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

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. 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).

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
▼ 42L011 New Hope Carolinas, Inc 101 Sedgewood Drive Rock Hill SC 4 (Atlanta) 06/19/2019 UU9311 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0037 Ep training program Standard
N0222 Education and training Element
▼ 42L012 Excalibur Youth Services, Inc. 404 Hampton Street Pickens SC 4 (Atlanta) 06/12/2019 M2XJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0119 Team developing individual plan of care Element
N0155 Orders for use of restraint or seclusion Element
N0218 Education and training Element
N0222 Education and training Element
▼ 42L014 Excalibur Youth Services, Llc 3683 South Industrial Drive Simpsonville SC 4 (Atlanta) 08/28/2025 KZ9611 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0004 Develop ep plan, review and update annually Standard
N0179 Notification of parent(s) or legal guardian Element
▼ 42L014 Excalibur Youth Services, Llc 3683 South Industrial Drive Simpsonville SC 4 (Atlanta) 01/09/2020 V4UD11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0006 Plan based on all hazards risk assessment Standard
E0009 Local, state, tribal collaboration process Standard
E0015 Subsistence needs for staff and patients Standard
E0018 Procedures for tracking of staff and patients Standard
E0029 Development of communication plan Standard
E0030 Names and contact information Standard
E0031 Emergency officials contact information Standard
E0032 Primary/alternate means for communication Standard
E0033 Methods for sharing information Standard
E0036 Ep training and testing Standard
N0218 Education and training Element
▼ 42L015 Generations Residential Programs, Inc 841 Dunklin Bridge Road Fountain Inn SC 4 (Atlanta) 06/14/2018 UEHO11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0006 Plan based on all hazards risk assessment Standard
E0007 Ep program patient population Standard
E0026 Roles under a waiver declared by secretary Standard
E0034 Information on occupancy/needs Standard
E0037 Ep training program Standard
N0188 Post intervention debriefings Standard
N0189 Post intervention debriefings Element
▼ 42L016 Excalibur Youth Services Llc-Kingstree 1370 North Williamsburg County Highway Kingstree SC 4 (Atlanta) 06/21/2018 NWRI11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0004 Develop ep plan, review and update annually Standard
E0009 Local, state, tribal collaboration process Standard
E0015 Subsistence needs for staff and patients Standard
E0018 Procedures for tracking of staff and patients Standard
E0026 Roles under a waiver declared by secretary Standard
E0031 Emergency officials contact information Standard
E0033 Methods for sharing information Standard
E0037 Ep training program Standard
N0188 Post intervention debriefings Standard
N0144 Orders for use of restraint or seclusion Element
N0147 Orders for use of restraint or seclusion Element
N0174 Monitoring during and after seclusion Element
N0189 Post intervention debriefings Element
▼ 42L018 Windwood Farm Home For Children, Inc. 4857 Windwood Farm Road Awendaw SC 4 (Atlanta) 05/01/2025 2H7P11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0126 Protection of residents Element
N0152 Orders for use of restraint or seclusion Element
▼ 42L018 Windwood Farm Home For Children, Inc. 4857 Windwood Farm Road Awendaw SC 4 (Atlanta) 05/23/2023 UZZ511 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0214 Education and training Standard
N0222 Education and training Element
▼ 42L018 Windwood Farm Home For Children, Inc. 4857 Windwood Farm Road Awendaw SC 4 (Atlanta) 06/21/2018 AELI11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0006 Plan based on all hazards risk assessment Standard
E0007 Ep program patient population Standard
E0009 Local, state, tribal collaboration process Standard
E0013 Development of ep policies and procedures Standard
E0015 Subsistence needs for staff and patients Standard
E0018 Procedures for tracking of staff and patients Standard
E0020 Policies for evac. and primary/alt. comm. Standard
E0022 Policies/procedures for sheltering in place Standard
E0023 Policies/procedures for medical documentation Standard
E0024 Policies/procedures-volunteers and staffing Standard
E0030 Names and contact information Standard
E0032 Primary/alternate means for communication Standard
E0034 Information on occupancy/needs Standard
E0036 Ep training and testing Standard
E0037 Ep training program Standard
N0140 Orders for use of restraint or seclusion Standard
N0183 Application of time out Standard
N0188 Post intervention debriefings Standard
N0143 Orders for use of restraint or seclusion Element
N0144 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
N0149 Orders for use of restraint or seclusion Element
N0189 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0207 Facility reporting Element
N0208 Facility reporting Element
▼ 43L001 Black Hills Children's Home 24100 S Rockerville Rd Rapid City SD 8 (Denver) 10/04/2023 XJUE11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0214 Education and training Standard