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PRINTED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES STATEMENT OF DEFICIENCIES X1 PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER 15E667 04/26/2012 FORM APPROVED OMB NO. The also be added to the annual in-service packet for LPN s RN s and QMA s. 5 By what date the systemic changes will be completed. May 4 2012. On 3-20-2012 the CNA involved in this event left the facility and has never returned to the facility. 0938-0391 X2 MULTIPLE...

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