| 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) |
| V0680 | CFC-PERSONNEL QUALIFICATIONS CFR(s): 494.140 This CONDITION is not met as evidenced by: Based on a review of facility records and staff interviews, it was determined that the facility failed to ensure that one of one Registered Nurse (RN AA) for the Home Hemodialysis Program, was competent to perform assigned duties, and responsibilities in providing safe and effective patient care. This deficient practice had the potential to harm the health and safety of one of one home hemodialysis (HHD) patient who was under the care of this facility and all future HHD patients admitted to this facility. Findings include: Cross reference: V 681 - Failure of the facility to ensure that the HHD nurse (RN AA), was competent to perform the duties and responsibilities assigned to her. |