Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 852556 (X3) Date Survey Completed 07/11/2019
Name of Provider or Supplier Thomas County Home Training Street Address, City, State 708 South Broad Street, Thomasville, GA
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

(Each deficiency should be preceded by full regulatory or LSC identifying information)
V0000 (Core) A recertification survey was conducted at Thomas County Home Training from July 9, 2019 through July 11, 2019. The recertification survey revealed that the facility was in substantial compliance with 42 CFR Part 494 Condition for Coverage for End Stage Renal Disease Facilities. However, the following standard level deficiencies were cited which resulted from the facility's non compliance related to the survey: