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Haven Healthcare

(562) 290-05582855 Temple Avenue, Suite a, Signal Hill, CA 90755
CMS Certification Number 058121 · Proprietary · Medicare-certified since 06/25/2002
10deficiencies since 2018
2serious
2inspections
2CMS 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 2024-03-24

· Complaint · 1 deficiencies · CMS source report (PDF)
Moderate Written Instructions To Patient Include:

The Home Health Agency (HHA) failed to ensure a copy of the current plan of care (POC- information identified based upon the patient identified needs and development of appropriate interventions) was provided to one of 5 sampled patients (Patient 3).

Source: CMS Form 2567, inspection 2024-03-24, tag G0612 · view on CMS
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Inspection 2024-02-05

· Complaint · 9 deficiencies · CMS source report (PDF)
Serious Patient Rights

The Home Health Agency (HHA) failed to ensure the Condition of Participation (conditions that health care organizations must meet in order to begin and continue participating in the Medicare [a federal health insurance for people 65 or older, and some people under 65 with certain disabilities or…

Source: CMS Form 2567, inspection 2024-02-05, tag G0406 · view on CMS
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Serious Care Planning, Coordination, Quality Of Care

The Home Health Agency (HHA) failed to ensure the Condition of Participation for Care Planning, coordination, quality of care was met as follows; The HHA failed to ensure a plan of care was formulated and physician's treatment order was obtained for one of 7 patients' (Patient 2) nephrostomy (a…

Source: CMS Form 2567, inspection 2024-02-05, tag G0570 · view on CMS
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Moderate Plan Of Care

The home health agency (HHA) failed to ensure a plan of care was formulated, and physician's treatment order was obtained for one of 7 patients' (Patient 2) who had a nephrostomy (a small tube to drain urine from kidney) site.

Source: CMS Form 2567, inspection 2024-02-05, tag G0572 · view on CMS
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Moderate Coordination Of Care

The Home Health Agency (HHA) failed to coordinate care and services for 1 of 7 sampled residents.

Source: CMS Form 2567, inspection 2024-02-05, tag G0600 · view on CMS
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Moderate Infection Prevention

The home health agency (HHA) failed to implement the accepted standards of infection control practice when the Registered Nurse did not follow proper nursing bag technique for 1 out of 7 sampled patients (Patient 2).

Source: CMS Form 2567, inspection 2024-02-05, tag G0682 · view on CMS
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Minor text mentions immediate jeopardy Be Free From Abuse

The home health agency (HHA) failed to ensure one of seven sampled patients (Patient 1) had the right to be free from physical abuse (the willful infliction of injury with resulting physical harm) and sexual abuse (non-consensual sexual contact of any type) by failing to: 1. Ensure Patient 1 who…

Source: CMS Form 2567, inspection 2024-02-05, tag G0430 · view on CMS
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Minor Immediate Reporting Of Abuse By All Staff

The Home Health Agency (HHA) failed to report allegations of physical abuse (the willful infliction of injury with resulting physical harm) and sexual abuse (non-consensual sexual contact of any type) immediately (without delay; at once) to the Department for one of seven sampled patients (Patient…

Source: CMS Form 2567, inspection 2024-02-05, tag G0488 · view on CMS
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Minor Only As Ordered By A Physician

The SN (skilled nurse) failed to provide indwelling catheter (tube that drains urine from the bladder to a drain bag) care as per physician’s order for one of seven sampled patients (Patient 5).

Source: CMS Form 2567, inspection 2024-02-05, tag G0580 · view on CMS
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Minor Promptly Alert Relevant Physician Of Changes

The visiting nurse failed to notify the attending physician for one out of seven sampled patients (Patient 5), who had sediments (solid materials) present in the urine.

Source: CMS Form 2567, inspection 2024-02-05, tag G0590 · view on CMS
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