| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 01D0027451 | (X3) Date Survey Completed 10/08/2025 |
| Name of Provider or Supplier Grove Hill Memorial Hospital | Street Address, City, State 295 S Jackson St, Grove Hill, AL | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies |
| D6054 | TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) (b)(9) Thereafter, evaluations must be performed at least annually This STANDARD is not met as evidenced by: Based on a review of 2023-2025 personnel evaluation records and an interview with General Supervisor, the Technical Consultant (TC) failed to assess and document the 2023 annual competency for one of the six Testing Personnel (TP) responsible for the blood gases testing. The findings include: 1. A review of personnel evaluation records for TP listed on the CMS-209 Form (Laboratory Personnel Report) from 2023-2025 revealed the TC failed to perform and document the annual 2023 competency assessment for TP6. 2. The Chief Operating Officer and the GS confirmed the above findings during the exit conference on 10-08-2025 at 4:28 PM. |