S&C QCOR ICF-IID 2567s
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ICF-IID 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific ICF-IID deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 03G008 Hacienda De Los Angeles 1402 East South Mountain Avenue Phoenix AZ 9 (San Francisco) 06/19/2019 2JUD11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0102 Governing body and management Condition
W0318 Health care services Condition
W0406 Physical environment Condition
W0104 Governing body Standard
W0331 Nursing services Standard
W0454 Infection control Standard
▼ 03G008 Hacienda De Los Angeles 1402 East South Mountain Avenue Phoenix AZ 9 (San Francisco) 02/08/2019 V3UG11 Complaint, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0102 Governing body and management Condition
W0122 Client protections Condition
W0318 Health care services Condition
W0104 Governing body Standard
W0111 Client records Standard
W0112 Client records Standard
W0127 Protection of clients rights Standard
W0148 Communication with clients, parents & Standard
W0149 Staff treatment of clients Standard
W0154 Staff treatment of clients Standard
W0155 Staff treatment of clients Standard
W0156 Staff treatment of clients Standard
W0157 Staff treatment of clients Standard
W0214 Individual program plan Standard
W0322 Physician services Standard
W0331 Nursing services Standard
W0341 Nursing services Standard
W0361 Pharmacy services Standard
W0390 Drug labeling Standard
W0454 Infection control Standard
W0455 Infection control Standard
▼ 03G008 Hacienda De Los Angeles 1402 East South Mountain Avenue Phoenix AZ 9 (San Francisco) 01/17/2019 V3UG21 Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
E0039 Ep testing requirements Standard
K0353 Sprinkler system - maintenance and testing Standard
K0355 Portable fire extinguishers Standard
K0923 Electrical equipment ? ground-fault circuit-interrupter protection Standard
▼ 03G008 Hacienda De Los Angeles 1402 East South Mountain Avenue Phoenix AZ 9 (San Francisco) 06/27/2018 29XV21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
E0015 Subsistence needs for staff and patients Standard
E0026 Roles under a waiver declared by secretary Standard
K0908 Gas and vacuum piped systems ? central supply system alarms Standard
K0916 Essential electrical systems ? alarm annunciator Standard
▼ 03G008 Hacienda De Los Angeles 1402 East South Mountain Avenue Phoenix AZ 9 (San Francisco) 06/20/2018 29XV11 Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0339 Nursing services Standard
W0363 Drug regimen review Standard
W0447 Evacuation drills Standard
▼ 03G010 Arizona Training Program Of Coolidge - 10 Sandstone Court 2800 N Hwy 87 Coolidge AZ 9 (San Francisco) 07/09/2026 22E385-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
K0353 Sprinkler system - maintenance and testing Standard
K0923 Electrical equipment ? ground-fault circuit-interrupter protection Standard
▼ 03G010 Arizona Training Program Of Coolidge - 10 Sandstone Court 2800 N Hwy 87 Coolidge AZ 9 (San Francisco) 04/16/2026 22E385-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0149 Staff treatment of clients Standard
W0159 Qidp Standard
W0192 Staff training program Standard
W0255 Program monitoring & change Standard
W0352 Comprehensive dental diagnostic service Standard
W0440 Evacuation drills Standard
W0445 Evacuation drills Standard
▼ 03G010 Arizona Training Program Of Coolidge - 10 Sandstone Court 2800 N Hwy 87 Coolidge AZ 9 (San Francisco) 12/22/2025 4WLT11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0331 Nursing services Standard
▼ 03G010 Arizona Training Program Of Coolidge - 10 Sandstone Court 2800 N Hwy 87 Coolidge AZ 9 (San Francisco) 05/21/2025 W0IB21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
K0341 Fire alarm system - installation Standard
K0918 Essential electrical systems ? generator or alternate source Standard
▼ 03G010 Arizona Training Program Of Coolidge - 10 Sandstone Court 2800 N Hwy 87 Coolidge AZ 9 (San Francisco) 05/15/2025 W0IB11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0153 Staff treatment of clients Standard
W0183 Facility staffing Standard
W0199 Admissions, transfers, discharge Standard
W0201 Admissions, transfers, discharge Standard
W0203 Admissions, transfers, discharge Standard
W0205 Admissions, transfers, discharge Standard
W0249 Program implementation Standard