| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 883829 | (X3) Date Survey Completed 02/09/2026 |
| Name of Provider or Supplier Humboldt Family Walk-In Clinic Llc | Street Address, City, State 1600 Coleman Drive, Humboldt, TN | |
| 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 the facility's policy, observation and interview, the Rural Health Clinic (RHC) failed to ensure that 3 of 5 multidose vials of medication were dated when opened and 3 of 10 medications were expired. The findings included: Review of facility's policy, "Emergency Kit Drugs/Biologicals Policy", with no date undated, revealed the Advanced Practice Registered Nurse (APRN) "...will remove and properly dispose of any expired drugs/biologicals..." Observation of medication storage cabinets located in the room behind the nurses' station on 2/9/2026 at 12:50 PM revealed the following opened multivials of medication with no opened dates identified: 1. Lidocain Viscous 2% 2. Ibuprofen- oral suspension 3. Infant Acetaminophen Observation of medication storage cabinets located in the room behind the nurses' station on 2/9/2026 at 12:55 pm revealed the following medications were expired: 1. Infant Acetaminophen- Expired 10/2025 2. Betamethasone Sodium Phosphate 30milligram (mg)/5milliliter(ml)- Expired 1/31/2026 3. Ubrelvy 100 millgram (mg)/tablet- Expired 1/2026 During an interview, on 2/9/2026, at 1:00 PM, the APRN reported the undated medication should have had an open date, and the expired medications should have been removed from storage and discarded. |