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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION Facilities Name: A.M.A. Care Home CHAPTER 100.1Address: 94392 Kahuna Street, Waipahu, Hawaii 96797Inspection Date: September 11, 2020, Initials PAGE

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How to fill out wwwcdphcagovprogramschcqstatement of deficiencies and

01

Access www.cdph.ca.gov/programs/hcq to find the Statement of Deficiences form.

02

Fill in the facility information including name, address, and license number.

03

Provide details of the deficiency including the date of observation and a description of the deficiency.

04

Include the corrective action taken to address the deficiency.

05

Sign and date the form before submitting it to the appropriate regulatory agency.

Who needs wwwcdphcagovprogramschcqstatement of deficiencies and?

01

Healthcare facilities licensed by the California Department of Public Health (CDPH) are required to complete and submit the Statement of Deficiencies.

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What is wwwcdphcagovprogramschcqstatement of deficiencies and?

The wwwcdphcagovprogramschcqstatement of deficiencies and is a document that outlines any areas of non-compliance or issues found during an inspection or audit of a healthcare facility.

Who is required to file wwwcdphcagovprogramschcqstatement of deficiencies and?

Healthcare facilities are required to file the wwwcdphcagovprogramschcqstatement of deficiencies and.

How to fill out wwwcdphcagovprogramschcqstatement of deficiencies and?

Healthcare facilities must provide detailed explanations for each deficiency identified in the wwwcdphcagovprogramschcqstatement of deficiencies and, along with proposed corrective actions.

What is the purpose of wwwcdphcagovprogramschcqstatement of deficiencies and?

The purpose of the wwwcdphcagovprogramschcqstatement of deficiencies and is to ensure that healthcare facilities are meeting regulatory standards and providing quality care to patients.

What information must be reported on wwwcdphcagovprogramschcqstatement of deficiencies and?

The wwwcdphcagovprogramschcqstatement of deficiencies and must include detailed descriptions of each deficiency, the impact on patient care, and proposed corrective actions.

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