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 013434 (X3) Date Survey Completed 02/01/2018
Name of Provider or Supplier River Region Family Medicine Street Address, City, State 41 Cambridge Court, Wetumpka, 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)
J0022 MAINTENANCE
CFR(s): 491.6(b)(1)

All essential mechanical, electrical, and patient-care equipment is maintained in safe operating condition;


This STANDARD is not met as evidenced by:
Based on review of the refrigerator logs and interviews with the staff it was determined the facility failed to ensure each refrigerator temperature was documented on a daily basis. This had the potential to negatively affect all patients served by the facility. Findings include: A tour of the facility was conducted on 1/31/18 at 9:00 AM with Employee Identifier (EI) # 1, Assistant Manager, who informed the surveyor the clinic was divided up into halls. Laurenzi Hall with exam room # 1, # 2, and # 3 and a Triage room with a refrigerator and extra office with a refrigerator. Lyons Hall with exam room # 1, # 2 and # 3. Murphy's Hall with exam room # 5 and # 6 and a Triage room with a refrigerator. Kent's Hall with exam room # 1, # 2 and # 3. Review of the refrigerator temperature logs from Laurenzi Hall in extra office, Murphy's Hall in the triage room, EI # 7, Operator, area which all stored patient medications revealed the following: The logs for the refrigerator from Laurenzi Hall in the extra office had not been updated since September 2017. The logs from Murphy's Hall in the triage room were not completed since November 2017. The refrigerator in EI # 7 office has a thermometer but no documentation a temperature log was kept for this refrigerator. An interview was conducted on 2/1/18 at 1:15 PM with EI # 1, Assistant Manager, who confirmed the above mentioned findings.