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CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF PUBLIC HEALTH
ST1\'CEMENT OF DEFICIENCIES
ANO PL. O. N OF CORRECTION(X2) MULTIPLE CONSTRUCTION(X1) PROVlDERISUPPLIERICLIA
IDENTIFICATION NUMBER(X3l
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How to fill out st1tement of deficiencies
How to fill out st1tement of deficiencies
01
Step 1: Start by reviewing the deficiencies mentioned in the statement.
02
Step 2: Determine the root causes of each deficiency.
03
Step 3: Develop a plan of action to address each deficiency.
04
Step 4: Clearly outline the steps and strategies that will be implemented to correct the deficiencies.
05
Step 5: Provide supporting documentation or evidence of corrective actions taken.
06
Step 6: Review and revise the statement as necessary.
07
Step 7: Submit the completed Statement of Deficiencies to the relevant authority.
Who needs st1tement of deficiencies?
01
Statement of Deficiencies is typically required by regulatory agencies or auditors.
02
It is needed by organizations or individuals who have been identified to have deficiencies in their operations or processes.
03
It helps them to document the corrective actions they plan to take to address the identified deficiencies.
04
The Statement of Deficiencies helps to demonstrate their commitment to improving and maintaining compliance with applicable regulations or standards.
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What is st1tement of deficiencies?
Statement of deficiencies is a document that outlines any areas of non-compliance or deficiencies found during an inspection or audit.
Who is required to file st1tement of deficiencies?
Organizations or individuals who have been notified of deficiencies or non-compliance are required to file a st1tement of deficiencies.
How to fill out st1tement of deficiencies?
The st1tement of deficiencies must be filled out by providing detailed information about the specific deficiencies found, the corrective actions taken or planned, and any supporting documentation.
What is the purpose of st1tement of deficiencies?
The purpose of the st1tement of deficiencies is to address and rectify any areas of non-compliance, ensuring that the organization is in compliance with regulations and standards.
What information must be reported on st1tement of deficiencies?
The st1tement of deficiencies must include details of the deficiencies found, the impact of these deficiencies, the corrective actions taken or planned, and any supporting documentation.
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