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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:4/20/2016 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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This visit was for a routine inspection of the facility.
The compliance officer or facility manager is required to file this visit.
The visit report must be completed and submitted online through the designated platform.
The purpose of this visit was to ensure compliance with regulations and safety standards.
The visit must include details of any non-compliance issues found and actions taken to rectify them.
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