| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 012500 | (X3) Date Survey Completed 09/16/2021 |
| Name of Provider or Supplier Fmc Capitol City | Street Address, City, State 255 South Jackson Street, Montgomery, 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) |
| V0101 | COMPLIANCE WITH FED/STATE/LOCAL LAWS CFR(s): 494.20 The facility and its staff must operate and furnish services in compliance with applicable Federal, State, and local laws and regulations pertaining to licensure and any other relevant health and safety requirements. This STANDARD is not met as evidenced by: Based on review of facility adverse event/ unusual occurrence report documentation and interview with the staff, it was determined the facility failed to follow State Licensure rules for End Stage Renal Disease for reporting unusual occurrences to the SSA (State Survey Agency). This had the potential to negatively affect all patients admitted to the facility. Findings include: Rules of Alabama State Board of Health Alabama Department of Public Health Chapter 420-5-5 Amended December 18, 2007 page 7 420-5-5-.01 General (7) Unusual Occurrences Unusual occurrences which threaten the welfare, safety and health of patients, personnel or visitors shall be reported by the ESRD (End Stage Renal Disease) facility within 24 hours, either by telephone (and confirmed in writing), or by facsimile to the Alabama Department of Public Health, Division of Health Care Facilities, and other agencies/authorities as required. Examples of unusual occurrences include: misuse of medical devices or medications, defective devices, suspected cases of patient abuse or neglect, life threatening burns, fires or other catastrophic occurrences, medical conditions or deaths that occur as the result of unusual circumstances. Any acute event that results in a patient receiving emergency treatment must be reported. Emergency treatment includes unscheduled transportation to a hospital or receipt of cardiac life support from a hospital, ambulance service or rescue squad, or staff member. Also to be reported are outbreaks of infectious disease or any condition in the facility, including the water treatment system, which would necessitate the temporary or long term closure of the dialysis facility (excluding inclement weather). 1. Review of the unusual occurrence circumstances on 9/16/21 at 9:15 AM with Employee Identifier (EI) # 1, Clinic Manager, revealed a patient had a sustained loss of consciousness at the facility during treatment on 9/2/21 and the patient was transferred to a hospital. The surveyor asked EI # 1 if the event was reported to the SSA. EI # 1 stated she/he would check with the charge nurse to see if it was reported. During an interview on 9/16/21 at 10:15 AM, EI # 1 confirmed the facility had failed to report the required unusual occurrence such as facility to hospital transfer to the SSA. |