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 883835 (X3) Date Survey Completed 03/31/2026
Name of Provider or Supplier Premier Family Care, Inc Street Address, City, State 9458 Highway 100, Scotts Hill, 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)
J0011 COMPLIANCE WITH FED., STATE & LOCAL LAWS

Standard-level Tag 491.4 Compliance with Federal, State and local laws The rural health clinic . . . and its staff are in compliance with applicable Federal, State and local laws and regulations.


This STANDARD is not met as evidenced by:
Based on review of the Rural Health Clinic's (RHC) personnel records and interview, the RHC failed to ensure 7 of 7 (Medical Director (MD), Advanced Practice Registered Nurse (APRN) #1, #2, #3; Registered Nurse (RN) #1; Medical Office Assistant (MOA) #1, and #2) patient care personnel were in compliance with applicable Federal, State and local laws and regulations. The findings included: Review of the RHC's personnel records revealed there was no documentation the MD, APRN #1, APRN #2, APRN #3, RN #1, MOA #1 and MOA #2 had received training and certification in Basic Life Support (BLS), nor Advanced Cardiac Life Support (ACLS) certification. During an interview on 3/31/2026 at 12:30 PM, the President of the RHC stated the documentation was not available for review.