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

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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
▼ 55G821 Salem Christian Homes, Inc. 2520 Mark Ln Costa Mesa CA 9 (San Francisco) 03/17/2026 EB2M21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
KS300 Protection - other Standard
KS345 Fire alarm system - testing and maintenance Standard
KS353 Sprinkler system - maintenance and testing Standard
▼ 55G821 Salem Christian Homes, Inc. 2520 Mark Ln Costa Mesa CA 9 (San Francisco) 11/05/2024 9KGZ21 Initial Certification
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
KS347 Smoke detection Standard
KS351 Sprinkler system - installation Standard
KS353 Sprinkler system - maintenance and testing Standard
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 06/02/2026 234582-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0369 Drug administration Standard
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 04/28/2026 22FC42-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0120 Services provided with outside sources Standard
W0369 Drug administration Standard
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 04/10/2026 22D80C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0323 Physician services Standard
W0331 Nursing services Standard
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 04/09/2026 22D80C-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
K0000 Initial comments - not a deficiency citation Memo
KS712 Fire drills Standard
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 09/24/2025 SW0T11 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0339 Nursing services Standard
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 02/25/2025 XSZ421 Initial Certification
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
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 02/20/2025 XSZ411 Initial Certification
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0362 Drug regimen review Standard
W0475 Meal services Standard
▼ 55G822 Momentum Agencies Northridge House Icf/Ddh 10401 Shirley Avenue Northridge CA 9 (San Francisco) 01/27/2025 VGN611 Complaint
Deficiency Tag Deficiency Description Tag Type
W0000 Initial comments - not a deficiency citation Memo
W0111 Client records Standard
W0339 Nursing services Standard