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Pediatric Home Service

(651) 642-18252800 Cleveland Avenue North, Roseville, MN 55113
CMS Certification Number 248149 · Proprietary · Medicare-certified since 11/30/2017
3deficiencies since 2018
1serious
5inspections
n/aCMS 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 2021-02-11

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

Inspection 2020-03-18

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

Inspection 2019-12-02

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

Inspection 2019-10-17

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

Inspection 2018-04-24

· Complaint · 3 deficiencies · CMS source report (PDF)
Serious Patient Rights

The Home Health Agency failed to ensure it complied with the Condition of Participation of Patient Rights when the agency failed to ensure that each patient was free from abuse for 1 of 6 patient reviewed (P1) when video revealed a staff member, RN-G abuse the patient, and failed to ensure that all…

Source: CMS Form 2567, inspection 2018-04-24, tag G0406 · view on CMS
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Minor Be Free From Abuse

The agency failed to ensure the patient was free from abuse for 1 of 6 patient's reviewed, patient #1 (P1), when a Registered Nurse staff member (RN)-G was recorded on video abusing the client, including violently slamming P1's head into the mattress, closing off P1's airway, levering P1's head and…

Source: CMS Form 2567, inspection 2018-04-24, tag G0430 · view on CMS
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Minor Immediate Reporting Of Abuse By All Staff

The agency failed to ensure immediate reporting of injuries of unknown source to the appropriate state agency for 1 of 6 Patient's reviewed, P3, when a staff member observed bruises of known origin but did not report it to the appropriate state agency.

Source: CMS Form 2567, inspection 2018-04-24, tag G0488 · view on CMS
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