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 012306 (X3) Date Survey Completed 02/27/2025
Name of Provider or Supplier Childrens Hospital Of Alabama Esrd Street Address, City, State 1600 7th Avenue South, Birmingham, AL
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)
V0114 IC-SINKS AVAILABLE
CFR(s): 494.30(a)(1)(i)

A sufficient number of sinks with warm water and soap should be available to facilitate hand washing.


This STANDARD is not met as evidenced by:
Based on review of facility policy, observation, and staff interview, it was determined the facility failed to ensure staff followed the facility policy for dedicated clean sinks. This deficient practice affected one of two observations of cleaning and disinfection of the dialysis station and had the potential to negatively affect the 17 incenter patients dialyzing at the facility. Findings include: Facility Policy: Infection Control of Dialysis Equipment Policy Number: 18640 Date Published: Not listed ...VII. Procedure ...3. Sinks in the patient care area are designated as clean sinks for patients and staff. 4. There are designated areas considered "Dirty" for cleaning and disinfecting of equipment, discarding used bicarb, acids, and/or dialysate sampling fluids. ...b. The hopper in the Soiled Utility room is designated for disposal and handling of waste products (dialysate,...) 1. An observation was conducted on 2/25/25 at 10:56 AM with Employee Identifier (EI) # 5, Unit Support Specialist, cleaning dialysis station 3. EI # 5 emptied the prime waste container and the remaining acid in the used acid jug in the designated clean sink in the patient care area. An interview was conducted on 2/27/25 at 12:19 PM with EI # 1, Director of Nursing, who confirmed staff failed to use the hopper in the soiled utility room for disposal of waste products.