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 883844 (X3) Date Survey Completed 04/01/2026
Name of Provider or Supplier Wtpc, Llc Street Address, City, State 541 West Park. Place, Henderson, 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 interview, the RHC failed to ensure 6 out of 12 (Advanced Practice Registered Nurse (APRN) #1, #2 and #4; Master Social Worker (MSW) #1 and #2; Medical Assistant (MA) #5) patient care personnel were not in compliance with applicable Federal, State and local laws and regulations. The findings included: During an interview on 4/1/2026 at 1:45 PM, the Practice Administrator stated there was no documentation available review showing updated cardiopulmonary resuscitation (CPR) certification for APRN #1, APRN #2, APRN #4, MSW #1, MSW #2, and MA #5.