| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852541 | (X3) Date Survey Completed 02/06/2020 |
| Name of Provider or Supplier Cairo Dialysis | Street Address, City, State 1182 5th St., S.E., Cairo, GA | |
| 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) |
| E0000 | A recertification survey was conducted at Cairo Dialysis from February 3, 2020 through February 6, 2020. The survey revealed that the facility was in compliance with 42 CFR Part 494.62 Conditions for Coverage for Emergency Preparedness Plan for End Stage Renal Disease Facilities. No deficiencies were cited. |
| V0000 | (Core) A recertification survey was conducted at Cairo Dialysis from February 3, 2020 through February 6, 2020. The recertification survey revealed that the facility was in substantial compliance with 42 CFR Part 494 Conditions for Coverage for End Stage Renal Disease Facilities. However, the following standard level deficiencies were cited which resulted from the facility's non-compliance related to the survey: |
| V0402 | PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY CFR(s): 494.60(a) The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public. This STANDARD is not met as evidenced by: Based on observations and staff interviews, it was determined that the facility failed to ensure that there was a safe environment for all 47 in-center hemodialysis patients, as evidenced by cracked and damaged floor tiles, caked substance/grime, and stains on the floor . Failure to keep the integrity of the floor could hinder proper cleaning/disinfection and could promote microbial growth. These environmental concerns were observed in one of one treatment room and in one of one water treatment room. Findings were: During a tour of the facility on 2/3/20 between 2:00 p.m. and 3:00 p.m., the following was observed: In the Treatment Room: - There were two long cracks on the tiled floor. The crack that was in front of Station 7 was approximately six feet long. The other crack was in the Nurses Station area, and was approximately four feet in length. - Broken floor tiles were also noted close to Station 7 and sink identified as "dirty sink". During an interview with the Facility Administrator regarding the above findings on 2/3/20 at 3:30 p.m., she stated that the floor was going to be repaired. In the Water Treatment Room: - The floor around the water tank, carbon tanks, and water drain had brown caked substances and grime. - There were black stains surrounded the drain. During an interview on 2/4/20 at 2:30 p.m., the Biomed Technician stated that the floor needed to be kept clean. |
| V0516 | PA-FREQUENCY-INITIAL-30 DAYS/13 TX CFR(s): 494.80(b)(1) An initial comprehensive assessment must be conducted on all new patients (that is, all admissions to a dialysis facility), within the latter of 30 calendar days or 13 hemodialysis sessions beginning with the first dialysis session. This STANDARD is not met as evidenced by: Based on a review of medical records and staff interviews, it was determined that the facility failed to complete a comprehensive interdisciplinary assessment that was conducted by the entire interdisciplinary team (IDT) within 30 calendar days of admission or after 13 dialysis treatments for two of three sampled patients (P) (#2 and #3), who were admitted in 2019. Findings were: A review of patients' medical records revealed the following: - P#2 was admitted on 12/12/19. The initial comprehensive assessment was completed on 1/21/20. - P#3 was admitted on 2/19/19. The initial comprehensive assessment was completed on 3/27/19. - The assessments were completed more than 30 calendar days of admission or after 13 dialysis treatments. During and interview with the Facility Administrator (FA) and Clinical Services Specialist on 2/6/20 at 2:35 p.m, the FA stated that the initial comprehensive assessments should have been completed earlier. |
| V0557 | POC-INITIAL IMPLEMENTED-30 DAYS/13 TX CFR(s): 494.90(b)(2) Implementation of the initial plan of care must begin within the latter of 30 calendar days after admission to the dialysis facility or 13 outpatient hemodialysis sessions beginning with the first outpatient dialysis session. This STANDARD is not met as evidenced by: Based on a review of medical records and staff interviews, it was determined that the facility failed to ensure that a plan of care was developed and implemented within 30 days of admission for two of three patients (P) (#2 and #3) sampled, who were admitted to this facility in 2019. Findings were: A review of medical records revealed the following: - P#2 was admitted on 12/12/19. The plan of care was not developed and implemented until 1/30/20. - P#3 was admitted on 2/19/19. The plan of care was not developed and implemented until 3/27/19 During an interview with the Facility Administrator (FA) and Clinical Services Specialist on 2/6/20 at 2:45 p.m., the FA stated that the plans should have been completed within the 30 day period as required. |