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 852575 (X3) Date Survey Completed 07/12/2022
Name of Provider or Supplier Cc&D Services Street Address, City, State 5040 Snapfinger Woods Dr, Ste 108, Decatur, 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)
V0542 POC-IDT DEVELOPS PLAN OF CARE
CFR(s): 494.90(a)

The interdisciplinary team must develop a plan of care for each patient.


This STANDARD is not met as evidenced by:
Based on medical record review and staff interview, it was determined that the facility failed to ensure that the Interdisciplinary Team (IDT) developed an effective, individualized plan of care for four of five sampled patients (P#1, P#2, P#3, and P#4). This deficient practice had the potential to negatively affect the health and safety of the four patients sampled. The facility census was 32. Findings include: - P#1 was admitted to this facility on 5/2/22. There was no documentary evidence that an Initial individualized plan of care was developed and completed by the entire IDT. - P#2 was admitted to this facility on 2/2/22. There was no documentary evidence that an Initial and 90-day individualized plan of care was developed and completed by the entire IDT. - P#3 was admitted to this facility on 12/20/21. There was no documentary evidence that an Initial and 90-day individualized plan of care was developed and completed by the entire IDT. - P#4 was admitted to this facility on 11/26/19. The last record for an IDT assessment was 10/7/21 however, there was no documentary evidence that an individualized Plan of Care was developed and completed by the entire IDT based on the comprehensive IDT assessment of 10/7/21. The Chief Executive Officer (CEO)/Owner stated on 7/12/22 at approximately 11:30 a.m., that he could not find any documentary evidence of the above patients' individualized plan of care.