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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15G16305/28/2015FORM

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What is this visit was for?

This visit is for conducting a routine inspection of the facility.

Who is required to file this visit was for?

The facility manager or designated staff member is required to file this visit report.

How to fill out this visit was for?

The visit report must be filled out by documenting the observations, findings, and any actions taken during the inspection.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with safety and regulatory standards.

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The report must include details of any violations found, corrective actions taken, and recommendations for improvement.

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