| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852550 | (X3) Date Survey Completed 06/09/2022 |
| 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) |
| V0540 | CFC-PATIENT PLAN OF CARE CFR(s): 494.90 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 develop or complete an individualized plan of care (POC) in collaboration with the entire Interdisciplinary Team (IDT) for five of five patients sampled (P#1 - P#5). This deficient practice had the potential to negatively affect the health and safety of all patients who were under the care of this facility. The facility had a census of 16 Peritoneal Dialysis (PD) patients and one Home Hemodialysis (HHD) patient. Findings include: Cross reference: V 0542 - Failure of the facility to ensure that the POC was completed by the entire IDT. |