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This document outlines the statement of deficiencies identified during a survey conducted at Celebrate Senior Living of Fort Wayne and includes the corresponding plans of correction submitted by the facility. It covers compliance with various health and safety regulations, particularly relating to emergency preparedness, life safety code, and fire safety standards.
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How to fill out form cms-2567
01
Obtain the CMS-2567 form from the CMS website or your local Medicare office.
02
Identify the facility being surveyed and enter its name and address in the designated fields.
03
Fill out the date of the survey in the specified area.
04
Document any deficiency findings in the appropriate sections, ensuring to include specific citations.
05
Provide a summary of the deficiencies and any corrective actions taken or planned.
06
Review the completed form for accuracy and completeness.
07
Submit the form to the appropriate CMS regional office.
Who needs form cms-2567?
01
Healthcare providers and facilities that are surveyed by CMS, including nursing homes and hospitals, need to fill out Form CMS-2567.
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What is form cms-2567?
Form CMS-2567 is a document used by the Centers for Medicare & Medicaid Services (CMS) to report deficiencies identified during inspections of healthcare facilities or programs that participate in Medicare or Medicaid.
Who is required to file form cms-2567?
Healthcare facilities that are surveyed by CMS, including nursing homes, hospitals, and home health agencies, are required to file Form CMS-2567 when deficiencies are identified during the survey.
How to fill out form cms-2567?
To fill out Form CMS-2567, facilities must provide specific information regarding each deficiency, including the regulation violated, a description of the deficiency, and the impact on residents. The form must be completed accurately and submitted to CMS as required.
What is the purpose of form cms-2567?
The purpose of Form CMS-2567 is to provide a standardized method for reporting and documenting deficiencies in healthcare facilities, ensuring compliance with federal regulations and promoting quality care for patients.
What information must be reported on form cms-2567?
Form CMS-2567 must report information such as the specific regulations violated, a detailed description of the deficiencies, the date of the survey, and the facility's response or plan of correction.
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