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 852539 (X3) Date Survey Completed 07/13/2022
Name of Provider or Supplier Eatonton Kidney Center Street Address, City, State 103 N Washington Avenue, Eatonton, GA
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)
V0710 CFC-RESPONSIBILITIES OF THE MEDICAL DIRECTOR
CFR(s): 494.150



This CONDITION is not met as evidenced by:
Based on observation, a review of facility records and staff interviews, it was determined that the Medical Director failed to demonstrate responsibility for the operations of the facility, and ensured the delivery of quality patient care and clinical outcomes. This failure had the potential to negatively impact the health and safety of seven in-center hemodialysis patients who were receiving hemodialysis treatment at this facility. Findings include: Cross References: V 547- Failure of the facility to provide the necessary care and services to achieve and sustain the clinically appropriate hemoglobin/hematocrit level. V 632 - Failure of the facility to develop and implement plans of action to improve the effectiveness of the facility's anemia management program.