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 852541 (X3) Date Survey Completed 02/06/2020
Name of Provider or Supplier Cairo Dialysis Street Address, City, State 1182 5th St., S.E., Cairo, 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)
V0402 PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY
CFR(s): 494.60(a)

The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public.


This STANDARD is not met as evidenced by:
Based on observations and staff interviews, it was determined that the facility failed to ensure that there was a safe environment for all 47 in-center hemodialysis patients, as evidenced by cracked and damaged floor tiles, caked substance/grime, and stains on the floor . Failure to keep the integrity of the floor could hinder proper cleaning/disinfection and could promote microbial growth. These environmental concerns were observed in one of one treatment room and in one of one water treatment room. Findings were: During a tour of the facility on 2/3/20 between 2:00 p.m. and 3:00 p.m., the following was observed: In the Treatment Room: - There were two long cracks on the tiled floor. The crack that was in front of Station 7 was approximately six feet long. The other crack was in the Nurses Station area, and was approximately four feet in length. - Broken floor tiles were also noted close to Station 7 and sink identified as "dirty sink". During an interview with the Facility Administrator regarding the above findings on 2/3/20 at 3:30 p.m., she stated that the floor was going to be repaired. In the Water Treatment Room: - The floor around the water tank, carbon tanks, and water drain had brown caked substances and grime. - There were black stains surrounded the drain. During an interview on 2/4/20 at 2:30 p.m., the Biomed Technician stated that the floor needed to be kept clean.