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 012505 (X3) Date Survey Completed 07/26/2018
Name of Provider or Supplier Physicians Choice Dialysis-Montgomery Street Address, City, State 1001 Forest Avenue, 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)
V0715 MD RESP-ENSURE ALL ADHERE TO P&P
CFR(s): 494.150(c)(2)(i)

The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers;


This STANDARD is not met as evidenced by:
Based on record review, facility policy and interview, it was determined the Medical Director failed to ensure the Registered Nurse (RN) followed the facility policy, completed and documented a nurse assessment evaluation prior to the first dialysis treatment in 1 of 1 new patient records reviewed. This affected Patient Identifier (PI) # 8 and had the potential to affect all patients served by this facility. Findings include: Policy: 1-03-07 Title: New Patient Pre-Treatment Evaluation Revision Date: October 2017 Purpose: To provide guidance for all new patients to be evaluate by a...RN prior to the initiation of their first treatment at the facility. Policy: 1. A...(RN) as required by federal regulation will perform an initial pre-treatment evaluation of all new patients prior to initiation of their first treatment at the facility... 2. The minimal nursing evaluation prior to initiating treatment for a new patient... 4. This pre-treatment evaluation will be documented on the...New Patient Pre-treatment Initial Nurse Assessment... **** 1. PI # 8 was admitted to the facility on 4/24/18 with End Stage Renal Disease. Record review revealed post treatment documentation that treatment was initiated at 10:51 AM on 4/24/18. Review of the New Patient Pre-Treatment Initial Nurse Assessment documentation revealed the RN completed the nurse assessment at 1:44 PM, which was after the first dialysis treatment was initiated. An interview conducted on 7/26/18 at 10:50 AM with Employee Identifier # 1, Facility Administrator confirmed the RN failed to follow complete the new patient evaluation prior to treatment initiation.