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Angels of Summit Home Health

(805) 584-30002139 Tapo St Ste 210, Simi Valley, CA 93063
CMS Certification Number 058442 · Proprietary · Medicare-certified since 04/03/2008
24deficiencies since 2018
2serious
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 2021-06-25

· Complaint · 1 deficiencies · CMS source report (PDF)
Minor Patients Receive Education And Training

The facility failed to ensure patients of the agency were educated on the protocol of electronic signature on home visit documents in one of one patient (Patient 1).

Source: CMS Form 2567, inspection 2021-06-25, tag G0610 · view on CMS
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Inspection 2018-07-26

· Complaint, Sample Validation · 23 deficiencies · CMS source report (PDF)
Serious Care Planning, Coordination, Quality Of Care

The home health agency (HHA) failed to ensure the Conditions of Participation for Care Planning, Coordination and Quality of Care were met as follows: G572 The HHA failed to ensure communication with the patient's physician for approval of orders, disciplines, treatments, and frequency of visits…

Source: CMS Form 2567, inspection 2018-07-26, tag G0570 · view on CMS
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Serious Quality Assessment/Performance Improvement

The home health agency (HHA) failed to ensure the Conditions of Participation for quality assessment and performance improvement were met as follows: G642 The home health agency (HHA) failed to develop, implement, evaluate, and maintain an effective, ongoing HHA wide data-driven quality improvement…

Source: CMS Form 2567, inspection 2018-07-26, tag G0640 · view on CMS
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Moderate Plan Of Care

The home health agency (HHA) failed to ensure communication with the patient's physician for approval of treatments and services prior to implementing the plan of care (POC) for four of eight sampled patients (Patients 1, 3, 4, and 5).

Source: CMS Form 2567, inspection 2018-07-26, tag G0572 · view on CMS
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Moderate Program Scope

The home health agency (HHA) failed to develop, implement, evaluate, and maintain an effective, ongoing HHA wide data-driven quality improvement (QI) program that measures, analyzes, and tracks quality indicators, including adverse patient events.

Source: CMS Form 2567, inspection 2018-07-26, tag G0642 · view on CMS
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Moderate Program Data

The home health agency (HHA) failed to develop, implement, evaluate, and maintain an effective, ongoing HHA wide data-driven quality improvement (QI) program that uses quality data to monitor the effectiveness and safety of services and identify opportunities for improvement.

Source: CMS Form 2567, inspection 2018-07-26, tag G0644 · view on CMS
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Moderate Program Activities

The home health agency (HHA) failed to develop, implement, evaluate, and maintain an effective, ongoing HHA wide data-driven quality improvement (QI) program that focuses on: 1. High risk, high volume, or problem-prone areas of service, and considered the incidence, prevalence, and severity of…

Source: CMS Form 2567, inspection 2018-07-26, tag G0646 · view on CMS
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Moderate Performance Improvement Projects

The home health agency (HHA) failed to ensure the agency developed and implemented a written performance improvement project which reflected the scope, complexity, and past performance of services and operations.

Source: CMS Form 2567, inspection 2018-07-26, tag G0658 · view on CMS
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Moderate Executive Responsibilities For Qapi

The home health agency (HHA) failed to ensure the governing board assumed responsibility for the quality improvement (QI) program to include: 1. Evidence of a QI program which is defined, implemented, and maintained.

Source: CMS Form 2567, inspection 2018-07-26, tag G0660 · view on CMS
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Moderate Infection Prevention

The home health agency (HHA) failed to ensure aseptic technique (free from germs that cause disease to prevent contamination of the patient's wound and supplies) was followed during wound care for one of three wound care observations (Patient 6).

Source: CMS Form 2567, inspection 2018-07-26, tag G0682 · view on CMS
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Moderate Information To The State Survey Agency

The Home Health Agency (HHA) was not in compliance with California State regulations which require the HHA to submit all changes for the position of director of patient care services (DPCS) to the Department.

Source: CMS Form 2567, inspection 2018-07-26, tag G0852 · view on CMS
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Minor Patient'S Or Legal Representative'S Signature

The home health agency (HHA) failed to ensure one of eight sampled patient's (Patient 8) signed the admission agreement which indicated the patient received a copy of the patient's rights and responsibilities.

Source: CMS Form 2567, inspection 2018-07-26, tag G0418 · view on CMS
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Minor Have A Confidential Clinical Record

The home health agency (HHA) failed to ensure the patient's clinical record was confidential and secure for one of eight sampled patients (Patient 6) when the skilled nurse (SN) used a personal cell phone to take photographs of Patient 6's wounds with plans to use personal email to send the…

Source: CMS Form 2567, inspection 2018-07-26, tag G0438 · view on CMS
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Minor State Toll Free Hh Telephone Hotline

The home health agency (HHA) failed to provide one of three home visit patients (Patient 5) with the toll free home health hot line for reporting complaints.

Source: CMS Form 2567, inspection 2018-07-26, tag G0444 · view on CMS
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Minor A Review Of All Current Medications

The home health agency (HHA) failed to complete an accurate medication review for three of three home visit patients (Patient 5, 6 and 7).

Source: CMS Form 2567, inspection 2018-07-26, 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 individualized plan of care (POC) included accurate specific interventions for three of eight sampled patients (Patients 2, 6, and 7).

Source: CMS Form 2567, inspection 2018-07-26, tag G0574 · view on CMS
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Minor Only As Ordered By A Physician

The home health agency (HHA) failed to ensure there were physician orders for changes in the services and treatments provided for four of eight sampled patients (Patients 1, 2, 4, and 5) Patient 1 The HHA did not notify the physician when they failed to provide visits as indicated in the POC during…

Source: CMS Form 2567, inspection 2018-07-26, tag G0580 · view on CMS
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Minor Verbal Orders

The home health agency (HHA) failed to have physician orders and plans of care (POC) authenticated and dated by the physician in accordance with agency policy for five of eight sampled patients (Patient 1, 2, 3, 4, and 5).

Source: CMS Form 2567, inspection 2018-07-26, tag G0584 · view on CMS
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Minor Promptly Alert Relevant Physician Of Changes

The home health agency (HHA) failed to notify the physician timely when one of eight sampled patients (Patient 1) was hospitalized.

Source: CMS Form 2567, inspection 2018-07-26, tag G0590 · view on CMS
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Minor Discharge Plans Communication

The home health agency (HHA) failed to notify the physician when the patient was discharged for one of eight sampled patients (Patient 4).

Source: CMS Form 2567, inspection 2018-07-26, tag G0598 · view on CMS
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Minor Visit Schedule

The home health agency (HHA) failed to provide written visit schedules that were consistent with the most current plan of care (POC) to two of three patients with home visits (Patients 6 and 7).

Source: CMS Form 2567, inspection 2018-07-26, tag G0614 · view on CMS
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Minor Patient Medication Schedule/Instructions

The home health agency (HHA) failed to ensure an accurate medication schedule with instructions was in the home for two of three home visit patients (Patients 6 and 7).

Source: CMS Form 2567, inspection 2018-07-26, tag G0616 · view on CMS
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Minor Preparing Clinical Notes

The home health agency (HHA) failed to ensure clinical records were completed timely for three of eight sampled patients (Patients 2, 5 and 6).

Source: CMS Form 2567, inspection 2018-07-26, tag G0716 · view on CMS
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Minor Ensure Clinical Manager Is Available

The home health agency (HHA) failed to ensure the Director of Patient Care Services (DPCS) or designee was immediately accessible by telecommunications during operating hours.

Source: CMS Form 2567, inspection 2018-07-26, tag G0950 · view on CMS
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