| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852550 | (X3) Date Survey Completed 03/25/2021 |
| 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) |
| V0000 | {CORE} A recertification survey, in conjunction with COVID-19 Focused Infection Control Survey was conducted at Dublin Kidney Institute from March 22, 2021 through March 25, 2021. The survey revealed that the facility was not in compliance with 42 CFR Part 494.140 - Personnel Qualifications and 42 CFR 494.180 - Governance, for End Stage Renal Dialysis Facilities. Also, the following standard level deficiencies were cited which resulted from the facility's noncompliance related to the survey: |