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 B03837 (X3) Date Survey Completed 03/25/2021
Name of Provider or Supplier Kentucky Family Medicine Street Address, City, State 706 Manor St, Corbin, KY
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)
J0010 COMPLIANCE WITH FED., STATE & LOCAL LAWS

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 CONDITION is not met as evidenced by:
Based on observation, interview and record review, it was determined the clinic failed to be in compliance with state laws/regulations. The clinic failed to ensure evidence of Tuberculin (TB) skin testing and of background checks for three (3) of three (3) employees of the clinic. The findings include: Review of the Kentucky Administrative Regulations for background checks (902 KAR 1:190) and for TB testing (902 KAR 20:205) revealed both were required for staff employed at health care facilities. Observation on 03/25/2021 at 11:00 AM revealed the clinic had three staff members working. Staff member #1 checked the surveyors temperature and then escorted the surveyor into the clinic. Staff member #2 and #3 were providers (Physician and Advanced Practice Registered Nurse) and were responsible for assessments of the client. Record review of three (3) staff's personnel files revealed no evidence of TB skin testing or background checks. Interview with Medical Physician, on 03/25/2021 at 12:00 noon, revealed the clinic had not performed background checks or TB skin testing on employees. He stated he was not aware this was a requirement but would be glad to ensure staff were tested/checked. He further stated that the Advanced Practice Registered Nurse (APRN) that worked at the facility "probably had them done because she worked part time at the hospital". He stated that he and his office manager had them done in the past just not recently.