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 012513 (X3) Date Survey Completed 07/14/2021
Name of Provider or Supplier Bma Langdale Street Address, City, State 8 Medical Park North, Valley, 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 observation, facility policy and interview, it was determined the staff had failed to display the current CMS (Centers for Medicare and Medicaid Services) Performance Score Certificate (PSC) in a prominent area in the facility viewable to patients. This had the potential to negatively affect all patients treated at the facility. Findings include: Facility Policy: ESRD (End Stage Renal Disease) Quality Incentive Program (QIP): Reviewing the Facility Reports Published: Not Set Version 3 Background ...Dialysis facilities are required by law to post their PSC prominently in a patient area until a new certificate is issued the following year. Policy ...In December of each year, PSC are posted on the qualitynet.org website for the facilities to download and print. It is the Clinical Managers responsibility to print, and display the PSC in a place where it is viewable to patients...Facilities have 15 business days from the date the PSC is available to post the document...signed by the Medical Director...posted in English and Spanish...behind a glass enclosure that prevents certificates from being stolen, defaced, or covered by other material.... During the facility tour on 7/12/21 at 10:30 AM Central Standard Time (CST), the surveyor observed the facility 2019 CMS performance scores posted in the lobby. In an interview on 7/12/21 at 10:55 AM CST, Employee Identifier # 1, Director of Operations, confirmed the staff had failed to display the 2021 PSC in the facility as required.