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This document is a Statement of Deficiencies and Plan of Correction issued by the Centers for Medicare & Medicaid Services (CMS) regarding compliance with infection control regulations at the Park Crescent Healthcare & Rehabilitation Center following a COVID-19 focused survey conducted on January 27, 2021. It outlines the facility\'s compliance status and corrective actions taken in response to any identified deficiencies.
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How to fill out cms-2567
How to fill out cms-2567
01
Begin by downloading the CMS-2567 form from the official CMS website.
02
Fill in the facility information section with the name, address, and ID number.
03
Enter the date of the survey or inspection in the designated area.
04
Provide details about each deficiency noted during the inspection including the regulation that was violated.
05
Describe the specific issue encountered and the impact it has on patient care or safety.
06
Include any evidence or citations that support the noted deficiencies.
07
If applicable, specify the corrective actions taken or proposed by the facility.
08
Review the completed form for accuracy and clarity.
09
Sign and date the form before submission.
Who needs cms-2567?
01
The CMS-2567 form is needed by healthcare facilities that have undergone inspections by the Centers for Medicare & Medicaid Services (CMS) or state survey agencies.
02
Providers must complete this form to report deficiencies in compliance with federal regulations.
03
It is also required by facilities when submitting a plan of correction to address cited deficiencies.
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What is cms-2567?
CMS-2567 is a form used by healthcare facilities to report their compliance with Medicare and Medicaid requirements, primarily documenting deficiencies identified during surveys.
Who is required to file cms-2567?
Healthcare facilities that participate in Medicare and Medicaid programs are required to file CMS-2567 if deficiencies are found in their compliance during inspections.
How to fill out cms-2567?
To fill out CMS-2567, facilities must clearly identify each deficiency, include the specific regulation violated, and provide a plan of correction along with the intended completion date.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to document deficiencies found during inspections, ensuring that healthcare facilities address compliance issues to improve patient safety and care.
What information must be reported on cms-2567?
CMS-2567 must report the type and number of deficiencies, specific regulatory citations, the facility's response, and the plan for corrective action.
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