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 757287 (X3) Date Survey Completed 11/03/2025
Name of Provider or Supplier Summa Home Health Care, Inc. Street Address, City, State 2500 E Foothill Blvd Unit 417, Pasadena, 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)
G0510 Comprehensive Assessment of Patients
CFR(s): 484.55

Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. For Medicare beneficiaries, the HHA must verify the patient's eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment.


This CONDITION is not met as evidenced by:
Based on observation, interview, and record review, the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutic services to a patient’s personal residence) failed to meet the Condition of Participation (refer to the requirements that healthcare organizations must meet to participate in federal healthcare programs) for Comprehensive Assessment of Patients as follows: 


a. The Home Health Agency (HHA) failed to ensure the comprehensive assessment (the required in-person clinical assessment of the patient's physical, functional, mental, psychosocial, and cognitive status to identify the needs of the patient and caregiver that will be addressed by the home health agency's services) was completed within 5 days from the start of care for one of 7 sampled patients (Patient 1).

This deficient practice had the potential to result in the patient’s needs not being identified and assessed, leading to poor quality nursing care needed to maintain the patient’s quality of life and well-being. (Refer to G520).

 

b. The HHA failed to assess the patients' continuing need for home care services for two of 7 sampled patients (Patient 2, and Patient 3). 

This deficient practice resulted in the continued skilled nurse services to these patients lacking the comprehensive assessments to clearly demonstrate the continuing provision of the home health benefits. (Refer to G532).

 

c. The HHA failed to maintain an accurate current medication profile for one of 7 sampled patients (Patient 2). 

This deficient practice has the potential to place the patient at risk for medication errors and adverse drug reactions. (Refer to G536).

 

The cumulative effect of these systemic practices resulted in the failure of the HHA to deliver mandated compliance (in a way that is decided and controlled by law) with Federal regulations for Comprehensive Assessment of Patients to ensure the provision of health care services in a safe manner are provided to certified home health patients.