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This document outlines deficiencies identified during a survey conducted at Good Samaritan Home & Rehabilitative Center, including plans of correction for each deficiency noted. It addresses issues related to quality of care, wound management, pressure ulcer treatment, behavior management, and dietary services, specifically highlighting non-compliance with established care standards and the subsequent corrective actions planned by the facility.
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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 Centers for Medicare & Medicaid Services website.
02
Fill out the facility information in Section 1, including the name, address, and contact details.
03
In Section 2, provide the date of the survey and the type of survey being conducted.
04
Identify the deficiencies in Section 3, clearly marking them as 'deficient' or 'not deficient' and providing a description.
05
In Section 4, include any plans of correction for each identified deficiency.
06
Sign and date the completed form in Section 5, ensuring that the information is accurate and truthful.
07
Submit the completed CMS-2567 form to the appropriate state agency as directed.
Who needs cms-2567?
01
The CMS-2567 form is needed by facilities that are surveyed for compliance with health and safety regulations.
02
It is required by nursing homes, hospitals, and other long-term care facilities participating in Medicare and Medicaid programs.
03
Healthcare providers must complete this form in response to surveys conducted by state survey agencies or during complaint investigations.
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What is cms-2567?
CMS-2567 is a form used by healthcare facilities to report deficiencies that are identified during inspections or surveys.
Who is required to file cms-2567?
Healthcare facilities that are certified by Medicare and Medicaid are required to file CMS-2567.
How to fill out cms-2567?
To fill out CMS-2567, facilities should provide detailed information about the deficiencies identified, including the specific regulatory citations, the nature of the deficiencies, and the facility's plan for correction.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to ensure that healthcare facilities address deficiencies in compliance with regulations to improve patient care.
What information must be reported on cms-2567?
On CMS-2567, facilities must report the identified deficiencies, the related regulatory citations, and a plan of correction.
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