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PRINTED: 12/18/2018 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION
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Pine Gardens Adult Care is a residential care facility for adults who require assistance with daily activities.
The owner or operator of Pine Gardens Adult Care is required to file the necessary documentation.
The required forms can be filled out electronically or by hand and submitted to the appropriate regulatory agency.
The purpose of Pine Gardens Adult Care is to provide a safe and supportive environment for adults in need of care and assistance.
Information such as resident demographics, medical history, care needs, and emergency contacts must be reported on Pine Gardens Adult Care forms.
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