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)
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 review of Rural Health Clinic's (RHC ) policy, observations, and interview, the RHC failed to ensure the appropriate storage of drugs and biologicals which are used in the clinic. The findings included: 1. Review of the RHC's policy,"Drugs and Biologicals Plan" revealed, "...Expired drugs will be searched for on a monthly basis and that examination will be documented monthly. Expired drugs will be disposed of in compliance with State regulations... In order to assure that drugs and biologicals are properly care for... To insure against deterioration... expiration dates are checked on old stock, and those expired drugs and biologicals are disposed of in the appropriate manner." 2. Observations on 3/31/2026 at 12:15 PM revealed the following medications stored in the refrigerator in the medication room past the expiration date: MIC-Super (a lipotropic vitamin supplement) Lot number 363012003- an opened vial with a beyond use date of 12/29/2025. A box of medication for Patient #1- expiration date12/20/2024 A box of medication for Patient #2- expiration date 3/20/2026 3. During an interview on 3/31/2026 at 12:15 PM, APRN #1 stated the MIC is a medication given with vitamin B, and the expired medications belonged to patients that were no longer receiving the medications; however, each of the medications was too expensive to discard. The medications remained in the refrigerator and were not discarded during the onsite visit.