| 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) |
| C0330 | PERIODIC EVALUATION & QA REVIEW CFR(s): 485.641 Periodic Evaluation and Quality Assurance Review This CONDITION is not met as evidenced by: Based on staff interview and review of QAPI information, policies and procedures, medical staff bylaws, rules and regulations, and minutes from meetings of the medical staff and the governing body, the facility failed to conduct an annual evaluation of its total program that met the regulatory requirements (C332, C333, C334). In addition, the facility failed to develop, implement, evaluate, and revise an effective, facility wide QAPI program (C337, C338, C340, C342, C342). The cumulative effect of these failures resulted in the determination that the condition of participation for periodic review and quality assurance was not met. |