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
▼ 49L033 Youth For Tomorrow 11835 Hazel Circle Drive Bristow VA 3 (Philadelphia) 08/07/2018 5YVU11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0100 Use of restraint and seclusion Condition
E0009 Local, state, tribal collaboration process Standard
E0024 Policies/procedures-volunteers and staffing Standard
E0025 Arrangement with other facilities Standard
E0026 Roles under a waiver declared by secretary Standard
E0031 Emergency officials contact information Standard
N0125 Protection of residents Standard
N0140 Orders for use of restraint or seclusion Standard
N0106 Beneficiary and accreditation requirement Element
N0110 Individual plan of care Element
N0113 Individual plan of care Element
N0115 Individual plan of care Element
N0127 Protection of residents Element
N0130 Protection of residents Element
N0137 Protection of residents Element
N0141 Orders for use of restraint or seclusion Element
N0143 Orders for use of restraint or seclusion Element
N0145 Orders for use of restraint or seclusion Element
N0167 Monitoring during and after restraint Element
N0189 Post intervention debriefings Element
N0190 Post intervention debriefings Element
N0192 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0201 Medical treatment for injuries Element
N0210 Facility reporting Element
N0222 Education and training Element
▼ 49L035 Jackson Field Behavioral Services 546 Walnut Grove Drive Jarratt VA 3 (Philadelphia) 12/14/2018 85XQ11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0018 Procedures for tracking of staff and patients Standard
E0024 Policies/procedures-volunteers and staffing Standard
E0026 Roles under a waiver declared by secretary Standard
E0031 Emergency officials contact information Standard
E0039 Ep testing requirements Standard
N0125 Protection of residents Standard
N0140 Orders for use of restraint or seclusion Standard
N0188 Post intervention debriefings Standard
N0137 Protection of residents 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
N0167 Monitoring during and after restraint Element
N0189 Post intervention debriefings Element
N0197 Medical treatment for injuries Element
N0222 Education and training Element
▼ 49L037 Umfs Of Virginia 13525 Leland Road Centreville VA 3 (Philadelphia) 03/10/2021 W0KX11 Focused Infection Control, Initial Certification, Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0125 Protection of residents Standard
▼ 49L038 Three Rivers Treatment Center 231 Hickory Road Kenbridge VA 3 (Philadelphia) 03/27/2025 ZDQS11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0100 Use of restraint and seclusion Condition
N0140 Orders for use of restraint or seclusion Standard
N0165 Monitoring during and after restraint Standard
N0188 Post intervention debriefings Standard
N0143 Orders for use of restraint or seclusion Element
N0145 Orders for use of restraint or seclusion Element
N0151 Orders for use of restraint or seclusion Element
N0152 Orders for use of restraint or seclusion Element
N0156 Orders for use of restraint or seclusion Element
N0167 Monitoring during and after restraint Element
N0174 Monitoring during and after seclusion Element
N0189 Post intervention debriefings Element
N0190 Post intervention debriefings Element
N0191 Post intervention debriefings Element
N0192 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0207 Facility reporting Element
N0209 Facility reporting Element
▼ 49L038 Three Rivers Treatment Center 231 Hickory Road Kenbridge VA 3 (Philadelphia) 04/14/2021 WP2P11 Focused Infection Control, Initial Certification, Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0188 Post intervention debriefings Standard
N0189 Post intervention debriefings Element
▼ 49L039 Southstone Behavioral Health 3046 Carlbrook Road South Boston VA 3 (Philadelphia) 03/24/2021 VN4S11 Focused Infection Control, Initial Certification, Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
N0100 Use of restraint and seclusion Condition
N0140 Orders for use of restraint or seclusion Standard
N0165 Monitoring during and after restraint Standard
N0188 Post intervention debriefings Standard
N0126 Protection of residents Element
N0130 Protection of residents Element
N0137 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
N0150 Orders for use of restraint or seclusion Element
N0151 Orders for use of restraint or seclusion Element
N0152 Orders for use of restraint or seclusion Element
N0153 Orders for use of restraint or seclusion Element
N0167 Monitoring during and after restraint Element
N0189 Post intervention debriefings Element
N0193 Post intervention debriefings Element
N0222 Education and training Element
▼ 51L004 River Park Hospital (Bridge) 1230 Sixth Avenue Huntington WV 3 (Philadelphia) 06/06/2018 T8MG11 Recertification
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0126 Protection of residents Element
N0147 Orders for use of restraint or seclusion Element
▼ 51L008 River Park Hospital (Roundtable) 1230 Sixth Avenue Huntington WV 3 (Philadelphia) 07/15/2021 OKM311 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0001 Establishment of the emergency program (ep) Condition
E0004 Develop ep plan, review and update annually Standard
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
E0025 Arrangement with other facilities Standard
E0026 Roles under a waiver declared by secretary 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
E0034 Information on occupancy/needs Standard
E0036 Ep training and testing Standard
E0037 Ep training program Standard
E0039 Ep testing requirements Standard
E0042 Integrated ep program Standard
▼ 51L009 Highland Hospital Association 300 56th Street Charleston WV 3 (Philadelphia) 01/31/2024 VQUH11 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0142 Orders for use of restraint or seclusion Element
▼ 51L009 Highland Hospital Association 300 56th Street Charleston WV 3 (Philadelphia) 09/13/2023 H6Q411 Complaint
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0100 Use of restraint and seclusion Condition
N0125 Protection of residents Standard
N0133 Protection of residents Element
N0145 Orders for use of restraint or seclusion Element
N0149 Orders for use of restraint or seclusion Element