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Pacific Health Services, Inc

(213) 387-95522501 West Burbank Blvd Suite 309, Burbank, CA 91505
CMS Certification Number 059678 · Proprietary · Medicare-certified since 08/17/2015
18deficiencies since 2018
2serious
3inspections
n/aCMS quality stars
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-20; CMS agency list file dated 2026-05-27. What the labels mean

Inspection 2026-01-29

· Complaint · no deficiencies cited · CMS source report (PDF)

Inspection 2025-12-05

· Complaint, Recertification · 9 deficiencies · CMS source report (PDF)
Serious Care Planning, Coordination, Quality Of Care

A public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to ensure the Condition of Participation (conditions that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid…

Source: CMS Form 2567, inspection 2025-12-05, tag G0570 · view on CMS
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Moderate text mentions immediate jeopardy Plan Of Care

A public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to implement the plan of care (POC, an individualized plan of care that summarizes the patients’ health condition, specific care needs, current treatments, and the disciplines…

Source: CMS Form 2567, inspection 2025-12-05, tag G0572 · view on CMS
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Minor Immediate Reporting Of Abuse By All Staff

An organization that delivers skilled nursing and other therapeutic services to a patient’s personal residence) failed to ensure an allegation of patient neglect was reported to the Department for one of seven (Patient 1) sampled patients as required.

Source: CMS Form 2567, inspection 2025-12-05, tag G0488 · view on CMS
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Minor Plan Of Care Must Include The Following

Public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to ensure the plan of care (POC, a detailed summary of the patients’ health condition, specific care needs, current treatments, and the disciplines providing the services) was…

Source: CMS Form 2567, inspection 2025-12-05, tag G0574 · view on CMS
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Minor All Orders Recorded In Plan Of Care

Agency providing skilled nursing and other therapeutic services to a patient’s personal residence) failed to ensure the plan of care (POC, document detailing a patient’s health needs, created by a healthcare team based on a comprehensive assessment of the patient’s condition and goals, outlining…

Source: CMS Form 2567, inspection 2025-12-05, tag G0576 · view on CMS
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Minor text mentions immediate jeopardy Only As Ordered By A Physician

A public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to ensure: 1.A physician order was obtained for tracheostomy (a surgical procedure that creates an opening in the neck into the windpipe [trachea] to allow for a tube to be…

Source: CMS Form 2567, inspection 2025-12-05, tag G0580 · view on CMS
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Minor Development And Evaluation Of Plan Of Care

Public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to ensure the Registered Nurse Case Manager (RN-CM) developed and evaluated the plan of care (POC, a detailed summary of the patients’ health condition, specific care needs…

Source: CMS Form 2567, inspection 2025-12-05, tag G0708 · view on CMS
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Minor Documentation Of Inservice Training

A public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to ensure written policies and procedures, describing its method(s) of assessment of competency and maintaining a written description of the in-service training provided during…

Source: CMS Form 2567, inspection 2025-12-05, tag G0778 · view on CMS
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Minor Required Items In Clinical Record

Public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to ensure the documented plan of care (POC, detailed document that summarizes the patients’ health condition, specific care needs, current treatments, and the disciplines…

Source: CMS Form 2567, inspection 2025-12-05, tag G1012 · view on CMS
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Inspection 2022-01-24

· Recertification · 9 deficiencies · CMS source report (PDF)
Serious Care Planning, Coordination, Quality Of Care

The agency failed to ensure the Condition of Participation for Care planning, coordination, quality of care was met as follows: For Patient 1, LVN 1 failed to provide correct insulin (a protein hormone that is used as a medication to treat high blood sugar) dosage as ordered.

Source: CMS Form 2567, inspection 2022-01-24, tag G0570 · view on CMS
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Moderate Infection Prevention

The home health agency (HHA) failed to ensure COVID-19 (the disease caused by coronavirus that can be severe, and can be spread from person to person) monitoring and surveillance are conducted to office staff and visitors, and ensure all staff are fit tested for N95 masks for respiratory protection.

Source: CMS Form 2567, inspection 2022-01-24, tag G0682 · view on CMS
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Minor Continuing Need For Home Care

The Home Health Agency (HHA) failed to clearly demonstrate the continuing need for the patient's eligibility to receive home health benefits for one of seven sampled patients (Patient 1).

Source: CMS Form 2567, inspection 2022-01-24, tag G0532 · view on CMS
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Minor A Review Of All Current Medications

The home health agency (HHA) failed to maintain an accurate, and current medication profiles for three of seven sampled patients (Patients 1, 5 and 6 ).

Source: CMS Form 2567, inspection 2022-01-24, tag G0536 · view on CMS
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Minor Only As Ordered By A Physician

The agency's skilled nurses failed to administer drugs and treatments as ordered by the physician for two of seven patients (Patients 1 and 6).

Source: CMS Form 2567, inspection 2022-01-24, tag G0580 · view on CMS
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Minor Promptly Alert Relevant Physician Of Changes

The agency staff failed to inform the physician promptly of any changes in patient's condition for one of seven sampled patients (Patient 5).

Source: CMS Form 2567, inspection 2022-01-24, tag G0590 · view on CMS
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Minor Provide Services In The Plan Of Care

The home health agency (HHA) failed to follow the plan of care (POC) for two of seven sampled patients (Patients 5 and 6).

Source: CMS Form 2567, inspection 2022-01-24, tag G0710 · view on CMS
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Minor Preparing Clinical Notes

The agency staff failed to submit clinical notes on time for one of seven sampled patients (Patient 5).

Source: CMS Form 2567, inspection 2022-01-24, tag G0716 · view on CMS
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Minor Documentation Of Inservice Training

The home health agency (HHA) failed to provide documented evidence of monthly in-service training for all staff.

Source: CMS Form 2567, inspection 2022-01-24, tag G0778 · view on CMS
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