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 08/02/2024
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)
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 observation and staff interview, it was determined that the facility failed to ensure that one of one Registered Nurse (RN BB) observed, properly wore personal protective equipment during the initiation and termination of hemodialysis treatment. This deficient practice presented a potential to expose RN BB to blood-borne pathogens. Findings were: During observation in the patients' treatment room on 7/31/24 between 10:41 a.m. and 11:58 a.m. and on 8/2/24 between 6:39 a.m. and 7:15 a.m., the following was revealed: - On 7/31/24 at 10:55 a.m., RN BB did not wear a face shield or eye goggles during termination of hemodialysis on Patient (P) #1 who had a catheter access at Station (S) 10. RN BB wore her prescription eyeglasses which did not completely cover her eyes from potential blood or body fluid splatters during the procedure. - On 8/2/24 at 6:39 a.m., RN BB did not wear a face shield or eye goggles during initiation of hemodialysis on P#4 who had a catheter access at S5. RN BB wore prescription eyeglasses which did not completely cover her eyes from potential blood or body fluid splatters during the procedure. The above findings were discussed with the Facility Administrator on 8/2/24 at 1:00 p.m. and did not offer any comments.