| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 883837 | (X3) Date Survey Completed 02/03/2021 |
| Name of Provider or Supplier Crossville Medical Clinic Rhc | Street Address, City, State 229 Interstate Drive Suite 105, Crossville, 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) |
| J0041 | PHYSICAL PLANT AND ENVIRONMENT 491.6(a) Construction: The clinic and the center is constructed, arranged, and maintained to insure access to and safety of patients, and provides adequate space for the provision of direct services. This STANDARD is not met as evidenced by: Based on interview the center failed to ensure local fire department inspections were completed annually to insure local codes were met and the inspections were available for review. The findings include: Interview with the clinic Manager on 2/4/21 at 10:51 A.M., by phone, confirmed the clinic had no inspections from the local fire department available for review. |