, Sample Validation
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
G0406 Patient rights Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
G0572 Plan of care Standard
G0578 Conformance with physician orders Standard
G0430 Be free from abuse Element
G0444 State toll free HH telephone hotline Element
G0488 Immediate reporting of abuse by all staff Element
G0536 A review of all current medications Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
▼ 059103 Gfk Services, Inc. 8891 Watson Street, Suite 201 Cypress CA 9 (San Francisco) 05/25/2023 5FCEC-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
E0021 HHA- Procedures for Follow up Staff/Pts. Standard
E0030 Names and Contact Information Standard
E0034 Information on Occupancy/Needs Standard
E0037 EP Training Program Standard
G0586 Review and revision of the plan of care Standard
G0684 Infection control Standard
G0687 COVID-19 Vaccination of Home Health Agency staff Standard
G0798 Home health aide assignments and duties Standard
G0478 Investigate complaints made by patient 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
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0622 Name/contact information of clinical manager Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0726 Nursing services supervised by RN Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0818 HH aide supervision elements Element
G0948 Responsible for all day-to-day operations Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 059103 Gfk Services, Inc. 8891 Watson Street, Suite 201 Cypress CA 9 (San Francisco) 03/13/2018 9EVD11 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
E0009 Local, State, Tribal Collaboration Process 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
G0372 Encoding and transmitting OASIS Standard
G0578 Conformance with physician orders Standard
G1024 Authentication Standard
G0478 Investigate complaints made by patient Element
G0484 Document complaint and resolution Element
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
G0608 Coordinate care delivery Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
▼ 059104 Goldencare Home Health Agency, Inc 436 W. Broadway Glendale CA 9 (San Francisco) 07/26/2018 HHUY11 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
G0590 Promptly alert relevant physician of changes Element
G0606 Integrate all services Element
G1022 Discharge and transfer summaries Element
▼ 059108 Montebello Home Health Care, Inc 19350 Business Center Dr Suite 200 Northridge CA 9 (San Francisco) 08/11/2023 60AD5-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0406 Patient rights Condition
G0510 Comprehensive Assessment of Patients Condition
G0570 Care planning, coordination, quality of care Condition
G0700 Skilled professional services Condition
G1008 Clinical records Condition
G0526 Content of the comprehensive assessment Standard
G0544 Update of the comprehensive assessment Standard
G0572 Plan of care Standard
G0612 Written instructions to patient include: Standard
G0702 Services by skilled professionals Standard
G0704 Responsibilities of skilled professionals Standard
G1024 Authentication Standard
G0410 Information to patient Element
G0412 Written notice of patient's rights Element
G0436 Receive all services in plan of care Element
G0444 State toll free HH telephone hotline 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
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0602 Communication with all physicians Element
G0610 Patients receive education and training Element
G0616 Patient medication schedule/instructions Element
G0726 Nursing services supervised by RN Element
G1012 Required items in clinical record Element
G1014 Interventions and patient response Element
G1022 Discharge and transfer summaries Element
▼ 059111 San Diego Home Health Care Services Inc 5050 Avenida Encinas Carlsbad CA 9 (San Francisco) 07/24/2025 1D1A19-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
G0798 Home health aide assignments and duties Standard
G0574 Plan of care must include the following Element
G0584 Verbal orders Element
G0590 Promptly alert relevant physician of changes Element
G0614 Visit schedule Element
G0800 Services provided by HH aide Element
G0808 Onsite supervisory visit every 14 days Element