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 013430 (X3) Date Survey Completed 04/06/2023
Name of Provider or Supplier Hill Hospital Physicians Clinic Street Address, City, State 724 Derby Drive, York, AL
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)
J0041 PHYSICAL PLANT AND ENVIRONMENT

491.6(a) Construction: The clinic and the center is constructed, arranged, and maintained to insure access to and safety of patients, and provides adequate space for the provision of direct services.


This STANDARD is not met as evidenced by:
Based on observations, clinic policy, and interview with staff, it was determined the clinic failed to ensure all electrical outlets had safety coverings in areas providing care to pediatric patients. This deficient practice had a potential to negatively affect all pediatric patients served by the facility. Findings include: Clinic policy: Hill Hospital Physicians Clinic Organizational Structure Policy number: none provided Reviewed: 1/10/23 ...The Clinic is ... constructed, arranged and maintained to ensure ... safety of patients... A tour of the clinic was conducted on 4/5/23 at 12:15 PM with Employee Identifier (EI) # 1, Clinic Manager. The following electrical outlets failed to have safety coverings: 1. In the lobby area four electrical outlets were without safety coverings. 2. In exam room # 2, two electrical outlets were without safety coverings. 3. In exam room # 3, one electrical outlet was without a safety covering. In an interview conducted on 4/6/23 at 1:30 PM, EI # 1 confirmed the clinic failed to ensure all of the electrical outlets were covered for safety of pediatric patients.