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This was a partial extended survey. Survey dates 7/31 8/1 8/2 8/5/2013 Facility 005330 Medicaid 100264320A Survey Team Dawn Snider RN PHNS Census Service Type Skilled Patients 400 Home Health Aide Only Patients 0 Personal Service Only Patients NA Total 400 Sample RR w HV 6 Total RR 12 Quality Review Joyce Elder MSN BSN RN August 7 2013 LABORATORY DIRECTOR S OR PROVIDER/SUPPLIER REPRESENTATIVE S SIGNATURE TITLE X6 DATE Any defiencystatement ending with an asterisk denotes a deficency which the...
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