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 07/21/2022
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)
V0122 IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL
CFR(s): 494.30(a)(4)(ii)

[The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment.


This STANDARD is not met as evidenced by:
Based on observations, facility policy and procedure, and interview, it was determined the facility failed to ensure staff cleaned and disinfected the dialysis station after patient treatments per policy, and maintained dialysis chairs in good repair to allow for thorough cleaning and disinfection between patients. This affected two of two observations of the cleaning and disinfection of the dialysis station, an observation of preparation of the hemodialysis machine/ extracorpeal circuit for an unsampled patient, and had the potential to affect all patients dialyzed by this facility. Findings include: Facility Policy: Infection Control for Dialysis Facilities Policy number: 1-05-01 Revision date: October 2021 Purpose: To minimize the spread of infections or blood borne pathogens in the dialysis facility environment. Policy: The Centers for Disease Control Recommendations for Preventing Transmission of Infections among Chronic Hemodialysis Patients will be followed when caring for all patients. ...Facility Hygiene ...46. Equipment including the... dialysis chair... IV (Intravenous) poles... will be wiped clean with a bleach solution... after completion of procedures, before being used on another patient... and after each treatment. 1. On 7/19/22 at 10:15 AM, EI # 5, CCHT (Certified Clinical Hemodialysis Technician), was observed cleaning and disinfecting dialysis station 14. While disinfecting the dialysis machine, EI # 5 failed to clean the four prongs of the IV pole. 2. On 7/19/22 at 11:21 AM, EI # 8, CCHT, was observed cleaning and disinfecting dialysis station 3. While disinfecting the dialysis machine, EI # 8 failed to clean the four prongs of the IV pole. 3. During observations on the treatment floor on 7/19/22 at 3:17 PM, the following was observed: a). Treatment chair at station 12 with an approximate six inch split in the headrest. b). Treatment chair at station 7 with an approximate 10 inch split in seat, with multiple small splits on both sides of larger split. 4. On 7/20/22 at 8:23 AM, EI # 8 was observed connecting the dialyzer and tubing to the dialysis machine at station 2. Following completion of machine set up, EI # 8, using both hands, pressed the garbage down in the garbage can. With the same gloved hands, EI # 8 closed both arms of the clean dialysis chair, and returned the chair to the upright position. EI # 8 then removed gloves, performed hand hygiene, and left the station. EI # 8 returned to the station with an unsampled patient and sat the patient in the contaminated chair. An interview was on conducted on 7/21/22 at 1:05 PM with Employee Identifier (EI) # 1, Facility Administrator, who confirmed staff failed to clean the dialysis station, per policy, and failed to provide dialysis chairs which could be thoroughly cleaned and disinfected.