| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 670068 | (X3) Date Survey Completed 03/18/2014 |
| Name of Provider or Supplier Texas Health Presbyterian Hospital Flower Mound | Street Address, City, State 4400 Long Prairie Road, Flower Mound, TX | |
| 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) |
| A0000 | Note: The CMS-2567 (Statement of Deficiencies) is an official, legal document. All information must remain unchanged except for entering the plan of correction, correction dates, and the signature space. Any discrepancy in the original deficiency citation (s) will be reported to the Dallas Regional Office (RO) for referral to the Office of the Inspector General (OIG) for possible fraud. If information is inadvertently changed by the provider/supplier, the State Survey Agency (SA) should be notified immediately. An unannounced complaint investigation was conducted on site. An entrance conference was held with the Director of Quality on the morning of 03/14/14 to explain the purpose and process of the investigation. The hospital representative was informed that this investigation would be conducted according to the State Operations Manual 42 CFR 482-Hospital Conditions of Participation. Survey findings were presented at an exit conference on the afternoon of 03/18/14 with the Chief Nursing Officer and other hospital representatives. The administrative representatives were given an opportunity to provide evidence of compliance with those requirements of which non-compliance had been found. None was provided to the surveyor. The hospital representatives were informed TX 00191167 was substantiated with deficiencies cited. |