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 852542 (X3) Date Survey Completed 08/08/2018
Name of Provider or Supplier Red Hills Dialysis Street Address, City, State 201 Old Albany Road, Thomasville, 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 facility record review, a review of patients' records, facility policies and procedures, interviews with facility staff and patients, it was determined that the medical director failed to ensure that one (1) of one (1) employees (Staff #4), adhered to the facility policies and procedures for (1) of one (1) sampled patient (Patient #1). This deficient practice resulted in the death of patient #1 and had the potential to negatively affect the health and safety of all 116 patients who dialyze at the facility. Findings were: Cross Reference: V 715 - Failure of the medical director to ensure that staff adheres to the facility's patient care policies and procedures.