11 Apr 2008
Name:
E-mail:
Facility Name: Creedmoor Psychiatric Center (CPC)
Facility CEO: Kathleen Iverson
Facility Address: 79-25 Winchester Blvd., Queens New York 11426
Facility Description (Brief):
# Beds - Adult: 420
# Beds - Child & Adol:
# Beds - Sub Abuse:
# Beds - Forensic:
# Beds - MR/DD:
# Beds - TotaL: 420
# Beds - CMS Distinct Part: 420
Survey Type: Unannounced
Surveying Agency: JCAHO
Survey Dates (inclusive): 4/8-11/08
Survey Days (e.g., Mon - Weds): Tues - Fri
Number of Surveyors: 4
Priority Focus Areas: Equipment Use, Patient Safety
Last Survey Ending Date: 2/18/05
Profile - Surveyor #1 (Name/Disc/Tm Role/Traits/Quirks): Susan Hill, RN Team Leader.
Comment:
Profile - Surveyor #2 (Name/Disc/Tm Role/Traits/Quirks): Edward K. Katz, MD. Comment:
Profile - Surveyor #3 (Name/Disc/Tm Role/Traits/Quirks): Joan E. Kateiva, MHA, RN
Comment:
Profile - Surveyor #4 (Name/Disc/Tm Role/Traits/Quirks): Thomas M. Messer, MBA, Comment:
Profile - Surveyor #5 (Name/Disc/Tm Role/Traits/Quirks):
# of Non-Compliant Standards: 2
APR/NPSG Cites (Tag#/EP#/Brief Descrip/Surveyor):
- NPRG 8B, EP 3 Organization needed to establish a process to provide clinic patients with a cop of their medication reconciliation form/information
RI/PC/MM/IC Cites (Stnd#/EP#/Brief Descrip/Surveyor):
PI/LD/HR/IM Cites (Stnd#/EP#/Brief Descrip/Surveyor):
EC Cites (Stnd#/EP#/Brief Descrip/Surveyor):
EC.7.30 EP 3. Battery operatied lights in emergency generator rooms not functioning when test button activated.
IF an emergency management tracer was conducted using a mass casualty simulation, please indicate which scenario was used.:
MS/NR Cites (Stnd#/EP#/Brief Descrip/Surveyor):
**Surveyor Compliments (Policies, Procedures, etc noted by which surveyor):
Preliminary Survey Result: JC: Some Requirements for Improvement
**Misc Comments, Suggestions, Etc:
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