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 012501 (X3) Date Survey Completed 06/30/2021
Name of Provider or Supplier Gadsden Dialysis Street Address, City, State 409 South First Street, Gadsden, 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 observations, review of policy, and interview, it was determined the facility failed to ensure the staff followed their own policy for hand washing sinks. This had the potential to negatively affect all patients dialyzing in this facility. Findings include: Facility Policy Title: Infection Control For Dialysis Facilities Policy: 1-05-01 Revision Date: October 2020 "Facility Hygiene 39. ...Clean sinks should be dedicated to clean activities such as hand washing and remain clean. Avoid placing, cleaning or draining dirty items in clean hand washing sinks. Used or contaminated items should be handled in designated utility sinks". 1. During observations of care on 6/28/21 at 9:04 AM the surveyor observed Employee Identifier (EI) # 7, Certified Clinical Hemodialysis Technician (CCHT), perform the dialysate pH and conductivity testing for dialysis machine preparation with a Myron L meter at station 6. After completing the conductivity testing EI # 7 rinsed the Myron L meter with RO (Reverse Osmosis) solution and emptied the dirty solution in the clean hand washing sink. EI # 7 did not follow the policy for the use of hand washing sinks. An interview was conducted on 6/30/21 at 11:50 AM with EI # 1, Facility Administrator, who verified the staff failed to follow the facility policy for hand washing sinks.