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)
V0115 IC-GOWNS, SHIELDS/MASKS-NO STAFF EAT/DRINK
CFR(s): 494.30(a)(1)(i)

Staff members should wear gowns, face shields, eye wear, or masks to protect themselves and prevent soiling of clothing when performing procedures during which spurting or spattering of blood might occur (e.g., during initiation and termination of dialysis, cleaning of dialyzers, and centrifugation of blood). Staff members should not eat, drink, or smoke in the dialysis treatment area or in the laboratory.


This STANDARD is not met as evidenced by:
Based on observations, review of policies and interviews, it was determined the facility failed to ensure: 1. Visitors were provided with PPE (Personal Protective Equipment) while on the treatment floor. 2. Staff removed PPE before leaving the treatment area. This had the potential to negatively affect all patients dialyzed at this facility, visitors, and facility staff. Findings include: Facility Policy: Visitor Policy Published: 6/20/18 Version: 3 Policy: Visitors in the patient care area Visitors have a responsibility to abide by FKC (Fresenius Kidney Care) policies and procedures... PPE will be provided along with instructions for proper use... Policy: Visitors in the Isolation room/area... PPE will be provided, and visitors must abide by all requirements for PPE. Facility Policy: Personal Protective Equipment Published: 2/14/18 Version: 5 Purpose: ... to identify Personal Protective Equipment (PPE) and potential areas for use. Policy: All personal protective equipment shall be removed prior to leaving the treatment area... Observations of care on 7/12/21 from 10:00 AM CST (Central Standard Time) to 3:30 PM CST revealed the following PPE infection control breaches: 1. At 10:00 AM CST, a police officer was observed sitting in front of the isolation room with no PPE on. The isolation room door was open. 2. At 10:20 CST AM, 2 emergency medical services personnel were observed assisting an unsampled patient at station 7 onto a stretcher wearing no PPE (gown or gloves). 3. At 10:35 AM CST Employee Identifier (EI) # 5, Patient Care Technician (PCT), prepared the dialysis machine at station 4. EI # 5 left the dialysis station, exited the treatment floor into the lobby wearing gown, mask and face shield then returned to the treatment floor without removing PPE as directed per the facility policy. 30952 4. At 12:30 PM CST, EI # 4, PCT exited the treatment floor wearing gown, face shield, and gloved with a bath jug in hand. EI # 4 failed to remove PPE prior to leaving the treatment floor. 5. At 2:15 PM CST, EI # 4, PCT again exited the treatment floor wearing gown, and face shield, gloves with a bath jug in hand. EI # 4 failed to perform remove PPE before leaving the treatment floor. 6. At 2:45 PM CST after disinfection of station 2, EI # 5, PCT exited the treatment floor gloved with the bath jug in hand and wearing a face shield. EI # 5 failed to remove the face shield prior to exiting the treatment floor. In an interview on 7/14/21 at 11:25 AM CST EI # 1, Director of Operations confirmed staff failed to follow facility policy and procedure for PPE use.