| 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) |
| V0750 | CFC-GOVERNANCE CFR(s): 494.180 This CONDITION is not met as evidenced by: Based on facility's record review, and staff interviews, it was determined that the Governing Body failed to demonstrate responsibility, and accountability for the operations of the facility. This failure had the potential to cause harm to all 16 peritoneal dialysis (PD)patients and one of one home hemodialysis (HHD) patient. Findings include: Cross reference the following cited deficiencies: V 713 - Failure of the Medical Director to ensure that one of one Home Therapy Registered Nurse (RN AA), was trained to perform her job responsibilities and performance evaluations were conducted to ensure comprehension of training. V 681 - Failure of the facility to ensure that one of one Home Hemodialysis (HHD) Registered Nurse (RN AA), had completed training in Home Hemodialysis and with current skills checks for HHD and peritoneal dialysis (PD) to evaluate her ability to perform the duties that was assigned to her. |