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 531311 (X3) Date Survey Completed 11/17/2011
Name of Provider or Supplier Crook County Hospital Street Address, City, State 713 Oak Street, Sundance, 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)
C0271 PATIENT CARE POLICIES
CFR(s): 485.635(a)(1)

The CAH's health care services are furnished in accordance with appropriate written policies that are consistent with applicable State law.


This STANDARD is not met as evidenced by:
Based on medical record review, review of policies and procedures, and staff interview, the facility failed to ensure staff furnished care for 11 of 22 sample patients (#2, #4 #9, #10, #12, #13, #14, #15, #18, #19, #22) in accordance with the facility's written policies. The findings were: Medical record reviews, staff interview, and review of policies and procedures revealed staff failed to adhere to facility policies and procedures while providing care for patients #2, #4, #9, #10, #12, #13, #14, #15, #18, #19, and #22. For details, refer to C151, C224, C276, C277, C280, C281, C295, C297, and C298.