S&C QCOR ICF-IID 2567s
d QCOR:  Quality, Certification and Oversight Reports.
ICF-IID 2567s
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Time Interval

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Provider Characteristics

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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
▼ 55G799 Villa Eseranza Wynn House 1920 E Vila Street Pasadena CA 9 (San Francisco) 08/11/2026 31C215-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
KS353 Sprinkler system - maintenance and testing Standard
KS354 Sprinkler system - out of service Standard
▼ 55G799 Villa Eseranza Wynn House 1920 E Vila Street Pasadena CA 9 (San Francisco) 08/06/2025 XLHB11 Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0159 Qidp Standard
W0331 Nursing services Standard
W0369 Drug administration Standard
W0426 Client bathrooms Standard
W0454 Infection control Standard
W0460 Food and nutrition services Standard
▼ 55G799 Villa Eseranza Wynn House 1920 E Vila Street Pasadena CA 9 (San Francisco) 08/05/2025 XLHB21 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
▼ 55G799 Villa Eseranza Wynn House 1920 E Vila Street Pasadena CA 9 (San Francisco) 09/26/2024 FZBZ11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0104 Governing body Standard
W0121 Services provided with outside sources Standard
W0327 Physician services Standard
W0454 Infection control Standard
▼ 55G799 Villa Eseranza Wynn House 1920 E Vila Street Pasadena CA 9 (San Francisco) 09/25/2024 FZBZ21 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
E0004 Develop ep plan, review and update annually Standard
E0039 Ep testing requirements Standard
KS211 Means of egress - general Standard
KS341 Fire alarm system - installation Standard
KS345 Fire alarm system - testing and maintenance Standard
KS351 Sprinkler system - installation Standard
KS511 Utilities - gas and electric Standard
KS712 Fire drills Standard
▼ 55G799 Villa Eseranza Wynn House 1920 E Vila Street Pasadena CA 9 (San Francisco) 07/03/2023 VJHO11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0127 Protection of clients rights Standard
W0156 Staff treatment of clients Standard
▼ 55G800 Mclennan Avenue Home 12325 Mclennan Avenue Granada Hills CA 9 (San Francisco) 01/29/2026 GDUH21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
KS351 Sprinkler system - installation Standard
KS353 Sprinkler system - maintenance and testing Standard
KS511 Utilities - gas and electric Standard
▼ 55G800 Mclennan Avenue Home 12325 Mclennan Avenue Granada Hills CA 9 (San Francisco) 01/28/2026 GDUH11 Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0111 Client records Standard
W0120 Services provided with outside sources Standard
W0129 Protection of clients rights Standard
W0164 Professional program services Standard
W0208 Individual program plan Standard
W0331 Nursing services Standard
W0338 Nursing services Standard
W0369 Drug administration Standard
W0382 Drug storage and recordkeeping Standard
W0460 Food and nutrition services Standard
▼ 55G800 Mclennan Avenue Home 12325 Mclennan Avenue Granada Hills CA 9 (San Francisco) 04/17/2025 HY3S11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0169 Professional program services Standard
▼ 55G800 Mclennan Avenue Home 12325 Mclennan Avenue Granada Hills CA 9 (San Francisco) 01/27/2025 9C8I21 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
KS353 Sprinkler system - maintenance and testing Standard
KS751 Draperies, curtains, and loosely hanging fabr Standard
KS761 Maintenance, inspection & testing - doors Standard