S&C QCOR ICF-IID 2567s
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ICF-IID 2567s
Selection Criteria ▸

Time Interval

Please select the calendar year or years for which you would like data.

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
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 09/03/2025 KYB321 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
KS345 Fire alarm system - testing and maintenance Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 08/28/2025 KYB311 Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0159 Qidp Standard
W0196 Active treatment Standard
W0237 Individual program plan Standard
W0249 Program implementation Standard
W0252 Program documentation Standard
W0268 Conduct toward client Standard
W0325 Physician services Standard
W0331 Nursing services Standard
W0342 Nursing services Standard
W0369 Drug administration Standard
W0454 Infection control Standard
W0460 Food and nutrition services Standard
W0472 Meal services Standard
W0474 Meal services Standard
W0488 Dining areas and service Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 08/11/2025 9USP11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0368 Drug administration Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 07/15/2025 NMZ611 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0159 Qidp Standard
W0252 Program documentation Standard
W0312 Drug usage Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 07/03/2025 RZMC11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0104 Governing body Standard
W0149 Staff treatment of clients Standard
W0156 Staff treatment of clients Standard
W0214 Individual program plan Standard
W0252 Program documentation Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 05/20/2025 EG9Q11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0104 Governing body Standard
W0331 Nursing services Standard
W0368 Drug administration Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 04/25/2025 CNMH11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0189 Staff training program Standard
W0331 Nursing services Standard
W0368 Drug administration Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 03/28/2025 UDNL11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0368 Drug administration Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 03/05/2025 LXVH11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0154 Staff treatment of clients Standard
W0237 Individual program plan Standard
W0259 Program monitoring & change Standard
W0331 Nursing services Standard
W0339 Nursing services Standard
▼ 55G794 Christine Circle 6540 Christine Circle Buena Park CA 9 (San Francisco) 11/12/2024 TMLT11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0229 Individual program plan Standard
W0237 Individual program plan Standard
W0249 Program implementation Standard