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PRINTED: 09/07/2022
FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION
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What is this facility complies with?
This facility complies with local, state, and federal regulations regarding environmental protection and safety standards.
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Owners and operators of the facility that meet specific regulatory criteria are required to file this compliance report.
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The report must include operational data, compliance status, any incidents of non-compliance, and measures taken to rectify issues.
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