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)
J0043 PHYSICAL PLANT AND ENVIRONMENT

The clinic . . . has a preventive maintenance program to ensure that: 491.6(b)(2) Drugs and biologicals are appropriately stored; and


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 no expired medications or supplies were available for patient use. This deficient practice had the potential to affect all patients treated at this clinic. Findings include: Clinic policy: Medication Area Inspections Policy number: none provided Policy update: 1/25/15 Re: Multi dose vials Multi dose vials will be dated immediately upon opening. The multi dose vial will be discarded on the 28th day after opening... A tour of the clinic was conducted on 4/5/23 at 12:15 PM with Employee Identifier (EI) # 1, Clinic Manager. 1. In the medicine cabinet the following medications were opened and not labeled: Dodex (cyanocobalamine) one ml (milliliter) multidose vial was opened, no label was on the vial indicating the date the vial was opened. Lidocaine 1 %, two ml single dose vial was opened and in the medicine cabinet for patient use. 2. In the laboratory area the following out of date supplies were observed: Two red top vaccutainer tubes with expiration dates of 8/31/17 and 12/31/19. One purple top vaccutainer tube with an expiration date of 9/30/22. One Hemo Cue Hb-201 test strips package with expiration date of 10/20/21. Nineteen OSOM Card pregnancy test kit packages with expiration date of 2/23/23. In an interview conducted on 4/6/23 at 1:30 PM, EI # 1 confirmed the clinic failed to ensure all medications had been labeled and/or discarded after opening and all supplies had been discarded after expiration date.