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)
J0042 PHYSICAL PLANT AND ENVIRONMENT

491.6(b) Maintenance: The clinic . . . has a preventive maintenance program to ensure that: (1) All essential mechanical, electrical and patient-care equipment is maintained in safe operating condition;


This STANDARD is not met as evidenced by:
Based on interview, the RHC failed to maintain a preventive maintenance program to ensure that all essential mechanical, electrical and patient-care equipment is maintained in safe operating condition. The findings included: During an interview on 4/1/2026 at 12:45 PM, the Practice Administrator stated there was no documentation of preventive maintenance available for review.