Professional Documents
Culture Documents
STATEMENT OF DEFICIENCIES (X1) PROVIDERISUPPLIERICLIA ()(2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
050589 B. WING 0510512011
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
PLACENTIA LINDA HOSPITAL 1301 ROSE DRIVE, PLACENTIA, CA 92870 ORANGE COUNTY
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\n)l deficiency statement endl ll with an asterisk (•) denotes a deficiency which the Institution may be excused from correcting providing it Is determined
hal other safeguards provide sufficient protection to the patients. Except for nursing homes, the findings above are disclosable 90 days following the date
•f survey whether or not a plan of correction Is provided. For nursing homes, the above findings and plans of correction are dlsclosable 14 days following
he data these documents are made available to lhe facility. If deficiencies are cited, an approved plan of correction Is requisite to continued program
•articlpation.
Hate-2567 1 of7
CAIJFO.RNIA HEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF PUBLIC HEALTH
STi\TEMENT OF DEFICIENCIES (X1) PROVIDERISUPPLIERICLIA ()(2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
050589 B. WING 05/05/2011
NAME OF PROVIDI;R OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
PLACENTIA LINDA HOSPITAL 1301 ROSE DRIVE, PLACENTIA, CA 92870 ORANGE COUNTY
1ny deficiency statement ending with an asterisk(") denotes a deficiency which the Institution may be excused from correcting providing it Is deterroined
~at other safeguards provide sufficient protection to the patients. Except for nursing homes, the findings above are disclosable 90 days following the date
•f survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following
1e date these documents are made available to the facility, If deficiencies are cited, an approved plan of correction Is requisite to continued program
•articipa\ion.
ltate-2567 2 of7
CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF PUBLIC HEALTH
Sl/\TEMENT OF DEFICIENCIES (X1) PROVIDERISUPPLIERICLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
050589 B. WING 05/05/2011
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS. CITY, STATE, ZIP CODE
PLACENTIA LINDA HOSPITAL 1301 ROSE DRIVE, PLACENTIA, CA 92870 ORANGE COUNTY
Any deficiency statement ending with an asterisk (•) denotes a deficiency which the Institution may be excused tram correcting providing it Is determined
that other safeguards provide sufficient protection to the patients. Except for nursing homes, lhe findings above are disclosable 90 days following the date
of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following
the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program
participation.
State-2567 3 of7
CAPFO~NIAHEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF PUBLIC HEALTH
STATEMENT OF DEFICIENCIES (X1) PROVIDERISUPPLIERICLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
050589 B. INNG 05/05/2011
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
PLACENTIA LINDA HOSPITAL 1301 ROSE DRIVE, PLACENTIA, CA 92870 ORANGE COUNTY
Any deficiency statement ending with an asterisk (') denotes a deficiency which the Institution may be excused from correcting providing it Is determined
thai other safeguards provide sufficient protection to the palients. Excepl for nursing homes, the findings above are disclosable 90 days following the date
of survey whether or not a plan of correction is provided. For nursing homes, the abo-;e findings ~nd plans or correction are disolosable 14 days following
the date these documents are made available to the facility . If deficiencies are cited, an· approved plan of correction is requisite to continued program
participation.
State-2567 4 of7
CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF PUBLIC HEALTH
STAli:MENT QF DEFICIENCIES (X1) PROVIOERJSUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (XJ) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
050589 B. WING 05105(2011
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
PLACENTIA LINDA HOSPITAL 1301 ROSE DRIVE, PLACENTIA, CA 92870 ORANGE COUNTY
Any deficiency statement ending with an asterisk(*) denotes a deficiency which the institution may be excused from correcting providing It Is determined
that ofher safeguards provide sufficient protection to the patients. Except for nursing homes, the findings above are disclosable 90 days following the date
of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following
the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program
participation.
State-2567 5 of 7
CALIFORNIA H~LTH AND HUMAN SERVICES AGENCY
DEPARTMEr·n OF PUBLIC HEALTH
STATEMENT OF DEFICIENCIES (X1) PROVIDERISUPPLIER!CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
ANb PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
: A. BUILDING
050589 B. WING 05/05/2011
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
PLACENTIA LINDA HOSPITAL 1301 ROSE DRIVE, PLACENTIA, CA 92870 ORANGE COUNTY
Any deficiency statement ending with an asterisk (•) denotes a deficiency which the instilution may be excused from correcting providing it is determined
that other safeguards provide sufficient protection to the patients. Except for nursing homes, the findings above are disclosable 90 days following the dale
of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following
the date these documents are made available to the facility. If deficiencies ere cited, en approved plan of correction Is requisite to continued program
participation.
State-2567 6 of7
CALl FORNI,\ HEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF PUBLIC HEALTH
STAT£MENT OF DEFICIENCIES (X1) PROVIDERISUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
050589 B. WING 05/05/2011
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
PLACENTIA LINDA HOSPITAL 1301 ROSE DRIVE, PLACENTIA, CA 92870 ORANGE COUNTY
Any deficiency statement ending with an asterisk(') denotes a deficiency which the Institution may be excused from correcting providing It is determined
that other safeguards provide sufficient protection to the patients. Except for nursing homes. the findings above are dlsclosable 90 days following the date
of survey whether or not a plan of correction Is provided For nursing homes, the abo~e findings and plans of correction are disclosabte 14 days following
the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program
participation.
State-2567 7 of7