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 531310 (X3) Date Survey Completed 05/03/2012
Name of Provider or Supplier Powell Valley Hospital Street Address, City, State 777 Avenue H, Powell, WY
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)
C0281 PATIENT SERVICES
CFR(s): 485.635(b)(1)

(1) General. The CAH provides those diagnostic and therapeutic services and supplies that are commonly furnished in a physician's office or at another entry point into the health care delivery system, such as a low intensity hospital outpatient department or emergency department. These CAH services include medical history, physical examination, specimen collection, assessment of health status, and treatment for a variety of medical conditions.


This STANDARD is not met as evidenced by:
Based on staff interview and review of the organizational chart, the facility failed to ensure the outpatient services department was accountable to a single individual who knew s/he was responsible for the department and who directed the overall operation of the department. The findings were: During an interview on 5/1/12 at 11:08 AM, the interim CNO, the corporate compliance officer and the director of medical/surgical services all agreed they did not have a single person in charge of and accountable for outpatient services. These services were defined as consisting of physical, occupational, and speech rehabilitation therapy; laboratory and radiology services; cardiopulmonary rehabilitation; emergency services; and outpatient surgical services. On 5/2/12 during an interview at 1:50 PM, the director of rehabilitation services stated he thought the outpatient services were under the direction of the CNO. He further stated that as an interim, the CNO probably did not know she was the director of the services. Review of the organizational chart showed outpatient surgical services were not accountable to the CNO.