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 670071 (X3) Date Survey Completed 02/28/2012
Name of Provider or Supplier Texas Health Heart & Vascular Hospital Arlington Street Address, City, State 811 Wright Street, Arlington, 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 citations(s) will be reported to the Dallas Regional Office (RO) for referral to the Office of Inspector general (OIG) for possible fraud. If information is inadvertently changed by the provider/supplier, the State Agency (SA) should be notified immediately. An unannounced entrance conference was held the afternoon of 2/27/12 with facility chief nursing officer in an office of Texas Health Heart & Vascular Hospital located at 811 Wright Street, Arlington, TX 76012. The purpose and process of the complaint investigation survey were explained and an opportunity given for questions. The survey was conducted to determine the facility's compliance with 42 CFR ยง482, Conditions of Participation for Hospitals. TX00155631 - Substantiated with a standard-level deficiency cited. An exit conference was held the morning of 2/28/12 with facility administrative staff in a conference room of Texas Health Heart & Vascular Hospital located at 811 Wright Street, Arlington, TX 76012. Preliminary findings of the survey and next steps in the survey process were presented and an opportunity given for questions and discussion. All questions were answered. An opportunity was also provided for the facility to provide evidence of compliance with those requirements for which non-compliance was found during the survey. No such evidence was either alleged or proffered.