| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852550 | (X3) Date Survey Completed 10/29/2019 |
| Name of Provider or Supplier Dublin Kidney Institute | Street Address, City, State 207 Industrial Blvd Ste 2, Dublin, 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) |
| V0750 | CFC-GOVERNANCE CFR(s): 494.180 This CONDITION is not met as evidenced by: Based on a review of facility records and staff interviews, it was determined that the Governing Body (GB) failed to demonstrate oversight of the home hemodialysis (HHD) program. This deficient practice had the potential harm to the health and safety of the other two patients, (P#2 and P#3), who were dialyzing in a Skilled Nursing Facility (SNF), after P#1's Hepatitis C Seroconversion. Findings include: - A review of the GB meeting minutes revealed that the last documented GB meeting was on 5/11/18. There were no documentation that the GB members met after discovering P#1's seroconversion on 7/4/19. - Cross reference the following cited deficiencies: V 110 - Failure of the facility to ensure staff followed infection control practices to prevent cross contamination in the treatment room. V 582 - Failure of the facility to demonstrate oversight of the home hemodialysis (HHD) program. V 715 - Failure of the facility to implement policies and procedures. |