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Adventist Health Home Care Services

(805) 955-81902796 Sycamore Drive, Suite 100, Simi Valley, CA 93065
CMS Certification Number 057537 · Non-Profit · Medicare-certified since 05/20/1983
11deficiencies since 2018
0serious
2inspections
4.5CMS quality stars
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-21; CMS agency list file dated 2026-09-21. What the labels mean

Inspection 2022-04-14

· Recertification · 6 deficiencies · CMS source report (PDF)
Moderate Plan Of Care

The Home Health Agency (HHA) failed to ensure the written plan of care (POC written plan of care ordered, with interventions and goals ) were implemented and coordinated with patients attending physician (AP) when : 1) Patient 7 did not receive skilled nursing (SN) services for one week…

Source: CMS Form 2567, inspection 2022-04-14, tag G0572 · view on CMS
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Minor A Review Of All Current Medications

The home health agency (HHA) failed to ensure the current prescribed at home medications (cardiac medications, vitamin B12) for one of ten sampled patients ( Patient 3) were in place and reconciled ( right order, right dose, amount), with the current plan of care or medication profile . This…

Source: CMS Form 2567, inspection 2022-04-14, tag G0536 · view on CMS
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Minor Plan Of Care Must Include The Following

The home health agency (HHA) failed to ensure the plan of care (POC- statement of care, interventions, and goals) , for one of ten sampled patients (Patient 3), addressed the care of a patient with a pacemaker (device inserted on the heart wall to regulate heart rates).

Source: CMS Form 2567, inspection 2022-04-14, tag G0574 · view on CMS
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Minor Visit Schedule

The Home Health Agency (HHA) failed to ensure skilled nursing (SN), physical therapy (PT) and home health aide (HA) visits/services were rendered as ordered to patients by their attending physicians (AP) for the following : 1) No SN visits/services were rendered to Patient 7 for one week…

Source: CMS Form 2567, inspection 2022-04-14, tag G0614 · view on CMS
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Minor Communication With Physicians

The Home Health Agency (HHA) failed to ensure designated attending physicians were notified and notification were documented when ordered home visits services were missed for two sampled patients (Patients 7 and 10) and one unsampled patient (Patient 11) 1) Missed visits for skilled nursing (SN)…

Source: CMS Form 2567, inspection 2022-04-14, tag G0718 · view on CMS
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Minor Ensure That Hha Employs Qualified Personnel

The Home Health Agency (HHA) failed to implement its personnel policy and procedures (P&P) on the timely documentation of skilled home visits in the patient’s electronic health record (EHR), for two of ten sampled patients (Patients 2 and 8) and one unsampled patient (Patient 12).

Source: CMS Form 2567, inspection 2022-04-14, tag G0952 · view on CMS
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Inspection 2018-02-20

· Recertification · 5 deficiencies · CMS source report (PDF)
Moderate Plan Of Care

The Home Health Agency (HHA) failed to ensure the plan of care (POC) was followed as ordered by the physician.

Source: CMS Form 2567, inspection 2018-02-20, tag G0572 · view on CMS
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Minor Plan Of Care Must Include The Following

The Home Health Agency (HHA) failed to include patient specific diabetes (uncontrolled blood sugar) interventions in the plan of care (POC) for two of 13 patients (Patient 2 and 7).

Source: CMS Form 2567, inspection 2018-02-20, tag G0574 · view on CMS
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Minor All Orders Recorded In Plan Of Care

The Home Health Agency (HHA) failed to incorporate physician's orders into patients' plan of care (POC) for two of 13 patients (Patient 7 and 11).

Source: CMS Form 2567, inspection 2018-02-20, tag G0576 · view on CMS
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Minor Only As Ordered By A Physician

The Home Health Agency (HHA) failed to ensure wound care provided to four of 13 patients (Patients 4, 7, 10 and 11) was completed per the physician's order.

Source: CMS Form 2567, inspection 2018-02-20, tag G0580 · view on CMS
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Minor Promptly Alert Relevant Physician Of Changes

The Home Health Agency (HHA) failed to ensure the physician was notified for relevant changes in four of 13 patients (Patients 2, 4, 5, and 7).

Source: CMS Form 2567, inspection 2018-02-20, tag G0590 · view on CMS
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