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 11/13/2013
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)
C0152 COMPLIANCE W ST & LOC LAWS & REGULATIONS
CFR(s): 485.608(b)

All patient care services are furnished in accordance with applicable State and local laws and regulations.


This STANDARD is not met as evidenced by:
Based on staff interview and review of infection control activities, the facility failed to comply with State requirements for reporting diseases and epidemiologically significant conditions for 2 (#1 and #2) of 5 sample patients with reportable conditions. The findings were: 1. Review of infection control records on 11/13/13 beginning at 8:40 AM showed 5 patients were identified in 2013 with infections or conditions that required reporting to the Wyoming Department of Health as specified in Statue Statute Title 35 - Public Health and Safety, Section 35-4-107. The statue requires reporting of significant infections and conditions to the health department within 24 hours of discovery; among the conditions defined for reporting by the Health Department are cryptosporidiosis and campylobacteriosis. Of the 5 sample patients with reportable conditions, the facility failed to comply with timely reporting for 2 patients, for example: A. Patient #1 had a diagnosis of cryptosporidiosis confirmed by laboratory testing on 11/9/13; this condition was reported to the Health Department on 11/12/13, 4 days after diagnosis. B. Patient #2 had a diagnosis of campylobacteriosis established on 7/16/13 and reported to the Health Department on 7/25/13, 9 days after diagnosis. 2. The infection preventionist confirmed in interview on 11/13/13 beginning at 9:10 AM that the facility failed to comply with timely reporting as required by the State in the 2 instances cited.