S&C QCOR PRTF 2567s
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PRTF 2567s
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Time Interval

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Provider Characteristics

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Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific PRTF deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 33L005 Stillwater 638 Squirrel Hill Road Chenango Forks NY 2 (New York) 04/04/2019 YUVL11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0006 Plan based on all hazards risk assessment Standard
E0007 Ep program patient population Standard
E0009 Local, state, tribal collaboration process Standard
E0015 Subsistence needs for staff and patients Standard
E0024 Policies/procedures-volunteers and staffing Standard
E0033 Methods for sharing information Standard
E0036 Ep training and testing Standard
N0160 Consultation with treatment team physician Standard
N0188 Post intervention debriefings Standard
N0143 Orders for use of restraint or seclusion Element
N0145 Orders for use of restraint or seclusion Element
N0148 Orders for use of restraint or seclusion Element
N0189 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0218 Education and training Element
N0221 Education and training Element
N0222 Education and training Element
▼ 33L006 Connors Children's Center, Inc. 824 Delaware Avenue Buffalo NY 2 (New York) 04/04/2024 U7E211 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
N0178 Notification of parent(s) or legal guardian Standard
N0188 Post intervention debriefings Standard
N0144 Orders for use of restraint or seclusion Element
N0148 Orders for use of restraint or seclusion Element
N0154 Orders for use of restraint or seclusion Element
N0190 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0222 Education and training Element
▼ 33L006 Connors Children's Center, Inc. 824 Delaware Avenue Buffalo NY 2 (New York) 08/12/2021 JXZO11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
N0188 Post intervention debriefings Standard
N0126 Protection of residents Element
N0132 Protection of residents Element
N0143 Orders for use of restraint or seclusion Element
N0145 Orders for use of restraint or seclusion Element
N0147 Orders for use of restraint or seclusion Element
N0148 Orders for use of restraint or seclusion Element
N0161 Consultation with treatment team physician Element
N0189 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0202 Medical treatment for injuries Element
N0222 Education and training Element
▼ 33L007 Jewish Board Of Family & Children's Svcs-6190 228 Linda Avenue, Cottages 2,4,10,12,14 Hawthorne NY 2 (New York) 09/17/2020 FVKV11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
E0007 Ep program patient population Standard
E0013 Development of ep policies and procedures Standard
E0036 Ep training and testing Standard
N0160 Consultation with treatment team physician Standard
N0118 Team developing individual plan of care Element
N0143 Orders for use of restraint or seclusion Element
N0145 Orders for use of restraint or seclusion Element
N0147 Orders for use of restraint or seclusion Element
N0154 Orders for use of restraint or seclusion Element
N0161 Consultation with treatment team physician Element
N0190 Post intervention debriefings Element
N0202 Medical treatment for injuries Element
N0208 Facility reporting Element
N0209 Facility reporting Element
N0210 Facility reporting Element
N0218 Education and training Element
N0219 Education and training Element
N0221 Education and training Element
N0222 Education and training Element
▼ 33L010 Hillside Children's Center 1183 Monroe Avenue Rochester NY 2 (New York) 10/06/2023 L8WW11 Recertification
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0100 Use of restraint and seclusion Condition
E0006 Plan based on all hazards risk assessment Standard
E0007 Ep program patient population Standard
E0009 Local, state, tribal collaboration process Standard
E0023 Policies/procedures for medical documentation Standard
E0024 Policies/procedures-volunteers and staffing Standard
E0026 Roles under a waiver declared by secretary Standard
E0031 Emergency officials contact information Standard
E0032 Primary/alternate means for communication Standard
E0033 Methods for sharing information Standard
E0034 Information on occupancy/needs Standard
N0160 Consultation with treatment team physician Standard
N0165 Monitoring during and after restraint Standard
N0178 Notification of parent(s) or legal guardian Standard
N0188 Post intervention debriefings Standard
N0145 Orders for use of restraint or seclusion Element
N0148 Orders for use of restraint or seclusion Element
N0149 Orders for use of restraint or seclusion Element
N0166 Monitoring during and after restraint Element
N0167 Monitoring during and after restraint Element
N0190 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0207 Facility reporting Element
N0208 Facility reporting Element
N0209 Facility reporting Element
N0222 Education and training Element
▼ 33L010 Hillside Children's Center 1183 Monroe Avenue Rochester NY 2 (New York) 04/08/2021 DRM211 Focused Infection Control, Other-Fed, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
N0140 Orders for use of restraint or seclusion Standard
N0188 Post intervention debriefings Standard
N0126 Protection of residents Element
N0134 Protection of residents Element
N0148 Orders for use of restraint or seclusion Element
N0154 Orders for use of restraint or seclusion Element
N0156 Orders for use of restraint or seclusion Element
N0189 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0202 Medical treatment for injuries Element
N0207 Facility reporting Element
N0209 Facility reporting Element
N0210 Facility reporting Element
N0222 Education and training Element
▼ 33L011 Hillside Children's Center 7432 Country House Road Auburn NY 2 (New York) 11/18/2021 WLCL11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
N0165 Monitoring during and after restraint Standard
N0188 Post intervention debriefings Standard
N0126 Protection of residents Element
N0134 Protection of residents Element
N0145 Orders for use of restraint or seclusion Element
N0147 Orders for use of restraint or seclusion Element
N0154 Orders for use of restraint or seclusion Element
N0156 Orders for use of restraint or seclusion Element
N0161 Consultation with treatment team physician Element
N0179 Notification of parent(s) or legal guardian Element
N0189 Post intervention debriefings Element
N0190 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0202 Medical treatment for injuries Element
N0208 Facility reporting Element
N0209 Facility reporting Element
N0222 Education and training Element
▼ 33L012 House Of The Good Shepherd, The 1550 Champlin Avenue Utica NY 2 (New York) 06/09/2022 167O11 Recertification
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0100 Use of restraint and seclusion Condition
E0015 Subsistence needs for staff and patients Standard
E0022 Policies/procedures for sheltering in place Standard
E0025 Arrangement with other facilities Standard
E0026 Roles under a waiver declared by secretary Standard
E0037 Ep training program Standard
N0140 Orders for use of restraint or seclusion Standard
N0165 Monitoring during and after restraint Standard
N0135 Protection of residents Element
N0167 Monitoring during and after restraint Element
N0193 Post intervention debriefings Element
N0202 Medical treatment for injuries Element
N0207 Facility reporting Element
N0222 Education and training Element
▼ 33L012 House Of The Good Shepherd, The 1550 Champlin Avenue Utica NY 2 (New York) 08/07/2019 2EST11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
E0013 Development of ep policies and procedures Standard
E0029 Development of communication plan Standard
E0036 Ep training and testing Standard
N0140 Orders for use of restraint or seclusion Standard
N0160 Consultation with treatment team physician Standard
N0115 Individual plan of care Element
N0189 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0210 Facility reporting Element
▼ 33L015 Parsons Child & Family Center 60 Academy Road Winnie, Lansing A&B Albany NY 2 (New York) 04/05/2023 C7GW11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
N0143 Orders for use of restraint or seclusion Element
N0151 Orders for use of restraint or seclusion Element
N0166 Monitoring during and after restraint Element
N0167 Monitoring during and after restraint Element
N0222 Education and training Element