S&C QCOR RHC 2567s
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RHCs 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific RHC deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 343443 Mission Health Center Rutherford 184 Allendale Dr Forest City NC 4 (Atlanta) 03/28/2018 NBN411 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0057 Patient Care Policies Standard
▼ 343444 Cape Fear Valley- Bladen Medical Associates 16 3rd Street Dublin NC 4 (Atlanta) 08/27/2021 Q6XU11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0160 Program Evaluation Condition
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 343447 Lifebrite Family Medical Of Danbury 1020 Hospice Drive Danbury NC 4 (Atlanta) 02/10/2025 ZPZD11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0042 Integrated Ep Program Standard
J0042 Physical Plant And Environment Standard
J0151 Patient Health Records Standard
J0152 Patient Health Records Standard
▼ 343464 Cape Fear Valley Bladen Medical Associates 88 E Green Street Clarkton NC 4 (Atlanta) 11/18/2021 VS0011 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0160 Program Evaluation Condition
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 343470 Lifebrite Family Medical & Urgent Care Of Pine Hal 3853 Us 311 Hwy N Pine Hall NC 4 (Atlanta) 02/11/2025 CR3M11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0042 Integrated Ep Program Standard
J0042 Physical Plant And Environment Standard
J0151 Patient Health Records Standard
J0152 Patient Health Records Standard
▼ 343918 Chadbourn Family Practice P A 104 Seventh Avenue Chadbourn NC 4 (Atlanta) 11/12/2020 V0EP11 Standard
Deficiency Tag Deficiency Description Tag Type
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
J0010 Compliance With Fed., State & Local Laws Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0023 Policies/Procedures For Medical Documentation Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0029 Development Of Communication Plan Standard
E0030 Names And Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means For Communication Standard
E0033 Methods For Sharing Information Standard
E0034 Information On Occupancy/Needs Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
J0011 Compliance With Fed., State & Local Laws Standard
J0042 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
J0124 Provision Of Services Standard
J0125 Provision Of Services Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 343951 Vance Family Medicine 381 Ruin Creek Rd Henderson NC 4 (Atlanta) 11/19/2020 1WI211 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0042 Physical Plant And Environment Standard
J0043 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
▼ 343963 Kings Mountain Medical Center 812 W King Street Kings Mountain NC 4 (Atlanta) 06/28/2018 2VIO11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0020 Location Of Clinic Condition
J0023 Location Of Clinic Standard
J0024 Location Of Clinic Standard
J0055 Patient Care Policies Standard
J0070 Records System Standard
▼ 348932 Family Care Center 1668 Nc Hwy 16 South Taylorsville NC 4 (Atlanta) 09/14/2021 4USS11 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
J0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
▼ 348939 Eastern Carolina Geriatric Assoc & Fam Care Ctr Pl 105 Commerce Street Powellsville NC 4 (Atlanta) 05/29/2018 9BKG11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0037 Staffing and Staff Responsibilities Condition
J0039 Staffing Standard
J0041 Physical Plant And Environment Standard
J0047 Physician Responsibilities Standard
J0062 Organizational Structure Standard