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This document outlines the Statement of Deficiencies and the Plan of Correction for the facility Stone Belt Arc Inc located in Bloomington, IN, after a survey conducted on March 1, 2022. The report indicates various deficiencies related to the management of client medications, staffing levels, and the overall management of the facility\'s healthcare services. The document details the corrective actions required and the agency\'s responses to address identified issues.
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How to fill out cms-2567
How to fill out cms-2567
01
Gather necessary information about the facility.
02
Review the CMS guidelines for filling out CMS-2567.
03
Start with Section A: Provide the facility name, address, and identification details.
04
Move to Section B: Identify the surveyor's information and date of the survey.
05
Fill out Section C: List the deficiencies observed during the survey.
06
Address Section D: Provide a plan of correction for each deficiency.
07
Complete Section E: Include any additional comments or notes relevant to the survey.
08
Review the form for accuracy and completeness.
09
Sign and date the form where required.
Who needs cms-2567?
01
Healthcare facilities seeking certification or compliance with Medicare and Medicaid.
02
Surveyors conducting inspections and assessments on facilities.
03
Organizations involved in quality assurance and improvement in healthcare settings.
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What is cms-2567?
CMS-2567 is a form used by healthcare facilities to report deficiencies found during surveys conducted by the Centers for Medicare & Medicaid Services (CMS).
Who is required to file cms-2567?
Healthcare facilities that receive Medicare or Medicaid funding are required to file CMS-2567 when deficiencies are identified during survey inspections.
How to fill out cms-2567?
To fill out CMS-2567, facilities must provide detailed information about the deficiencies identified, including specific citations, a description of the issue, and a plan of correction.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to document compliance or non-compliance of healthcare facilities with federal regulations and to ensure that facilities take corrective actions when deficiencies are found.
What information must be reported on cms-2567?
CMS-2567 must report the specific deficiencies, citation numbers, the date of the survey, the facility's name and address, and the plan for correction for each deficiency.
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