Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 757188 (X3) Date Survey Completed 02/13/2025
Name of Provider or Supplier Simple Touch Home Health Care, Inc Street Address, City, State 5250 Santa Monica Blvd Suite 211, Los Angeles, CA
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
G0000 The following reflects the findings of the California Department of Public Health during a Complaint Validation Survey, conducted from 2/11/2025 to 2/13/2025.


Complaint Number: 112075





Active Patients- 5


Unduplicated admissions: 7


Sample Size - 7


Home visits – 3





The following Condition of Participation not met:


484.55 Comprehensive assessment of patients


484.110 Clinical records