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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:6/6/2016 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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What is this visit was for?
This visit was for a routine inspection.
Who is required to file this visit was for?
The company's designated safety officer is required to file this visit.
How to fill out this visit was for?
The visit must be filled out using the online reporting portal.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with safety regulations.
What information must be reported on this visit was for?
All safety hazards identified during the inspection must be reported.
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